1 00:00:00,240 --> 00:00:03,220 Imagine this. You're at the Hyatt Regency Chicago 2 00:00:03,439 --> 00:00:05,859 surrounded by the top minds in the ambulatory 3 00:00:06,160 --> 00:00:07,540 surgery center industry. 4 00:00:07,919 --> 00:00:10,960 Welcome to the Becker's 30th annual meeting, the 5 00:00:10,960 --> 00:00:14,259 business and operations of ASCs from October 30th 6 00:00:14,400 --> 00:00:15,705 to November second, 7 00:00:16,324 --> 00:00:19,285 2024. Picture the excitement as you collect business 8 00:00:19,285 --> 00:00:22,184 cards from over a 1000 executive level attendees 9 00:00:22,404 --> 00:00:23,945 forging priceless connections. 10 00:00:24,404 --> 00:00:25,864 Feel the buzz of conversations 11 00:00:26,164 --> 00:00:28,904 as you participate in more than 60 sessions 12 00:00:29,045 --> 00:00:29,969 led by over 13 00:00:30,849 --> 00:00:33,030 225 elite ASC speakers. 14 00:00:33,649 --> 00:00:37,090 Envision yourself gaining actionable insights on topics like 15 00:00:37,090 --> 00:00:38,390 private equity strategies, 16 00:00:38,929 --> 00:00:43,030 ASC business growth, and innovations in spine, orthopedics, 17 00:00:43,635 --> 00:00:45,734 GI, ophthalmology, and cardiology. 18 00:00:46,354 --> 00:00:49,954 Now imagine yourself listening to inspiring keynotes from 19 00:00:49,954 --> 00:00:53,094 Hall of Fame boxing world champion, Lila Ali, 20 00:00:53,155 --> 00:00:56,879 and professional basketball player, Caitlin Clark. Their stories 21 00:00:56,879 --> 00:00:59,199 will motivate you to take your business to 22 00:00:59,199 --> 00:01:01,600 new heights. You'll leave with a wealth of 23 00:01:01,600 --> 00:01:03,920 knowledge and a network of connections to help 24 00:01:03,920 --> 00:01:06,719 lead your ASC into the next year. Don't 25 00:01:06,719 --> 00:01:09,619 miss out. Get registered today. Visit beckershospitalreviewdot 26 00:01:10,834 --> 00:01:12,754 com and click on the events page to 27 00:01:12,754 --> 00:01:15,094 find the conference website. That's the beckershospitalreview.com 28 00:01:17,075 --> 00:01:19,094 events page. See you in Chicago. 29 00:01:20,114 --> 00:01:22,274 This is Laura Dirdo with the Becker's Healthcare 30 00:01:22,274 --> 00:01:24,879 podcast. I'm thrilled today to be joined by 31 00:01:24,879 --> 00:01:27,120 doctor Cho Kim, who's a spine surgeon with 32 00:01:27,120 --> 00:01:29,060 ExCeL Spine Center and UCSD 33 00:01:29,359 --> 00:01:31,439 Medical Center East Campus. Doctor Kim, it's a 34 00:01:31,439 --> 00:01:33,219 pleasure to have you on the podcast today. 35 00:01:33,680 --> 00:01:35,620 Thank you very much for having me. 36 00:01:36,274 --> 00:01:38,274 Now I'm looking forward to our conversation because 37 00:01:38,274 --> 00:01:39,554 I know you're really on the cutting edge 38 00:01:39,554 --> 00:01:40,834 of a lot of the things that are 39 00:01:40,834 --> 00:01:43,554 happening in spine surgery, really more minimally invasive 40 00:01:43,554 --> 00:01:45,394 procedures, and some really cool, 41 00:01:45,715 --> 00:01:47,394 innovative things that you're working on. But before 42 00:01:47,394 --> 00:01:49,075 we dive into that discussion, could you tell 43 00:01:49,075 --> 00:01:50,515 us a little bit more about yourself and 44 00:01:50,515 --> 00:01:51,174 your background? 45 00:01:52,250 --> 00:01:52,750 Absolutely. 46 00:01:53,209 --> 00:01:56,090 Let's see. I'm in private practice in, sunny 47 00:01:56,090 --> 00:01:56,990 San Diego, California. 48 00:01:57,770 --> 00:02:01,390 I specialize in minimally invasive surgery and endoscopic 49 00:02:01,609 --> 00:02:03,950 spine surgery in treating patients with, 50 00:02:04,409 --> 00:02:06,944 degenerative conditions of the neck and back. I 51 00:02:06,944 --> 00:02:08,645 went to medical school at Harvard, 52 00:02:09,104 --> 00:02:12,784 did my orthopedic surgery internship and residency at 53 00:02:12,784 --> 00:02:15,824 the universe University of California San Diego. Then 54 00:02:15,824 --> 00:02:17,824 I did a fellowship in spine surgery at 55 00:02:17,824 --> 00:02:19,125 the Mayo Clinic in Rochester, 56 00:02:19,504 --> 00:02:21,344 and then I came right back. I was 57 00:02:21,344 --> 00:02:22,004 on faculty 58 00:02:22,680 --> 00:02:23,659 at UCSD. 59 00:02:24,359 --> 00:02:26,919 And during that time, I was the, fellowship 60 00:02:26,919 --> 00:02:29,159 director, the research director, and I started the 61 00:02:29,159 --> 00:02:32,120 Society For Minimally Invasive Spine Surgery, which I 62 00:02:32,120 --> 00:02:33,560 think is coming up on its 20 year 63 00:02:33,560 --> 00:02:34,060 anniversary. 64 00:02:35,479 --> 00:02:37,799 And then after about 8 years, I left 65 00:02:37,799 --> 00:02:38,299 and 66 00:02:38,775 --> 00:02:40,955 started private practice where I am now. 67 00:02:41,655 --> 00:02:43,514 And I try to take care of, 68 00:02:44,375 --> 00:02:46,635 like, high demand, high activity patients 69 00:02:47,094 --> 00:02:49,675 who are looking for, like, minimum invasive options. 70 00:02:50,055 --> 00:02:52,135 And I kind of really focus on a 71 00:02:52,135 --> 00:02:55,159 few surgeries. My favorite surgeries are endoscopic discectomies 72 00:02:55,300 --> 00:02:56,040 and decompressions, 73 00:02:56,979 --> 00:02:58,919 minimum invasive fusions for spondees, 74 00:02:59,699 --> 00:03:01,800 and cervical disc replacements for, 75 00:03:02,500 --> 00:03:05,159 cervical radiculopathy or stenosis or neck pain. 76 00:03:05,780 --> 00:03:07,794 I used to do everything, like deformity, but 77 00:03:07,794 --> 00:03:09,875 it more recently, I've really focused on trying 78 00:03:09,875 --> 00:03:11,715 to do a few surgeries really, really well 79 00:03:11,715 --> 00:03:14,694 and try to optimize it. And, at this 80 00:03:14,754 --> 00:03:16,514 stage in my career, that's been a really 81 00:03:16,514 --> 00:03:18,915 good idea because I've been at it for 82 00:03:18,915 --> 00:03:20,294 about 22 years now. 83 00:03:21,400 --> 00:03:23,159 Oh, that's amazing to hear. You know? And 84 00:03:23,159 --> 00:03:23,740 and certainly, 85 00:03:24,280 --> 00:03:26,280 great to hear about all the different things 86 00:03:26,280 --> 00:03:28,460 that you've done throughout your career. And congratulations 87 00:03:28,520 --> 00:03:30,360 on 20 years with the Society For Minimally 88 00:03:30,360 --> 00:03:33,159 Invasive Spine Surgery. That's a huge accomplishment, and 89 00:03:33,159 --> 00:03:35,055 I know, you know, such an important way 90 00:03:35,055 --> 00:03:36,895 to connect spine surgeons and those in the 91 00:03:36,895 --> 00:03:37,794 spine field, 92 00:03:38,175 --> 00:03:40,014 to to make sure that patients have access 93 00:03:40,014 --> 00:03:41,314 to care. Now 94 00:03:41,615 --> 00:03:43,135 from your vantage point, what are some of 95 00:03:43,135 --> 00:03:44,895 the biggest issues you're following in health care 96 00:03:44,895 --> 00:03:47,489 right now, especially as a private practice spine 97 00:03:47,489 --> 00:03:49,889 surgeon and and somebody who is interested in 98 00:03:49,889 --> 00:03:51,969 in the cutting edge technologies? What's really top 99 00:03:51,969 --> 00:03:52,949 of mind for you? 100 00:03:53,969 --> 00:03:55,430 I think the overwhelming 101 00:03:56,849 --> 00:03:58,549 thing that really is 102 00:03:59,364 --> 00:03:59,864 worrisome, 103 00:04:00,164 --> 00:04:02,185 and I think it's an issue is 104 00:04:02,805 --> 00:04:05,784 what I call insurance directed care. 105 00:04:06,644 --> 00:04:08,644 So over the last 22 years, it's just 106 00:04:08,644 --> 00:04:09,705 obvious how 107 00:04:10,724 --> 00:04:12,959 every year there's more and more impact of 108 00:04:12,959 --> 00:04:15,840 medical decision making based on what insurance companies 109 00:04:15,840 --> 00:04:17,060 tell us to do. So, 110 00:04:18,000 --> 00:04:18,660 I find 111 00:04:19,519 --> 00:04:21,379 myself and my a lot of my colleagues 112 00:04:22,160 --> 00:04:22,660 make 113 00:04:23,120 --> 00:04:25,439 medical decisions and decisions on what type of 114 00:04:25,439 --> 00:04:27,220 surgery and what type of care to provide 115 00:04:27,834 --> 00:04:30,495 based on what is allowed by insurance companies. 116 00:04:31,194 --> 00:04:31,694 So 117 00:04:32,954 --> 00:04:34,014 I would like it 118 00:04:34,555 --> 00:04:35,615 that we're more 119 00:04:36,074 --> 00:04:39,055 physician directed care because that seems more normal, 120 00:04:39,675 --> 00:04:40,175 but 121 00:04:40,829 --> 00:04:43,250 it has been a relentless kind of progression 122 00:04:43,310 --> 00:04:45,310 toward more and more impact of insurance companies. 123 00:04:45,310 --> 00:04:47,069 So if there's one thing that I'm really 124 00:04:47,069 --> 00:04:48,769 worried about is is 125 00:04:49,629 --> 00:04:52,110 how little say we have in medical care 126 00:04:52,110 --> 00:04:54,689 as it comes to policy making and how 127 00:04:55,855 --> 00:04:58,115 difficult it is for us to impact that 128 00:04:58,574 --> 00:04:59,634 kind of field 129 00:05:00,014 --> 00:05:00,915 in part because, 130 00:05:01,295 --> 00:05:03,455 you know, our pair our payers and insurance 131 00:05:03,455 --> 00:05:03,955 companies, 132 00:05:04,495 --> 00:05:05,855 they make it very difficult for us to 133 00:05:05,855 --> 00:05:07,375 interact with them. Like, I wouldn't even know 134 00:05:07,375 --> 00:05:09,134 how to reach them and explain something to 135 00:05:09,134 --> 00:05:11,629 them. And and when I do do these 136 00:05:11,629 --> 00:05:13,409 things, what we call peer to peers, 137 00:05:14,189 --> 00:05:16,110 I've noticed that there's nothing I can say 138 00:05:16,110 --> 00:05:18,110 or do to change their mind. Whereas 10, 139 00:05:18,110 --> 00:05:20,430 15 years ago, they would ask me, and 140 00:05:20,430 --> 00:05:23,225 they would legitimately care about my opinion. And 141 00:05:23,225 --> 00:05:25,384 let's face it. Patients are unique and different, 142 00:05:25,384 --> 00:05:27,144 and everyone's different. So that's why we have 143 00:05:27,144 --> 00:05:29,644 these doctor to doctor interactions. But, 144 00:05:30,745 --> 00:05:32,745 most of the interactions that I have with 145 00:05:32,745 --> 00:05:33,245 another 146 00:05:33,944 --> 00:05:36,504 physician that represents the insurance company is more 147 00:05:36,504 --> 00:05:39,150 about than just telling me what the policy 148 00:05:39,150 --> 00:05:41,730 is and very little about, 149 00:05:42,350 --> 00:05:44,110 you know, my kind of take on the 150 00:05:44,110 --> 00:05:44,610 situation, 151 00:05:44,990 --> 00:05:47,389 why I wanna do this. And and it's 152 00:05:47,389 --> 00:05:48,990 very difficult to convince them that what I 153 00:05:48,990 --> 00:05:50,770 wanna do for the patient is right. 154 00:05:51,794 --> 00:05:53,814 But here's the thing. Eventually, they will 155 00:05:54,194 --> 00:05:54,854 they will 156 00:05:55,475 --> 00:05:55,975 relent 157 00:05:56,435 --> 00:05:58,595 because, you know, I'm not I'm just trying 158 00:05:58,595 --> 00:06:00,194 to do what's best for the patient, and 159 00:06:00,194 --> 00:06:02,294 they just make us work very, very hard 160 00:06:02,354 --> 00:06:03,875 to get that point across. And at some 161 00:06:03,875 --> 00:06:05,235 point, I can just picture a lot of 162 00:06:05,235 --> 00:06:07,250 people just just give up. So 163 00:06:08,029 --> 00:06:09,389 we need to figure out a way where 164 00:06:09,389 --> 00:06:10,529 we can be more 165 00:06:11,710 --> 00:06:14,430 impactful in that whole process because it should 166 00:06:14,430 --> 00:06:17,410 be a team approach. It should not be 167 00:06:17,629 --> 00:06:18,689 so adversarial. 168 00:06:20,334 --> 00:06:21,774 And I can just tell you that's the 169 00:06:21,774 --> 00:06:23,714 one thing that I feel very 170 00:06:24,735 --> 00:06:26,814 unempowered to address. I wouldn't even begin to 171 00:06:26,814 --> 00:06:28,435 know how to tackle that problem. 172 00:06:30,014 --> 00:06:32,115 That's such a great point. And, you know, 173 00:06:32,175 --> 00:06:34,334 something that we have certainly watched over the 174 00:06:34,334 --> 00:06:35,910 years here at Becker's is that 175 00:06:36,389 --> 00:06:36,889 relationship 176 00:06:37,350 --> 00:06:40,490 between those peer to peer conversations with the, 177 00:06:40,870 --> 00:06:43,589 physicians on the from the insurance companies. And, 178 00:06:43,589 --> 00:06:46,330 you know, hearing that, it's become more challenging 179 00:06:46,790 --> 00:06:47,290 to 180 00:06:47,830 --> 00:06:50,089 have those conversations in a longer process, 181 00:06:50,925 --> 00:06:54,125 than to eventually get those procedures approved. I 182 00:06:54,125 --> 00:06:56,785 can imagine it's hard to work, 183 00:06:57,245 --> 00:06:59,564 through that on the process side and the 184 00:06:59,564 --> 00:07:01,324 operation side of the practice, but more so 185 00:07:01,324 --> 00:07:03,324 even just for the patient trying to access 186 00:07:03,324 --> 00:07:03,810 care. 187 00:07:04,209 --> 00:07:05,970 It seems like it'll be such a big 188 00:07:05,970 --> 00:07:06,470 challenge. 189 00:07:07,169 --> 00:07:10,310 When you think about, you know, moving forward, 190 00:07:10,449 --> 00:07:12,050 I know you mentioned it's hard to know 191 00:07:12,050 --> 00:07:14,930 exactly even the first, move to make in 192 00:07:14,930 --> 00:07:17,169 how to resolve that problem. But, 193 00:07:17,730 --> 00:07:18,389 you know, 194 00:07:18,704 --> 00:07:20,544 is there anything that you're trying to do, 195 00:07:20,865 --> 00:07:21,524 in order 196 00:07:22,305 --> 00:07:24,084 to figure out how to, 197 00:07:24,704 --> 00:07:27,185 you know, continue to move forward and make 198 00:07:27,185 --> 00:07:28,865 sure your patients have access to care in 199 00:07:28,865 --> 00:07:31,024 the best way possible despite some of these 200 00:07:31,024 --> 00:07:31,524 challenges? 201 00:07:32,399 --> 00:07:33,060 Well, unfortunately, 202 00:07:34,319 --> 00:07:36,160 the strategy that I've taken is just hire 203 00:07:36,160 --> 00:07:37,939 more people to spend more time 204 00:07:39,120 --> 00:07:41,680 badgering the insurance companies because they will relent 205 00:07:41,680 --> 00:07:42,420 if you 206 00:07:42,800 --> 00:07:45,199 badger them enough because they figured, okay. He's 207 00:07:45,199 --> 00:07:47,105 serious. He's not just joking around. 208 00:07:47,564 --> 00:07:49,665 So, I have a massive team, 209 00:07:50,525 --> 00:07:52,925 and then processes that try to do the 210 00:07:52,925 --> 00:07:54,605 best we can. But I think the first 211 00:07:54,605 --> 00:07:55,964 thing is is that we need to increase 212 00:07:55,964 --> 00:07:57,824 awareness of this problem among everybody. 213 00:07:58,279 --> 00:08:00,279 Because if it's just the physicians, I don't 214 00:08:00,279 --> 00:08:01,740 think we'll have much say because 215 00:08:02,520 --> 00:08:05,080 I don't find that policymakers really care what 216 00:08:05,080 --> 00:08:06,699 we think as an individual. 217 00:08:07,319 --> 00:08:09,259 Almost, like, as a as a group. 218 00:08:10,199 --> 00:08:12,279 But they do care about everybody else, especially 219 00:08:12,279 --> 00:08:13,259 the patients who 220 00:08:14,014 --> 00:08:16,355 are their clients, who pay the premiums. 221 00:08:18,014 --> 00:08:20,014 And I'll just give you an everyday example 222 00:08:20,014 --> 00:08:21,774 of how how big of a deal this 223 00:08:21,774 --> 00:08:22,274 is. 224 00:08:22,975 --> 00:08:24,574 Just the nature of my practice. I take 225 00:08:24,574 --> 00:08:26,355 care of a lot of high demand individuals, 226 00:08:26,415 --> 00:08:27,314 including physicians. 227 00:08:28,139 --> 00:08:28,639 And 228 00:08:29,100 --> 00:08:31,519 the way they get their care is entirely 229 00:08:31,579 --> 00:08:33,659 different than a whole another group of patients, 230 00:08:33,659 --> 00:08:34,559 like, when I was, 231 00:08:35,019 --> 00:08:36,299 early in my practice and took care of 232 00:08:36,299 --> 00:08:38,299 everybody that's insured and a lot of HMO 233 00:08:38,299 --> 00:08:38,799 patients, 234 00:08:40,174 --> 00:08:41,634 and, like, managed care models. 235 00:08:42,014 --> 00:08:44,274 So if you blew out a disc today 236 00:08:44,735 --> 00:08:45,875 or a week ago, 237 00:08:46,414 --> 00:08:47,714 if you're the typical 238 00:08:48,095 --> 00:08:48,595 patient, 239 00:08:48,975 --> 00:08:50,814 the this is the way the insurance companies 240 00:08:50,814 --> 00:08:52,174 want you to get your care. You go 241 00:08:52,174 --> 00:08:54,029 to your primary care doctor. You tell them 242 00:08:54,029 --> 00:08:55,549 I blew out a disc. I'm in severe 243 00:08:55,549 --> 00:08:57,009 pain. I can't get out of bed. 244 00:08:57,789 --> 00:08:59,549 I think something's really wrong. Can we get 245 00:08:59,549 --> 00:09:01,230 an MRI to find out what's going on? 246 00:09:01,230 --> 00:09:03,149 The answer would be no because the insurance 247 00:09:03,149 --> 00:09:05,789 companies won't authorize an MRI until you do 248 00:09:05,789 --> 00:09:06,850 6 weeks of PT. 249 00:09:07,664 --> 00:09:09,584 So there's a large group of patients that 250 00:09:09,584 --> 00:09:11,264 go through PT in the right. They get 251 00:09:11,264 --> 00:09:12,565 better, and you don't need an MRI. 252 00:09:12,945 --> 00:09:14,865 But there's a significant group of patients that 253 00:09:14,865 --> 00:09:17,105 the whole that at the end of PT, 254 00:09:17,105 --> 00:09:18,544 they're not better, and then they get the 255 00:09:18,544 --> 00:09:20,144 MRI. And then there's a group of patients 256 00:09:20,144 --> 00:09:22,399 that even though they get better, the whole 257 00:09:22,399 --> 00:09:24,799 time they're worried that they're doing something wrong 258 00:09:24,799 --> 00:09:26,980 and they're harming something, so they don't really 259 00:09:27,039 --> 00:09:28,980 participate in physical therapy meaningfully. 260 00:09:29,840 --> 00:09:30,340 And 261 00:09:30,720 --> 00:09:32,960 I guess 20 years ago when MRIs cost 262 00:09:32,960 --> 00:09:33,700 2, $3,000, 263 00:09:34,160 --> 00:09:35,539 that kind of made sense. 264 00:09:36,245 --> 00:09:38,664 But MRIs are, like, 2 or $300 now. 265 00:09:39,365 --> 00:09:41,384 And it doesn't make sense 266 00:09:42,004 --> 00:09:44,324 to not have a diagnosis before you start 267 00:09:44,324 --> 00:09:46,245 any kind of treatment. We don't do that 268 00:09:46,245 --> 00:09:47,065 anywhere else. 269 00:09:47,684 --> 00:09:50,990 It's it's so now that it's only 2300, 270 00:09:51,129 --> 00:09:52,350 you'd think it like that wouldn't 271 00:09:53,289 --> 00:09:54,350 change, but it doesn't. 272 00:09:55,129 --> 00:09:55,629 Because 273 00:09:56,250 --> 00:09:57,949 change is slow for 1. And 2, 274 00:09:58,570 --> 00:10:00,429 no one says that this is a problem. 275 00:10:00,970 --> 00:10:01,470 Now 276 00:10:01,924 --> 00:10:03,384 here's the other group of patients. 277 00:10:03,924 --> 00:10:06,564 If you're a physician or somebody that knows 278 00:10:06,564 --> 00:10:08,404 a physician or has a family member that's 279 00:10:08,404 --> 00:10:09,064 a physician, 280 00:10:10,404 --> 00:10:12,084 if you had a blown out disc in 281 00:10:12,084 --> 00:10:13,605 your bed bound a week ago, you're gonna 282 00:10:13,605 --> 00:10:15,605 get an MRI this week sometime, and you're 283 00:10:15,605 --> 00:10:16,424 gonna probably 284 00:10:16,884 --> 00:10:20,000 hear from a spine surgeon sometime this week. 285 00:10:20,940 --> 00:10:23,179 This is what happens the vast majority of 286 00:10:23,179 --> 00:10:24,860 time if you're a physician or have a 287 00:10:24,860 --> 00:10:26,700 family member that's a physician where you just 288 00:10:26,700 --> 00:10:27,980 pick up the phone and make some phone 289 00:10:27,980 --> 00:10:28,480 calls. 290 00:10:28,860 --> 00:10:30,460 And I find a lot of my patients 291 00:10:30,460 --> 00:10:32,879 just pay cash to get the MRI because 292 00:10:33,605 --> 00:10:34,985 that's what I would do. 293 00:10:35,605 --> 00:10:36,985 I wouldn't wanna start PT 294 00:10:38,485 --> 00:10:40,585 without knowing what my diagnosis is. 295 00:10:42,085 --> 00:10:44,485 I mean, just mentally, and it's makes more 296 00:10:44,485 --> 00:10:47,384 sense. So that's just one small example of 297 00:10:47,709 --> 00:10:48,850 the difference between, 298 00:10:49,629 --> 00:10:51,789 what should be happening. I mean, that may 299 00:10:51,789 --> 00:10:54,049 be an extreme case and what is happening. 300 00:10:54,509 --> 00:10:55,009 And 301 00:10:56,909 --> 00:10:58,429 I think the first step is awareness, and 302 00:10:58,429 --> 00:11:00,190 then the second step would be find people 303 00:11:00,190 --> 00:11:02,914 that care about this, that like interacting with 304 00:11:02,914 --> 00:11:04,215 insurance companies and 305 00:11:04,674 --> 00:11:06,434 let them know that some things need to 306 00:11:06,434 --> 00:11:08,195 change. And just I bet you if we 307 00:11:08,195 --> 00:11:09,335 just ask the insurance 308 00:11:10,434 --> 00:11:10,934 executives 309 00:11:12,355 --> 00:11:13,394 by the way, I take care of a 310 00:11:13,394 --> 00:11:14,914 lot of, like, doc I took care of 311 00:11:14,914 --> 00:11:17,190 several doctors that are peer review doctors that 312 00:11:17,190 --> 00:11:18,230 get on the phone and tell you you 313 00:11:18,230 --> 00:11:20,629 can't do your surgery. Guess what they do? 314 00:11:20,629 --> 00:11:22,629 They that they do exactly what I just 315 00:11:22,629 --> 00:11:24,389 said. They get an MRI within that week. 316 00:11:24,389 --> 00:11:25,929 They they hear from somebody, 317 00:11:26,470 --> 00:11:28,629 like a spine surgeon, right away about what 318 00:11:28,629 --> 00:11:30,149 the diagnosis is. And if it's a big 319 00:11:30,149 --> 00:11:31,830 blown out disc, they'd get seen. If it's 320 00:11:31,830 --> 00:11:33,535 nothing, then they go to PT and stuff 321 00:11:33,535 --> 00:11:34,355 like that. But, 322 00:11:35,295 --> 00:11:36,575 we just need to ask them, what would 323 00:11:36,575 --> 00:11:38,014 you do for yourself? Because that's what you 324 00:11:38,014 --> 00:11:39,154 should do for your clients. 325 00:11:40,095 --> 00:11:42,415 That simple question, I think, will take us 326 00:11:42,415 --> 00:11:43,634 most of the way there. 327 00:11:44,654 --> 00:11:47,475 That's, you know, fascinating to hear. And, certainly, 328 00:11:48,440 --> 00:11:51,620 I can imagine, especially as I've been hearing, 329 00:11:51,840 --> 00:11:53,860 you know, for a while now that consumerism 330 00:11:54,320 --> 00:11:56,639 is becoming a huge part of the health 331 00:11:56,639 --> 00:11:59,679 care ecosystem. And those, like you said, who, 332 00:11:59,679 --> 00:12:01,375 you know, don't wanna wait for care, it 333 00:12:01,375 --> 00:12:03,134 seems like such a reasonable price, a couple 334 00:12:03,134 --> 00:12:03,634 $100, 335 00:12:04,414 --> 00:12:06,735 versus going through 6 weeks of physical therapy. 336 00:12:07,214 --> 00:12:09,075 If you think you have a a problem, 337 00:12:09,695 --> 00:12:11,454 makes a lot of sense. And, yeah, it 338 00:12:11,454 --> 00:12:13,214 just it'll be fascinating to see how the 339 00:12:13,214 --> 00:12:15,949 next couple years, you know, with the focus 340 00:12:15,949 --> 00:12:17,409 and and really looking into, 341 00:12:17,949 --> 00:12:20,189 the types of issues on quality as well 342 00:12:20,189 --> 00:12:22,209 as costs, if that will make a difference. 343 00:12:22,509 --> 00:12:24,509 Now I'm wondering too, what are you most 344 00:12:24,509 --> 00:12:26,589 excited about right now, and and what makes 345 00:12:26,589 --> 00:12:27,250 you nervous? 346 00:12:28,605 --> 00:12:29,665 Probably 2 things. 347 00:12:30,845 --> 00:12:33,184 And and these are both exciting and, 348 00:12:33,804 --> 00:12:37,105 nerve wracking. The first is, like, social media. 349 00:12:37,565 --> 00:12:40,304 And I've really embraced social media because 350 00:12:40,830 --> 00:12:43,730 I'm all about awareness. And things have changed 351 00:12:43,790 --> 00:12:46,110 drastically compared to 10 years ago and before 352 00:12:46,110 --> 00:12:48,529 COVID. Because social media is so 353 00:12:49,149 --> 00:12:50,690 prevalent now and such 354 00:12:51,070 --> 00:12:51,570 a 355 00:12:52,110 --> 00:12:53,490 common way for 356 00:12:54,174 --> 00:12:56,735 everyone to get information that I can just 357 00:12:56,735 --> 00:12:58,815 make a post and thousands of people might 358 00:12:58,815 --> 00:12:59,934 see it. I I have a video that 359 00:12:59,934 --> 00:13:02,035 has over a 100,000,000 views. 360 00:13:02,894 --> 00:13:04,335 10 years ago, there'd be no way I 361 00:13:04,335 --> 00:13:06,174 can get any kind of message across to 362 00:13:06,174 --> 00:13:07,154 that many people. 363 00:13:07,535 --> 00:13:08,035 So, 364 00:13:08,415 --> 00:13:10,559 you know, social media has all its problems, 365 00:13:10,559 --> 00:13:13,139 but one huge advantage is that 366 00:13:13,600 --> 00:13:14,420 it allows 367 00:13:14,960 --> 00:13:16,740 information transfer to be 368 00:13:17,360 --> 00:13:18,740 much more easy 369 00:13:19,040 --> 00:13:20,420 and much more grassroots. 370 00:13:21,679 --> 00:13:22,820 And I bet you 371 00:13:24,495 --> 00:13:26,514 it's gonna be the swell of, 372 00:13:26,975 --> 00:13:27,634 you know, 373 00:13:28,654 --> 00:13:31,294 knowledge on social media, awareness through social media 374 00:13:31,294 --> 00:13:33,855 that's all these issues that will kind of 375 00:13:33,855 --> 00:13:34,355 stimulate 376 00:13:34,654 --> 00:13:36,195 change much more rapidly. 377 00:13:37,700 --> 00:13:39,059 But at the same time, you have to 378 00:13:39,059 --> 00:13:41,779 be careful because it's an opportunity to put 379 00:13:41,779 --> 00:13:44,919 out there a lot of misinformation too. Now 380 00:13:45,860 --> 00:13:48,100 looking at it from my perspective, I'd rather 381 00:13:48,100 --> 00:13:48,600 have, 382 00:13:48,980 --> 00:13:51,160 you know, an open spigot on both ends, 383 00:13:51,220 --> 00:13:54,495 good information and misinformation than to try to 384 00:13:54,495 --> 00:13:55,475 control information 385 00:13:55,855 --> 00:13:57,375 and decide which is good and which is 386 00:13:57,375 --> 00:13:57,875 bad. 387 00:13:58,175 --> 00:13:59,955 I mean, those are the two options, and, 388 00:14:01,535 --> 00:14:02,754 I don't know how to 389 00:14:03,215 --> 00:14:04,595 how to police that. 390 00:14:04,970 --> 00:14:08,350 That's hopefully something that somebody's thinking about. But, 391 00:14:09,529 --> 00:14:12,490 overall, net net, I would say that if 392 00:14:12,490 --> 00:14:14,110 I was a patient and a consumer, 393 00:14:14,730 --> 00:14:17,070 social media is unbelievably helpful 394 00:14:17,450 --> 00:14:19,290 in trying to learn about what's going on 395 00:14:19,290 --> 00:14:21,785 and trying to figure out what I should 396 00:14:21,785 --> 00:14:23,945 do next and who I should believe and 397 00:14:23,945 --> 00:14:25,485 who I should go see and, 398 00:14:26,264 --> 00:14:29,384 and questioning, you know, information from just one 399 00:14:29,384 --> 00:14:31,545 source because there's multiple sources. And after a 400 00:14:31,545 --> 00:14:33,065 while, you can kinda get a sense of 401 00:14:33,065 --> 00:14:36,129 what's believable or not. That's that's my optimistic 402 00:14:36,129 --> 00:14:38,149 view of information transfer. 403 00:14:38,769 --> 00:14:41,250 But if, if an evil entity decided to 404 00:14:41,250 --> 00:14:41,750 overwhelm 405 00:14:42,370 --> 00:14:44,529 the Internet with misinformation by the way, that 406 00:14:44,529 --> 00:14:46,850 happens a lot. Like, our food industry is 407 00:14:46,850 --> 00:14:47,509 like that. 408 00:14:48,610 --> 00:14:50,504 That would be bad. The other thing I'm 409 00:14:50,504 --> 00:14:52,745 really excited about and also petrified about is 410 00:14:52,745 --> 00:14:53,964 AI. And 411 00:14:54,345 --> 00:14:56,264 I don't like the using the word AI. 412 00:14:56,264 --> 00:14:58,764 I just like using it's it's like 413 00:14:59,704 --> 00:15:02,764 you want, like, better and better apps 414 00:15:03,149 --> 00:15:03,889 and programs 415 00:15:04,269 --> 00:15:05,789 that do stuff that you don't need to 416 00:15:05,789 --> 00:15:08,990 do and remember things. And there's so many 417 00:15:08,990 --> 00:15:11,329 things that we do in medicine that involves 418 00:15:11,389 --> 00:15:12,690 these huge checklists, 419 00:15:13,309 --> 00:15:16,610 and it's shocking how resistant humans are 420 00:15:16,985 --> 00:15:18,745 in going through a checklist of, like, 50 421 00:15:18,745 --> 00:15:21,705 items. The airline industry does it meticulously. That's 422 00:15:21,705 --> 00:15:23,325 why they're probably one of the safest 423 00:15:23,865 --> 00:15:26,105 industries on the planet. I mean, they they 424 00:15:26,105 --> 00:15:27,085 have very little, 425 00:15:28,264 --> 00:15:32,139 relatively speaking, like industrial injuries, like crashes and 426 00:15:32,139 --> 00:15:33,840 things like that because they are 427 00:15:34,460 --> 00:15:36,799 they're like into Sigma 6 and checklist manifesto 428 00:15:36,860 --> 00:15:37,919 and things like that. 429 00:15:38,620 --> 00:15:41,340 In the field of medicine, we really kind 430 00:15:41,340 --> 00:15:42,879 of resist that for some reason. 431 00:15:44,274 --> 00:15:46,595 So with AI, we're gonna be in a 432 00:15:46,595 --> 00:15:50,195 situation where we can focus people's energies on, 433 00:15:50,195 --> 00:15:52,274 like, high level things. Not like making sure 434 00:15:52,274 --> 00:15:54,034 that, you know, there's enough Band Aids in 435 00:15:54,034 --> 00:15:56,115 the in the Pyxis, and we're not we're 436 00:15:56,115 --> 00:15:57,554 not in the middle of surgery forgetting to 437 00:15:57,554 --> 00:15:58,215 do this. 438 00:15:58,539 --> 00:15:59,919 Like, everything is just 439 00:16:00,220 --> 00:16:02,080 totally laid out, consistent. 440 00:16:03,019 --> 00:16:05,259 And just like all the kind of apps 441 00:16:05,259 --> 00:16:06,879 and programs and 442 00:16:07,419 --> 00:16:09,039 and things that we use, like 443 00:16:09,500 --> 00:16:12,160 like, you know, NASA? They have programs to 444 00:16:12,465 --> 00:16:14,305 plot out all the different trajectories of their 445 00:16:14,305 --> 00:16:16,305 space flights because it's kinda complicated. It's not 446 00:16:16,305 --> 00:16:17,585 like just a straight line. They use all 447 00:16:17,585 --> 00:16:19,445 kinds of, you know, gravity 448 00:16:19,825 --> 00:16:20,644 things that 449 00:16:21,024 --> 00:16:23,745 swing things around planets and just bizarre things, 450 00:16:23,745 --> 00:16:25,629 and you can do it in so many 451 00:16:25,629 --> 00:16:28,429 different permutations at different times to find when's 452 00:16:28,429 --> 00:16:30,190 the best time to launch this rocket. If 453 00:16:30,190 --> 00:16:31,549 you didn't have programs to do that, you 454 00:16:31,549 --> 00:16:33,809 would it would be impossible to find easily 455 00:16:34,029 --> 00:16:35,250 all these different parameters. 456 00:16:35,710 --> 00:16:37,710 And the same thing should happen in medicine. 457 00:16:37,710 --> 00:16:38,929 We should be empowered 458 00:16:39,575 --> 00:16:41,514 to be better at what we do, 459 00:16:42,534 --> 00:16:44,695 and that includes, like, an AI program that 460 00:16:44,695 --> 00:16:47,195 will help me decide what the best 461 00:16:47,815 --> 00:16:50,134 treatment for this diagnosis is. It may help 462 00:16:50,134 --> 00:16:50,955 me decide 463 00:16:51,509 --> 00:16:53,190 what that diagnosis might be if it's a 464 00:16:53,190 --> 00:16:55,750 little confusing because we can always use information. 465 00:16:55,750 --> 00:16:57,049 You as a human 466 00:16:57,990 --> 00:16:59,669 make the final decision. You may have a 467 00:16:59,669 --> 00:17:00,490 few options 468 00:17:01,110 --> 00:17:02,870 to choose from, but you don't have to 469 00:17:02,870 --> 00:17:04,789 rack your brain and your cognitive energy to 470 00:17:04,789 --> 00:17:06,150 do all the basic things to get to 471 00:17:06,150 --> 00:17:08,275 that point. You can save all that energy 472 00:17:08,654 --> 00:17:11,375 for very high level things that involve human 473 00:17:11,375 --> 00:17:13,394 things. Like, you know, we don't make decisions 474 00:17:13,934 --> 00:17:16,255 purely on logic. We're not Vulcans on Star 475 00:17:16,255 --> 00:17:18,755 Trek. You know, Vulcans are never the hero. 476 00:17:19,069 --> 00:17:20,690 It's always that really emotional 477 00:17:21,309 --> 00:17:23,869 Kirk. Kirk is like the he's, like, not 478 00:17:23,869 --> 00:17:24,369 rational. 479 00:17:24,829 --> 00:17:25,650 He's passionate, 480 00:17:26,029 --> 00:17:28,670 and and that's what, in the end, we 481 00:17:28,670 --> 00:17:31,230 gravitate towards. So I don't think AI will 482 00:17:31,230 --> 00:17:32,690 ever replace humans 483 00:17:33,595 --> 00:17:34,414 at the end, 484 00:17:34,955 --> 00:17:36,875 but they will replace a lot of things 485 00:17:36,875 --> 00:17:38,975 that humans aren't very good at 486 00:17:39,595 --> 00:17:40,414 and really 487 00:17:40,875 --> 00:17:43,215 don't enjoy doing. And so 488 00:17:44,795 --> 00:17:46,875 I think for somebody like me that's always 489 00:17:46,875 --> 00:17:48,634 looking to be better and better and better 490 00:17:48,634 --> 00:17:51,250 and better and trying to, like, eliminate, like, 491 00:17:51,250 --> 00:17:53,109 little things that slow me down, 492 00:17:53,809 --> 00:17:55,570 AI would be great because I'm a huge 493 00:17:55,570 --> 00:17:56,549 checklist guy. 494 00:17:57,250 --> 00:17:58,690 But at the same time, I can just 495 00:17:58,690 --> 00:18:01,454 see if we swing too far that we 496 00:18:01,534 --> 00:18:03,375 start living in a world that is completely 497 00:18:03,375 --> 00:18:04,515 devoid of emotions, 498 00:18:05,054 --> 00:18:05,554 feelings, 499 00:18:05,855 --> 00:18:07,315 of things that are very human. 500 00:18:08,974 --> 00:18:11,075 And we may end up making 501 00:18:11,454 --> 00:18:13,375 poor decisions because we don't take that into 502 00:18:13,375 --> 00:18:15,470 account. I can't picture an AI program being 503 00:18:15,470 --> 00:18:17,470 able to address that issue. It'd be sort 504 00:18:17,470 --> 00:18:19,569 of like AI can generate art, 505 00:18:19,869 --> 00:18:20,369 but 506 00:18:20,750 --> 00:18:22,909 whether that art is beautiful or not, in 507 00:18:22,909 --> 00:18:23,950 the end, is in the eye of the 508 00:18:23,950 --> 00:18:24,450 beholder. 509 00:18:25,390 --> 00:18:27,884 Right? The final decision on if you're gonna 510 00:18:27,884 --> 00:18:29,825 pay some money for that piece of art 511 00:18:30,285 --> 00:18:32,144 and how much if that's a human decision. 512 00:18:32,365 --> 00:18:33,825 And we'll always have that. 513 00:18:34,445 --> 00:18:37,184 And those two things are, like, social media 514 00:18:37,404 --> 00:18:39,724 with AI. Those are all high technology things 515 00:18:39,724 --> 00:18:40,224 that, 516 00:18:40,924 --> 00:18:41,825 its evolution 517 00:18:42,940 --> 00:18:44,940 is not like little by little. It is, 518 00:18:44,940 --> 00:18:45,440 like, 519 00:18:46,299 --> 00:18:46,799 exponential. 520 00:18:47,340 --> 00:18:48,559 So in 10 years, 521 00:18:49,019 --> 00:18:51,180 I think my work environment will be very 522 00:18:51,180 --> 00:18:52,859 different. I will have a lot less people 523 00:18:52,859 --> 00:18:54,160 doing mundane tasks. 524 00:18:55,174 --> 00:18:56,775 All those things will be done by, like, 525 00:18:56,775 --> 00:18:57,275 scheduling, 526 00:18:57,974 --> 00:18:58,474 authorizations. 527 00:18:59,974 --> 00:19:02,294 I mean, even dictating a note. Like, there 528 00:19:02,294 --> 00:19:04,454 are pro AI programs that will generate a 529 00:19:04,454 --> 00:19:06,134 clinic note based on your conversation with the 530 00:19:06,134 --> 00:19:08,154 patient. It will just record your normal conversation. 531 00:19:08,990 --> 00:19:10,110 And you have to right now, you have 532 00:19:10,110 --> 00:19:11,150 to do a few things to kind of 533 00:19:11,150 --> 00:19:12,670 prompt it to know that you're looking at 534 00:19:12,670 --> 00:19:13,410 an MRI. 535 00:19:13,710 --> 00:19:14,910 But you can you don't have to go 536 00:19:14,910 --> 00:19:17,330 in order. You can just see the patient, 537 00:19:17,390 --> 00:19:19,789 record the whole thing. It will know who 538 00:19:19,789 --> 00:19:22,130 you are, who the patient is, who patient's 539 00:19:23,265 --> 00:19:24,005 partner is. 540 00:19:24,545 --> 00:19:26,464 It will know that you don't have to 541 00:19:26,464 --> 00:19:28,705 put in things about the dog walk yesterday 542 00:19:28,705 --> 00:19:30,484 and how the dog pooped on your lawn 543 00:19:30,545 --> 00:19:32,644 and a lot of extraneous thing. It's shocking 544 00:19:32,785 --> 00:19:35,025 how already it's so much better. So we 545 00:19:35,025 --> 00:19:37,349 don't need, like, scribes. We don't need transcriptions. 546 00:19:37,490 --> 00:19:39,089 We don't need me to sit down and, 547 00:19:39,089 --> 00:19:40,769 like, type while we're talking to the patient. 548 00:19:40,769 --> 00:19:42,230 I can devote my entire 549 00:19:43,089 --> 00:19:46,049 cognitive energy and attention to the patient and 550 00:19:46,049 --> 00:19:48,549 the patient's needs. And that's gonna be great. 551 00:19:49,545 --> 00:19:51,005 But I'm fearful that 552 00:19:51,465 --> 00:19:53,945 I'll end up being by myself in an 553 00:19:53,945 --> 00:19:55,785 office with no one to talk to, and, 554 00:19:55,785 --> 00:19:57,225 you know, I'm an extrovert as you can 555 00:19:57,225 --> 00:19:57,725 tell. 556 00:19:58,265 --> 00:19:58,765 And 557 00:19:59,065 --> 00:20:00,525 that sounds really lonely. 558 00:20:01,305 --> 00:20:01,805 So, 559 00:20:02,940 --> 00:20:04,380 like everything, it's a good and a bad, 560 00:20:04,380 --> 00:20:06,220 but this is a those 2 things are 561 00:20:06,220 --> 00:20:07,819 freight trains coming. There's just no way we 562 00:20:07,819 --> 00:20:09,119 can avoid it. 563 00:20:09,819 --> 00:20:11,259 And I think the best thing to do 564 00:20:11,259 --> 00:20:12,960 is that we embrace it, 565 00:20:13,259 --> 00:20:15,980 identify all the positives, and take advantage of 566 00:20:15,980 --> 00:20:17,599 it, and try to 567 00:20:18,315 --> 00:20:18,815 limit, 568 00:20:19,355 --> 00:20:19,855 mitigate, 569 00:20:20,315 --> 00:20:21,615 control if possible 570 00:20:22,075 --> 00:20:24,315 as many negative aspects of it as possible. 571 00:20:24,315 --> 00:20:25,994 And it will be no different. Like, I 572 00:20:25,994 --> 00:20:29,214 guess when TV came out, people said, like, 573 00:20:29,274 --> 00:20:31,194 when it gen create a generation of, like, 574 00:20:31,194 --> 00:20:33,115 brain dead people because they'll never read. That 575 00:20:33,115 --> 00:20:35,029 never happened. Same thing with, 576 00:20:35,570 --> 00:20:37,009 calculators. Like, you're not gonna be able to 577 00:20:37,009 --> 00:20:38,930 do math. It's like, who cares, like, if 578 00:20:38,930 --> 00:20:40,289 I can't add up all that stuff? It's 579 00:20:40,289 --> 00:20:42,210 not, like, important to me. No one's gonna 580 00:20:42,210 --> 00:20:44,210 test me on it anymore. And it's just 581 00:20:44,210 --> 00:20:46,150 that in a whole another level. So, 582 00:20:47,090 --> 00:20:50,565 net net, I love technology. I love doing 583 00:20:50,565 --> 00:20:52,424 things better and better and better. And, 584 00:20:52,725 --> 00:20:55,465 overall, I'm extremely excited about the future. 585 00:20:57,045 --> 00:20:59,445 That's fascinating. And, you know, certainly, all those 586 00:20:59,445 --> 00:21:01,445 different things that you've mentioned, whether it's looking 587 00:21:01,445 --> 00:21:03,525 at AI or social media or other ways 588 00:21:03,525 --> 00:21:06,460 that technology is really transforming health care in 589 00:21:06,460 --> 00:21:08,940 so many industries right now. It is exciting 590 00:21:08,940 --> 00:21:10,940 to think about the future and what the 591 00:21:10,940 --> 00:21:14,059 possibilities are. We'll also, you know, trying to 592 00:21:14,059 --> 00:21:16,539 be mindful of limiting or mitigating some of 593 00:21:16,539 --> 00:21:17,839 the challenges. And, certainly, 594 00:21:18,154 --> 00:21:20,474 you know, we always love having you here 595 00:21:20,474 --> 00:21:23,274 at Becker's, doctor Kim. So, you know, never 596 00:21:23,274 --> 00:21:24,414 have to be in a 597 00:21:24,794 --> 00:21:26,894 room by yourself with us. That's for sure. 598 00:21:27,595 --> 00:21:29,355 Before we wrap up here, I'm wondering, you 599 00:21:29,355 --> 00:21:31,274 know, looking into the future, whether it's some 600 00:21:31,274 --> 00:21:31,684 of the, 601 00:21:32,759 --> 00:21:35,099 payment challenges or some of the other challenges 602 00:21:35,160 --> 00:21:37,559 on the operational side of health care and 603 00:21:37,559 --> 00:21:40,359 then to some of the exciting possibilities and 604 00:21:40,359 --> 00:21:40,859 opportunities, 605 00:21:41,240 --> 00:21:42,759 what do you think is going to be 606 00:21:42,759 --> 00:21:45,160 important for spine surgeons and leaders in spine 607 00:21:45,160 --> 00:21:47,055 in general to do in order to be 608 00:21:47,134 --> 00:21:48,494 successful in the next 2 to 3 years 609 00:21:48,494 --> 00:21:49,154 or so? 610 00:21:50,015 --> 00:21:52,255 Well, there's kind of, I think, 2 layers 611 00:21:52,255 --> 00:21:52,914 of that. 612 00:21:53,215 --> 00:21:55,295 There's the layer of how can spine surgeons 613 00:21:55,295 --> 00:21:57,055 be successful on a day to day basis 614 00:21:57,055 --> 00:21:57,875 with their practice. 615 00:21:58,575 --> 00:21:59,315 And then 616 00:22:00,430 --> 00:22:02,609 what spine surgeons need to do to 617 00:22:03,710 --> 00:22:05,230 deal with this whole issue of what I 618 00:22:05,230 --> 00:22:07,549 call, like, you know, insurance directed health care 619 00:22:07,549 --> 00:22:08,450 and hospital 620 00:22:09,390 --> 00:22:09,890 administrator 621 00:22:10,269 --> 00:22:12,990 directed health care. Because I'm sure you all 622 00:22:12,990 --> 00:22:15,347 know, but I'm not sure that everyone else 623 00:22:15,347 --> 00:22:17,671 is aware. If you plot the growth of 624 00:22:17,671 --> 00:22:19,994 physicians at a hospital on a curve, it's 625 00:22:19,994 --> 00:22:22,318 kind of like this flat linear line that's 626 00:22:22,318 --> 00:22:24,642 just gradually increasing. If you plot the number 627 00:22:24,642 --> 00:22:26,965 of administrators in a hospital, it is like 628 00:22:27,256 --> 00:22:30,140 it's, you know, log myth logarithmic curve. So 629 00:22:30,140 --> 00:22:32,059 maybe 20 10, 20 years ago, it was 630 00:22:32,059 --> 00:22:34,220 like 1 to 1, maybe 2 to 1. 631 00:22:34,220 --> 00:22:36,339 Now it's like 20 to 1 or 30 632 00:22:36,339 --> 00:22:37,119 to 1. 633 00:22:38,059 --> 00:22:38,559 Administrators 634 00:22:39,419 --> 00:22:40,159 to physicians. 635 00:22:41,099 --> 00:22:41,599 So, 636 00:22:43,005 --> 00:22:43,744 you know, 637 00:22:44,045 --> 00:22:46,785 the kind of, like, the momentum is toward 638 00:22:47,244 --> 00:22:47,744 more 639 00:22:48,045 --> 00:22:48,944 people that 640 00:22:49,724 --> 00:22:52,605 are not directly involved in patient care, making 641 00:22:52,605 --> 00:22:55,565 lots of really important medical decision making policy 642 00:22:56,680 --> 00:22:57,180 policies. 643 00:22:58,200 --> 00:22:59,500 And I 644 00:22:59,880 --> 00:23:02,119 came to realize how important this is with 645 00:23:02,119 --> 00:23:04,440 the recent acquisition of my little hospital called 646 00:23:04,440 --> 00:23:07,240 Alvarado by UCSD Medical Center. So I've been 647 00:23:07,240 --> 00:23:08,839 at UCSD for a long time. I did 648 00:23:08,839 --> 00:23:11,934 my undergrad there. I did my internship and 649 00:23:11,934 --> 00:23:13,475 residency there. I 650 00:23:14,255 --> 00:23:15,795 was on staff as faculty, 651 00:23:16,494 --> 00:23:18,894 assistant and associate professor there for 8 years. 652 00:23:18,894 --> 00:23:20,654 And when I had a big surgery, guess 653 00:23:20,654 --> 00:23:21,795 what? I had it at UCSD. 654 00:23:22,174 --> 00:23:24,914 So I know that entity very well. And 655 00:23:25,134 --> 00:23:26,515 10, 20 years ago, 656 00:23:27,049 --> 00:23:27,950 it was like a 657 00:23:28,569 --> 00:23:29,230 state university. 658 00:23:29,849 --> 00:23:30,990 That's why I left. 659 00:23:31,529 --> 00:23:33,769 But something happened in the last 10 years, 660 00:23:33,769 --> 00:23:36,409 and the leadership of UCSD really represents kind 661 00:23:36,409 --> 00:23:37,630 of, like, what I think 662 00:23:38,569 --> 00:23:39,529 what the future 663 00:23:40,664 --> 00:23:42,585 you know, like, health care leaders should look 664 00:23:42,585 --> 00:23:43,085 like, 665 00:23:43,785 --> 00:23:44,525 to really 666 00:23:45,465 --> 00:23:46,825 address some of the problems that we deal 667 00:23:46,825 --> 00:23:48,984 with. So, you know, as you can imagine, 668 00:23:48,984 --> 00:23:51,144 I'm talking about the whole policy thing. So 669 00:23:51,144 --> 00:23:51,644 UCSD, 670 00:23:52,184 --> 00:23:54,285 all the big gun leaders 671 00:23:55,309 --> 00:23:56,769 still see patients. 672 00:23:58,190 --> 00:23:58,690 Now 673 00:23:58,990 --> 00:24:00,609 from a salary perspective, 674 00:24:01,150 --> 00:24:03,890 it is hard to, like, replace 675 00:24:04,269 --> 00:24:06,269 the income that you might have with seeing 676 00:24:06,269 --> 00:24:07,869 a patient because that's what you've been trained 677 00:24:07,869 --> 00:24:09,535 for. You're not trying to be, like, an 678 00:24:09,535 --> 00:24:12,974 administrator. So, usually, when you do administrative work, 679 00:24:12,974 --> 00:24:15,535 it's almost like you're volunteering your time. So 680 00:24:15,535 --> 00:24:17,634 you never get anybody that's really high level, 681 00:24:17,775 --> 00:24:20,835 dedicated, and has enough time and cognitive energy 682 00:24:21,055 --> 00:24:24,309 to devote toward important administrative functions. But 683 00:24:24,690 --> 00:24:26,630 if you set up a system where 684 00:24:27,090 --> 00:24:27,670 the leaders 685 00:24:29,170 --> 00:24:31,990 can see patients, but they have protected time 686 00:24:32,369 --> 00:24:33,990 to be like the vice chancellor 687 00:24:35,144 --> 00:24:37,484 without having to sacrifice too much. 688 00:24:37,945 --> 00:24:39,005 Now you've got, 689 00:24:39,865 --> 00:24:41,625 you know, a group of physician leaders that 690 00:24:41,625 --> 00:24:42,845 still are reminded 691 00:24:43,545 --> 00:24:45,945 what it's like being in the trenches. Because 692 00:24:45,945 --> 00:24:46,684 in the end, 693 00:24:47,650 --> 00:24:49,170 no matter what you do, it's all about 694 00:24:49,170 --> 00:24:51,269 the patient in front of you. I mean, 695 00:24:51,730 --> 00:24:53,250 if that's not important to you, you should 696 00:24:53,250 --> 00:24:54,630 have probably not gone into medicine. 697 00:24:55,009 --> 00:24:56,130 When you have a patient in front of 698 00:24:56,130 --> 00:24:58,710 you, that's like that's begging you for help. 699 00:24:59,944 --> 00:25:01,164 You feel very important. 700 00:25:01,785 --> 00:25:04,265 Making decisions about policy? Yeah. But when a 701 00:25:04,265 --> 00:25:06,025 patient's looking to you for help, that is 702 00:25:06,025 --> 00:25:07,545 the most important thing you gotta be doing 703 00:25:07,545 --> 00:25:09,625 at that time. So if you have trouble 704 00:25:09,625 --> 00:25:11,065 with things like that and you run into, 705 00:25:11,065 --> 00:25:12,204 like, these little obstacles 706 00:25:13,319 --> 00:25:15,319 and you are in a situation of lead 707 00:25:15,480 --> 00:25:17,480 in a position of leadership that can make 708 00:25:17,480 --> 00:25:17,980 change, 709 00:25:18,440 --> 00:25:19,880 I think when I go to tell them 710 00:25:19,880 --> 00:25:22,200 what I'm trouble having trouble with, they're more 711 00:25:22,200 --> 00:25:23,179 likely to understand. 712 00:25:23,480 --> 00:25:24,839 And I'll give you an example. I just 713 00:25:24,839 --> 00:25:26,140 did a peer to peer with insurance 714 00:25:26,894 --> 00:25:27,394 physician. 715 00:25:28,414 --> 00:25:30,654 And one of the first things that physician 716 00:25:30,654 --> 00:25:31,394 said is, 717 00:25:31,775 --> 00:25:33,474 I looked it up on UpToDate, 718 00:25:33,934 --> 00:25:35,234 and I didn't see 719 00:25:36,494 --> 00:25:38,414 I I couldn't get enough information to make 720 00:25:38,414 --> 00:25:39,075 a decision. 721 00:25:39,539 --> 00:25:41,619 So I said, great. I've got tons of 722 00:25:41,619 --> 00:25:43,859 information because up to date is trying and 723 00:25:43,859 --> 00:25:45,460 it's great, but it's not usually up to 724 00:25:45,460 --> 00:25:46,759 date. And let's face it. 725 00:25:47,059 --> 00:25:48,900 Every patient's different. So I went on this 726 00:25:48,900 --> 00:25:51,220 long diatribe about why this patient needed the 727 00:25:51,220 --> 00:25:51,720 surgery. 728 00:25:52,545 --> 00:25:54,785 And that physician listened, listened, listened, and you 729 00:25:54,785 --> 00:25:56,545 could tell he couldn't care what I said. 730 00:25:56,545 --> 00:25:57,285 He goes, 731 00:25:58,384 --> 00:25:58,884 well, 732 00:25:59,184 --> 00:25:59,924 I can't 733 00:26:00,705 --> 00:26:02,865 change this. This is actually not a peer 734 00:26:02,865 --> 00:26:05,105 to peer. I'm just here to tell you 735 00:26:05,105 --> 00:26:05,605 why 736 00:26:06,420 --> 00:26:07,160 it's denied. 737 00:26:07,779 --> 00:26:09,799 I can't actually override this. 738 00:26:10,259 --> 00:26:10,759 And 739 00:26:11,140 --> 00:26:12,039 I was shocked. 740 00:26:12,740 --> 00:26:14,340 I mean, I'm on the phone. I did 741 00:26:14,340 --> 00:26:15,960 some research. I pulled articles. 742 00:26:16,340 --> 00:26:18,519 I talked to him about it, and I 743 00:26:18,660 --> 00:26:20,519 gave him a very coherent, 744 00:26:21,494 --> 00:26:22,555 convincing argument, 745 00:26:23,015 --> 00:26:24,875 but he does not care because 746 00:26:25,734 --> 00:26:27,035 he's an insurance guy. 747 00:26:27,734 --> 00:26:29,335 He probably doesn't seem to have any patients 748 00:26:29,335 --> 00:26:31,115 because he's not busy enough to, like, 749 00:26:31,414 --> 00:26:32,934 fill up his time. Otherwise, why would you 750 00:26:32,934 --> 00:26:34,855 wanna do that? Why would you wanna deny 751 00:26:34,855 --> 00:26:35,994 care to other surgeons 752 00:26:36,430 --> 00:26:37,970 unless you need to fill up your 753 00:26:38,589 --> 00:26:40,750 kind of book of business? And he wasn't 754 00:26:40,750 --> 00:26:41,890 even a spine surgeon. 755 00:26:43,309 --> 00:26:43,809 So, 756 00:26:45,710 --> 00:26:47,470 I think the change needs to happen at 757 00:26:47,470 --> 00:26:49,390 the top. We need to figure out a 758 00:26:49,390 --> 00:26:50,210 way to 759 00:26:50,750 --> 00:26:54,724 have the, you know, talented people, not the 760 00:26:54,944 --> 00:26:57,184 people that are not succeeding in clinical practice 761 00:26:57,184 --> 00:26:59,265 that go because usually the people that aren't 762 00:26:59,265 --> 00:27:00,644 succeeding clinical practice 763 00:27:01,265 --> 00:27:03,204 tend to go into these types of fields. 764 00:27:03,505 --> 00:27:05,204 If you're a busy, 765 00:27:06,200 --> 00:27:08,839 successful physician, why would you wanna do insurance 766 00:27:08,839 --> 00:27:10,940 work? You're too busy seeing patients. 767 00:27:11,559 --> 00:27:13,000 Those are the types of people that you 768 00:27:13,000 --> 00:27:15,740 want in the leadership position because they've demonstrated 769 00:27:16,440 --> 00:27:17,900 success in clinical care. 770 00:27:18,914 --> 00:27:19,414 They, 771 00:27:20,355 --> 00:27:22,434 are aware of all the challenges that we 772 00:27:22,434 --> 00:27:25,075 face, taking care of patients, and it's already 773 00:27:25,075 --> 00:27:27,555 challenging enough just medically taking care of patients 774 00:27:27,555 --> 00:27:28,535 as a spine surgeon. 775 00:27:28,835 --> 00:27:30,515 I try to do the perfect surgery on 776 00:27:30,515 --> 00:27:31,255 every patient. 777 00:27:31,970 --> 00:27:34,289 There's no way I have perfect results. It's 778 00:27:34,289 --> 00:27:35,910 like Formula 1. You're gonna crash 779 00:27:36,289 --> 00:27:38,289 a lot. And then now you got me 780 00:27:38,289 --> 00:27:39,809 trying to think about something else on top 781 00:27:39,809 --> 00:27:41,730 of that. It's completely unrelated to this particular 782 00:27:41,730 --> 00:27:42,230 patient. 783 00:27:42,529 --> 00:27:44,210 There's just no way. It's like trying to 784 00:27:44,210 --> 00:27:46,734 play 2 professional sports well. There's only a 785 00:27:46,734 --> 00:27:48,494 few people that can do that. Maybe Bo 786 00:27:48,494 --> 00:27:48,994 Jackson. 787 00:27:49,375 --> 00:27:51,154 Maybe one. Bo Jackson. 788 00:27:52,335 --> 00:27:52,835 Even 789 00:27:53,294 --> 00:27:55,934 Michael Jordan, the most talented athlete on the 790 00:27:55,934 --> 00:27:56,434 planet, 791 00:27:56,894 --> 00:27:58,494 didn't do well enough to to make it 792 00:27:58,494 --> 00:28:01,049 in the major leagues. Yet in basketball, he's 793 00:28:01,049 --> 00:28:01,789 just a standout. 794 00:28:02,170 --> 00:28:02,670 So, 795 00:28:04,009 --> 00:28:05,609 we need to figure out a way, like 796 00:28:05,609 --> 00:28:07,869 UCSD did, to take talented clinicians 797 00:28:08,809 --> 00:28:09,309 and 798 00:28:10,410 --> 00:28:13,130 embrace their desire to make change because they're 799 00:28:13,130 --> 00:28:13,630 leaders, 800 00:28:14,585 --> 00:28:16,664 and make it so that they're able to 801 00:28:16,664 --> 00:28:18,825 do that without too much sacrifice. I suspect 802 00:28:18,825 --> 00:28:20,825 they're sacrificing anyway, but if you make them 803 00:28:20,825 --> 00:28:23,085 sacrifice too much, they won't do it. 804 00:28:23,464 --> 00:28:26,525 People that are talented and capable and successful 805 00:28:26,664 --> 00:28:27,164 won't 806 00:28:27,589 --> 00:28:28,890 won't do it. It's it's 807 00:28:29,910 --> 00:28:31,509 it's not the most pleasant job being an 808 00:28:31,509 --> 00:28:32,650 administrator as a physician. 809 00:28:33,109 --> 00:28:34,710 So if there's one thing I would do 810 00:28:34,710 --> 00:28:37,109 is I would tell every hospital system and 811 00:28:37,109 --> 00:28:39,430 every university that they need to fill their 812 00:28:39,430 --> 00:28:42,070 ranks, not with a bunch of administrators, but 813 00:28:42,070 --> 00:28:42,570 with 814 00:28:42,974 --> 00:28:43,714 physician leaders 815 00:28:44,575 --> 00:28:45,634 that take care of patients 816 00:28:46,174 --> 00:28:46,835 and then 817 00:28:47,375 --> 00:28:49,454 find a way to protect their time so 818 00:28:49,454 --> 00:28:52,494 that they can devote to leadership activity without 819 00:28:52,494 --> 00:28:53,795 sacrificing too much. 820 00:28:55,710 --> 00:28:56,210 That's 821 00:28:56,509 --> 00:28:58,509 amazing to hear, you know, and certainly great 822 00:28:58,509 --> 00:29:00,589 to know what you've done in UCSD and 823 00:29:00,589 --> 00:29:01,890 how they've been able to, 824 00:29:02,430 --> 00:29:05,150 tap on not only clinical leaders who have 825 00:29:05,150 --> 00:29:07,710 been very successful clinically, but then support them 826 00:29:07,710 --> 00:29:09,855 on the administrative and leadership side as well. 827 00:29:10,095 --> 00:29:11,535 Doctor Kim, thank you so much for joining 828 00:29:11,535 --> 00:29:13,134 us on the podcast today. This has been 829 00:29:13,134 --> 00:29:15,375 such a fascinating conversation, and I look forward 830 00:29:15,375 --> 00:29:16,914 to connecting with you again soon. 831 00:29:17,375 --> 00:29:18,595 Thank you very much. 832 00:29:19,214 --> 00:29:20,515 It was great being here.