148 "Physicians Are Bad Business People" And The MedikalPreneur Author Who Says That’s A Lie

This week on Inside Reproductive Health, Griffin hosts MedikalPreneur author, board-certified REI and OBGYN, and Inside Reproductive Health fan-favorite, Dr. Francisco (Paco) Arredondo to discuss the misguided concepts of physicians as business owners and operators, and what it takes to make it as both a healthcare provider as well as a successful proprietor. https://medikalpreneur.com/product/medikalpreneur/

Listen to hear:

•  Dr. Arredondo’s 5 H’s for hiring success.

• Griffin point out that doctors can get away with bad business techniques because their trade is so high in demand.

• Griffin press on the tension between employee satisfaction and client retention, and question who really comes first, and why it matters.

• How much culture influences business success, and what to ask yourself about your own clinic operations.

• Dr. Arredondo’s crash course in business success as a practicing physician.

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Transcript

Griffin Jones  00:03

physicians are lousy business people. That's what some people say about you. So do you often say about yourselves and talking about how you don't get business training in medical school? There's one entrepreneur in the medical space, a physician that you're familiar with, because I've been on the show so many darn times Dr. Francisco Arredondo starting a new practice, again, has been involved in other ventures. Like I said, Last time on the show, I didn't even know that he was on the main board or that he had started his foundation, because he's an entrepreneur, and he's doing so many different things. And he has a book called MedikalPreneur and we explore what he calls this myth that physicians are lousy business people, and you know, me, I tend to be at least sometimes I'm an extreme centrist. So I don't think it's a complete myth. But I also think that it's something that people on the business side say to cover up for us being sucky business people sometimes. I think that there is a crutch that physicians are able to lean on that most business people cannot because you're so skilled and in demand professionals, but that does impact when you're building an entrepreneurial venture. Now you're competing against entrepreneurial ventures. So we go through the book, MedikalPreneur, we talk about negotiation, hiring, accounting. The reasons to be medical are newer the management and accountability chart. So please enjoy my guest again, Dr. Francisco Arredondo talking about MedikalPreneur, Dr. Arredondo Paco. Welcome back to Inside reproductive health now your fourth time on the show? Yeah. So you're busy, because the first time I think it was, it was probably almost two years ago. And year and a half ago, maybe that was about when you were starting to come up with the concept for MedikalPreneu  And you were you were starting to lay out the book, then you came on to talk about what it was like to own and sell a business, then you were on recently to talk about training OBGYN. But now we're talking about the book itself. It is written, it's published, I've got a physical copy in my hand, right here. It's called MedikalPreneur, The Official Guidebook for Physician Success in Business. And I'm gonna read the intro of why I wrote this book. This is you saying why you wrote the book, I wanted to change the mentality as well as the mythology that physicians are lousy business people, physicians can be great entrepreneurs, they just don't know it. So why don't you talk a little bit about why this book and the case that you're making in this book? Yeah,

Dr. Francisco Arredondo  03:03

well, it is. Just thank you very much for the invitation once more, and I'm really happy to see that the show has been growing in audience and, and a lot of talk among all our colleagues. So it seems like people are listening to the show. So I grew up, always hearing that physicians were lousy entrepreneurs or lousy business people. And in a sense, I did believe that. And perhaps because I did believe that I started studying more and learning more, and I have always liked to learn and read things outside medicine. But then, as I became an entrepreneur and start developing our own ventures, I realized that the software of the mind that it's required to be a good entrepreneur, and actually, the hardware is already there. I mean, that we have as a physician, very solid basis to be great business people and entrepreneurs, especially in the third millennium in the 21st century.

Griffin Jones  04:28

So I think that the operative word in your intro is that physicians can be great entrepreneurs. I don't know if you're arguing that they are great entrepreneurs. I don't really think you are in the book. I think you're saying they can be great entrepreneurs and here's the framework for them to think about it. I don't know if it's a myth, but I do anyway. The axiom that physicians are lousy business people is too broad to be accurate for me and what I mean by that is, I think that it's often an excuse for other business people to use that myth as an excuse for not creating enough value. Yeah, everybody in the field says it. So for all you doctors walking by the people in the booths, all the people in those booths are saying that physicians are lousy business people, they say it all the time. I hear it all the time. I said it early on, and then I started correcting myself for two reasons. One, as a business person, you always have to put the onus back on yourself. So if I'm saying a bit, because basically what I'm saying is my customer doesn't know what they want. And that's, that's a telltale sign of a lousy business person, that would mean that I'm a lousy business person. But more specifically, I think this is where it gets kind of accurate, is that I think, I think that physicians and sub specialty sub specialists who are in demand are like skilled trades, people that can often get away with bad habits, in business that many business people cannot. So like, a, an REI, there's 1100 of you in the country, as you've talked about on the show several times, we're serving a fraction of the population that could be served. We have a shortage of electricians, we have a shortage of plumbers, if I need to get my toilet fixed. It doesn't matter if my plumber stinks that most of the aspects of a business, there are that few of them, and I need one right now. And so I think that I think that there are a lot of things that that physicians can get away with that that many businesses cannot because they're so in demand because they're so the the licensure and the knowledge required for their craft is so high that like Domino's Pizza can't do that, because everybody can sell pizza. So Domino's has to be a really are Papa John's has to be a really sharply run business. How would you respond to that?

Dr. Francisco Arredondo  06:57

No, I think you are totally correct. And, and we become a little bit less discipline, because fortunately, our industry has general healthcare is generous, is becoming less generous in the margins and everything. But it traditionally has been very generous. But I would say two things regarding the premise of why I do agree with you that nobody's trained as a business person or intrapreneur. But that I mentioned the book, the difference between hardware and software. And in hardware in the 21st century, in the third millennium, whoever does business just to make money is out of the gate, you actually have to look at the money as the bypass product of the end. And the end is to add value, to create a solution for a problem and the money will come in. So if you think about it, physicians are very good at listening to a problem trying to figure it out, diagnosing and creating a solution to physicians are very good at reading patterns, which is indispensable for business. They are very hard workers, which is indispensable for a good success in business. They actually we make decisions with imperfect information, which is essential for business. We have all the hard work, the good ethics, the intention, the good intention to solve problems. We just require a little bit of discipline and business discipline, but even with our quote unquote bad discipline, because we don't learn it in school, which is changing fortunately. I think that if you look in statistics, if you have 100 business that open today, I believe this that takes us and they're more accurate than the book. It's like 50% cancer, you know, they're they're done in one year, by the third year like 75%, and very few survive more than five years. Less than 10% Something like that. When have you seen that a doctor closes their office. Very rare.

Griffin Jones  09:47

So even if that's what I mean, though, Pacos the rest of us are faced with that sword of Damocles and I see that more as evidence of they don't have to be as entrepreneurial There's that in demand and where the rest of us are dealing with that reality. Nobody's like, oh, we need more marketers out there, I really need to craft a niche I need to, to develop the firm itself. And and I think that because marketing firms do close, and they do follow that pattern that you just described, and because practices don't follow that, I think that's what gets lets them get away with bad habits.

Dr. Francisco Arredondo  10:31

Yeah, there is no way no question that there is, in general, as a physician, a demand is by issue that is in your favor. I believe that by 2050, we're going to have like 40,000 shortage of physicians in the United States, because also the medical schools are not producing enough. So yeah, I do think that there is an element of that. However, I do think that physicians have a lot of the capabilities in there is another very important distinction to make, that there is in the book doesn't address these from the name, but there is a different software that you need for being a good manager, or an intrapreneur. And sometimes, these are actually counter intuitive, they're an opposite. Because an intrapreneur entails that you're going to create new ideas that you're going to take risks that you're going to fail, that you're going to innovate. And actually, to be a good manager implies that you have to be very good at consistency, very good at precision, very good at repetition. So having navigate both sides, it is it is very important as a physician, a medical professional to understand my role right now is as an intrapreneur. So I have to innovate, I have to think out of the box, I have to break some rules, if you may, I have to. And then when you create the idea and implement it, now you have to be a good manager. And you see it even I see it right now in our industry, where you'd have great entrepreneurs out there that come up with great ideas, but then they don't know how to handle the the boat, there are great architects of thinking ideas, but they don't have the ability to do the boat. So it's an important concept that I think we need to think that there are different software's, it's no different than being a very good clinician, and then a good division director, you're required different skills. Also, so being a good teacher, and being a good clinician is different skills. And here in business, the intrapreneur is different than the manager. There are some overlap skills, but

Griffin Jones  13:31

there can be there. There are some people who are really good but what you're talking about as entrepreneurs tend to be higher in trade openness, and managers tend to be a little bit lower in trade openness, managers might or actually meet entrepreneurs might be lower on trait conscientiousness managers tend to be higher and trait consciousness of course, takers, yeah, you can find some overlap, but often they are different profiles. And so let's talk about that a bit about why someone would want to do this, you give three reasons to be a med of a MedikalPreneurr, off the top of my head, it's freedom, prosperity, and flipping open a page 41 and satisfaction and fulfilment. And so, talk about what in on what MedikalPreneur  has access to why does it matter have access to more of those things than an employee, let's say the freedom, infinite potential for prosperity and helping people and satisfaction and fulfilment.

Dr. Francisco Arredondo  14:38

Well, I think that the, the freedom is obvious because you construct your own destiny, and you define and choose who your teammates, you define and you control your engine under your time, so there is a lot of control and independence that you get with that. Now, as you know, being yourself an intrapreneur, to me is that when you say that you really have to love what you do, because in a sense, you're doing it 24 hours a day. So when I say free domain, it means that, that you, you love what you do, otherwise, you wouldn't do it. Because we are thinking in the in the enterprise 24 hours a day, obviously, we need the brakes, and it's very good to have the detachment from from reality. So that is the now when you're an employee, you have the the security of a paycheck, you have the security of a umbrella and somebody else to do other things for you. But I think that intrapreneurship is not for everybody. And management is not for everybody. But you have a limited amount of things that you can explore outside of what you were trained to do. It is it is certainly limited in in that sense.

Griffin Jones  16:24

Yeah, let's talk a little bit more about that chair. Because I think that's a great way of describing the freedoms that entrepreneurs have you if I was an employee for someplace, I can't just say we're starting a podcast tomorrow, I could potentially pitch that to bosses. But this is what I wanted to explore. And the different areas of business that I've wanted, if I were just a salesman, I probably wouldn't have studied finance as much as I have as an entrepreneur. And so our business owner, and so that's part of where entrepreneurs really, I think do have more freedom. Now, we should probably talk about the flip side of that, which is the the transition from from the transition to owning a business from being owned by the business is the great struggle that every entrepreneur signs up for. And many of us, many of them don't make it to that other side of really owning the business as opposed to it owning you everything that happens in the business is in is at some point down the line, a cause of the limitations of the entrepreneur, if something happens in my business, it's my fault, it doesn't matter if it's a junior copywriter that writes something, you know, that's under my creative direction, it's, it's some if, even if it's someone else's responsible for it, it's either a process I didn't put in place, or I didn't properly coach the person to put that in place. Or I'm flawed as a recruiter that I can't get the right people or I'm flawed as salesmen that I can't sell fast enough to afford the right people faster. Yeah, everything is the fault of the entrepreneur at the end of the day, and you never get to just blame somebody else. And that, that doesn't feel like freedom to a lot of people.

Dr. Francisco Arredondo  18:13

Yeah, you have 100% Be curious responsibility and be curious liability of a lot of the things. But that also gives you you know, when you have a lot of successes that you know, you will not be able to do and just by yourself, you also harvest those. So it is it is a balance in the sense that you accomplish things that you know perfectly well that that you will not be able to do them otherwise, I think there is a there is a balance and and as an entrepreneur, you like those risks.

Griffin Jones  18:53

Let's talk about some of the the problems that people are signing up to solve and then what that's like in today's hiring landscape. So you talk about in the book that their problem is our problem to solve it like a customer service attitude. Can you talk about how you implemented that in practice originally?

Dr. Francisco Arredondo  19:17

Well, one of the things is in I don't know if you and I have different views here on this on Iran, but but a lot of people and especially a lot of the companies and a lot of the people with the business savvy have sold the idea to certain physicians that oh, we want you only to do medicine, we will take care of the rest. That is the biggest nonsense of all time. Why? It is proven scientifically in a lot of the studies. That for example, whenever you Separate the clinical from the administrative. Actually, you start committing more mistakes. For example, there is a reason why are the two biggest and most successful medical centers in the world are the three if you may, Mayo Clinic, Cleveland Clinic, Johns Hopkins, from day one, from day one, the leader is a physician from day one to this day, and they don't have meet anybody that is not a physician as a leader. Because the person has been on the trenches until like Dr. Castro from Cleveland Clinic. He used to have one day a week seeing patients till these days. Why because that is the only way that you are directly into the trenches when these people are in the ivory tower, the business people in the ivory tower up here, and they don't understand what the nurse that is outside there is struggling, what is the immediate patient's struggle to pay a bill or to do this, they will never understand, they will never understand they may have an idea. But they never understand. There is the same reason why the best coaches of NBA have been basketball players, the best racecar drivers that team team, team leaders have been pilots. So it is so important and not everybody can or would like to be an executive as a physician. But it is so important that the person, the only person in their scientific evidence that the best way to evaluate another physician is another physician. So the hiring has to be done by physicians to physicians. And there is plenty of evidence, I think I've quoted there a Harvard Business Review article, where they look at the quality measures of hospitals, where the physician was the chief executive versus a non physician, and it is significantly higher. So now, that doesn't mean that the business people have no role to play in health care. That's nothing further from the truth. It you need and physicians need to be more open and less close minded. To learn from other industries, which we do not I would say that's a general rule. A lot of physicians do not like to listen or to look outside of the healthcare to learn. I mean, let me give you an example. You go to any IVF centers, and the inventory is done by all fashion moment pop schools, and anywhere the inventory. It's like totally automatized right now, we can learn from them. So I would say that we should not fall crap into the oh, if you do only physician work and we do the business. They both both have to be at the top intermingle.

Griffin Jones  23:44

I've been dubious that they can be totally separated whenever I have the CEO of a network on and everyone said, you know, we never interfere in, in clinical operations. I just I you I don't see how you can't totally separate them. In even if you do have a chief officer making those calls, even if you do have a CEO, that's a physician that they're still going to make calls that impact that like protocols. And I just don't see I don't see how you can totally separate those two. I give the example of ultrasounds for example. We have one one of our clients is just an amazing doc loves their their patients and this person does all of their own ultrasounds, I know they could be seeing more patients. But they want to do their own which is fine. That's their decision. But if I were the owner of a network and want to and my chief medical officer says no, Doc's don't need to and maybe my chief met my Of course my chief medical officers a doctor, and that individual doesn't see all day they don't do all their own ultrasounds and they say yeah, ducks don't need to do all their own. Okay, well then that's our policy. Now. I just don't see how you can totally separate those,

Dr. Francisco Arredondo  25:02

you can separate them and, and in fact, you know, I hear people that come from different healthcare industries, and walk into a different healthcare industry because I'm a healthcare industry expert, then I can help you. For example, you know, or I'm the I was the national director of a large company, and now I'm coming to a fertility company. What does that one has to do with another? Imagine this example that I'm going to put to you, who has been the best basketball team coaches of the whole history. It is Phil Jackson. And for in the bulls in in Chicago, they had an 81% winning rate. Nobody has ever done that. The five people were NBA players, etc. Nobody can argue that that is the best team of coaches in the entire world in history of basketball. Imagine that you grabbed them, and you put them to coach the Dallas Cowboys or the Yankees? Are they going to be successful? They will figure it out? There is no question. There is no question that they will figure it out in five years or eight years. But in the meantime, they don't know who is selling the peanuts? Who what kind of incentives the players have with best, what kind of tricks do they do, what kind of socks they are comfortable with? They don't know all the nuances of the actual industry, where they are. And here we have people that are yellow, as I mentioned to you, if you and I go in to a restaurant in we are actually we like the restaurant and we put a review or we don't like the restaurant we put our review. Is our opinion valid? No question is very valid. But does that make us food? Industry experts? By no means I don't even know who's in the kitchen? What are the incentives how they pay, and we have people in our field, that just because they were patients now they are actually the the they understand everything about fertility. It helps you there's no question there's an empathy issue. But that doesn't make you an expert. I think the expert it is the physician that has been doing this for a while. And again, the physician needs to learn from the business, no question

Griffin Jones  27:30

about it. Right? It gives you it can give you insights in so far as I have insights into the public school system from having been produced by it as a student. But that doesn't mean I really know how to run schools. I've never been a teacher, I've never been an administrator. I've never worked in a school. And so you can get insights. But so that's the that's what every entrepreneur finds out, though, isn't it is that entrepreneurs kind of get to where they are. And they're working for somebody else when they think I could do that. And then you go off and start your own, you're like, oh, gosh, there was so much that I didn't know this is really tough. And so I want to talk a little bit about the why I think it is that like what you were talking about with the CEO of the Mayo Clinic CEO of the Cleveland Clinic, and why we don't often see physician at the helm in the CEO role. So I'm going to share my screen and for everybody listening on the podcast, it's going to be Theatre of the mind, but you can go to fertility bridge.com. To see this. And I really need to customise this chart to the fertility field. But this is an accountability chart for for many businesses in that you have your visionary at the top, that's who you were talking about the architect in the book, you're talking, you talk about the visionary as the architect, you talk about the managers, the captain, in this case, the integrator, and then you have different departments, you got your sales and market your three core functions of any business or sales and marketing operations, finance and admin. And I might break off HR apart from finance anatomy, because I think it's something different in our field, you might break operations into two lab and clinic, but they're they're quite similar. And the problem is Paco is that you have a lot of seeds underneath these seeds. And the person who owns the practice is in a lot of them. And they devote most of their time down here because that's their production role. Their production role as a physician is, while I'm an RA I have to do I have to see 14 patients a month or 30 patients a month that I need to do 1520 30 for however many they're doing cycles a month. And so they first fill up their time in this seat, which isn't even on my chart here. It's below here because they're they have their production requirements. Whereas I feel like if if I Are the if I were an REI that wanted to be to build something big, I would keep my production role as small as possible, really only for the purpose of, of just staying current with the paint, like you said the one CEO. I think it was Mayo that patients once a week,

Dr. Francisco Arredondo  30:21

mayo in Cleveland, they do they have one day a week to see the patients.

Griffin Jones  30:27

But But in our field, it's often flip like maybe businesses that may be physicians will have one admin day a week maybe and and that's also admin. That's, that's, that that's not like visionary work. And so I think it's flipped for a lot of the visionaries in our field. And I think when people are looking at this, they're like, Hmm, do I want to be the do I want to be in this visionary role and see few patients as possible? Or is it better for me to see as many patients as I can, and then just kind of plug in a patch work for other people in the business, I think they often do the latter

Dr. Francisco Arredondo  31:05

dilemma. And then we mentioned it, that with the shortage that we have physicians, we have to be clever to think, and innovate outside the current business models where we use everybody at the top of our license. And there are certain tasks that a reproductive endocrinology, in my view should not be doing. I mean, you could do it, and you know, how you should know how to do it. So you can teach people to do it. But if you want to run this system efficient, you really have to use advanced practitioners, you have to use pas, nurse practitioners and other and now AI, in order to maximize your productivity, and the balance of how much clinical versus visionary work you have to do. I think it's an individual decision making. And also it is a circumstance, you know, when, when you're early in, in an enterprise, you have to wear all the hats. And then later on, you start, you know, dividing it.

Griffin Jones  32:16

You owned your last practice for 10 or 12 years before you sold it. How long did

32:21

14 years 1314.

Griffin Jones  32:23

Okay, we're at the end of those 13 years, were you doing as much production work as you were in the beginning?

Dr. Francisco Arredondo  32:32

No, in fact, when I used to be the Chief Medical Officer of inception, I used to have two days clinical day or week only. So And before that, I would say I'd have three days. So it was half and half.

Griffin Jones  32:49

What do you think the number that I have?

Dr. Francisco Arredondo  32:51

So per theme, I mean, the team was superb. And they did a lot of the work, and they were very, very good. And I could not be happier than that.

Griffin Jones  33:01

So that's my question to is like, at what point do you think somebody can start to do that where they are only maybe doing two clinic days or one clinic? I mean, do they need to have do they need to be working with 678 10? Doc,

Dr. Francisco Arredondo  33:17

I would say when you already have four physicians, if the vision is to increase and grow the pack the practice and to make it thrive, because one of the other mistakes that a lot of industries do is that they think of growth, growth, growth, growth, growth. And you know, the only thing that grows, grows, grows grows is cancer, and that multiple cells are not good when they keep on growing without any measurement. You don't want the economy just to grow, you want the economy to thrive. So when you want a company to thrive, and then make it grow, that's a different way to do it. When you want it to thrive, I would say that even when you are at three to four physicians, you need one of those individuals to take a significant 25% of the role dedicated exclusively to do the vision, the growth, the standardization, there is actually a very nice book that is called Growing Pains and it points out how the different levels of growth and how at different points of revenue, you really have to standardize the procedures you know create the basics of the human resources because when we open the clinic one to physicians we just open it with basically no Mission Statement are nothing we're going to change, you know, hang a shingle there and keep the patient's coming. But there is no corporate structure. And there's no basis. And then when we tried to do it after we have 10 physicians, that's too much. And because it is too much, because now everybody has a different philosophy. And this is the only thing that happens. That when you grow, you have different cultures. And when you see these companies that are growing not by organic growth, that they go and build another one and build another one from the inception and go in and go up. But they actually just grow by acquiring companies. What happens is that they're buying problems. They're buying, actually, everybody, all the private equity, people focus on the lecture and on the numbers. And very few focus on the culture. And it is the reverse, you have to define what is the culture that you have to?

Griffin Jones  36:10

Well, that they're not there because they don't have a centralized culture that they're buying. They're they're buying a number of different practices that don't have the farm culture, you haven't

Dr. Francisco Arredondo  36:18

created the uniform, where are the points of congruence of all those in created there, find it and then all the financial elements and everything else will fall into place. But they do it backwards. And then they are focused on in the monitoring the monitoring the synergies and all this and the culture. Everybody goes wherever they want.

Griffin Jones  36:40

I'd said that when Gina bar tz came on the show, I said that I think that is a huge advantage that people underestimate about kind body and people can say whatever they want about I'm not qualified to evaluate every piece of a business I own a client services from what I am, but I do feel really qualified to analyze this is is centralized, cogent, and coherent messaging. And they've got that in spades, you can you're rallying around one thing, and I don't know everything about their HR. But and and there's a lot more to delivery than just brand. But you it certainly is a huge advantage to structure culture system, including down to the procedural HR process level when you have that central theme. And I think that's a huge, I just think that's a huge challenge that private equity networks have that I wonder about their ability to, to scale to do economies of scale, if they can't, if they can't plug it into one culture. Oh, true, cuz because but then by nature, they're always piecemeal. And they're always patch working at that.

Dr. Francisco Arredondo  37:51

Yeah, it's like, you know, sometimes you buy an old house, and it's better just to demolish it and put it from the ground up, then and try to fix,

Griffin Jones  38:01

you might own the practice, you might manage the practice. In either event, you want to like we get more productivity from your staff without driving them crazy, meaning getting more productivity from them by actually helping them and by actually helping your patients improving their experience. You've heard me talk about engaged in de different practices have signed up for it, because they heard it on the show, I've begged you the audience to send me an email if you had a negative experience with engaged somebody and I still haven't gotten one. And so if you still don't want to take my word for it, as someone who just talks to practices, then you can see what the practices themselves are saying, just go to the engaged md.com homepage, you scroll right down to the bottom, you're going to see testimonial after testimonial talking about reducing the length of appointments, what used to be a our 90 minute appointment is now 15 minutes because the patient is better, better educated. And they're asking questions that are specific to them instead of general questions. And they're happier about that because the information that they are getting is more informed. It's a better educated question that they're getting the answer to and it's personalised to them and then you're gonna see logo after logo, a logo of every kind of Fertility Centre. There are independently owned small groups. There are huge network groups. There are academic centers, every kind of Fertility Center, works with engaged MD. And like I told you, I still have not heard one bad one. I'm not saying it's not out there, but I'm begging people to send me an email if that's the case and I haven't gotten it. All I hear is that it's one of the biggest things that has allowed people to relieve their staff at a time when staff are swamped. And where patients are overwhelmed with everything else happening in life to give them a better experience so that they are have more rapport and better education when they're interacting with your team. And by the way, informed consent is a whole other thing that we could talk about. But in the meantime, maybe you focus on this work load piece and just see what other practices are doing. If you go to engage them d.com/griffin, they'll do a free workflow analysis for you. It's free, just tell them my name. So you that you heard it on the podcast, you can see what other practices are doing. And you can see any gaps that you might be missing. But now is the time to do this. Because it adds so much value at a plate is in time when staff are swamped out of their minds, and patients are constantly looking to be delighted. It's so hard to delight them when staff are so overwhelmed, engaged md.com/griffin Enjoy the rest of the episode. Let's talk about that culture. Then you have your five H's for hiring and I will read those to the to our listeners here. Don't worry guys, you don't need an audible subscription. You can just listen to my raspy voice hungry, humble, happy, honest human skills. All five of those are what you describe as making for a player's what I really want to hear from you is you're starting a new practice group now. Right? Yeah, Positivf. And in 2022, and then there's other ventures that you're associated with. And you first made RMA of Texas in the mid 2000s. Was, Is that right? And so 2006 Yeah, so in 2006, there was not a baby boomers had not yet begun to retire. And Millennials were just barely arriving in the workflow workforce. Me and a couple other 21 year olds. And, and so it contrast that with today. And now, baby boomers are not entirely retired, but it seems like 75% At this point, and and now millennials aren't even the youngest generation, and we have a new one. So talk about what it's like, trying to live up to all five ages today and 2022 versus what it was, like 16 years ago.

Dr. Francisco Arredondo  42:27

Oh, certainly, we have a shortage choice of talent. But I think once more, if you have a good idea that resonates with the team members, they will join that vision. Fortunately, for our new team here, that is actually our old team. You know, our my partner and lab director 20 Anderson, you know, we've been working together for more than 14 years, the fertility coach, the nurse, I have been working for her for 20 years. Since I was in Cleveland. So everybody is a it's a tribe. So it's a tribe. But in this era, I think that is still valid, that if you have a good philosophy of the practice that really resonates with the values of the new millennials, II will thrive. The the millennials are much more collaborative and less competitive. And you need to appeal to that. I would say also that you have to have a mission and your company is no longer about the money only. And more important, I honestly believe that the great leaders are not the ones that have followers. The great leaders are the people that empower others, to become leaders in our next fast venture. I think five or six people in our teams have their own business while working for us and we stimulate it. Yeah, go into that go into that go into that because we have to create other leaders but a lot of the times the leaders that are not eight people because eight people will always hire eight people and beat people will always hire see people because they're scared of themselves. They're scared so I have no question. hiring somebody that and knows much more. And, you know, everybody knows that there are a lot of things that I am not good at. But I, I welcome that. And I know what I can do, and I know what the other person can do. So I think that if you create an environment where you set those rules, that you can say, you come here, and you can be a leader, we will allow you to be a leader. And in the time, you might leave, that's fine. But for you, every you should not be scared, especially on an industry like ours, that 90 or 85% of the market is on top. That's where we have to be more collaborative in our industry. And let's say instead of carrying all the cards close to your chest, that's the business of the 1950s. Nowadays, you have to be collaborative share ideas, and everything is going to come back in a much better way for your company.

Griffin Jones  46:04

I want to talk about that mission and values. Because I see both sides of the sword on one side, it's where I've built my company on on five values. And we evaluate the team with that, and I use it in hiring and I try to live up to them. And I tried to for some of our clients now that haven't done branding work yet, I'm trying to get them to do branding for their next initiative, even though they're doing very well. And so they're kind of saying, Well, what do we what do we need to upgrade our brand for if we're perfectly busy with volumes, and it's like, well, but you also have people that are not coming in to work or not coming into, or they're not, they're not showing up for interviews. And it's, it's partly because to be a desirable place to work requires being someone that communicates a mission and values that's really attractive, and you've got more competition there than you ever have before. To your point and and people want to be involved with that. What I see the other side happening, ie employees boycotting Netflix, ie, some, Spotify and some other places is that eventually, if the if the mission, the values like any religion, eventually the the the congregation, the follow the faithful, as it were, are are going to split into the practical and the end. And ultimately the ideal. And there comes to be a point where you can't live up to the ideal because we live in the real world, or somebody has a different version of it in their head. And so I see in some companies right now being ransom by their own ideals and their own missions. Well, this is what we really stood out for. And, and I see I see the the tension. So I wonder if you can talk about a bit about that of eventually the entrepreneur has to say, Okay, well, this is what I mean by these values. And no, I'm not just gonna let you be a mob that that guides the values of this company. This is what they actually mean.

Dr. Francisco Arredondo  48:24

Oh, I think, you know, this reminds me a lot of a book that I was recommended recently that I just finished, that is called productive tensions in this guy's go over eight different tensions that ought to be in every single company. And you need to balance that tension. We mentioned one of them, which was the natural tension of, of being medical exact. Because we, if you fail, you can kill people. But at the same time, you have to innovate because if not, you're going to miss opportunities. So that's that's a tension. In this particular case of what we're talking about of employees. I personally think that the current Millennials are people that are going to, in average, have five or six different careers in their lives. So it would be silly to think on the mentality of the 1920s or 40s or 50s of IBM, that you expect an employee to be five

Griffin Jones  49:36

or six different careers, not five or six different jobs with five or six different careers. Yeah, right. Yeah, I think the number of jobs will be way more than

Dr. Francisco Arredondo  49:47

much more than that. Yeah. So I think that it will be if we don't adapt to that as intrapreneurs as managers, that we understand that Sometimes, these people are going to go in a different direction. So it's better for us and for society to give them the tools to become leaders. And to help us out to build the company, for example, in this company that we created, we have made the decision that we are not going to put noncompetes on any healthcare provider, because I believe that the, the people won't leave, because we're gonna treat them so well, they want to be so happy here, that they're not going to leave. And, you know, I think that we're very committed, you know, things may change, but I think we are so committed to that. Because the moment you put a noncompete, you basically bought the right to mistreat that physician. Because they can go anywhere else. And so we're very clear on that, you know, things may change in May in the future. But I think that

Griffin Jones  51:15

the counter argument to that Paco is that I bought the right to invest in my physician, because I'm going to share all of these things with them, and then they can't just take it across the street.

Dr. Francisco Arredondo  51:26

What did we invest? I mean, we basically the only way,

Griffin Jones  51:32

I introduce them to my OB GYN network, I diverted my call centre to take my waitlist and bring those patients to them, I use my marketing department to to funnel their social media, the benefits that that I vested in them, the plane training that they didn't get in fellowship to your point I gave to them that first year

Dr. Francisco Arredondo  51:57

in the plane would not have flown without a pilot, so you will not have sold tickets. So that plane and all those tickets that you saw, would not have been flown if you didn't have a pilot. So there is a synergy. So again, it's an all NAR Anon, I think that you know that people should pay something, or learn at the beginning and not have high salaries. Unfortunately, right now, or fortunately for all the people that are graduating or getting, because what happens is it is that there are people that are graduating that are earning more than the people that have been there for a while. And, you know, that's that's also unfair, but it is what it is, is supply and demand.

Griffin Jones  52:51

Well, so let's go to the first ah, in your, in your five agents, which is hungry, which is right now, I think it's it can be hard to find people that are hungry in different in different areas, because there's more food on the table. And I really want to build a company that is that, that treats their employees super well, that is a cut above the market. And it's it's it's hard to be able to get to a place when there are when there are those tensions in play. And I'll come back to that tension because you reference the different tension. But when you see so many people right now that either don't show up to an interview, or you know, they barely do a follow up and like I just don't like I just need to see a little bit more hunger to hire you. And I see less of that now than I did even three years ago. And and I see people on LinkedIn saying, well, employees are getting what they're worth now. It's like well, they're getting what they're worth now is we dump a tonne of money into the marketplace, and that makes housing prices go up. That's what and that's and that's what that does to housing inventory. That's what housing is worth. Now, if there's a big dip, then there'll be worth something different. And I think we've we're we're we've swung so far to one way that it can be hard to screen for that first age it can be it can be hard to find somebody who's really hungry because recruiters are everywhere offering them food. Here's here's a job here. Here's, here's another job, here's a promotion. And so I wonder if you've found that yet.

Dr. Francisco Arredondo  54:32

Fortunately, I haven't we haven't had that challenge, but I do see a lot of people having those challenges. It is we have to admit that this is a very unusual circumstances that we have, you know, anemia has happened only every 100 years. So this post pandemic is a very unique time. This allows a lot of people to reflect and reset their values. So I think that it's going to come back to a little bit more to the middle. But it's not going to go back to before, that's for sure. So I think that in that sense, it's a little bit unfair to judge what's going to happen in the next two years of what is happening right now. But the people are not going to work unless they have at least one today's remote work. They, because now it's a norm. So we have to change the way in the business model. And this is our argument for fertility, we've been practicing fertility the same way since 1978, IVF, the same way, we need to think differently. So hungry. It is, it is certainly difficult to assess at this point. But I think you can, you can tell that, if not in the interview immediately in the first 90 days, you can tell who is hungry. So then you got to the other age,

Griffin Jones  56:15

people might be hungrier if there's a dip in the market and risk and unemployment goes up to 12%. Hunger seems to be lower than than it does, normally. But I still think it's worth it, I still think that it's worth screening for even in today's day and age, the solution is that you have to invest more in what the candidates see in your company so that they are hungrier for that if there's more food in the marketplace, more jobs and more money, etc, then they need to see something in yours that makes them still want that more despite all of the other options on the table. And when when I talk about tension, though, in terms of culture Pacos, what I'm really seeing is that the customer experience almost everywhere has suffered from whether it's professional services firms or hospital systems that are understaffed with nurses, or if it's the roofing company that finishes the job halfway and then doesn't do it again for another three and a half weeks, because they have so many jobs or, or the the restaurant that used to be instant, and they just slapped the food on and it takes 45 minutes to get your food. I I see that the customer experience has suffered almost everywhere. And I think that this is tied into the employment market, but you talk in the book, you say their problem is our problem to solve. But like that I had is a real tension between employees interests, and patient or customers interests in the case of fertility patients, what infertility patients want an answer whenever they darn well, please, whenever they call, whenever they ask for it. What do employees want, they want work life balance, they're saying like crazy, they don't want to be working until eight o'clock. They don't want to get have to answer emails at nine. But but that's what the patient wants to that's what customers want. They want instant feedback. So this is a huge tension, not just in our field, but that particular example is. So how do you reconcile that tension? Because I don't believe that when people say, Oh, employees come first, but customers also come first. At some point, you have to decide

Dr. Francisco Arredondo  58:38

it's a balance. But again, be if it's in the culture of the team have been very patient centric. They will do it, especially if you also treat your team members. Well, so yeah, it's I cannot I cannot think in a binary way that it's only about employees, it's only about the customers. But what I what I say is, are the same that their problem is our problem is that in a lot of places, they say oh, you know, I didn't have my medication? Well, it's not my problem. There's a pharmacy that didn't you know, send it well no, actually, even if it is the if it is not your fault in you make it your problem. And you try to resolve it and then you go and go to the root cause of that and you prevent it. So you know, we have to analyze all these problems and try to prevent them in the future.

Griffin Jones  59:47

Let's skip ahead a little bit because I want to talk about negotiation. I'm going to skip over accounting just because I don't want to go in there but but I do think that people should buy your book even if just for the accounting chapter especially prospective practice owners for for those younger Doc's, they're thinking of opening a practice by MedikalPreneur just for I think it's chapter five on accounting that talks about owed, where Paco gives a sample, income statement, profit and loss statement. And I think just

Dr. Francisco Arredondo  1:00:25

compare it to be compared to a patient in the intensive care unit, it is the same in the three things that you ought to know, which is the balance sheet, the profit and loss and the pro forma or cash flow is like entering and seeing a patient in the ICU. That's the analogy that I use there. And it's very, very easy for a physician to understand if they go in and think that way.

Griffin Jones  1:00:53

But you also like start off with the ACC with numbers in there that people can can at least use as a baseline to see like, Oh, I'm this is how far I might be off from from that, but it's very useful. And so but I want to talk about negotiation, because there are a lot of younger Doc's that listen to this show, and you have a diagram on page 185, where you show the overlap. And in this instance, you're talking about negotiating rent, but the landlord has a range of of where of where they've got alternatives and other options of what they have what they would love to get. And the tenant has other options, and they have an area of what they would love to get. And there's some overlap between those two. And that overlap is not one point, it's it's a range of points. I mean, in in this case, it's

1:01:51

the the theory or positive will be the possible deal.

Griffin Jones  1:01:55

The most that the tenant would ever pay in this particular instance, is $8,500 a month, that's the most of the tenant would ever pay. The the lease that the landlord whatever rented for is 7000. And so that's the overlap in this case, in the instance of getting to this overlap, the conventional wisdom has said, always say the first number first say say or excuse me, never say the first number never say the first number. Mike experience tells me otherwise. What do you think?

Dr. Francisco Arredondo  1:02:29

Yeah, I think you're delving into the technique of the bargaining, which is different than the negotiation.

Griffin Jones  1:02:39

Alright, so zoom us out. So what So what

Dr. Francisco Arredondo  1:02:42

Action is, basically you have to look at all the variables that you are going to bargain. So is it only the size if you focus only on the salary you're kaput? I mean, you're just limiting yourself, but you have to that's why being creative is good for for negotiation. You have to think of ways that are a positive sum game, what are the things that the two parties can actually benefit from versus something that in the bargaining is a zero sum game? The bargain is a zero sum game and it is what it is and there are specific techniques, I think I mentioned one in the book of how to do it, but I think that the negotiation has to be bigger than that as to where do you do the negotiation the timing, the presence when you want to ask have you study your needs and their needs, but the most of

Griffin Jones  1:03:45

the information that you got Garner before the negotiation before the bargaining searcher

Dr. Francisco Arredondo  1:03:51

in not only from them, but from you I think that is the most important negotiation is within is what is my walk out point, if you enter into a negotiation, without understanding or knowing your walkout point, you're dead you have to know that if I will never pay $1 million for this right or the most I will pay for this pen is $20 So yeah, I'm I started you know, getting this and that, but whenever the other sizes is 22 and is now moving from there by because I know my workout point is 20 but if you enter without knowing what is what you want, what is your workout point, then you will never you get into the emotion of the of the bargaining. And you get you get lost. You get lost so you have to know what it because if not you do the neurosurgery you're gonna be so angry at us. Out of that you obtain this red herring up here. But what it was important for you, you didn't get it. So it is the worker point is not one point in the number it is like, you know, I, it could be days, it could be medications, it could be places, it could be bonuses, I don't know, what is your walk out point, but everybody has different the CD where you're going to leave if you're negotiating for something outside. So I think the most important message would be know your walk out points, learn one or two techniques of bargaining. And three is be creative. Think outside of the box. So you can create a positive sum game instead of a negative sum game or a zero sum game.

Griffin Jones  1:05:59

And establishing that value in the other person's eyes before the bargaining is also going to help you get to the ceiling. It may even get you past what they originally thought was the ceiling of their bargaining. I think about this all the time. Now part of it if I were going to go interview for a job, now that I've interviewed so many people, and I know what I'm looking for, I feel like I would just totally disrupted I feel like I would just crush the interview process now. And part of the reason is what I see a lot of people not doing is investigating what are the outcomes for the role? And, and and then asking the right questions and showing how I really convincing me that they can hit those outcomes. So a lot of people coming in talking about like, what kind of person how hard of a worker, they are their accomplishments. And some of it might relate to the outcomes. And some of it might not what would I really want to see somebody discerning the outcomes of the role. And most job descriptions don't have outcomes in the role. But that's a start for you to to use as, like, let's say we're talking about a job in this incident, the job has job descriptions, you're going to do IVF cycles, you're going to do IUI, you're going to work in this office. Okay. How many IVF cycles do you want me to be doing after your one? After your two? After your? How many? And then how many? So if that's good, what's Excellent? And what's what's the bare minimum that if I don't hit that this would be a total failure? And, and then what offices do you want me to open? What procedures do we have in place for that? And so when you can see somebody asking questions about an outcome, and they're really discerning, this is what it would take to get the outcome done, then, like the people that have sprung the most for pago are the people that in my mind, I see like, Yeah, this is the person that's going to hit this outcome that I have for them. This is the person that's going to let me walk away from this seat. And when people can do that first, then bargaining is something that comes after later. But the other person, you've at that point, you've already got the other person thinking like, oh, this you? This is someone who's differentiated.

Dr. Francisco Arredondo  1:08:13

Right? Correct, because he has been thinking through the process, no question.

Griffin Jones  1:08:19

That chapter on negotiation. I also recommend for any doctor, but especially the younger doctors pago, how do you want to conclude we got it's your colleagues that listen to the show, many of them have owned their practice for many years. Some of them might want to start a side venture, others might just be starting their career and they're thinking about if they're gonna open their own practice, or if they're gonna work for somebody else and start another kind of business. How do you want to conclude the lessons of MedikalPreneur?

Dr. Francisco Arredondo  1:08:51

Basically, how we started that? Yes. You have to change the mind set that yes, you can be a great business person. Yes, you can be a great entrepreneur, that you have to understand what you're doing. Are you innovating? Are you managing two different things? Are you doing a little bit of both, so then you have to change your hats of how you approach things. To use some of the skills that you use as a physician, read a lot, investigate a lot, Western a lot, and most importantly, be convinced that you can do it, but I I hope that more and more in our medical field, we instil some of these concepts because I think you know, my daughter is applying to medical school as we speak and she was one of the ones that read through my book and all this and she said wow, so nothing of this is in medical school. It says know nothing of medical There's always lessons. So I mean, there's a lot of things that are so useful but my daughter, she's biassed, but I think that that was the whole message that we need to put this into the minds of the of to the physicians that unnaturally in a lot of professionals wouldn't be able to teach us a lot of these things.

Griffin Jones  1:10:25

Well, this is one crash course that people can take, they can get it at Medikalpreneur.com medical Preneur spelled with a K. Or you can go right to Amazon medical n\ with a que by Dr. Francisco Arredondo will link to both of those links in the show notes. Paco, thanks so much for coming back on inside reproductive health.

Dr. Francisco Arredondo  1:10:47

Thank you. Thank you very much. Bye Griffin..

1:10:52

You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health