Ever wondered why some patients with TMJ pain never find relief despite trying everything? Dr. Ryan Vaughan unlocks the hidden connection between nasal breathing and jaw disorders that's transforming outcomes for patients who've struggled for years.
Dr. Vaughan's journey began with a personal stake—his own mother developed TMJ issues—revealing glaring gaps in treatment paradigms. This sparked his mission to create something fundamentally different in specialty care. When he launched Exhale Sinus and Facial Pain Center in February 2020, the timing seemed catastrophic. The pandemic hit two weeks later, shutting down healthcare nationwide. Yet remarkably, this challenging start became his greatest advantage, giving him space to refine his approach while patients became increasingly receptive to breathing techniques and alternative treatment options.
At the heart of Dr. Vaughan's revolutionary approach is understanding that seemingly unrelated conditions—TMJ disorders, sleep issues, headaches, and sinus problems—often share root causes in breathing mechanics. His practice combines surgical expertise with a comprehensive evaluation of sleep patterns, diet, supplementation, and psychosocial wellness. What makes this approach unique? As he explains, "Somebody comes in, and yes, I can really laser focus on how to do a minimally invasive nasal surgery. But there's also extra effort spent understanding sleep restoration, meal timing, screen habits, and bedroom settings."
This holistic approach requires substantially more time per patient but yields transformative results. To make this financially viable, Dr. Vaughan has structured his practice with multiple revenue streams—combining insurance-based procedures with cash-pay ancillary therapies like red light treatment and infrared sauna. As healthcare grows increasingly fragmented, Dr. Vaughan positions himself as an "unfragmenter," coordinating care across functional medicine, dentistry, myofunctional therapy, and orthodontia.
Ready to discover how breathing mechanics might be the missing piece in your health puzzle? Listen now to understand the intricate connections between nasal breathing, jaw function, and total wellness that conventional medicine often overlooks. Share your breathing journey with us and subscribe for more innovations reshaping healthcare delivery!
📱 Guest Contact Info for Episode Bio
Name: Dr. Ryan Vaughn, MD
Practice: Exhale Sinus and Facial Pain Center
Specialties: TMJ, Headache, Sleep, ENT
Website: https://exhalesinus.com
Phone: (773) 234-5880
Fax: (708) 273-5332
Location: 814 E Woodfield Rd, Schaumburg, IL 60173
Instagram: @exhalesinus
LinkedIn: https://www.linkedin.com/in/ryancvaughn/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:02):
Okay, so welcome back to Voices in Health
and Wellness.
This is the podcast where weexplore the challenges and
innovation shaping the future ofprivate healthcare practice.
Today, I'm excited to welcomeDr Ryan Vaughan, a dual force in
medicine and entrepreneurship.
He's a board-certifiedotolaryngologist and founder of
Exhale Sinus and Facial PainCenter, where his team
(00:23):
specializes in TMJ disorders,sleep and healthcare, and
advanced ENT solutions.
Dr Vaughan brings a unique lensto the conversation, combining
deep clinical expertise with anentrepreneurial mindset to
rethink how specialty care isdelivered in a private
healthcare setting.
If you're a clinic owner,specialist or anyone navigating
the evolving world of healthdelivery, you're going to find
(00:43):
this one insightful.
So, Ryan, thank you so much forjoining us today.
Really appreciate you jumpingon the call.
Dr Ryan Vaughn (00:47):
Yeah, thank you for having me.
Dr Andrew Greenland (00:49):
And where are you calling from?
Just so all our listeners know.
Dr Ryan Vaughn (00:53):
I'm in my satellite office in Rockford
Illinois.
Dr Andrew Greenland (00:56):
Wonderful.
Okay, so I'm in the UK.
Well, nice that this is aglobal thing.
Perhaps we could start off.
Could you share a little bitabout your role and how Exhale
Sinus came to be?
Dr Ryan Vaughn (01:06):
Sure, yeah.
So I trained as a generalotolaryngologist, meaning that I
was seeing anything related tothe ears, nose, mouth, throat,
neck, and was treating anythingfrom birth all the way through
end of life.
Through that process I actuallyhad a couple of patients,
including my own mother, uh, whodeveloped TMJ issues and within
(01:29):
the United States we reallydon't have great, I would say,
worldwide my experience.
Uh, we don't have greattreatment paradigms on how to
manage these TMJ issues.
Um, it became such a passionfor me.
Uh wanted to become singlyfocused on TMJ, tmd and all of
the surrounding things andreally then marrying the idea of
(01:53):
doing minimally invasiveprocedures to help with those
conditions, as well as seeminglyunrelated conditions of nasal
obstruction, sleep disorder,breathing and sinus issues.
And as I started creating moreand more of a treatment paradigm
that was treating TMJ, throughwhat the actual triggers are, I
(02:17):
started realizing, wow, thatmost of these TMJ patients have
nasal obstruction as theirprimary driver of what's
developing their issues and ifwe fix that, sometimes we fix
their whole problem.
Or, conversely, if we don't fixthe nasal obstruction, they can
have less success with thedental therapies that are done.
(02:38):
So at the time that I finishedmy training in residency.
I joined a group and was partof a 10 member group.
I had worked my way up tobecome a partner, tried to do
something just uniquelydifferent in that practice, but
you know, the practice had beenaround for 60 years.
People were very entrenched inhow they wanted to see
(03:02):
healthcare delivered, and sodoing something different just
really didn't fit their model.
Because I was so passionateabout doing something different,
I decided I'm just going toleave that Left behind my
partnership contract and saidI'll walk away from that and
start my own thing, reallytelling my wife that, even if I
(03:28):
never made more money by doingmy own thing, but actually had
more flexibility and freedom,that it was worth it.
So that was February 1st of2020 that I quit my job and
decided to open my own practice.
So then, two weeks later, thepandemic hit and all of
(03:48):
healthcare was shut down.
So 2020 was bumpy, it was rockyand at the same time, though, it
was really an amazing time.
People were more open-minded,patients were coming in to me
more interested in learningabout nasal breathing and nasal
techniques, and I had theopportunity to slow down and
(04:12):
learn some more things.
So, through that kind of bumpystart, it actually was an
amazing gift that I was able toreally dive deep into.
What are the things that we aredoing that are helping our TMJ
and nasal patients, um, what'sworking, what's not working, how
(04:32):
do we set up uh protocols forevaluating success?
How do we Define success, um,and how do we see what's not
working and how do we cut thataway?
So that brings us to today,where I've built out a team.
We have three surgeons, sixmid-level providers we call them
(04:54):
physician assistants and nursepractitioners here in the US,
three different locations and wecontinue to grow off of this
paradigm, this base,understanding that if we can
help our patients breathe betterthrough their nose, that we can
(05:14):
start to really get at thetriggers for the TMJ, much of
the migraine headaches, much ofthe headaches, as well as the
sinus issues that these patientshave.
Dr Andrew Greenland (05:24):
Amazing.
So is your secret sauce thiskind of more holistic approach
to a given problem, or do youhave any specific sort of
techniques which are your secretsauce?
Dr Ryan Vaughn (05:34):
Yeah right, I think that's a great question,
super insightful.
So I really think the secretsauce is what you said in the
former statement there, that itis a holistic approach.
You know, said in the formerstatement there that it is a
holistic approach.
You know, somebody comes in tosee me and, yes, I can really
laser focus on how do we do aminimally invasive nasal surgery
.
But then there's also an extraeffort that is spent.
(05:55):
Well, we know that there's aton of restoration that happens
during sleep, for example, andwe may get a sleep study that
shows some disruptive sleep.
We can put on a CPAP, we can dooral appliance, but what else
is contributing?
What time are you eating?
When's your last meal?
When are you last consumingliquids?
(06:16):
When are you turning screensoff?
What does your bedroom settinglook like?
We're diving into patients'know we're diving into patients
diets.
We're diving into theirsupplements.
We're diving into theirpsychosocial wellness.
All of this understanding gosh.
You know, yes, I can help makea crooked nasal septum straight,
(06:40):
but that's only a small part ofthe puzzle.
Dr Andrew Greenland (06:45):
Amazing.
Is anybody else caught ontothis?
Because it sounds like I mean,I'm very much a holistic
practitioner myself, so Iappreciate the way that you dive
into all these differentaspects of the patient's
lifestyle and their currentproblem.
Is anybody else doing this inthe ENT world?
So-?
To the level you are.
Dr Ryan Vaughn (07:02):
Yeah, right, Like.
So.
This is where, like I've hiredtwo other surgeons and really
trying to mold them into thisway of thinking and
understanding, we are uniqueapproach XL sinus is unique.
There are other folks.
There's one other ENT physicianout in New York that advertises
(07:24):
as a functional ENT.
I have not been able to connectwith her so I don't know
exactly how she's approachingthings.
But to my knowledge, really ourangle of trying to holistically
approach nasal sinus, TMJ andheadaches, I don't see it
anywhere else.
Dr Andrew Greenland (07:44):
I mean, do you think?
I mean how much have you beenable to reduce surgery by using
this approach and notnecessarily have to do something
more?
Interventional, surgical?
Yeah right.
Dr Ryan Vaughn (07:54):
You know I would .
I'd kind of reframe that to say, like, how do you define
surgery In that we can do minorprocedures that are not a big
sign of surgery, and how much doI back somebody off who maybe
needed, if I would have seenthem 10 years ago done a
(08:15):
significant sinus surgeryoperation, and now I can do
something invasive, 80% of thetime, taking somebody who has
you know?
So it's part of this holisticapproach, right?
Like when I was trained wetalked about you know, all the
(08:35):
way back to training.
You have two options forbreathing your mouth or your
nose and I was trained that theywere equivalent, that there's
no advantage to breathingthrough the nose over the mouth.
And we were taught in a way thatsomebody who's complaining of
nasal congestion we'd throwmedicines at them, never really
(08:58):
give much thought to diet andcertainly didn't give a whole
lot of consideration to justlike a functional nasal surgery.
That obviously, as I was out ofresidency and in more private
practice world, was notacceptable.
Patients really wanted betteroptions than just throwing
medications at them, optionsthan just throwing medications
(09:18):
at them.
But sometimes it's not just thenasal septum, right?
And so then the holisticapproach comes like okay, what
could a dentist do where,understanding that the hard
palate is the floor of the nose?
And if we get a thoughtfuldentist who can do a palate
expansion, they can actuallymake a meaningful difference in
some of our patients who haveextremely narrow nasal airways.
(09:48):
It's funny.
It seems very common in mypractice now, but even in the
United States it's not widelyaccepted.
I will interact withorthodontists even within the
last month who quite franklythought that I was crazy talking
about doing expansion on afour-year-old.
Thinking in our thought is okay, let's get this kid the best
nasal airway possible, let's notmove the.
It's not really about movingthe teeth, it's really about
(10:10):
expanding the palate so thatthey can breathe.
And so again back to yourquestion of surgery versus
procedures.
So again back to your questionof surgery versus procedures.
Most of the time when I'mseeing a patient they're getting
some sort of intervention, andthat may be a dietary
(10:34):
intervention, but typically it'sgoing to be something along the
lines of making the nasalairway work better.
Dr Andrew Greenland (10:40):
Interesting .
So what does your typical daylook like at the moment?
I guess you're fairly clinicalhands-on.
You've got your scrubs andeverything on.
How much of it is sort ofmanaging the business and the
sort of strategy side of things.
Dr Ryan Vaughn (10:55):
Yeah, yeah.
So, as my wife says, I work allthe time.
I work five days a weekclinical, so that turns out to
be typically one day a weekdoing a procedure or surgery day
.
Four days a week treatingpatients just clinically in the
(11:16):
office.
Um, the the mornings um are aretypically involved.
I will.
Most mornings I woke, uh, I my.
My pattern is I wake up at sixo'clock pretty much no matter
what's going on for the day.
Um, I start doing some sort ofwork until my wife wakes up, and
then we always have coffee, Iwork out, uh, hang out with my
(11:39):
daughter before she goes toschool and then off to the
office.
So typically they're startingto see patients around 9 am,
seeing patients until about 3.30, and then the afternoon is
where I do most of my businessmeetings, and that's anything
from podcast interviews tosocial media.
We're doing a lot of socialmedia pushes, meeting with the
(12:03):
C-suite folks at our practice,the attorneys, you know,
whatever.
And then I try to limit to onebusiness dinner per week, just
so I'm not away too much.
Yeah, I could fill my schedulewith as much stuff as I want.
I really have a passion forteaching and teaching this stuff
(12:27):
, educating people about whatare minimally invasive.
What's the importance of nasalbreathing, why do we care about
nasal breathing, what are theimpacts of not nasal breathing,
and then what are the minimallyinvasive ways to do that?
So I again try to stop myselfand only do one of these types
(12:48):
of educations per week.
But it's another area ofpassion.
And then that bleeds into thebusiness side of things, where
the more I educate, then themore referrals we get, and and
so it's uh.
It is a uh a cycle where itfeeds itself, um, but it keeps
me energized, uh, that I keepgoing.
You know, when you start doingwhat you love, you just keep
(13:10):
going amazing.
Dr Andrew Greenland (13:12):
So I've been doing a number of these um
interviews and I've been hearinga lot from other private clinic
owners, particularly in the us,around so rising operational
pressures around insurancereimbursements and the rise of
corporate roll ups.
What's your kind of take onthese things?
Dr Ryan Vaughn (13:27):
Yeah, so obviously, to be successful in
running a business, you need to.
The ability to manage a teamcomes from having a good
management team, right?
So I have my finance guy, whojust takes care of the finance
(13:53):
stuff.
I have my operations woman whotakes care of all of the
operations, and really I getinvolved only at the highest
level.
I'm a visionary, long-term, bigpicture type of thinker, and so
then them having all theirroles allows me to really focus
on what the vision can be andneeds to be.
(14:17):
We are in a healthcare modelwhere private insurance pays for
a lot of what we do, and so theprivate insurance side of
things we need to figure out,like, how do we have enough
volume coming through the officein order to keep the lights on?
But, part of this holisticapproach, we can't have high
(14:41):
volume, right?
Like we have to be able tospend 30 to 45 minutes with our
patients to ask them all thesedeep, probing questions and
really get to know them andtheir situation.
So we've incorporated othertherapies and things that can be
going on in the background inorder to have multiple revenue
streams.
So we have a small retailproduct line.
(15:04):
We have ancillary therapies ofred light therapies.
We'll do infrared sauna.
We're bringing in dentistry todo so instead of like referring
out, so then we'll just keepinternal.
(15:25):
So the business side of mybrain is really geared towards
how do we optimize the ancillaryincome that is not so driven by
insurance.
We opened our third location ina different state, and by
opening in a different statethere's just different
regulations, and so in the otherstate we can actually charge
(15:49):
what's called a facility fee,and so by charging a facility
fee it allows us to getreimbursed not only for surgical
and procedural work butactually for the overhead costs
of the equipment.
In the state of Illinois theydon't allow that, and so it's.
You know, clearly the laws ofIllinois were written in such a
(16:14):
way that favors the biggerhospital systems because they
can charge the facility fees.
But if you're a small privateclinic like myself, you cannot,
and so I've had to be creativein adding things to patients,
procedures that allow us to beable to actually cover our costs
, and that's like the idea ofred light, and it really has
(16:38):
been a self-fulfilling cycle, ifyou will.
If I add on an ancillarytreatment that actually has
research backed, I reallybelieve in it, but insurance
isn't going to cover it.
Then we can ask patients to paycash for it, and our population
seems to really understand thebenefits of these types of say
(17:01):
like pick red light therapy.
Um, so then I can add in anancillary treatment through a
procedure got it amazing.
Dr Andrew Greenland (17:10):
Um, what about trends in sleep and ent,
shifting your model from thepoint of view of?
Often, patients are much moreinformed these days.
They've read the internet,they've gone on dr google,
they've gone on Dr Google,they've gone on to chat GPT but
also from the point of view ofperhaps being more fragmented in
their care.
How have these sort of thingsshifted and how do you see them?
Dr Ryan Vaughn (17:29):
Yeah, yeah, I'm going to go to your last point
there, the fragmentation thatyou're absolutely right that
they do start to get fragmented,and I see my role as actually
an unfragmenter and I really tryto bring in whether it's
functional medicine, whether itis dentistry, myofunctional
(17:50):
therapy I don't know if you'refamiliar with that but kind of
like speech therapy, orthodontiaI often will see myself as a
quarterback of okay, I'm goingto try to help kind of fan you
out to like here's each of theareas that you really need in
order to to defragment your care, allowing them to really get
(18:13):
the benefits of treatment.
I spend a tremendous amount oftime, whether it's educating
other providers, but educatingpatients.
Right, so they come in and DrGoogle may have said, okay, so
here's what I know, here's whatI can do.
It's really incredible what youcan find on Google and ChatGPT,
(18:34):
but it's often not the wholepicture.
I just saw a patient thismorning and, based on online
learning, he was able to start abreath program, start a dietary
program.
He was mouth taping.
He's doing everything he can tobreathe through his nose, but
(18:56):
he's still getting sinusinfections and he still has a
deviated septum and so he's likethis guy that we went through a
scan this morning and I'm likeyou know we could send you to an
orthodontist for expansion.
That won't straighten yourseptum but it at least help you
breathe through your nose andunfortunately won't help your
sinus issues.
And so he's a guy back to yourone of your first questions like
(19:17):
we're going to actually do apretty big surgery for him
because that's what he needs.
He's failed everything else andso he's the guy that's going to
start here, but then we willdefragment that stuff.
And how does he do?
Later We'll decide.
We'll determine.
(19:38):
Ok, do we send you to this, oursleep dentist for dental
appliance, or who are the otherancillary folks that we're going
to bring in?
And not everybody needs it, noteverybody wants it.
But it's something that when wefind that patient who really
needs to dive deeper, thatGoogle, chatgpt, youtube
(20:03):
unfortunately just doesn't givethem the ability to really get
as deep as they need to go Gotit.
Dr Andrew Greenland (20:10):
On a similar vein.
I don't know how it is in yourarea, but what's your take on
the rise of telehealth andretail clinics?
I mean, do you see them as athreat or a complement or
something else entirely?
Dr Ryan Vaughn (20:20):
Yeah, yeah, yeah , definitely not a threat.
We're so specialized thatthey're not a threat.
The only threatening part ofthat is that when somebody comes
to whether it's a retail clinicor telehealth complaining of
ear pain and hearing loss,they're likely to be diagnosed
with an ear infection and givenan antibiotic and they may not
(20:43):
need it, and so it's not so mucha threat as much as a I see
really as an opportunity.
I've worked hard to educate alot of the retail clinics around
us in not in any way to bedemeaning, but really not in any
way to be demeaning but reallyan ear examination is really
(21:06):
really difficult and even as anENT doctor accurately diagnosing
middle ear fluid, we're onlyright about 80% of the time, and
so that's all we do is look inears and we're still wrong 20%
of the time.
So the expectation that a nursepractitioner at a retail clinic
can get it right 100% of thetime so the expectation that a
nurse practitioner at a retailclinic can get it right 100% of
the time is just unrealistic.
(21:27):
And so giving them the freedomto say I don't know can be super
empowering.
And then we actually get abunch of referrals from these
centers that say, wow, this guywas actually really nice, taught
me something and I think he'lltake good care of you.
Really nice, taught mesomething and I think he'll take
good care of you.
(21:48):
Telemedicine I actually just Ieducate throughout the United
States we could sayinternationally here and we get
a lot of out-of-state referralsand so I work with whether it's
local ENTs or local dentists, toreview imaging and then do a
telemedicine visit.
And so I do some telemedicinevisits, even in what's
(22:10):
considered kind of a heavyprocedural practice, really
trying to make sure that thesepatients are all optimized.
Because, back to another one ofyour early questions, not many
ENTs really want to do this,they don't really want to dive
into this stuff, they don't wantto think about.
Dr Andrew Greenland (22:32):
TMJ.
Besides, how do I get this TMJpatient out of my practice as
fast as possible?
What would you say is workingreally well for you right now in
terms of your patient care andbusiness operations?
Because you talked a little bitabout how you structure your
business and the various teammembers that you have, but
what's really kind of killing itfor you at the moment?
Dr Ryan Vaughn (22:47):
yeah, yeah.
What business-wise.
What's really killing it isadopting new technology.
So adopting new technology forminimally invasive sinus
procedures has really allowed usto capitalize on doing less for
the patient.
Dr Andrew Greenland (23:09):
Brilliant, so obviously a very high-tech
clinic using all the latestprocedures and everything
Amazing.
And on a similar kind of vein,what's the most frustrating part
of doing what you do?
Do you have any particularbottlenecks or challenges that
you're kind of kind of workingon?
Dr Ryan Vaughn (23:25):
yeah, yeah.
So I'm sitting in our umexpansion satellite clinic out
in rockford, which, um is amedically underserved community,
and in being medicallyunderserved um, it kills me that
.
So we've been in this locationfor less than a year, but trying
(23:51):
to get the traditional internalmedicine doctors and family
practice doctors to understandthe importance of nasal
breathing and that not everypatient with a headache needs to
be put on medications has beena much greater challenge than
I've really expected.
I thought that we'd kind ofwalk in and people would welcome
(24:13):
us with open arms and as we'recoming in and saying let's try
to, I'm capturing a lot of thefringe, if that makes sense, but
I'm struggling to reallycapture the mainstream and so
(24:40):
I'm working hard to figure out.
Is it messaging?
Is it I'm not getting in frontof the right people?
What is it that's limiting myability to really help as many
people as possible?
I understand.
Dr Andrew Greenland (24:54):
How do you see the role of private
speciality care sort of likeyours, but not just exclusively
yours evolving over the nextthree to five years?
So people doing your kind ofniche work, or you work, or a
much more focused approach to aparticular problem?
Dr Ryan Vaughn (25:08):
Yeah, well, I think it depends on what happens
with nationalized healthcare inthe United States.
I don't think it's really goingto change in the next three to
five years, but say that it does.
I think there's going to, and Ithink what we're seeing is just
two pathways, or two tracks, ifyou will.
(25:28):
There's the nationalizedhealthcare track that your
average patient is going to justgo through that track, and then
there's going to be the private, and so I think the
subspecialty niche care clinic,like myself, is going to really
thrive in that secondary track,being independent of national
(25:52):
health care and working on moreof private insurance or cash pay
model.
I think that, like the practicethat I left, is going to have
to adopt more and more nationalhealth care, more and more of
the crummier private insurances,just to stay afloat because
their margins become so thin.
(26:16):
I see more patients becomingeducated about the current
health care system now that youknow.
You see a patient who's, forthe first time in their life,
using US healthcare and they'rejust blown away by how much they
have to pay in order toactually get healthcare and they
thought they had this amazinginsurance policy and they want
(26:36):
to deny half of the proceduresthat the patient needs and so
there's much moredisenfranchisement that's
building within the UnitedStates.
I don't think we're three tofive years away from anything
really changing dramatically.
I think it needs to changedramatically, probably more.
In a time horizon of like 20years I think there'll be major
(27:00):
changes, but three to five yearsI have a feeling it's going to
be basically the same majorchanges but three to five years.
Dr Andrew Greenland (27:07):
I have a feeling it's going to be
basically the same.
Where do you want to be in thenext sort of six to 12 months
with Excel signers?
Is this sort of more growth,new services?
Dr Ryan Vaughn (27:14):
team changes.
All of the above.
All of the above, yeah, yeah,we want more growth.
So we're just opening the doorsto our third location here in a
couple of months, to our thirdlocation here in a couple of
months.
With that, we have other plansfor satellite clinics there and
other major hubs throughdifferent states.
It's really we just hired afriend of mine who used to do
(27:39):
device sales and she's gonnastart doing some like outside
sales for us, of approachingother surgeons, of we could do
this differently, we could dothis together.
Consistently, I meet dentiststhroughout the United States and
the dentists seem to be somethought leaders in how to really
focus on airway and they'refrustrated because they can't
(28:02):
find an ENT doctor that reallyis interested in actually
helping nasal airway, and so I'mworking really hard in the next
12 months to connect with moreENT doctors to teach them not
only the importance of nasalairway but also how to
financially do it in a way thatmakes sense that they can either
(28:23):
be as successful or even moresuccessful just by doing it on
their own.
Brilliant.
Dr Andrew Greenland (28:29):
And if you could solve one big challenge,
what would it be?
And it might be the educationpiece around the doctors, I
don't know, but is thereanything else that you'd like to
solve in your kind of growth?
Dr Ryan Vaughn (28:40):
You know, from a business perspective, it'd be
educating other providers.
From a technical perspective,the challenge that's constantly
in front of me is how do I do aprocedure on somebody and give
them the best, fastest recoverypossible?
And that's where all theseother ancillary things from red
light to saunas to hyperbaricoxygen everything's really
(29:01):
coming into.
What can I do to give somebodythe fastest recovery possible?
Dr Andrew Greenland (29:07):
Okay, amazing.
Ryan, thank you so much foryour time this afternoon.
It's been a really interestingconversation.
Thank you for your insight,your honesty and the depth of
the answers has been reallyfascinating.
I'm sure people are going tofind this an interesting lesson,
but I really appreciate yourtime giving up your time this
afternoon.
Dr Ryan Vaughn (29:22):
My pleasure.
Thanks for inviting me.
Dr Andrew Greenland (29:24):
Thank you.
Dr Ryan Vaughn (29:25):
Take care.
Okay, so welcome back to Voices in Health
and Wellness.
This is the podcast where weexplore the challenges and
innovation shaping the future ofprivate healthcare practice.
Today, I'm excited to welcomeDr Ryan Vaughan, a dual force in
medicine and entrepreneurship.
He's a board-certifiedotolaryngologist and founder of
Exhale Sinus and Facial PainCenter, where his team
(00:23):
specializes in TMJ disorders,sleep and healthcare, and
advanced ENT solutions.
Dr Vaughan brings a unique lensto the conversation, combining
deep clinical expertise with anentrepreneurial mindset to
rethink how specialty care isdelivered in a private
healthcare setting.
If you're a clinic owner,specialist or anyone navigating
the evolving world of healthdelivery, you're going to find
(00:43):
this one insightful.
So, Ryan, thank you so much forjoining us today.
Really appreciate you jumpingon the call.
Dr Ryan Vaughn (00:47):
Yeah, thank you for having me.
Dr Andrew Greenland (00:49):
And where are you calling from?
Just so all our listeners know.
Dr Ryan Vaughn (00:53):
I'm in my satellite office in Rockford
Illinois.
Dr Andrew Greenland (00:56):
Wonderful.
Okay, so I'm in the UK.
Well, nice that this is aglobal thing.
Perhaps we could start off.
Could you share a little bitabout your role and how Exhale
Sinus came to be?
Dr Ryan Vaughn (01:06):
Sure, yeah.
So I trained as a generalotolaryngologist, meaning that I
was seeing anything related tothe ears, nose, mouth, throat,
neck, and was treating anythingfrom birth all the way through
end of life.
Through that process I actuallyhad a couple of patients,
including my own mother, uh, whodeveloped TMJ issues and within
(01:29):
the United States we reallydon't have great, I would say,
worldwide my experience.
Uh, we don't have greattreatment paradigms on how to
manage these TMJ issues.
Um, it became such a passionfor me.
Uh wanted to become singlyfocused on TMJ, tmd and all of
the surrounding things andreally then marrying the idea of
(01:53):
doing minimally invasiveprocedures to help with those
conditions, as well as seeminglyunrelated conditions of nasal
obstruction, sleep disorder,breathing and sinus issues.
And as I started creating moreand more of a treatment paradigm
that was treating TMJ, throughwhat the actual triggers are, I
(02:17):
started realizing, wow, thatmost of these TMJ patients have
nasal obstruction as theirprimary driver of what's
developing their issues and ifwe fix that, sometimes we fix
their whole problem.
Or, conversely, if we don't fixthe nasal obstruction, they can
have less success with thedental therapies that are done.
(02:38):
So at the time that I finishedmy training in residency.
I joined a group and was partof a 10 member group.
I had worked my way up tobecome a partner, tried to do
something just uniquelydifferent in that practice, but
you know, the practice had beenaround for 60 years.
People were very entrenched inhow they wanted to see
(03:02):
healthcare delivered, and sodoing something different just
really didn't fit their model.
Because I was so passionateabout doing something different,
I decided I'm just going toleave that Left behind my
partnership contract and saidI'll walk away from that and
start my own thing, reallytelling my wife that, even if I
(03:28):
never made more money by doingmy own thing, but actually had
more flexibility and freedom,that it was worth it.
So that was February 1st of2020 that I quit my job and
decided to open my own practice.
So then, two weeks later, thepandemic hit and all of
(03:48):
healthcare was shut down.
So 2020 was bumpy, it was rockyand at the same time, though, it
was really an amazing time.
People were more open-minded,patients were coming in to me
more interested in learningabout nasal breathing and nasal
techniques, and I had theopportunity to slow down and
(04:12):
learn some more things.
So, through that kind of bumpystart, it actually was an
amazing gift that I was able toreally dive deep into.
What are the things that we aredoing that are helping our TMJ
and nasal patients, um, what'sworking, what's not working, how
(04:32):
do we set up uh protocols forevaluating success?
How do we Define success, um,and how do we see what's not
working and how do we cut thataway?
So that brings us to today,where I've built out a team.
We have three surgeons, sixmid-level providers we call them
(04:54):
physician assistants and nursepractitioners here in the US,
three different locations and wecontinue to grow off of this
paradigm, this base,understanding that if we can
help our patients breathe betterthrough their nose, that we can
(05:14):
start to really get at thetriggers for the TMJ, much of
the migraine headaches, much ofthe headaches, as well as the
sinus issues that these patientshave.
Dr Andrew Greenland (05:24):
Amazing.
So is your secret sauce thiskind of more holistic approach
to a given problem, or do youhave any specific sort of
techniques which are your secretsauce?
Dr Ryan Vaughn (05:34):
Yeah right, I think that's a great question,
super insightful.
So I really think the secretsauce is what you said in the
former statement there, that itis a holistic approach.
You know, said in the formerstatement there that it is a
holistic approach.
You know, somebody comes in tosee me and, yes, I can really
laser focus on how do we do aminimally invasive nasal surgery
.
But then there's also an extraeffort that is spent.
(05:55):
Well, we know that there's aton of restoration that happens
during sleep, for example, andwe may get a sleep study that
shows some disruptive sleep.
We can put on a CPAP, we can dooral appliance, but what else
is contributing?
What time are you eating?
When's your last meal?
When are you last consumingliquids?
(06:16):
When are you turning screensoff?
What does your bedroom settinglook like?
We're diving into patients'know we're diving into patients
diets.
We're diving into theirsupplements.
We're diving into theirpsychosocial wellness.
All of this understanding gosh.
You know, yes, I can help makea crooked nasal septum straight,
(06:40):
but that's only a small part ofthe puzzle.
Dr Andrew Greenland (06:45):
Amazing.
Is anybody else caught ontothis?
Because it sounds like I mean,I'm very much a holistic
practitioner myself, so Iappreciate the way that you dive
into all these differentaspects of the patient's
lifestyle and their currentproblem.
Is anybody else doing this inthe ENT world?
So-?
To the level you are.
Dr Ryan Vaughn (07:02):
Yeah, right, Like.
So.
This is where, like I've hiredtwo other surgeons and really
trying to mold them into thisway of thinking and
understanding, we are uniqueapproach XL sinus is unique.
There are other folks.
There's one other ENT physicianout in New York that advertises
(07:24):
as a functional ENT.
I have not been able to connectwith her so I don't know
exactly how she's approachingthings.
But to my knowledge, really ourangle of trying to holistically
approach nasal sinus, TMJ andheadaches, I don't see it
anywhere else.
Dr Andrew Greenland (07:44):
I mean, do you think?
I mean how much have you beenable to reduce surgery by using
this approach and notnecessarily have to do something
more?
Interventional, surgical?
Yeah right.
Dr Ryan Vaughn (07:54):
You know I would .
I'd kind of reframe that to say, like, how do you define
surgery In that we can do minorprocedures that are not a big
sign of surgery, and how much doI back somebody off who maybe
needed, if I would have seenthem 10 years ago done a
(08:15):
significant sinus surgeryoperation, and now I can do
something invasive, 80% of thetime, taking somebody who has
you know?
So it's part of this holisticapproach, right?
Like when I was trained wetalked about you know, all the
(08:35):
way back to training.
You have two options forbreathing your mouth or your
nose and I was trained that theywere equivalent, that there's
no advantage to breathingthrough the nose over the mouth.
And we were taught in a way thatsomebody who's complaining of
nasal congestion we'd throwmedicines at them, never really
(08:58):
give much thought to diet andcertainly didn't give a whole
lot of consideration to justlike a functional nasal surgery.
That obviously, as I was out ofresidency and in more private
practice world, was notacceptable.
Patients really wanted betteroptions than just throwing
medications at them, optionsthan just throwing medications
(09:18):
at them.
But sometimes it's not just thenasal septum, right?
And so then the holisticapproach comes like okay, what
could a dentist do where,understanding that the hard
palate is the floor of the nose?
And if we get a thoughtfuldentist who can do a palate
expansion, they can actuallymake a meaningful difference in
some of our patients who haveextremely narrow nasal airways.
(09:48):
It's funny.
It seems very common in mypractice now, but even in the
United States it's not widelyaccepted.
I will interact withorthodontists even within the
last month who quite franklythought that I was crazy talking
about doing expansion on afour-year-old.
Thinking in our thought is okay, let's get this kid the best
nasal airway possible, let's notmove the.
It's not really about movingthe teeth, it's really about
(10:10):
expanding the palate so thatthey can breathe.
And so again back to yourquestion of surgery versus
procedures.
So again back to your questionof surgery versus procedures.
Most of the time when I'mseeing a patient they're getting
some sort of intervention, andthat may be a dietary
(10:34):
intervention, but typically it'sgoing to be something along the
lines of making the nasalairway work better.
Dr Andrew Greenland (10:40):
Interesting .
So what does your typical daylook like at the moment?
I guess you're fairly clinicalhands-on.
You've got your scrubs andeverything on.
How much of it is sort ofmanaging the business and the
sort of strategy side of things.
Dr Ryan Vaughn (10:55):
Yeah, yeah.
So, as my wife says, I work allthe time.
I work five days a weekclinical, so that turns out to
be typically one day a weekdoing a procedure or surgery day
.
Four days a week treatingpatients just clinically in the
(11:16):
office.
Um, the the mornings um are aretypically involved.
I will.
Most mornings I woke, uh, I my.
My pattern is I wake up at sixo'clock pretty much no matter
what's going on for the day.
Um, I start doing some sort ofwork until my wife wakes up, and
then we always have coffee, Iwork out, uh, hang out with my
(11:39):
daughter before she goes toschool and then off to the
office.
So typically they're startingto see patients around 9 am,
seeing patients until about 3.30, and then the afternoon is
where I do most of my businessmeetings, and that's anything
from podcast interviews tosocial media.
We're doing a lot of socialmedia pushes, meeting with the
(12:03):
C-suite folks at our practice,the attorneys, you know,
whatever.
And then I try to limit to onebusiness dinner per week, just
so I'm not away too much.
Yeah, I could fill my schedulewith as much stuff as I want.
I really have a passion forteaching and teaching this stuff
(12:27):
, educating people about whatare minimally invasive.
What's the importance of nasalbreathing, why do we care about
nasal breathing, what are theimpacts of not nasal breathing,
and then what are the minimallyinvasive ways to do that?
So I again try to stop myselfand only do one of these types
(12:48):
of educations per week.
But it's another area ofpassion.
And then that bleeds into thebusiness side of things, where
the more I educate, then themore referrals we get, and and
so it's uh.
It is a uh a cycle where itfeeds itself, um, but it keeps
me energized, uh, that I keepgoing.
You know, when you start doingwhat you love, you just keep
(13:10):
going amazing.
Dr Andrew Greenland (13:12):
So I've been doing a number of these um
interviews and I've been hearinga lot from other private clinic
owners, particularly in the us,around so rising operational
pressures around insurancereimbursements and the rise of
corporate roll ups.
What's your kind of take onthese things?
Dr Ryan Vaughn (13:27):
Yeah, so obviously, to be successful in
running a business, you need to.
The ability to manage a teamcomes from having a good
management team, right?
So I have my finance guy, whojust takes care of the finance
(13:53):
stuff.
I have my operations woman whotakes care of all of the
operations, and really I getinvolved only at the highest
level.
I'm a visionary, long-term, bigpicture type of thinker, and so
then them having all theirroles allows me to really focus
on what the vision can be andneeds to be.
(14:17):
We are in a healthcare modelwhere private insurance pays for
a lot of what we do, and so theprivate insurance side of
things we need to figure out,like, how do we have enough
volume coming through the officein order to keep the lights on?
But, part of this holisticapproach, we can't have high
(14:41):
volume, right?
Like we have to be able tospend 30 to 45 minutes with our
patients to ask them all thesedeep, probing questions and
really get to know them andtheir situation.
So we've incorporated othertherapies and things that can be
going on in the background inorder to have multiple revenue
streams.
So we have a small retailproduct line.
(15:04):
We have ancillary therapies ofred light therapies.
We'll do infrared sauna.
We're bringing in dentistry todo so instead of like referring
out, so then we'll just keepinternal.
(15:25):
So the business side of mybrain is really geared towards
how do we optimize the ancillaryincome that is not so driven by
insurance.
We opened our third location ina different state, and by
opening in a different statethere's just different
regulations, and so in the otherstate we can actually charge
(15:49):
what's called a facility fee,and so by charging a facility
fee it allows us to getreimbursed not only for surgical
and procedural work butactually for the overhead costs
of the equipment.
In the state of Illinois theydon't allow that, and so it's.
You know, clearly the laws ofIllinois were written in such a
(16:14):
way that favors the biggerhospital systems because they
can charge the facility fees.
But if you're a small privateclinic like myself, you cannot,
and so I've had to be creativein adding things to patients,
procedures that allow us to beable to actually cover our costs
, and that's like the idea ofred light, and it really has
(16:38):
been a self-fulfilling cycle, ifyou will.
If I add on an ancillarytreatment that actually has
research backed, I reallybelieve in it, but insurance
isn't going to cover it.
Then we can ask patients to paycash for it, and our population
seems to really understand thebenefits of these types of say
(17:01):
like pick red light therapy.
Um, so then I can add in anancillary treatment through a
procedure got it amazing.
Dr Andrew Greenland (17:10):
Um, what about trends in sleep and ent,
shifting your model from thepoint of view of?
Often, patients are much moreinformed these days.
They've read the internet,they've gone on dr google,
they've gone on Dr Google,they've gone on to chat GPT but
also from the point of view ofperhaps being more fragmented in
their care.
How have these sort of thingsshifted and how do you see them?
Dr Ryan Vaughn (17:29):
Yeah, yeah, I'm going to go to your last point
there, the fragmentation thatyou're absolutely right that
they do start to get fragmented,and I see my role as actually
an unfragmenter and I really tryto bring in whether it's
functional medicine, whether itis dentistry, myofunctional
(17:50):
therapy I don't know if you'refamiliar with that but kind of
like speech therapy, orthodontiaI often will see myself as a
quarterback of okay, I'm goingto try to help kind of fan you
out to like here's each of theareas that you really need in
order to to defragment your care, allowing them to really get
(18:13):
the benefits of treatment.
I spend a tremendous amount oftime, whether it's educating
other providers, but educatingpatients.
Right, so they come in and DrGoogle may have said, okay, so
here's what I know, here's whatI can do.
It's really incredible what youcan find on Google and ChatGPT,
(18:34):
but it's often not the wholepicture.
I just saw a patient thismorning and, based on online
learning, he was able to start abreath program, start a dietary
program.
He was mouth taping.
He's doing everything he can tobreathe through his nose, but
(18:56):
he's still getting sinusinfections and he still has a
deviated septum and so he's likethis guy that we went through a
scan this morning and I'm likeyou know we could send you to an
orthodontist for expansion.
That won't straighten yourseptum but it at least help you
breathe through your nose andunfortunately won't help your
sinus issues.
And so he's a guy back to yourone of your first questions like
(19:17):
we're going to actually do apretty big surgery for him
because that's what he needs.
He's failed everything else andso he's the guy that's going to
start here, but then we willdefragment that stuff.
And how does he do?
Later We'll decide.
We'll determine.
(19:38):
Ok, do we send you to this, oursleep dentist for dental
appliance, or who are the otherancillary folks that we're going
to bring in?
And not everybody needs it, noteverybody wants it.
But it's something that when wefind that patient who really
needs to dive deeper, thatGoogle, chatgpt, youtube
(20:03):
unfortunately just doesn't givethem the ability to really get
as deep as they need to go Gotit.
Dr Andrew Greenland (20:10):
On a similar vein.
I don't know how it is in yourarea, but what's your take on
the rise of telehealth andretail clinics?
I mean, do you see them as athreat or a complement or
something else entirely?
Dr Ryan Vaughn (20:20):
Yeah, yeah, yeah , definitely not a threat.
We're so specialized thatthey're not a threat.
The only threatening part ofthat is that when somebody comes
to whether it's a retail clinicor telehealth complaining of
ear pain and hearing loss,they're likely to be diagnosed
with an ear infection and givenan antibiotic and they may not
(20:43):
need it, and so it's not so mucha threat as much as a I see
really as an opportunity.
I've worked hard to educate alot of the retail clinics around
us in not in any way to bedemeaning, but really not in any
way to be demeaning but reallyan ear examination is really
(21:06):
really difficult and even as anENT doctor accurately diagnosing
middle ear fluid, we're onlyright about 80% of the time, and
so that's all we do is look inears and we're still wrong 20%
of the time.
So the expectation that a nursepractitioner at a retail clinic
can get it right 100% of thetime so the expectation that a
nurse practitioner at a retailclinic can get it right 100% of
the time is just unrealistic.
(21:27):
And so giving them the freedomto say I don't know can be super
empowering.
And then we actually get abunch of referrals from these
centers that say, wow, this guywas actually really nice, taught
me something and I think he'lltake good care of you.
Really nice, taught mesomething and I think he'll take
good care of you.
(21:48):
Telemedicine I actually just Ieducate throughout the United
States we could sayinternationally here and we get
a lot of out-of-state referralsand so I work with whether it's
local ENTs or local dentists, toreview imaging and then do a
telemedicine visit.
And so I do some telemedicinevisits, even in what's
(22:10):
considered kind of a heavyprocedural practice, really
trying to make sure that thesepatients are all optimized.
Because, back to another one ofyour early questions, not many
ENTs really want to do this,they don't really want to dive
into this stuff, they don't wantto think about.
Dr Andrew Greenland (22:32):
TMJ.
Besides, how do I get this TMJpatient out of my practice as
fast as possible?
What would you say is workingreally well for you right now in
terms of your patient care andbusiness operations?
Because you talked a little bitabout how you structure your
business and the various teammembers that you have, but
what's really kind of killing itfor you at the moment?
Dr Ryan Vaughn (22:47):
yeah, yeah.
What business-wise.
What's really killing it isadopting new technology.
So adopting new technology forminimally invasive sinus
procedures has really allowed usto capitalize on doing less for
the patient.
Dr Andrew Greenland (23:09):
Brilliant, so obviously a very high-tech
clinic using all the latestprocedures and everything
Amazing.
And on a similar kind of vein,what's the most frustrating part
of doing what you do?
Do you have any particularbottlenecks or challenges that
you're kind of kind of workingon?
Dr Ryan Vaughn (23:25):
yeah, yeah.
So I'm sitting in our umexpansion satellite clinic out
in rockford, which, um is amedically underserved community,
and in being medicallyunderserved um, it kills me that
.
So we've been in this locationfor less than a year, but trying
(23:51):
to get the traditional internalmedicine doctors and family
practice doctors to understandthe importance of nasal
breathing and that not everypatient with a headache needs to
be put on medications has beena much greater challenge than
I've really expected.
I thought that we'd kind ofwalk in and people would welcome
(24:13):
us with open arms and as we'recoming in and saying let's try
to, I'm capturing a lot of thefringe, if that makes sense, but
I'm struggling to reallycapture the mainstream and so
(24:40):
I'm working hard to figure out.
Is it messaging?
Is it I'm not getting in frontof the right people?
What is it that's limiting myability to really help as many
people as possible?
I understand.
Dr Andrew Greenland (24:54):
How do you see the role of private
speciality care sort of likeyours, but not just exclusively
yours evolving over the nextthree to five years?
So people doing your kind ofniche work, or you work, or a
much more focused approach to aparticular problem?
Dr Ryan Vaughn (25:08):
Yeah, well, I think it depends on what happens
with nationalized healthcare inthe United States.
I don't think it's really goingto change in the next three to
five years, but say that it does.
I think there's going to, and Ithink what we're seeing is just
two pathways, or two tracks, ifyou will.
(25:28):
There's the nationalizedhealthcare track that your
average patient is going to justgo through that track, and then
there's going to be the private, and so I think the
subspecialty niche care clinic,like myself, is going to really
thrive in that secondary track,being independent of national
(25:52):
health care and working on moreof private insurance or cash pay
model.
I think that, like the practicethat I left, is going to have
to adopt more and more nationalhealth care, more and more of
the crummier private insurances,just to stay afloat because
their margins become so thin.
(26:16):
I see more patients becomingeducated about the current
health care system now that youknow.
You see a patient who's, forthe first time in their life,
using US healthcare and they'rejust blown away by how much they
have to pay in order toactually get healthcare and they
thought they had this amazinginsurance policy and they want
(26:36):
to deny half of the proceduresthat the patient needs and so
there's much moredisenfranchisement that's
building within the UnitedStates.
I don't think we're three tofive years away from anything
really changing dramatically.
I think it needs to changedramatically, probably more.
In a time horizon of like 20years I think there'll be major
(27:00):
changes, but three to five yearsI have a feeling it's going to
be basically the same majorchanges but three to five years.
Dr Andrew Greenland (27:07):
I have a feeling it's going to be
basically the same.
Where do you want to be in thenext sort of six to 12 months
with Excel signers?
Is this sort of more growth,new services?
Dr Ryan Vaughn (27:14):
team changes.
All of the above.
All of the above, yeah, yeah,we want more growth.
So we're just opening the doorsto our third location here in a
couple of months, to our thirdlocation here in a couple of
months.
With that, we have other plansfor satellite clinics there and
other major hubs throughdifferent states.
It's really we just hired afriend of mine who used to do
(27:39):
device sales and she's gonnastart doing some like outside
sales for us, of approachingother surgeons, of we could do
this differently, we could dothis together.
Consistently, I meet dentiststhroughout the United States and
the dentists seem to be somethought leaders in how to really
focus on airway and they'refrustrated because they can't
(28:02):
find an ENT doctor that reallyis interested in actually
helping nasal airway, and so I'mworking really hard in the next
12 months to connect with moreENT doctors to teach them not
only the importance of nasalairway but also how to
financially do it in a way thatmakes sense that they can either
(28:23):
be as successful or even moresuccessful just by doing it on
their own.
Brilliant.
Dr Andrew Greenland (28:29):
And if you could solve one big challenge,
what would it be?
And it might be the educationpiece around the doctors, I
don't know, but is thereanything else that you'd like to
solve in your kind of growth?
Dr Ryan Vaughn (28:40):
You know, from a business perspective, it'd be
educating other providers.
From a technical perspective,the challenge that's constantly
in front of me is how do I do aprocedure on somebody and give
them the best, fastest recoverypossible?
And that's where all theseother ancillary things from red
light to saunas to hyperbaricoxygen everything's really
(29:01):
coming into.
What can I do to give somebodythe fastest recovery possible?
Dr Andrew Greenland (29:07):
Okay, amazing.
Ryan, thank you so much foryour time this afternoon.
It's been a really interestingconversation.
Thank you for your insight,your honesty and the depth of
the answers has been reallyfascinating.
I'm sure people are going tofind this an interesting lesson,
but I really appreciate yourtime giving up your time this
afternoon.
Dr Ryan Vaughn (29:22):
My pleasure.
Thanks for inviting me.
Dr Andrew Greenland (29:24):
Thank you.
Dr Ryan Vaughn (29:25):
Take care.
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