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Imagine this. You're at the Hyatt Regency Chicago

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surrounded by the top minds in the ambulatory

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surgery center industry.

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Welcome to the Becker's 30th annual meeting, the

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business and operations of ASCs from October 30th

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to November 2nd

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2024. Picture the excitement as you collect business

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cards from over a 1000 executive level attendees

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forging priceless connections.

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Feel the buzz of conversations

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as you participate in more than 60 sessions

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led by over

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225 elite ASC speakers.

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Envision yourself gaining actionable insights on topics like

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private equity strategies,

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ASC business growth, and innovations in spine, orthopedics,

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GI, ophthalmology, and cardiology.

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Now imagine yourself listening to inspiring keynotes from

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Hall of Fame boxing world champion, Lila Ali,

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and professional basketball player, Caitlin Clark. Their stories

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will motivate you to take your business to

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new heights. You'll leave with a wealth of

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knowledge and a network of connections to help

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lead your ASC into the next year. Don't

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miss out. Get registered today. Visit beckershospitalreviewdot

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com and click on the events page to

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find the conference website. That's the beckershospitalreview.com

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events page. See you in Chicago.

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This is Alan Condon with the Becker's ASC

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podcast. I'm delighted to be joined today by

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doctor Bethuel Rehore

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from Apex Spine and Neurosurgery

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in Georgia. And doctor Rehore, a real pleasure

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to have you join us for the podcast

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today. Before we get things going, I'd love

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to turn the floor over to you, hear

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a little bit more about your role and,

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of course, your practice in Georgia.

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Oh, thank you very much, Alan, for having

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me as a guest today.

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I belong to a 4 person,

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neurosurgery

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group. We're independent.

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I've practiced now for 12 years. 8 of

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those, I was employed.

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And, 4 years ago, we made the switch

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against the current

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of

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going to set a private practice group.

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So we started, and

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now we're excited. We have our AAC up

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and running.

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Fantastic. Yeah. I know. So 4 person group,

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I believe you've got 4 locations including that

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one ambulatory service center that you just mentioned.

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But can you talk to me a little

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bit about what prompted that that,

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move to go independent, start this practice of

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your own, and how has it been in

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the last 4 years or so?

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Well, you know, it's not been easy. We

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were not very good at telling the future

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because we left employment

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right before COVID hit.

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Mhmm. And,

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it's not been easy. It's been quite difficult.

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But the reasons we decided to not be

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employed

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still made sense

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that we go independent.

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You know, as employed surgeons, you have

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a very good floor. You have a good

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base, but you also have a roof. You

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have a ceiling on your head of how

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far you can go.

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And

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being the people who are creating the value

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in patient care,

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we are not only doing the surgery, but

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we generate

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all the other ancillary

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incomes for the hospitals.

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We thought we had more value, and we

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worked very hard.

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And

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our goal was to maximize the value that

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we bring into the system.

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And

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as a surgeon, as a physician, there's really

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no way you're going to maximize it

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unless you get a role

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in the ancillaries

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and

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the surgical centers, etcetera,

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which is part of the value that you

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bring to

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a hospital system.

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So

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that was our second reason. Our first reason

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was we just wanted to take care of

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our patients better.

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Mhmm. We wanted to

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have a more active role

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in

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being in charge of the experience that our

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patients have,

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you know, when you're employed.

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Obviously, your employer determines

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how many,

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you know, support staff you can have, and

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sometimes that does affect the quality of care

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that you're able to give.

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In one of my previous jobs, you know,

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I I'd I'd see 35 patients in clinic

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without a mid level. And, obviously, the quality

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of

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patient 35 at about 6 PM in the

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evening,

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you know, you need was not

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the way you wanted your patients

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to experience you as a surgeon.

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So

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our first goal was

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to be in charge of our patient experience

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and,

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to make it better,

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which was still our goal. Now just like

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I said, we did not read

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the weather well. And in February of 2020,

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when we,

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wrote our resignation letters, COVID had not showed

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up.

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So it's been rough trying to

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manage and stabilize, and I believe we are

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at a at a good point

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currently.

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Obviously,

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all the challenges of a start up,

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getting the right

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employees

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who want to do the right thing

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with the markets the way, you know, the

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way it was coming out of COVID,

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trying to be competitive

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in,

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you know, in the salaries that you're paying

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in the rough,

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climate was quite a challenge.

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But I believe we've surmounted all of those

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challenges at this point,

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and our practice is actually growing.

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Yeah. Absolutely. And and who could have foreseen

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what was gonna come in March 2020 just

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to force the fair concern, but, great to

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hear. Really kinda weathered those challenges by the

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sound of things and really getting back to

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a point of growth for your practice.

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I'm curious to hear for any, for any

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neurosurgeons,

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spine surgeons who are thinking about following in

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your footsteps, I. E, potentially leaving the hospital

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world to set up their own practice. Is

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there 1 or 2 key piece of advice

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that you'd have for them?

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Well, the first piece of advice out of

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our experience is know the contract you signed

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for your employment.

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We actually got sued for noncompete,

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and that take us out of our area

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where we had the sweet spot,

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and we had to stay out for 2

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years.

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But we eventually came back into the area

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where people knew us and people trusted the

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quality of our work.

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So first of all is know your contract.

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But even before you know your contract, I

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would suggest don't even think of leaving

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if you're not confident of the quality that

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you're going to provide to patients out there.

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I think that's the first thing. You know?

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You have to care for your patients, and

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you have to really love taking care of

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your patients because

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that's what comes through whether you're in an

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independent group, whether you're employed.

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If you don't care about your patients, then

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maybe stay employed

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because there is a a net, a fifth

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net.

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But, yes, the two things is

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be confident about the care

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that you're giving the patients

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and the quality and the value that you're

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bringing into people's lives.

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Secondly,

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know the contract

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of your employment

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and obviously know where you want to go

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start, but

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it's gonna be uphill.

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You know?

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Starting a practice is uphill. Starting any startup

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is always uphill.

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You have to obviously have some finances,

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stored up

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because

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everything in health care takes time.

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You know, if you do a case,

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the insurance company will pay you in 2,

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3 months,

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but the people who work for you want

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their checks every 2 weeks.

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Mhmm. So there is a big huddle,

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but it's surmountable,

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definitely. It's

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you can surmount all the huddles. Yes.

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And and I'm curious to hear. You said

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you're surmounted

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a lot of these challenges in getting getting

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to a point where you're now growing your

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practice. You you'd mentioned earlier in the conversation

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about how important those ancillary services are. I'm

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curious to hear from you, what are the

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couple of areas that you're really focused on

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in terms of growing your practice, for the

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future?

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Well, for right now,

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we are we've we've focused heavily on getting

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into an ASC,

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And after several hurdles, we finally have an

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ASC that's running and taking care of patients

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with great outcomes,

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but also the ancillary area with with, setting

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up an imaging center.

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100%

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of my patients are the neurosurgeon will get

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some form of imaging.

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And

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being able to participate as a provider

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of some of the imaging that

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that they need, I think, does improve our

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bottom line and makes

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the whole system,

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you know, be worth how you want to

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take care of your patients. You know? When

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you order an image

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and

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you're able to get them scheduled in a

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an efficient manner,

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in a comfortable environment.

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No.

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You know, it's not uncommon patients come and

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tell you how

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cramped

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the imaging place they went to was,

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how the magnet was not

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you know, was uncomfortable.

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And for us to say, hey. This is

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what the patients are telling us.

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Why don't we fix that problem? We get

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the right magnet. We get the right environment.

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We schedule them in an efficient manner.

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And as a you know, when we when

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we as a as a as a provider

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is controlling all of that and not just

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some back office somewhere that received the referral,

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I think there's more soul and human to

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it and more care we put on to

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that.

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You know, we also have,

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partnered with providers of other services like physical

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therapy, etcetera.

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But, you know, in the future, could those

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potentially come in house? Yes.

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At this point, we are just going

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in a stepwise version,

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to see what we could

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utilize and,

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bring to fruition

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in a

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appropriate way as we are now

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we are walking. I think we've come off

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the crawling phase.

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Now we are in the walking, and hopefully,

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we'll start running and adding on all the

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ancillary parts

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and all the value chain players into our

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Apex

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environment.

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Yeah. Absolutely. It sounds like really kind of

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taking seriously

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that feedback that you're getting from your patients

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and then working, to kind of incorporate these

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things into your practice to really improve the

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overall patient experience. Am I right? Yes, sir.

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Yeah. And and, doctor Rory, I'm curious,

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there's so much going

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on, in the world of health care and

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the ASC space at the moment.

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I'm curious to hear, is there anything if

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you could kind of pinpoint 2 or 3

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trends that you're really focusing on and following

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in health care at the moment, what might

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they be?

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I think right now,

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the first trend that I'm really excited about

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is

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how much technology is improving

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to allow us to do cases that once

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took a lot more time in the hospital

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to be able to do them in an

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efficient way, in a safe manner in the

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ASE space.

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And, you know,

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using,

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you know, using things like stealth

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navigation

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allows us to make very small incisions.

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You know, using a microscope, we've been able

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to extend and even do a complete

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decompression

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without having to do an a traditional open,

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you know, open type of spine surgery. So

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I think that

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the improvement of technology and the AI parameters

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in helping us

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extend the cases we're able to do in

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the ambulatory center, I think that's a huge

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trend.

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Secondly,

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the patients are becoming aware.

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You know?

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If I have a disc herniation, will I

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go to the hospital

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and mix with other people with their COVID

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and their diarrhea issues while I can go

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to a surgery center where,

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you know, everyone who goes in there is

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healthy and the nurses will have full attention

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on me. You know, we only have 2

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rooms in our surgery center. So most times

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we have,

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at the most, maybe 2 to 4 patients

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in our recovery area, and all of those

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are healthy patients. So the trend of patients

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becoming aware that

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ambulatory

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surgery

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center is an option, that's an exciting trend.

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The third trend is

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the assimilation by payers and, the government payers

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into

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extending the procedures that they can pay for

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in the ambulatory surgery center space. That's also

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an exciting trend.

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Is there any particular

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surgeries or procedures when you talk

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spine procedures specifically on the outpatient setting? Or

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Yes. This,

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we only do spine procedures. That's that's that's

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the reference.

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Yeah.

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Doctor Riordan, a real a real pleasure, having

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you on the podcast.

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Fantastic to hear about your transition.

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No doubt it's come with some challenges over

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the past 4 years, but great to hear

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how you're not walking, maybe walking, and so

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hopefully sometimes running into the future. But really

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great to hear the growth of your practice,

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and I can't wait to have you back

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in the podcast down the line. Thank you

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very much, Alan, for your time and for

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the invitation.