Dr. Michael Fang — A Geriatrician Building Healthcare That Scales

Transcript YouTube English auto-captions. Hey guys, this is Dr. Mike Wuang. Welcome to another edition of Bootstrap MD, the podcast for physician and healthc care entrepreneurs. From time to time, I love to spotlight physician entrepreneurs who are out there in the trenches making a difference into the world. And I've got another amazing guest that I'm sure you're going to get a lot out of. He is an internist and general deratric medicine physician turned entrepreneur driven by a mission to democratize healthcare. As a co-founder and CEO of base 10, he launched an infection control clinical decision support software that is used by over 150 nursing homes during the coic pandemic. The software has generated over $35 million in revenue over three years before the company was eventually acquired. He also co-ounded Imosphere which tracked social determinance of health for over 7 million mental health patients in the UK, Ireland, and Scotland. He currently serves as the chief strategy officer for Northwestern Fineberg School of Medicine Institute of AI and Medicine, while now leading RISE, an insurance company whose health plan solution is redefining healthcare coverage for independent physicians and medical practices nationwide. Other than that, he really hasn't done a lot. Want to introduce to the program Dr. Michael Michael, it's a pleasure to talk with you today. >> Thank you, Mike. Thanks for having me on the show. Yeah. And as an aside, we're also going to be speaking at the upcoming PIMDC con. That's right. Which is happening Southern California. So, we'll be glad to meet you in person. And I'll do a little bit of plug as I work with Peter. So, if you haven't registered, be sure to do so. And so, you can meet us at the flesh and I'm sure he'll be happy to meet other aspiring physician entrepreneurs. But, Michael, let's get into this. You're a busy guy. And so tell me how does a geriatrician how does he end up becoming an entrepreneur? We'd love to hear about your journey. >> Yeah, appreciate it, Mike. Honestly, like most of us, we didn't go to college and premed thinking we're going to be entrepreneur. I really uh wanted to be a physician ever since I was eight. Probably because my mom had a lot to do with that. And then but by the age of 12, I knew I wanted to take care of elderly people. I didn't know that was called geriatrics, but I knew by the age of 12, I want to take care of senior people. And that's exactly what I did. went to Northwestern University, did my didn't do any skip years, went straight to med school, went straight into my internship and fellowship and achieved my dream, became an internist and geriatrician and honestly loved what I was doing as a physician. But as as we all know, when we start practicing, you start to see some of the brokenness of healthcare. And for me, that was the how siloed the data was when it came to me trying to help my patients, right? There's only about a thousand plus geriatricians in the country and 30 million Americans that are aging. So we really needed to be very efficient as a subsp specialty of medicine and getting the data we need for these senior patients and didn't have time honestly right that we were all busy. I was a new father and trying to be a good husband among trying to be a physician. So I didn't have time to go back and get a masters in informatics. And keep in mind my major was cell molecular biology. I didn't major in computer science or programming. Didn't know how to code a single line of anything. but just took the opportunity to talk to the EHR vendors, right? This was back in 2008 when all the hospitals were having be told to be digitized, right? And most physicians were yelling at the vendors like, "How come this button doesn't work?" And I was actually not yelling. I was like, "Oh, how come that button doesn't work? Teach me why. Show me why this data doesn't if I entered it here, how come it doesn't show up here for the nurses?" And they actually taught me a lot about data architecture. And this is the way we built the code. So this why it takes a while for us to change the software even though we get we understand the data needs to be in front of that person it's going to take us a couple weeks I ended up learning from the software folks themselves and that's how I ended up foraying into informatics as a side gig learned enough in fact to become the director informatics for Indiana University health system for a number of years despite like I said not having had the chance to go back to get a masters in informatics and from there of course once you're in informatics world once you're in the data world especially in the last 20 years technology and entrepreneurship became the part of the next journey. >> So that's interesting and what a lot of physicians want to know is what led you to like jump in because I don't know about you. I had no training in business. I don't know if you've had an MBA or maybe there was there entrepreneurship in your family or what sparked it for you? >> So yeah, no didn't get an MBA either. I got a fun story around that later but didn't again too busy to even go back and get an MBA. I think I think what we physicians are really good at, right? So folks ask me that a lot. How do I get into it? I would say this, with all that you had to endure to make it through the gauntlet of becoming a physician, the med school, the internship, you gained a lot of the soft and hard skills that's needed to be an entrepreneur, to be a business owner. It's just that in our particular profession, we have applied those in a very narrow lens of what we do. But think about it. In order for you to become a doctor or to get through your day, how efficient are you at organization? How efficient are you at? Basically aggregating large amounts of information and then quickly identifying what's relevant and what's not relevant to come up with a diagnosis and then even a plan for a patient. How amazing is your communication skill that in two minutes of you entering a patient's room, you have to make them comfortable and be able to agree to everything you want them to do for the rest of the day and in five minutes after that communicate that entire plan to the nurse, the social worker, the case manager, right? and the pharmacist is like you have to be incredibly good at what you do and those are the same skill sets that quite frankly as I started building companies I realized that those are the same skills I needed to run a good business now of course we need additional knowledge right so if you're going to be running a business of anything quite frankly whether it's a medical practice or a met device right or even if you were saying I'm going to do real estate there's knowledge that we have to learn but you're also the best at learning knowledge because we had to learn right how to deliver babies in a month. We have to learn how to close sutures and do ER procedures within a month, right? We only have one month to learn every single rotation. So, you are already naturally selected as a type of individual that can ingest large amounts of information and master it in a very short period of time. This is very fascinating to and I really want to delve deep into this Michael because a lot of physicians get very frustrated with lots of things that we do at work with software with the flow with insurance companies started your own company because that is a big leap and that's something that I've worked with aspiring entrepreneurs who said yeah they we found a lot of flaws in medicine but only a certain number decide that they want to do something about it. >> I think for me I really was one of those types. So when I decided to become a physician, you asked me earlier, do we have schools in my family? I'm the only physician in my family, right? The rest of my family members are all business folks. Honestly, all business folks actually. And to me, I as a family, we talked about how, oh, it be so nice if somebody in the family understood medicine because whenever the older generation of relatives got sicker, right? you despite their business knowledge or my dad being a very successful financial entrepreneur himself in his days he had a hard time understanding what was happening with grandpa what was being explained or what are the choices of medicine so the families always said it's be great if somebody in the family was a doctor now for me that was my personality if I saw a problem I want to solve it right if I saw a need I want to fill it and for an early on part that was yeah let me be the family for a physician for the family to help the family out right and as I became a physician I would say there's a gap in the way that we can care for senior patients and I want to figure out how to fill that gap. Then it became more how do we do that at scale because there's so many of them. How do we do that when I'm asleep or when I'm not there? And that's when I started to get into technology as the way to solve. But I think all of us have the really it is a decision. You have to feel that problem is really relevant to you and you have to convince yourself that I'm the only one that can solve this. And I I would say that in honesty in healthcare really as a physician, you are the only one that can solve it or you're at least the best one to solve that problem. And if you don't do it, someone else is going to try, but it's probably not going to be the best. If that's the push you need, then tell yourself that I'm the only one that can do this and that will give you the push to jump in. >> Now, a common question that you get, I get this all the time, is are you still seeing patients? And if not, what led you to decide to do that? Because that again is another one of those big decisions that many physicians have a hard time grasping. >> Yeah. Like I said, when I became a jurian, that's little kids wanting to be astronauts, right? I did not want to stop seeing patients. So, for the 10 15 years while I was building software companies and and so forth, I still practice full-time as a physician. Wow. >> And in fact, there's two quick comments I'll say about that. Right. When you're practicing as a physician, one of the things our salary affords us to do is we could actually use a bit of our salary very easily to build our startup, right? You'll hear other startups going out there and pitching and competing for $10,000 in prize. That for us is maybe two weeks of night shifts, right? So, you can fund your own startup much easier with your physician work than anything else. Now, I'm not saying you should do that forever, but if you were trying something, it's much easier to fund it yourself. It's you have colleagues who are fellow physicians who if they like what you're doing can probably throw in another $10,000 with you to do something right. So we have a nice professional community as physicians that can support us in our entrepreneurial journey. No, I wouldn't say that you have to give up your physicianship to pursue your entrepreneurial dream. But I did practice all the way through the story behind that is I actually practiced all the way until 2020 2021 in the midst of the pandemic. What happened was two years before the pandemic happened. You mentioned earlier about my company base 10. So two years in 2017, I had this concept where as a geriatrician who was very busy, right, but I'm also trying to help patients in the nursing home, but I'm not at the nursing home all the time. So it was very frustrating for me that a lot of time was spent on the phone with a CNA who was doing her best, right? She's not a diagnostician. She's just saying, "Hey, Dr. Fang, Mrs. Jones having throwing up. She's having fever. She's right. She's trying to give me the symptoms." And the two of us are then on the phone trying to go into the EHR and figure out all the information and then me finally saying, "Okay, I think it's this. We should probably order an X-ray and a blah blah blah." And that always took so much time. And I said, "Why can't we have something that's like Google Maps for that, right, for clinical decision support where you know you're at point A, which is your symptoms, and your point B is your differential diagnosis. And the software goes in the chart and confirms your symptoms and your potential diagnosis and then tells you what to order next. So that's actually what we started building in 2017. So we built that platform, believe it or not. And at the end of 2019, we started piloting it in some nursing homes. And of course, 3 months after we started piloting it, COVID hits the nation and everything was shut down and the nursing homes were burning up with cases, right? So our platform was perfectly there to basically collect all the symptoms. The software would then match the symptoms. So you say cough, is there another way someone would say cough right in the chart? time stamp those and then be able to verify that yes, there's some symptoms going on. If the differential diagnosis is pneumonia versus flu versus fever, then the software would say, "Okay, we need to order a flu test versus an X-ray versus a sputenant culture versus a COVID test once they started to come out." And what was great was that with basically a handful of nurse practitioners, literally a handful of nurse practitioners in our laptop, we were able to evaluate 1.7 million plus cases of infections in 150 nursing homes nationwide. What we also accomplished was in all 150 nursing homes that were using our platform, didn't matter if they were in a red state or blue state or what they believed or what their policy were around PPEs and vaccinations at that time, all 150 nursing homes had 30% less death from all cause infection and COVID during the three years of epidemic >> and I was still seeing patients at that time as a physician. But see the numbers I was like okay I am killing myself trying to see patients during the day. I'm seeing like almost 50 60 patients just running through the nursing home trying to triage whatever we can. In the meantime, my software with five nurse practitioners is dealing with 50,000 cases per months. So at the end of the >> at the end of then yes, as you mentioned earlier, the company did make a lot of money. We made literally 30 plus million dollars in the span of two years, right? The timing was of course there and the software had a relevance to the pandemic. So of course timing was very important. But when I looked at that and said, "Okay, it isn't that I want to give up seeing patients." But this is what I'm talking about. I can I love patients, but I can only see 60 of them in a day. I can only maybe save the life or change the life of 60 patients a day. But if I did something correctly, if I led the development of a technology platform, I can affect 1.7 million patients. And that is where at the end of 2021, I said, you know what, I I think I need to focus on this. I would love to go back and I still think about that. In fact, I'm still exploring maybe with partners going back and having a private practice somehow. It's just that I would be I feel bad because I would not be a very contributing partner at this point in time. But I feel that with what I'm doing, I can make a bigger splash across and really change the needle the course of the needle for senior care in US. Yeah, that's a beautiful story and it obviously co was devastating for many on in there but in times of disruption that's when entrepreneurs really flourish and we see that time and time again not only in Europe but this whole tele medicine and it just I think was a wakeup call in medicine is there's a better way to do things now we're in this restricted environment yeah maybe we don't need to do the ways that we did this 20 40 50 years ago it was a success finan Financially, you were success-wise. It was a success. Most people say, "Oh, I can go now to the Bahamas. I can rest on my laurels." Doesn't sound like that that aspired to you. So, >> what happened to that? >> Like I said, I'm a guy who when I see a problem, I just can't let it go. Right. As I mentioned, even though I stopped my clinical practice in 2021, when the pandemic started to lessen up, right? So towards the end of 2022 starting 2023 I started looking and say okay I sold my company and yes I could go take a nice break and we did I took some time off to take care of my family and they sacrificed a lot during the pandemic for me as well but I started looking at going back to practice actually like I said I started talking to partners saying hey you how are you guys doing and maybe we should partner up on opening up new clinic and as I started to speak to more and more of my colleagues something came up which was actually not related to technology. It was really more just a simple unmet need. Hey, in starting our own practice, we need better health insurance. Uh we need health insurance to cover ourselves and our family. In fact, if we're going to be small business owners of our own little medical practice, we need to think about how to get benefits for covering our employees. And this is where we realize that doesn't make any sense, right? Because we are the most medically educated profession, including our staff at our clinic. Yet, we're probably paying some of the highest rates to use insurance because you're a small business. You're not a big corporation. You don't have the number of employees to get a discount from a broker, right? So, we're paying for some of the highest insurance while using it the least. And for a lot of physicians I spoke to, health benefits next to payroll and perhaps the rent for the office was like the third or fourth most expensive item on their business, P&L statement rent. So, I said that doesn't make any sense. So again, I found a problem and I couldn't let my mind go. So I was like, there's got to be something that someone must have solved this, right? So first I tried to talk to the big insurance companies and say, "Hey, if we did this, would you give us nope, no discounts because you guys are all small businesses?" Okay, what about all these other industries like the Fortune 500 companies, the tech companies, the hospitals who have their own health plans? Could we put together a health plan of our own or has somebody put that together that we can join? The answer is not really, right? The hospitals have their own health plan. The big corporates have their own health and private equity has their own health plan that they use they sponsor themselves for their employees but we as a small business have never grouped together as a community to do. And once I realized, okay, don't want to build something if it's already been built. But once I realized it wasn't built, that's when I decided that I'm going to commit to building Rise and and taking out that one little factor, right? Because honestly, like if you're you got enough to think about when you're as a physician to say, "Hey, should I go independent? Should I leave the big hospital safety or should I leave the academic safety and finally start on my own practice and have my own decision as what I want to do and the patients I want to see and right so on so forth." And the last thing you should have to think about in weighing that decision is, "Oh man, I should stay at my job because I still need health insurance." That's not even a golden handcuff. That's just bad handcuffs. So, I wanted to take that out as a decision gate basically for all physicians so that at any time if you want to start your own business, at least your own family and your and health of your employees and their families wouldn't be the one that's weighing you down in making that decision. >> Yeah, it's funny. I deal with aspiring entrepreneurs and say I want to start my own business. I want to build something of my own but this health insurance is really good at this and realizing it's they just don't have the information in education and with why. So what are some of the things that maybe surprised you about getting into this big insurance behemoth helping the little guy out? Were there was there any challenges that you had starting out? >> Uh RISE has been a three-year work in the process, right? and it's probably going to take us another seven years to get to where we really need to be and that is to be the foundational health insurance for all independent physicians. A lot you learn along the way. It would be difficult for me to summarize all of that in the short time that we have together, but the first thing you learn about is whether there are biases that you had about insurance as a business that is true or false. I hate to say there's a lot of things that we have as biases are not biases, they're actually true about the insurance industry. And then you have to be able to learn about that and then say, "Okay, I'm going to make a very different decision." One of my physician friend had this amazing term that she I borrow all the time. She said, "Sometimes as physician entrepreneurs, we have to make the decision to be the benevolent dictator, right? You have to be able to learn enough about how a game works. You have to be able to dominate the game, but then you have then as the person dominating that game, you then make it fair for everybody, right? And that is I would say in a nutshell a lot of what we had to figure out in the last three years." in building rises. What are the games that are being played in health insurance world? Which one of those are regulation and therefore good reason? And which one of those are somebody made a business decision, right? But it became pervasive, right, as the business decision. And can we not make the same business decision in order to effectuate a greater change and build a better health insurance product for independent physicians. Those are the things we had to learn. But again, I think at some point you you say some physicians see this and they're like, "How do I get involved in that?" And like it's like any other muscle, right? Like when you first when I first had to lose weight and I'd get up every morning to run, the first two weeks was just so painful, right? Like you have to wake up in the morning and you but then you keep doing it and it becomes just easier and easier and again these are skills we've already done. Like the first time you had to get up and go prep a patient for surgery or the first time you had to right think about doing a case study or you had to do a medical chart review, right? It was painful, but you do it and you do it and it becomes easier and easier as time goes on and eventually you don't even think about it. It just becomes something that you can do very naturally. >> So, let's get into the nitty-gritty. How does Rise Health works? We've got a number of physicians on here. They're starting a practice. Is there a criteria who would be best served by using your company? >> Yeah. So, we're really catering to a lot of the independent individual physicians, right? So we know that especially since the pandemic a lot of physicians are starting to explore very unique career paths right we always know there's been locals sadly I didn't even know my locom's friends didn't have health insurance I only found out after I started building rights they said no when you work for a locom company they don't pay for your health insurance you have to get your own there are physicians now doing pure tellahalth there are physicians doing direct primary care right so those physicians who are saying hey I'm literally a army of one with my own little practice LLC doing my medical practice those are the folks that we could really help with rise. As time has come on in the last couple years, we also started uh working with medical practices. Now, that gets a little bit harder, but right now uh we're able to work with medical practices are anywhere from 50 to 100 or larger. In fact, we have some medical practice talking to us that are 400 to 600 employees. Now, I know that's not the most of us. Even when I had my medical practice, I had 50 employees. But we're working from the both ends, right? for helping some of the very big large medical groups who believe it or not are still not getting great health insurance, still getting for lack of elegant way of saying screwed over by the big payers whenever they have to renew their yearly employee benefits for their hundreds of employees. They're still not getting the best price. So, we're helping them, but then the individual physicians, those ones were really good at helping. And then we're starting to close the gap in the middle with practices are like, we only have five five employees or 10 or 15 or 25. We're starting to close the gap closer and closer on that. Hopefully by Q1 of 2026, we'll be able to help everybody regardless of what size medical practice that you're in. >> Can you share me like a case study or some people that you work with how it rise has really helped helped them out in terms of their insurance? >> Yeah. So, the way Rise works is what we call a health captain. And health captive means that we're a private health insurance company. We're not taking federal dollar. We don't take CMS dollars, which allows us to make our own rules, right? And allows us to make our own program. When you're part of the fully insured plans like that's on the health marketplace for example, we're you're subsidizing number one as an employer or as a physician yourself the potential cost of Medicaid and other types of patients in that population. So by us just grouping ourselves together, we're already taking ourselves out of that risk pool. So that automatically drops your premium significantly because again as physicians we know that you're much more conscious of your health. you have the financial means to take better care of your health. So, you're already in a different risk pool than the I hate to say it the average American. So, by taking ourselves out of that risk pool, our premiums are already going to drop. Like I said earlier, we can also make better decisions. So, we can do medication programs that doesn't have to go through PBMs and wholesalers and rebates, which we some of us have heard about that drives up the cost of medications, right? So, as Rise, we said, "No, we're not going to work with PBMs. we're not going to go through or if we do work with the PBM, we get to select the ones that are very transparent and doesn't play the rebate game. We as insurance company don't want to play the rebate game and how so how can we get closer to the the pharmacy or even the manufacturers themselves. So we're able to bring down for example the cost of our specialty medications, the drugs that typically can be hundreds if not tens of thousands of dollars. We're able to bring that down by 50% for our members. So if you needed a drug and it let's say Skyrizzy as an example, Sky Rizzy is usually $20,000. for us is like eight, right? So, we're able to take care of our physicians and their families or their colleagues who may have a GI disorder and need it, right? Or even the GLP1s, like I hear some pretty high numbers on the GLP ones. I won't say what our numbers are on this call, but we're able to bring that down by 30 40%. Right? These are the kind of things that we can do once you're your own health plan and with the type of community that we're servicing, which is medical professionals, we're able to help save a lot of money for them. >> I want to talk about we care IPA. What is it about? Why did you start it? tell us all about it. >> Yeah, we actually is a partnership. So, one of the friends I reached out to, Dr. Lisa Ang out in New York. We cure IPA actually came from her. She's the founder of Weare IPA. And as I was talking about joining her and helping her with her practice, that's when I learned about the plight of health insurance and that's where Rise actually came out of. But as Rice started to grow, Lisa and I were became really close friends and I said, "Hey, look, you have an amazing passion for independent physicians. She's a DOB guy. She's always been practicing by herselves and she's always been advocating for New York physicians to be independent and helping with the policym there and I say I love to take what the spirit of we care I love the name like we care nothing says we care like what we're doing for you so we wanted to take we care IPA and make it more of a national community and that's what we're doing with rise and we care it's almost two sides of a of a coin rise is providing an unmet need in terms of health benefits to help you get into independent practice but we care as a community provides the addition support right so this is where we provide additional members benefit I mentioned about the specialty drug program earlier when we realized we could lower drug prices by 40% as a health insurance company for ourselves we said why can't we offer the same prices to our members for their other patients why do you have to be a rise patient in order to get access to cheaper medications so we actually turned our specialty pharmacy into a weare member benefit so you can join weare if you don't need rise insurance so be it I'm not here to arts sell you on insurance, right? But if you don't need Rise Health insurance and let's say you're a rheatologist or a neurologist or a GI doctor or cardiologist and you are ordering these specialty meds or you're a family medicine doctor trying to help patients with weight loss and you're starting to use GLP1s as part of your regimen, right? You could actually sign up at WeCare and get access to the same pricing from our partners, our specialty med partners on those medications that we get at Rise as Insurance. So, think about if BlueC Cross Blue Shield actually opened up their pricing of their drugs to you as a doctor. I'm sure they're not getting the same price of drug as you are. So imagine if they opened up their pricing to you as a physician to use for United Healthcare. They will never do that, but we are. And again, because we're not in the same game. We're not here to be an insurance company. We're here to be a community of supporting physicians and their independence. Insurance just happens to be one of the things you need. Um, but if it's not what you need, we are happy to open up other resources to you via our weare community. >> I love it what you guys are doing. The independent physician is a dying breed. Again, I have many colleagues who are a bit into these big health companies. >> Hospitals employ thousands of us and it just seems harder and harder to do that. So with Rise Health and with Weare IPA, we are able to you guys are helping us. >> We want to reverse that trend, Mike. We want to reverse that trend. >> Absolutely. I understand the trend. I've read the same articles from American Hospital Association. I get it. That is what's been happening. But that's what happens when you when physicians don't have the support uh that they need, right? as a foundation or as a community. But this is why I love what you're doing on the podcast and letting folks know about the possibilities of what they can do. Yes, plug in for PIMD as well, right? Great community there and teaching physicians the way that they can become financial free. And we certainly hope that with Rise and Weare, we can provide another yet another missing piece so that the day arise you want to be your own entrepreneur and be your own boss, you can. >> Yep. Yep. And I think we are seeing it also through again with co through the growth of tele medicine. I got a number of doctors now who are working they're doing 1099 work working for bunch of different companies on in there but they don't have health insurance. So this is going to be this is going to really help them out. So before we wrap up I just wanted to give you some rapid fire >> questions on here keeping you on your toes. >> All right >> and come to PIV con you can talk to Michael in person but just a few questions here. So what is the best advice you could give a doctor who wants to start something outside their clinical practice? I would say like the best advice I would say is we as physicians tend to research way too much and that's just part of our occupational hazards of being in academic rigor for so many years right we tend to read and read before we do something and I would say most businesses you learn by doing and again this right you can read all you can about doing a surgery or suture or delivering a baby but nothing changed nothing really gets your hand right in in terms of experience when you get in there and deliver your first maybe or do your first surgery or take care of your first code. Nothing you read helps you with that situation, right? And I would say that is the same of any business that you're thinking about. Jump in. You're going to you're going to make mistakes. Like our attendings used to tell us that you're going to you're going to screw up, right? But that's part of it, right? And you just have to jump in and try and know that mistakes will be made. But you are in a very good situation as someone with like I said all the hard skills and soft skills and even some of the financial cushion of being a physician with our salary to be able to cushion against some of those failures. So if there's somebody that could afford to fail and learn quickly, it's you. >> I always tell my clients you can't treat life as a double blinded placebo study. If you're the only one who can run the code, it's you. You can't but hide in the call room and research it. It's on you. Productivity. Productivity is something that we all have challenges with. Do you have any productivity hacks or tools that you use as a physician entrepreneur? >> I'm a little bit different. I know there's a lot of physicians who are really now there's a heavy trend and I love it. I see the effect of it. Maybe I should jump on the trend, but a lot of physicians do outsource to virtual assistants. I think a lot of my colleagues have used that and with great feedback. I myself haven't, but I'm a little bit OCD and I love playing with technology. So, I leverage AI a lot. So I really teach myself some of the AI tools and using chartp andor other AI tools to automate my day right and that gives me again I love tinkling with these kind of technologies. So it gives me a chance to really learn by getting my hands dirty and it allows me to customize the systems to my specific needs right versus with a virtual assistant I may have to train her and if she doesn't work then I have to get another one right so for me it was easier to works with some of these AI tools and I do really encourage a lot of physicians if you don't if you haven't started even using any of these AI tools please get into it because again it will change the way we practice as medicine so would be a good time in terms of productivity to start using some of these AI automate Are there any books or any podcasts that you listened to early on that inspired you to become an entrepreneur that you could recommend to other physicians? >> Oh boy, there are I did a lot of reading back in the day. Here's what I will say. You know how when you're traveling at the airport and you're busy and you're just waiting for a flight to to happen. I used to read a lot of the Fortune Ending magazines and I would always flip to the articles that's about the the founders or the CEOs. Now, they're not going to be physicians, but it was always great reading about the stories of those folks and to be able to find similarities between what they're doing or what they've experienced in their life and the challenges they're trying to do and tie that to what you did. Even if it's I had to do something similar to get into a residency, those challenges are real, right? And they apply. So again, those inspiring stories really made a difference for one of my other favorite books, though, although I'm not sure if it's 100% relevant, is I love this book called The 48 Laws of Power, and it was a it was by Robert Green. It I'm a history fan, so I love whenever someone can say, "Here's an example of how to, you know, do the right politics like the Romans did or or Napoleon took over power like they this is how they did And the 48 laws of power was very interesting because as physicians we tend to we tend to want to be a team player right so we want to say I know my area and I really want to let other people who right and that's fine but it's also where I feel in healthcare as a profession because we are of that personality where we say we're humble and we say we don't really know that but maybe someone else should do it and somebody does but here's the thing that person may not know it any better than you do. Okay. And the other thing too is we tend to be good students right? So we tend to feel that if we do if we show our work eventually we'll be praised and promoted and that's not what happens in entrepreneurship. It's the person who knows how to obtain power that know that can get up there. Right? So you sometimes see and we can all say this, right? We can all name a colleague who were like, "Yeah, we don't know why he became the CMO, but he really got on the good side of the board or the CEO, right? I'm not saying it's right or wrong. I'm just saying but that he knew how to play the power, right? So that is a book that I would read with just an open mind. Not all the examples in there are necessarily like morally on the right side of things, but it does show you how to how how folks potentially got in power or at least how to protect yourself from having power taken away from you, right? Because that that really is something that I see is an important part of what we need to do as physician. We talk about, oh, we got to take back power. We got to take back power. There's a unique way to do that and we need to learn how. that funny because I have that book in my in my library there, but I didn't finish it because some of them Yeah, they really get into depths, but it's a great book. >> It's a fun book to read. >> It it is a fun book to read. And also in the other example that you gave, I used to love getting the Inc. 5000. Yes. And the Inc. grid and just like seeing all these companies and what it if you're not familiar it shows you they get chosen based upon how much growth that they've done their company and it just gives you just more success stories more success stories and what I like to do is to see which ones actually stay on the 5,000 list >> those are the ones that that have figured out a pivot and piece of cake Michael this has been tremendous thank you for sharing everything any last minute words before we end the call today >> no thank you so much Mike for the time I love your podcast I watched a few of those in the past as well. Always appreciate you featuring physicians. I think uh you being the voice of letting and giving a platform for us to let others know that hey, you can do what we done. If we did it and like I said, I have no MBA training right out of this background. If I could do it, you could do it as well. And I just really wish everybody the best of luck and that they find their passion and like I said, don't hesitate. Just go ahead and pursue it. >> Wonderful. Michael, this has been fantastic. And for doctors who are ready to explore what Rise Health is all about, what it can do for them, I know a number of independent physicians are listening on there. Head over to risehealth.com/bootstrapm where you can learn more all about it. And again, another plug, if you BMD con, we'd love to see you and get to know you as well. This has been very inspiring for me and for my listeners. Again, for those listening, again, you're going to have your ups and downs as a entrepreneur. Do something a little each day to get you closer to your goals and keep moving forward. All right. All right.