The Scope of Practice Podcast

5 Things that will Make or Break your Medical Business - Dr. John Shufeldt

• Brent Lacey • Episode 89

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Episode 89 - Our guest today has been a serial entrepreneur for decades and has built many businesses from the ground up, including a series of urgent care centers that he started before urgent care centers were even considered a valid concept. He has written a great book on the subject of entrepreneurship, incorporating all the many lessons learned during his time as an entrepreneur, and I’m excited to share his tips with you so you can grow your own business over the next year. Hopefully, with these suggestions, 2022 will be your best year ever.

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Meet Dr. John Shufeldt

John Shufeldt has nearly three decades of experience leading high performing teams and being a thought leader and agent of change in the delivery of healthcare, entrepreneurism and leadership.

John received his BA from Drake University in 1982 and his MD from the University of Health Sciences/ The Chicago Medical School in 1986. He completed his Emergency Medicine Residency at Christ Hospital and Medical Center in 1989 where he spent his final year as Chief Resident. John received his MBA in 1995, and his Juris Doctorate in 2005, both from Arizona State University. He is admitted to the State Bar in Arizona, the Federal District Court and Supreme Court of the United States. His certifications include Fellow, American Board of Emergency Medicine, College of Legal Medicine and American College of Emergency Physicians. In 2015, he completed his Six Sigma Black Belt from the Fulton School of Engineering at Arizona State University. In 2019 he completed a certificate program in Artificial Intelligence at MIT’s Sloan School of Management. In 2021 he started his Certified Alternative Investment Certificate from CAIA and a certificate in Entrepreneurism and Innovation from Harvard Business School.

Connect to Dr. John Shufeldt

5 Things That Will Make Or Break Your Medical Business

2021, Brent Lacey And The Scope Of Practice Podcast
The Scope of Practice Podcast


Transcript

[0:00] I've been really impressed with the inspired Creations that I've seen from a lot of our fellow Physicians and Healthcare professionals during the pandemic
as they say necessity is the mother of invention
well there have been a lot of incredible businesses that have been invented or have sprung up in the wake of the covid pandemic and the global economic shutdown
Our Guest today has been a Serial entrepreneur for decades and is built
many businesses from the ground up including a series of urgent care centers that he started before urgent care centers were even a thing and he's written a great book I really a series of books on the subject of Entrepreneurship incorporating all the many lessons learned during his time as an entrepreneur and I'm excited to share his tips with you so that you can grow your own business over the next year hopefully with these suggestions 2022 will be your
best year ever let's kick it it's not.

[0:49] Music.

[0:56] Welcome to the scope of practice podcast where we help busy Healthcare professionals learn to manage their businesses successfully in master their personal finances now here's your host dr. Brent Lacey.

[1:09] Hey y'all thanks so much for joining me for the scope of practice podcast where you can get the knowledge and resources you need to grow your leadership skills your business and your personal finances.
Welcome to episode 89.
If you haven't already subscribe to the podcast please be sure to go ahead and hit that subscribe button right now and also hit the button at the top of the podcast player to turn on the automatic downloads
now what you can listen to these episodes anytime anywhere even if you're in a place that doesn't have good cell phone service also don't forget the podcast is now eligible for category 1 CME credits and it's free,
just click the link in the podcast description or go to www.desktoplearn.com / podcast CME to download your CME credits for free.
My guest today is dr. John shoe field dr. shufelt has nearly three decades of experience leading High performing teams and being a thought leader and Agent of Change in the delivery of healthcare entrepreneurism and Leadership he's been a lifelong student learning,
I can't believe I'm saying this an MD and MBA and even a JD,
I mean it's he's been in school forever he's found in numerous health care and non-healthcare businesses over the course of his career under his leadership.
This is going to blow your mind his Urgent Care Center business Grew From a single Clinic to 60 clinics in Six States with a revenue of nearly 100 million dollars.

[2:29] I mean that should blow your mind,
John has authored and co-authored numerous books on emergency medicine and Entrepreneurship he's got an incredible business mind and I'm excited for him to share that mind with you today
so here is my conversation with dr. John shufelt.
Hey y'all I am super excited to welcome my guest today to the scope of practice podcast he is an emergency medicine physician serial entrepreneur and author of the new book entrepreneur prescription Doctor John shufelt dr. shufelt thanks so much for joining us.

[3:04] Brent thank you so much pleasure to be pleasure be on your show you know it's great to have folks on that are that are really good at.
Multiple aspects of medical business because we talked to a lot of folks that are just in the entrepreneurial space or they're in the business space but and then we talked a lot of folks that are just
Physicians and there's great things to learn from both sides but I love being able to talk to someone who is really
intimately involved in both camps I mean as of you've been an emergency medicine physician for a long time,
but you've also started in grown and sold multiple businesses and so you've got a lot of stuff to teach us both from,
the theory side as well as from the Practical side just based on your personal experience so I'm really excited about this can you give us a little bit of an idea for folks who maybe aren't familiar with your work you didn't start off planning to grow multiple businesses that you're worth
a hundred million dollars or anything right he started out as just an emergency medicine doc so walk us through that journey of starting from
you know just being a basic MDOC and now growing to where you are now.

[4:06] You know it actually is not all that exciting so I thought I'd be an academician my whole life I mean I love practicing emergency medicine I still practice I've got a shift tomorrow at a ship two days ago.
In the middle of covid and I really thought I'd be knocking the mission.
But I moved out to Phoenix and I kept seeing things I thought well gosh that's a weird way to do things I want there's one of those easier way to do this so the first one was urgent care.
So 93 there weren't really any urgent cares around you know now you can't really spit without hitting one but in 93 it was was an out of the you know when I went for the health plans and said hey I'm starting to urgent care they looked at me and said we don't know what that is how is this fit.
But I would see patients in the emergency department who didn't need to be there and you know I went into em2 do sick and critical you know sick patients critically ill or injured patients and you know seen a lot of patients who were spent a lot of money to see me and they didn't need to be.
Just started the first version care 93 and grew that over 17 years to about 60 centers and 100 million little over 100 million in Revenue.

[5:05] Brought in private equity in 2008 and I was out in 2010.

[5:09] But a lot of my entrepreneurial Journey was just seeing a problem thinking of a way to solve it so another example was teleradiology.
So back in the early 2000s you know we're spending a lot of money transporting films all over the place to be read out of these urgent cares.
That's all why don't we do this electronically so I figured out and set up a teleradiology business.
And Contra resolve our own centers but then a lot of other centers around the country.

[5:35] And solve that business about 2013 or 2014 I think when I saw the Advent of AI,
coming into reading plain films of out of now's a good time to get out so it was really just seen a problem
thinking of a way to fix it and then trying to fix it and make it a ton of mistakes along the way
so what gave you the the the courage or the confidence to feel like you can go out and do this I mean especially with that first
Venture trying to create a
an urgent care center when that thing that concept wasn't really a thing yet you know there's a lot of risk there right I mean what happens if you get nothing what happens if you fail I mean what gave you the confidence to feel like this is something that you should do and that you could reasonably achieve,
probably ignorance and so you know I kind of grew up failing and you know I was a,
you know kind of a failure which school through high schools I was kind of used to not doing all that well I played Sports growing up and you know everything from football to taekwondo to basketball through discus and I was okay at some of them and I was horrible at others but it failing never really
bother me the sense I was thought well,
I'll just figure out another way to do it and so for me it was just having to invest 10,000 dollars which was my investment to the first to next gear and just gut it out and you know I work there during the days and in the EDM nights and weekends.
Hired people to work when I couldn't had two other partners we started the first guy dropped out in about two months so I can guy said look I'll do one of these with you but I don't want to do anymore.

[7:04] And I just went from there and triple mortgage my house and I always thought well brawl blows up I can always work I can always earn money
and so I'm sure it'll work out and knock and what it did
well that's awesome I mean that takes a lot of guts and you know tremendous amount of work you're working basically double shifts all the time
to make that kind of thing possible I think that's one of the things that I see a lot with entrepreneurs is that the reason that they don't go into it as either because they just lack the confidence,
they feel like they are not willing to risk failing,
or they don't feel like they can acquire the knowledge and the skill set and they're unwilling to go do it or like you're just saying that you're just not willing to put the work in and you know if you're not willing to put the work in that's okay there's nothing wrong with that you know it's not.
It's not going to be very successful that way but it sounds like that was really the big thing more than anything because you know just was just getting,
getting in there just grinding it out day by day is that right it is I'll tell your listeners this and you know and I'm 100% sincere if I can do it.

[8:09] Anybody can do it and I'm totally sincere and it really just comes down to resilience.

[8:14] In Grid that it's not intelligence you know you want to have a good idea and I had to do it again I would do it a little differently I would go out and come up with the idea to do the business plan.

[8:25] Build a minimum viable product and go out and raise some raise some money I did it with all debt for the first 15 years you know Bank debt triple mortgage my house I was sort of thing.
There's a lot smarter ways to do that I talked about them in the book entrepreneurs are X but that said there is absolutely nothing special about me in the sense that.
You know I literally made every mistake in the book some of them twice many of them totally stupid and ridiculous but knocking what a guy learned along the way and in this development.
More and more confidence as we had some success but there are a lot of failures
well we're going to jump into some of that here in a minute so I really want to see you up to coach us with some great lessons from your book here in a few minutes but speaking of that I want to ask
when you were going on this entrepreneurial journey I guess at the beginning it sounds like you just kind of jumped into it with both feet,
did you have any preparation for a did you read any books on starting a business did you talk to anybody or just decide hey I see a problem and it's going to try this.

[9:27] You know I'm a voracious reader and I had not as I recall read any books it's a time about starting the starting a business now subsequently read a ton of books will back-to-school that all that sort of thing.
But when I went into it and I thought I started this emergency medicine Staffing Company just about less than a year beforehand.
So that time I was managing Staffing three emergency departments for emergency departments and then started this next care company,
which we call the first Arizona family and Urgent Care until I heard a staff member answer the phone thank you for calling off fuck and I thought that's not going to work.
And so if we change the name quickly after that but it was I was doing I'll actually go back to school and got an MBA along the way.
Right with the same years the company started So eventually you went on and you got your MBA and you got a JD did you feel like either or both of those degrees was particularly valuable is that something that you think that.
Entrepreneurs generally should be considering or do you feel like,
at the beginning it's it's okay to be more Scrappy like you were and just kind of jump in start trying to solve a problem get a minimum viable product see how it goes and then expand later.

[10:38] I mean you understand this you know Brent anybody who's gone through Medical School clearly has the resilience and the brains to do something in business if they so desire if they want to put in the work,
what I went back I and I loved getting my MBA do you need to have an MBA to start a business absolutely not there's a lot of books out there you can learn anything online you know and 93 there was really no
there's no Google yet there's not much online
but I've always been very pragmatic when I went back so you got an MBA to the side okay I've got to learn how to do this I was a sociology undergrad major had took no business classes at all I was always kind of entrepreneurial but didn't really know what I was doing.

[11:14] And then for law it was for me why want to learn as much as I can about the loft is going to impact my businesses but I also thought I was just pragmatic and thought you know there's me a day when I don't want us to grind it out in the emergency department again even though I loved it.
But I want to represent physicians in front of medical boards I thought this would be a great career I like Physicians obviously I understand them understand how they think.
And you know we get ourselves in trouble occasionally reppin them representing their in front of medical boards be a great career well that's why I went to law school took the bar pass the bar and started doing that realized I hated it,
you know the the medical boards were kind of Mickey Mouse you know if the client before the person before irritated the boar they take it on your client.
And it was just there was no really rule of law there it seems to be very kind of Hit and Miss as far as what would happen to this position some of them deserve to be gettin smacked around a little bit some of them didn't.

[12:04] I'm not sure I want to do this is a kind of almost a zero sum game so bright now I do contract reviews and
write a lot and speak about it but I don't represent physician in front of medical boards yeah I can see that being super frustrating having done a little bit of that kind of thing myself with you know some depositions and you know writing
medical opinions and legal cases that sort of thing it gets very dry very quickly so if you're into that kind of thing there's a actually a decent living to be made doing that and certainly it's very important work,
you know 97 percent of Physicians get sued at some point in their career so we're all going to need it and we might as well be helping each other out.
Yeah I mean I've done a lot of expert witness work and I still do a little bit of it that actually being the actually be the attorney of record for some of these providers was tough because some of them.

[12:52] You know they were they would get a DUI and you be representing them and said look this is going to
this is going to get a little ugly here and you are going to have to you know take the poison for a period of time and I'm happy to help you but at the end of the day you got on this one
and so some of it was just you know some was kind of sad and rough yeah so I want to dive into the the mind of dr.xu felt and dive into the experience of dr. shufelt here I want to talk about
what you would consider to be top five things that will make or break your medical business so this is coming from 30 years of the school Hard Knocks and just doing this thing grinding it out
and now having literally written the book on the subject would love to know if you know for the folks that are out there that,
they're just out of there just out of training or their five or ten years into practice and thinking about doing something different or they're looking to grow their looking to expand their looking to change let's start with number one was the number one thing that you have seen that will make or break a medical business.

[13:53] Why think before you start you need need to look at yourself in the mirror and say am I up for this because.
Everybody in myself included always underestimates the amount of work it will take to get something up and running I mean it's you know it's like Ray Kroc Center McDonald's you know someone's there is an overnight success he says well 30 years was a long night,
and you know you've heard this quote repeatedly but it's but it's really true so the first is a self-reflection.
And talking to your family are they up for the challenge because you know I would say ideas are easy everybody has them but the execution is where the rubber meets the road so but that's really number one.

[14:30] Number two are you willing to risk some capital and you know some people.

[14:35] Are not there risk-averse and I'm really not risk-averse I mean I wear a helmet while riding bikes and you know I don't do things that are
super crazy but I'm not a risk-averse person and then number three is finding people around you who have different skill sets
and the Jew could have creative disagreements with them.
It's not come up with a conclusion and act on that conclusion and that mean God I've made my share of hiring the wrong people over the years so what I've learned is you know attitude Trump's aptitude.
You can train for aptitude you can't train for attitude so as with folks in this quadrant in the you know top upper right quadrant is great work ethic great attitude very competent hugged those people keep them forever.

[15:18] But anybody with a bad attitude you gotta you know not hire them or identify it early and help them choose another career path because you do not want them you know I've struggled with that over the years
so let's start with number one then so no yourself be sure this is a worthwhile idea this is really something you want to do I mean that requires some serious introspection it's very easy to go from I have this idea
two six months later you're like what have I gotten myself into is there a way with some of these
Ventures is there a way to kind of dip your toe in the water or or go in a little ways before you just commit a ton of resources just to just by way of trying to see if this is something that you even want to do
well I think there is particularly for you know us Physicians who are kind of shift workers I mean for gastroenterologist is probably be a little more difficult as you got to practice to run.

[16:12] Procedures to do but for us who do shift work even intensive sem docks Radiologists Pathologists you know we could all probably do convert the shift work.
I think it's relatively easy to say okay I'm going to develop one day a week or two days a week to this.
And almost do it as a side hustle and I don't love that phraseology because you've kind of got to be all in even if you're not a should be something that's occupying your mind.
But if you're an open up an urgent care for example which I would not recommend anybody do nowadays because they're so pervasive but I think you can go into that and.
And go into that with a toe in the water find some Partners hoping to spot a turn Staffing and see what it does but a lot of things this is getting your minimum viable product up.

[16:53] And see and what the adoption rate is and working through that and then if you find some adoption great.
Move on if you don't okay do as a do I persevere and pivot or do I throw in the towel and say yeah and wasn't a great idea.
You know I've had a bait that I started the business and having 2014 was called healthy bit which I thought of the time was a great idea it was a reverse auction.
So we were provider who needs plastic surgery or some non some elective surgical procedure you basically say okay,
are you my gallbladder out it's not an emergency I want to do within 75 miles of my house they've got to be a board-certified surgeon I want to do as an outpatient.
Who will bid on that and so then the providers and surgery centers will say great we'll do it for 5 grand and so get a high deductible plan or no insurance at all.

[17:41] It was almost like you were in control of the price and the cost of it and I think it we were just too early to market for,
but I've worked on for about a year built a website got all the data got people involved in the realized this is not going to take off or if it is is when they go off 10 years later,
and so we threw in the towel so the MVP was up.
The product worked it just was not getting any adoption and so okay I wasted a year and you know I'm twenty thousand dollars or so capital and call it a day,
do you think it's important to get some buy-in from people in your life you know talk to friends talk to family talk to mentors to you know kind of,
try to coach you out of it or try to convince you it's not a good idea and see if it's,
because if it's something you can be convinced of in a simple conversation you needed to be convinced as my thought but if you think that's an important thing to do ahead of time or do you do you think that that just invites people discouraging you from doing something you're genuinely passionate about.

[18:36] So that's a phenomenal question but here's the duality of it
you know what I started the urgent care business people are like the health plans Physicians everybody was like well this is dumb there are their primary care doctor or the Ed what's the say in the middle when I started virtual care in 2010.

[18:54] You know there's some people are like oh yeah that's kind of cool but the vast majority of people has told those I'll never use that I'll never do that.
And so this Duality is like same with even went back to like Facebook and Google and God knows I was never that bright or that successful but.
But when they first put it out there like Airbnb when they first put it out there people like no I'm not going to have people my home is the craziest idea ever.

[19:18] And you almost want people to say this idea is so out of context and so weird that I can't even consider it.

[19:27] And so I always think the best ideas with a bronze of people say well we've never seen that before we've never done this before so I think part of it is if you really have a want to Blockbuster,
like an Uber idea I think it's got to be pretty far out there that people haven't considered it you'd otherwise you're just a me too.
Conversely you'll have some ideas on God knows I've had them where people say once a dumbest thing I've ever heard John so that angle is it dumb or am I just way ahead of the game.
And used under stop,
and so I got okay you're right then TV was probably a video bitch or he's probably not going to need something to watch but in my mind it made a lot of sense so I don't have an answer for you how about that,
no that's good it's I think it's one of those things that having those conversations can help you sharpen your Arguments for why it's a good idea I think it can help you clarify whether this is something you're just,
interested in or something you're genuinely passionate about and
hopefully you can find people who will do it in a loving way is to so as to not completely destroy your self-esteem but on the other say on the other hand if you're not willing to put in some emotional Equity some Sweat Equity and yes in capital,
you probably don't need to be doing the idea in the first place,
exactly I mean if you want to buy a franchise and I thought about buying some in fact I franchised urgent cares back in 95 I think we have six of them and at that point urgent cares I mean Healthcare never been franchise when we did it.

[20:51] And you gotta my mind I thought it was you know really smart idea great thing to do.
Years later Doctors Express started a Urgent Care franchise they did much better than I did I ended up buying them.
In 2015 and sold them a couple years later about the year and a half later I think.

[21:07] But they really did a right I was not a great franchise or in order that that great franchisees.
But my point is if you're going to buy a franchise great someone's already approved the model becomes a cash flow generator for you you dip your toe in.
Wonderful but if you really have a push the envelope idea I think it will get a lot of naysayers out of the gate.
So let's talk about number two then you said you have to be willing to risk some Capital now this one's going to be a big sticking point for a lot of folks I mean so.

[21:34] I'm sure a lot of people are hearing your story and displaying into two camps your store going.

[21:39] You triple mortgage your house you did what and they're freaking out like oh my gosh is that what I would have to take to succeed,
and there's some people that are sitting there going yeah you do it man you were the man that's fantastic and they're seeing the end of this phenomenal story but you know there is a long period of time in there where you didn't really know where for whether this thing was going to take off and really work.
So putting your money where your mouth is that is a big big step there what do you find is the approach to that that really makes
sense because it's something you have to have I think a little bit of crazy in you to be willing to invest money in something that you don't know if it's going to work or not but if you don't take those risks you never get those rewards either so
how do you start to balance that when you how do you know when it's so risky it's not worth it versus when it's just risky enough to try it,
you know I think that's the just going through your business plan on coming up with the MVP you know yet about how to do it again I'd do it a little differently I would put in my own money to a point proved the concept
and then go out and raise Venture funding back in the day I didn't know about any of that so I went to the bank.
And you know it's not burning my house my wife is a physician you know we both did okay and in the bank said okay well you know loan you up to ax and then we did factoring as well.
If we had a hundred thousand and they are we could fact we could borrow 70% of it and there was,
years of every week doing the borrowing balance with the bank with this factoring company and saying that we can draw another 50 or owed to these we got to pay them another 50.

[23:08] Based upon what RAR was.
And you know I always say that a lot of sleepless nights talking to the ceiling fan which oddly enough never answer but you I think you have to accept that that's how it's may be rough for a while.
And if again if you can do that and I always had a confidence in myself that if it fails I'll you know I mean ER doc I'll always have a job.
I'll always be able to go work some place and making okay living and that was really my backstop and I think it's Physicians you know we all do relatively well.
And if you say okay well yeah this might cost me 100 Grand but you know what and 100 Grand and great grand scheme of things I can make that up and this will be a great opportunity if it works will be a lot of fun and I'll learn a lot and that's why I tell people look at the end of the day the journey is really defined.

[23:52] And it's like when you graduate from school or sell your business there's some disappointment in there as well because I kind that was a hell of a ride and not what am I gonna do,
and so I always have that aspect so how do you determine when it's time to bring on venture capital I mean you do it right out of the gate in most cases or is it you know do you want to get something
going and get the basic concept proved and then start reaching out.

[24:18] So I you know with with be seized if you have a track record they'll invest in your idea I think for most of us and I'm literally in the process of starting a kind of a physician-led.
VC fund nabila love helping physician entrepreneurs machine probably tell I think for most of us who don't have this great track record of building multiple companies and then you'll have to go to them with a plan.
Product or service and some history and say look.
Here's what I've done so far but I think this can scale with this investment and so you go to venture capital companies who invest in early stage seed or series a rounds.
And you know I think if you impress them with what you've done and what sure,
MVP is your minimum viable product I think you'll get some investments in them I mean I'm surely you know our Venture Capital company would invest in that it was a few months ago we had on dr. Lance Black used to be the
head of innovation for the Texas Medical Center and now runs a startup company for doing the same kind of thing that you're talking about and he said much the same thing and there's
the thing that's great about this that I want people to hear from what dr. shufelt saying is that there's lots of people that want to believe in you there's lots of people that want to support your idea and so I hope that is encouraging to people that,
you know there are folks out there that are ready and willing and eager even to see your idea come to fruition and try to support you through that.

[25:43] I agree you know I think there's a lot of Physicians out there so it look because of because of my specialty I'll never be able to.
Have this entrepreneurial dream however,
I would love to be a limited partner in a venture capital company and invest in these companies where I'm helping other physicians in doing so maybe I'll get to hit it out of the park too.
I mean we think of Peter teal and Facebook you know he put half of the 500,000 dollars in Facebook.
And just killed it now he already done PayPal they needed palantir you know Facebook I believe was probably one of the first big Investments as a venture capitalist.
Yeah man it's a lot of Physicians out there said wow I mean it's a unicorn is a homerun I could.
You know 10 20 30 x my money yeah I mean it's worth considering so well that's great so that's number two is be willing to risk some Capital so number three you said have people around you with some skill sets that can help you so.
Don't bend don't be the smartest guy in the room at everything right so have people that are experts that are really high quality individuals that will disagree with you I love that how do you find those people.

[26:52] So what you know I've I've stalked a lot of people on Lincoln which sounds really creepy.

[26:57] But you know you can hire you know I called fractional executive so you can hire somebody and say like I can't afford a full-time CFO.
However can I afford you know half a day a week from you and we'll pay you fairly but we don't need a full-time CFO we need half a day a week and so you want to you want to engage with people and hire people for the company that you want to become not the company that you are today,
are you gonna have some people that are you know for your size or who that's who you're going to get and I've had a lot of those people which are wonderful.
But you got to make sure you understand a lot of times the horse you're riding the battle on is not the horse right out of Babylon.
And so you have to be willing to satisfy me but you know you've been amazing you got out let's get this far but your skillset not is not aligned with where we need to go and it's a hard decision it's a hard conversation to have and I've had to have it.

[27:45] But they know going in what you know kind of where they fit in this puzzle of,
opportunity and just be kind and empathetic and open about it but it's a discussion has to be had
now it's very easy for that kind of thing to spin completely out of control right so if you are hiring someone for say bookkeeping then you're hiring someone to be an advertising then you're having someone to do R&D
and you it's very easy to say well I'm going to hire this guy and this guy in this gallon this gal and then all of a sudden you look up in your like oh my gosh I have spent so much money on this so
at some point it makes sense to do some of these things yourself you know to start to acquire some skills bootstrap it a little bit but then at some point there's an inflection point where
ability is capping the level of success that your company can have how do you recognize when you get to that point and be able to Pivot to try to get someone else to come on board and help you out.

[28:41] I mean you know that actually see you again killed it on your question you know when we started in the Urgent Care I was doing the QuickBooks myself.
And for a pair of the time and I was working ships in the Urgent Care while I was doing QuickBooks.
And trying to do it all but then at some point you start out growing your own abilities which me was always early in the game since I lack them.
I'm sorry find somebody in the first you find a bookkeeper then you Outsource it to an accounting firm.
You know you start doing your own advertising coming up with your own direct mailers back in the day and that you said right,
drawing that we can afford some professionals here to do it some of the things you want to get professionals right out of the gate you know if you're going to try to develop IP intellectual property you're going to want to get some.
High-quality coders for example to do it because I can't code but you kind of know when the time comes will notice and go God I don't know where else I can take this however I know where I wanted to go,
I don't know how to get there so that's when you hire the quote professionals.

[29:37] I like it I like it all right so let's review so number one you said know yourself be sure that this is really a worthwhile Venture that you want to get into,
number to be willing to risk some capital and I think that applies to like you said money but emotional Equity Sweat Equity be sure this is really something you're willing to put time,
effort and money into.
Number three have people around you with skill sets that can help you and help you grow so bootstrapping it for awhile works but then at some point you need someone to help you grow up.
Okay so what would be a fourth thing that will make or break a medical business.
I mean being able to look over the horizon a little bit and you know so I've called standing on the shoulders of giants where you know I talked about trying to see a little bit farther Over the Horizon see where the world is going.
So for me it was just thinking hey in the future was Healthcare going to look like and how can I get there for so.
You know back in I don't know probably 2,000 cash eight or nine I started working on AI projects with a group out of University of Chicago.

[30:37] And what they told me was totally blew me away and then I started getting into it and say okay wow this is amazing how can this impact where Healthcare is going so I started really spending a lot of time.
And thought I'm using a AI to help diagnose but also help streamline Healthcare I guess they're just being able to look creatively around the corners and say may not be right.
But in my perfect world this is what help is going to look like in 2030 so for example we sold me and D to Walmart and one of these we talked about.
So we got lower the cost of the time the men health care how can we do it and really the way to do it is with a.
So you go through this AI process in the provider find a time and says okay mrs. Jones you know I see you have XYZ peers that you in fact do have make it up sinusitis.
Yay I already suggested the course of treatment the discharge instructions are done the prescriptions waited to be e-prescribe and you hit send.
And so now your interaction is about 90 seconds long where before is about 12 minutes long.

[31:39] And you know for me that was my try to look around the corner where Healthcare is going y so you know it's Imaging company years ago because I thought way I shouldn't take over these image reading
and someday no one's in them are paid ten or eleven dollars for x-ray they're going to want to pay less than a dollar
so that's an important point that you're making there that not only do we need to have a long-distance view of things when were first starting out but we've got to keep that so that we don't get stuck into dinosaur modes of thinking
that we eventually have our business consumed,
before we even realize what's going on because it would have been very easy I would say for you to have just kept hammering and hammering away at that business and then have the AI just completely
take your business to nothing because that's the way that that's the way the technological revolutions go right eventually everything that we do gets replaced by whatever the latest thing is,
and if you're not constantly in a mode of looking far enough into the future that you think about those things you could easily end up getting passed by.

[32:35] Well it's yeah I mean you hit it on the head if you think you have you know you hear this about them they're called the black cabbies in London and how they take a three year course of study to come and Cabbie and London and they know every corner of the city.

[32:47] And they memorize just an ornament of information while the black cavities were just crushed by the iPhone because all of a sudden now,
you can map your own routes in fact ways we'll die together even quicker than the black can be well and then you have you know things like ways to do it or you have Uber,
and so I think unless you're and I've always noticed this with positions a lot of us are like well that's the way we've always done it when I started my MD I want to urgent cares and I said look.
Is that you're only seeing patients about 3 to 4 miles around your Center when your Center is slow if no one's coming in you're paying this provider and their your highest cost a lot of money to sit around
and so I always laugh at these providers into practice in their golf swing like hey I'm paying you for this and I said yeah show me some basins I'll take care of them and like okay touche.

[33:33] And so I thought I'd write with with me and D with virtual Health Care you take care of patients in the entire state,
so your lasers your cares and say look you can expand your reach of the entire State and it's a will you have a little camera lizer on business I said yeah he'll have some people that will use it when they would have come in and paid you more.
But you can see if you on the whole state I got one urging care to do it back in 2010 2011.
None of them would do it and now of course they're all doing it because now they've been forced to do with Cohen.
But at the time it me to me I was like well guys you've got to do this you got to expand your reach but I could not get them out of their fixed mindset of,
this way we've always done it well and as the leader you know having that vision and then communicating that Vision constantly reinforcing that Vision to other people showing them why,
it's so important how to get it done
is going to absolutely be critical so that's a great number for I love it so having a vision standing on the shoulders of giants constantly looking into the future to see what's coming down the pike.
All right and wrapping it up number five what's Your Number 5 thing that can make or break a medical business,
so you know Andy Grove Intel and negro we don't have said you know maintain a high degree of paranoia and I've never really paranoid but I understand what he what he means by.
Thinking obviously and who's coming over my shoulder so easy as exercise how can I beat next care so we would sit around the room and say alright if I was going to do a start-up how do we beat us.

[34:57] And I think of all his ways and you know I'd be here's how I beat next care and then we think okay that's how we beat next year let's become that.

[35:04] So we started this called Wahoo wait at home or office where people could log in online all their medical data in.
By the time then we call them or text them say hey your rooms ready in the Urgent Care they come in and they put through the Urgent Care in the few minutes because everything will be done prospectively.
And so that was one of the things that came out of how can I be next care so it's a dose of paranoia and saying all right if I was going to come out and compete against myself how would I beat me.

[35:30] It sounds odd but it really gets you creatively thinking of who's coming down the pike because someone is.
That is a brilliant way to think about that I really love that concept one of the things that an exercise I'll take my team through some sometimes it's kind of similar we call it the what if game we play the what if game and so everyone just starts.
Throwing ideas out and every sentence has to start with what if and it's like well what if we were able to get two rooms going at the same time what if we were able to eliminate,
you know these forms in our intake process what if we were able to write until we're discussing these pain points that our staff has were discussing these frustrations that patients have expressed and say well what if we change that and what would that look like so I really love
that idea and that's a great way to kind of dovetails into number for it kind of you're constantly looking for what is the next thing coming around that potentially has,
the opportunity to completely upend everything that you've been working towards and how do you stay ahead of that pitch I think that's really really smart well this is really great so let's do a quick review so,
number one no yourself be sure you've got a worthwhile Venture number to be willing to risk some Capital number three have some people around you hire folks for attitude rather than aptitude but get people that have skill sets that can really help you out.

[36:50] Number for having a long distance Vision really be thinking ahead looking always towards the future number 5,
just thinking I love this how are you going to be take it out like what's going to be the force that ends you and how do you become that I think that's a really great way to think about it so,
as we start to wrap up here what is your your last bit of parting advice to someone who's who's thinking alright I'm just starting on my medical business and or I'm looking to grow my business
but I'm just not sure where to begin I've never really thought about this the whole idea kind of scares me what do you tell those people.
Read education for me reading for me is like putting on a new pair of glasses and I can't tell you how many business I've started ideas I've had,
that I that I read a book inside oh my God how have I missed this this is right in front of my eyes I'm an idiot I'd mrs. my whole life but now so I've got a new pair of glasses on.

[37:40] And boom is wide open to me and for me doing these other things as help me I think I'm a better physician because I don't feel burned out or they don't have this moral injury and it's really understand the people that do.
But I've always had other creative outlets and all my life I wanted to be as a doctor since I was 5 years old and so I don't think I'm any less of a physician doing other stuff I think I'm actually have become a better physician because I've expanded my mind,
and not had to rely on medicine I've been able to rely on other things as well so my advice is diversify your interest.
Well I think that's really great and you know we've talked about this on the podcast before it'll be the same person you are 5 years from now except for the people that you meet
and the books that you read so if you're constantly learning you're constantly growing you're constantly meeting new people
you'll grow and I think that's fantastic well dr. shufelt if people want to connect to you want to get a copy of your book which they totally should they want to learn more from you get your get your content how are some ways that people can do that.
Um easy I'm about as regionals you can get John she felt em d.com is right to my website you can find me on LinkedIn as well under my name.
And I'm happy to interact with people I mean I said I.
I'm going to cut it also the last third of my career I think I'll be like Pablo Picasso and died in my studio and I'm 96 and so I'm really enjoying now helping folks realize their own potential but I think most of us underestimate our potential.

[39:05] It's fantastic will make sure to have all the links to that
stuff in the show notes and you'll be able to get a link to buy a copy of entrepreneur RX which you definitely should so this was dr. John shufelt he's the author of entrepreneur RX and so be sure to go check all that stuff out and get a copy of the book and I will make sure to have all the links in the podcast description in the show notes for you
so dark she felt thank you so much for joining us today on the scope of practice podcast or really appreciate it dr. Lindsay honor to be here thank.

[39:31] Music.

[39:37] Entrepreneurs are the growth engine of the world economy maybe you're listening to this episode in your thinking yeah Brent but I'm not an entrepreneur well let me tell you something entrepreneurship is not an innate skill it's a learned skill.
Some people may be more naturally inclined towards entrepreneurship than others but anybody can do this I mean for example if you had told me three years ago that I'd be running something like the scope of practice while also pursuing my full-time clinical practice I would have said you were crazy.

[40:05] There's no reason why you can't do the things the doctor shufelt talked about and that's my challenge to you today what's one thing that you've been really excited about that you just haven't taken the first step on,
is it starting a business expanding your current business investing in real estate,
don't let 2020 to hold you back use the rest of 2021 to think about the one idea you're most excited about that you want to execute on in 2022 and then.
Go do it.

[40:32] To help you find the inspiration and practical steps you can take to achieve that goal I'm excited to tell you about this weeks free resource which is a PDF download called the scope of practice reading.
This list is the top 35 books that I recommend for Physicians who want to have a more successful career and stronger personal finances.
If you can read just one book from each of the seven recommended categories you'll be in the top 5% of physicians in terms of knowledge about this stuff.
Just go to the podcast description find the link there in your phone and you can download the free copy of the scope of practice reading list today.

[41:08] Podcast description will also have all the links to all the other resources we mentioned during the show so just scroll on down find what you need and take advantage of that and everything that's in there is for free I hope you enjoy.
Thanks so much for joining me on this scope of practice podcast today I'll see you next time.
Thanks for listening to the scope of practice podcast at www.viki scope of practice Dot.

[41:31] Music.