November 4, 2024 • 28 mins
Welcome to another insightful episode of Nurses With Voices. In this episode, we have the pleasure of speaking with Dr. Alejandro Badia, a renowned hand and upper extremity orthopedic surgeon, author, and healthcare entrepreneur. Dr. Badia is the founder of OrthoNow, a network dedicated to providing timely and specialized orthopedic urgent care, bypassing traditional inefficiencies in the healthcare system.
In this episode, we delve into Dr. Badia's journey in addressing systemic healthcare challenges, from the difficulties faced by OrthoNow in engaging communities and scaling up, to his experiences with franchising and the bureaucratic hurdles that slow down patient care. We'll also discuss his book, "Healthcare from the Trenches," which calls for systemic change and awareness, and explore the broader issues within the U.S. healthcare system, including the pivotal role of nurses and the often-overlooked contributions they make.
Join us for an engaging conversation that highlights the need for public advocacy, the impact of media focus, and Dr. Badia's vision for a more efficient and collaborative healthcare future.
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00:00 Ortho offers specialized urgent care with app.
03:23 Alandra's solution struggles with gaining broader engagement.
09:25 Clinicians should authorize procedures, not insurance companies.
11:00 Healthcare cottage industries strain financial resources.
14:43 Microsurgery at Bellevue poorly paid, discussed publicly.
18:06 Discuss frustrations openly to inspire grassroots change.
22:00 Mandatory tests despite medical necessity concerns.
23:41 Dangerous surgeon halted; skilled spine surgeons unrecognized.
28:00 Clinicians must collaborate, engage, share, and market.
29:34 Thanks for coming; stay inspired and empowered.
Takeaways
Dr. Badia founded OrthoNow to address patient access issues.
The healthcare system often leads patients to unnecessary stops.
Engagement from the community is crucial for growth.
Authorization processes create significant barriers to care.
The healthcare system is burdened by non-clinical decision-makers.
Collaboration among healthcare providers is essential.
Public awareness and advocacy are needed for change.
The pandemic accelerated the writing of Dr. Badia's book.
Healthcare professionals must share their experiences to drive change.
The future of healthcare requires a collective effort to improve.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Welcome back to another episode of Nurses with Voices. I'm your host,
Dr. Lendra James, DNP, RN and today
I have Dr. Alejandro Badia. Dr. Alejandro
Badilla is a hand and upper extremity orthopedic surgeon.
He's an author and healthcare entrepreneur and he's the
founder of Ortho now, the first network of
(00:26):
orthopedic walk in centers. And this has helped to address
the frustrations of patients having to wait
and seek timely and expert musculoskeletal
care. He's also the author of the book Healthcare from the
Trenches, which provides an honest examination of the
underlying causes of inefficiencies. Excuse me, in
(00:48):
the US Health care system. The work from this
book later inspired his podcast, Fixing
Healthcare from the Trenches. And I just love that.
So where during in the podcast, Dr. Badia
invites healthcare leaders and other experts to discuss the challenges
and potential solutions for improving the US healthcare system.
(01:09):
So, Dr. Badia, I'm so sorry.
Welcome. Thank you. Thank you. Thanks for having me
on, Linda. It's going to take things like this
to really make a change because it's tough as you know. It is.
It really, really, really is. And, you know, and again, thank you for being
here and for sharing your expertise. And I
(01:31):
love Ortho Now. I want to start there and talk about that
and the patient experience. So what? Ortho now
was created to provide patients with timely and specialized
musculoskeletal care. Can you share the biggest challenges
you face in establishing this network and how it has impacted
patient outcomes compared to traditional healthcare settings?
(01:53):
Yeah, it's actually an easy question. Let's start with how it impacts
healthcare. If you think the average person has
an experience with some orthopedic injury or more importantly,
pain. Right. So it's orthopedic urgent care, but we don't even use that
tagline. So the bottom line is, you know, 80% of human beings have, for
example, severe back pain at one point in their life. In fact,
(02:15):
I threw out my back two days ago. Now I'm an orthopedist, so I knew
I didn't need to go somewhere. But the average
patient will go, say, to an emergency room, which is
way too complex for something like that. Right. It's not a, you know,
not a femur fracture. Many patients now go to urgent
cares, which are a great addition to our health care system, but
(02:37):
they don't have the expertise, so you end up actually making
additional stops. What Ortho now does is tries
to disrupt that by saying there is a Walk in
place that we have an app you can call an Uber or lift.
In the app you can tell us when you're on your way. You can send
a picture of your swollen ankle or, and, and then
(02:59):
you're being seen by somebody who actually knows orthopedics.
Many times they will resolve it or if it needs
somebody like me, they'll send a ortho
chat, which is a dialogue, HIPAA
compliant with, with the X rays, MRI images,
etc, to then for that person
(03:20):
subspecialist to then resolve the problem. So it is
an obvious solution to a big, big issue,
the problem. The challenges Alandra has been engagement, whether it be
from the community, our municipal leaders,
our chambers of
commerce, which alleged to help businesses, right? They all come
(03:42):
together to network, but we bring this to them and they're like, oh, that that's
a nice idea. And that's it. So very little has
changed. We've grown organically because if you look at our
reviews and you look at, you know, even social media, you see, wow,
people actually have positive comments. But, but that's not a
way to grow a business. So our challenge has been getting big entities,
(04:04):
you know, whether it be gyms and CrossFit. My own kids
school, my own kids private school, very expensive,
has been very difficult to get them to engage in this, which is an
obvious thing. You don't have to be a rocket science to
understand the advantages. So. So that has been the challenge. But I'm happy
to announce, and you're only the second podcast I announce this
(04:26):
on, that we are in due diligence with a
company that will help us grow because I'm still a busy
surgeon. So we should be closing the transaction
in the next month. So you'll be hearing a lot more about ortho now,
hopefully in your community. Awesome. Awesome. That's
amazing. It's amazing and it's interesting when you
(04:48):
talk about the struggles and the challenges that it takes. But I'm so glad to
hear that, you know, that's going to shortly be behind you because I think once
people see the impact and what it can actually do, it
only takes, you know, it only takes one, right? It only
takes one. Yes. And the rest is history. So I
love that, I love that. Yeah, we're getting there. But it's been a 14 year
(05:09):
journey. Now. I have to say that Ortho now at first I made the mistake
that when people got interested, I franchised it and I thought
that my colleagues would engage because they're busy surgeons and say, you know
what? I'D like to have, let's say, you know, a pipeline for patients
who need me, but if they don't need me, I'm still, you know, making that
income instead of the general urgent care. Right. No.
(05:31):
The problem with our own colleagues and I talk about this in chapter four of
our book is it's very hard to get collaboration.
I say that it all started organic chemistry, sophomore year in
college. The competition starts, but I tell my
colleagues, we got to stop competing because the
insurers and the big healthcare systems are all killing
(05:54):
us because they know that we don't collaborate.
And while you mention that, I want to switch gears and talk about your
book. Right. So your book, Healthcare from the
Trenches, and it's not really switching gears, is really segwaying,
I should say. It really offers a unique insider's
(06:15):
perspective on US Healthcare, on the US Healthcare system. Right.
Can you tell us what inspired you to write this
book? What was the message you were hoping to
convey? Well, a little bit similar to founding Ortho now.
I was frustrated. I. I guess, you know, they say
entrepreneurs are born, not made. I have no idea where I got this
(06:36):
from. There's nobody in my family who's like this. And it's kind of a
curse, to be honest. I see a problem, I want to fix it.
You know, I, you know, I'm driving, traffic lights aren't aligned. I'm like, I want.
Who can I call to get this fixed? Right. Right. We all, we all have
that. The difference, I think, with an entrepreneur is they take it one step
farther. And in healthcare, that's very difficult. And that's why I
(06:58):
kind of called it a curse. In fact, My tagline in LinkedIn is
Reluctant Healthcare entrepreneur. Because it, you
know, I, I almost wish I could just put my head down and just be
a surgeon because that, that I think I'm good at. I don't think I'm necessarily
a good businessman, to be very blunt. So why did
I write the book? Same reason I started Ortho now, I, I saw a
(07:21):
need. So the need, fourth on Al, was as a hand
surgeon. Every patient seeing me has been to two or three places,
and they, they didn't fix the problem. They're not expected to because they
don't have the knowledge. But. But it also sucks money out
of system because then their insurance company all paid
for those multiple stops. Right. I wanted to.
(07:43):
To. That was symbolic to me about what's happening in our US Health care
system. And I wanted to tell the story to patients
from the trenches, from Somebody who's not, you know, a big academician,
not somebody who's a bureaucrat, not somebody who works, you know, in a health. Because
those are the people who are out there talking, you know, you, you, you know,
I, I don't really care what Blue Cross, Blue Shield executive says
(08:06):
about health care. They're not awake like you and I are,
Andrew, at three in the morning. Right. Trying to save a patient.
Right, right. They're not, let's be, let's be very blunt.
So the message needs to come from people like us. So that's why
in the book, I have 26 contributors. There's nurses,
there's therapists, there's even a hospital CEO of
(08:29):
an orthopedic hospital who understands, like
everyone, that we need to fix it. So that
was the reason for the book. And I had started preparing it mainly
with the contributors, but my portion is about 90% of
it. And I hadn't written mine. I had all the ideas.
And then when the pandemic hit, bam, I wrote it in
(08:52):
10 weeks. Here's a book. So it's 460 pages.
I literally wrote this in 10 weeks.
Wow. Wow. You know, when you talk about
the challenges in the UF healthcare system in your
book, you highlight the complex behaviors that
both providers and patients face. Right. In the. Within
(09:15):
the healthcare system. Could you elaborate on some of the
most significant challenges that you observed as
a practicing orthopedic surgeon? Yes, I
think all clinicians. And this, this will include
nurses, techs who do studies, that there is
this ridiculous barrier called authorization.
(09:38):
And I know, and thank God, and I, you know, I'd like to say I
have a humble little part in helping changes. But I think there is some
movement, as even the insurance companies are realizing, my God, we spend
a lot of time and money on this. Who is the best person to
authorize a procedure or study
the clinician, whether it be a nurse practitioner, a pa,
(09:59):
an allopathic physician or osteopathic physician, we have
the expertise and training. Why should somebody at a desk
at an insurance company be putting these hurdles?
And guess what? That hurdle costs money. That person
isn't not working. They have a salary,
benefits, including ironically, health insurance. Right.
(10:22):
So they are standing in a way. So I would say that is the
biggest impediment to streamlining our health care system
because it delays care. It often leads somebody to
say, maybe you has an early malignancy to now have, you know, a stage
three cancer. Or in my case,
I can give you plenty of examples where somebody, you know,
(10:44):
comes and sees me and months later, by the time I get to do what
I need to do, the problem is more advanced, that
that is a pervasive problem in our system and that that would be the one
thing I would change and that. That involves getting the middlemen out of the
way. Right. So I just wrote an article that'll. That'll come
out if I could get the popular media to care. That's the
(11:05):
problem. I just wrote an article that basically talks about
the cottage industries and healthcare, all these people that you get
right in your LinkedIn box and you're who. Who want to, you know,
offer all these little services, but they're not free. I'm
thinking that's, you know, that's smart, but we don't
really need it. Right, right. And we need it because we created
(11:28):
this bureaucracy and little by little, as Medicare cuts
us every single year, you know, two and a half, 3%, there
isn't that margin to now pay all these people to be
ascribed to help me, I don't know, make sure
there isn't cancellations of appointments in my office. I mean,
I have my staff, I pay. Do I need an outside agency to do
(11:50):
that? It's really a. So that's. That article will be
coming out and you know, my biggest challenge, just like ortho now, is just getting
engagement that an interest. You know, if I, if I put
something with a cute, I don't know, in social media, put somebody, a cute kitten
or I'm in Miami, a sexy girl. Why does that get thousands of likes
and share and yet I put something that affects us every day
(12:13):
and yeah, you know, maybe one person shares it.
1. You know, we're gonna reach an. I can't
breathe. And I hate to bring up another societal issue, but
really. Yeah, let's go for it. When are we going to reach
our I can't breathe moment? When. When some bad cops cause
some really good social change. And yet in
(12:35):
healthcare, people, you know, can't get an MRI
because their insurance company doesn't approve it. When are people going to get outraged? I
don't want them to burn cars or break windows, but I'd
like to see some outrage in the public. Absolutely. And
I completely agree. And I hear what you're saying, because the people who are approving
or denying these services a lot of times are not
(12:58):
clinicians and that aren't. Lendra, you don't. They usually are
not. They're not. And that's what's scary. Right. And to
your point, we're allowing disease Processes to go on for too long.
And so I love your energy and I love your passion behind it. And you're
right, there does need to be more, there needs to be more of a fight
and more advocacy behind this so that the people understand
(13:20):
how they are affected. You know, it shouldn't take. Like today I was
watching GMA and Halle Berry was on and
she was talking about menopause. Right. And you
know, but now everyone's grabbing, has the attention because
it takes Halle Berry to talk about it and it shouldn't. You get what
I'm saying? Yes. Like it, this should be something that people understand that
(13:42):
affects their day to day. And it's not until they're sick is when they
realize that there's a problem here with our healthcare system. But
you're right. Why does it take a celebrity to bring that,
you know, enhanced surgery? I remember and a colleague of
mine did, did the reattachment basically of his. It wasn't
completely amputee, but he had something called a ring avulsion. Okay. And that
(14:05):
I get confused with the two late night talk show hosts. I
still think they're the same person. But what are the two guys
that. Oh, what's their names? Who was who that
night? Jimmy Kimball. Yeah. And then the other one, Jimmy
Fallon. Is it Jimmy Fallon? Okay. Yes, Jimmy
Fallon. So he had an injury and he actually, he did something I thought was
(14:27):
very admirable. He talked about his injury comes out. I saw the tapings.
I, I don't watch as much, you know, that stuff as I used to. So
I, I saw the taping of, of. And he
invited his hand surgeon. He had his finger. I, I believe is
that, I believe it was at Bellevue, which was, which. Yes, it was at Bellevue,
which was where I trained. So it's a big micro, you know, we do a
(14:47):
lot of microsurgery at that big city hospital in New York. And
he invited his, his surgeon, Dave Chu, who's a
friend and colleague of mine, to come out on the show and talk
about this. And I thought, wow, you know, we've been doing microsurgery and
reattaching digits and really complex stuff that's poorly
reimbursed, by the way. And I hate that term, poorly paid, I should say. Why,
(15:09):
why is it reimbursed? Not reimbursed. It's paid. Right. Poorly
paid for, you know, being all night under the microscope to do
this. But he invited the surgeon out and
I thought, and he told the story and I thought that's awesome. But it was
a Little frustrating that why does it take a celebrity to bring attention to
these? So maybe Lender, you and I can work together and that
(15:31):
whoever's listening, and I'm hoping that whoever's listening will
share your excellent podcasts. Because liking
it doesn't help us. Right, right. It's, you know, that, you know, that
just helps, you know, our egos. Right,
right. No, it's to your point. And this is why we do this. Right. And
this is the nurses with voices. Right. Healthcare workers. And this is why,
(15:54):
you know, we need to talk. There needs to be more education. It needs to
be more discussions around these topics. And you know,
like I said, not just when something happens to a celebrity or you
know, when you see it on happening to someone with a big name. We need
to understand because it affects us. Right. Every day
we. I want. So what I hope is
(16:15):
that somebody who's watching this or my podcast, which I will say
has been frustrating because again, the modest amount of engagement
with something and I've had some incredible guests. I mean, I've had the only
practicing surgeon in the U.S. congress, Greg Murphy
from North Carolina. Your hood. Right,
Right. Yeah. I mean, this guy
(16:37):
came on and I'm like, why isn't there more shares and more
or more challenges? I'd love somebody to say, hey, I don't agree
with you, Doctor. And that would be refreshing.
Right, right, right, right. You know, at least, because when I get
comments and when people say I actually I, I take the good
comments and I take the other because it tells me that you're listening. Right.
(17:00):
And that's what I want. I want thought provoking because now I just provoke the
thought. And then Linda, one of those people watching may have
a friend who's a columnist in the New York Times
or, or something like that. It actually moves a needle or
Forbes. And then they say, my God, why haven't we
written about this? I mean, this is a pervasive problem in our society.
(17:22):
Authorization by a non medical person literally telling a
doctor or a nurse that okay, you can, you can do
that treatment. Right. I mean. Right. I honestly think a
decade from now we're going to look back and we're going to say, boy, we
were, we were idiots in our society. I
mean, who thought it is the. Way everything is changing, especially
(17:44):
with AI. So it's like you just, it's so many unknowns as
what's going to go on and what's going to happen. With that said,
what advice would you, would you give to your fellow healthcare providers?
Right. Who are struggling with the challenges that you've
described. And how can they navigate these
issues while providing the best possible care to their patients? Well,
(18:07):
look, we all, we all go through this, right? So it's not. There isn't
an easy solution. It is what it is. Like I mentioned, I think there is
some positive change, but the most important is talk about
it. And most people now are on some type of social media and it
doesn't cost anything. So all it is is talk about this
and let's get something from a groundswell, you know, from,
(18:29):
you know, we can call it from the trenches or, or, you know, from,
from grassroots efforts, but we have to talk about this so
that we can get change because we're all experiencing the frustration.
But, but it, I call it an issue
on a micro level, not a macro level. Everybody will talk about
this. Your own family. Oh, I can't, I can't get this test or something
(18:52):
because I'm waiting for the approval from the insurance company. The insurance
company. My understanding. And it was like this really
kind of when I first went to practice in the 90s, the insurance
company is supposed to collect
premiums, right? And healthy people like me. I just had a big heart
study yesterday that I had to pay for. But I'm, thank God, I'm perfect. But
(19:13):
I paid for it. Of course, Humana did. It isn't going to pay a cent,
literally or not. But if we, but, but what?
I pay Humana and everybody else pays Humana. We put that
together, then there's money to actually pay for
the services, right? But we, they, they waste
so much money. System waste so much money on avoiding the
(19:35):
payment. And it wasn't like that many years ago. Insurance companies did very
well and their goal was to collect premiums and pay
out, not to actually practice or interfere with health
care. Now I want to make a comment. I do this every two
weeks on, on the podcast. We do need oversight, right,
Landra? You know, there's, there's bad apples in healthcare and in every
(19:58):
other profession. So you need oversight. I don't mind that. And if
I'm, as an upper limb surgeon, if every person comes to my
office is being booked for shoulder arthroscopy. Wait
a second. Let's. Let's look under the hood with Dr. Badia. And
I think as physicians, we would welcome that, except the bad
players. But why are, why are the majority of
(20:20):
clinicians who are practicing good medicine, why are. Do we have all
these interference? So what I would say to answer your question is
people listening. Your colleagues My colleagues talk about this,
talk about it, and, And. And. And try to figure out a way to bring
this to the public. You know, I wrote this for the public, and,
and, and, you know, it's not
(20:44):
like it's not on the bestseller list. Right. But I will say I want to
make the announcement that literally 72 hours ago, it
went live on audio, so you can find it
on Google Books. It was very difficult. I had to get the
manuscript. Yeah, it was very difficult because I actually had to get
my IT people involved. It was very difficult, Very challenging to
(21:05):
get the book. The manuscript on Google Books. But once it was there, AI.
And you could pick the voice, and then if it's
really successful, I may decide to take, you know, four or five days
and read it myself and put it as an audio book. But. But
I. The guy has a nicer voice than me, so I. I'm
hoping. But again, I have to see engagement, you know. Yeah, I'm
(21:27):
sure with you with your podcast, if you see that people aren't
really listening or comment or sharing or. Then you get to the
point where I go, what am I doing with my one hour of time? Right,
right, right, right, right, right. Yeah. Because it's all to make a difference. It really,
really is. And it's funny that you bring up, you know, oversight
(21:48):
very on or. I think I was probably still in nursing school, and I worked
for this doctor's office, and he used to.
Everyone had to have. And he was a cardiologist, so everyone
had to have a stress test. A stress
test and an echocardiogram. Like every. I think it was every
six months or whenever they were due for, like,
(22:09):
whenever the insurance company would pay for it, everyone had to have it. So whether
it was indicated or not, everyone had
to have one. It was a stress test, an EKG in an echocardiogram.
And, you know, he actually got audited eventually. And we would be
in the office and we would be saying, like, when is someone going to. Finally
going to, you know, going to audit this guy? Because there was, like,
(22:31):
no indication for. But everyone was, you know, being ordered these
tests. So to your point, yes, there does need to be some
oversight. However, that's the. That's the
exception and not the rule. Right. It's one of those things where. Thank
you. That's exactly the point. And that's why we do need the oversight, but we
don't need the constant interference. Right, right, right.
(22:52):
That is the. That is the problem. That's. Yeah,
that's the problem. So, I mean, in my book, I talk about malpractice,
for example, and that's the bane of every doctor, right? Because most, let's face it,
a lot of its lawsuits are frivolous, right? You don't have. You don't have a
good outcome. You know, I tell my patients, you know, thank God I'm only
a hand surgeon, but I have friends who are oncologists, and guess what? Some of
(23:14):
their patients die, and he died a miserable death. Does that
mean that they should be sued? Does that mean. Right. They're not a good
oncologist. So. Right. But, but, but there are bad apples,
right? So we, we all know the media, of course, plays up, you know, Dr.
Death. There's actually two of them now, but the original Dr. Death was
a guy who was in jail for the rest of his life, who was a
(23:35):
neurosurgeon, who was just an atrocious spine
surgeon. And he had. He. He maimed many people,
paralyzed. Some people died on the OR table or post
op, and he should have been stopped. And this was in Texas.
And the hospitals were afraid of being sued
because we're limiting his ability. And thank God it
(23:58):
was for a vascular surgeon on one of the hospitals who said, enough
is enough, enough is enough. But I'd love to talk about all the
incredible spine surgeons around the country who do
things that get people back to functioning or back. But you
know, that's not really talked about. That's not exactly. Exactly.
And you know what's funny? I actually recently met the good nurse. The nurse
(24:21):
who. Because there was. There were. They made a movie about it about
the. The nurse who was going around injecting insulin into
people's fluids and everything. And I actually recently met
the good nurse at a. She was at a nursing summit.
And to your point, it's. You know,
I almost. I didn't know who she was at first, and. But everyone knows
(24:43):
now. Yeah, everyone does now. Right. And I didn't know who she was at first,
but those are the things that grab attention, right? Those are the
things that. When, you know, because you were, you know, you helped take a serial
killer down. However, what about the nurses who
have just. Every day. And it's so funny, right? When we,
During COVID we were heroes, you know, they had pictures of nurses with
(25:06):
capes and. Yeah. You know, and
now, you know, we're just nurses. It was. Thank you for your service,
and I'd. Love to understand why that is. Maybe some of your
listeners have some insight. Why do we think that is? Is that because
people's you know, in terms of news cycles, you know,
news now. I mean, people. That's why it's hard to get people to read my
(25:26):
book. Right. They want, they want everything in bytes, but not
everything can be in sound bites. Yeah,
I'd like to see somebody discuss that because the nurses are still
doing a job. They're still, you know, there with you at three or four in
the morning, you know, when you're in pain or when you need something.
And yet, you know, we're not talking about that.
(25:49):
Right. And we're not talking about that. Where do you see the future of health
care going in the US and are you optimistic in the
direction that is heading? I tend to be optimistic.
I get that, I don't know, from my parents, I guess, might, you know, I
made the big mistake of letting my dad manage my brokerage account many
years ago and he always thought it would go up. So, you know, you can't,
(26:11):
you know, you can't do that with stocks. Right. But in terms of health care,
I, I'm
cautiously optimistic. I think that we have to get
the middleman out of the way and that is going to be a
challenge. If we can do that. Absolutely. But that is going to
require the public being, you know,
(26:34):
outraged about this. Maybe a celebrity being
denied. But that's not going to happen. Right. A celebrity being being denied
a test or a surgery for a month because they're waiting for somebody to put
a little piece of paper, you know, a little, A number on a little piece
of paper. Right. That, that is what's going to
take. So I'm, I'm hopeful, but I will
(26:56):
confess I've lost a little bit of my mojo lately
there because I, you know, same reason I
mentioned before. I mean, my, my podcast, I've had some incredible guests and
I keep it short. Right. 15 to 20 minutes. Right,
right, right. The attention span. I get that. You know, we're, we're busier for
some reason. Right, right, right. But even then. So I haven't done
(27:19):
it a while, but people like you actually inspire me. So I, I'm gonna think
of my next guest and start up again. Yeah, there you
go. Yeah, I'm on episode 37 or something, so I've been doing
it for a year and a half, but I think I'll start
again. So thank you. Yeah, absolutely. Well, good. I'm glad I can inspire you,
Dr. Medea. Really. And, you know, I have to be honest with you. You know,
(27:41):
when I saw, I saw your book, I was like, I need to speak with
him. I need to speak with him. So as we wrap
up, is there one key takeaway that you want to, you
know, really share with the listeners to remember maybe from your,
from your book or from this conversation? Yeah,
I think that we have to, clinicians have to collaborate. I may, I
(28:04):
may give a different takeaway if it was mostly the public, but because of
your audience, I would love that
Nurses listening, other clinicians, some public
talk about this. That means really sharing your podcast, but commenting
on it and engaging. And I think
that is the one takeaway I'd like to see. Yeah, I'd love for them
(28:28):
to. I mean, the book doesn't make any money, of course, but, but I'd love
to see more of sales at ad and then I can show you on my
shelf here, the books I read to be more educated to
write mine. And then I, and I keep reading afterwards and I
wonder how those books, now, some of them do have
a lot of readers and I'm not sure what that takes. I,
(28:50):
I, one thing I'd like with my book is to maybe try to get maybe
a publishing house that has the marketing engine to
make this of interest. Oh, you know, we should
definitely, we. Should be in the trenches. Yeah, I'm in a trench. You know, I'm
thinking about my, you know, the, the, you know, the two of
international. I, I operate on a lot of international patients. Right.
(29:12):
And so I'm thinking about that every week because they fly in for
me. And honestly, that's my priority, I have to
say. Yeah, I love to change the health care system, but my
priority really is each and every one of my patients where I operate on anywhere
from their fingertip to their shoulder. That is what I love.
That's really what I'm good at. Right. The other part is just
(29:33):
hope. Gotcha. Gotcha. Well, listen, thank
you so much for coming on and sharing your expertise with
everyone into the listeners. Until next time. Next time, everyone
make sure that you stay inspired, stay educated, and stay
empowered. Thank you.
Welcome back to another episode of Nurses with Voices. I'm your host,
Dr. Lendra James, DNP, RN and today
I have Dr. Alejandro Badia. Dr. Alejandro
Badilla is a hand and upper extremity orthopedic surgeon.
He's an author and healthcare entrepreneur and he's the
founder of Ortho now, the first network of
(00:26):
orthopedic walk in centers. And this has helped to address
the frustrations of patients having to wait
and seek timely and expert musculoskeletal
care. He's also the author of the book Healthcare from the
Trenches, which provides an honest examination of the
underlying causes of inefficiencies. Excuse me, in
(00:48):
the US Health care system. The work from this
book later inspired his podcast, Fixing
Healthcare from the Trenches. And I just love that.
So where during in the podcast, Dr. Badia
invites healthcare leaders and other experts to discuss the challenges
and potential solutions for improving the US healthcare system.
(01:09):
So, Dr. Badia, I'm so sorry.
Welcome. Thank you. Thank you. Thanks for having me
on, Linda. It's going to take things like this
to really make a change because it's tough as you know. It is.
It really, really, really is. And, you know, and again, thank you for being
here and for sharing your expertise. And I
(01:31):
love Ortho Now. I want to start there and talk about that
and the patient experience. So what? Ortho now
was created to provide patients with timely and specialized
musculoskeletal care. Can you share the biggest challenges
you face in establishing this network and how it has impacted
patient outcomes compared to traditional healthcare settings?
(01:53):
Yeah, it's actually an easy question. Let's start with how it impacts
healthcare. If you think the average person has
an experience with some orthopedic injury or more importantly,
pain. Right. So it's orthopedic urgent care, but we don't even use that
tagline. So the bottom line is, you know, 80% of human beings have, for
example, severe back pain at one point in their life. In fact,
(02:15):
I threw out my back two days ago. Now I'm an orthopedist, so I knew
I didn't need to go somewhere. But the average
patient will go, say, to an emergency room, which is
way too complex for something like that. Right. It's not a, you know,
not a femur fracture. Many patients now go to urgent
cares, which are a great addition to our health care system, but
(02:37):
they don't have the expertise, so you end up actually making
additional stops. What Ortho now does is tries
to disrupt that by saying there is a Walk in
place that we have an app you can call an Uber or lift.
In the app you can tell us when you're on your way. You can send
a picture of your swollen ankle or, and, and then
(02:59):
you're being seen by somebody who actually knows orthopedics.
Many times they will resolve it or if it needs
somebody like me, they'll send a ortho
chat, which is a dialogue, HIPAA
compliant with, with the X rays, MRI images,
etc, to then for that person
(03:20):
subspecialist to then resolve the problem. So it is
an obvious solution to a big, big issue,
the problem. The challenges Alandra has been engagement, whether it be
from the community, our municipal leaders,
our chambers of
commerce, which alleged to help businesses, right? They all come
(03:42):
together to network, but we bring this to them and they're like, oh, that that's
a nice idea. And that's it. So very little has
changed. We've grown organically because if you look at our
reviews and you look at, you know, even social media, you see, wow,
people actually have positive comments. But, but that's not a
way to grow a business. So our challenge has been getting big entities,
(04:04):
you know, whether it be gyms and CrossFit. My own kids
school, my own kids private school, very expensive,
has been very difficult to get them to engage in this, which is an
obvious thing. You don't have to be a rocket science to
understand the advantages. So. So that has been the challenge. But I'm happy
to announce, and you're only the second podcast I announce this
(04:26):
on, that we are in due diligence with a
company that will help us grow because I'm still a busy
surgeon. So we should be closing the transaction
in the next month. So you'll be hearing a lot more about ortho now,
hopefully in your community. Awesome. Awesome. That's
amazing. It's amazing and it's interesting when you
(04:48):
talk about the struggles and the challenges that it takes. But I'm so glad to
hear that, you know, that's going to shortly be behind you because I think once
people see the impact and what it can actually do, it
only takes, you know, it only takes one, right? It only
takes one. Yes. And the rest is history. So I
love that, I love that. Yeah, we're getting there. But it's been a 14 year
(05:09):
journey. Now. I have to say that Ortho now at first I made the mistake
that when people got interested, I franchised it and I thought
that my colleagues would engage because they're busy surgeons and say, you know
what? I'D like to have, let's say, you know, a pipeline for patients
who need me, but if they don't need me, I'm still, you know, making that
income instead of the general urgent care. Right. No.
(05:31):
The problem with our own colleagues and I talk about this in chapter four of
our book is it's very hard to get collaboration.
I say that it all started organic chemistry, sophomore year in
college. The competition starts, but I tell my
colleagues, we got to stop competing because the
insurers and the big healthcare systems are all killing
(05:54):
us because they know that we don't collaborate.
And while you mention that, I want to switch gears and talk about your
book. Right. So your book, Healthcare from the
Trenches, and it's not really switching gears, is really segwaying,
I should say. It really offers a unique insider's
(06:15):
perspective on US Healthcare, on the US Healthcare system. Right.
Can you tell us what inspired you to write this
book? What was the message you were hoping to
convey? Well, a little bit similar to founding Ortho now.
I was frustrated. I. I guess, you know, they say
entrepreneurs are born, not made. I have no idea where I got this
(06:36):
from. There's nobody in my family who's like this. And it's kind of a
curse, to be honest. I see a problem, I want to fix it.
You know, I, you know, I'm driving, traffic lights aren't aligned. I'm like, I want.
Who can I call to get this fixed? Right. Right. We all, we all have
that. The difference, I think, with an entrepreneur is they take it one step
farther. And in healthcare, that's very difficult. And that's why I
(06:58):
kind of called it a curse. In fact, My tagline in LinkedIn is
Reluctant Healthcare entrepreneur. Because it, you
know, I, I almost wish I could just put my head down and just be
a surgeon because that, that I think I'm good at. I don't think I'm necessarily
a good businessman, to be very blunt. So why did
I write the book? Same reason I started Ortho now, I, I saw a
(07:21):
need. So the need, fourth on Al, was as a hand
surgeon. Every patient seeing me has been to two or three places,
and they, they didn't fix the problem. They're not expected to because they
don't have the knowledge. But. But it also sucks money out
of system because then their insurance company all paid
for those multiple stops. Right. I wanted to.
(07:43):
To. That was symbolic to me about what's happening in our US Health care
system. And I wanted to tell the story to patients
from the trenches, from Somebody who's not, you know, a big academician,
not somebody who's a bureaucrat, not somebody who works, you know, in a health. Because
those are the people who are out there talking, you know, you, you, you know,
I, I don't really care what Blue Cross, Blue Shield executive says
(08:06):
about health care. They're not awake like you and I are,
Andrew, at three in the morning. Right. Trying to save a patient.
Right, right. They're not, let's be, let's be very blunt.
So the message needs to come from people like us. So that's why
in the book, I have 26 contributors. There's nurses,
there's therapists, there's even a hospital CEO of
(08:29):
an orthopedic hospital who understands, like
everyone, that we need to fix it. So that
was the reason for the book. And I had started preparing it mainly
with the contributors, but my portion is about 90% of
it. And I hadn't written mine. I had all the ideas.
And then when the pandemic hit, bam, I wrote it in
(08:52):
10 weeks. Here's a book. So it's 460 pages.
I literally wrote this in 10 weeks.
Wow. Wow. You know, when you talk about
the challenges in the UF healthcare system in your
book, you highlight the complex behaviors that
both providers and patients face. Right. In the. Within
(09:15):
the healthcare system. Could you elaborate on some of the
most significant challenges that you observed as
a practicing orthopedic surgeon? Yes, I
think all clinicians. And this, this will include
nurses, techs who do studies, that there is
this ridiculous barrier called authorization.
(09:38):
And I know, and thank God, and I, you know, I'd like to say I
have a humble little part in helping changes. But I think there is some
movement, as even the insurance companies are realizing, my God, we spend
a lot of time and money on this. Who is the best person to
authorize a procedure or study
the clinician, whether it be a nurse practitioner, a pa,
(09:59):
an allopathic physician or osteopathic physician, we have
the expertise and training. Why should somebody at a desk
at an insurance company be putting these hurdles?
And guess what? That hurdle costs money. That person
isn't not working. They have a salary,
benefits, including ironically, health insurance. Right.
(10:22):
So they are standing in a way. So I would say that is the
biggest impediment to streamlining our health care system
because it delays care. It often leads somebody to
say, maybe you has an early malignancy to now have, you know, a stage
three cancer. Or in my case,
I can give you plenty of examples where somebody, you know,
(10:44):
comes and sees me and months later, by the time I get to do what
I need to do, the problem is more advanced, that
that is a pervasive problem in our system and that that would be the one
thing I would change and that. That involves getting the middlemen out of the
way. Right. So I just wrote an article that'll. That'll come
out if I could get the popular media to care. That's the
(11:05):
problem. I just wrote an article that basically talks about
the cottage industries and healthcare, all these people that you get
right in your LinkedIn box and you're who. Who want to, you know,
offer all these little services, but they're not free. I'm
thinking that's, you know, that's smart, but we don't
really need it. Right, right. And we need it because we created
(11:28):
this bureaucracy and little by little, as Medicare cuts
us every single year, you know, two and a half, 3%, there
isn't that margin to now pay all these people to be
ascribed to help me, I don't know, make sure
there isn't cancellations of appointments in my office. I mean,
I have my staff, I pay. Do I need an outside agency to do
(11:50):
that? It's really a. So that's. That article will be
coming out and you know, my biggest challenge, just like ortho now, is just getting
engagement that an interest. You know, if I, if I put
something with a cute, I don't know, in social media, put somebody, a cute kitten
or I'm in Miami, a sexy girl. Why does that get thousands of likes
and share and yet I put something that affects us every day
(12:13):
and yeah, you know, maybe one person shares it.
1. You know, we're gonna reach an. I can't
breathe. And I hate to bring up another societal issue, but
really. Yeah, let's go for it. When are we going to reach
our I can't breathe moment? When. When some bad cops cause
some really good social change. And yet in
(12:35):
healthcare, people, you know, can't get an MRI
because their insurance company doesn't approve it. When are people going to get outraged? I
don't want them to burn cars or break windows, but I'd
like to see some outrage in the public. Absolutely. And
I completely agree. And I hear what you're saying, because the people who are approving
or denying these services a lot of times are not
(12:58):
clinicians and that aren't. Lendra, you don't. They usually are
not. They're not. And that's what's scary. Right. And to
your point, we're allowing disease Processes to go on for too long.
And so I love your energy and I love your passion behind it. And you're
right, there does need to be more, there needs to be more of a fight
and more advocacy behind this so that the people understand
(13:20):
how they are affected. You know, it shouldn't take. Like today I was
watching GMA and Halle Berry was on and
she was talking about menopause. Right. And you
know, but now everyone's grabbing, has the attention because
it takes Halle Berry to talk about it and it shouldn't. You get what
I'm saying? Yes. Like it, this should be something that people understand that
(13:42):
affects their day to day. And it's not until they're sick is when they
realize that there's a problem here with our healthcare system. But
you're right. Why does it take a celebrity to bring that,
you know, enhanced surgery? I remember and a colleague of
mine did, did the reattachment basically of his. It wasn't
completely amputee, but he had something called a ring avulsion. Okay. And that
(14:05):
I get confused with the two late night talk show hosts. I
still think they're the same person. But what are the two guys
that. Oh, what's their names? Who was who that
night? Jimmy Kimball. Yeah. And then the other one, Jimmy
Fallon. Is it Jimmy Fallon? Okay. Yes, Jimmy
Fallon. So he had an injury and he actually, he did something I thought was
(14:27):
very admirable. He talked about his injury comes out. I saw the tapings.
I, I don't watch as much, you know, that stuff as I used to. So
I, I saw the taping of, of. And he
invited his hand surgeon. He had his finger. I, I believe is
that, I believe it was at Bellevue, which was, which. Yes, it was at Bellevue,
which was where I trained. So it's a big micro, you know, we do a
(14:47):
lot of microsurgery at that big city hospital in New York. And
he invited his, his surgeon, Dave Chu, who's a
friend and colleague of mine, to come out on the show and talk
about this. And I thought, wow, you know, we've been doing microsurgery and
reattaching digits and really complex stuff that's poorly
reimbursed, by the way. And I hate that term, poorly paid, I should say. Why,
(15:09):
why is it reimbursed? Not reimbursed. It's paid. Right. Poorly
paid for, you know, being all night under the microscope to do
this. But he invited the surgeon out and
I thought, and he told the story and I thought that's awesome. But it was
a Little frustrating that why does it take a celebrity to bring attention to
these? So maybe Lender, you and I can work together and that
(15:31):
whoever's listening, and I'm hoping that whoever's listening will
share your excellent podcasts. Because liking
it doesn't help us. Right, right. It's, you know, that, you know, that
just helps, you know, our egos. Right,
right. No, it's to your point. And this is why we do this. Right. And
this is the nurses with voices. Right. Healthcare workers. And this is why,
(15:54):
you know, we need to talk. There needs to be more education. It needs to
be more discussions around these topics. And you know,
like I said, not just when something happens to a celebrity or you
know, when you see it on happening to someone with a big name. We need
to understand because it affects us. Right. Every day
we. I want. So what I hope is
(16:15):
that somebody who's watching this or my podcast, which I will say
has been frustrating because again, the modest amount of engagement
with something and I've had some incredible guests. I mean, I've had the only
practicing surgeon in the U.S. congress, Greg Murphy
from North Carolina. Your hood. Right,
Right. Yeah. I mean, this guy
(16:37):
came on and I'm like, why isn't there more shares and more
or more challenges? I'd love somebody to say, hey, I don't agree
with you, Doctor. And that would be refreshing.
Right, right, right, right. You know, at least, because when I get
comments and when people say I actually I, I take the good
comments and I take the other because it tells me that you're listening. Right.
(17:00):
And that's what I want. I want thought provoking because now I just provoke the
thought. And then Linda, one of those people watching may have
a friend who's a columnist in the New York Times
or, or something like that. It actually moves a needle or
Forbes. And then they say, my God, why haven't we
written about this? I mean, this is a pervasive problem in our society.
(17:22):
Authorization by a non medical person literally telling a
doctor or a nurse that okay, you can, you can do
that treatment. Right. I mean. Right. I honestly think a
decade from now we're going to look back and we're going to say, boy, we
were, we were idiots in our society. I
mean, who thought it is the. Way everything is changing, especially
(17:44):
with AI. So it's like you just, it's so many unknowns as
what's going to go on and what's going to happen. With that said,
what advice would you, would you give to your fellow healthcare providers?
Right. Who are struggling with the challenges that you've
described. And how can they navigate these
issues while providing the best possible care to their patients? Well,
(18:07):
look, we all, we all go through this, right? So it's not. There isn't
an easy solution. It is what it is. Like I mentioned, I think there is
some positive change, but the most important is talk about
it. And most people now are on some type of social media and it
doesn't cost anything. So all it is is talk about this
and let's get something from a groundswell, you know, from,
(18:29):
you know, we can call it from the trenches or, or, you know, from,
from grassroots efforts, but we have to talk about this so
that we can get change because we're all experiencing the frustration.
But, but it, I call it an issue
on a micro level, not a macro level. Everybody will talk about
this. Your own family. Oh, I can't, I can't get this test or something
(18:52):
because I'm waiting for the approval from the insurance company. The insurance
company. My understanding. And it was like this really
kind of when I first went to practice in the 90s, the insurance
company is supposed to collect
premiums, right? And healthy people like me. I just had a big heart
study yesterday that I had to pay for. But I'm, thank God, I'm perfect. But
(19:13):
I paid for it. Of course, Humana did. It isn't going to pay a cent,
literally or not. But if we, but, but what?
I pay Humana and everybody else pays Humana. We put that
together, then there's money to actually pay for
the services, right? But we, they, they waste
so much money. System waste so much money on avoiding the
(19:35):
payment. And it wasn't like that many years ago. Insurance companies did very
well and their goal was to collect premiums and pay
out, not to actually practice or interfere with health
care. Now I want to make a comment. I do this every two
weeks on, on the podcast. We do need oversight, right,
Landra? You know, there's, there's bad apples in healthcare and in every
(19:58):
other profession. So you need oversight. I don't mind that. And if
I'm, as an upper limb surgeon, if every person comes to my
office is being booked for shoulder arthroscopy. Wait
a second. Let's. Let's look under the hood with Dr. Badia. And
I think as physicians, we would welcome that, except the bad
players. But why are, why are the majority of
(20:20):
clinicians who are practicing good medicine, why are. Do we have all
these interference? So what I would say to answer your question is
people listening. Your colleagues My colleagues talk about this,
talk about it, and, And. And. And try to figure out a way to bring
this to the public. You know, I wrote this for the public, and,
and, and, you know, it's not
(20:44):
like it's not on the bestseller list. Right. But I will say I want to
make the announcement that literally 72 hours ago, it
went live on audio, so you can find it
on Google Books. It was very difficult. I had to get the
manuscript. Yeah, it was very difficult because I actually had to get
my IT people involved. It was very difficult, Very challenging to
(21:05):
get the book. The manuscript on Google Books. But once it was there, AI.
And you could pick the voice, and then if it's
really successful, I may decide to take, you know, four or five days
and read it myself and put it as an audio book. But. But
I. The guy has a nicer voice than me, so I. I'm
hoping. But again, I have to see engagement, you know. Yeah, I'm
(21:27):
sure with you with your podcast, if you see that people aren't
really listening or comment or sharing or. Then you get to the
point where I go, what am I doing with my one hour of time? Right,
right, right, right, right, right. Yeah. Because it's all to make a difference. It really,
really is. And it's funny that you bring up, you know, oversight
(21:48):
very on or. I think I was probably still in nursing school, and I worked
for this doctor's office, and he used to.
Everyone had to have. And he was a cardiologist, so everyone
had to have a stress test. A stress
test and an echocardiogram. Like every. I think it was every
six months or whenever they were due for, like,
(22:09):
whenever the insurance company would pay for it, everyone had to have it. So whether
it was indicated or not, everyone had
to have one. It was a stress test, an EKG in an echocardiogram.
And, you know, he actually got audited eventually. And we would be
in the office and we would be saying, like, when is someone going to. Finally
going to, you know, going to audit this guy? Because there was, like,
(22:31):
no indication for. But everyone was, you know, being ordered these
tests. So to your point, yes, there does need to be some
oversight. However, that's the. That's the
exception and not the rule. Right. It's one of those things where. Thank
you. That's exactly the point. And that's why we do need the oversight, but we
don't need the constant interference. Right, right, right.
(22:52):
That is the. That is the problem. That's. Yeah,
that's the problem. So, I mean, in my book, I talk about malpractice,
for example, and that's the bane of every doctor, right? Because most, let's face it,
a lot of its lawsuits are frivolous, right? You don't have. You don't have a
good outcome. You know, I tell my patients, you know, thank God I'm only
a hand surgeon, but I have friends who are oncologists, and guess what? Some of
(23:14):
their patients die, and he died a miserable death. Does that
mean that they should be sued? Does that mean. Right. They're not a good
oncologist. So. Right. But, but, but there are bad apples,
right? So we, we all know the media, of course, plays up, you know, Dr.
Death. There's actually two of them now, but the original Dr. Death was
a guy who was in jail for the rest of his life, who was a
(23:35):
neurosurgeon, who was just an atrocious spine
surgeon. And he had. He. He maimed many people,
paralyzed. Some people died on the OR table or post
op, and he should have been stopped. And this was in Texas.
And the hospitals were afraid of being sued
because we're limiting his ability. And thank God it
(23:58):
was for a vascular surgeon on one of the hospitals who said, enough
is enough, enough is enough. But I'd love to talk about all the
incredible spine surgeons around the country who do
things that get people back to functioning or back. But you
know, that's not really talked about. That's not exactly. Exactly.
And you know what's funny? I actually recently met the good nurse. The nurse
(24:21):
who. Because there was. There were. They made a movie about it about
the. The nurse who was going around injecting insulin into
people's fluids and everything. And I actually recently met
the good nurse at a. She was at a nursing summit.
And to your point, it's. You know,
I almost. I didn't know who she was at first, and. But everyone knows
(24:43):
now. Yeah, everyone does now. Right. And I didn't know who she was at first,
but those are the things that grab attention, right? Those are the
things that. When, you know, because you were, you know, you helped take a serial
killer down. However, what about the nurses who
have just. Every day. And it's so funny, right? When we,
During COVID we were heroes, you know, they had pictures of nurses with
(25:06):
capes and. Yeah. You know, and
now, you know, we're just nurses. It was. Thank you for your service,
and I'd. Love to understand why that is. Maybe some of your
listeners have some insight. Why do we think that is? Is that because
people's you know, in terms of news cycles, you know,
news now. I mean, people. That's why it's hard to get people to read my
(25:26):
book. Right. They want, they want everything in bytes, but not
everything can be in sound bites. Yeah,
I'd like to see somebody discuss that because the nurses are still
doing a job. They're still, you know, there with you at three or four in
the morning, you know, when you're in pain or when you need something.
And yet, you know, we're not talking about that.
(25:49):
Right. And we're not talking about that. Where do you see the future of health
care going in the US and are you optimistic in the
direction that is heading? I tend to be optimistic.
I get that, I don't know, from my parents, I guess, might, you know, I
made the big mistake of letting my dad manage my brokerage account many
years ago and he always thought it would go up. So, you know, you can't,
(26:11):
you know, you can't do that with stocks. Right. But in terms of health care,
I, I'm
cautiously optimistic. I think that we have to get
the middleman out of the way and that is going to be a
challenge. If we can do that. Absolutely. But that is going to
require the public being, you know,
(26:34):
outraged about this. Maybe a celebrity being
denied. But that's not going to happen. Right. A celebrity being being denied
a test or a surgery for a month because they're waiting for somebody to put
a little piece of paper, you know, a little, A number on a little piece
of paper. Right. That, that is what's going to
take. So I'm, I'm hopeful, but I will
(26:56):
confess I've lost a little bit of my mojo lately
there because I, you know, same reason I
mentioned before. I mean, my, my podcast, I've had some incredible guests and
I keep it short. Right. 15 to 20 minutes. Right,
right, right. The attention span. I get that. You know, we're, we're busier for
some reason. Right, right, right. But even then. So I haven't done
(27:19):
it a while, but people like you actually inspire me. So I, I'm gonna think
of my next guest and start up again. Yeah, there you
go. Yeah, I'm on episode 37 or something, so I've been doing
it for a year and a half, but I think I'll start
again. So thank you. Yeah, absolutely. Well, good. I'm glad I can inspire you,
Dr. Medea. Really. And, you know, I have to be honest with you. You know,
(27:41):
when I saw, I saw your book, I was like, I need to speak with
him. I need to speak with him. So as we wrap
up, is there one key takeaway that you want to, you
know, really share with the listeners to remember maybe from your,
from your book or from this conversation? Yeah,
I think that we have to, clinicians have to collaborate. I may, I
(28:04):
may give a different takeaway if it was mostly the public, but because of
your audience, I would love that
Nurses listening, other clinicians, some public
talk about this. That means really sharing your podcast, but commenting
on it and engaging. And I think
that is the one takeaway I'd like to see. Yeah, I'd love for them
(28:28):
to. I mean, the book doesn't make any money, of course, but, but I'd love
to see more of sales at ad and then I can show you on my
shelf here, the books I read to be more educated to
write mine. And then I, and I keep reading afterwards and I
wonder how those books, now, some of them do have
a lot of readers and I'm not sure what that takes. I,
(28:50):
I, one thing I'd like with my book is to maybe try to get maybe
a publishing house that has the marketing engine to
make this of interest. Oh, you know, we should
definitely, we. Should be in the trenches. Yeah, I'm in a trench. You know, I'm
thinking about my, you know, the, the, you know, the two of
international. I, I operate on a lot of international patients. Right.
(29:12):
And so I'm thinking about that every week because they fly in for
me. And honestly, that's my priority, I have to
say. Yeah, I love to change the health care system, but my
priority really is each and every one of my patients where I operate on anywhere
from their fingertip to their shoulder. That is what I love.
That's really what I'm good at. Right. The other part is just
(29:33):
hope. Gotcha. Gotcha. Well, listen, thank
you so much for coming on and sharing your expertise with
everyone into the listeners. Until next time. Next time, everyone
make sure that you stay inspired, stay educated, and stay
empowered. Thank you.
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