OUT OF THE SYSTEM | She Didn’t Quit Medicine… Just the Way It’s Practiced

You partner with people that are your mentors. You surround yourself with people who are the experts in the things that you are weak at, right? If I'm the stupidest one in the room, then I'm in the right room.

Yeah, yeah.

Right? How many people have said that? And I actually, I think in business, or you're doing something that is totally foreign to you, or very fairly foreign to you, that surrounding yourself with people that know what you need to know is the way to go. Yeah.

You didn't build your clinic to feel like an employee in your own business. I'm Matthew Cologli, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable, patient-centered practices and doing it their way. Hi, Tammy.

Hi, Matt.

How are you?

I'm doing very well.

It's great to have you here.

Thank you so much.

I'm looking forward to this conversation.

I have been too.

So we've known each other, gosh, 5 years. Did we know each other pre-pandemic? That's how I pretty much know, like that's, I think that's how I put everything in bookends.

It was during the pandemic. 2020.

Right. And you had just started— how long had you been in practice at that point?

I left December of 2015, but kind of put up the shingle officially in 2018.

That's like old-school, early days of the regen, orthobiologic space, isn't it? I mean, it wasn't Wild, Wild West then, but it was— Maybe just the West.

Little fringe.

Little fringe.

Yeah.

Why'd you leave the system? And tell everybody, you're anesthesia pain, right? Was that—

I am.

Okay. And so what caused you to leave?

I simply could not practice ethically in the kind of practice that I wanted to. I knew that my patients were not getting the care that they deserved, and it was a no-brainer for me.

But you, you left, but you didn't have your practice to go to right away. What did you do? You just did locums work?

No. Well, it was technically, I guess, locums, although I was hooked up locally. I did not have to travel for locums, but all the while was gaining the skills, gaining the science, gaining the clinical construct and how I put together a business. And so that I knew that when I did come back in, it'd be on my terms and to the benefit of my patients.

Was that hard to do? Was that hard to leave the system?

Not at all.

Really? Because a lot of people are like, they get that security. I mean, paycheck.

I was dying inside.

Were you? Tell me about it.

I was with a very large ortho group and I was solo without a PA or an NP. And in that realm, it's volume, volume, volume. You talk about this every day. Yeah. Yeah. Yeah. Yeah. And Typically, the other guys that were in the practice were being fed procedures by their PA or their NP, and they'd spend 2, 2.5 days a week in the procedure suite, and that's where the practice made money.

Mm-hmm.

And if you don't have that generating, and they were taking care of the prescription refills, and they are taking care of, you know, everything but maybe the new patient consults and driving needles.

Mm-hmm.

It wasn't hard to leave when I knew that I was spending an extra 4 or 5 hours a night documenting.

Right.

Because thorough, if it wasn't said, it wasn't done. If it's not documented, it wasn't done. And I just, I wasn't practicing reflexive or defensive medicine. It was, this is what they told me. This is what really is happening. And here's my thought process. Here's where we're going to go with this. Here's the, 1 through 5 of where I want to help this patient. And I actually, frankly, got told, if you don't pick up the pace, if you don't start producing, you owe us money. It was a no-brainer to say, then I'm out. I've got anesthesia to go back to, and I will do this right when I come back.

Wow. You know, obviously, you're at a lot of conferences where we're at, and you hear these stories all the time. When a doctor who's in your— was in your situation, and they come to you and they're like, I don't know if I should really do this, or, how do I do this? What's your advice to them about going out on their own?

Oh, it is, what's your why? Why do you want to leave? Is it just that you're tired of being the chart monkey? Is it tired of being the needle jockey? Is it tired of that? Or are you literally being sucked dry in your soul? If you have a really strong why, then the answer is, Mm-hmm. So you go back to them and you ask them, what is it that they miss about why they went into medicine in the first place? What is it that you miss about really connecting to patients and really seeing them thrive based on your engagement with them and your partnership with them? So it's— people end up answering that themselves. It's not that they're just— they need to hop practices or— or do whatever it is that may help them.

Right.

I think they need to look at why they went into medicine in the first place. What are they missing? And then you say, well, if that's really what you're missing, there are so many people out there that have done it. There's so many ways that you can engage in a group of your peers, and masterminds, and conferences, and just being in like-minded groups that will get you through it. This is not 100% you on a life raft in the middle of the Indian Ocean.

That's the thing that I think a lot of people miss is that there's a group of people already doing this.

Oh, yeah.

And they— one of the things I have found, and you know me, I've worked in a lot of different industries, the medical industry really is unbelievably encouraging, which is interesting because the whole training is to build a silo. Like, be the smartest, be the best, be the best, and, like, be the best. at the expense of others, right? But then you see these doctors that come out of the system, and it's almost like they realize how badly they were abused.

Right.

Right? And then they're like, come on, we could— I'll show you some things. Like, let me, let me help you along. Did you have someone— did you have people showing you the way, other physicians taking you and showing you, or were you figuring this out on your own?

A lot of it was a figure out on your own at that phase.

Yeah.

Now there are people who have done their, you know, the direct primary, DPC. There's a DSC, Direct Specialty Care. And there's entire groups in Facebook and on LinkedIn or through SoMeDocs. I think you've met Donna Corriell. Oh yeah. Yeah. And there are just so many people that are there now. At the time, there really weren't. And there were a lot of eyebrows and like, why would you do that? And what are you thinking? And how are you going to do that? But I just gutted it out in a way that, you know, you, you fail, but you learn the most from the failures and you just keep learning and it keeps getting easier and easier.

What's the— been the big— what were some of the biggest challenges for you when you went out on your own?

I think not having had business training.

Yeah.

Not having had the experience with, here's how you market, here's how you don't spend marketing money, here's where you—

That one, how not to spend— how don't spend marketing money is the bigger one.

Right? It is a big one.

That's a big one.

I knew from the beginning that I was not going to go down the path where I mortgaged the second mortgage or big business loan. It was going to be bootstrapped and it was going to be stay as lean and mean as possible. And I'm still running lean and mean. And I think that that was one of the very best victories I've had is remaining lean.

Did you, how big a facility do you have? How many square feet?

Oh.

How many offices?

Uh, one 20 by 20.

Yeah.

It's it.

Yeah, it's really small.

It's one room, but it's a larger center, me and my practice within. So there's the, the associated services or collaborations right there. So I don't have to be the one with the 3 or 5 or 7-year lease.

Right. So you're with inside of a unit, right? And do they have all the other tools that you need, like fluoro or things like that? No, that is separate.

And I have a colleague who's in traditional pain that has a suite that's not always being used. And we've talked about the days that are— it is most available. And I plan ahead, I bring my own fluoro tech, and I have that facility, which is fantastic. And I just pack up everything in the car, and we turn it into a surgical suite, and then we break it down, and I go back to the office.

That's a really good point that for people to understand is We'll meet people. I had a call this morning, somebody who's starting up. Okay, I gotta get, I'm looking at like 2,500 square feet and I gotta outfit it. And then, you know, the computers and all the machines and da da da da. And like, and this is, this was more BHRT, you know, the functional medicine. So they were looking, oh, I gotta get red light laser and I gotta get H-bot. And I go, please don't.

Timeout.

Go sublet space at a med spa. They're like, what? And I go, seriously, I have orthopedic surgeons that set up Regen practices on Saturdays in med spas, sublet space in med spas, rolling the— and they're, and they're doing ultrasound guided, right? They're not doing back, right? They're doing knees, shoulders, hips, right? Simple stuff.

Right.

Simple stuff. Sorry, everybody who does knees, shoulders, and hips.

They're not simple.

No, I know they're not simple, but after a while they are. And we have clients that'll do like $50,000 a month just subletting space. So like, oh, I don't need all this stuff.

No.

And you did the same. You kept it, you've kept it unbelievably lean.

Very lean. And that's been remarkably— you're agile that way. You're flexible. If something happens with the sublet, fine. You know, you're fine. My ultrasound is on wheels. I have a case, I put it in, and I wheel it.

Yeah. PRP machine on wheels.

Uh, centrifuge.

Centrifuge. Yep.

Absolutely.

What about when you're doing, when you're harvesting bone marrow?

That's in the spine suite.

Okay.

Because it's fluoroguided, but the PRP and the Because I use every bit of what I harvest in terms of the bone marrow plasma into the ligaments and the muscles and the whole thing in this systems approach, functional spinal unit, the ultrasound's there too.

Yeah. That's great. All right. So I'm going to go— I want to go way back.

Way back.

Way, way back. At what age did you know you wanted to be a doctor?

So it was, I either want to be a veterinarian or I want to be a physician at age 9.

Really?

Yeah.

That might be the youngest I've had. Most people say 12 to 13. Now the vet thing I get, 'cause isn't every girl wanna be a vet like before they're 10? Like that's kind of like the standard thing, right?

Yeah.

I know my daughter wanted to be a vet till she was like 11 or something.

It was because in, that was the year that I started 4-H.

Ah, okay.

We lived on what I would call a mini farm. It's all of an acre and a half, but we still had chickens and sheep and rabbits and dogs and cats and the Pigs were across the way at our neighbor's house. And then the—

Where was this?

Where'd you grow up? Beef cattle was with my uncle on more land in Bend, Oregon.

Bend, Oregon. Okay.

So you could start 4-H in the 4th grade. And that's when I would take my market lamb, you know, from birth, you're responsible for the shearing and the worming and the vaccinations and all these things expense-wise, but your market lamb then sold on the the fair on that Saturday market. And as a kid, you know, $4 or $5 a pound on a 100-pound lamb, as a 4th grader, I knew that that was a way that then I could buy my first car, my bikes, my college, my anything I needed, I was self-sufficient for.

Wow.

So that's where the veterinary piece came in. But also I love that part of the animal husbandry of we would help deliver the lambs. We would take care of them. If there was a baby that was an orphan, then we'd bottle feed it, a bummer lamb. And similarly, we did that with some cows. And—

And so that led to, at what point did you decide between medical school, but physician or, uh, being a vet?

It came down to college and Willamette University as a small private liberal arts college in Salem, Oregon versus Oregon State University, a very large system. in Corvallis, which had a direct program with the UW and veterinary. And I got just as many scholarships, actually better. It would cost me the same amount of money to go to a state school on scholarship as it would to go to the private small liberal arts college. And I fit into that better.

That was me. Yeah, I could see you doing better in a small liberal arts school.

That would be better for you. I do better than a number. It's just my personality. And I thrived at Willamette and I was pre-med all the way.

Wow. Okay. So, walk me through that journey because I find this— one, I find it fascinating. Two, I'm always curious, like, what was that experience like for you? Residency can be challenging, especially in anesthesia, pain. What was that like for you? Was it difficult? Was it like— did you— some people find medical school a breeze. Other people find it really difficult emotionally. What was that like for you?

I was at a small school, Kirksville College of Osteopathic Medicine in Kirksville, Missouri. We were only there for 2 years because it was such a small town that then we knew we would be farmed out to these regional places for our clinical rotations. That was Phoenix for me. So, the first 2 years being in that small environment, where I was in the mecca of osteopathic medicine, was fantastic. I thrived. I met a lot of great people. colleagues who are still colleagues to this day. I was on a health profession scholarship, so I didn't worry about money. My first year I financed. The third, fourth— second, third, and fourth years were 100% on scholarship, which meant that I would owe 3 years to the Navy once I was back. So, for me, it was fine. And then moving to Phoenix got me closer to Oregon, and I fell in love with the desert. So, that again was amazing. I was meant to be in the desert and fall in love with hiking and— everything that, you know, these beautiful red rocks have to offer. So it was good. It was very, I guess, good for my soul, those small groups, a small, intimate, get to know your instructors, get to know your classmates. It was fine. And I knew that I would then become active duty after that. And that was, you know, in the Navy's hands at that point.

Right.

I did an internship in Spokane, Washington, and I actually was in love initially with emergency medicine.

I thought maybe ER. I could see that for you. Yeah, 'cause you're like, you're, you know, you're the same every day, right? You're— you don't— nothing rattles you, from my experiences.

So, I liked that, right? Until I was getting spit upon and cursed out, and I'm just trying to help you, dude. You're spitting at me as I'm trying to sew a lac on your forehead. And I was done with that. So, I thought, well, I really like the procedures. I like doing things. I'd like to take— Derm and another level, that complex rotational flaps and the beautiful plastic closures and maybe even plastic surgery with reconstruction, not the plastics plastics, but the reconstruction and helping rebuild somebody after they've had a devastating thing. And then Fallujah, then 9/11. And I'm like, how am I going to serve my brothers and sisters when I am popping zits?

Yeah. Right? Right.

So it really, it really was set in stone for me. I would go to Walter Reed National Naval Medical Center. At the time that we were receiving 3 large plane loads of wounded warriors a week. If you weren't a burn patient who'd go on to Brooke in San Antonio, then you came to us. And that's 24 to 48 hours after you had sustained your injury. You may have gone to Landstuhl for an initial surgery, a washout, and then you came to us. And from there it was, I mean, it was go. It was acute pain, acute pain, acute pain. It was managing that pain service. It was taking these guys and girls back to the OR every other day for washout of their multiple amputations. And it just, it was, I was in my element because I was helping. And it really means so much to me. It fulfills me to know that what I'm doing makes a difference. Yeah.

When did it move for you from service to the patient, helping your fellow humans, to— at what point did you realize that the system was completely and totally effed up?

It was after I got out.

So after you left the military?

When you're military, you can still get what needs to be done. You don't do prior authorizations. You don't do peer-to-peers. You may have to say, well, we're going to have to put you on limited duty for this period of time. time because this is going to take a little bit longer, and I know you're in a critical mission billet right now.

Mm-hmm.

But there weren't those constraints. You'd think, on the other hand, that— but you're, yes, sir, yes, sir, yes, sir, take it up the chain of command, do all these things, and you're getting told no or stay in your place. But I didn't really find it that way. I was seeing it that I could get exactly what my patients needed, and they were getting what they needed. the military trained me. They knew they were going to send me to Japan right after residency. So I did extra pain at Hopkins, extra pain at Mayo, extra pain within Walter Reed National Naval so I could open pain clinics in Okinawa and in Rota, Spain. So I was already practicing pain management before the fellowship.

Okay.

And it— that's when I started to see a little constraint. But even at Stanford, there's not a lot. Right? We were very well funded. Patients had maybe seen a dozen other pain clinics at that time that they'd come to see us. And we had good resources and we had a fantastic holistic approach. You're a brand new patient, you see me for an hour, you see our physical therapist for an hour, you see our pain psychologist for an hour, then all of us go to a noon conference.

Wow.

And talk about what would be the best holistic integrative approach to your care. And then we meet back with you and say, Here's what we'd like to do. How does that sound?

That's fascinating. I never even knew that, that— I never— one, I never knew that you did all that, that extensive work. And how long did you do that? How long were you doing that kind of work?

So fellowship was 1 year. Then I purchased a practice right outside of fellowship in San Francisco.

In San Francisco?

In the city.

Okay. So you had a pain practice?

A pain practice. And it was integrative. There was already a PT, there were already 2 pain psychs. It was the reason I gravitated towards that practice. Plus, it was a high-volume neuromodulation practice, meaning a lot of intrathecal drug delivery systems, pain pumps, and neuromodulator stimulators.

Mm-hmm.

And Stanford was not known for, and is not known for, heavy surgical. And again, Right. I love the procedures. I love the surgical, the advanced cases. And I knew that the retiring physician in the transition would train me in the operating room so that I could build up those skills while also learning the side of medicine of taking over a practice and growing. So, that's when I first started seeing volume issues.

Right.

That's when I first started seeing the billing side of things. And That's when I was like, wow, this is, this is not what I want to do ultimately.

What year was that?

2012 to 2014.

Okay. And then you came here and you were working in the system and after a year you're like—

That's when I was with the big group. Yeah. Um, that transition of, wow, this is not what's best for patients. This is not integrative. This is not, um, the kind of system that I want to practice in and I'd rather leave.

What did you think you were losing inside of you when you were in the system? What was— what was dying inside of you? What was happening to you?

Autonomy was gone. Having the ability to use my clinical judgment as the expert, as the one who has trained so hard and who has seen so many patients, many wonderful things happen when you can work with patients the way they deserve to in an integrative approach was gone. And it was turned into instead chart, chart, chart, don't sleep, chart some more, chart, chart, chart. And, um, you're gonna owe us some money.

Yeah, that's just crazy. All right, so let's, let's go to the opening. So you started very lean. Did you start taking insurance at all or was it straight cash?

No. 100% cash from the very beginning. Why?

No, I'm with you.

I—

people will ask me sometimes, right? And I'll be like, I have to sense what the— how the person— because for some people, it's a security blanket. And I will tell them, like, you can take insurance. Just let's be really clear about what this is, right? This is nothing more than a security blanket because You're not going to get a better patient by taking insurance for the office visit because now they're conditioned to expect everything else is going to be covered by insurance. You're not creating a hurdle where they have to reach into their pocket and give you money, right? Like, but there's a lot of doctors that they have that security of like, oh, I just, I want to, it's a, it could be a lead gen.

But it's not, they're not the same mindset patients. They're not the same at all. And it's really an albatross around your neck that's dragging you to the bottom of the ocean.

I couldn't have said that better. It's like you read my mind on it. Yeah, I think when I've been doing this 11 years, right? And when I think about doctors as they leave, all the fear that they have is not real. Like, what did you fear when you left? Or did you not have any fear?

I was pretty secure in knowing that I would not lose my house, lose my car, lose my license because I wasn't committing malpractice because I was missing something in these 5-minute visits of, right? Or somebody was going to overdose on the opioid prescriptions that I was basically bartering for procedures.

Yeah.

I felt freer to be able to go back into anesthesia. When I had more control, I tell you when I work, how many shifts I can do, how many of these things so that I can be building in the background.

Yeah.

So I really didn't fear those things. I mean, certainly when you start to wean down and the security blanket of the income goes down, if you've not built up a nice nest egg and have these backup funds if you're not going to go the loan route. The fear of failure can be real. And I've failed, and I've risen. And so, it's just one of those things. I guess it depends upon your risk tolerance, but I don't think I'm a low-risk tolerance person. I calculate risk.

Yeah, you calculate risk. Like, risk to me is like, it's just part of the deal, right?

It is part of the deal.

Yeah.

And so is fear because— and you'd be silly if you weren't thinking that this could fail. Or that I could run into some hurdles. That's going into it with your eyes open, not with blinders on.

You know, and I've been bankrupt, right? And part of it was the economy. Like, I had a real estate investment company, so, like, 85% of my friends went bankrupt. So it's like, we all, you know, we all kind of laughed about it. But the— once you go broke, you really don't— you either get so safety, security-minded that you never take any risk, or you go to the other end of it, and you're like, Well, I've already been broke, so I've already had the cars repoed and the sheriff show up at the house. So how much worse can this get?

Yeah.

Right? And you just, you, I take for granted at 58 now my ability to handle stress, like financial stress, growing a business, right? We're growing this business. There's just because I've done it before doesn't mean that I don't, it's not like I got a truckload of money sitting out there somewhere, right? Like you still run it lean and you're just like, All we gotta do is get through today. That's all that really matters. Let's just get through today. Tomorrow's got enough trouble of its own. Like, can we pay the bills today? Let's do that. Let's just pay the bills we can today. Tomorrow, we'll figure it out tomorrow.

Mm-hmm.

And I think that creates— the thing is, if I could teach a doctor from a business standpoint to take their medical training and apply what they learned to dealing with traumatic, stressful situations, and apply that to business. And like, it's— you save lives. This is just business, right? Like, you know, you've resuscitated people, you've changed people's lives. You have cardiac surgeon or whatever, or your knee, whatever, right? You've helped people walk again. Like, that's way more difficult than this. Like, just keep some perspective, right?

Yeah.

Um, how have you— because you're pretty level-headed— like, how did you keep your What's about you as things were challenging?

In the business or in private life?

Yeah, no, in the business. I'm sorry. In the business. I'm sorry. Thank you. Yeah.

Sure. Well, it's not my saying, but I do remind myself, this is not med school hard.

Yeah. Right?

So, you partner with people that are your mentors. You surround yourself with people who are the experts in the things that you are weak at, right? If I'm the stupidest one in the room, that I'm in the right room. Yeah. Yeah. Right. How many people have said that? And I actually, I think in business, or you're doing something that is totally foreign to you or very fairly foreign to you, that surrounding yourself with people that know what you need to know is the way to go.

Yeah. Who mentored you in the regen space? Who did you, who are the people that stood out to you from the medical side?

I think it's more the institutions having the, backdrop of Toby, the backdrop of IOF, um, those things where you could get around like-minded people from actually all over the world, not simply within the United States, and you could learn from people that are doing it so many different kinds of ways and in other systems that, that had a bigger impact than say one person in general.

Yeah.

I mean, certainly there are some, I would go back to fellowship and say, okay, this was an entrepreneurial attending. There were very few. Most of them were within the academic system, but there were some visiting professors who would, not visiting per se, but they just, they were doing their own thing. They were in Silicon Valley, they were building other things. So, kind of bending their ear on something like that, or specifically as a woman in business.

How is that been?

Being surrounded by other successful women in business has been very empowering and helpful to just kind of know Was that hard to find other women that were willing to open up? Sometimes. Um, there is a group, you know, WOW, I think it's called, like Women in Orthobiology. Yeah. Yep.

Great group.

So that has been really refreshing to know that we can share protocols or share, how did you get over this HR concern? Or how did you deal with whatever it is? Um, it's nice that it's not this competitive thing or this, I'm not going to tell you because you're going to take it and steal it and, you know, get so much further ahead of me. I don't find that that's really in this space.

Yeah, that's, you know, I, um, I find that the friends that I have, women entrepreneurs, and the funny thing is like 40% of my client base are women, like, which is significantly higher than the number of women in the medical field. Like it's 40 to 50% at least. But the thing that I've always found fascinating Is guys, male entrepreneurs are much more open to share. And when I communicate with female entrepreneurs, they say it's even harder because it's almost like women don't have a lot of sharing, a heart to share, women entrepreneurs. But you didn't find that. You found that women have been the Maryam Boks of the world or the Arianna DeMers. People on WOW, like, they've been very open to share in insights.

In general, yeah.

Yeah.

I think that you find this camaraderie, and you say that we are a, you know, sisterhood because there can be fewer women in medicine, fewer women in a surgical subspecialty such as anesthesia, et cetera. So, to find somebody that's like-minded and is rowing in their own boat, but you're on the same path, is refreshing, and it's just a little bit grounding. And I've really not found that. Yeah.

Yeah, that's good. Because I think, you know, the industry needs it. I'm, you know, you know where I stand on a lot of things. We have to get more doctors free.

Yeah.

We have to. We have to. There's just, I just had, uh, 3 doctors at my house on Saturday for what we call a one day. Come to my house, we'll spend a day together, walk you through the systems, you know, we'll buy you lunch, go out to a really nice dinner. And obviously there's an opportunity to sign up and there was a doctor there 59 years old, um, local community family doctor for 35 years. And he's like, I've been losing money for the last 5 years. Like, you've got to get me out. Like, like, I've got all these tools. What do I do? Another one who has, who's in pain and goes, yeah, the, the personal injury stuff is great. Making really good money on it. He said, but it keeps reducing every year and I see what's happening in other states. I know it's just a matter of time.

Mm-hmm.

You know, client's gonna go from $85,000 for what we make on a case or something like that to $8,500. Like they see it happening. It's, I have such, what would you tell someone? What would you tell a doctor who's in med school right now? What would you tell them to do when they come out? Meaning not specialty. Would you encourage them to go out on their own? Would you, what, what path would you, what advice would you give them?

Start your brand right now. Get your own domain right now, yourname.com. Start building your presence now. And that's not going to be anything that's usurping what's going on in whatever residency you fill in, or, you know, be mindful of HIPAA.

Mm-hmm.

Be mindful of these things, but start building your brand now. And do go out on your own. You do not have to follow suit with The things that in your residency, you're only seeing those kind of things.

Mm-hmm.

And I'm trying to make a change in that with presentations at ARMA for— we had a spring training, and really it was for residents in the anesthesia department. And it's like, there are options other than academic. So, we had on the panel, we had private practice, we had hybrids, we had academics, we had all these different options. And if you don't hear about it early, if the residency programs don't allow you to rotate, in electives early, right? Come rotate with me. Come rotate. So, I think it would be know that there are ways out and that you can see what's happening around you. This generation is coming out saying, I'm not even sure I even want to practice medicine. Do I even want to finish getting my degree?

Yeah.

Therefore, yes, and start building your brand because you may not be the best consultant straight out of medical school, but you can start working with and engaging with medtech and other companies and, you know, bringing, I guess I would call it legitimacy to everything that you see on social.

Right.

You should be the voice of authority. You should be the voice that is saying, this is what's about peptides. This is what's about the intermittent fasting. This is what's about— name your passion. Not somebody that doesn't even have a degree, or if they do, it's certainly not in medicine, right? And doesn't have all the anatomy, physiology, and all of that background. So start from day one. Even in medical school, you can start building your brand.

Yeah. Is that how you've built your practice? How have you grown your practice? And tell everybody, what's the name of your practice, by the way?

Precision Regenerative Medicine.

And it's located in North Scottsdale?

It is.

Okay. And what do you focus in on?

You—

are you mostly spine?

I am spine and joint.

Okay.

I do not focus on wrist and hand or ankle and foot, but everything major joints and spine. I'd say it's about 50/50 joints and spine, but it's more of a whole system approach. It's a constructive regenerative medicine approach.

Okay. So tell me about that. What does that mean?

It means that traditional pain and even some of these, um, traditional ortho, orthospine, neurospine, anybody who's doing these kind of procedures is destructive. Anytime you use a steroid, it's destructive.

Yeah.

It may be a temporary bandaid, but we have numerous studies that show the cartilage acceleration into osteoarthritis is faster.

Mm-hmm.

The idea that you can rupture a tendon from repeated injections.

Mm-hmm.

All these things, it's destructive. And when we destroy the medial branch nerves that go to the facet joints in the spine, which are kind of little tiny guys that help here, and that's that bending, twisting, extending motion, that Home Depot belt across the low back or across the neck pain, that those nerves also go to the stabilizing muscles of the spine and you're destabilizing, therefore accelerating in the case of spine, to fusion, accelerating in the case of joint to total joint arthroplasty. So destructive, not about that at all.

Okay.

It's constructive. So think about anything that would build. Well, then you gotta step back and say osteopathic principles, structure and function. You've gotta look at the way the body's moving. If we've got flat feet, we're going to put an undue amount of stress on typically the medial aspect of the knee. We've gotta work on that. So from the ground up. The whole kinetic chain. So there's that. There's diet. There's hormones. There's how are you nourishing this body with regard to sleep and stress reduction and the whole mind-body connection that's constructive. That's before we even put a needle in.

Are you, are you running full blood panels on people and putting them on hormones before they'll do treatment?

I'm not typically doing the hormones myself because that is an expert level above and beyond where I want to Right. I am an expert in other things. So that is where I will likely partner with somebody who's fantastic at, particularly in the men's space. I can understand the women's space.

Yeah.

But from the men's space. But yes, there are baseline labs, and depending on the person, that baseline panel will differ. Are we going into the fasting insulin because there is absolutely screaming, you're insulin-resistant labs? Or is it more of, it's a healthy athlete who just keeps getting reinjured and we've got to do kind of some of the But absolutely, metabolic health, and I include hormonal health as part of that, is vital. Otherwise, we're taking inflamed blood, putting it into an inflamed joint, and we're rolling the dice on whether or not we're going to get any benefit from all this hard work and investment.

We, uh, to me, that's the future. Those two, those two areas are merging. They have to merge.

They have to.

There's a couple of reasons. One, let's— it's the best thing for the patient. Without a doubt, right? Like we noticed this at the ED clinics. We were the pioneers of using PRP for erectile dysfunction, venous leakage, and Peyronie's. A lot of clients with Peyronie's, the scar tissue with the unnatural bend. And so what we noticed is that we had this, we had some patients that came to us and then we put them on hormones, right? And this was basic, like this was basic cypionate or pellets. Like there was no, like we, there was no peptides. Like there was no, there was nothing, right? There was just No semaglutide or anything like that. But what we started noticing is the guys that would be on hormones, and they were— if they were on hormones for at least 2 weeks prior to doing their PRP injection, we started noticing that they were getting better, faster outcomes.

Hmm.

So my Dr. Gibbons— Dr. Gibbons came in, he said, you need to take a look at this. I'm like, so I know it's anecdotal, right? Like, this is not a double-blind study. I'm like, huh. He's like, I think we need to change the protocol. I'm like, okay, let's do it. Change protocol. Our, our improvements went through the roof. And that was the first time— this is 2015, 2016.

Mm-hmm.

I mean, who knows how many billions of cells— like, we had the Magellan, so I'm gonna, you know, I'm assuming we were getting a good cell count. We didn't have a— we weren't counting. We were just pulling blood and injecting back in. But you started to see this, and that was where the first light bulb went off in my head. I'm like, If we did this full scale and what we know now about the whole functional health space. And do you know Dr. Schachter? You know Schach?

I do.

You know, he's doing this at a big scale. Like, he just spoke at the BHRT Training Academy cruise symposium at sea. His numbers are insane.

Great.

People, and people are spending money. They're like, they're like, get me fixed. And I'm glad to hear you're doing that. Do you're— now, are you doing like anything like HBOT or laser shockwave pre-post, anything like that?

I have not added in, um, HBOT. I don't have chambers. I have referrals for chambers.

Yeah, it is an expensive thing. Nobody needs— but yeah, get a referral partner.

Exactly.

Yeah, don't go for it.

That's what that's about. Similar with red light, the lady that I have space with has entire red light room we can bring in before doing the PRP, and we can do the high-intensity interval training with If the red light's on, then we draw the blood. We were doing little things like that. But where I'm more likely to use the adjunctive is in the in-season athlete, or say, you're getting ready to do a charity golf tournament.

Right.

And it's not the right time to inject your elbow right now because it's your dominant arm and you're gonna feel it. So what can we do to get you ready and to palliate and get space for, but there's still regeneration going on prior to the actual— using of your own cells. So that's all part of prehab.

Okay. Are you— are you doing multiple PRP injections for a joint depending on— are you doing— are you a one-and-done person? What's your philosophy on that? What do you feel is the right approach?

I personally have had great success with one. Okay. We certainly reevaluate. Oh, yeah. You know, it determines whether or not we're going to do a booster. But that booster is not at 6 weeks. It's not at 8 weeks. It's not at 10 weeks. And it may not even be until 4 months Oh, really?

Because you wait that long?

Because we are still on that trajectory. Where did we get versus where do you want to go? Did I get you 80% better, and it's realistic that we can get another 10%? Did I get you 50% better, and you'd be settled with 70%? What happened in that post-injection timeframe? Were you able to maintain the rules? Were you immediately back to sport, or did you go on, you know, a trip to Amsterdam for 2 weeks and, you know, All the alcohol, right? Yeah.

Smoking weed. Yeah. Walking around.

Yeah. So what was it about? And, and each individual, but I found that if you do it right the first time and you know the baseline platelets and you know what your system gets and you know what you're delivering precisely with ultrasound and/or fluoroguidance every single time, that you can do really well with one injection.

Are you testing cell counts on every patient?

I am testing cell counts on my new patients. If it's a secondary follow-up, I'm not likely to. On my stem cell ones, bone marrow aspirate, 100% across the board since the very beginning. And that's an investment in and of itself, but it's worth it to me to have that kind of data.

You know, that was the thing that I remember about when we worked together is that you were one of the first that I was really exposed to that was doing that kind of detailed work.

Yeah.

But that was early on. Like, this was like 1920 or something, 2820 or something like that.

That's my quality assurance. Yeah.

And that's— I was like, oh, well, yeah, that makes sense. You know, like, nobody was doing that.

No.

How are you getting patients? How do you market you and your facility? What do you do? What works? What do you think works?

I think having very good relationship with your patients, and they are the ones that tell you It's that organic. I ask everybody how they found me.

Mm-hmm.

Everybody. And I'm the one answering the phone, so I know, right? And they fill it out on the form. But, uh, there's some Google. So having a very strong online presence is critical. Owning yourself, your website, your Google Business Profile, everything that is out there on you. I Google myself regularly, or I'll ask the LLMs regularly, who is the best Who is the best? Who is the best? And if I'm not showing up, then I've got some work to do. And I want AI to say, Dr. Tammy Penhaligon, Precision Regenerative Medicine. And I work very hard for that. But most of it is, my sister came to you, or my uncle, or my doctor said that you're the best.

Do you have a specific process to make sure that those happen? Are you— do you ask them for referrals? Anything in particular that you're doing?

I do ask. It's a little bit hard. People are a little bit shy even to leave a review.

Yeah.

I try to make it as easy as possible to leave a review, a QR code they can scan, those things. Really well done. Or just say, if we could just help one person just like you, it would mean the world to me. One person. So you think one person, I can think of one person, right, to tell about you. So making Make it actionable, make it small, not like, hey, tell all your friends and family. That's too vague. So being very intentional about who you ask and what you ask them to do, the timing of it, not right after you put a needle in them and they're kind of aching. You know, those things.

You just did their elbow and they're like, that really hurts.

Exactly.

Or they're coming out of the MKO meld from the back part procedure. Yeah, so—

Not the right time.

Not the right time.

No.

Right time, you know, it's a good time, but it's not the right time. My— Christine's mom just had her hip and knee done. She went to go see Donnie. And, uh, I was like, how was it, Diane? She goes, man, those MKO Melts are fantastic. I'm like, yeah, they are. She's like, have you tried them? I'm like, no, but I've heard about them. Like, a bunch of us are like, you know, maybe we should just get them and like, I'll get in a room and like take some MKO Melts and have a good fun hour or something like that.

Who would have to document that?

Yeah, I know. And then he's like, yeah, right. Yeah. I'm like, yeah, well, maybe that would be against the law. Maybe we shouldn't do that. It's like, all right, maybe we'll stick to something else. We'll go to Denver and do ketamine or something like that. Um, what has, so do you do like any webinars or, um, like live events? It's, or is it all just word of mouth is how you're growing?

I had done webinars. I didn't see a lot of bang for that. Um, I have gone live on YouTube a few times and I try to stay involved in the community. There's the Women 360, which is a very large networking group throughout this whole Phoenix metro area. And there was a March to Wellness.

Mm-hmm.

Um, event live and purchased a booth and was on stage. So those kind of, you know—

Well, you've been speaking a lot more, haven't you? You've been intentional. I know you've been at the conferences. You've spoken a couple of times, right?

I'm very intentional about that.

Yep.

Um, I don't tend to turn down the invitation if that's a possibility. And some of them are even webinars for the AAOM.

Mm-hmm.

Those things that are just educating physicians. So part of it is how many people can I reach versus how many people can we collectively reach if I join train the physicians in the benefit of prehabilitation, the importance of the functional spinal unit, the importance of the functional elbow or the functional knee, name that joint unit, rather than just intra-articular and done, right? Then we're going to give the whole practice of regenerative medicine a better name because, as you and I mentioned before we even started, this is the wild, wild west. Yeah.

Maybe it's only one wild.

Okay.

Maybe we've dropped one of the wilds. It's not too wild wild. Maybe it's just wild.

Doesn't fit for the name of the song, though. But every day—

but yeah, I know. But every day, it gets a little bit more— you know, it's like every day, you see it getting a little bit more tighter and a little bit— but there's a lot of renegades out there. You've been pretty active on social media, on LinkedIn, about calling out some of the renegades.

I still get phone calls from patients that had a mother calling on— or excuse me, a daughter calling on behalf of her mother, 90-year-old mother and talking about how, well, we talked to this guy and he said that if we did IV exosomes, that her brain fog would go away. And we've even got evidence against the dementia she has. Wouldn't it be fantastic? Why would you want to draw her blood and do things like this if we can't just use exosomes in the IV? Like, oh my God.

Because they're dead.

Oh my God. But that's happening. And so it is wild, wild from the stories I'm hearing.

Yeah. What concerns you the most about What are you worried about?

The erosion of trust already coming out of the pandemic. And you look at poll after poll after poll and the erosion of the patient-doctor relationship, the feeling of trust within the medical community, and that, that's what so many people say, that's what drives them to the gym bros. That's what drives them to the quack clinics and the scam cell clinics on the corner.

Scam cell clinics.

And all those things that are not legit. I think the bad actors out there can really— what do you say as a coach that, you know, one bad review, how many good reviews do you have to—

Oh, 10 to 12.

Okay. So—

People, you can have 55-star reviews and you get one person who just has a vendetta and they'll give you one star and people will focus on that infinitely. Okay.

Similarly to this.

Yeah.

One bad scam cell clinic It takes how many legit operators who are practicing ethical regenerative medicine to outweigh that?

So how do we stop it? How do we, how do we get our arms around it?

Outcomes, data, publishing, those kinds of things are going to be important to those who want to say, look, we've got— and here I have a little bit of a problem with academia. You know, there's only so many double-blinded randomized complete, you know, Yeah, there's only so many controlled trials that you can do when people are people.

Yeah.

Right? We are, you cannot control for all the variables. Absolutely cannot. So you're never ever going to be able to say, don't eat your protein, don't take your creatine, don't do your, right? Don't let your blood pressure get out of control, but I don't care if it's a little bit whack because that's the only thing we're controlling for right now. We're controlling for how did you do with PRP in your left Right. Right? We're never going to be able to do that. So I'm not sure that I can put all of my eggs in the, there's got to be more studies. I do like the patient-reported outcomes and the outcomes databases. I think that gives us a lot of credence.

Do you use, like, DataBiologics, or who do you use?

I personally do not. I collect my own.

You have your own data?

I do.

Okay.

I do.

And then do you share that data with patients?

I do.

Yeah. It's a really powerful tool.

It is.

And this— I'm not pimping for DataBiologics. I mean, they're, we're friends, right? But we have clients that will take the printouts and show this to the patients and they're like, bam.

Right.

It moves the needle so fast.

Well, if you can say people like you.

Yes.

It needs to be a 55-year-old golfer with elbow pain that is not morbidly obese, is not diabetic, is not this, has done like this.

Yep.

Right? Not comparing—

Did you read my file?

I know you, Carl.

Right.

You've told me your age.

Yes.

Yes. So, versus comparing it to a, you know, 18-year-old who's being scouted for a Division 1.

Mm-hmm.

And they've got a rotator cuff tear or a labral tear. I can't show 50—

Right.

X-year-old male to an 18-year-old female swimmer. Totally different. So, to be able to do that, you, that's where I do see the benefit of a large database.

Mm-hmm.

And paying extra within that construct to be able to compare yourself to the others within that. So, yes, that's one way to maybe earn back some of that trust because trust has been eroded.

Yeah. What's your feeling on some of the changes that have been coming from HHS, from Health and Human Services, peptides? It's a big, broad topic.

It really is.

But what's your feeling in that?

My feeling is that the possible benefit of, let's just say July, and having a certain number of peptides come off of the no-go list and potentially be able to be compounded by reputable 503 compounding pharmacies, that it takes things out of the gray market.

Yes.

The gray market is where I'm concerned that people are using for investigational use only things. You have no idea how sterile that is, if it's actually Mm-hmm. What it says it is, and you have no oversight over what if there was a fungus that was then replicated or a— name that— endotoxin, bacteria, vi— whatever it is, that right now it is truly garage-level gym bro stuff that we really don't know what's being injected, and the safety concerns are mine. Yet I've read arguments that say, well, physicians aren't doing anything about it, so I'm just gonna get it the way I want and I'm not even gonna tell my physician what I'm using. Right. Yeah. Yeah. So then I wonder, are they telling me what they're using? And if we get an untoward effect from what we're working together, was it the undisclosed use of something that was for investigational use only or for animal use only? Or was it something that truly happened in your own physiology?

I was at a party in LA a couple weeks ago, um, pretty high— higher end, right? A friend of mine there is there, invited me. He's an eye doctor, surgeon. And we're hanging out and people are asking what I do. You know, I work with doctors, anti-aging, longevity, Regen. And I must have had 5 people say, can you get me peptides? I'm like, I— no, I can put you in contact with the doctor. No, no, no. Like, I just need like some BPC-157. It's almost like it's become like the designer drug.

Right.

You know? No, it works. I mean, I can't lie. take it every day. I mean, I take a lot of peptides, right? I mean, testomorphin, you know, I do all those things. Um, but they're all, you know, clean, reputable, like, you know, I mean, but then talking to this guy, he goes, oh, I can get you peptides. I got to go overseas. He goes, let me give you, I'll give you his number. Here's his WhatsApp. I'm like, you're going to buy peptides from somebody's WhatsApp number? Well, yeah. Like, how bad can they be? I'm like, they could be really bad. Like, you're not— please go call, talk to this doctor. Please go talk to somebody who's going to do this the right way.

Right now, is there a right way? Is there a legal right way for those that are on that no-go list?

Well, technically, I'm not a lawyer, thank God. And I got a D in contract law. So, um, I feel pretty confident that there are a number of reputable compounding pharmacies, not the small ones, the big ones that are producing this, that I'm pretty— and my doc— doctors that we work with are using them and recommending them and prescribing them, that they're going to be clean and they're going to be good. Is it legal? Technically, probably not. And yet I have seen the results in and I know what it can do for humankind. And then I always ask myself, is it worth it to be the trailblazer?

Right.

And I don't have the answer for that, Tammy. Like, I don't have a medical license. I don't own a pharmacy. As Brigham Bueller said, you're in the perfect position. He goes, they can't come and investigate your pharmacy like they can with me, and they can't threaten to take your license. Right? Here's what I know. I see— I'm going to use my own body As, 'cause you knew me 6 years ago, I was much heavier, right? With the use of these, I'm in the best metabolic health at the age of 58 that I've ever been in my life. So why not?

Yeah. I would like more data in humans.

Yeah. And I respect that.

I would like to have a mechanism of action of each of these in humans. And some of them, I'm just not sure that we do. I'm excited. I think there's potential. Yeah. Yeah. Yeah. I'm not trying to push it. I don't put wet blankets on anything. I know you're— yeah. But I'm also, I'm data-driven.

Yeah.

And I'm safety. I'm an anesthesiologist. I am your primary safety officer, right?

You are paid to keep them alive.

Right? So that, that's a big deal to me. And my medical license is quite valuable.

Mm-hmm. I'm encouraged. I'm encouraged that at least the conversation is happening.

I am too.

You know, because they're inexpensive, they're cheap.

Really?

Yeah. The cost of them are— all of our clients, we teach them, you know, you put it into a package. So it's overall, like, you're not— it's not the cost of the medication that's getting marked up. It's the wisdom to apply it, right? That's really what it is. But I think some of these things like thymosin alpha and testomorlin and And, you know, BPC-157 and all of these can have really great positive impact on people. I mean, I can tell you my own injuries that I've had of injecting BPC-157 as I have an injured shoulder and in my delt, and I get markedly better faster. I mean, so I think there's great potential with these things.

Yeah.

I really do. And I get excited anytime we can move control of care from the pharmaceutical and the health insurance companies back into the hands of the doctors. In my view, that should be a decision purely between the doctor and the patient. And the doctor should have the time to talk to the patient about the options.

Absolutely.

And educate them.

You can't do that in 7 minutes, can you?

No. You can only say, I'll see you in 6 to 8 weeks. And then you get another 7 minutes. So, I'm encouraged. I'm encouraged about what— you know, Secretary Kennedy is obviously a controversial person, right? But I'm encouraged. I like the fact that we're actually finally having the conversation versus in other administrations, it was just straight demonization. Because I think that there's a lot of other things out there that could help benefit the human race.

Agreed.

You know? And I think we should be exploring all of them. And as Dani said, we shouldn't have to spend $1 million to go through an FDA trial. It's crazy.

Agreed.

It keeps all the little guys out where all the innovation happens, you know? So, I'm all about pushing, let's see what we can come up with. I think we're just scratching the surface. Every time I send somebody to go get a regenerative therapy procedure, like I said, we sent Christine's mom, And now her dad just called me this morning. He goes, I'm gonna go get my shoulder and knee done. What do you think? I'm like, it's about damn time, Bill. Like, go for it. You know, like, you're gonna feel much better. Physical therapy isn't working. Shit.

Right.

So, um, when we were talking before the cameras were rolling, I want to dive into this because you had some pretty— and I want you to let it, let it fly. We're talking about bolt-on, bolt-on services and bolt-on businesses. Tell me what you meant by that. What do you mean? And what's— because that's something that you have a pretty strong opinion about.

Similar to the Wild West aspect of things where you maybe have people that aren't fully trained doing these kind of procedures that should be done. I think that's not great. It's not great for patients, or they're doing them without image guidance. 100% no-go. Oh, God. Yes. Or whatever, right?

Yeah. People doing without image guidance should be done. Are you talking about, like, the orthopedic surgeon that's read the— that are only doing 8 cc's or 10 cc's and not—

Yeah. So, so, both of them. I mean, first of all, let me say, I have compassion for the physicians that we want collectively to break away and leave the system and gain their autonomy and truly help their patients. I absolutely feel for that, that the— The insurance companies are taking more and more and more, and every single year, your reimbursements go down. Granted, I'm giving you all of that.

Mm-hmm.

However, one of the things I see marketed to physicians in insurance-based practices is add Regen, add this cash base. It could be a laser, it could be a shockwave, it could be PRP, it could be whatever. But when we're talking about regenerative medicine and it's actually harnessing the body's own cells to take And so, to take that and bolt it on to your insurance-based practice without understanding the systems-level changes that need to occur and the mindset shift that needs to occur in you, it is a paradigm.

Yes.

It is not, I'm still going to inject with cortisone, and if that doesn't work, let's go PRP the next week.

Yeah.

All right? Or, I'm going to take the very first rep that comes to me and says, oh, well, I'm an orthosurgeon and I happen to use this brand in the OR of this implant. And they also happen to have a centrifuge and a PRP kit that is, let's just say, like doing plasma instead of doing platelet-rich plasma, at best.

Maybe getting a billion cells at best, maybe?

Maybe. Maybe. So that is a shift in the system, and it's the antithesis of the constructive approach. It's still that I'm just— I'm praying that I can keep the doors open, We're going to add some cash-based services, and this is a way to do it. And it might be my little, my little flight line, my little thing of pulling me up. It's not the same. And I would say, please, please, please get educated. Change the whole thing. And if that means you've got to transition from 100% insurance-based to hybrid and drop, drop, drop, drop like you teach, that's a whole different story, Matt. Yep. Yep. But it's not the same as, well, Well, we just need some cash-based stuff because the guys that are running the numbers say it's going down, it's going down. What are we going to do? And you've not made that shift in your mind that is 100% patient-centric. That's not why you're doing it. You're not adding a cash-based service so that you can help patients. That is not it. No. Well, that's what bolt-on is.

So the thing I noticed, and, you know, we, I've, you know, I talked to 20 doctors a month on the phone, right? You know, deciding whether or not they're going to come work with us. Most of them, if they have cash services, maybe $5,000 a month on the top end, $10,000 a month. And you mentioned something is they haven't made the shift in the mind.

Right.

So when you— what happens when you're struggling psychologically, when people are struggling financially, they actually start grasping at straws instead of doubling down on what they know works. Okay? And so, they start looking for quick fixes. It's like the heroin addict who, you know, will inject anything 'cause they can't get their fix, right? And so, what happens is that they have a lot of these incomplete things. I've got this over here. I've got this over here. They're looking for the tactic to save them versus going through the transformation to become the person, the future self that they need to become.

Exactly.

Right? And you said something beautiful. is that you've got to have that mindset. You have to— when we can get a client focused on their future self, and calling that future self into them, not chasing the future self, but calling that future self into them— we talk about the quantum field— pulling that person from the quantum field, your future self, and acting and operating the way that they do, then that transformation happens like that. Like, within 90 days, we'll see, like, a massive change. In the person first, then the business. People expect the business to change, which then will change them. You have to change yourself first. And it starts with that future self. So I love what you said, like the bolt-on from a concept of, if I'm gonna use this as a transition, is one thing. But the bolt— what you're saying, if I understand this correctly, the bolt-on as the savior is not— you don't like that approach. You don't wanna see the bolt-on as the quick-fix savior.

You're— Because it's not going to. You're practicing crappy regenerative medicine. It's not regenerative medicine. No.

Yeah. Anybody out there who's listening to this, if you're injecting without ultrasound guidance, you need to call Colin Rigney and Ryan Martin and get trained. 'Cause like, you're doing a disservice to the industry.

Right.

Absolutely. And if you don't know what your cell count is, for the love of God, just get a machine that proves it to you that cell count is right. Or get a counter for whatever.

Send off specimens.

Just whatever.

If you don't have the ability to do it yourself. Yeah. you know, QA on the machine every day.

Anytime I see Donnie— I love it when Buford posts those studies of like, here's a study in the American Medical Association Journal about how PRP doesn't work. And he's like, you can tell in the first 2 paragraphs, they didn't know what they were doing. They pulled 10 cc's out. Like, what do you expect?

Right.

I love those. I love it when he breaks it down and just eviscerates somebody. What do you feel— so you've been on your own So, you've been on your own since '18, 2018, 8 years. Um, and you've been in the industry for, obviously, for that long plus. What do you see coming on the horizon? What are the things that excite you about some of the things that you see that have promise? I understand the study's under 100%.

Sure.

But when you look at the initial stuff you get excited about, what are the treatment things you see coming?

I'm excited about expanded cultured autologous cell therapy. Okay.

Tell me about that.

Taking your own bone marrow or your own adipose, coming back a month or several weeks later based on whatever it is. Fat takes longer to just isolate into and expand upon MSCs, mesenchymal stem cells. Adipose can be done in— excuse me, bone marrow can be done in about a month.

Okay.

But bringing that to the US, not having to rely upon one industry, one group in Grand Cayman, which is a fantastic and totally legit facility.

Yeah, no, they're great.

But in terms of being able to bring it to the masses and bring it on our shores would be ideal. I think it would decrease the number of medical tourists that are going to countries where the safety, again, is dubious. Patients that then end up in ERs, patients that then come back across the border and have to say, Look at this massive infection, how can we fix this? So I think that's exciting, although I'm not hanging my hat on that it's just the stem cell.

What do you think?

It's not just the MSC.

What do you think it is?

I think it's the whole enchilada when we talk about bone marrow, that there's the iRap, there's all the other things within the bone marrow plasma and the bone marrow aspirate concentrate specifically, 'Cause I double spin and concentrate, that if I were to take head-to-head, I don't know what the number's gonna be, Matt, but let me throw something out. Say 18 million stem cells in a vial of just stem cell fat, what would it take to overcome what I can do with bone marrow?

Mm-hmm.

It's probably, I, I don't know. I mean, I'm thinking that you're missing a lot if you don't have all the other things that are in there.

Yeah.

And so some people who are using fat right now that is not expanded, we'll add PRP because you're looking at, you've isolated the stem cells within the, the micronized adipose, mFAT, and you add the PRP. So you've got the growth factor— growth factors, anti-inflammatory cytokines, et cetera. So I'm excited about that aspect of it. And I think we are gonna be able to overcome for things like age-related decline in stem cells.

Hmm.

It is going to make your, my prehab even more effective in terms of optimizing a patient beforehand, before the harvest. But then we're going to also have that option of expanding even above and beyond because there is a dose-response curve. So that's what really excites me.

Okay. Anything else that's really exciting you?

Oof. That's the big one.

What is your medical feeling? Some of the states have been approving and saying, like Utah and Tennessee and Florida have been saying, hey, umbilical cord is fine to use. What's your feeling on that medically?

Well, I don't think there's any data right now that shows that those cells, in terms of stem cells, are alive.

Right.

And when we have the ability to use our own stem cells from either bone marrow or adipose, I would rather use your own for several reasons. A, they're dead. B—

The umbilical cord, right?

Yeah, they're dead. And they're not always made in a cGMP facility. So again, one endotoxin, one virus, one bacteria, one whatever multiplied and cultured, it could be— at worst, you get no benefit.

Uh, at best.

At best. At best you get no benefit.

That's what I was gonna say.

Sorry. At best you get no benefit. At worst, you're blind, you've got a massive infection, you've spent tens of thousands of dollars on something you got no benefit from, or I think that there can be lo— longer-term ramifications. It also hurts the field.

Mm-hmm.

Um, it makes sense to say, oh my gosh, wouldn't it be amazing to have day zero stem cells? But the process of preserving those, irradiating those, thawing them, et cetera, Dr. Centeno has done the work. Yeah.

Yeah.

He's plated these things. I have seen no appreciable stem cells on those plates. And I don't think he's making this up. This man is a consummate physician and scientist. So I don't really see a benefit of that. I understand right to try when we're talking about something that is truly life-saving, like I'm, I've I've got stage 4 cancer. I want a right to try something that is going to potentially give me more time with my family. This is not that situation. I understand osteoarthritis is, can be devastating. Back pain can be devastating. I'm not negating that, but this is not one of those situations where it's a compassionate use. So I do have some issue with that.

You think they're pushing that so that then they can get those things approved with the health insurance companies and it becomes a financial boom for the supplier of those?

I don't know. That's usually the path. But then you have to look at it as a doctor who's maybe thinking, oh my gosh, I can do it. It's so easy just to get a vial and inject a vial. We're not going through the hassle of liposuction or bone marrow harvest, et cetera.

Harvesting the patient.

But what— tell me, how does that work out for you when you were getting $1,200 to do a mild procedure and now you're getting $12,000? Right. When I was getting paid $10,000—

Look, it's not a benefit for the doctors. It's a benefit for the pharmaceutical companies.

But doctors who are doing it thinking that it's fantastic for patients, Yes. The patient might see that right now, I can get a margin of X on a vial of Y. If that does go through and the middlemen do become involved and it does become this health insurance-related thing, that's why I'm not a fan of PRP, bone marrow, or micronized adipose ever becoming covered. Oh, God, no.

I'll fight that to the last.

Because, right, then you're going to get paid $2.50 to do something that costs you literally your time, all the risk all the, every, not to mention heart loss.

Oh, and they'll tell you, they'll tell you you can't pull 60 cc's or 120 cc's or do a double spin. The concentration will be wrong. They'll just, they'll be like, no, let's, and then there won't be any benefit.

No. So I don't agree with the same argument when we're talking about birth tissues. Yes.

Yeah. The thing for me, and I get asked this a lot, right? I bet. A ton. Again, same party, right? Um, and I'm standing, uh, it was actually in this guy's yacht. So we're standing on this, which was really nice.

Fat? LA.

And so we're standing up on the 3rd level and he's taking us out through the harbor and we're standing there. I'm talking to some folks and this guy's like, yeah, you know, I like, I just had, you know, umbilical cord injected into my knee and, you know, da da da. And I'm like, so how much did you pay? I forget the number. And I said, why didn't you look at doing your own? He goes, oh, well, 'cause, you know, I'm older. My stem cells are not, they're not as vibrant. And I go, you know, What if all those stem cells were dead that they injected in you? He goes, what? I go, for the same, for less than that cost, for most, whatever doctors are charging, but on par, that's less expensive for you to harvest your own. And we know for a fact that it works better. Like, I don't have, I've never seen any study that animal umbilical, any of that performs better than my own. And I won't say that I've read the studies in detail like you would, right? Like, and I get a lot of my studies from talking to doctors, but I've never seen one study that even gets remotely close. Anecdotal, data biologics, you know, whatever. I've never seen it. It's such a sales job. It really pisses me off.

So can we call it wild, wild again?

I can call it fraud. How about we call it fraud? Okay? It's— It's charlatan stuff. I mean, I get phone calls, hey, we want to introduce you to, you know, my doctor. Your doctor's going to love this. Here's a doctor who's doing great. I'm like, just get away from me. Like, one, I don't do that to my doctors. That's not my job. Two, no.

No.

It's just, I find that stuff so bad. It's just really stunning to me. So, What is, for you, what does your future look like? What are you, what do you see on the horizon for your practice and for your growth?

Uh, continuing to help patients in clinic, certainly taking them on that constructive journey and changing their lives, but also on a larger scale. As I said before, when I teach physicians, their patients are impacted. We can make a larger reach at that point. Like, your goal is to save how many doctors?

100,000.

Okay.

We're going to lead the exodus of 100,000 doctors worldwide out of insurance-based care.

So that's fantastic because then you extrapolate and say each one of those doctors can affect this many patients.

We can affect $40 trillion in healthcare savings in the United States.

Okay. I don't have that, those numbers for what I— It's in the book.

You can read it. It's in the book. It's chapter 13 in the book. You can read it.

I will.

Now, they're soft numbers.

Okay.

Like, let's, you know, it's not like, but if you look at how much money you save and it takes 18 months for somebody to go through like the prep for a hip replacement and the wasted time with work and energy and all that and the drugs and all that. Like, and then if you look at saying spending $12,000, if they were to do a high-level BMAC, if they needed that, right, with some hormones or BP, whatever. It's about $12,000, right? On average. Um, some of them might be a little higher, some might be a little bit lower. The cost is $48,000 if you go down the traditional path of what the patient's going to pay out of pocket. Okay.

Right.

I mean, that means we're saving $36,000 per patient. We get 100,000 doctors serving 1,000 patients, I think is what the math is. You get to $4 trillion pretty quickly.

You do.

I mean, it doesn't take very long. We can save— I believe we— I believe the future of our country There's a lot of issues in every country. I believe the future of our country is fully based on our ability to fix our metabolic health issues and the way that we treat patients.

Yeah.

I think that we've done more harm since 1986 than times 10 than all the rest of the years combined, which includes the people that used to think that leeches were a good way to heal people. Like, we've done— we are so far behind. from practice, understanding the body and medicine, and the— we understand it. We understand how it works. We're so far from the application, the ethical application of that, because everything is about money.

Everything.

Everything is about money. And it— look, I'm all for doctors charging what they're worth, right? It's one of my core tenets. But at least it's going into their pockets. pocket and it's helping the patient versus going into some politician's PAC. I just looked up the numbers. $86 million to the top 20 people in the United States Senate.

How many people could we help with that?

$86 million to prove their point that they're right. So frustrates me. It pisses me off. It pisses me off to no end.

So when people have authority, when people have voices, when people have, they are the expert, then using that for good is a calling. And that's one of my callings. So to educate as many as I can and whether that be, well, it will be, it will be patients. Obviously it will be other physicians trying to leave the system or who have left the system and want to find the way and having a very structured way that they can incorporate it into their practice. They don't have to do what I did, where you reinvent the wheel over and over again. You can take something that is proven and something that has results, and you can apply it, and your impact then is magnified.

Yeah. Imagine, you know, Scottsdale has a lot of retirees, right? Phoenix. Imagine, imagine a world where 80% of the joint replacement surgeries are deferred for 5 to 10 years because of regenerative therapies.

Or 15 in the case of knee.

Yeah, 15 is in the knee.

That's the data from Dr. Hernagu on the intraosseous.

What about—

what's that? We don't— I don't have that data.

Okay, that's fascinating.

15 years. Yeah, one knee replaced, one knee bone marrow A 15-year follow-out.

I was having dinner. I have a college buddy of mine that lives here in town, and I was at dinner with he and his wife, and we were in Old Town. And we were doing like a wine thing, right? We were going from— so we were walking, right?

Sure.

And she's like— this was right around November, and I think it was right after Thanksgiving. And she's like, oh yeah, by the way, I'm going to get a hip replacement. I'm like, what do you mean you're going to get a hip replacement? We're walking. There's no limp, like nothing. And I go, what do you mean you're going to get hip replacement? She goes, yeah, I went and saw the orthopedic surgeon. He says I need a new hip, so they're going to get me before the end of the year. Did they do an MRI? She's like, no. They didn't do an MRI? Nope. X-ray? Nope. Ultrasound? Nope.

Huh.

You just went and saw the orthopedic surgeon and they said you need a hip replacement? She's like, yeah. I said, you don't need one. She's like, I'm not a doctor. You know that. You don't need one. You walk fine. Go call— and I said, you'd call Ash, right? And I texted him. She went and had it done. And he gets the MRI done on her, and he's like, you don't need hip replacement surgery. And all I could think of is that orthopedic surgeon was trying to make their RVUs. Trying to make their bonus by the end of the year. She's like, "Well, we went to the largest you know group." Da da da da. And I'm like, "Oh, that pisses me off." Yeah. That pisses me off to no end because there's so many surgeries—hip replacement, knee replacement, shoulder—tons of them to me that don't need to be done, that could be saved.

At least postpone for quite some period of time. And how much more activity do you have during that timeframe? And you're getting healthier through the system all the while. And you may even get to a point where you don't even have the inflammation in that knee. I consider it a success. For example, if a woman comes to me and she's— every joint aches and she's not hiking, she's not doing the things she wants to do. Her shoulders, she can't play pickleball. She's in Florida. Menopause. We correct the hormones. We get her eating anti-inflammatory. She's now sleeping better. She's now— nothing hurts. Thanks. Yeah, that's okay. That's fantastic because look what we just did. You're a healthier being for even have met me.

Yeah. Well, and you know, the anti-inflammatory diets that they get put on, do you use that as well?

Absolutely.

Yeah. Yeah. It's so powerful.

It is.

Yeah. So anything else you want to share? Tammy, anything else that's on your heart and mind?

Not really. You sure? Yeah. Okay.

Thank you for coming in. It's my pleasure. Thank you. It's always great to connect with you. You're going to be at Toby and IOF?

Absolutely.

Good. Love to see you there too. Thank you. Okay. Thanks, Tammy. Appreciate it. My pleasure. 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 Visit MavericksProfitSystem.com to schedule your free discovery call and explore how far your business can go.