From Compliance to Autonomy: A Doctor's Path Out of the System

Then you turn your back on that life and you go to get your dad's approval. How much do you think that has stunted your growth in your 40s, in your 30s and 50s, or 30s and 40s, I should say?

Yeah.

How much has that stunted your growth?

A lot because I was so, I was so focused on follow these steps, right? Here's the, here's the system. If you stay in the lane, right, this is the lane, right? It'll get you where you're supposed to go.

You won't, you won't be unbelievably wealthy, but you'll have a pretty comfortable life. You'll have a good enough life.

Exactly.

Do you want a good enough life?

That's it. No, I want a great life.

You didn't build your clinic to feel like an employee in your own business. I'm Matthew Golubly, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable, patient-centered practices and doing it their way. You know, it's interesting, the, we were talking about while we were off camera, we were talking about your dad, right? Mm-hmm. And I'm here with Colin Rigney, who owns AMSKU, which we'll talk about in just a little bit. But I wanna talk about this 'cause I think it's really, really important. Your dad never talked about his past ever. No.

I mean, only stuff he wanted me to know, wanted me and my brother to know about like his school or, you know, good memories. Yeah. Yeah.

But he was adopted, right?

No, he was born out of an affair.

Oh, he's born out of an affair. So did he ever talk about his dad? Did he ever know his birth dad?

Rarely.

Rarely.

Rarely talked about him. I think I met, I've met his birth dad twice in my life. Once that I remember.

Really?

Never. We never talked about his dad.

Does your mom talk about it at all?

My mother?

Yeah.

Yeah. Mainly just the regret of my dad not knowing, or the regret and the, you know, just the empathy of him not knowing his dad.

Yeah.

You know, and part of that was, you know, It was, uh, they were born out of an affair, both. My grandmother was a World War II, um, flight nurse and he was a B-17 pilot.

Oh yeah, there we go. Based in Europe?

No, the Pacific.

Oh, wow.

And so they met in Hawaii and that's where my dad was conceived. And I don't know the story. So my grandmother, you know, had a really, um, kind of a man-hating streak to her. And I don't think she intended it to be that way.

Yeah.

But whatever it— we'll never get the whole story.

Our family will never know the story.

Yeah, you never know the piece.

Same thing. Yeah. Like, I won't know the whole story.

This is all pieces, and I don't— and I can't read between any more lines than I've already tried to. But yeah, and so he was raised by a single mother who was a nurse and pretty much tiger-mommed, you know, him into being a doctor or a lawyer. And He had a traumatic accident where he was run over by a car when he was like 5 or 6 years old. He was in a body cast for a month and the projection was he wasn't gonna walk again.

Geez.

And that to him steered him toward the field of medicine.

And he was a family doc, right?

He's a family practitioner.

Back in the day when a family doc was actually like—

Leather bag.

Yeah.

Home. Yep. Home visits. He would travel, travel the miles to see his patients.

Moonlight Graham from Field of Dreams. You ever watch Field of Dreams?

Yeah.

Yeah.

Yeah.

Moonlight Graham. Yeah.

Very, very similar.

That's like Tom Nabity. Tom Nabity comes from 3 generations. Dr. Nabity, if you're listening, Tom, from Nebraska. I'm like, so your grandfather's Moonlight Graham? He's like, yeah, exactly. Anyway, go ahead.

No, very similar. Very similar. So yeah, we grew up in a, after he was, my first decade was, he was in the Army. So we moved around a lot, you know, base to base to base to base. And then he got out, partnered in a practice in Northern California. a small town called Scotia, which is a company-owned lumber town. So in Humboldt County, California, where there's 3 major industries, fishing, logging, and weed. And, and then the last of which is the most profitable, the last of which is the most profitable. And so we ended up in this town that was total throwback. You know, the average, the average person at the mill would make, you know, close to 6 figures on a high school education. And it was kind of like This vestige, like it was a total throwback town.

Company-owned town?

Pharmacy. Yeah. Company-owned town. The rent was like $400 a month. It was, I mean, just—

Was it idyllic? Did you enjoy it?

Yeah, I did. Yeah, it was. Yeah. We had a gym, its own basketball league, baseball. I mean, everything was right there within walking distance. Everything you wanted was in walking distance. It's a town of about 1,000 people. And so I grew up, my dad was the town doc. You know, so everybody knew you. Everybody knew me. I was Doc's kid. Right. And so you go to the grocery store, the pharmacy, you know, it was, there was no, you know, being unseen. Right. If you got in trouble at school, you know, your parents knew about it before you got home type of thing.

Yeah. Sounds like life in the Catholic church growing up. So how did your dad being in medicine, did that really kind of, is that something that you always wanted to do was to be in medicine?

You know, I didn't know. He involved me a lot.

Would you like go, would you hang out with him at the—

Oh, totally. Yeah. Yeah. I, I really—

Your own former rotations?

Yeah. I, I really enjoyed, I really enjoyed going to the, cuz his office was across the street.

From the house.

You can see his, you, you could see him working in his office on the second floor from my bedroom. And—

That's kind of cool.

It was pretty cool, you know, and, and being, he was a bit more than a just family doc. So he did minor surgeries. He actually started off in ortho and then pivoted to family. after a couple years. So he would do a lot of like higher level procedures, fracture management and that sort of thing that, that was really valuable for that, for the town. So I would go in, my first exposure to imaging was, 'cause he took his own x-rays back in the day when it was just films. You set the patient up, take the film, develop the films, all that stuff. And so—

Sure. That wasn't toxic developing film. No, no, not at all. Not at all. Clean room. No problem. I'm sure there's plenty of ventilation.

Exactly. But he taught, he was my first instructor.

Yeah.

Yeah. Yeah. And so we would, you know, anytime one of my friends would, you know, break their arm, whatever, he'd manage it. You know, he was just a, he was kind of a, he was a, he was a pillar of the, the town for sure.

Yeah.

Yeah. And I, I really, I, I really did enjoy it at a young age. And then you start to grow up and get your own identity, strive for your own identity. And that's, that's where, you know, the friction kind of started to happen right around probably freshman, sophomore year in high school.

You mean like where it happens with most fathers and sons?

Yeah.

When we think that we know more than our dads. So you had a different, I didn't have a dad at that stage. I just had my mom and she was gone. Right. So I didn't really have that friction. I just, I didn't have anybody to rebel against. So I just played a lot of golf, you know? But yeah. Interesting. And you wound up in PT. So tell everybody what you do. Like, so I think that's important, like, you know, for people, like, and we'll talk about that, but tell everybody what you do.

Yeah. Yeah. Yeah.

So as Pascal comes in and makes the adjustments, the world's stealthiest.

Yeah. So by, by trade, I'm a physical therapist.

Doctor of PT, right?

Doctor of physical therapy.

So I have to call you doctor, right?

No, you don't have to call me doctor.

I don't call any of my clients doctor, by the way. I know.

Yeah. Doctor of physical therapy by background. And I'm, I'm a, I'm the owner of Advanced Musculoskeletal Ultrasound Center, where we help transform physicians' skill sets and mindsets by using ultrasound diagnostics at the point of care and helping them be better injectors and, and be better for the community and have better outcomes.

Why? Why is that important? Why do they have to have that skill? The doctors, like, especially if they're, and you're, you know, these are people that are doing orthobiologics regen, depending on which class of camp of classification you wanna be in.

Really? I mean, Matt, really it's the gateway to, it's the gateway to that specialty. Ultrasound is the gateway to all of that.

Yeah.

It is.

Why?

2 things. Number one, these are, these are cast services and typically If you're going to position yourself there, you need to be able to set the, set the tone on that first visit with the patient. Right. And so somebody comes in with a rotator cuff problem and you have the ability to diagnose it in the span of 10 minutes and give the educational breakdown as far as what's going on. Here's, here's some, here's the options. Here's what I recommend. And we can even do it today if you want.

Right.

Versus having to rely on—

do the PRP or the BMAC or whatever.

Right. Whatever the intervention is.

Right.

Right. Or based on what I'm finding here, I want to get an MRI because this, this, and this. Okay. That rec— they're going to be more compliant with your recommendations because you've already established the tone. It's a ultrasound is a trust accelerator. If you can, if you can leverage this in your office at the point of care, especially on the first visit with the patient, it's very interactive because it's a, It's a screen that they're wondering what's going on. Hey, I don't know. I'm glad I know what you're looking at, 'cause I don't.

It's weird.

Right? And, and then, and then that starts a conversation, right? Mm-hmm. And so you, then you start talking to 'em about their anatomy. Here's this, this, and this. You have some irregular findings here, but this is kind of normal for the stage of, for the, for the stage of life that you're in, or your activity level or your history or that sort of thing, right? And then you get to say, okay, but here's where we get to the problem area, right? And so you're able to say, here's this, and you have the ability to look at their other side quickly. If you wanna show a comparison, well, here's what your good knee looks like.

So here's, here's what the bad knee looks like. Here's what the good knee looks like. What's your experience when doctors like, well, okay, so let's, cuz I wanna dive into this. I think it's really important. Why, what, so orthopedics, ortho, orthopedic doctors, they don't necessarily, this is not necessarily a skill that they have, right? This is not something that they're trained on.

No, not, not traditionally.

No. No, not traditionally.

No.

I mean, During medical school, residency, things like that.

Yeah. Some fellowships, they'll, they'll get it in some fellowships, but not, not, not to an extent, really on a superficial level.

Right.

Okay. Yeah.

But pain management, they have a, they're pretty skilled with the ultrasound generally.

Generally PM&R and pain management have more exposure to ultrasound than orthopedists.

Yeah. Right. Which makes a big difference when it comes to doing any type of diagnosis. Right?

Yep.

Okay. So my, I guess my question then is, is like when people are going through this and they're learning about this skillset, and you said it's not something that is like, this is not about generating more insurance revenue. You're saying that this is the gateway for them to be able to do cash-based procedures, right? Okay. So let's talk about that. Like, is this a skill that is difficult to learn? Like, let's say I want to learn a knee.

Mm-hmm.

How long is that going to take me to learn how to really effectively image a knee using ultrasound and then do ultrasound-guided injection. How long is that going to teach, take me to learn?

You know, I think with, I think as adults, we look at starting something new. We, the hardest part is making the decision to do it. Right. And so you start to overthink how long it's going to take. And if you don't have a guide, right, it will take you a long time and it will be hard. Okay. But to answer your question, We've developed a system where this is something you can learn in a matter of weeks, 12 weeks. Now, by no means you'll be a Jedi at the end of that 12 weeks. However—

Well, there's a reason why you're called a Jedi. It takes a little while to learn how to be a Jedi.

Right.

I mean, you got to levitate the spacecraft out of the swamp.

Yeah. Yeah. But the foundation's there, right? So that's all you need. And that's all you need to have a skill is the You set the foundation. If you set the foundation, okay, then after that, the learning will continue to evolve at a rate that you want to learn at, but to do your top 5 to 10 injections, you have to be able to at least identify the anatomy under the ultrasound in order to, in order to really drive the needle to where it's supposed to go. That sort of thing, you know, doesn't take any more than 3 months to learn it.

Why do you think they don't? train doctors on this kind of stuff? Why, why is it in med school and residency and their fellowships? Why is this not something that is taught? I mean, especially if you're dealing with joint pain. I mean, let's just, well, I mean, I'm not talking about, I don't know. Well, I'm not going to pick a specialty because I'll screw it up. You know how I am, but why is it that like, this, this is not something that is taught at a very high level and in depth?

I think that, you know, Again, I'm going to take the filter off. I think that med school is underwritten by, same with PT school, same with OT school, is underwritten by the insurance companies indirectly. Right. And so, you know this.

Well, I mean, the podcast is out of the system, so we pretty much skewer those people.

Right. And so that, I think right there is one of them. Okay. Why it is something that does take resource and skillset and time additionally to to implement and put into the curriculum. But I think they look at the time element of it and they totally overestimate what it would actually take to, to throw that skill into the curriculum.

Do you think it's purposeful to not teach it because it's more of a, the way things are set up now, it's more of a cash-based procedure? I mean, what would be the—

I wouldn't go that far.

Okay. So why wouldn't, okay. So why wouldn't they want to teach it? Like, You know, like, why do you think that is?

I think it's the perceived amount of time and resources it would take to actually implement it.

Okay.

Okay. And then they'll say, well, we have MRIs anyways, right? And we just teach people how to refer out for that.

Are MRIs more profitable, do you think, for the industry?

Of course they are.

It used to be. They're not, well, it's not profitable for the imaging center.

In the, in the, in the system model, absolutely it is.

Yeah. Yeah. Because it's something, it's another channel that they can own. Right?

Absolutely.

And it delays payment. It takes, cuz ultrasound I can do in the moment right then and there, and I can get a diagnosis. MRI is something that I have to go, I have to refer out. MRIs can take, depending on where you are, I've heard people saying they can get, like if we're here in Phoenix, I can get MRI done, especially in the summertime.

Right.

Probably this afternoon. In January, I probably have to wait 2, 3 months to get it done. Right. But that slows the timeline. It slow rolls the process.

Right. Slow, slow rolls the, just, it delays the, the, the, The decision-making, right?

Uh, no, it displays, it just, it delays the disbursement of money.

Oh, right. Yeah.

Because the insurance company doesn't have to pay. Right, right, right. Deny, delay, death. Was it dispose, death? Yeah.

Yeah.

Is that what it is? Deny, delay, dispose, and dispose, death.

Yeah.

Yeah. I find it fascinating. It's, you know, you and I, we spend quite a bit of time together now that I'm here. Like, it's fascinating to me. I've never been much of a conspiracy theorist, right? Like, I believe we landed on the moon and returned. But the more I dive into some of the medical stuff, I'm like, that's really fucked up. Like, I really look at some stuff now and I'm like, that's really—

What's the biggest thing for you there?

Oh, I think COVID really took my eyes. Like, I, I watched—

Me too.

I watched doctors, I walked, I watched, uh, doctor friends of mine who are brilliant anti-aging longevity doctors, people that have like pioneers in the industry, like Dr. Mickey Barber, right?

Mm-hmm.

Been doing it 25 years. And I watched her YouTube channel get shut down. And when I got COVID and she prescribed ivermectin for me and she prescribed whatever the dose, whatever the normal, whatever the protocol was that they were putting people on when they got it.

Mm-hmm.

Let's say it was 6 days and it was whatever this dose was. And I went to the pharmacy and they gave me 3 days. First and foremost, they said no. So then she called, then I only got 3 days and half the dose. And she called me like 5 days later. She goes, how are you doing? I said, you almost done with your ivermectin? I said, no, I was done with it 3 days, 2 days ago. She got furious and she called the pharmacy and chewed 'em out. And they sent me the rest of my dose. I got the rest of the dose. Hmm. Put me back on the 6 days. I watched her, I watched her fight the system and I watched people buy into 6 feet social distancing when I knew that it was bullshit.

Yeah.

Like I watched people wear masks when—

At the dinner table.

Fucking bullshit.

COVID stops when you eat.

The most, here's the most, this is the most fascinating thing to me about, I was thinking about this this morning. This is the most fascinating thing to me is, and I'm going to put people in conservative and liberal camps. Okay. The liberal camp, and I'm not going to use Democrat or Republican because I have people that I know that are like, I'm just going to use these 2 classifications. I watch people that are incredibly liberal that, that you would think like Woodstock generation fought the system, basically become shills for the man. And I watched my conservative friends become like the people that were Woodstock saying, let's burn the whole goddamn thing down. That was the most fascinating thing in the world to me.

It's a crazy flip.

Wasn't it?

Yeah.

Like, it's amazing to me. Like, obviously, you know, Christine lives in California, so I spent a lot of time in Southern California. I love Southern California. It's beautiful.

Okay.

I'm okay with the traffic. And the nice thing about Southern California is you can be whoever you want to be unless you smoke a cigar.

Really?

So here's the fascinating— you can, in LA, you know, live your truth, live your truth, man. And I go, I remember asking her this question. I said, so if I'm a pedophile, does that mean I can live my truth? She goes, well, no, no, no, no, no, no, you can't do that.

Right?

I said, but you say I can live my truth. So my truth is that I like, that I'm a pedophile. Can I live that truth?

No, no, no, no, no, no.

There's like boundaries to like living your truth. Not that truth. Not that truth. You can't live that truth. Right? And like this industry that is all about like their art and don't stifle my art.

Right.

They're like the biggest shills in the whole goddamn thing about COVID I know. Right? Like, I can walk into a bar, I can chop a line of cocaine, snort it off the bar, pull out my heroin bag, take the spoon, heat up the heroin, tie off my arm, inject heroin, go outside and take a dump on the street, walk back in. Everybody's like, live your truth, man. If I pull out a cigar and I want to dry smoke it, hey, you can't do that in here. You're gonna give us all cancer.

Yeah.

I think it's the most fascinating thing. Isn't it fascinating? It's like, yeah, COVID really took COVID really, I was like, oh fuck, this ain't right. Like there's some shit going on here. What about you? Was there, what you said for you, COVID, um, what, like when did you really start to realize that like there's bigger forces at play?

The outdoor mask wearing.

My favorite is the pulling up next to the guy and he's got, and there's 3 people in the car and they all got masks on.

Or the death tracker. It, it was probably a handful of things like this.

I forgot about the death tracker.

Well, talk about What's a psychological, I mean, it felt like a psychological operation, a mass one to me, honestly, you know, from the media perspective.

Oh, totally. Well, yeah, I mean, yeah, I mean, if you listen to Zuckerberg's interview on Rogan and we talked about it with the Biden administration, basically, 'cause it was right now, now we know what it was, but we knew, and when we were going through it, I'm like, hold on, like, hold on there.

I mean, you got the death tracker, you got like all these things, you're just bombarded with the same, like, and it's global. How, how is it this coordinated? Like this, right? Again, conspiratorial tones aside, it was like, I just internally, I felt that something was, some, like something's missing to all this.

Something was not right.

Something is missing to all this. And I don't trust it. It was just an instinct I had. And I'm, I'm a pretty perceptive individual. And when you start to walk around and you see, you know, people, you know, like, and used to trust a little bit, all of a sudden, like wear their mask outdoors or like, hey, the 6 feet thing, or like, you're wearing your mask when you come here. Right. Okay.

Or better yet, you know, people asking you private medical information. Have you had your, have you had your shot?

Right.

How did you answer that when people would ask you? I'm not going to ask you if you had the shot, but like, how did you answer that?

I was only asked it maybe a handful of times, to be honest with you. I just, I'm not answering that question.

My answer was I had COVID. Did you have your shot? Yeah, but I had COVID. What does that mean? I have the antibodies, right? I mean, yeah, it was, it was, I would tell you that Up until COVID, I was happily oblivious.

Hmm.

And I watched, I'm going to use, um, the Michigan Center for Regenerative Medicine, Dr. Tom Nabati and Dr. John Santa Anna in this example, clients, former clients. And I saw John this weekend at Toby. And I remember when the shutdowns happened in March, my phone, I had about 10 clients at the time and my phone lit up. Like, what are we going to do? Okay. And what we did in Michigan, cuz Michigan had some pretty draconian laws, like they never knew if they were gonna open. And so what we did was we pre-sold Regen procedures and we had people put 50% down, which gave John and Tom enough cash to keep things going because they were in the middle of construction.

Mm-hmm.

Like, and they had this construction loan and they had all this stuff. And when they opened in mid-May, I think they allowed 'em to start doing procedures again. In like mid-May through June, that 6-week period, they did more than they would've done for March, April, May, June, and through June. And we raised prices, which was like nuts at the time.

Mm-hmm.

And we collected 50% upfront. And as soon as they said they could open, they were stacked doing procedures. Right. Yeah. And it completely changed their business. And I sat there and I was watching this and I watched what was going on with Mickey. Dr. Barber. I watched what was going on with some other doctor friends of mine. I was watching people get shut down. And I think it was, I don't think, I know it was at that moment that I was like, this system is fucked up. We got to burn it down. Like I watched doctors, I watched healers unable to heal. And that really upset me.

Mm-hmm.

You know, like And then I really started realizing like, and we don't look, our doctors, you know, we do a lot of work in regen functional. At that time it was mostly regen. So the regen doctors really didn't have an opinion about ivermectin or hydroxychloroquine or anything like that, or Demisphere or the shot. But like my doctors, which at that time was 20% of the functional medicine space, they had very definite opinions about it.

Mm-hmm.

And it was, it was really when I think, I know it was then that I realized that This system is fucked up. You know, when did you realize the system was really fucked up? That it wasn't working to the benefit, like that you were just a cog in the machine and they were just using you up until they had somebody else to replace you.

Yeah. I mean, I kind of felt that way. I kind of felt that way leading, like in the few years into before COVID mainly in the physical therapy space. So we would, you know, I'm an equity partner in a local company here where we have multiple locations that combine sports doctors and physical therapists. All the PT is insurance-based and the medical side is cash. And in, in PT to get paid, it's, you bill time codes. Right. And so it's literally, I mean, it's time for money, but, but, you know, the rules change a little bit every year and how you use like your assistants or your physical therapy, your PTAs or your techs, you know, there's all these rule changes and to keep up with it. I'm like, this is garbage. I am, I'm like so frustrated and done. I'm a glorified biller, you know, basically.

Yeah.

And I'm done with this. And I didn't know what my window out of it. I mean, I had an idea like the training company. company was AMSKU was still kind of in the planning stages at that point. But I started to look at what am I doing? This is like, I'm not, I'm not really helping anybody here. And—

So you're not really able to do the PT that you want to really help somebody?

No, not even close.

No. How much, how much of that PT were you doing that you think was like on a scale of 1 to 10, 10 was where they needed to be and like what the insurance companies were letting you do? What was on a scale of 1 to 10?

Probably a 5 or a 6.

Wow. It's that high. I thought, I would think it would be like a 2 or a 3.

Yeah. I mean, I would say 5 or a 6 mainly because I, I really care and I did, I did the extra stuff that went uncoated. Okay.

I'm not talking to you, but just kind of industry-wise. Wide.

Probably a 3 or probably a 3.

Yeah.

Yeah. Probably a 3. What we were doing is, wasn't even that bad compared to like the mill model. You know, you're seeing 4 patients an hour. Each patient in that hour might get 10 minutes with the actual therapist. And we've known this for a while, but then, you know, insurance, it, it's just the reimbursements get cut every year.

Mm-hmm.

So what are you required to do? Is it time-based code? So you gotta see more people per hour, right?

Right.

And there's a, there's a rate limiting, that's the rate limiting step. And, and so like, you know, for me it was the frustration, everything culminated with COVID And so when things got shut, I mean, Arizona didn't shut down like a lot of the states did, but it was impacted for sure. That really was the time when I saw, like, as I was talking about before, the media operation, all of the messaging, what I was hearing, and from the experts, why are certain experts promoted while clearly somebody like Dr. Malone, who was, you know, one of the, one of the inventors of the mRNA technology. I don't think he was the only one, but he was on a patent.

You mean the guy that has, you mean the guy that has the patent on it?

Right. Yeah. Yeah. Right. And so why, why are we shutting this guy down? Right. It seems like a pretty important guy to listen to.

You mean the guy that came out that I invent, I have the patent on the mRNA technology and I would not use it for this. And YouTube and Facebook took down his channels saying that was false information. And he sent them all his patents and all his certifications and they still refused him. Right. They're like, you're, you're talking heresy. He goes, I invented the goddamn thing.

Yeah.

And that's my words, not his. Yeah.

Why, why is the other side anti this anti-fascist rhetoric so happy to shut down talking free speech? Free speech. Yeah. You know what I mean?

Well, it happens in the industry all the time in the metaverse.

That really made me mad.

Yeah.

Honestly, it made me really mad. And you know, what can I do about it? I think I didn't. I'm still on the journey, but exiting kind of out of the system, exiting the system. I want to, I want to work with people who are aligned in the sense that in order to provide the best care possible for their patients, their communities, and, and, and their employees, you have to go direct to the patient. You have to go direct consumer.

Can you do that in PT?

You can.

Is there a model? Talk about that. There is.

Yeah, there is.

What do you think the model is? Well, the model is like the same thing in medicine.

If you say, fuck it, I'm not going to think direct primary care, it's the same. You have similar models, like a membership model versus the package model. There's a, there's a great, there's a great one here in Scottsdale called the Doctors of Physical Therapy. His name's Tom Padilla, phenomenal guy. They run an excellent organization and it's probably one of the first ones in the Valley to really get the legs. Now there's a good handful of them in the, in the, in the Valley, in the Phoenix area here. It takes It takes gumption. It takes, uh, an entrepreneurial spirit that, you know, is, you gotta have in you to, to make it work. But people, I think it comes down to people want it. They just don't know if they don't know what, they don't know about it cuz they don't know it's available to 'em. Right. So if you make it available to 'em and, and you present it like, wow, this option is, uh, I forget what the quote was. People don't know what they want until they know what they can have.

Yes.

Who said that? But It's exactly that.

Great line, right?

Yeah, is exactly that. So once you actually, you know, yes, you're, you're, you're charging more per visit for the eval, all that stuff. Okay. But you're getting better in like 5 or 6 visits compared to like, you know, 12 to 15, you know.

People don't, this is the biggest conversation. So we were just at Toby this last, at the time of this recording, we were just at Toby. So by the time this comes out in a couple of months or something like that, this is the biggest question that we, this is the Number one statement we always get, my patients won't pay cash.

Right.

Which I know is a complete and utter lie.

Yeah.

Right. Because you've seen, you've seen the work we've done, right? You're in the med, you're in steel mill. You see it like you see what doctors charge left and right. $10,000, $5,000, $18,000, $23,000, depending on a bunch of different things.

Mm-hmm.

And we've seen success where some doctors have a PT center like Dr. P.

Mm-hmm.

Who's been on the podcast. There's a couple of other, like Chactors are doing some stuff. They don't have the PT right there, but I think they have a partnership with somebody and they're just embedding the cost of the rehab and the patient is a lot happier. And you're right, the patients don't know that they want this or that it's available to them.

Mm-hmm.

They haven't even been given the choice. They've been brainwashed.

Mm-hmm.

We, they have been brainwashed. And there's a large percentage of the patient base, let's say 80%, that are completely brainwashed and like, well, if it's not covered by insurance, I'm not, it's not, can't be any good. I'm sorry. Make everybody stupid sound like they're from the South. So, uh, sorry folks, that's not intended. I can do it as an Irish accent later cuz I'm Irish. The, but the, the, you know, the thing is, is that they want most patients, most people want choice. They just don't realize they want it.

Yeah.

Right.

Yeah.

You ever go to a restaurant like, oh, I'm gonna have steak and then there's something else on the menu. You're like, ooh, let me try the branzino.

Yeah. Fuck yeah. I want that.

Right. That's exactly what we're talking about.

Right. Exactly. Yeah. No, totally.

Like, what would be the difference? So what do you get paid? What's an average case that gets paid per visit in PT? What's the average reimbursement these days? Oh God. I know I'm gonna probably make you break out in a cold sweat.

It's been a while. I haven't even, I haven't worked in therapy for a couple years now.

What do you think it is? Like $25?

No, no, it's more than that.

Um, $47.

It depends on how, what depends on how your contracts are set up. So if you're set up like as a PT taxonomy, uh, Medicare will pay around, I, I want to say around $100 a visit. Uh, PT, they'll pay a PTA like $80 a visit, which is not Bad. It used to be, you know, it used to be 25% more than that not too long ago. Most commercial plans are—

Living proof that the reimbursement rates never go up.

Cigna's the notoriously the worst. Blue Cross Blue Shield United are all, you know, I, I always say somewhere between $60 and $75 a visit. Really? What do you get?

What do you get if you're going direct to consumer, do you think? What are they charging directly to the consumer?

Yeah.

What's that feel like?

The range is between $150 to $250.

And the patients are like, yeah, let me have it.

Yeah. Oh yeah. Yeah. Yeah, for sure. Yeah. Because you're getting, you're getting the, you're getting the one-on-one, you're getting the, you're getting to the root of the issue and you've taken the, right, as a therapist who works in the system, right? You're not just seeing the patient, right? You got a room full of other people and you know, you got 3 or 4 more people waiting to see you because 4 of them came in that hour and you're not really present with the person you're supposed to be with at that time. And you, you transition to this setting and the patients know that too, right?

Well, if you're seeing 4 patients in an hour, you're not really pushing 'em, are you? Which is what physical therapy's all about is pushing 'em, right?

Mm-hmm.

Like if we are professional athletes, you can't dig.

Yeah. You, you can't dig into their problem. You, you can't, you, you, they're not gonna, they don't respond to the coaching the same way. They're not accepting the coaching the same way because it's like, you know, going to a McDonald's and expecting a 5-star experience, right? It's just not something you do. You go to a mill, kind of a mill model.

Well, you can't push somebody unless you have a relationship with them.

Right. That's a good point. That's the key. Right. I mean, and you can't establish a relationship with somebody unless you actually have some time to talk with them.

Right.

Right.

All things, all transformations happen because of know, like, and trust.

Yeah.

All transformations, unless you have know, like, and trust, you cannot build a transformation. And I've coached people for, since 2004. Well, prior to that, when I was in the golf business, giving golf lessons, mm-hmm, which I started giving golf lessons in 1990, '91, '92. It's, people think it's about technical knowledge. It's all about know, like, and trust.

Yeah.

Because if you have, if you have a relationship with somebody, it's easier to get them to buy into what you're doing than it is to just tell 'em the tactic of what to do.

Yeah.

Thoughts on that?

Yeah, it's all about— so I've done a lot of coaching too. I used to coach basketball and I was a basketball player. I coached a lot of basketball summers and all that stuff. And when you have to make the relationship first to get into the psychology and everybody responds to some different cues. So you can say the same thing to one person To the next person, they're not going to respond to it.

Give me an example.

Okay. I'm going to go, I'm going to change it from basketball to Olympic weightlifting because that's my more recent coaching experience. So, so one of the, one of the main, so if you ever watched an Olympic lift, a snatch is the one where they lift it. There's 2 lifts in the, in the, in the Olympics, the snatch and the clean and jerk. And so the snatch is one movement with a wide grip over your head like this. And the clean and jerk is here and then here. The snatch is the most technically difficult lift that there is, more difficult than any powerlifting movement. Any single lifting movement you can think of is the most difficult one in the world. And the most common, the most common error people have is leaving their feet too soon to jump with the weight. And so some people respond to stay back on your heels, right? Because if you stay back on your heels long enough and you wait for that bar to hit your hips, the right movement, you're actually not lifting the weight. The movement you're generating off the floor is catapulting the weight seamlessly right up your body, right overhead. And it should feel like an effortless thing.

Okay.

Okay. Provided, you know, all their strength stock is there and all this, right? They're doing the appropriate weight for what they're capable of. And so if I were to give that, like some, if I was staying on my heels, okay. If I told, so one person who gets it right. And then I would say to the next person, stay on your heels or stay back on the heels, right? Put your weight through the heels and try jumping. Just try standing in one place and jumping with your weight through the heels. You can't really do it, right?

No.

You have to— at some point you have to get up on the toes, right?

Right.

Okay. But if I haven't, if I haven't provided the context for them, as far as if I haven't coached them as to the why behind that, you know, then, then it's going to be file not found when I give that cue, right?

Yeah.

So, so it, you just made, you now you just coached yourself out of 2 things you have to like unwind. Right. So there, I mean, there's systems to it all, right? In, in the, in the perfect model, like you have a system to how you coach, right? And, and you should, right? As a foundation. But then there's plays that are meant to be broken in coaching, right?

Mm-hmm.

And so just cuz you have this system doesn't mean you, you gotta, you've gotta fit this round peg into a square hole. And so the, the cueing, the cueing matters. And so like when we're coaching ultrasound, it's, You know, some people respond to, okay, clockwise, counterclockwise, because it makes sense with the transducer.

Right. Right.

Okay. Some people totally don't get that. They don't think like that.

And so I don't think I understood clockwise, counterclockwise till I was like 25. Right.

Dumb kid.

22 maybe.

Right.

Yeah.

And, and, but, but it's a motor skill and they're, they're looking at a screen. It's like playing a video game and, and you're asking me to move this thing. Right. You know, You, you have to, you have to, if you haven't prefaced that, that cue with, if you haven't prefaced that cue with them with some context, like as far as here's what I may ask when you get to this point. Okay. The glenohumeral joint's a big one because people always fall off at a particular angle and say, hey, turn a little bit clockwise. You're going to get the right view.

Okay.

And so I, I prefaced the shoulder training with that. And so when you hear me say that, here's what I mean. Boom. Okay. And so when we get to that point, predictably, okay, they fell off. It's just the way it kind of I thought maybe would happen. And so I'm going to give you the cue now. Okay. I want you to turn it clockwise, just a hair. Okay. So the glenoid comes in and you see the humerus and the joint and the labral triangle coming in at this angle right here. Okay. Ah, yeah, that makes sense. This aha moment. Okay. So coaching is an art. I mean, you know, this coaching is an art. You have to, you have to know the person. And so generally, like, generally my style is, you know, my style is like, I, I love, I I'm a high, I'm a high communicator. I like to communicate, um, what I like to set expectations, number one, and communicate, here's what to expect during this session. Here's some of my common cues. And we get to this point, if these cues aren't making sense, you need to let me know so we can work to find an alternative.

Okay.

Right. Okay. So that's a big thing, right? And so if they're not, if they're not adapting to the cueing, okay, I need to go into plan B and C with, with the, with the alternates, right?

Do you go in with a plan B and C already set in your head, or do you just kind of—

Usually. Yeah.

Really?

It's, I mean, it's so pre-programmed at this point. Yeah.

I wonder if, I don't know if I do. Go ahead. Keep going.

Well, ultrasound's a very technical skill. And anatomy, here's the thing with anatomy.

Yeah. I'm talking about coaching people. This is a very technical skill.

Okay. Anatomy never changes. Right. And so once you, once you get to a point in anatomy, right. I mean, I, I'm ne— I never cease to stay very humble. I, I really love to learn from as many people as I can.

You have to, if you're coaching people.

You have to.

You gotta stay humble.

You have to. But once you have, once you have a a certain foundation in anatomy, like it never changes. The, the propositions for, for the most common things that people need to know to use ultrasound in the office and maybe teach somebody else down the road never changes, right? And so how we get to that point, there's, there's 4 or 5 different ways to get them to that point, right? Um, just because the first way doesn't work doesn't mean there's not an alternative. But, but in this, in this particular instance, that because it's such a technical skill and it's, and it's anatomy-based, which never changes. Like I said, it's very, it's very easy to like, okay, plan B and C. Right. But maybe some psychology, you know, of, of the person coming in.

Do you deal with psych— when you're, when you're working with a doc, I know you're gonna do training with doctor's offices. So you were just up in Vegas working with Dr. McGee and his team. Do you, when you're doing that, are you thinking, okay, so anatomy never changes, right? Right. It's a very technical thing. What you do is a very technical thing. How much does the mental side block them from getting it? And if so, how do you handle that? Do you even think about it?

No. Okay.

I mean, that's a fair answer. I, 'cause it's so technical.

Yeah. I mean, there's, it's so technical that there's, I mean, they're willing to just like, doctors are really good at following steps. So if step 1 doesn't work, here's step 2. They all work. Let's just find the one that works for you. You know what I mean?

Yeah.

Oh yeah. The, the big thing with docs and what we do is, especially because we're getting 'em more early on for the most part, is actually the easiest part, Matt, about training physicians with ultrasound is the actual technical skill side. It's very—

Because they know their anatomy. They've got, what about like their PAs or MAs if they're using it? Like, do they, do you have more troubles, trouble there?

Yeah, they generally, their, their anatomy base isn't as high.

Yeah. They've got very cursory overview of the anatomy.

Yeah. Yeah. They know. Yeah.

Right. So basically I'm help— I'm hopeless then if you were to, since I don't know shit about the anatomy.

You know, I could teach you how to, I could teach you how to do it. It's, you know, it, it's, I think the deltoid's up here, right?

It's up there somewhere.

Yeah, it's, it's up in that, it's up in that general shoulder region. Yeah. Okay, cool. All right. We can, we can get you there. Um, yeah.

What about the Fetzer valve? Where's the Fetzer valve on the human body?

Fetzer valve.

You sound, nevermind.

Yeah, right.

It's a Fletch joke.

Nevermind.

Go watch the movie.

Okay. So the technical side is one of the easier things to teach people, even for PAs or mid-levels, even physical therapists are pretty good at it too. Athletic trainers, the how to assess what I'm seeing and how do I make a decision with it?

That's the—

That's the big challenge.

That's the hard part.

Yeah.

Okay. Talk to me about that.

Because some of them are really, they're so used to looking at MRIs and outsourcing the read to help make their decision. Now they're the ones having to do the assessment and make the decision.

So is that a mental block or a technical block, or is it both?

It's both. Okay.

So let's talk about the mental block on that.

The mental block is they're concerned about liability and they're so deathly afraid of making a mistake.

How much does that drive their doctor's decision-making?

I think a lot. It's very fear-based.

How counterproductive is that, do you think?

It's very, I mean, it's very counterproductive, right? I mean, fear-based thinking.

I think it's the biggest challenge facing the industry.

I think so too. Is the fear, right? Because fear of change, fear of failure, fear of litigation, fear of like, and it's the fear of litigation.

It's the fear of getting in trouble, right?

Yeah. Yeah. And, and can you blame them for some of that?

No, I can't blame them because they, let's think about what has happened to them. They, doctors used to be the ones to be like, I don't know, let's try it.

Right. Yeah.

I mean, let's cut the body open.

That was my dad. Right.

Yeah.

Fuck.

I don't know if this is going to work. Let's give it a shot.

Yeah. Right. Yeah.

And there was no repercussions. Like, if, no, to me, if you look at what medicine, medicine is science, right?

Yeah.

What is science? Science is constantly questioning. Science is not this absolute thing.

No.

It is an ever-evolving, because if, if we never questioned, we'd still be using leeches.

Right.

Right. Yeah. Okay.

Yeah.

And it's a constant questioning of the norm. Yeah. So here's the norm of what life is, of what the industry says science and medicine is about. Well, that doesn't make a whole lot of sense. What happens if we did this? And what happens if we did this? And what happens if we did this? And let's run this trial and, oh, we get this over here and this is what the result is.

Right.

This is a better result than what this— so medicine to me is a constant evolution and questioning what is the status quo.

Yeah.

And that's been eliminated in the industry.

Yeah.

It's been completely eliminated because if you question the status quo, if you go outside of the box and you try something and it doesn't work, you can get sued and lose your license and your malpractice goes up.

Yep. It's a real fear.

It's a total fear-based thing. And what I see that that does to our clients is I would say that I have a simple question I ask everybody now, and I go, when you fell in love with your partner or whatever, where'd you feel it? So when you fell in love with Jess, where did you feel it?

It was in my gut.

It was in your gut.

Yeah. Okay.

When I ask doctors that, guess where they tell me, guess where 80% of them tell me?

Their head?

No, their heart.

Okay.

I said, so you didn't feel it in your head? You didn't have a checklist? Well, some did, by the way, after they felt it in their heart, they kind of were like, you know, Ben Stiller's character in Along Came Polly. Um, so, but they, and this is really important, but medical school cuts their heart off from their head. Yeah. Because the entire industry, if I'm a healer, I believe that most of the people that are healers are heart-centered.

True.

Okay. Now, Roddy McGee, Dr. McGee is more gut. Like he knows in an instant what to do. Like he's that guy that like he would make a great trauma surgeon cuz he would just be like, no, this is what we're gonna do. And he's very calm, right? And he's very matter of fact, right? Don Buford's the same way, right? Donnie's the same way. No, this is what we're going to do. Okay. But most of them, when I asked them the question, how did you know? When did you feel it? I felt it in my heart. Okay. Where do you practice medicine? I practice in my head. Ah.

Hmm.

And if you think about it, the industry has completely cut the highway from their heart to their head because heart— think about love. Does love make any sense? To you?

No.

Like, it's a total emotion, right? Like when you met Jess, were you like, fuck, Jess is his wife, by the way. Were you like, goddammit, I didn't wanna meet her now?

I pretty much knew. I, I was dating 2 other girls at the time and I had to, I called them like literally the next week and—

And you didn't even have a commitment from her. You're just like, no, I'm gonna pursue this.

Mm-hmm. Right. Yeah.

Yeah. Isn't it nuts?

It was to secure a first date. Yeah. Yeah.

Isn't it nuts? One day I'll go into my story a little bit more. I'm not ready yet, but yeah, same thing for me. When I, when our eyes met, we're like, shit. And not like, no matter how hard we tried, it was like, can't stop it.

Yeah.

Yeah. So, you know, it's to go back to this, I think, I think the fear is like the biggest hurdle we have.

Mm-hmm.

Like, are they, how I think— how fearful are they of making a bad decision using ultrasound, or do you get 'em past that pretty quickly?

Well, 80 to 90%, we get past that point.

Okay.

For sure.

Okay.

With, with, so it's not just the hands-on training, but there's gotta be, our platform has, has a bunch of bridge points in between that, that help validate, you know, validate their learning process and where they're at.

Yeah.

Right. And so getting them more and more comfortable. Okay. This, this type of finding you're seeing on the ultrasound, this is really analogous to, you know, when you read those MRI reports and it says this, this, and this, right? Okay. You're com— you, you know what I'm saying? Right? Oh yeah, yeah, yeah. This is what it looks like on ultrasound. Oh, okay. Got it. Okay.

So you can connect the dot pretty quickly.

Connect the dot really quick. Okay. And you can only do that by getting to know them. And spending a good amount of time with the ultrasound with them, but also them, they have to be a pro. They have to be an active learner in the process. They have to be, they have to be an active participant in their own recovery, you know, or in their own growth. Yeah. And so there lies the rub. The ones, most of them are pretty invested in what they do with us. The best ones are always sending me updates, pictures with questions. Hey, What does this look like to you? I was thinking this, you're spot on. Or have you considered this, this, and this potentially, right? Um, you get over that and that probably takes, that probably takes about, I mean, everybody's a little bit different. I would say in about 6 to 8 months, um, almost a total transformation, you know? Okay.

So what's the financial impact of somebody's business by learning this? Like, do they charge? Let's start at the beginning. Is this something that Your clients are running the diagnostic through the insurance protocol, or are they just bypassing it and they're charging for it? Like, how does that all work?

Most of our, what do you see? Most of our clients, they're, they're in a cash-based system.

Or they're transitioning to a cash-based system, or they're fully in?

Most are charging cash for it. Okay. And they're in a cash-based system. Probably 20% are in the insurance model and they're, and they're billing insurance for it, but their PRP and stuff is cash, right?

So what are they charging on an office visit if they're doing ultrasound diagnostic? Do you ever, do you know? Do you have a range?

I don't even know.

Yeah. No, we, I mean, I'll tell 'em Dr. Meyer charges $500 for his office visit and you have to pay it upfront. You don't pay it when you walk in to secure your spot because one, they send you out for imaging. Two, they do ultrasound in the office.

Mm-hmm.

They do both.

Yep. I tell 'em, I tell 'em whatever you're doing, add at least $250 for the ultrasound.

Do patients have any resistance to it?

No.

Yeah.

No, no. 'Cause they're, they're, It's a value add and you cost more than $250 to get an MRI somewhere, right?

If you're paying cash, what would you say to somebody who's doing regen orthobiologics, injecting PRP without doing ultrasound guided that they know? I know the knee. You ever hear this? I mean, don't you love this phrase? I know the knee.

I hear it less and less now.

Yeah.

Maybe it's because of, you know, the industry, the world that we live in, industry's changing. And I think maybe my, the circle's getting narrower, but I do think, I do think word is getting around. The, it's, I haven't heard it in a while, to be honest. I don't know the last time I heard that. Most of the people who I encounter know that something guided is better than blind. And—

Yeah. I mean, could you imagine like just being, uh, yeah, I'm gonna—

Yeah.

Can you imagine a heart surgeon?

Yeah.

Heartish.

The ones, honestly, I did talk to somebody recently who is in the system, has no plans on leaving the system, and they were inquiring about training and we had the discussion, you know, they're probably somebody who's in that system who's just reliant on, who's going to be reliant on the third party for you know, for reimbursement and that sort of thing, they're, they're going to be less open to wanting to change the skills. And so like, well, I can just do that blind, right? I guess you can, but have you considered maybe it's not always getting to the right place? You know, when you sleep better knowing that it got there, you know, that sort of thing. But that does, that's a, that's become more of a rare conversation now.

I liken it to, you know, we don't have basements here in Scottsdale. I grew up in Chicago. where we have basements and basement leaks was a big issue, right?

Sure.

And this wasn't when I was growing up, but it's happening now. And I remember a friend of mine was having a major basement leak and he had to get, like, he had to get the basement sealed from the outside cuz there were cracks and, and they used imaging to get exactly into the crack and into the area.

Interesting.

And then around the area to create the barrier. And it made me think of, imagine trying to fix the foundation without using any imaging. Like, I'm just gonna spray this all over the baseline and it's gonna be all the, the outside of the basement's gonna be fine.

Yeah.

Would never work, you know?

Yeah. No, no. And then the, the functional means of treating these things with orthobiologic now. So take a shoulder, you know, that has a partial thickness rotator cuff tear, but they also have a, maybe a mild glenohumeral arthritis and some acromioclavicular joint arthritis. And, you know, you're not just going to treat one thing now, you're going to treat them all. The AC joint has like a 40% success rate blind, you know, it's just right there. Right. You think that it's a home run, but no, it, once you, once you present some of this and there's multiple studies and they vary a little bit in terms of, you know, blind versus, versus guided, but for the most part, there's not a single study that has come out ever that, that's, that says you're any less accurate with With ultrasound or image guided than, than you are blind.

When we go to these events and I have, you know, I will pick sometimes new staff members. I'm like, come on, come to an event.

Yeah.

Because the events is, you know, that's where we acquire our customers. It's where we connect with the industry. And really, you really get the understanding of the doctors, right?

Mm-hmm.

And when I'm, obviously everybody listens to this, doctors, providers like PAs, NPs, all of that. And I love when we take 'em to a Regen event and they're doing Like, I remember, I can't remember what event, I think it was AAOM and they were doing injections in the booth next to us.

Uh-huh.

Guys from Fort Lauderdale. I can't remember his name. I can't think of their company name right off the top, but they were doing injections right there. And Annie Truong was having her back injected.

Uh-huh. Right.

You know Annie, right? Who doesn't know Annie?

Right.

And, uh, I was, I'm like, come here. Let me, and you know, there's like 40 doctors around, right? They're all watching. And I said, mind if I let, you know, Natasha, my— and she's like, what are they doing? I'll go, that's the needle. You see it going in there. And then one of the doctors are like, let me explain. And he's like explaining this and you see where they're injecting her back. And she's like, are you kidding me? Like, it was fascinating for her to see it.

Yeah. Yeah.

Because that's when you really understand, like a layperson, I'm like, now, Natasha, do you understand now why we teach and tell our doctors in the regen space that you must do ultrasound guided? Imagine just trying to blindly do that into somebody's back. She's like, oh, that would never work. Now you understand.

And you want to position yourself with premium pricing. You have to also position yourself as the authority and the expert as to why you're— why the justification for that price.

Yeah.

Right. And you do that through commanding, commanding the skill of being able to diagnose at point of care.

Yeah.

You know, I mean, there's— it's so, it's so satisfying to watch Watch our physicians go from month 0 to month 3 to being able to diagnose a rotator cuff tear and start, start making money while they're with us and be a part of that growth pathway, you know, while, while we're, while they're still learning, right?

Yeah.

You're equipping them with the tools as they go, but also teaching them that, look, man, you do this the right way. I mean, your, your program, you'll pay for your program with us in 2 months, you know? And it takes a lot of, you know, it takes a, it, it takes a few things, but really what it takes a lot of is they have to be willing to do the work and they, they have to be able to trust you.

Mm-hmm.

And you do that through creating a good relationship.

What's been your, what's been your biggest transformation as a person in your entrepreneurial journey? So you, like, when did you start AMSKU and really kind of focus in on it?

Um, we started that in 2019.

Okay. But like, when has it become like a major focus?

Oh, when I met you.

Yeah. Well, thank you. But yeah. So like 2 years ago?

Yeah. It's about 2 and a half years. 2 years. Yeah. 2 and a half years now.

All right. But had you gone through like, cause I know you're, you're an equity partner in this other group, but were you really involved in like the day-to-day entrepreneur decisions?

No.

Okay.

Not the major things. Things like clinic flow, uh, training, how we hired, Who to hire, what, you know, what program pathway, like those are the things that, that Ryan and I would, would, um, and Ryan's your partner. Ryan. Yeah. Ryan Martin, that him and I would lead, um, and make sure that that was done the right way. But, but as far as like big business decisions, no.

Let's talk about your entrepreneurship journey. Yeah. Because it's not just one thing. What's that been like for you personally?

It's exposed a lot of, well, it's exposed a lot of places where I've been blocked for a long time and I didn't even know it. Like, I mean, that's a really broad question.

Yeah, no, it's purposely a broad question.

Yeah. Yeah.

I just want to see where you go.

Well, it's exposed a lot of, it's exposed a lot of blockages that I've been carrying around for a long, long time.

Did you know they existed prior?

I didn't know they existed.

Okay. And I know some of them we can talk about on air, right? So I know we were having a great conversation. We were having a really deep conversation. So I'll let you kind of create the—

I'm comfortable sharing. Okay.

So Let's talk about like, what are, what are some of the big blockages that you've uncovered that you never knew existed?

Well, I'll start with, I'll start with the, the easiest one was I have been making decisions almost my whole adult life for my dad's approval, with the exception of marrying my wife. He didn't want me to marry her.

Really? Really? Yep. Does Jess know that?

Uh, yeah.

Okay.

Yeah.

So talk about that. Why were you trying to make your dad happy with and get his approval? Well, was he, was your dad a loving dad? Did he kiss you or hug you? No. Or tell you that he loved you or he was proud of you? Was he a very stern man? Tell me, what was your father's name?

Buzz. Buzz.

Charles.

Charles is his name, but Buzz. Buzz.

Perfect. Okay, let's talk about Buzz. Buzz, we're, and for those of you listening, we're not being any disrespect to Buzz, right?

Like this is just, You know, no, my dad, he's a very special man and I've come to understand. So the way I made decisions was to get his approval for pretty much until he was diagnosed with a terminal disease. And it was only then did I get to know him as an adult.

And what changed with that?

Oh my gosh. The guard was down. His guard was down. He told me he loved me.

How did that feel?

Oh my gosh, dude. It was I mean, I can't put it into words. Yeah.

How old were you?

32, 33.

And then how long ago, how long was it? Did he live after that?

He lived about a year and a half with the diagnosis.

Was it a good year and a half for you too?

It was hard to watch, but I think it was God's way of, it was God's way of letting me know, letting him just giving us the chance to do it. Under the circumstance, you know, I had to get past that. But what, what I was able to get out of it, I think, you know, that's, that's the memory I'm gonna choose to, to go with.

Okay. So you were 32. How old are you now?

I'm 44.

But you were still making decisions from 32 to 44 to please him?

Yeah.

Talk about that.

Yeah.

What does that look like?

I just think how Once you're programmed, you're programmed, you know? And substance abuse was a big part of my life for a long time. Like not just smoking weed, but like real sub— real abuse.

Like really hardcore abuse. Yeah.

I, I had smoked pot and I didn't even know what I was doing. I didn't even know how to get high. And so pot didn't really do anything to me, like freshman, sophomore year. And so my, the summer between my sophomore and junior year, I was introduced to methamphetamine.

And it's a nice progression.

Natural progression, right? Natural progression.

Very quick.

Yeah. And I, you know, a series of decisions. I was in the early stage of rebellion against my parents and, you know, hanging out with the wrong people. And I went to this guy's house who had a, had a rock the size of a tennis ball on the table, just right in front of us. I had no reference point. But now I know that that was like a very massive thing. How did it get there?

Yeah.

And so, you know, like anything, the first one's free, right? So when I did that—

Best business model in the world. First hit, first hit's free.

Yep. When I did that, it was, I mean, at the time I'd never experienced anything so good in my life.

Yeah.

Like, you know how some people can try cocaine or try heroin and they just, they can never do it again because it's such a bad feeling or an opioid.

I did, I did cocaine twice and I said, I can't ever do that again because I will go down the rabbit hole. I was lucky. I don't have that. My brothers are addicts.

Mm-hmm.

My brother Dan is definitely an addict, but I, and I never tried heroin. Mm-hmm. 'Cause I knew, I think I knew that if I tried heroin, I'd be done.

Right. Yeah. It's whatever my pharmacokinetics internally are, it's, it's just a sponge for that stuff.

Wow.

And, um, you know, uh, went down the road of, okay, you want more? Well, hey, You know, you have access to people at high school, you know, why don't you sell a little bit on the side and make a few bucks to take your girlfriend out on the weekends type of thing. And that's how, that's how things started. And so you go fast forward, you know, I'm still making bad decisions, bad decisions get worse.

Mm-hmm.

And the gravity of each bad decision is compounded. In a negative way. And I'm not going to go into all the details, but I got caught up in, in a legal issue and I was given a choice to either pay the consequence with, with jail, possibly prison, or work with law enforcement. So that was something that You know, in order to preserve, in order to preserve my, you know, what I do.

Freedom.

Um, freedom. You know, I, I chose to work with law enforcement and—

That had to be a really easy, hard decision. Do you know what I mean by that?

Yeah.

Like on the surface it's, well, it's an easy decision, but it had to be really hard.

Extremely hard.

Yeah.

Extremely hard. It's difficult to even talk about it still, you know, but— Okay.

So what happened? How did that shape your then desire to please your dad?

So I went back, I, I, the, the rubber band took me back. So man, this is really bad. Once I get, once I, once I get out of this—

The bungee cord snapped you back.

Once I get out of this, you know, I'm gonna do what my dad said and, and get right on stuff. And so that I had an aptitude for athletics and working out. And at that point, I'd, I'd had a knee surgery. I played basketball in college and I'd been to rehab and, um, physical therapy. And, um, I thought it was pretty cool how, you know, they got to help people. Basically, they in a gym teaching you how to use your body to get better.

Mm-hmm.

And I thought that was really cool. I love being in the gym. It's like one of my favorite places. And so I was very attracted to that and I didn't know where it was going to take me. And so I followed the path. I got my grades good enough to get out of undergrad, to apply for PT schools and started the journey of, you know, I am going to get really good at this.

Mm-hmm.

I didn't know how it was going to happen. I didn't know what I was going to be doing, but I just knew I was going to be good at it. And my dad was a great mentor, you know, during the time I was in PT school and getting out, pursued residency and then specialty. And I, throughout this process, my interview to my, actually my interview to PT school was with a guy named Wayne Smith, who he was one of the pioneers in ultrasound. He was, he's a physical therapist, athletic trainer who's, you know, been around a long time. I think he's about 80 years old now. He, he had worked at the Andrews Institute down in Pensacola with their fellows and their non-op sports programs. And I saw his career path and I thought, man, that's pretty cool. You're, he's in the clinic, out of clinic, but he has his, his, he was just multidimensional. And I never saw myself doing one thing. Like I, I still don't see myself ever doing one thing. I'm very like, I want to, there's a yearning for, to just—

Growth.

Growth.

Right.

And so, Where I was at, at that point in time, I'm like, that is pretty cool. Show me what to do so I can do that. And that started my path. And so I was introduced to ultrasound in 2009 more formally and got access to equipment and I started learning how to train. It was very, very patchwork at the time, just with books, some CDs, you know, Wayne would drop in and gimme correspondence letters when he was in town and he would When he was in town, we would do hands-on training.

Yep.

He'd go back to Florida. We'd, we'd talk and like break down cases and that sort of thing. And so that's, that, that, that was the start of the ultrasound journey for me.

With your dad's approval. And then, so you lived this life that was pretty wide open. Then you turn your back on that life and you go to get your dad's approval. How much do you think that Has stunted your growth in your 40s, in your 30s and 50s or 30s and 40s, I should say.

Yeah.

How much has that stunted your growth?

Thanks for putting me back on track a lot because I was so, I was so focused on follow these steps, right? Here's the, here's the system. If you stay in the lane, right, this is the lane, right? It'll get you—

You won't, you won't be unbelievably wealthy, but you'll have a pretty comfortable life. You'll have a good enough life.

Exactly.

Do you want a good enough life?

No, I want a great life. I want a big life.

Yeah.

Right. Yeah. And internally, I think that a lot of the things that, a lot of things that make me rebellious, I think part of my attraction to like your personality is, and why we get along so much is I think the same, the same like root.

Yeah.

Root, um, ambition. Right.

Well, it's this, and it's this rebellion.

And I've been stifling that for so long. It's been, 20, 20, over 20 years. And it, you can't just recover it.

Uh, well, you bury it. So let's think about this, like what you were doing and what you were doing in your teens and your 20s was very rebellious. So then you get presented with this thing of prisoner work. Yes. So now what that does is that shuts you off. And what it does is it narrows the boundaries.

Mm-hmm.

And like the entrepreneur world is let's open the boundaries, right?

Yeah.

Let's see how far we can push the boundaries. There's a great book. My daughter gave it to me at Christmas and she doesn't realize how much this has changed my life. Like it completely, she has no idea that giving me that book completely changed the trajectory of my life over 14 days. when I went, oh, fuck, I can't keep doing this other thing. I gotta go do this thing. Right?

Yeah.

And she gave me this book called Comfort Crisis.

Okay.

Maybe she gave it to me around Thanksgiving. Anyway, I think she gave it to me around Thanksgiving and I read it throughout the month of December and I went, I could be really comfortable on this path, but I'm not wired for, I don't wanna say I'm not wired for comfort 'cause I like, look, I like having money in the bank, knowing the mortgage is gonna be paid.

Yeah.

Like, I like all of those things.

Yeah.

But comfort from a standpoint of, I look, I'm 57 years old. I look at my college friends and I'm still in touch with them. Most of them are overweight, getting new hips. They're all talking about how many more years they can work before they retire. And I look at them and I'm like, fuck, I'm just getting started.

Yeah.

Right?

Yeah.

Like I, 'cause I grew up in a very, you know, my story of my household, right? Very dysregulated. Everything was like, don't fuck up. Right. Goddamn it, Matthew, sit down. Shut up. Don't make a spectacle. But like, we think that comfort in society is actually a badge of honor where we're actually, for people like you and I, that's not how we're wired to be. We're those, we're wired to be like, well, let's, let's open up the boundaries. Let's push the envelope. Let's see what this is like.

Yeah.

Does that make sense?

It does.

Do you feel like you were stifling that in you?

Totally stifling it.

Yeah.

The one thing it did teach me, I have an insane work ethic.

Yeah, you do.

I have an insane work ethic. More, I have more capacity than most people tolerate.

Absolutely. Yeah, totally.

So that's, that's something I'm glad I, I'm glad I went through to get.

Yes.

But it can't be at the expense of my own growth. And I think that I've negotiated myself out of that for way too long.

Well, what happens if you take that work ethic and apply it to your growth?

No shit. Right.

Right.

Yeah, exactly.

That's a writer-downer, folks. Like if you're like, yeah, that work. This is why I love working with doctors.

Yep.

If I can get an orthopedic surgeon or a pain management doc, which to me are like, they're in a special class by themselves.

Yeah.

If I can get them to take that same drive that they took to become an orthopedic surgeon, I'll use that as an example cuz they make it off Survivor Island. If I can get them to apply the same thing To growing, to building a cash practice, it's over in 12 months. They're out in 12 months. It's done. Same thing with my PM&Rs.

Yeah.

Okay. The ER docs are a little bit different. Urologists are kind of the same, like, you know, the functional medicine space, it's a different group of people generally that wind up in that space.

Mm-hmm.

But like in the regen space, that's a highly technical skill, like precision.

Oh yeah.

It's, if I can get them to apply that same drive not drive that same— without working 120 hours a week, but that same focus and dedication to mastering a craft, it's over.

Yeah.

Like, and I can see when the lights, when the switch goes, like when the switch went with Schachter or McGee or any—

Yeah.

Like, remember when the flip— remember when the switch flipped on Ash?

Yeah.

It was like, oh, and it was 12 months. He was out.

Insane.

He's like, got it. I see it.

Yeah.

Yeah. Yeah.

There's such, I mean, most, all, uh, most physicians I've had the privilege to work with, they're some of the most brilliant people I've ever worked with.

Aren't they unbelievable? They're really amazing humans.

And they sell themselves short in so many other phases of their life.

Like what, in what way?

Well, put it this way. I don't know. And, and Maybe my own, like just my own exposure, but I don't know a lot of physicians who have great family lives, you know? But, but I guess staying there, multiple marriages, you know, where does that come from? You know, I know my dad, my dad and my mom were, were exceptions, but it wasn't because I, it's just because my mom, I think, had an insane like tolerance to kind of letting my dad's marriage to medicine be his first wife.

You know what I mean? Oh yeah.

That was his first marriage for sure. Like medicine. And I think that's, I think that's where I think honestly, that's, this is how I see it. I'm, I'm maybe some, maybe some doctors would agree. Um, but when they got into medicine for their heart, right, they married it. Absolutely.

With their heart. Right. Well, I think that happens with a lot of entrepreneurs.

Right. Yeah. Right. I know we forget how to forget, or we had the blinders on or for whatever reason, like overlook applying it to other places in our life, cuz it's freaking freaking hard work, you know, and factor in that all of the, all of the stuff that the physician has to go through to get through the day, who's working in the system, right? The codes, the, I got a whatever, like this FMLA paperwork and the pre-auth. Oh, I got a peer-to-peer, like all the stuff, you know, staff issues, like you name it, go down the list, right? What's the last thing they have time for, right? To actually work on themselves.

I'm always impressed by the ones that get married and have kids in residency.

Amazing, right?

I mean, that's like the Schachter.

I know. Yeah, I had a, there was a story from, it was, I think it was, I think Roddy actually told me this, was he, he was telling a story about a friend in residency who, you know, had like 2 or 3 kids at the time. And, and he's like, dude, how do you do it? He's like, well, and then the answer was like super depressing. Like some days I'm a shitty dad and some days I'm a shitty resident. You know, so it was like a choice, you know?

That's, that sucks.

What do I want to be? Exactly. Right.

Well, 'cause the system tells 'em that they have to put everything else aside.

I know.

Like it's such an abusive system.

Yeah.

Right.

Yeah.

It's, the system is designed, it's like, it's like the mafia, you know? Uh, if you ever watch Michael Franzese, we talked about this when we, so he's a mafia guy, right? Who's now talks about the mafia. And when he became a soldier, he goes to see the boss and the boss says, from now on, we're your— we're number one. If you're at your mother's bedside and she's dying and we call and you have to do something for us, you leave your mother's bedside. From now on, we are number one in your life. It's kind of like what med school is about. It's kind of like what they teach him as a doctor is the medicine becomes— the patient becomes the number one thing.

Yeah. Yeah. You said it very nicely. We cut— they cut the connection between the heart and the head, you know? And it's a It's a desensitization process to the thing they care most, used to care most about.

And what most people don't realize, not even doctors, what most people don't realize is that gets carried down like 2 to 3 generations, right? That gets encoded in your daughter's egg's DNA 3 generations down. I mean, you can, the science is really clear on it, right? Like this gets like from a If you read the book, it's not, it didn't start with you. Like that carries itself down. And so you got to make a decision as to whether or not you want to be the one that changes that.

Yeah.

You know?

Yeah. Yeah, absolutely. And it's been awesome these past couple of years meeting so many physicians. You've seen it. I've seen it. So many physicians who have made the change in their life. They'd done the, it takes the hard work, but they've made the change and the work's going to continue because there's, there's levels to it. Right. But that's where I wanna be. That's who I wanna live with. That's who I wanna work with. That's where, that's where, that's where the, that's where the, it's fun.

Yeah.

Right. Especially when the, the, the alignment in the community, like where support is there for it all, you know? But it, it's, yeah, it, the current state of the system and didn't start with COVID but it sure accelerated it, right? Of The third-party model of managing this nation's healthcare, like, has major, major issues. People are now more aware of it than ever. And I think that's been also a good thing to come out is people are more conscious of their health. You can call it the RFK effect.

I'll definitely call it the RFK effect. Sure.

Yeah. Look, I think I heard it from you, but I see it, right? And And that's what we want. You want people to be aware. You, you want people to, you want people to now, well, what is best for me? And be open to hearing not quack stuff, right? Um, we're talking like people who are available to, to them.

The industry has to back, go back to its roots of questioning.

The industry has to go back. Exactly.

Like it's, but the thing I really, the thing that I really appreciate about RFK is that this is a man that watched his uncle and his father get murdered. Okay? I mean, just go read, just go read the fact that his father was shot in the back 5 times and Saron Saron was in the front. Like, just go there. Like, that— let's not even go with the grassy knoll. Like, it's even more clear that they took out his dad.

Yeah.

Okay? Now imagine what that would do to you at that age. Imagine watching your uncle and your father in the span of 5, 6 years, Get taken out.

Mm-hmm.

Okay. And then people want to give him shit about doing heroin and all the things that he did. I'm like, what would you fucking done? But what came out of that is, I think the, I know the roots of our country are questioning the status quo. It's what our founding fathers did is they questioned the status quo.

Mm-hmm.

They're like, this whole taxation without representation thing.

Yeah.

There's gotta be a better way.

Yeah. Right? Yep.

And to me, you know, people are like, I got a problem with his stance on vaccines or the fact that he took a dead bear and left it in Central Park. I'm like, okay, so let's just take a look at your life of some really stupid shit that you've done.

Yeah. Right.

And let's just, okay, let's start there.

Yeah.

But here's the thing that I, I really think is important and why I think it's, this is such a critical time is we know the window is going to be really, really short because what's going to happen in 4 years or 5 years? Somebody else is going to come through and they're going to swing back through. And it all depends on how far we can get from the freedom standpoint of the doctors. Not vaccines are bad or anything like that. Not that conversation. That's, that's not the battle I'm fighting.

Take the restrictions off the way they practice.

Thank you. Exactly. Give doctors the freedom again to be healers. What would that look like for our country? What if we created an environment where doctors were like, Let me question this and see if there's a better way.

Exactly.

I mean, I think that would do a lot.

Mass, mass.

So what do you see for the industry over the next couple of years? What do you think's gonna, what do you see?

Man, it's such a fun time to be in the industry. MSK Medicine and Orthobiologics and—

It's some great stuff, isn't it?

Oh my gosh.

I mean, my back, my elbow, my—

Yeah.

It's just unbelievable.

Yeah, absolutely. I mean, I've, You know, I had a plantar fascia tear a couple months ago. I got a PRP. I'm almost 100% again. It's amazing, you know, but, but the way they're actually, you know, and following the leaders here now, we're, they're dosing, we're figuring out, oh, here's how you dose it like medicine for this condition. Right. Databiologics, all these things coming out, laser, shockwave, they all work in synergy. This combination of orthobiologics and energy medicine, we're just scratching the surface and just getting started with it, in my opinion.

Yeah.

Now I think, I think things are going to continue on the trajectory it's on. It's probably going to accelerate in the next 2 to 5 years. It's going to accelerate, not probably.

Can we save the industry? Do you think, do you think we can save healthcare in America?

Man, I think, well, so think of it this way. What does it take to, what does it take to, I read something the other day. It was about like starting a revolution only takes like 3% or 4%. Yeah.

That's it. Right. So we're past that number, I think.

Yeah. So I think that, I think that enough, it's up to the people, honestly. I think that the answer is yes, but it's up to the people.

When you say the people, is it the patient or the doctors?

Both. The doctors have to lead the way. Yeah. The right doctors have to lead the way.

I think the patients want it. They don't know that they can.

Patients want it, but they need, they want to be led too. Right. And so I think that if you have the right physician messages, the right people leading it, people will follow and they need to understand that I, I just like with a lot of things in this country, how we've been pacified over the years into like, this is the way it is, right. As a population and, and all these things, you know, with media, drugs that keep you kind of like out of, out of place. Right. Where you just kind of follow. And it only takes a small percentage of people to wait, hold on here.

There's got to be more.

I mean, we can do this.

Yeah.

You know? So, I mean, the answer, the answer is yes. And I think that if we can just contribute to, if everybody just contributes to 1, 2, 3 degrees of separation of people we know, profound things can happen, you know? And I think that that's, that's how I choose to look at it. And so, I mean, you know, knowing you, working with you, being on this podcast and, you know, in other, through other means too, but being able to deliver a message in a way that people hear and resonate with, this is how you're going to impact 100,000 doctors, right?

Yeah.

So, you know, what do you think?

I, well, I'm always a, the glass is always half full and the sky's always blue kind of guy. I'm also a real pragmatist, like of really understanding like the work involved.

Yeah.

My biggest concern, I think we're in a season with Trump in office, whether you agree with his policies or not, that's not the conversation. So please don't shut me off. There's a period in our country right now where we have to make a lot of advancements in a very, very short amount of time.

Yeah.

Because if the pendulum swings in the other direction, and let's say, and I'm gonna say Republicans and Democrats, let's say Democrats come back in and they put somebody in place in charge of Health and Human Services, which is a shill of the insurance companies and pharmaceutical companies, they're gonna unravel everything that's happened. So my thing is that we have to push so hard, so fast to get so far out there, not out there from the craziness, but out there that the consumers are gonna be like, don't take that away from me. Kind of like the way people are about guns. Do you know what I mean?

Yeah.

Like, and that's a bad analogy, but you get the point that we've gotta push this thing really hard, really, really fast.

Yeah, I think you're right.

Because what if I've, if I've learned anything in my 57 years is the swings in the pendulum are much more severe and they're much more dramatic in shorter timeframes. I mean, my God, Mark Zuckerberg went from being a shill to the Dem— to the Republican or to the Biden administration to putting Dana White, who's on the, uh, who's the head of UFC on his board.

Yeah.

You know, that he went from one political extreme to the other really quickly to save his ass and his company's ass. Okay.

Yeah.

I'm not condemning the man for either, like, that's not, but all you gotta do is look at, look at the severity of how much things are swinging back and forth in our country. There is no moderate ground left anymore.

It's very true, huh? It's, it's, it's one side or the other.

There is no middle ground anymore.

Yeah. Yeah.

Which is sad because that's, I'm a, I'm a centrist. Like I'm a total independent centrist.

I would prefer to be there too.

You know, it's hard though.

It's really hard because I think that you saw what COVID was and then all you got, you already, you already kind of already got a window. COVID was, you got a window on what the other side was, was wanting to do vaccine passports, like a very kind of draconian things, right?

Remember all that, you know, we're for personal freedom, but you got to have this card, right?

You know, so I, and you do have this window right now that's, that the opportunity is there. I just, I just want, I want freedom. Like, I like freedom. I love freedom. I know this is good for people. You know, we're talking about orthobiologics and it's great for people. It's great for people. I've said this, I've said this multiple times. There's such a huge gap in the space. Like, Surgery, physical therapy, right? The 2 pills, like steroid injection, bracing, right?

You got— Boy, that lawsuit, that class action lawsuit on corticosteroids is going to be massive. But anyway, now that we know how bad they were, right?

Yeah. Well, totally. Um, and then gosh, and everything in between what we're figuring out, like, oh, you mean micronized fat stem cells? Like do this to tendons to make them heal.

Yeah.

Like, like, how about that instead of, instead of getting surgery, you know, if, if that's appropriate for you, you know, um, stuff like that, like 5, 6 years ago wasn't a thing.

Wasn't even part of the conversation 2 and a half years ago.

Right.

Do you realize how fast this has changed in the last 2 and a half years? Remember when we met like probably 3 years ago at Arthur Sono, right? In Vegas when we were back at Planet Hollywood. I always like mark time by when we did the event at Planet Hollywood. But do you remember, like, think about how far we have come.

Yeah.

I mean, IOF used to have 250 people. Next year they'll have 750 people at IOF. I mean, it's, yeah, it's amazing. So yeah, we gotta run. I know you probably have other things to do. How do they get in touch with you if they wanna find out and become a fucking ninja?

So you can go to our website at amsku.com. I'm also active on LinkedIn. You can follow Colin Rainey, myself, or Ryan Martin on LinkedIn. Um, you know, send us, send us a direct message or, or Or, or get through our website to, uh, reach out to us.

And that's amsku.com.

amsku.com.

Okay, great. By far the best training in the industry.

We think so.

I know so, 'cause I see our clients do it. So Colin, thanks for taking the time. I enjoyed it. And, uh, when you get done with, um, some other stuff, we'll have you back on and we'll dive even deeper, like in 6 months on the entrepreneur conversation. Okay.

Thank you. Thanks for having me.

Thanks for having me, buddy. If this episode got you thinking differently, hit follow and share it with someone stuck in the system. Please leave a review. It helps us grow. Want more? Visit MavericksProfitSystem.com to schedule your free discovery call and explore how far your business can go.