Podcast

Ep 17: How Orthopedic Surgeons become Orthopreneurs with Scott Sigman, MD of Orthopedic Surgical Associates of Lowell

About Scott Sigman, MD:

Dr. Scott A. Sigman is a board-certified orthopaedic surgeon providing comprehensive care to patients at Orthopedic Surgical Associates of Lowell since 1996. Specializing in Sports Medicine, Dr. Sigman possesses the skills and experience to diagnose and treat sports injuries and conditions affecting the knee and shoulder.

In addition to his practice duties, he has served as the Team Physician for the US Ski Jump Team, and serves for the last 20 years as the Team Physician at UMASS Lowell, and is the past Chief of Orthopaedics at Lowell General Hospital.

Dr. Sigman has also contributed to numerous publications and research studies regarding advances in the field of orthopaedic surgery. He takes great pride in remaining informed of the latest state-of-the-art arthroscopic techniques for both knee and shoulder surgery. He also gives presentations and lectures and instructional courses to fellow surgeons throughout the world in new shoulder and knee surgery techniques.

In 2019, Dr. Sigman was elected as a Fellow of the Royal College of Physicians of Ireland, Faculty of Sports & Sports Medicine. This certificate is a culmination of his ongoing efforts to change the paradigm of postoperative pain management.

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Learn more about Dr. Sigman’s work here:

About Dr. Sigman

Transcript

Everyone does your host cause he had a growth here. Jensen health, another fantastic episode of journey to private practice. The man, the legend, the night I got them done, or you know how Scott title the pro, if you know Dr. , I’m joined by Dr. Scott. Thank you so much for joining us. How you doing today?

Oh, Mar what a wonderful introduction, man.

I got to come back in again. I want to hear that one more time.

Absolutely. She ever take up a career in NNA, a boxy recipe. You need like bad ringside announcer. I will do it for you. Free of charge.

Oh, I love it. I can tell great stuff. Thanks for having me, man. Appreciate it.

Absolutely. Absolutely. Now we have a really interesting topic for today, which is the, the business and medicine specifically on the side of franchisee.

You’re an orthopedic surgeon and you know, you seem to have it all because you not only enjoy private practice library business, you also podcast goes for the ortho show. Great show, leave links in the show notes, but also this franchising model with, uh, your company, you of called ortho laser. And I want to get into that, but before we do, I want to hear the origin story of Crow.

Yeah. Where’d you grow up? Where’d you go to school? Why do you pick medicine and why didn’t I was somebody calling in the middle of already. And dude, I know

any idea who right now, oh my God. That’s too funny. Uh, and, and not only that, but it’s a robocall, but, uh, so yeah, so, you know, I grew up in Baltimore and, um, you know, my father was a chemical engineer from MIT.

My mother was a head hunter. No, it was one of those things that, uh, in high school, I was good with sports. I played football and lacrosse captain of both teams. I was really good in the science and then sort of had a knee injury, like in 10th grade. And there were about four or five kids in my, in my class at high school whose fathers were orthopedic surgeons.

And I was like, this seems kind of cool. You know, they seem to be okay, they’re doing it right. They got a nice car. They’re dressing. Well, you know, dad seems to be really responsible in the community. And I’m like, what if I get through this? You know, maybe I could be a sports medicine, orthopedic surgeon.

And, uh, I put my head to the grindstone in 10th grade and I said, that’s what I’m going to do. And that’s what we did. And so I went to a, I went to Tufts undergrad. My father was from, you know, from MIT. He said, you got to pick a school in Boston. It’s the greatest place to go to school. And I did. I had four great years of tops and then went back to university of Maryland for medical school.

Then back to Boston where I did all my medical training, except for the Kerlan Jobe clinic in Los Angeles, which has this sort of world renowned sports medicine clinic, where we took care of all the pro athletes. And then I went into private practice and 27 years later, I’m sitting here talking to you, Omar.

That’s amazing. What a great story I love. I love that. And especially Baltimore is a hell of a city. I did some research at Hopkins back in my undergrad days. It’s a great city. Great place for medicine.

Yeah. Phil’s point the horse you rode in on tablet where basically that’s where we would spend every Monday night because all the medical school tests were were on Monday, you know?

So they give you the New York telephone book and they’d tell you, you got to memorize. If your test on Monday, we go, I’d get drunk. And then they give you the LA phone book on Tuesday. So you can stop the memorize that for the following Monday. So we had some really fond memories of Baltimore and we would go to the Orioles games.

My, my dear friend, Billy Yurman, his father had season tickets. So we’d go over like the third inning. We’d hang out for like three or four hours. And then we go to and the little literally we’d have awesome food at two in the morning. Just great memories of all.

It’s a great, it’s a great, it really is a great place.

Uh, absolutely. And you know, when, when you decided to pursue, uh, orthopedic surgery, I mean, who, who was sort of the, you know, they always say that, you know, you go into medical school, uh, thinking, you know, what you want to do, but you end up, uh, sort of falling in place based on where your personality fits, you know, but how did, how did that light bulb go off?

Where, where you realize like, yeah, ortho, I, you know, I need to be an ortho.

I knew it in 10th grade, man, there was this guy, Larry Becker. He was an orthopedic surgeon. He played, he played lacrosse at Hopkins. He was like the star go-to guy and became a sports medicine, orthopedic surgeon in Baltimore. And I went to high school with, uh, with Jill and Gary has his two kids and, uh, just saw the whole thing.

And I’m just like, dude, this is what, this is what this is perfect. I mean, I love sports. I play sports. I’m kicking ass in school. I’m getting straight A’s. I can put all this stuff together and nobody in the family had ever been a doctor, but I was like, this is what I want to do. I want to combine all the sports school stuff that I do with being a doctor.

And then that’s just what it was. And it was never even a moment Omar, where, where that wasn’t the case, you know what, on the ortho ship podcast, we interview with the peak surgeons from all over the world. We hear these awesome stories and everybody always has a different story. You know, Nancy and Shipley was just on and it took her five years to figure out that she wanted to go to medical school and you know, and then there’s other people like, well, you know, it was my third year and I did this rotation and that’s what, no, no, no.

I was doing this thing from day one. I got accepted to medical school. Uh, in my junior year, I applied early admission. I got accepted to medical school before I took my first test senior year, uh, in, in, uh, an undergrad and then medical school was, was pretty straight forward. And I was very fortunate to do well and got into a great residency, did well in my residency, got into a great fellowship.

And in that fellowship, Kerlan Jobe orthopedic clinic in particular has opened up doors for me throughout my entire career. And it’s really allowed to allowed me to grow. And I mean, I love what I do. I probably only do 70% of my day is where the week is really spent on clinical medicine. But as you mentioned, 30% of what I do is other stuff I teach.

I learn, I travel, we have the podcast, we have ortho laser, you know, where the big laser centers as a franchise. And it’s been a real passion of mine to be able to share all the things that I’ve learned and be able to pass that on and then learn as much as I can from other really remarkable individuals.

That’s fantastic. And I think that, you know, especially in people can follow you on LinkedIn and all these other platforms, but looking at your career, I think it’s, it’s kind of the, the future of what it means to be a physician, which is yes. Like, you know, don’t go and this is just my personal thing. I don’t, you know, don’t go to medical school thinking like, oh, this is my path making a lot of money.

Cause trust me, there are other things that you should do. And don’t go to medical school just to go work for a hedge fund. That’s just my personal. But, but if you do end up going to medical school and you’re practicing right. Find outlets where your interests can really be aligned with, in my opinion, you know, elevating career, making more money.

Now, it’s interesting. And I want to get into the business model aspect of it, of ortho laser, but, you know, before you founded Orthodox, you were already doing some really you’re consulting and industry. You’re involved in a lot of interesting projects. And so you would think that already, you kind of had that itch scratched.

What specifically made you say, Hey, I want to start a franchise. So tell us the early days of ortho, laser, what is it? And then you can kind of get into the business model of it, because I think a lot of surgeons want to know how do I start doing more, you know,

bigger business opportunities. No, all great, great points.

And so for me, anybody that knows me, you know, my mantra is, you know, Dr. Scottsdale. I am the original opioid sparing, orthopedic surgeon, healer of knees and shoulders left and right. Hashtag follow the pro host of the authorship podcast and chief medical officer of the laser where the big laser centers and now cure of COVID.

And we’ll talk about that too, but my point, no mother, no mother of dragons, but I got a lot of stuff going on there. And, uh, so, you know, it started for me really opioid sparing space and, and, you know, over a decade ago, I just recognized the harshness of, of, of the, of the falseness of the opioid epidemic and how we had all been really sort of schnockered, you know, it wasn’t bad people for the most part, it was really just doctors who were trained and taught with experience-based medicine.

That what we do hurts, you have to use opioids because they’re inexpensive and they’re really not very addictive. And obviously we all know that that couldn’t be any further from the top. But that’s what we were told. That’s what we were taught. And so it was a culture of pain medication and pain management that was really devastating for us within the medical community.

And so, you know, about a decade ago, I just recognized that it was just too much. It was time for transition, tried to come up with new ideas. And that’s, that’s when I got started with a company called Pacira with this medication called liposomal bupivacaine, which is a long acting anesthetic, and I did some consulting work for them.

And, and then from there it just blossomed and it really just became my, my gig. And I would, you know, I would just profess it and I would travel and I would give lectures, you know, crazy. I mean, I got invited to, to this society meeting in Dublin, Ireland, they loved my talk on opioids. And I was asked to become a fellow of the Royal college of surgeons in Ireland, which was just an amazing experience.

And that whole thing, that whole concept of trying to come up with alternatives to opioids is where ortho laser was born. I got a call from Ryan Mooney. Who’s now my partner and says, Hey Scott, we’ve got this thing. It’s a niche. It’s a laser. I’m like, what the hell is the laser? I don’t know anything about it, but it turns out I had another friend that was using it.

I’m a big believer in trusting and believing in what other doctors are doing that I believe in. And I tried it and it was pretty cool. And, uh, I liked it a lot. And then, you know, and talk about medical practice, right? I have a group of 10 doctors that I’m partners with, you know, trying to get 10 orthopedic surgeons to agree on anything is nearly impossible.

It’s like that’s right. Yeah. Seriously, just, it’s just painful to make major big time decisions. So after about three months, I just recognize that this was not working. You know, I was getting. You know, the press Digitate or the, you know, that, you know, somebody called me, they were calling me a chiropractor and all these things.

Not that I love chiropractors. It’s not a, it’s not a negative connotation, but you know,

I know exactly what you mean. I feel like in medicine, it’s a, it’s a very dogmatic culture and especially amongst surgeons. And let me tell you, they, they know how to stick it to the, I think someone who’s your doc, it was back to Corktown.

Who’s mentioning the first orthopedist who decided to start using, um, uh, implants, uh, like, uh, of different materials and learned from dentist, Pete, you know, all the orthopods were just like, you’re a moron. Who’s a stupid that guy’s like a

zillionaire now, dude, that is such a common story. I mean, you know, innovation requires courage and to change and move into a different direction is not right.

And for the most part, most people don’t want to take that direction. They’d rather stay in their MOC and do the things that they’ve been taught and not have to worry about change. And so, you know, very early on, I was like, all right, this is the same work out of here. And I was like, then I’m like, well, why am I, I have this laser, right?

I’ve got this really expensive orthopedic clinic where we got tremendous overhead. We’ve got 70 employees, there’s insurance authorization, just layers and layers of employees that we have in overhead. I’m like, okay, this, this, the laser doesn’t have to be in that setting. Why isn’t it in its own clinic?

Why just have the lasers and do laser healing, do the diagnosis here, but send patients, is there healing like in a salon or whatever where they can get their treatments done? So I bought three lasers. I opened up a, I bought this little dentist office that had just gone under, uh, I trademarked the name ortho laser, where the big laser centers.

I spent some money on the logo. Uh, and I said, I’m just going to do this thing. And I started it on my own. I asked some of my partners in the practice that they wanted to do it. It became way too political. So it was a hot potato. They decided, no. I said, I don’t care. I believe in this, this is something that really, I think will make a difference in people’s lives.

Uh, and we started, and so all of a sudden, about three months in the laser distributor who sold me the lasers, he was knocking on the door and they’re like, wow, this is pretty cool. We kind of liked this idea. And what they have been doing is really selling lasers one or two at a time to different clinics, to podiatrists chiropractors, MDs, dos, but they were selling one or two at a time.

You know, it wasn’t a, it wasn’t a mass production sort of were scalable event for them.

And it was behind the curtain tubes. It wasn’t something that was front and center like, Hey, this is what you’re getting is what we’re special. It’s kind of like. There’s great technology, but it just, you know, it’s like, uh, you know, purchasing a robot, but not having anything about a robotics, you know, front front facing it’s, it’s sort of behind the seat, which loses the

value.

Right. Very, very interesting and really, really a solid point. But, but they were like now, okay, now we can see that this now can take it to a whole nother level. If we were to franchise something like this, we can scale it. We can sell multiple lasers, you know, at multiple times. And they could really increase their sales.

For me, it was like, this is a way to help spread the word on what I’ve really found to be really quite amazing healing modality. And so we sat down over the piece of paper and Panera, we had a bagel and a cup of coffee, and we wrote some shit down on a piece of paper. And next thing you know, we’re, we’re applying for our franchise disclosure documents for the FTC, and we filed her for franchise rights and it took us a while to go through.

And, but not crazy. I mean, there’s money involved. You probably was about a hundred thousand dollars in legal fees. To get through the process to be able to have the documents and the franchise feet, you know, the setups to the likes of the federal government and how long

the ortho laser functional clinic before you made that decision to do franchise,

believe it or not probably only eight or nine months.

It was one of those things where it was productive early on. They love the idea. And we were just like, yeah. What were

the signals that you saw from the business early on? Because I think, you know, any idiot can make a decision about scaling a business or franchisee. Massive cashflow and et cetera, they’re going to do it that early.

There must have been a few key signals out of the noise. If you focused on said, yeah, this is we, we should take this to the next level, but what were those signals that made you say

that? So in medicine, you know, nobody wants doctors to make money. Okay. I mean, that is just the way of the world.

Isn’t that a true

why?

I don’t understand it right now. They want us to, I mean, if you take a look at the last 25 years, Louis MacIntyre is taking a look at the orthopedic CPT codes for surgical interventions. We have been on the straight downline reimbursement for what we’ve been doing, despite the fact that technology has improved outcomes are improved, you know?

Yeah. When you’re working more,

more, and with your outside

higher, higher volume, you know, and putting more, you know, and, and taking more risks associated with that yet we continue to be ratcheted down. And so there’s these things called designated health services that the federal government has set up.

So for example, imaging x-rays MRI, physical theater, Things like that, where they say, you know, because of the fact that these are things that are really important, you know, you can only generate 25% of your overall revenue from designated health services, because the idea is, is that you’re going to self refer to a facility that you own, or you have this thing and you’re going to overload it so you can generate more cash.

Well, what’s interesting is that laser, despite the fact that the basic science behind laser is absolutely impeccable and the clinical studies from around the world are improving literally on a daily basis. Oh my God, God, I’m a popular guy. Jesus, let me turn this thing off. Um, and so, um, so, you know, so where was it?

Oh, so for laser, the basic science, the clinical studies were, were, were, were bearing themselves out. Um, and, uh, again, I just lost my train of thought. Where was I? Omar help me here. What was I talking about? Franchising? What

were the signals that

big nose, there we go. So the number one signal was the ability to self refer to a facility that you own legally without restriction.

So from a pure business standpoint, now, remember it’s okay to be a doctor. It’s okay to be in business. It’s like doctors feel like they got a high behind their white coat and they can’t, you know, they can’t advertise or they can’t talk about themselves or they can’t join into a business because that’s just not what we do.

But at the end of the day, you know, if you’re, if you’re in, if you can take, you know, this business to a community and provide an opiate alternative solution for acute and chronic pain for a community, and you’re bringing that service to that community, you are providing a serious, important thing for them.

It’s a very positive thing. So there’s just some running a business is not necessarily a negative. The doctors out there that are thinking about what investments or what ideas they made.

And this is just a perfect, I mean, you know, the other thing that people will get it, this is part of the culture of medicine.

As you go back in history, you know, had their own business. My father owned businesses. There’s nothing wrong here. Obviously, if you’re, if you’re, if you’re doing things where you’re essentially in a gray area, when it comes to business, we all know what that, what that was with life. You know, doing anything like this, but in certain areas like this, it makes complete sense.

This is the other option, which is more people are addicted to opioids and they’re tens of thousands of Americans who’ve been killed, killed in the last few years because of it. Right.

So you’re right. You’re absolutely right. So, you know, it’s, it’s, it’s the, you know, when there’s a problem, can you come up with a solution?

I always said it to my kids don’t bring me problems, bring me solutions. And so the people that can just see around corners and just look around and see the things that are happening around them. And then come up with an idea and then be able to move forwards with it. And trust me, I mean, every, you talk to every CEO of any company that’s ever been started, it’s always two steps, two steps forwards, and one step backwards.

There’s no cookbook, nobody hands you the book on how to do this. And so there’s always things that happen that are, that are positive or negative, but the idea is you solve you move and you, and you continue on the, one of the other things that was really important for me is sort of understanding as to why I thought this was going to really work was if I could connect with the technology, right.

I didn’t have intellectual property. I didn’t, you know, I’ve got a co I have a couple of patents on some cool stuff, but you know, that’s not what this was about. This wasn’t about coming up with a new technology. What it was, was taking an existing technology and bringing it to the people in a different way.

And so making it more available, uh, making it more brand aware as well. So branding is super important for us in, in the franchise world and what we’ve done as well. And so within that technology, we have this robotic laser, which is super cool because there’s a bunch of other lasers that are out there, but they’re sort of handheld and they generate heat energy and you have to move them around.

Otherwise you’re going to cause skin burns and complications. Our laser is pulse 1500 times a second, and it has a mobile head. So the laser never touches the patient. And so what that does is it heals the patient’s relatively fast and three times more powerful than any other laser, but I’m okay to say this out loud or more.

We can do three to four patients per hour with a single laser. So if you’re going to open up a business, you gotta know your margins, you got to know what your costs are and you gotta be able to have a successful model. And so we’ve done that with ortho ways, or now we know exactly how many lasers, how many patients, what size the place needs to be.

We take your CAD cam drawings and we have a company called Wadsworth designed to build them. Every worth of lasers will look identical. So it’s perfectly branded. All of that sort of came together, you know, early on as we were going to decide to do this. So it just, it just, and then we locked in the technology and I gotta tell ya, you know, I’m a smart guy, not so much just because I’m a smart guy, but because I know that relationships matter, you got to make sure you’re surrounded by other smart people that have expertise in areas other than what you have.

And so partnering with these distributors, getting an amazing lawyer, getting an amazing CPA. All of that helped us to put this package together and we’ve got nine stores open now across the country with 16 more committed. Uh, and we’re just really hitting an exponential growth curve coming out of pandemic because doctors and patients alike are looking for alternative treatments to surgery.

They don’t want to go to the big hospital with sick people. Uh, and doctors are also looking for additional revenue now because of the pandemic and the concerns that they had with being shut down for months.

Absolutely great, great American success. Right. And that’s what I love. And again, I mean, at least for us and, and Genta and, you know, making sure that, you know, private practices stay independent.

And I love, you know, this story that you share because not everybody has the chutzpah, right. Or the pain threshold sort of take that big leap and do this, you know, do this. And there’s a bit of luck involved as well, but essentially a path for that surgeon. Who’s listening to this to say, no, I would want to venture off into the business world, but I don’t know where or how I can franchise the next best thing, because essentially everything is templated out.

You have some math to work with, you know, you’ve got a model framework and I think that’s why a lot of. You know, they, they prefer that model, I think will, in my opinion, I guess, anecdotally, a lot of physicians don’t open these, there are practices back in the good old days. Like my dad is toxic. It’s like you finished training, you open a practice, you go talk to a few people in the area and then they refer to the seat.

But now there’s so many hospitals are buying up, practices, corporations, private equity, they own everything. So even your buddy down the street, like, Hey, you know, I love what you do. I can’t send my patients to you because you know, I worked for this hospital. I can’t do it. You know? So I prefer this model, this physician run it.

You know, the other option is that every physician in America is working for a large corporation and they’re caught on

the wheel and everybody’s miserable. Yeah. You know, private equity is really pushing into the orthopedic space at a very rapid rate. It’s impressive. How do you feel about, I’ll be honest that we’re in discussions right now with private equity group.

Who’ve signed a letter. I don’t want to go beyond that at this point. But, you know, I think for private practice groups like ourselves, which have been incredibly successful in, in our ability to heal, but also successfully financially, we’re pressured from a lot of different places. As you said, you know, our local hospital just joined this group called the Wellforce, which is what two other hospitals.

And now these outside people are coming in and like, I wanted to order something new for the Orr. And I had to fill out a requisition slip to go down to Boston for somebody to say was okay. And I’m just saying to myself, You know, we need the rally, the troops here. I want to be around other like-minded innovative doctors who have a good sense about business.

And so if you join in with private equity and you have those other successful practices that are rallying with you, then you’re, you’re, you’re basically rallying the troops and you have people that are really worth looking out for you. Like my, you know, I I’ve been working with the same hospital group for twenty-five years.

I have a great relationship with the primary care doctors in the C-suite, but at the end of the day, I’m still a private practitioner. I don’t work for the hospital. They have their interests. I have my. And so for me, I really liked the idea of maintaining independence. We have a doctor that’s thinking about joining our Portsmouth ortho laser center up in New Hampshire.

And he works for a large hospital group for the contract. And he’s not sure he can do it because he’s got to see if he can do outside stuff. And so you get really limited, you know, and it’s fascinating because I think there’s a lot of these younger surgeons are coming out of medical school, residency, and then looking for jobs.

I’m not sure they understand the nuances. At this point, you can go to work for a large hospital corporation. You’re going to get salary. There’s not a lot of upward mobility. You’re going to take a lot of call you join and they own you. And you can’t do outside stuff. Forget about entrepreneurial stuff and ideas of business that you can’t do any of this.

And then if you join private practice, what’s your status there? You know? So the private equity thing. Potentially really opens up doors. You know, it’s interesting, you know, if you’re an orthopedic surgeon, you reach 65 and decide to retire. The general rule of thumb is you get two months of accounts receivable and you’re done, right.

Uh, but now you actually own shares in this corporation and the corporation continues and then you can get fair market value for your price when you exit. And there’s actual, you know, you’ve really built a business over years and, and doctors in particular have never really taken advantage of that. Yeah.

Maybe, you know, I think he kind of influenced me in a sense, because at least my experience with private equity and medicine had been kind of private equity comes in, they acquire practices, they reduce the number of positions just because it’s cheaper. Right. But in the sense where you, whether it’s a franchise model or a larger practice, you partner with private equity, Right, right.

That makes complete sense because it gives you a sense of more level, because that’s the biggest thing that I think physicians are faced with these days, which is, Hey, you have a practice to successful. Even if you’re out in the rural areas, at some point, the big regional hospital or IDN or anything is going to say, Hey, why don’t you expand out there?

And so you need capital to have leverage to essentially that, that I couldn’t in, in Massachusetts or one of the Northeastern states that the hop is having a big push out into a variety of different areas, acquire and practice. I feel like is a Massachusetts.

So the mass general and the Brigham, it used to be called the partners, but now it’s called mass general Brigham organization or something like that.

MBO, they, they put out a note that they were going to do a $2 billion expansion into the eighties. And so the concept was, you know, in Boston, in particular, oh, it’s mass general. It’s the Brigham people are always going to come from all over and drive into Boston to have their meds. And they would sit there, you know, you’d have to leave it for the morning to get your surgery done at seven 30 because of the traffic.

But people would just did it. It was like, whatever, this is, this is what we’ve always done. But nobody wants to go to the big white building with sick patients in it anymore. Everybody wants to go to an ASC and outpatient surgery center. Right? It’s clean. There’s no sick people. You’re having elective surgery.

Why do you want to be around people with germs and bacteria and stuff? And so what’s happening. The realizing is the push is now to have these ASC ambulatory surgery centers in the community. So people can go right from their home and then have these doctors. The problem was is that it’s a huge group.

They’ve already got tremendous market share. And the attorney general was like in the department of public health was like, you know, no, we’re not just gonna let you do this. You know, we’re, we’re concerned. Why would we put another ASC in when we’ve already gone one sitting right there so you guys can make more money and grow.

So I think it really is important to, to be able to maintain some independence as a physician. I’ve always, I mean, I don’t want to work. I want to work for myself. I mean, I’ve never really wanted to work for someone else. I think that’s really important. And even within private equity, I want to stress that.

I mean, they don’t really change your clinical practice. They don’t want to, you’ve been successful at what you’re doing. If you’re asking you to join in the private equities, because whatever you’ve done is work. Uh, they want to basically make money. That’s what private equity does, but they don’t want to take away your ability to clinically practice.

And so you’ll still be a doctor doing what you want to do with your nurse practitioner, PA and making the right decisions for your patients. Uh, but it just gives you the potential, uh, to be able to push back and have money for expansion in ways that you might not have had before. Uh, and you’re partnering with these people.

It’s not like you’re just working with them. The whole idea is that they, everybody grows together, you know, in this process and you’re with like-minded. Outstanding. You know, we’re the PD groups that are doing the exact kind of work that you are in your building best practice.

That makes complete sense.

So let’s, let’s get into that model. So say that I’m an orthopedic surgeon and I say, you know, I listened to this podcast with Dr. Sigman. This sounds right in line. What I’m interested in, what are those next steps look like? Like how do you know that a Frank, you know, getting into franchising is for you to still be hiding, you know, how do you, what it,

so it’s funny.

I mean, I think Matthew, Ray, Scott, do you follow Matthew Ray Scott on LinkedIn, the bearded one

I had, I had the bearded one on this podcast a couple of weeks ago. We’ve noticed as many of yours, great. This he’s got a heart of gold.

That’s such a great egg, just a great person on the planet. I mean, he just thinks so differently at the time he’s talking about shit.

I don’t know what the hell he’s saying, but at the end of it, I’m like not in my head. I’m like, that’s what I wanted.

But, you know, ortho printer for us, you know, so what’s, I

was wondering where that came back. I saw that floating around on LinkedIn. I was like, who came up with that?

I’ve already asked for ya. So, so you know, who, what are we looking for? We’re looking for innovative, you know, doctors that understand new technology that are looking for new technology, uh, that, that aren’t afraid to start a new business.

And so, you know, as a general rule, the place to be in the sweet spot of things for three laser orthopedic laser centers to have a minimum of four doctors, but we actually think even like six partners that would self refer it. And what, what makes most sense is if you spread it across multi-specialty, so you get a hand surgeon, you get a sports surgeon, you get a BA you know, a pain specialist, the foot and ankle specialist.

So you’re, you’re covering a lot of different, you know, uh, disease, uh, options that are there for. And then you caught combined together and then you refer into this facility, that’s one model and that’s been very successful.

Everybody has their own own clinical practice. And it’s like, Hey, after I do, sir, I’m referring in here.

So it makes a lot more sense when you’re with a group, because if it’s just one physician with that, I think that gets a little dicey,

right? You want to have, because the whole idea is you don’t want to spend any money on marketing, right? Marketing is what’s really expensive. If you open up a hair salon, those acquisition

costs are expensive.

Certainly we don’t want you to spend any money on marketing, maybe a little bit on Facebook or something, but we basically want four to six, you know, actively practicing doctors who are referring two to three patients a day with three lasers. And your facility is fully booked within six months. And that just rolls.

You know, it’s a patient pay model. So everybody needs to know that the insurance does not cover laser at all. Uh, we’ve got great efficacy data, as well as our safety data is impeccable. There’s no single, single reported incidence of complication with laser over the 10 years that this laser in particular has been FDA clear.

And the efficacy about we’re saying 80% of our patients are seeing at least a 50% reduction in their vast scores over their, over their 10 treatments. And so they’re very satisfied as well. So, so basically if you, if you do all of that, then these, your, your, your business is filled within six months. The model has been proven.

We have a beautiful center in Milwaukee with bill Pennington and Joanne Pennington and Dr. and the rest of the crew that are out there. And within three months, they went from three lasers to six lasers because they could not keep up with the volume that was happening. And we’ve set up an ortho laser university there where we’re taking all of our franchisees.

Once they sign on, you’re going to go, you’re going to be trained in the laser. You’re going to be trained in tactics and strategy and how you run a franchise and a business. Um, and so, so that’s the one model, but then there’s been another model which has really been really quite interesting. And that is a lot of the medical device distributors and medical device reps who have really deep black books in the area of wherever we are, that we’re going, they come on for equity ownership as well.

And so that model is really fascinating because that’s run more like almost like a surgery center kind of gig. So what happens is let’s say you’re a medical distributor, let’s say you, Omar, you decide you want an open up an ortho laser where you are, and you’re going to keep 40% of the equity for yourself.

And then you’re going to distribute 60% of the equity. Maybe you give 10% to six doc. Those doctors are pretty excited because Omar says I’m doing all the work. Okay, guys, I’m going to open this thing up. I’m going to find the people I’m going to manage the HR and the payroll and all that stuff. All you six dudes need to do is send in a couple of patients a day and then I’ll send you a distribution check every quarter for your, your time.

So some doctors are all in. They want to run the facility. They want to be the managing part of them went to for everything. But other doctors are like, I like the surgery center model where someone else does most of the work I send my patients in and I get a distribution. And then, so what’s happening, especially, which is really fascinating is that we’re getting these, you know, the margins are so good because the overall costs to run this laser.

And we can talk about, you know, as far as you know, what it takes to get in, but it’s not big money compared to like, if you want to open up an urgent care center, a franchise urgent care center, it’s a minimum of $1.5 million to buy all of the inventory. That’s required. X-ray machines, EKG, blood work, you know, all the stuff that’s required in.

You know, for us, it’s three lasers. It’s a couple of computers and some desks and some stuff on the wall. And so it’s leased them, at least a building, you lease the space, you don’t have to own the space. It’s 2000 square feet. We don’t even have most of our people aren’t even going into retail space.

Because again, it’s not a walk-in clinic it’s referred. And are you referring for your patients? Yeah. So you don’t need, you don’t need

like prime real

estate medical office space, which is like 30 or 40%, less than retail space, 2000 square feet. You get yourself a few lasers. There’s a couple of computers.

We train up your laser technicians and you’re ready to roll. And we do all that. And that’s why you sign up for a franchise is that, you know, we call it sort of business in a box. I mean, we, you sign on the dotted line and we’ll take care of all that stuff so that when you do open, you’re going to be ready to roll.

And so what a lot of people are doing because they love the numbers so much and the margins are so good. We’re getting a lot of interest in area development agreements. And what does that mean? It means like, okay, I want Chicago, what Chicago, I want the whole thing I want to know. I want to basically be able to go north south east, west, can’t go north in Chicago that puts you in the lake, but you know what I’m saying?

And like, literally, you know, you get all of those zip codes held and then what they do is they hold the equity for themselves. And then they partner with additional doctors at the next zip code. So they’re bringing in four or five doctors for that zip code and giving them the X. So it’s just, and so indirect

way to get exclusivity.

Yeah, that’s smart. I like that. That sounds,

that’s actually a really great model. And then, you know, speaking of exclusivity, I’ll tell you one of the other stories, which we haven’t talked about yet, but, you know, they came to me when I first said let’s do this franchise thing. And at the time it was the M six laser it’s like BMW that changed the model every like three or four years.

So the best technology at the time was the. But they were also selling the M six to other, you know, other healthcare providers. It wasn’t exclusive to doc to MDs or dos. And so I said, oh, so, you know, you can’t be, I can’t be competing, you know, against a chiropractor that has the same laser down the road because they’ve been using laser forever.

I’m like, so we need something that sets the MDs and the dos apart, what’s it going to be? Well, they had this brand new technology that was just coming out. They completely changed the marketing campaign. We signed on the dotted line. And the only way you can get an ma laser, which is three times more powerful than the MCX is if you sign on for ortho laser with big laser center.

That’s awesome. I mean, so that was another real lock enforce. We’ve got the technology, you know, now we’ve got this, this great way to heal people. Uh, the margins are fantastic. And physicians are looking for an opportunity for additional revenue source and it’s really a positive thing for them as well.

So it’s really a, and you’re bringing this great, amazing technology to communities to would open.

And, you know, I know that

has, it seems like there’s opportunity for non-orthopedic surgery evolved. It’s like, what are some other positions? I know, like our audience is kind of like all of them, man, especially as like, what are some other positions, you know, that, that have been involved. Well, franchise,

I want to get real creative.

It’s great though. You’re, you’re actually, you’re asking all the right questions. So certainly pain management specialists, right? All the podiatrist or the anesthesiologists that are in pain clinics. I

mean, how many people would they be eating into their own, into their own pockets? Or is it, is it kinda like, Hey, if I had a patient that I’m, I’m probably private, I might lose otherwise I might as well give them that option, not

the way 20 epidural steroid injections on the same patient.

I mean, eventually. What you’re doing, it’s basically one more arrow in your quiver, right? Okay. Yes. I’ve got a pain stimulator. Yes. I can burn your nerves or yes, I can do an ESI or we’ve also got this laser thing, which you can’t hear feel, or see a thing it’s completely painless and you can go across the street and get that instead.

And

let me point something out because it’s something that, again, again, my not 75 years old and so old school, general shows are actually on county and here’s the history. Remember, look what happened in general surgery. Everybody started to pick off of diseases like the left and right. And so you may not be, I don’t know, interventional pain guides, like what the hell is, Hey, if it clinically is showing efficacy, patients are loving it.

You better be on board and start adopting and be involved. Otherwise you are leaving a huge risk. Am I wrong in saying

no, you’re absolutely right. It’s not just in general surgery. I mean, within north, if you decided, you know, 15 years ago that you were going to continue to do open rotator cuff repair and you wouldn’t take the time to learn how to do an arthroscopic, rotator cuff repair, you are out of the business of rotator cuff surgery.

So technology is not necessarily a bad thing. You don’t have to be the first one on the way, but it’s okay to be accepting of technology as it starts to bear itself out. And so, you know, that’s sort of what we’ve seen. So yeah, I think your, your analogy was fantastic. So we’ve got pain specialists, we’ve embraced the podiatrists.

Who’ve actually had success with laser, but we’ve done is with little lasers for them is they really haven’t found a way to monitor ties. If it sits in their office, they have one laser they’re charging a little bit here for therefore it, but you know, it’s not in this scalable environment of where you can be a part of something much larger.

So the podiatrist room. Um, even, you know, we’ve had, we have chiropractors down that have joined us as well. Uh, we have an outstanding chiropractor, Steven, Sarah who’s in business with me now who’s, you know, has an amazing reputation in our community. We were thrilled to be able to bring him on board. Uh, and then, you know, it’s, it’s, um, you know, it, all the orthopedic specialties, obviously Omar, all of those, but then there’s another magic place that we’ve been having amazing success and that’s with wounds.

So the laser works amazingly well on all types of significant wound complications, whether it’s venous, stasis, ulcers, arterial ulcers, you know, these, all these, these treatments that have stalled, we’ve just had, we have patient after patient, after patient who have had remarkable success with the laser.

So we’re actually talking to wound care specialists now to see if they may be interested. There’s a lot of different ways in which you can.

Very early. I had a couple of questions, more on one business clinical side. What exactly, exactly. Clinic clinic. Physiological insulator.

Great question. So, so I always, I always say this to everybody.

When I first get started on my webinars and my talks, I’m like, all right, do you believe in photosynthesis? I definitely do. Right. How can you not? Do you look outside? The sun comes up and your grass grows, right? That’s photosynthesis. So, so why should it come as a surprise that a species living on a planet that has a sun deepest genetic code would have sensitivity to light as well?

The next thing I bring up is vitamin D we’re all familiar with vitamin D, right? You have to be in the site to activate your vitamin D. So your body is affected by light and it’s. Inner core of its genetic code. So I’m going to harken you back now to your high school science days. And we’re going to talk about the mitochondria and the Krebs cycle, which is the powerhouse of the cell, which generates all of this energy for you.

So there’s these enzymes inside your micro, your mitochondria, the cytochrome oxidase, and they are sensitive to light. They are excited by specific wavelengths of light. And most of the time that’s in the near infrared zone, which means you can’t see it. It’s below the visible light spectrum. Uh, it’s usually about the 600 to about a thousand nanometers for those geeks out there that are really into the Wavelink type stuff.

And it’s all about the penetration of the laser. So you gotta make sure that the laser gets into where the action is. It’s got to go four to five centimeters that’s based on your skin, pigment your water content, and then your hemoglobin, all of those things absorb the photons. But with the right wave lengths and the right power, you can generate these photons into the mitochondria of the cells, increasing the, the, basically the metabolism of the cell.

And it generates all these things. So it increases vasodilation. So there’s increased blood flow to the area. There’s clear demonstration on a Petri dish that if you do a fiberblast scratch test, and then you lay laser over top of it, the fibroblasts get all excited and they go, and they cross the scratch much faster than if they didn’t.

So the fibroblasts, which are the healing cells of the body come in as well. There’s a slight increase in temperature of two to three degrees, Celsius well below, uh, any kind of, uh, a concern for burn. What does that do? That sort of gets everything moving around a little bit. It loosens things up a little bit, and that’s where we get help in our chronic inflammatory conditions.

And then we’ll segue into COVID. Cause I want to talk about that. I think that we’ve had some profound results using our laser for COVID. Yes to cure cure of COVID I’m going to catch some shit for that, but I don’t really care. It’s okay.

go, go, go, and go, go fro go fro, um, so, so yeah, so, so, uh, oh my God, you broke my train of thought again. So where was I

cure COVID either. I don’t think that for marketing purposes.

Yeah, exactly. Um, you know, so, so the bottom line is, you know, we were just all of these things, you know, create a reduction inflammation.

Here’s where I was going to go with this. So we know the cytokine storm, right. We all heard that for COVID right. And so the cytokines are these proteins that if they’re unleashed, they create havoc and they create a very pro inflammatory condition and the laser for whatever reason, basically when it goes in, it gets, goes into the cells.

These inflammatory cells are called inflamma zones or macrophages, whatever you wanna call. It produces these, these anti-inflammatory proteins, which block the formation of the proinflammatory proteins. So basically you block the inflammatory cycle from, from going haywire. And so that’s what happens in arthritis and tendonitis in any place that you have inflammation, you’re creating the laser to per group to produce these anti-inflammatory cytokines to block.

And so that’s what happened with COVID. If you’d like to go there at this point, I mean, I was using my laser and if you have somebody that rolls their ankle, or they have an MCL injury to their, to their knee, or they have a hamstring tear and they get this tremendous bruising, if you put them under a laser, 100% of those patients get better, it basically evaporates acute inflammation.

So that was a big issue with COVID is that you have such a huge cytokine storm with fusion. And for all of us were really big into this. And I think there are there’s one company called. Whose device essentially was a filter virus. And that was like one major issue with it. And you’re saying that the laser essentially crises anti-inflammatory markers and walks the cytokine storm

that is, and then your body can catch up, do its thing without having a crazy immune response, but an appropriate immune response to the virus.

And so, so, you know, we were using it and, you know, look when March rolled around of 2020 or 2019, I forget 20, the world did not need an orthopedic surgeon that specialized in sports medicine. Right. I was grounded. I was put on the sideline. COVID striking. All of the operating rooms are shut down. And here I am, I’m stuck in the closet in my master bedroom, you know, podcast, closet studio.

And I’m trying to think, know, what am I going to do? You know, I’m not gonna just sit here all day and do nothing. And then the whole, whole sort of laser thing sort of came to me and I called my hospital. I said, look, what if I donate my, my laser to the hospital, we run a trial using my laser because I think it’s going to be on a cute coat,

very surgeon, like things for you to think of like that only a citizen to say like, Hey, Mr.

Or Mrs. CEO hospital, let me link to this capital equipment. Here’s what I want. Here’s what you get.

I love that. I love that problem is, is you’re dealing with doctors. And as you said, you know, they’re stuck in their ways or dogmatic. They know what they know and they don’t know what they don’t know. And so

I wasn’t set on Twitter.

Uh, there’s not, there’s not more trash talking between positions. It’s very civil on Twitter. Like ortho, Twitter. I was like, is he got on them? Just like a garbage fire. How has this maybe cause it’s, it’s humbling.

I go to the, I go to the IRB, which is the institutional review board of the hospital and say, I want to run this laser study. They’re like I say, it’s FDA cleared, but it’s not, it’s really off label for use if we’re going to do it for this. And they’re like, well, we don’t know shit about lasers. It’s like the only way we’re gonna let you do this is if you give us some guidance from the FTA.

So yeah, because that’s so easy to get, right, bro has got some chutzpah, as you said. And guess what? I picked up the frickin phone and I called the FDA and six hours later, they called me back. Are you kidding? I am not kidding you. Six days later, I gave him the specs of the laser, which had already been FDA cleared.

I said, here’s the deal. We went back and forth emails over six days and they said you’re a non-significant risk device and you can use this for COVID. And I basically went back to my IRB. We applied for it. We put the study on clinical.gov. And, uh, I brought my laser into the hospital and we started laser and, uh, it was, it was really hard.

It was difficult. All the hospitalists at the hospital had never heard of laser. They were completely uncomfortable with the idea of using it. What is this? We don’t know anything about it. And yeah, that’s exactly right. But you know, something, you know, how they were treating patients in the hospital at that time with oxygen.

I mean, there, it was the, it was the lowest morale of anytime I’ve ever been in medicine in my 30 years, walking through the wards at that hospital because it was death. This was April, April and may. So this is like literally

getting close to the shit, hitting the fan.

It was just the smell of death and demoralized nurses and doctors who really weren’t doing anything for their patients.

Just watching them die. None of the medications were working with. And so basically here I am, I bring this long shot in, I say, let’s do the laser, let’s try it. And 90% of the hospitalists who were taking care of the patients refuse to have their patients, you know, care. And so we wanted to do a 20 patient study, 10 in the control 10 and the treatment.

Uh, but at the end of the day, we only were able to treat 10 patients five in the control group and then five in the treatment group of the five patients in the control group, three of them died after going and getting intubated in the ICU. The five patients that were treated for once a day treatments for 28 minutes, for four days in a row, all left the hospital or alive and well with no long-term pulmonary supply, their chest x-rays dramatically improved over that four day window.

We have chest x-rays before and after we have some interleukin six data for some of the patients, which is one of those pro-inflammatory cytokines, which went down and, you know, very proud that paper was published in a peer review journal. A year later, this was. It was published about, you know, four months ago.

Um, and it’s really seen some international regard and we have, I’ve had, you know, emails and calls from doctors in Brazil and from India in particular, most recently, uh, where they’ve actually taken the same laser and have had great success. So that was unbelievably gratifying, but still here in the U S no one has wants to read the study.

No, one’s knocking on the door calling to say, can we use these lasers in the clinic? You know, can we bring them to the hospital? It just hasn’t been able to break through. I know it’s a small study, but our whole goal of doing that study was to have a larger academic institution pick up the ball and then do a larger study, you know, and from there, you know, what’s even more interesting now is obviously we don’t have a lot of acute COVID left where we are, but we’ve got a ton of chronic long haulers that are walking around that just have these unexplained pulmonary symptoms.

Well, after they’re contagious and they just are severely limited in their ability to function. And, uh, and work hearing them. I’ve had three nurses most recently from our hospital who were really, you know, could they were, they were incredibly, you know, great athletes and able to function and do all the stuff that they want to do prior to COVID.

And then they could barely walk up the stairs afterwards. And those three nurses in particular have all been completely character asymptomatic at this point after 15 laser sessions. So we’re about ready to embark on a chronic long holler COVID study. We have the, the, uh, application into the IRB and we’re going to run a study free to the patients because I’ve just been so impressed by this for donating my laser again, to be able to run this study and be able to get some data, to show that it works for chronic cough hollers as well.

So, you know, it’s, um, it’s, it was, uh, a major, you know, sort of struggle bus to sort of, you know, figure this thing out and get it across the finish line. But we did it and I had two amazing partners in the study. So Hilo, muck, Molly, and Marianna Patrese or MD-PhD from camp. Um, you know, you have to remember, like, I had no idea.

I’m like, I’m a laser guy for, for like bones and joints. I’m like, what the hell is, what am I, how am I supposed to laser the lungs? You know, it’s like, what do I do? What’s the dose? And so I pulled out the Google machine and I just threw out, you know, laser for COVID. And sure enough, there was a theoretical paper that had just been written by these two, IDM them on research gate, which is like the geek aroma of Facebook for scientists.

And she got right back to me and she gave me like all the information or what those suggested use. And it was just amazing story from beginning to end to get that thing done. That’s it.

Please let us know when you can assess study and they’ll do a few times. She sees more about that. Now. I want to be mindful of time. I’m good.

More stuff. Let’s keep going, brother. I’m good.

Absolutely. Does. I know that our audience is eating this up. There’s a few orthopedic and spine surgeons. I know that are loving.

Just pinning back the business side on it. So I’m going to give you a scenario. I won’t say this person’s name, but perfect scenario. Young orthopedic surgeon in clinical practice, working for hostel, not having wants to quit. Right. Interested in entrepreneurship. Is your advice to that pers if they want to get into the ortho latest franchise is to go and do that a model you mentioned of taking a larger equity stake, going into recruiting, IE, referring physicians in a certain area.

Right. And once they have that coming back to you, launching the franchise long gone, is that in a nutshell what you recommend or would it be different?

No, I think that, I mean, so there’s two things to that story. First and foremost, I’m assuming that they definitely have decided that they’re not going to continue with their career.

They’re done. They’ve already made a decision so that they’re moving on. So, so the first question I would ask them is that, okay, this may not have been right for you, but do you have solid relationships in your community with the doctors in which you were working? Uh, and if so, then the answer is absolutely.

Yes, you can build upon that. Uh, and you can, you know, develop this, you know, the go through the process of signing the franchise application, which at the end of the day is non-binding for 60 days. And then you go run around, you find the doctors that you think you’d want to work with. And then you build that equity pool in a way in which you want to design it.

Uh, and then yes, you start. And our model basically is we want you to be successful at your opening franchise. Once we know three months in that you guys are cooking with gas and the numbers look good, then we say, okay, fantastic. Let’s sign an area development agreement. We’ll give you five more zip codes.

And then that person, that doctor who’s still a doctor would then start working on collaborating and finding the next group. And that model has been very successful for us. Uh, in Milwaukee, for example, their first facility opened up, I think about eight months ago and their second facility is going to be probably opening in two months.

They then collaborated with the large group from Dallas and formed. Big holding company and now six sites in Dallas that they’re going to be opening as well. Wow. You know, so, so we’re on the, we’re on the, you know, the real exponential growth phase of where we see this thing going. And, uh, it’s just sort of the perfect storm, right?

If you take a look, uh, at, at an opportunity to be able to help your communities by providing this alternative treatment option for them, it is a patient pay model, but you know, something patients are used to paying for stuff. At this point, nobody has a $10 copay anymore. I mean, everybody has high, high PPO deductible plans and they’re used to paying for their medicine.

So for $70 a treatment, which is what this is, which is it’s 70 bucks a treatment. And so for the acute injuries, if you roll your ankle, or if you have a fracture in your little grandma, can’t, you know, she’s on opioids because she broke her shoulder, screw that you bring it to work. The laser and sixth street.

Her pain will be gone. The bruising will be gone and she requires it. I mean, you

look to you solely like, look, I’m technically that population. My, you know, my wife, uh, you know, her, her out of, for a long time since she started going to a chiropractor recently, and you, you know, it’s helping me make her feel better pumping like 40, 50 bucks a car.

I was much out of this trial. I’m going to check for the laser locations here.

Here’s California is like the people’s Republic of China, but it’s not exactly the place to

do business. Yeah, seriously. I mean, this is, I want everybody to notice. I’m not from here. I’m, I’m a, I’m a, I’m a guy from Texas. They ended up out here because my parents decided to retire.

So Cal, Hey, if I have to pay these crazy taxes, I’m okay. Living like close to the beach and in wine country, but yeah. Yeah. And people are leaving the state and ruining other places. They’re ruining Texas and I’m waiting for the cost of living to go down here. It keeps going up on us. It’s like they’re leaving and making things worse, worse than other places in here.

But that said, here’s an interesting question. And again, for those listeners who are paying attention right now, I’m excited to get what are some markets right now that are untouched by the ortho wave, where you’re like, man, if I was in that market, I would go gangbusters.

And somebody’s going to get somebody on a, on a, on a goal,

Florida, Florida, Florida. So

you guys don’t have any ortho relations in Florida. We

have one open in Pensacola. They have this very interesting. Are you kidding me? That’s in Florida and the entire state. It’s interesting because you know, Florida has this, this self of the physician self-referral act, which states that you cannot own more than 50% of anything outside of your clinical practice that makes money regardless of insurance, or if it’s a cash.

But that model then is perfect for your buddy. Who’s basically looking to start these franchises. He’ll own 50% of the franchise, and then five other doctors that refer in and they’ll each own temporary. Nobody’s over the 50% rule because the other, person’s not a clinician that’s referring in and it’s like this perfect scenario.

So Florida’s a great state. Uh, we’re just moving into we, we got Dallas tied up San Antonio. Houston is another tremendous market, very large market that Arizona is ripe for the picking, you know, Scottsdale, Phoenix, another great spot Vegas as well. Another high populated area, uh, I would say probably 80% of the, of the states across the country have really no major regulations against the idea of you opening up a laser clinic.

There are some places that do that are fairly strict. For example, New Jersey as the Cody law, which is the harshest sort of law in the state, in the country where it says that physicians can’t own anything outside of their clinical practice. Because some, I guess some guys made some money doing some stuff.

Selling some stuff out of the back of some vans on the Jersey turnpike or something. I don’t know, but yeah, never, that never happens, but, so we’ve got some really good in Chicago that’s happening right now, but literally, you know, basically just about every Ohio is, is a little dicey. We were just about ready to open up a bunch of centers in Ohio.

We got a little bit, uh, pushback there. Uh, but I would say in the Midwest in particular, uh, Maryland is wide open at this point, too. We’re really excited about the possibility of Maryland though. There are some restrictions there. North Carolina is ready to rock and roll. That’s wide open as well. Um, so I think the advice in that, what I would say to your listeners is this, is that, you know, if you’re truly interested, we had worth the laser have, have done the work.

I mean, we’ve analyzed the regulations of each of the major states that are out there. And we have for, for any state, we can provide the counsel as to whether or not it’s something that’s worthwhile or not. So I wouldn’t be, I wouldn’t necessarily say that you’d be limited to any specific market I would say is, is this concept something that you’re into, do you want to have, you want to have ownership in a business where you’re providing an amazing service to your community and then also be able to generate additional revenue, uh, and then, you know, move forwards and scale this thing with us as we move on.

Now, I want to wrap things up and again, I appreciate you being very gracious with your time. So last, last question on the ortho for ortho laser, and then I want to move into a couple of, you know, sort of, uh, I, I forgot

the term. Essentially,

uh, they’re they’re quick and fast question. I don’t remember. I don’t, I don’t know why we call it some reasons, but I’ll leave it in the show notes for everybody.

Check out your website, but just as general, like for somebody who’s just listening, what would you say are the minimum three criteria to benefit? Think about right before they let’s say go to the website and engage, engage you all. It sounds like, you know, obviously like having some good referral, a referral network set up, what are the, what’s it that a minimum three things where like, if you get these three things that you’re a really good spot

be successful.

So first and foremost is relationships with the doctors in the community that you’re going to be setting this up. So if you have a deep black book in the medical space and you know, the orthopedic doctors, the pain doctors, and you have relationships with. That’s absolutely. Number one. If you can do that, you’re going to open up doors and you’re going to make it easy as well.

I think that, uh, you know, as far as that, that the concern about money should not be that great. I would say that out loud, it’s really not that expensive to open up one of these or the laser centers, uh, for as little as about $150,000 pulled money with everybody in together, you should be able to open a center.

So that 150, 150,000 that’s

that’s below average franchisees, but for like

everything as well. Absolutely. And now remember, that’s just, if you’re a startup, you still have to pay stuff as you go. But yeah, we’re a little bit, pre-startup 150 grand in the bank with six people, uh, you know, depending on how much equity you’re going to want to be keeping your.

You should be able to pay the franchise fee. You should be able to do some of the build out. Most of it’s going to get covered by the, by the bill, the owner of the building. Anyway, uh, and then you put money in the bank for a little bit for the lawyers, and then you have money set aside for, for wages and salary for two months of expenses and your rock and roll.

Um, and so, so the money isn’t crazy, which is also great. And then the question really becomes is, and this is really important and that is, you know, are you an entrepreneur? Do you, do you, are you going to focus on this business or are you going to put your heart and soul into it? Because that’s, what’s required to have a successful business.

You can’t just do this and then hope it becomes successful. You have to do it because you’re going to make it successful. So those are the three things I would say.

Got it. Fantastic. Now let’s get into the last, last bit again. We appreciate your time and I remember the term, but it’s rapid fire questions.

I don’t know why I can remember so rapid fire questions you can take as long as you want to answer these, or as quickly as you want, we’ll get to the next one. First question is during the pandemic, we all bought a bunch of like ridiculous stuff off Amazon. What’s the most ridiculous thing that you bought.

Like you’re super happy for Abbott.

Oh, it’s my Yeti microphone. Are you kidding me? This thing is fricking awesome. Look at this thing. You guys got to see this. Oh my God. I love that thing gets like you have, what do you got? Oh, there you go. I love it. That was my best purchase by far.

Got it. Next question.

You know, along the way in medicine, continuing education is always a big thing and we’ve we read a lot of books, right? This is how we get our information. What book do you feel like you’ve recommended or gifted most

people and why? It’s the book thing? You know, it’s funny. I’m not a big, I’m not a big reader I should be, but, uh, but I’m really not.

I’m just what I would say instead is that I would say the daily podcast, if you want to have information and learn what’s happening around the world in a timely way, that can be explained to you and things that oftentimes are difficult to understand. The daily podcast is fantastic by the New York times.

I’m a conservative, I’m not a liberal. They do follow the middle ground. And I really, really appreciated listening to them.

I didn’t know about that. I’m going to definitely check that out. Last question for you. Um, I want you to imagine that for the next year, a billboard is bought out in every city, every suburb of American, every in this case, orthopedic surgeon is going to see this billboard going into work.

What does that billboard say? And it cannot be anything related to ortho waste.

It’s very simple. It’s the beard and the fro on that billboard. Cause we are all things right. I love it. I love

it. Awesome. Awesome. Awesome. Well, thank you so much. Hey, how can people find you online? What are your

social handles?

We’re all over the place. So you can see me Scottie Sigmund MD on Instagram. Nice and easy. Also Scott, Dr. Scott Sigman MD on LinkedIn. Also Scott, a Sigmund MD on Facebook. I don’t do Twitter. Uh, I’ve been as an opioid sparing superhero. There are opioid zealots out there that help in times really criticize us.

And so I’ve decided to stay off of that network rather than fight that process. Uh, but I’m also, uh, the ortho show.com is where you’ll be able to see and listen to all of our podcasts from the ortho show, which I’m so happy to be a part of. I have great partners there and of course, ortho, laser.com is

fantastic.

I’ll leave that all to showed us. I have big feelings. Our audience is going to want you back. Dr. Scott, Susan. Thank you so much. Everyone does another episode of juried, private practice of your host. Omar MPTT we’ll see you next time. Scott, stay long, stay on for a second and let’s chat.

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