76. Sunk Cost Fallacy, Digital Health and Startups & Becoming More Than a Physician | Rami Wehbi, DO

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Our guest today is Dr. Rami Webby. Now Rami graduated medical school at Michigan State University, osteopathic, and when it came time for match, he initially tried his hand at physical medicine rehab, but unfortunately it didn't work out. He then matched into family medicine, but there was one thing that he knew. He wasn't going to go down the track of becoming a clinical physician. He actually transferred residencies and it was his plan all along to leave. So what is he up to now? He's actually the founder and VP of clinical operations of Beyond Medicine Group, which is a community of clinicians and health tech leaders building their journeys in the digital health industry. Rami is currently making waves. He's a master at networking, and what I love about him is that he's never afraid to speak on the reality of what medicine is and his journey. So throughout this episode, he's going to keep it real, he's going to keep it authentic. And if you're in medicine, hands down, you got to listen to this and probably send this episode to somebody else. But even if you're not, a lot of the lessons that Rami talks about is going to be relevant. Enjoy. Rami Webby, my man, how are you doing? I'm doing well, man. I'm doing well. I'm excited to be on the show with you guys. Likewise, man, we are super excited to have you on here. We connected some time ago. We've done clubhouse together. We're on stage together on that platform. And you really have a unique perspective when it comes to looking at healthcare, looking at what it means to be coming a physician, right? And it's just a perspective that's so unique that I really want to delve into it. So why don't you take us through what sunken cost fallacy is and kind of how that relates to you? Sure. Yeah. So I'll give you a quick background about myself. So this all makes sense, too. But trained in Michigan, went to medical school there, did some of family medicine training that about two years of family medicine training, a little bit more than two years of family medicine training than I actually left residency to pursue a more business-oriented path in medicine. And there's obviously a lot more nuance than that, and I'm happy to get into it. But one of the things I really thought about a lot was the sunken cost fallacy, and it wasn't really until I left, I think until I left my training that this all started to make sense. But especially as physicians, we spent, we invest so much money, time, effort, resources into becoming doctors. And essentially put on the golden handcuffs, as we call it, and it makes us stuck in our careers. And I tried to figure, like I knew, and maybe my second year of medical school, maybe this isn't for me, fourth year of medical school, I contemplated just graduating and not doing residency. After my first year, I resigned. I got cold feet, and then I transferred to a new program, and thinking things might get better. And then after my second year, I called it quits for good. Because I knew it ultimately wasn't leading me down the path that I wanted to go down. It would have been nice to finish just to have that, just sometimes it's nice to hang the paper on the wall and do it. But it just reached the point where I was really unhappy. And I knew that even when I did finish, I was going to go and do the things I was already doing, or setting myself up to do. And so I had to grapple with how do I justify leaving a career in medicine, leaving, you don't quote unquote, I don't feel like I've actually left a career in medicine. I'm just working in a different part of the healthcare scene. And I had to figure out how to justify that. And one of the things that the SONCOS FALSE does is it confuses us. It's a cognitive bias. It's hardwired into us. Because evolutionarily, when we need it, anything that we invested money time or effort into was key to our survival. And so it wouldn't make sense to leave something you invest a lot into. But when you think about living a fulfilling life, sometimes you have to do that. And for me, it was just kind of creating a new perspective on how I can look at things to make it make sense to me, because it didn't make sense. And to everybody around me, it didn't make sense. But I knew that if I could reframe it and make it so that my brain didn't play tricks on me and wasn't influenced by outside influence, then I could probably, I could do this. And without being like hung up on it. And one of the things that I did was I tried to think of it in terms of a fellowship. You've done a fellowship. So I said, if I can give myself three years to do my own personal fellowship that I can focus on building my career on the business side of health here and do self-learning for three years, it's really not hard for me to, it's really not hard to make $70,000 a year. It's really not hard to make a fellowship salary. You could do that as a consultant in three months. And so I just framed it in that way and figured out how to change my brain around that so that I could actually not just be depressed about the $300,000 that I invested in my medical training and not being a board certified doctor and not doing it like all these things. And I stuck around long enough to get my medical license, which actually helped me feel a little bit better about it. But the sun cost is I think something that especially doctors struggle with and struggle just like figuring out how to break out of their handcuffs and maybe go down to your career path or try something new. And so that's really where all the talks that I've been doing around sun cost and right now writing a book on actually my experience and how I navigated the sun cost fallacy. The book's called Unsinking. I don't know when it'll come out but I'm working on it. So yeah, that's really my experience with the sun cost and I'm happy to dive in more into more practical things about how you can break out of it. And that's amazing to me and you know, the thing that stuck out to me as you mentioned that your two years in and the listeners of this show know that, you know, a friendly medicine primary care to three of residency and so my first thought was, man, just so close to the finish line, right? Undergrad for yours in medical school just one more year and you mentioned how multiple checkpoints where you thought about, hey, let's just hang it up. Let's hang up the cleats. But you're like, now I'm going to push through one, two, three. So I want to, I want to time jump back to try to dig a little bit deeper, understand your thought process. Where did you grow up? I grew up in Metro Detroit just outside. It's a suburb called Dearborn where all of the Arabs are. I'm sure a lot of any Arabs listening here, everybody knows Dearborn. My, my, my favorite, my, just the entire world. If I could have just one food every single day to be chicken sure, and I, and I heard Dearborn Michigan has some incredible sure mess. You know, as well as the buckle of a, we do, we do, we do have the good stuff. I do miss it where you're, was anybody in your family, like your parents, anybody physicians? Nope. First doctor. Bronco is a dentist, but I'm the first doctor in the family. So, so what was the inspiration to even pursue medicine in the first place? Yeah, great question. I mean, I think a lot of us with ethnic backgrounds can relate to this, but, you know, I think growing up for our generation, you know, our parents and our community viewed the ultimate success as being a physician. And you know, you probably, you know, a lot of us have grew up around other, maybe we knew as a doctor or a dentist or somebody in this healthcare profession that did really well and lived a good life. And I think that, you know, for me growing up, like, we have, my family had a lot of struggles financially. And so I always felt like I carried a little bit of this burden of like I have to make sure that I position myself and my family for success. And it wasn't like a lot of people have had that moment where they were like, you know, they knew their life's calling was to be a doctor. I don't think I particularly had that. I think I just knew I really wanted to be successful in whatever I did. And I don't know, maybe just most doctors won't admit this. I think maybe there are other people that are doctors that feel this way too, but most probably, it's not the virtuous thing to say. But that's my truth. And so, so yeah, you know, I just, I think when I got to high school, I was playing sports and I got injured and then I visited a doctor and I actually liked it. I was like, I wanted to know about why I tore my MCL and why I tore my meniscus and like, what was that all about and how do I recover? And I went through a recovery process that sparked my interest. And then later into college, I met a mentor and I was just, I was just curious. I did always like science too. I was a geek for physiology and I did really well in those classes and I really enjoyed them. I liked understanding why things happened in your body, like, so physiology and actually organic chemistry. I like super geeked out about that and did really well. That's weird. Yeah, really weird. There was the only class that I actually probably did well in, but actually I'm in the minority here at Darsch, also nerds out in chemistry as well. Yeah, so I just, I liked that part of things. So I, you know, it wasn't all like just, I was doing it because I wanted to be successful part of it was I really genuinely enjoyed certain parts of medicine. But I think when I got to like my clinical years in medical school, that was when I really was like, I don't actually think this is for me. And especially when I started meeting doctors that were burnt out and we did those, like, the two preceptorships and I quickly realized I don't think I'm in the group of doctors that's going to be super fulfilled because what I noticed is the doctors that were really happy in their practices is probably a minority now. The doctors that are really happy, like super love medicine, right? Like they geek out over every study. They're excited about it. You, we've all had that maybe attending that we did rounds with. That was just such a good teacher and you could tell like, this stuff lit them up. And I realized very early on, I was like, oh shit, this is not me at all. Like for me, I was like geeking out about, you know, how to run a business. I was always, I ran a business all throughout, half through medical school and then all through residency. And like I loved that side of things. Like that's what I geeked out about. And so I knew there was something like disconnected there. I just figured like it would always get, I just always figured it would get better at some point. Again, you mentioned certain checkpoints that you had that you wanted to keep pushing through until you made that final decision. Was it at the end of your second year or was it somewhere in the middle? It was a little bit after my second year. It was like three months into, while like three or four months into my second year. But the details behind that are that basically, I didn't get full credit for my first year. And I needed to do, basically wasn't meeting my graduation requirements. And so, you know, I had a meeting with my program director and they're like, hey, we can't graduate you. You're going to have to do another year of residence. You're going to have to do an extra year. And at that point, I was like, okay, well, now I have a year and a half left. That sounds terrible. And I think I just, I was just like, I'm, I think I'm ready to hang it up. And you know, I think it would have been great to finish, but it wasn't like that important to me because I knew that I didn't. And actually, to be honest, I really think it's been a blessing in disguise because had I finished, I would have been very tempted to just take a job as a full-time family medicine doctor, because you know, like there's, there's good offers out there. Like in some places, they're making 300K, which I wasn't making my first year out of, out of training. You know, I was barely paying my rent for that first year. So, so it's actually been a blessing in disguise, but, but yeah. So, you know, there was some other circumstances that played into that, but of course, you know, I think it was always in, it worked out really well for me, I guess I would say. What was the conversation like when you ultimately told your family, you're, I know you have a younger brother who's actually down this path now. And, you know, again, you mentioned us folks, you know, kind of in the South Asian Middle Eastern community. You mentioned your doctor, really, if anybody who's in the Brown community kind of, if you come here as an immigrant, first generation, there's three professions, right, that you can be a physician and engineer and lawyer, really, that's really all that counts. It's getting a little bit better, but I'm curious to prior to, you know, that final point, did you talk to your parents about it, your brother about it, somebody, your friends, and then when you finally decided this is it, what was it like, what was that feedback like? I think that, well, they always knew, like, they always knew, I was like, I'd say it all the time, I'd tell my friends, I'm like, look, guys, I'm going to graduate and I'm never practicing medicine again. Like, I'm so, I'm like, I just knew I wanted to go in a different direction. Like, I've seen, I think I might have been seeing it in medical school too. I think so everybody around me sort of knew, like it was no surprise to anybody that really knew me. But my parents, this is funny. I actually didn't tell them for like six months after because I didn't want to stress anybody out too, especially as I was still figuring it out. So like those first six months after I left residency, like I was like really in that space of like I saved up a little bit of money and I could pay my rent for like another six months and I was starting a business and making, you know, trying to make that work. And then the podcast made a little bit of money. And so I was just like, I'm not going to tell anybody right now. Like this is, this is, I've given this to myself. So I got my shit together because I don't want to stress my family out. I don't want them to think I've lost, completely lost it. So until like it was about six months in that I really, that I kind of gained a little bit of footing. And at that point, I was like, I went, you know, to my parents and they were actually super supportive. Like I think they just trusted me at that point. Like they know, like I've got my shit together. I'm going to figure it out. And I don't think they were too worried. How did your co-residents take it? Because, you know, one of the topics we always talk about, Altman Shani, you know, with other guests, what it comes to burnout is residents have a tough time taking off, right? And for the listeners that don't know in family medicine, right? It's not just clinic. There's also hospital rotations, which can be teen based, right? And especially in family medicine, you might have like a clinic day where your co-residents might cover, you know, what was the thought in your head? Like, did they know from the beginning? Was that something that you were struggling with in terms of telling your co-residents that, hey, they may be quote unquote one man down? Yeah, yeah, that was hard. That was, of course, that was probably one of the hardest parts of it, of course, because like, you know, I was super close with my co-residents, especially like a small, like, you know, you know, you got your like little click. So that was, that was obviously very hard. It wasn't, I don't think it was too disruptive to the workflows, because I think we just had enough coverage. Maybe for the clinic a little bit disruptive, but not, I don't think it was anything extraordinary. I think they all just knew like where my head was at and they wanted me to be happy. And, you know, I'm still in touch with a lot of them. And yeah, yeah, it wasn't too disruptive. I know in some programs, it can be because like, you lose one person, your call schedules all screwed up, and then you got to pick up an extra day call. But I don't, for our clinic, I don't think that was really the case. Yeah, for sure. That's great. I want to go back to some cost fallacy, you know, you mentioned a word in there saying reframe. And I think reframing is one of the things you need to have a great life, right? Just a great perspective on life. Knowing that you had a business throughout medical school residency, how did you, right, like, how did you know that everything was kind of going to work out in your head, right? Was there ever a time where you said, okay, thank God I have this license to quote unquote fall back on, or was the plan always, you know what, this I'm not going to do medicine because I still have, you know, 50, 70 years, 80 years of my life. And I'd rather live on my terms. Yeah. Well, that's a great question. Well, yeah, actually having a license was super helpful because at like, I think six, after six months, I was like, all right, I really got a, I really got to pick things up. I don't want to just be scraping by at this point, trying to build a business. And so I went and picked up. So I actually got my license. I moved back to Michigan because it was just I, I, I use a practice owner and I was like, I went in there and started working in a, in a private practice doing primary care and urgent care. So, you know, did, did, you know, it was making good money doing that. And then I did that two or three days a week was able to, you know, more than paying my bills. And also the, those other three or four days a week, I was full time trying to build the business. And at the time, it was, it was a media company, healthcare media company. And we were doing productions with biotech and biopharma companies. And then, and then as that progressed, got into consulting with, with startups that I'd actually get connected with through the podcast. So, so yeah, that did, that did significantly help. I don't do that anymore. I don't practice it all anymore or do urgent care. But in that small timeframe, it was actually really nice to know that I do have this license that I can fall back on. And I'm fully confident like even in my clinical skills, I got really great training. I, you know, I feel, I felt very confident like to go in and practice and, you know, just do the run of the mill primary care stuff and urgent care stuff that, that, you know, we were trained in. But, you know, obviously there's limitations to that if you, really, if, if I wanted to really practice medicine, then I'd go back and go do another year, I probably have to do another two years to get that board certification to go in as a second year. But I don't, you know, I don't knock on the wet. I don't anticipate that. I will have to do that. Yeah, for sure. You know, you, you talk about consulting. You're very business oriented. One of the things that I've heard you also talk about is how doctors kind of get pigeonholed into only practicing medicine, right? And talking a lot about taboo money, safety, what job satisfaction or just having a job. And one of those other things is as a doctor, it's okay to not necessarily practice medicine. Tell us a little bit more about your perspective on doctors doing more than just being a doctor. Yeah, well, I mean, I think a whole new world opened up to me as I got into the consulting and health tech side of things. And I, you know, really my first realization was my first advisory role where I worked with her. I was helping a pretty large tech company get into the healthcare vertical. And they were trying to figure out, they were trying to sell to primary care practices. And I, you know, I was just trying to help in the beginning. And, you know, I went over all their marketing material. I made a bunch of notes and sent it back to them. And to them, look, I don't think this is the right way to sell them to practices to do this. You have to do this, this and this. And also, I don't think this integration is going to work well in the workflow of doctors because for a number of reasons. And I sent that all over. And that was where I realized, wow, I can't believe like, this is a company. This is a billion dollar company that doesn't even know what is, they don't know what they don't know. And I was trying to figure out how do I communicate this? How do I show my value? How do I propose my value? And that led me down this whole rabbit hole of like figuring out how to start a consultancy and actually show my value to these companies in a way that made sense for them. And that was the start of starting beyond medicine group, which started as my consulting company, where I would basically, you know, work with health tech companies, provide advisor in consulting and sell it as a package bake, basically. And so I think a lot of doctors like to answer your question, a lot of doctors, all doctors have us, you know, very specific knowledge in their space. So as PMNR doctors, you obviously understand the rehab, the rehab space extremely well. And you understand the workflows of PMNR doctors, you understand how if a health tech company were to come and try to create a solution for patients that need rehab, you would understand super intuitively things that they can't even grasp at all. And how do you put a price on that? If it takes you 30 seconds to answer a question, how do you put a price on that? This is knowledge you've gathered over years and years of experience. You know, there's, there's, how do you monetize that, right? Like that was the piece I was trying to figure out. And I think that's the hard part because it's clinicians and especially as doctors, we're trained not to think about that side of things. We were always told like just focus on the medicine, focus on the clinical stuff. Don't think about the business, don't think about how to sell, don't think about how to market yourself. But you really cannot reap the benefits of your clinical skills in a consulting or an advisory capacity if you don't know how to do those things. And that's what I started doing and teaching and like really building around with the with the BMG group. When did the podcast start? You said you have a lot of the connections you made, a lot of the opportunities that were open up to you were through the podcast. Did you start that before or was it after the group? No, so I started the podcast in like 2017 2018, beginning of 2018. So it was pretty early. I think one of the other podcasters was like Frank Kusomano's podcast, surviving medicine. And I was on his show and then right after that I started mine. So it was fairly early. I think my first few guests didn't even know what a podcast was at the time. What was the impetus behind that? Well, I think it was because I was doing the whole Instagram thing. So I started that in like 2014. I was like in my second year of residency 2015. And I was like one of like very few doctors at the time doing that. It was like maybe like five or ten dogs. Like there wasn't a lot. And so like I when you use the hashtags at the time, you could get in front of a lot of pre-med and med students. And so I started doing that and my page blew up fairly quickly. I think I was, you know, grew to like 10,000 and then like 15,000 at my peak. And when I was doing that, I was connected with all these influencer dogs and like, you know, people that is just such a weird thing. I don't do it anymore. I took a store influencer was a thing. Yeah. Yeah. So, you know, I had a realization at one point because I was doing golden lectures, studying for a step two. And I was doing it in my commutes. And I was like, this is really great. And then at the time I was, I just got in a new car. And I realized that when I plug my phone into my car, there's a dashboard that come up and all the, all the apps would come up on there. I was like, oh, that's really interesting. And I realized, oh, I have an app called podcast. What the heck is that? So I click on it and I'm like, oh, I can listen to podcasts and while I'm driving, this is great. How is, no, how do we not know about this? And then I just like, I think it all clicked for me at one point, like size, some realization. I'm like, oh crap. When like five years, 10 years down the road, when everybody's got like a, you know, a newer car that integrates with your phone and puts that dashboard there, it's going to make streaming while you're driving so much easier. And everybody's going to do this because everybody's stuck in traffic. So I was like, all right, I got to start a podcast because I think this is the future. And, and, you know, sure enough, I think it is the future. And so the other thing is that I was connected with all these big docked famous doctors on Instagram. So would instead, everybody that I had on was DMed. So hey, want to do a podcast? Let's do it. And send him a, I think I started doing it with Skype actually in the beginning. So I sent him a Skype link and then we'd record. And then I just like, I built a website and figured out the whole RSS feed and started posting it. And like, we would make them content. So like, I'm sure you guys figured out the strategy, but like when you bring on somebody with a lot of followers and you make them content, and then they share it, you start getting their audience. And so we ended up growing super fast. At one point, we were a top 50 podcast. And we're getting like maybe 10, 15,000 monthly downloads in the beginning. And that was like, what the hell? How did this happen? Which was really cool. We're going to come back to this about developing site projects, social media content creation, that kind of stuff, just because you've done an exceptional job. And, and we didn't finish the previous conversation offline. So, but, but I want to stay on something you said, right? You kind of alluded to the fact that these startups, the, the business of medicine, you know, we often talk about how the business of medicine dictates the practice of medicine, which more often than not is a problem, right? Because that's not really why most physicians went into it. Some will go in for the money, but most all, especially not the ones with $300,000 of debt, not me, not this guy. And, you know, I think I've been lucky that many of my mentors, especially early on in medical school, even before when I was an undergrad and I was shadowing, they, they discussed the business of medicine with me, how you can actually do it the right way. And they stress the importance of being a good businessman and also being a good healthcare practitioner and then actually merging them. And that's the only way that it's sustainable long-term. And so I always had that in the back of my mind. And then even though I went to residency and I didn't have a lot of mentors and residency who talked about that, I knew because that seed was planted early on. Now, at the risk of playing Monday morning, quarter back here, do you think that if you had most of more of those conversations during your training, that things would have ended up differently? I don't think so, no, I think because we did, you know, here and there we would get some conversations on finance and, you know, how to invest your money at a later stage. But I don't think that, I think that even if it was explained to me, I just knew that where my passions line, it was not on the clinical side of things. I don't think there's anything that was going to change that for me personally. I think for others, it might help. But I think the business side, I think it's like a, I think there's a certain, I don't want to say brainwashing because it's a strong word, but there's a certain culture that we're taught that is, like, we're not supposed to learn this other stuff and it's frowned upon almost. Like, if you're, you know, think about it, think about it like this, if you are, if we were all going into private practice, it would be much more less frowned upon and much more talked about of how to run a successful practice. And you see this with other healthcare professionals, like natural pathic doctors or even chiropractors. And I'm not like promoting any of them, but they all, like, they're, they're a bit super business savvy. They know how to do the socials. They know how to run a, a lean practice. They know how to do all those things. But we're like, we're kept a little bit in the, in the, in the gray area dark because, you know, they don't, the idea is not for us to go into private practice. It's to take a job with, with a hospital or clinic and, you know, do that sort of thing. And there's some that do go into the private practice sector. And I think they end up having to figure it out the hard way. Well, now it's impossible because most big organizations, healthcare systems, hospitals are buying up most of the practices in today. And so even when I was coming out, I think most of my attendings say, well, you're going to have a difficult time finding a group and stuff just because the, the scope of healthcare has, has changed drastically. You know, I think about one of your recent conversations with Daniel Paul. And and I think he mentioned that if you don't learn a mastery on business, somebody else will. And you know, we're referring to, you know, MBAs and admin folks who really have no clinical sense and are dictating how we're supposed to practice. And it's so incredibly frustrating. You know, it leads to just early burnout, right? Things that shouldn't be happening for physicians, you know, in their 20s, 30s. A lot of things that you've talked about on your show and with some of your guests. So let's come back to the podcast, right? As promised, you mentioned, created a lot of opportunities for you. You got the guest. You disclosed how, you know, earlier on, it was easier to just kind of access to the advent of social media. How are, now, you're, you're generating revenue from that as well, right? You create a lot of awesome content. Is that true? And in the beginning stages, yeah, we did a little bit. Yeah. And so what about now? Is that still producing revenue for you at this point or is this kind of just like a? Oh, yeah, we do. But in a different way now, so it's more through sponsors and through, and through branded episodes. So we, it's just a different monetization structure now. But, but basically just a different way to do the episodes. So, you know, there are plenty of ways to think about how to do it. So I'll use, I'll use a friend's example. So I don't know if you guys know on the back table podcast or air fritz. But he has, he has a device company sponsor his episodes. And I don't want to disclose any information, but the way we have a very specific audience, right? And a high, and a high income, high value audience. The, the, the CPMs and like, just like whatever $50 per thousand listeners are like, like, I don't think that applies to us because when you have a very specific valuable audience, you can, you can monetize that in a different way. And I think you can, can put it out there and ask for your price. And you know, that's what I do. And I think that's what some other successful podcasts do. But I, you know, the podcast for me, like, my intention was not really to monetize it is just to provide value. And, and, and really the, the main benefit of it is obviously the networking that comes from it. You meet great people. You get opportunities. You'd never get, you know, like the networks that in the relationships I built through the podcast start with a hundred X anything we've ever made, you know, monetarily. No, I couldn't agree more. I think, you know, I, I feel the same exact way. And I know it darshtestable, but we've been doing this for a little over two years now. And I think just meeting the people who've inspired us, right? We've talked a lot about how, again, brainwash is a strong word. And just the culture of medicine, it's so archaic in so many things that we do. And we've been so fortunate, again, just through social media or just cold email or, or whatever it might be that somebody's come on and shared how they're doing a better way, right? Hence the name of the show. But I think this is so important talk about because the, the new age physician, right? Like our generation millennials, the next generation, they realized that they've grown up in social media. They've grown up in the podcast ic world, even though I think you're referring to Apple play or Android Auto when the first time you saw it, right? To them, this is just intuitive. And they recognize that, hey, doctoring, quote-unquote, you know, or health care isn't just in the, you know, in the vicinity of the clinic, right? It continues happening education on social media, education through, through other platforms and that kind of stuff. And so, but the problem becomes there's an opportunity cost, right? It takes time, right? It's time from your family, time from going to the gym, time for other things that might, you might have your warning. And there has to be a purpose behind it. And so this is also a business. And that's why I think it was so important to kind of touch on it. But maybe they can reach out to you for, for maybe a future course or something and then get that information. Yeah, I mean, I'm happy to help. And we have the shameless plug here beyond medicine group, which is our, you know, our community where that's how it's done slack. And, you know, we share all the resources in there. And, you know, a lot of the doctors that are in this group are doctors that either work in health tech or, you know, do consulting or advising. So we've built a really niche community of others that are already sort of in this space. Awesome. So let's shift gears a little bit, right? Let's, let's look towards the future. I once heard you say something to the effect that, you know, we're not going to fix this healthcare system. We can only build a new one. And I've been thinking about that a lot, Remy, because again, the name of the show is medicine redefined. And I think when, you know, we thought a lot about this and maybe we should have thought more, it's like, hey, maybe we can change things. Maybe we can think makes things better. I, or maybe we can at least contribute to that, right? And my question for you is, is it, is there nothing that we can salvage? Like, you know, like when we're looking for a better system, we've talked a couple of things that you're doing that we're doing. A lot of like-minded folks are doing. What is it about the current system that you still think is worth keeping that you like? The people. Everything else needs to go. But on a, like for real though, I think that it would, I don't think we can solve all of the problems in healthcare. I think we can, you know, you know, make small significant changes. But the incentives are so misaligned in healthcare that in the traditional system, I really don't see it being possible to create real change, right? Because the incentives for the patients, the incentives for the payers, and the incentives for the providers and doctors are all completely misaligned. In America, in the American healthcare system, you get paid for doing things, right? Not to prevent things. And that in itself is a conflict of interest. And so like in how we provide care and how we incentivize results are just not where they need to be. And I don't think you could, you can only build layers, you can add technology, you can make things more efficient, but you're only making them more efficient to the extent that the foundation is laid, which is incentives. And there are some things that are getting better, like obviously with value-based care now incentives are prioritized a little bit more, but even that's still like not working great. And there are certain, I mean, I think grassroots movements like direct primary care, direct specialty cares. I think that's heading in the right direction. But you know, I don't, technology will obviously be a big contributor to solving some of these problems. And I think that's, it's definitely going to help. But you know, when or if a technology that can actually, you know, like not too long ago, three of the biggest tech giants in the country and the whole world came together to build a healthcare solution and they failed miserably, you know. And you know, there's a lot of reasons for that. But I think that like, I think I think if big enough players come in to really disrupt things, it's possible. But I don't think what the current way things are, it'll be, it'll be an easy task. Yeah, where do you, where do you truly see medicine going? You know, maybe in the next 10, 20 years, but also in the future. I mean, you were right about podcasts. You've got the pulse on tech, NFTs metaverse, you know, Mark Cuban now is trying to change the game with prescription medicine. What do you exactly see happening? Well, I see a two tiered system possibly coming. And I think that most physician, I think so what's happening is obviously you have different types of providers. You have physicians, you have nurse practitioners, you have PAs. And I think what a lot of physicians are realizing is that they're not getting what they want in the traditional system. So a lot of them are going to direct care, direct specialty type of practices. You know, for the ones that it makes sense for, it doesn't make sense for all specialties. But there's a movement and it's a growing movement year over year in that direction. And I think the fee for service model, a lot of those models will be man-powered, woman-powered by nurse practitioners and PAs, especially in primary care. And so I think is going to end up happening is people that can afford to pay that subscription service or to pay for exceptional care, pay to see a doctor are going to opt into that, right? Because I think that a lot of people will still prefer to see a doctor, but not see a doctor over seeing someone that will give them time. So if you are a doctor and you can give time to someone that is a huge value add and people want to pay for that. And I think if you can afford it, I think that like our federally qualified health centers and the hospital clinics will staff mostly nurse practitioners PAs. And that's the more economic way for them to do things. And I think they're going to go in that direction. And that's likely where your fee for service and insurance-based healthcare will take place. That's just a prediction. I don't think it'll be a 100% in that direction, but I think that's one outcome we might see in like maybe 10 years. Yeah, absolutely. I think there's going to be this schism where you might even increase that gap more from people who can afford the higher precision medicine, get the individualized labs, go to the new tech device companies that are coming out for even more of that precision medicine, right? And then you're going to have the people who are maybe missing out on that, right? And we'll have to go through the current base model that we have. So I definitely see it going that way. And I think it's important to know these things. I mean, when I talk to premed and medical students, their eyes light up, their ears aren't fire when I talk about this stuff. The path to digital health that had path to industry, a lot of it's your network and your connections. And I've been preaching that for a while. That's actually why I started beyond medicine group because I wanted to connect the physicians with the community that I was already getting connected with, which was the health tech founders, the investors, the builders of health tech. And so for me, through the podcast and through just being in different groups, networking, like, I had a goal at one point where I was going to meet five people every day, like, for like a month. And I did that. And like, I'll just schedule Zoom meetings, make introductions randomly. Sometimes that would lead to a consulting gig. So I made it a huge point to broaden my network and meet a lot of people. And most physicians you talk to that do consulting work or advising. They're either in, they're already in that startup ecosystem. They're either in a geographic location like Silicon Valley where they're just organically around all of that and their networks just tech people and founders and, you know, so they just get plugged in. And so like a lot of these Silicon Valley docs, they're already they're already plugged into the ecosystem. But if you're not in that geographic area, you can, you can get into networks, you can get into groups. And once you start building that network, it's a small community. Once someone, once a couple founders know you, like, it kind of spreads. And that's the cool thing about BMG is that we've brought in founders and investors and connect, starting to connect them with our with our physician leaders. And there's already been several consulting gigs that took place just through connections that happened in BMG, which is, which is pretty cool. I would definitely save even for met students residents. Try to try to network with your friends that are in venture, your friends that are in private equity, startups, if any of them are running startups, healthcare startups, try to network with that group. There's a few other good groups out there. I think MD plus is a good one. And health tech nerds is another really good one. Cool. We'll definitely put those in the show notes, but I can agree more. I mean, I've been telling even my colleagues like, hey, just just get on social media. Even if you don't post, just keep your pulse on what's going on. Who's who are we following? What's the newest trend? Like, what is happening? It's the only way that you'll really be able to discern kind of what you like, what you don't like. And it's funny. I mean, a lot of pretty meds will be like, how do I how do I network on Instagram? Like, do I just email? And I'm like, well, emails kind of outdated. I mean, honestly, just DM the person. If you're trying to go to that med school and you know a med student from there, that's a that's a simple step. Did you think, hey, how'd you like the med school is DM them? And I think most physicians, most students would be more than happy to respond, right? Because we all like to create value. I mean, it's also a reason why we go into medicine right in the first place. So yeah, I definitely definitely agree with you on that. Yeah. I want to turn the tables for a second. I want to ask you personally, how do you feel? How do you feel that social media is helping you and your future endeavors? Because like, I used to I used to do the social media and, you know, the whole, you know, doctor fluencer thing and document my journey. And there was a lot, you see, there's a lot, a lot of value from it. I stupidly deleted my account and started over. But actually, actually, I think I think it was actually a really, really good thing because it allowed me, I think it's hard to fail in public. And sometimes when you have a social media account, this is, and correct me from wrong here, but for me, I felt like I had so much pressure to continue what I had already built and continue being the doctor that I had portrayed myself as, that now I really, I didn't feel that I wanted to transition publicly. Like, I didn't want to do that in a public way and, you know, get criticism and of course, criticism's always going to come, but I don't know if a pigeon holds you a little bit if you, if you do that. Do you, do you feel any sense of that? So for me, you know, I created this second year medical school. It's kind of where I started. And I just wanted to create value and I enjoyed it. But the main reason I also created this social media was it helped me accountable for what I was preaching. And that was the biggest thing as to why I started it. So a lot of it was personal plus the medicine, right? It was just like my life. And I always wanted to pivot it, like to pivot or create a second account. But it was like, it's just too hard. I mean, I just didn't want to start over. And I'm all about being authentic, right? Like, there's this new app called Beavriol that literally I just saw the SNL skit, and I'm just laughing my head off on it because I still think it's crazy. But I'm with Gen Z in terms of being like authentic self, right? And that's like kind of what I pride myself on with social media. So I mean, for me, it's for like the reason I do it now is just to find like many people who align with kind of what I say. And I'm a little over the place, right? I don't think I have a specific super niche, you know, I'll talk about book reviews, I'll talk about perspective, philosophy, I'll talk a little bit about medicine, nutrition, you know, whatever there is, whatever I care about. And, you know, I think Instagram, most people, I've hit their cap, like it's just so saturated now. Like a 200k following on TikTok doesn't really mean anything. And over on Instagram, like, I'm losing followers day by day. I was the ones that like 8,000 announced that like 7,000, 8,000 years, something, right? So I don't think it's winning game. Like you said, I don't think it's a future for me. No, they said no. Yeah, exactly. I'm looking at it. I think I gained three today. I was like, what is robot coming from? Because I was like, no one knew it's following me. So it's a funny game. I think it's a game you kind of have to play, but you can't get lost in it, right? But I think again, it's important to keep your pulse on what's going on. But I don't think it's going to help in any way of my future in terms of how I want to practice or what I want to practice. That's probably where my mainstream income is going to be. I'm very interested in consulting as well. So, you know, more of that's going to be the focus. And right now, it's kind of just showing who I am in my life and trying to meet cool people, you know, like you and stuff and follow cool people. So yeah, yeah, interesting. How about you, old? Yeah, I'll let's hear from you too. Well, I don't do nearly as good as you do. So I'm not sure my opinion is as valid. I think for me, it's a good way to carry information, right? Again, it's been a really good way to connect with like minor folks and to filter information that you might not have come across otherwise. And so, you know, I follow a lot of folks in the health and wellness, quote, unquote industry, a lot of physicians. And I find inspired by them. I am also sometimes handstrong because it does get the better of me. And I find myself mindlessly scrolling. I listen to one of your recent podcasts run me with, I think, Laurie got her last name. It's case me. Santa. Yeah. And you guys were talking about this conversation. You know, again, these superficial interactions. Now, fortunately, nobody is DMing me. And so I'm not having interactions, but I still find myself being trapped where I'm just, you know, scrolling sometimes. And I've said this to Darshoff line. I was like, I sometimes I don't even know how I got there. And yeah, but I think more often than not good does come from it. I think in terms of responsibility, just like this podcast is a way to do our best to communicate good information, right? There's a lot of bad information out there. And the only way to combat that is to spread good information. That's one way that you might not get an audience, right? Somebody's not listening to a podcast because that's especially some of the newer younger generation. I've got young cousins who they cannot listen to in our podcast. Their intention is bad. It's got to be a 30-second clip. That's challenging for me. And that's why maybe I'm not so good at it. But I don't know. Interesting. Cool. Yeah, I think that the social media space is obviously important. And I think you definitely need it now, especially if you want to run a business like it's super helpful, more run of practice. I think it's super helpful as well. I think what people, I think what a lot of, maybe this is an interesting thing for us to talk about or not, but a lot of what I see from residents or like from med students is you sort of learn what works and you sort of learn like how to gain attention. And then you keep repeating that over and over again because it works. Obviously, and then you forget like why are you here? Is this even the kind of stuff you want to talk about? Do you even care about talking about this? I fall into that trap. I know for sure. Now I'm trying to just do more content that I'm just like really, really interested in. I don't care if it gets like three likes as, as long as I'm just putting out stuff that I can consistently talk about enthusiastically is really the direction I want to go in. And I think, like, I love that you do the book reviews and you do things like you're like, you know, you know, they're not going to get as much engagement, but you enjoy them. And you know, that's the important part. Which is why I love, I love your new like videos now talking about startups, man. I think there's so much value that it provides because so many of us just aren't in it, but we want to get in it. And you know, you know, it's not like you have the most aesthetic at times. Sometimes you're just in your car, but it's like real talk, right? Yeah, I think your last one's real good lighting, though. Yeah, I just got the new setup now. Yeah, but I like that's what I enjoy listening to. And you know, I think it also comes down to like with high value people. What do you think care about listening? And they're going to be the ones to really like promote that, right? In terms of when it comes to high level jobs, high level success, high level networking, not saying all my listen, all my audience or whatever followers like not high level quote unquote, but it does matter who you put your content out to, right? Like I'm looking for people who respect that have the same ideals and they can share value back or connect me to the next level or collaborate, right? So I think that's also a key. Yeah, absolutely. It's so funny, because if you look at I'm sorry to hijack your ass. But there's I don't know if you notice this, but like throughout the pandemic, like it feels like so like the Instagrams doctor, social media scene got kind of weird. We're like a bunch of people fell off, like including myself, and then like some people like just stop posting. Some people came back like it's good. Do you guys feel that way or no? Well, I think just the world got crazy in general, you know, you had that. You had racial tensions at its highest. And I think now that you mentioned that if we had less voices, less maybe reasonable voices out there, the ones who had really polarizing messages just kept getting amplified, right? Just because there were less people out there, but now they're a bit of shout louder. So it did get to be quite a scary place. Sometimes it's still a scary place. And if you read the comments section, again, fortunately, I don't have a big following. So nobody comments on my stuff. But sometimes I read the comments on other people's things. I'm like, holy moly. Like why would you say this? Yeah. So yeah, it's interesting. Yeah, I mean, if you listen like the VPC deep podcast, or I was the dog MD and Vinay Prasad, I mean, they're always talking about influencers who like go through their ups and downs, just like getting haters or being so polarizing and definitely think COVID shifted that. But also just the rise of TikTok. Like I was at first kind of shocked in terms of like, how do I win this game? I mean, this is way too short of an attention span for me. And like I'm still not the biggest fan of TikTok. I probably won't use it just because it's just I don't gain anything out of it as much as I would with Instagram where I can sit with the posts, sit with the real read a caption and actually absorb, you know, something. Yeah. TikTok is just it's just too quick. Yeah. Yeah, I think there's obviously like I'm I'm in the same boat as you guys because I think we all we we enjoy longer form content. And for me, like I could do podcasts every day. I love I like to actually talk about things that matter. I think at some point we'll do TikTok and and but like it'll be if it's not something I'm absolutely very much wanting to talk about or it's my team posting on our social medias like clips. I don't think I'm going to do it because for me, it's not interesting enough like if it's it's about like meaningful conversations really. Yeah. Right. Exactly. I think that's what the executives are doing and like, you know, the high level people are doing that too. It's having meaningful conversation. Well, Rummy, we do you have do you have somewhere to be or you want a couple more couple of minutes? No, no, I'm good. I'm good if you guys want to keep going. Yeah, man. No, this is exactly what we want here. So, you know, I you mentioned a lot of great projects, right? The last couple of years have been good. We've kind of talked about different ways that we should be doing things we should be doing. Maybe, you know, rep up, take talk maybe maybe when you don't rethink our opinions on that. Maybe that that's going to be a better business opportunity. Who knows? What is it that you're excited about? Right? We ask you about the future of what you see of medicine. So, I'm not really interested in that unless that's what you're excited about. In the near future, in the next one of two years, what gets you stoked that you're like, man, this is going to be the next thing. It could be personal. It could just be healthcare. It could be really anything. Yeah. I mean, I'm stoked about a lot of things right now. Like, for number one, it's the startup that I'm currently at, you know, being a early stage executive on the team. Just, you know, being on the ground floor, getting to build, you know, we are we're consumers of medical assistance company and we do like, we work with the population health side of things with payers and then we also work with with independent practices and really basically create a really amazing front-end experience for practices, basically just, you know, completely taking over and making an efficient, making that interaction for patients so much better and providing an extraordinary amount to our clinics that we're partnered with. And, you know, I'm just super excited about this. So, right now, I'm in charge of everything, basically, clinical operations and business development on our team. So, I love being on the ground floor. I love getting to work with our team. I'm just I'm 100% like right now, just all in on that. And then, of course, beyond medicine groups like my passion project, my baby, on my goal is to build my goal with beyond medicine group is to build the absolute bar non-best community for health tech. And that's that be for physicians, for health tech builders, for investors, you know, just bar non-best community, online community out there as my goal with BMG and just bringing value to people. I want to give back because I've learned a lot in the last two years and I think a lot of our colleagues want to break into the health tech and start up sphere. Want to use, you know, we all want to be valued for our intelligence, for our clinical knowledge. I think most doctors want to contribute in that way. There's just some pieces missing and I'm trying to I'm trying to fill in those pieces. One being the network, two being the resources and the knowledge base and our community, the best way to do that is through community in my opinion. And we've got some, you know, top level digital health CEOs who are physicians in the group, really just a group of like mentors I would look at is like mentors and then even we have beginners and learners, I would put myself in that category. And you know, we have people that just want to help each other and that's the thing that's that's what community is about. A lot of online communities now are, you know, pseudo online communities. They're just there and you're part of them, but you don't know the person, you don't know everybody in the group, you don't know your neighbors. Like for me, like I want to build a real community here. So everybody, I want everybody in the group to know each other. I want our community to the values of the community to be about helping each other to make connections. It's really ingrained. I'm trying to, you know, make that ingrained in what BMG is. And I think it's starting to show. I think that even though it's just a slack group, you click on BMG and you're in BMG, you feel it. You know it's a different experience in there. And that's the feedback I get from a lot of our members. And to me, that means everything. So that's what I want to continue doing with BMG, with the podcast, providing value to our, to our community. And who is BMG open to? It's open to, yes, it's open to, well, you do have to request an invite, but it's open to all physicians and any health tech founders, any health tech investors, and builders and health tech are welcome to. We do have a screening process just to make sure we're bringing in people that are going to contribute in a meaningful way and bring value to the community. Of course, you guys are always welcome. Your listeners are welcome to join. And that's, you know, if you beyondmedicinegroup.com, forward slash community is where you can find the, the form which you'd fill out and you'll get a, you'll get to invite directly from me. Perfect. I'll put down the show notes as well. But I want to ask you, you're in Austin, Texas. How has that changed the game for you? I mean, I know a lot of people are coming in, huge tech boom, Peter Tias there, Tim Ferris, just to name some prominent people, but how's that been treated to you? Oh, man, I love it here. I don't want any more people to come because it's getting crowded, but I mean, me being one of those people that is crowded there, haven't just moved here eight months ago. But it's great. I think the best part about it is the health tech community. There's like really good health tech communities or good tech community. Startup community here is insane. I've met a lot of people, man, and this just reinforces my belief that geographic location actually really, really matters when it comes to getting the right opportunities. You know, second to that, obviously is online network and online presence and community like that definitely helps. But I don't think there's anything that matches just being in an ecosystem here that is thriving with young entrepreneurs, startups. Like, it's just really cool to be around that. I was, you know, our community is we're always surrounded by physicians, which is amazing because we can relate to each other and connect. But now my, my, my sphere is like expanding into this other side of things, which I'm really loving. But you guys should definitely come visit. I would love to host you guys here anytime. I'll show you around. It's a, it's a really great place. I was actually going to come for the F1. Oh, really? So F1 is, and yeah, it was like two weeks, October 21st, but I kind of make it. But me and my wife are actually thinking of coming down to watch that because Ed Sheeran's also playing. Ed Sheeran, you can't miss that. Come on. Yeah. Yeah. This isn't. Don't lie. You're coming here for a dog. You're coming here for Ed Sheeran first. That's very true. That's very true. 100%. But I'll definitely make it out at some point. Well, Remy, I just want to thank you, man, as we come to a close here. I think, you know, I, I want to share this with you. You know, when, when Darcy told me that we're bringing you on, you know, of course, like naturally bringing listeners behind the stage here, you know, you go, you do a lot of research and lucky to come across your podcast. And so you get a sense of what the person is, you know, what they're about, what inspires them, what their passions are, as you mentioned. And I have to say, I've done that with a lot of guests. We've been doing this for two years. And I don't think I've ever bookmarked anybody's episodes as much as I have for you so I can go back and listen to them just because of the guests that you've had, the conversations you've had have really resonated with me. So I want to thank you for everything you're doing. It's very inspiring. I hope you continue to do it. I'm glad that we've been able to connect. And I do want to ask you, I mean, you strike me as a person. You say you, you listen to a lot of podcasts. I know you, from time to time, we'll listen to some audiobooks and you had some guests before. What are two books that have changed your perspective on life, the, the last two books that you've read? Well, thank you, man. First of all, I'm humbled. Thank you so much for that. I love that that's as good of a compliment as I can get. So thank you so much. Two books that I've recently read. One book that I really enjoyed, and this is more like a business slash marketing book. It's called Play Bigger by Al Ramadan. That book really changed my thinking on category design and how to go from start up world talk of zero to one and really creating a new categories and thinking about things in terms of not trying to build a competitive business, but building a business that doesn't need to compete. So that was one of my really, my favorite probably reads that got me thinking a lot of something in a new way. Recently, I read a book that was recommended to me from someone and it's not in my typical real house of books that I read, but I just finished reading it and I thought it was really, really interesting. It's called The Way of the Superior Man. I don't know who the author is, but it was one of those books that I could resonate with in a lot of ways. So I think for young males, this is a particularly good book to check out. It's more about life and just life as a man and tapping into your certain life forces, which is like a little bit raw raw, but also for me, a little bit spiritual and a little bit enlightening. So I like that one. David, data, data. That's right. Yeah, that's the author for those who are interested. So we'll certainly link them the show notes. And now the last question that we like to ask everybody else and we've kind of touched on in different aspects of it here and there, but how do we add the health back health care? That's a great question. By building a new health care, because right now health care is sick care. It's not health care. We all know that. We're not promoting health. We're helping sick people hopefully get better. But if we want to put the health back in health care, let's really be mindful about what actually health is and what promotes health. And I think that to do that, we need to rethink our business model. We need to rethink our incentives. And we need to rethink our commitment to our patients. And for some people that might mean leaving a traditional system, starting a non-traditional type of practice and not being hung up by all of the sunk costs that we bear as physicians. And one last thing, I'll leave the audience with just as maybe as a source of inspiration. But for anybody listening who has that idea or feels like there's something they want to pursue that they haven't been able to fully commit to or haven't even been able to just get off and start doing it. And you're just weighed down by the commitments you've made, the sunk cost, the money, the time, the resources, everything you've put into becoming a doctor or whatever it may be, maybe as a lawyer, maybe it's something else. If you can take yourself, take yourself out of the driver's seat for a second. Take a step back and think about your journey as an educational journey. Think of it as a fellowship, as a commitment to not need to make that doctor's salary that you're making right now. But perspective shift and look at it as an opportunity to get to where you want and just dedicate time to it. So for me, I dedicated three years. I'm on, I'm on currently, I just completed year one in July of my fellowship. I'm on year two. I'm going into year two, then I got year three. So if everything crashes and burns for me, I've already made that mental commitment that this is part of my residency. This is part of my fellowship. And I hope that doesn't happen. I hope that I continue on this trajectory that I'm on. But if that does happen, I've prepared myself mentally for it. And you gain a so much freedom when you can do that. And if you can block out and give yourself room to do something, like you have one life, you don't have six of them. You just got one and you're never going to get the best time for you to do that thing you want to do is right now because the older you get, the more commitments you have, the more responsibilities you have and you really won't have as great of an opportunity as you do today. So think about those things. If you can figure out a plan or reframe something and this podcast inspires you, then I've done my job here. Rethinking, reframing, redefining. That's what we're about, man. Thanks, Robbie. Thank you, guys. Thanks, bro. Thanks so much for tuning in. If you enjoyed what Robbie was talking about, make sure to give him a follow on Instagram where he continues to keep it real about what health care truly is, right? And that is exactly why we brought him on to our show is because his vision aligns with what we've been talking about through and through with every episode. If you're a physician and you're interested in doing other types of work like consulting or really getting into digital and health tech, make sure to visit beyondmedicinegroup.com and you can join Robbie's Slack community. As always, everything in this podcast is for educational purposes only. It does not constitute the price of medicine and we are not providing medical advice. No physician, patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues. We'll see you next time.