The Path to a Medical Practice Success: Dr. John Ferrell III's Approach

All right, today on the Practice Profit System, you're going to hear from Dr. John Farrell III, the general managing partner of Rossum, and you're going to listen to his journey about how he went from sports medicine to owning and being the general managing partner and CEO of 8 locations and their vision for worldwide growth. Now, you might think Matt, I'm just a local guy or gal. What has that got to do with me? Well, you're gonna learn a lot about John's journey because John's not a business guy. He didn't grow up in an entrepreneurial family. He is a doctor just like you. And there was a pivotal moment in 2017 when he decided that, you know what, it's time to step up and learn this, and you're gonna hear about his journey. So join us today on the Practice Profit System. All right. Good evening. Good morning. Good afternoon. Wherever you are, welcome to the Practice Profit System podcast. I am your host, Matthew Gallogly. And today we have Dr. John Farrell III. Got to get that right, John, right? We got to, we don't want to confuse that with senior or junior. But he is the chief medical officer and founder of what is known as ROSSM, which is Regenerative Orthopedics and Sports Medicine. They have 8 8, right? 8 locations in the Baltimore, Washington, Annapolis corridor. And you did hear that correctly, that he is a doctor and he has 8 locations. So we're gonna dive into that today on the Practice Profit System. We're gonna talk a lot about his journey and his journey really from the standpoint of, as I like to call it, going from a doctor to a business owner and just kind of that transformation. Because I think that's a lot of things that our clients need to hear and our prospects need to hear. So, Dr. Farrell, thank you for taking the time to be on the, uh, podcast today. I know you are wicked Busy. So let's talk a little bit about your journey. Do you come from a medical family? Do you come from like an entrepreneurial family? Do you come from like a family of like being in medicine, being an entrepreneur is like the furthest thing from your mind or the closest thing from your mind? Let's talk about that.

Yeah. Well, Matt, first of all, thanks for having me.

Yeah, man. Yeah.

So the background is, you know, my parents were both first-generation college graduates. You know, my dad was a project manager for a lot Lockheed Martin, and my mom was an accountant for the government. So no entrepreneurial background in that. And, you know, I was the first physician in the family. You know, I grew up as a native Washingtonian in the Washington, DC area. And then out of the DC area, we spent 5 years in Naperville, so suburb of Chicago.

Oh, I know that well.

Wow.

No wonder I like you so much. I'm from Barrington. So, you know, Naperville was the truly— is a truly manufactured city out in the middle of nowhere. So anyway, keep going.

And then came back to the D.C. area where I did high school in Prince George's County, and then from there we went to University of Maryland for undergrad, and then I did Penn State for med school. I always tell people I was lucky enough to have a rich uncle pay for med school.

That was Uncle Sam, and then his balance sheet sucks, but he's got a lot of money.

The women always ask, "Is he looking for a young wife?" He's your sugar.

He will be your sugar daddy for a fee. Absolutely. And then you know after med school.

I did a surgery intern year, and then I did 4 years in the Navy. And after the 4 years in the Navy, that's really kind of when I fell in love with kind of regenerative orthopedics. So I decided to hop out of the Navy. I did a family medicine residency with the goal of going into a sports medicine fellowship. And then after I got my sports medicine fellowship, I jumped in working as a team physician for DC United and working with an orthopedic surgeon. And I quickly realized after butting heads and fixing people that he would normally operate on, that we had to kind of break out and do something different. And that's in 2014, we started Regenerative Orthopedics and Sports Medicine.

All right. So I want to talk about that. So here you are. You are the team physician for DC United, right? That's another, by the way, podcast topic about what it's like to play at JFK or is it RFK? Whatever it is, whenever RFK and all the rats running around in the sewer. The open sewage. But, okay, so you'd met, you were mentioning you were butting heads with the orthopedic surgeon. Why? Let's talk about that.

Yeah, so, you know, it was a private practice and, you know, orthopedic surgeons make money by doing surgery and they're very good at it. And there's a lot of people that need the surgeries. But there are some times that we're able to prevent surgery. And, you know, using regenerative medicine, and that's really kind of where my passion is, is getting people better in the least invasive way. And if we can do that, you know, we figure that that's a win. And we were saying, hey, look, this guy had a small partial thickness rotator cuff tear. I did 2 PRPs and they got better. And the surgeon was like, no, we operate on those. You send those to me. And I was like, this is not going to work.

So wait a minute. Player, athlete is back in 6 weeks versus surgery on the rotator cuff tear, which is 6 months, 9 months. What's the— is that— do I have that right? Is that kind of the variance I would say in the recovery time?

Yeah, you know, I mean, maybe 3 months to 6 months, but yeah, you know, very flow.

Yeah. So why do you think the— I mean, I understand the orthopedic surgeon makes money doing surgery, but why do you think— and I'm not trying to disparage this orthopedic surgeon, so if you're listening, we're not trying to slam you— but why do you think they have— why do you think that there was such resistance to this?

Well, you have to then take a step back and look at the training, right? So when you Train as an orthopedic surgeon, historically, you need to see 10 patients in order to find one that's a surgical candidate.

Mm-hmm.

And when you look at the way most orthopedic practices are set up is that they're gonna see about 4 patients per hour. And they're gonna use mid-levels like nurse practitioners and physician assistants to help them quickly kind of determine, is this candidate a surgical candidate or not? If they're not a surgical candidate, they're gonna be offered physical therapy. They're gonna be offered a cortisone shot. You know, they're gonna be offered, give it more time. When it's bad enough, come back and see me. If it is a surgical candidate, they're gonna spend a little bit more time with them. They're gonna order the MRI. They're gonna make sure that they figure out what they can do to get more of these surgical candidates because they get paid more for surgery. They love doing surgery and they're really good at surgery. And when it's done in the proper, you know, patient population, they get really good outcomes. And so that's kind of their training.

That's their setup. Okay.

And so it's a machine. You know, most orthopedic practices, you go in their waiting room, it is busy. There's a lot of people out there and they're getting the people in and out quickly. But from a consumer standpoint of being the actual patient, you're like, I don't know what just happened. A whirlwind came through. The doctor came in, put hands on me for a couple of seconds, and then he gave me either a cortisone shot or just sent me to therapy. And I didn't feel like I was heard. And I saw that time and time again. And I saw that happen also to, you know, family members and friends. And I was like, this is not the right way to practice orthopedic medicine. There's gotta be a better way. And so that's really when we kind of find the regenerative medicine helps out with that.

What year was this?

So this was 2012. Wow.

So 12 years ago. Yeah, 10, 11 years ago. This was really in the infancy of regenerative. How did you discover regenerative? How did you get exposed to it?

Yeah, so, you know, my kind of story is in med school, I fell in love with orthopedics. Yeah, my third year as a med student, it's the middle of the night. And motor vehicle accident comes in, pelvic fracture. I'm in the OR with the orthopedic surgeon. It's 4 in the morning. He looks at me, he hands me a drill, and he's like, here, I want you to screw this right into this guy's pelvis. And I'm like, this is cool.

Right. See, see, in marketing, in marketing, or so my, my version of this would be bartending, right? It would be like, okay, make this guy a gin and tonic. But that's, you know, Screw this guy's pelvis. Nice.

Yeah.

Okay.

So that's— that opened my eyes up that I kind of fell in love with orthopedics. You know, my internship was a surgery internship. And then, you know, when you're in medical school and when you're in kind of residency or internship, you just keep your head down, you do the work, and you don't think about anything else. You just know that this is A gauntlet that you have to get through. So you just take things day by day. So I went from working 100 hours a week— this is before they instituted the 80-hour work week in residencies— to working 40 hours a week for the Navy. And I was just like, what is all this free time? What is this tension that was lifted off of my shoulders? Like, you know, and you actually— You're like, there's something other than living in a hospital. Right. You know, it was this awakening, right? And my Type A go-getter personality was so bored, I ended up getting a second job at Patient First because, you know, I'm used to working 80 to 100 hours. I'm only working 40 hours in the Navy. I got all this free time. I needed to do something with myself, right?

God forbid we should like go for a walk, you know, work out or anything like that. Let's go, let's go see more patients.

Exactly.

Oh my God, that's great.

And, you know, the goal was still, all right, finish up these 4 years in the Navy, go back and apply to orthopedic surgery. And literally, I had my application in my 4th year in the Navy for orthopedic surgery. And I decided to go to this course called the Advanced Team Physician Course. They still do it to this day. It's every year in December. And I go down to this course and, you know, with the intent mindset of just really talking to all the different docs that are there. And it's a unique course because it has you know, primary care sports guys, physiatrists sports, and it has orthopedic surgeons. And I find the guys that, you know, had a little more gray hair, they're in their kind of 50s, 60s, in the twilight of their career. And I talked to, you know, it's a small sample size, you know, and of 4 orthopedic surgeons and of 4 family practice sports medicine docs. But all the ortho guys didn't seem happy in the twilight of their career. You know, they were on their third marriage.

Really?

They were like, there's no halftime in between, you know, part-time surgery. If you're gonna operate, you've gotta go up. Wake up early in the morning, you got to round on your patients, you got to do this. You know, there's no kind of, you know, easing out of that. And all the primary care sports guys seemed so happy. And I was just like, there's something, something's going on here. Somebody's trying to tell me something, right?

Mm-hmm.

So this is, okay, this is also the year that Tiger Woods got PRP for his knee. This is also the same year Hines Ward got PRP for his knee 3 weeks before the Super Bowl and ended up being the Super Bowl MVP. And so I'm looking at all these things, I'm like, I think that this is the future of orthopedic medicine. So I did some soul searching, did some praying, you know, kind of came up with and said, you know what, screw this. I'm pulling all my orthopedic applications. It's too late to apply for primary care for sports medicine fellowship because the applications are already in. So I call all the primary care locations that are in the DC area because I promised my wife I'd get her back up to DC. And so happens that one of them picks up the phone in Baltimore and they said, hey, Hey, you're off cycle. You don't have to apply the regular route. Come on in and let's talk. So I go in for an interview and she literally has a picture of a Navy admiral on her desk. She goes, that's my daddy. She has a picture of a Navy captain on her wall. She goes, that's my brother. I grew up in a Navy family being taken care of physicians just like you. What do I have to do to get you into my program?

Wow.

And I'm like, God, this is just like it was meant to be. And then I turn and look at her in her eye and I say, I just have to rewrite your curriculum. She's like, what?

Pretty ballsy.

Yes. And I was like, look, the reason why I'm doing this is I want to get into a great sports medicine fellowship. All of your electives are in the 3rd year. That's too late. I need them in the 2nd year. If I can rewrite your curriculum, get them in the 2nd year, I think I can get the fellowship I really want.

What was that response?

She looked at me, you know, like you said, you know, she's like, this guy got set balls on him. But she said, if you write it up and it makes sense, I'll make it work. And that's how we created our sports medicine fellowship curriculum for kind of Franklin Square in Baltimore.

Wow. Trailblazer at an early age, my man. Way to go.

Well, it's, you know, you have to know what you want. And when you know what you want, you can create a path to get there.

All right. So you have today, you have these, you have 8 practices, which we'll talk about that journey. A little bit more here in just a minute, but I wanna, I, I need to ask you, I think, which is a, well, I think it kind of sets up the conversation we're gonna have. So the, here's the question for you. When did you start realizing that having an understanding of business was going to be a key component for your success?

I think that that's a, a, a great question. And so as we go back, And so the practice was founded by 3 of us. It was myself, David Wang, and Victor Ibrahim, who has since passed, unfortunately. Victor was really the visionary as we initially started to kind of put the practice together. And he was like, hey guys, let's get together. We all have skills that we can grow and we can do this. And, you know, personally, I came from working with an orthopedic surgeon group where I was looking at his skills and I'm like, if he can do it, I can do it.

Yeah.

And, you know, we really kind of had that mindset. And it wasn't until, you know, we just said, hey, let's put things together. Let's see, you know, we had a rough idea of how businesses ran. And, you know, we said this, it was really a mom-and-pop shop. It wasn't until when Victor passed and I took over as the managing partner, I realized that, okay, I can't play at this anymore. I have to educate myself, do the work to really become an entrepreneur, understand business. Otherwise, this thing can fail.

Right.

And that's really what I really became the managing partner. That's really when I was like, okay, this is not a game anymore. Everybody's looking for me to make the right decisions in order to grow this organization. We have a pretty unified vision of taking regenerative orthopedics nationally. We have a really good vision of saying, we know what's the proper way to do this using musculoskeletal ultrasound, using evidence-based, you know, literature to kind of guide our decision-making. And we want to make sure that we protect this and not abuse it as we've seen some chiropractors or bad actors where the FDA is going to come and take regenerative medicine away because people are doing it as a cash grab. And so, you know, this was kind of some of the mission and vision. And as we all had that as a unified goal, we had to say, okay, how do I train myself in order to get us to this goal?

So what year was this?

I took over managing partner in 2016, 2017.

Okay. And you had been open how long at that point?

We opened up 2014. So after 3 years.

After 3 years, still had just one location or did you have multiple locations?

We had 3 locations at that time. So, okay, initially we started off with one location and 3 partners. After 2 years, we opened up the second location in North Bethesda. So that was kind of like my location. And just kind of, you know, bring that up as a, that was my baby and I wanted to grow that and expand and get that busy. And the third location was Dave's location in Virginia. And we're like, all right, 3 partners, each of us own a location, make sure that we bring in a new doctor, train them up, and then pass our patients down to that doctor so they can get busy. And realizing that it's not, it's, you have to think of bigger than yourself. If you can build a team, that's how you can continue to grow. And these aren't my patients, these are our patients. And having that mindset, which is difficult for some doctors to do, especially in a private practice when it's an eat-what-you-kill model.

Yeah, you just, you made some, you just made a statement that is, I want everybody to latch onto. They're not, they're our patients, not your own, not your patients, right? Because they're coming, it's the brand of Rossum, right? That's the, that's why the patient is coming. Okay, so it's 2017, you become general managing partner. Now you have to learn business. Did you have any business experience at all? Did you have like a lemonade stand as a kid growing up or a car wash business on the side? Any business experience?

No. You know, I had a job since I was 16, but I was always employed, right? And, you know, I never, you know, had my own thing and this was the first time having my own thing. And so, you know, what'd you do?

Like, okay, so now you're general managing partner, you signed some documents, do you go, Fuck, now what? Like, what do you— what happens? What's your— how did you— let's talk about that learning journey.

Yeah, so, you know, number one, it started us off with mentors, right? You know, so we had an accountant who's a very smart businessman, and, you know, he's been in accounting business for over 30-plus years. He would help, he would guide us, and, you know, give us good information. I would start with kind of reading books on, you know, leadership, books on organizations, Books on entrepreneurship, putting that together, having a good COO that would have my back and been in multiple different businesses and kind of guide us on different ways to work this. And then taking a step back and looking at your organization and trying to figure out where your biggest holes are. And at that time in our organization, our biggest holes were culture.

Mm-hmm.

And we had set up a culture of, If you serve your master, you were untouchable. Meaning—

Well, yeah, what does that mean?

Our staff, if they took care of their doctor, they could be a terror or a cancer to everyone else in the organization because their doctor was going to protect them. Oh, and, you know, the doctors didn't see that. They just knew that this one person makes my life easier. And so I wanna reward them, but they weren't seeing what that person was doing to the rest of the organization.

Got it. Got it.

So I brought in an HR consultant that helped me kind of see that and see that that's what was one of the things that was stagnating our, our growth is that we had cancers in the organization. We had to remove some of those cancers.

And I bet some of those cancers had been with you from day one, right?

Yeah.

And you really thought that they were like all in, but they were, Not— I mean, what was it like to let those people go?

It was tough. It was very tough because, you know, you're like, hey, they were with us from day one. They've always been there. They've always supported me. But what I wasn't seeing is what they were doing to the morale around everyone else, how they would stifle the growth of other people for fear of making them look bad or somebody else getting more attention or someone else being more important to you than them. Yeah.

All right. Okay. So you met, you just mentioned a whole lot in that very short 3-minute window that I wanna unpack more. So let's talk about these books. What were some of the books that you read that were the most influential that really kind of helped you broaden your horizons and expand your thinking?

So I think that, you know, as we go through some of those books, a big one is Good to Great by Jim Collins.

Yeah. Great book.

Oh my gosh. And so he goes through it, all of the top businesses, and breaks down, you know, who are their leaders and what are the attributes that these leaders give to these organizations. And, you know, it's a very high bar to kind of aspire to, but it gives you, okay, these are things in ways that I need to act in order to kind of grow and expand.

What were some of those things? What were some of those things you needed to do to grow and expand?

I think that when we kind of, you know, look at the, Leadership, it's that your job as the leader, as the CEO, as the managing partner, is not to handle all of the day-to-day fires.

No.

Your job is not to make all of the decisions. Your job is really to have that 30,000-foot view, look down to say, okay, what are the 3 biggest things that will affect the business that if I look at In 12 months, we've done these 3 things. We are, we are successful for the year.

Okay.

And focus on those 3 things every day with those 3 things in mind and hire other people to handle the other things and be able to give them the autonomy and responsibility for managing those things. So you don't have to, you can keep your eye on the prize of those major 3 things that'll keep your company successful.

How hard was that at the beginning for you to do that?

It's extremely hard. You're used to having your finger on the pulse. You're used to making every decision. You want everybody to run everything by you and to give up the reins for that. That's a tough thing. But as you do it, it gives you a sense of freedom and it allows you to focus on the things that are most important.

Yeah.

Yeah.

It's so funny because at the time that we're recording this last week, We had our end of the year planning meeting, right? Here's what we're gonna be. This is what, you know, this is our vision for '24 going into '25. And it was so funny because I just hired a director of operations and it was literally her first day, right? I'm like, look, you're really technically not supposed to start until January, but why don't you wanna come in? She's like, yeah, you bet.

Right?

And of course now she started right away. She's done working at another job. She's like, I'm done. I'm gonna go do this thing. But literally at about 10:30, after I get done casting the vision, I look at her and I look at the team and I go, here you go, Catherine, here's the marker. You're in charge of the meeting. And I left. I was there with Atiba because, you know, Atiba, he's on my board. And after about 45 minutes, I look at him and I go, what are we doing here? He goes, nothing. Let's go get lunch. So we went out, got lunch, brought lunch back for everybody else, hung out for like 30 minutes. I'm like, we're gonna go now. So, but yeah, that's like really, really hard though, right, John? Like to give up that control.

Yeah.

Like, aren't you afraid of missing something? Like, what happens if something misses? How do you feel about it?

Yeah, well, I mean, you know, then it's, you have to have a reasonable meeting cadence, right? You're gonna meet with people on a regular basis to see, okay, what's going on? I talk to my COO every day, except he may give me a break on Saturday. We usually even touch base on Sunday. So it's, you always kind of know what's going on, but you also have to be able to kind of give them the authority to kind of make some decisions on their own. And you don't, 'cause if you don't give them that authority, then they feel hamstrung, right? You know, it's like, all right, I don't have the power to fire this person, or I don't have the power to enforce this. I always have to run back to mommy or daddy. And that's not a way to run an organization. That hamstrings them, and they kind of look like they're built up, then they don't have any authority. So you have to give them that autonomy and give them that authority to make those decisions. You have to have the trust that they can do that.

So Colin has the right to let people go without Does he run it by you? I mean, what if he wants to— what if you have a doctor, a provider that's not up to speed? How does that model work?

Yeah, so I think, you know, these are things that I don't think he would make that decision on his own without me. But, you know, he has to have the ability to, if he has to enforce something, to say that, yeah, I'm gonna dock your pay. Or, you know, if it's under the level of a physician that, hey, somebody did something that's so egregious, You're fired on the spot. He has to have the ability to do that. Now, these are things that, you know, we don't like to make rash decisions. We always wanna say, hey, let's come back and let's meet as a team. And, you know, we'll bring in HR, we'll bring in Colin, we'll bring myself in and say, hey, okay, what's going on? What's the situation? Have we done an investigation? All right, is this egregious enough to let someone go? Okay. And if it is and we make that decision, uh, how do we do this in an intelligent way and make sure that we're not gonna get sued on the back end? You know, so.

Well, there is that. Right? Yeah, there's the whole darn lawsuit thing. Yeah, because that happens a lot. Yeah. So that's, that's fascinating. Okay, so Good to Great. What was another book that you read that has been transformational for you in your growth?

Another one is by Jocko, and I'm forgetting his last name.

Jocko Willink.

Yes. And, you know, it's Extreme Ownership. And, you know, former Navy SEAL and just talking about owning everything. And so as a leader, you have to realize that when you win, you pass down those wins down to your team. When you lose, you have to take responsibility and ownership of that. And that's in sports, in business, in life, that's the way. And so you give your team all the accolades when things go well. When things go wrong, you take responsibility. And that's how you can kind of make sure that you own things and things can kind of move forward.

When you started in 2014, right? That's when the clinic opened. Wow, we both opened our clinics in the same year. But when you started in 2014, so the— was the vision just to have 3 locations or was the vision what it is today?

No, even back then we, we knew that now was a perfect opportunity to grow. So, you know, we kind of felt like Bill Gates in the '80s. Like, we got regenerative medicine at the right time. We got it in its infancy and we had 3 kind of experts leading this field, you know, and we could build around this and turn this into a national thing. So we knew that we had something special and we knew that the world just didn't know yet. And it still doesn't know yet. Most people don't know that, you know, there are other opportunities or other options besides cortisone, PT, and surgery. And once that gets out there and they realize that, We actually have more data for that than the 10 most common orthopedic surgeries that are performed. It's gonna change the way people think about it. So that's always been the growth is that, hey, it's an opportunity to take this at least nationally, if not internationally.

Yeah, that is, I would agree with you. I think this stage that we're in, especially in the regenerative space, I would, yeah, I agree with you. This is kind of like we're just at the stage where maybe Windows is going to get released. Remember when Windows, like, transformed the way that we used computers. I kind of feel like we're right there now because I also think that like less than 10% of the population even knows about regenerative. What do you think? What percentage of Americans know about this option of regenerative medicine?

Yes, I think somewhere between 10% to 20% is a reasonable number. You know, I think a lot of people have heard of PRP just because if you're a sports fan, you hear that, you know, some of the athletes get it. People loosely kind of know stem cells, but they don't know what that means. You know, is that coming from a baby? Do I have to go overseas to get stem themselves? Can you even doce themselves in America? These are questions that people kind of loosely know about, but really don't understand what it means.

Mm-hmm.

Yeah. So the more we can get education out there, let people kind of know, hey, these are things that are evidence-based, that are beneficial, that are helpful, and these are the type of people that will do it correctly.

Yeah.

I think that that will really start to explode things.

Do you get a lot of pushback from orthopedic surgeons still today? Do they kind of poo-poo you or badmouth what you all are doing?

Yes. So less in person, but we still hear it through patients, right? It's like, yeah, I went to my surgeon. They said, that's hogwash. That's not going to work. Or, you know, oh, fine. Here, I'll do it for $500 and I'll show you it won't work. Like, never get an injection from somebody who says, here, I'll do it for you to show you that it won't.

Show it doesn't work.

Yeah. Yeah.

Because they don't even know what platelet count is and why it's important, right?

Yeah.

Oh, let's look, we'll spin, we'll just spin it down, you know, whatever, we'll be okay. What is the biggest challenge that you have faced in this business growth?

Yeah, so I think that, you know, if we go back 10 years, it's that we didn't have the data. So, you know, we kind of had a target behind our back. And so, well, here's this stuff out there that you can use. We're getting really good results. There's some early studies that show it's beneficial, but, you know, it's growing, the field's growing, the field's growing. And then now it's 10 years later and now we got level 1 evidence to show it's helpful in osteoarthritis. Level 1 evidence to show it's helpful in lateral epicondylitis, Achilles tendinopathy, glute tendinopathy, low back pain. We have really good studies to show that this is beneficial, that we can take people that have grade 3 and even grade 4 osteoarthritis and put stem cells from their fat in there and give them less pain, better range of motion, better function. We have data showing all of these things now. And so now I'm not kind of cowering behind, you know, the closed doors and saying, hey, we can try this stuff. I'm actually on national TV or, you know, local news talking about it because I have the data to back it up.

Yeah, that's so powerful. I mean, I think any particular database that you use more to put your— so are you posting all of your results? Are you going into like a DataBiologics or is there someone else that you use to get that evidence? What tools do you use?

Well, so, you know, one, we have research that's been published through PubMed that is out there that anybody can pull up, right?

Yep.

And this is research that's international from Europe to America and above. So that's kind of step one, that we publish that in a research diary. 2 is we collect our data. And right now we are using 2 different systems and figuring out, you know, which one we want to go with to kind of collect our data. And so we also have cell counters that allow us to verify kind of our cell count of our platelets and make sure that we're getting good optimal treatments for patients. And if somebody didn't get a good outcome, was it because their platelet count was low? Or, you know, what's going on in that?

So are you checking platelet count on every single patient? You're just running it through the counter?

At one location, we're trying to, you know, every single patient. That's huge. We're just trying to— the data is so important. And so as we collect more and more of this data, it really helps to shape the field. Yeah.

And that's the I think that, you know, the data that we now have available today, I look at everything through a marketing lens, right? Because that's my, that's my training. And I look at the data and I go, wow, we could really make some pretty compelling arguments from a marketing standpoint and from an education standpoint to help transition the patients. Speaking of patients, do you still see patients today?

I do. Really?

You're the CEO of 8 locations and you still see patients?

Yeah.

Wow.

So it's still a passion. It's still fun. And so I have med students come through. We have residents come through. I even have my niece who's a high school senior interning with me. And it's an amazing feeling when you go in there and, you know, they're talking to the student, your patient's talking to the student like, hey, you're with a great doc. You know, he changed my life. He got me out of pain. I'm now able to do things that I wasn't able to do. And that's— it's a drug. Like, you know, that feeling of going in and knowing that you're helping people every single day is extremely powerful.

Okay.

But I also remember working in the Navy, and I was at Patient First, and it was a 50-year-old Navy captain. And I said, hey, sir, I know you're probably happy to actually be in here. You're actually seeing patients again. Yeah, because, you know, when the Navy, as a captain, you're not seeing any patients. He looked at me and he goes, son, when I make a decision in the Navy, it affects 100,000 sailors. And that always stuck with me. And so that's also why I love the fact of making decisions on 8 different locations that's going to affect thousands of patients. And although you'd love kind of doing the day-to-day work, when you have scale, when you have mass and you make decisions, You're now providing care to thousands. And I think that that makes a bigger impact. And, you know, I always kind of have that in the back of my mind.

Yeah, I think, well, you know, one of the big challenges we hear from people is, well, I don't want to stop seeing patients. And my answer is, well, then don't. Right? I agree because you have to, as a business owner, I love being as close to my clients as I possibly can. Like, I just got back from Las Vegas. I was at A4M. All I did was just walk the hallways and pretend and just act as a frontline doctor, even though I'm not one. But just, I try to stay as close to that experience as I possibly can because I think it makes me a better leader. Do you find that's the same deal with you by staying so close to it?

Yeah, I mean, you know, you have to have your finger on the pulse. And if there are frustrations, if there are issues, patients don't have a problem telling me, you know, hey, I had an issue calling the front desk and I couldn't get through, or they put me on hold. We had a really long wait time over the last 2 times that I've been here. I'm not really happy about that, right? And if you're just sitting in your back room and, you know, just looking at, you know, things from that 30,000-foot view, you don't ever get, you know, down into the ground level, you're gonna miss these things. And what made your organization so special and to give so much growth just from word of mouth, you end up losing some of that feel and you won't know about it unless you have other ways of getting that information. And we do have other ways of getting that information. We send out reviews to pretty much a third of all of our patients, and it's at random. And so it gives them a great place to give us feedback and feedback that we can implement and act on. And it also allows them then, if they had a great experience, to then continue to publish it onto Google and kind of, you know, boost the Google ratings. But for us, that helps quality assurance that they're having a good experience with us.

Do you go to all the locations on a regular rotation? How does that work?

Yeah, so one, yes, but not as much as my COO Colin does. And so we task him and his team to get out to the different locations on a more frequent basis. And so usually one of his team members is out at one of the different locations at least once a week. With me, it's more like, all right, once a month we're going to get out to different locations and kind of check in. Kind of have people see my face and give them a chance to complain, congratulate, but, you know, speak to me and get a chance to get some feedback from kind of boots on the ground.

I always find that they put their best foot forward when that happens. So you don't really get a chance to see. How do you and Colin, because I know Colin has, he has his team, operations team, but how do you really, really get that sense and that pulse? Because it's easy at your location, right? You're there. People are probably going to know you a little bit more. They're not going to be kissing your ass as much. They're going to probably be a little bit more open with you. But let's say you go to whatever location. Let's say you're out at the new one in Lansdowne or wherever it is. Loudoun. I'm sorry, Loudoun is where you put it. How do you make sure that they're not just telling you what you want to hear and giving you and feeding you a line of crap?

Oh no, of course they're going to tell me what I want to hear.

You know, so you just don't believe it, right? You just believe that they're bullshitting you.

Exactly. But I have 2 amazing women that are my practice managers. So Manuka has DC and Virginia. Janelle has the Maryland corridor. And so they were medical assistants for a very long time that rose up through the ranks and now are kind of our practice kind of leads. And so they have their finger on the pulse and they help manage the team. And they give us feedback when there's mumbling, when there's grumblings, where people are upset about certain things. And so that's really kind of where I get my finger on the pulse from, is hearing from them if there's issues that are starting to arise.

Are all your managers, are they homegrown? Meaning, did they, did they come up through the system?

So, yep. So those 2 came up through the system, and then I have an HR consultant that works with them on their managerial skills. So giving them, all right, in this situation, here's what I want you to do. Here's how I want you to document this. Here's how I want you to put this information back out. And so they almost have a personal coach that helps them coach up going from peer to supervisor, which is always a very tough jump to make.

Yeah, that's really hard. But I would tell you the growing from the in-house, I find that it, it helps really root the culture down in because at the end of the day, the culture Is what's— is what helps this grow and helps it sustain its growth. How do you keep the culture intact?

Yeah, making decisions based on your core values, which is very difficult to always hold on to those. And when you don't, sometimes it comes back and bites you in the butt. And so knowing who you are as a business, making those core values around not just aspirational values, but really values that you live, breathe, And do, because you need to hire, you need to fire, you need to make all those decisions with those core values in mind.

Mm-hmm. All right, so let's talk about that, these core values. How did you develop these core values? Have they changed over time? What do they look like today?

Yeah, so it was a process. And, you know, we brought in consultants to help us go through the core values. And I think that they probably went through about 3 different iterations for us to come to the ones that we kind of have now. And it changed as the leaders in the organization changed too, right? As you add in more partners and as the organization grows and you have to look at all of the people that you've hired and say, do these people really fit these kind of core values or did we bend this one a little bit to make this person fit? We used to have what we kind of say is when we hire people, specifically physicians, we used to say we had a no asshole rule, right?

It's good, by the way, good rule to have. Especially when dealing with physicians. You should try working with them.

As you've bent that rule, you know, here or there, you have to kind of look and say, are we really living up to our core values? Are these the right core values for us? And if we didn't live up to that, are these the core values that we want to be? And really kind of knowing what you are as an organization and kind of tailor it towards the way that you feel and how you want that organization to run.

Is there a core value that Is really kind of the, the core value? If you were to sum up when somebody is saying, what's it like to work at Rossum? Is there a core value that you would say is the overriding one?

I think the overriding one is to provide world-class care.

So it's not about the money, right? It's not about the money.

No.

Because I think a lot of doctors are like, oh my gosh, I'm going to have to sacrifice patient care. So you're not sacrificing patient care at all.

No. Yeah. Our number one core value is to provide world-class care. The second one under that is act with integrity. And so, you know, we want people really to do the right thing by the patient. And that might be telling them that what they need is a stem cell procedure. It might be telling them that there's nothing we can do for you. And don't waste your time spending money on a PRP when you actually need surgery, right? And sometimes it's just telling them, hey, you haven't even done physical therapy. Come back and see if you get better with that before we do anything. So it's using the evidence to make the right decisions, having the integrity, especially in a space that can be cash-based, that you're doing the right thing and you're not just doing injections to make money.

Yeah, that's a big, that's a big, big thing because there's a, there's a lot of bad actors out there that will just basically do a BS exam and then throw in the closer to make them pay $8,000, $15,000, $20,000. I don't have an issue charging $8,000, $10,000, $15,000, $20,000. Provided it's in the best interest of the patient. Everything has to be, and what we teach, everything has to be, it's, let's not forget, the number one issue is it's got to be in the best interest of the patient. And I love that. If they're not ready, send them to PT. Now, do you take any insurance at all? How do you, let's talk about this because I think this is another big thing for doctors to struggle with. Insurance is still part of the picture. How is it part of the picture? How do you handle patients when they say, is this covered by insurance? Let's talk a little bit about that.

Well, you know, our goal is still growth as far as the organization, right? You know, year over year, we're growing approximately 15% to 20%. We're adding new doctors, we're adding new locations. And so with growth, which can be expensive, we decided to stay in insurance. And the reason why is we want no barrier for people to come in and get information. So—

That's brilliant. It's a great move, by the way.

Yeah. So all you have to do is pay your copay and you can come in. You'll get a good history, a great physical exam, a great ultrasound exam, and we'll lay out all the different options for you. And if you can afford these options and it makes sense for you, great. If you can't afford the option, no harm, no foul. All you did was pay a copay and you can still go back down the classical cortisone surgery route.

Are you still doing like cortisone or OA or anything like that, or is it all After they do the insurance visit, is it just purely presenting cash options to them?

Yeah, so there's certain things that we might do that will be covered under insurance. Hydrodissections, nerve blocks, you know, those are covered by insurance. We do a little bit of HA. It's not a big part because it doesn't seem to be disease modifying. And, you know, so it's palliative. And if you want it done, sure. Or a lot of times we'll even mix it with the regenerative. So here's something palliative that will kick in quickly, but we know that Adding PRP to it will give it a longer benefit and can actually be disease-modifying. So.

Are you doing any prolo as well?

We are. We actually do a ton of prolotherapy. We find that there's certain areas that prolotherapy really just performs very well. One of it is chronic low back pain. And, you know, when we look at chronic low back pain, we think that there are so many ligamentous structures back and around the SI joint, around L4-L5, that are so weak That when we do a comprehensive prolotherapy, you are building up the foundation to hold that low back in place.

Yeah.

And we do that first before we jump to an intradiscal or PRP epidural. We actually find that when we do this comprehensive, you know, lumbar prolotherapy, plus or minus a caudal epidural, we can get a significant amount of low back pain patients better.

Really? Wow. Okay. Geez, during golf season, I'm gonna have to come see you because, you know, that just takes a beating on the lower back, as you can imagine. All right, so, so insurance— so you're really just using it for lead gen. What percent of your treatment protocols would you say is insurance-based?

I think that we are currently 60/40. 60% is cash, 40% is insurance.

Um, and do you— are you handling all your own billing in-house? You have a third party that handles it? Because, you know, even at 40%, that's still a nightmare. That's a ton of freaking overhead.

Yeah, so we use Athena, which is, you know, lackluster at best at billing. So we have a third-party billing—

Lackluster at best. That is the quote of the day, by the way. Athena is lackluster at best. That's very politically correctly done to anybody listening from Athena.

Yeah.

But their campus is gorgeous and their bonuses are fantastic. So go ahead.

Yeah.

Yeah.

So, you know, I, I would never, you know, trust them solely to do all of my billing. Yeah. It's just, it's just, you know, it's the, the things that go through smoothly, great. They go through smoothly, but there's a lot that gets kicked back. There's a lot that gets denied. And like, literally, we just dropped UnitedHealthcare because they just decided not to pay.

Yeah, because they suck.

Great business model. What a great business model.

We're gonna collect all this money, but we're not gonna pay any of it. That's why we're so profitable.

Exactly.

Yeah, it's a great freaking business model. If I had, if I had $20 for every doctor of mine that says we just dumped UnitedHealthcare in the last month, I'd be a rich man.

And it was nuts because, you know, we hired a guy to actually negotiate with them and he negotiated like an increase in reimbursement by about 20%. But then we were like, but hold on, we're not getting paid. And they're like, oh, well, that's not our side. That's the Optum side. You gotta work that with that. So who cares if you got an increase of 20% if they don't pay you?

Oh my God. Oh my God.

I—

this is the business model I wanna have in my next life is I wanna have a business model where I can collect money and it doesn't matter how I treat my customers and I can keep all the funds. That's what I wanna do. That's the next business model I wanna create. Oh my God, it is such a train wreck. All right, I know we only got a few minutes left. Let's talk about the future of medicine. What would you tell— first and foremost, what would you tell your younger self in med school knowing what you now know?

It's a great question. You know, I think that, you look, you know, I think everything happened for a reason. I would tell myself always to be open-minded, all right, and look at all the different options that are out there. Set your goals Because once you have your goals, you can always work backwards in order to put together the plan to get you to those goals. And never be afraid to trust your gut because a lot of times it's not going to steer you wrong.

Yeah. Yeah. What do you think is going to happen in medicine in the next 5 years? If you were to put your, let's get our crystal ball out. What do you think? Where do you think's hap— what's going on with medicine in this country and where's it going to be in 5 years?

It's a big question, huh? We're talking about specifically orthopedic regenerative medicine or medicine just in general?

Let's just start, let's stay in our lane. Let's just talk orthopedic.

And regen.

Orthopedic and regen. Yeah.

Yeah. So I think that, you know, it's going to do a couple of things. You're going to find that more orthopedics, specifically regen orthopedics, is going to become more cash pay. It's going to be a little bit of a tale of the haves and the have-nots. And as we're seeing a lot of longevity medicine increase and people are trying to figure out how to optimize their life, optimize their health, live longer, healthier lives. More and more people are going to be doing regenerative medicine because we can find that it's disease modifying. It's a non-invasive way of maintaining your health, maintaining your activity level, and keeping people going. And then we're going to see the change of all of the companies now that will create allogeneic stem cells. That can come out of a can, canister, freezer that we're going to start using. And so we're going to start getting FDA approval, and then big pharma is going to come in. And now we're going to get these stem cells kind of covered by where you can pull something off of a shelf. And so that's really where, you know, it's going to go from taking your own bone marrow and taking your own fat to, oh, this is FDA approved specifically for this indication. And now we have a third-party allogeneic stem cell that I can get out of a bottle and then inject into people. And so I think that you start seeing that in about 5 years.

But in that case, then the insurance companies are back in control and then we lose control of pricing, right? So that's not necessarily a good business model, is it?

No. And, you know, the— go back and look at history. It's probably looking at when epidurals first came out and people were making a killing doing these epidurals. And then all of a sudden the reimbursement dropped. And then now everybody went from doing epidurals on the right people and doing them at a slower rate to, all right, how many epidurals can we fit in a day? And just turn into a needle jockey and just injection, injection, injection, injection. And so that's what I hope doesn't happen. But yeah, you know, if we look at history, that's happened in the past.

Yeah, they're always going to figure out a way to, you know, the, the problem that the insurance companies have with medicine is they have to use doctors. And if they could figure out a way to get rid of the doctors, I think they would, right? I mean, that's a pretty broad-reaching statement, but if I think about this from a business model standpoint, the constraint for the insurance provider is the doctor, right? If they could just— because God forbid the doctor should speak up for the patient. Let's just, you know, or what's in the best interest of the patient. And, you know, you said something that I didn't touch on, but you also have expanded and gone— you've like gone to Wharton, Weekend, like they do like those week-long business school things. Haven't you gone to like Wharton and Harvard and all of those places for, to expand your business knowledge?

Yeah. So, you know, another book I didn't talk about is a book called Scaling Up. Oh, Vern's great.

Have you ever met him, by the way? Have you ever met Vern Harnish?

I have. Yeah. What a great guy. Yeah. And so that's a great book on people that really want to kind of scale their business and it gives you kind of a blueprint on how to do that. I've joined the Entrepreneur Organization. So this is a worldwide organization of entrepreneurs. And so with that organization, they have a lot of different events where you can meet people like Vern Harnish. They also have events at Wharton at Harvard Business School where you work on finance, you work on operations. They help to kind of teach you things and give you that different business mindset. And, you know, you get to be in a forum, which is a group of 6 to 10 local entrepreneurs and talk about issues that CEOs face managing their business. And people will do different experience shares. on how they got through different situations that were similar to yours.

Yeah, the mentorship. I can't imagine— I've had mentors, I've been in masterminds, these kind of groups for since 2003, and I can't imagine not being in them. I mean, I mean, if you look at my advisory board and the person I just hired from the director of ops, they all came from this group that I'm in. Every single one of them. I mean, they speak the language. So, well, John, I know you gotta run and I gotta run as well, but any final thoughts or comments for anybody that is listening to this? Any bits, final bits of wisdom and words of advice that you'd share with them?

You know, I think that this is something that can be done. You know, anybody who's gone through medical school, they're a physician, they obviously have the, you know, mental capacity to kind of run their own business. And it's literally making that mindset change that this is a business and this is not just a practice anymore. And being willing to invest the time and learning on how to run a business and think business-mindedly, which is different than just caring for the patient. And, you know, being able to put on 2 different hats as you kind of go back and forth. And that's a hard thing to kind of do is to switch one on and one off. But that's really the step that you have to make in order to kind of be successful in your own practice.

Yeah, I always tell them, look, if I can learn and understand medicine, you can easily learn and understand business. Because understanding medicine for me, for most people, it's a lot harder. Businesses, to me, it's a lot easier, but I understand the challenge. So, well, John, thanks for taking the time. I know you're a busy guy and I know you don't, probably don't want to give out your personal information, but if people wanted to learn more about you, where do they go? What's the best places for them to stalk you online?

Yeah, the website, Regenerative Orthopedics and Sports Medicine, or rosm.org. We have Instagram links. We have YouTube links. All those pages are up on that area there. You can email me on the info link there and all that gets to me too. So that's an easy way to kind of get to me.

And you're like at every regenerative orthobiologics event known to mankind, right?

I've gone to a number of them.

Yes. Yes.

Yeah.

If you're going to be one of those events, you're probably going to find John and I somewhere in the back of the room laughing and telling stories. So thanks, John, for taking the time. I appreciate it. Look, follow John's journey. This can be you as well. It doesn't have to be AIDS. It doesn't have to be worldwide, but The process, the path is laid, folks. So it's out there for you. Take advantage of it. Thanks, everyone.

All right. Thank you.