Ep 20: How Sales Reps Become Trusted Advisors

Hey podcast listeners is Omar. MTT your host to journey to private practice. My guest today is a friend, dear friend from LinkedIn. He, he was, we were online friends for a long time, and it was only a matter of time before we actually got to virtually meet each other. And that’s Dr. Vino DASA. Dr. Dawson, how are you doing?

I’m doing great. Thanks. Now, aside from the fantastic content you put on LinkedIn, and of course, you know, you’re the, one of the founders of doc.social, which is the next, you know, hot social media platform, especially for those in healthcare, which I want to get to in a moment, you know, you put out this extremely unique content that I’ve never seen, any physician put out, which is advocating.

For med tech reps, because usually it’s the opposite, right. But you’re the first, you know, physician, especially surgeon, who’s really advocated for this idea about the value and medical rep provides. So I want to talk about that today. So, you know, before we do, for those who are just getting introduced to you, maybe he shared like your one minute, like high-level origin story and bio.

Your whole life story in a minute. Yeah. So I’m a orthopedic surgeon. I’m the vice chair and director of research at the LSU department of orthopedic surgery here in new Orleans. Uh, and we’ve got, uh, uh, developed a pretty big research platform. Specifically look around health disparities and inequities, or emerging basic science with population health, with a unique tissue repository that we’ve created.

I’ve got a clinical practice where we’re doing outpatient, opiate free, a total knee replacement. So really pushing the envelope and trying to push the system to think differently from that perspective. And then have some, uh, ventures, uh, an entrepreneurship, uh, work they’ve been doing, uh, something called site medical to help support reps, uh, become more productive and more valuable.

Uh, bring more value to the system. Uh, doc social, as you mentioned, a platform where all of healthcare can get together. So we’re not all siloed in these specific, uh, specialty specific, uh, areas. Uh, and then some other things that, that I’ve been working on. So yeah, so pretty broad trying to stay. That’s fantastic.

Now I w I li I really gravitated to her content around the value of reps, because for me, you know, I was in medical school in Texas tech. I left at my first job that I was able to get. Fortunately, it was at the top of, in my opinion, the med tech mountain, which is surgical robotics back in 2013. And I joined Missouri robotics, first robotics spine company, and we were training.

Not just to be a sales rep, but we were trained so that when we walk into a hospital or practice that they look at us as a trusted advisor, meaning not only clinically, we also need to know business. We have to know marketing. How does the hospital grow? It’s PR it’s business. How does the practice do it?

You know, if a physician wants to go on podium, how do we, how do we train them to do a good job? So you’re the first surgeon that I’ve really seen. Talk about this. How did this come about? Yeah. So, you know, it’s, it’s been interesting. So I’ve seen the evolution of reps, you know, over time and I’m involved in supply chain.

I’m involved in a lot of things, uh, you know, at the healthcare level, at the organizational level. And one of the things I think that’s been fascinating is to see this kind of ying and yang, this, this back and forth, uh, around implant pricing and reps, and you know, who’s doing what and why and box openers and laser pointers and all this kind of stuff.

Mish-mash uh, and no one really has their hands. Right. You know, and what’s interesting is the hospital administration values what I call the heart stuff. Right. So stuff you can put on a spreadsheet, the folks in the trenches. So, uh, surgeons, uh, circulators, scrub, surgical techs, you know, all the folks that are actually kind of in the trenches, taking your patients value the soft stuff, right.

Which is efficiency and culture. And. Yeah. You know, throughput and, uh, competency and all those kinds of things that you can’t fit on a spreadsheet. And there’s this disconnect, uh, between kind of the administrative, uh, folks and in the clinical folks in terms of who values, what, and what drives, what, and it seems like.

Everyone wants to kind of put the blame or, you know, everyone wants a neck to choke, right? Because, you know, they just, you want someone to represent all your frustrations and all your issues. And for whatever reason that has landed on the reps, uh, that represent the, the, the implants and the devices and things that we use.

So I know for a fact that, you know, Uh, on demand on-site manufacturing and 3d printing is, uh, is a long way away. So hospitals are not going to be, uh, manufacturing implants anytime soon. Um, we know that, uh, OARRS are struggling with staffing and competency as surgical techniques get more and more complex.

Right? If you think about it, you know, 15, 20 years ago, there were only handful of surgeries. That was it, you know, there were no robots and computers. There was nothing. It was, you needed a hernia, you didn’t open hernia. You had an open gallbladder. You kind of took three hours to do a knee replacement because you know, we’re just in its infancy.

So there’s only a handful of things that got done. Uh, and so a lot of the workflows and processes were hardwired for that kind of old healthcare model. Fast forward. Now healthcare is getting extremely complex. Surgeries are getting extremely complex, you know, whereas before you had maybe one textbook for all of orthopedics, spine hips, knees, shoulders, everything.

Now you’ve got one textbook for one part of a joint, let alone for all of orthopedics. Right. And so then now the question is, is as surgery becomes more and more complex, you know, what do we expect to happen in the operating room? We’re expecting a lot of our or staff, uh, that truly, I think is unfair. Um, you know, I’ve got a surgical tech that’s making maybe 15, $18 an hour and we’re expecting them to have a skillset and a knowledge base equivalent, maybe even surpassing a PA.

Yeah, right. So it’s not practical. It’s just, it’s just not practical. And so, because we’re, we’re, we, we haven’t transitioned that the system hasn’t kind of figured out how to address that deficiency or that issue with competency and saying they’re an incompetent. What I’m saying is it’s just impossible, humanly impossible for someone to basically memorize.

All the surgeries, all the surgeons, all the implants, all the techniques. It’s just, it’s just impractical. I mean, I can’t even remember if you asked me to do a rotator cuff surgery, forget it right now. Right. And, and, you know, theoretically I’ve, I’ve reached the pinnacle in terms of training and knowledge and all that kind of stuff.

Cause that’s not what I do. And so then if our or staff is struggling to keep up with the advances in surgery, And then who’s going to help them. Right. So reps are going to be actually even more important as we move forward. Not less important, you know, this whole concept of going reckless and all this stuff.

Yeah, it sounds great on paper for, for, for people that aren’t in the day-to-day work of the, or, but for those of us that are in data, it’s actually going to become even more important to have reps around because surgery is getting even more and more complex. Absolutely. And so, you know, as new devices and implants and techniques and theories come out, who’s going to execute on that right.

In a scalable way. I completely agree. And you know, what’s interesting is that when I got my career started in medical devices, and again, I built my career in surgical robotics. You know, my father is a general surgeon and I used to ask him like, you know, just out of curiosity, you know, I was like, Hey, that, like, where do you get your information on new technology techniques?

He’s like threats. And I was like, come on and he’s, he’s like, no, I was like, I don’t talk to other surgeons because they, they don’t know about all the different techniques and technologies. Like it’s the reps. And then when I go to the conference conferences, like I have to go to the exhibit hall because that’s where we ended up learning a lot.

And it’s, it’s so true. You know that one of our guests, who’s also a great customer. I was Dr. Chang roll-on he’s, he’s an integrative medicine. He talked about this idea of collaborative medicine, not only with physicians, but also industry. And I think that as you know, the world’s getting more complicated.

It’s not getting. And so as a result of that, the care of the patient is going to is involving so many different parties. And I think that’s why many decades ago we were, we’re kind of trying to depart from this idea as the physician or the surgeon as the hero. It’s like, no, that’s just not how it works anymore.

And so it sounds like you’re sort of expanding on that idea in the sense that the rep is not just somebody who’s showing you. And, you know, selling, selling stuff, but they’re a trusted advisor to make sure that you’re optimizing the surgery and outcomes. Is that correct? Yeah. So I completely agree. So it’s becoming a team sport.

It’s not so much me and my scalpel anymore. It’s everyone around me. And so if we start thinking more broadly, more episodically and more holistically about the patient. So we’re now thinking about the patient, not just from the moment they park until the moment they get back in their car and go home.

We’re not thinking about them 30 days before surgery and how do we optimize their diabetes and their hypertension, all this stuff. We’re now thinking about. 90 days after surgery because we’re in bundles now and we’re going at risk. And then soon it’s going to be at one year, right? So who is actually going to help do all of that work?

Does that mean the hospital’s going to have to hire more staff because we’re going to have to manage these patients across a broader continuum. We don’t just kick the patient to the curb anymore. We actually are responsible for their outcomes. So if that’s the case, then who’s going to help us figure out all this out.

Because when the patient leaves the four walls of the hospital, it’s the wild, wild west. You’ve got so many patient engagement platforms. You’ve got so many wearables and so many technology, and you’ve got AI trying to predict this, that and the other, you know, so who’s going to help us get our hands around this.

Is it going to be the hospital? I don’t think so. You know, I mean, they’re worried about staffing, the ER, you got COVID, you got, uh, you know, uh, ER, doctor that just called in. All kinds of stuff. Right. And now you’re, you’re, you’re expecting people that have so much on their plate to think at a whole different level.

That’s not practical. So then who’s going to bring all of this information to me as a surgeon, because I’m going to be held responsible. Who’s got their kind of finger in the air, kind of paying attention to which way the wind is. That I trust. That’s going to bring me kind of information that’s been properly screened and understands the way I think the way I behave my interests, you know, my fears, my issues who understands me at that level.

If you think about it, the rep is uniquely positioned and poised to bring innovations, to bring new ideas, new things, to teach, to consult the code. The surgeon and their team, as we become more and more responsible for things that happen outside the four walls in which we work. And so I see reps evolving into my alter ego, the business side of medicine, kind of the technology side of medicine, the whatever side of medicine that doesn’t involve the scalpel and the pen there.

That part of me that I can’t be, or I never trained to be, or I never learned to be. Right. So I almost see my reps or the reps in general, kind of evolving into my agent. That’s constantly looking to improve my practice, getting me a better deal, helping me with my career because as I improve, then they win.

Right? Because I bet you, every physician career-wise financially, whatever is leaving money on the table, leaving opportunities on the table. And there’s no one advocating for them. As an individual. And I see the reps potentially filling that gap and filling that void, because remember, as we start moving to measuring quality, we’re going to have winners and losers, right?

You were going to have a system where, you know, if you’re a surgeon or your hospital, your team is not achieving X outcome. You’re not as pretty as you think you are. Right? So then if you’re not as attractive as you think you are, how do you become more attractive? Who’s going to help me get there. And if you are at that level, who’s going to let me capitalize on that.

Who’s going to help me figure out how do I maximize that value if I’m a blue chip player. Right? So as healthcare changes. I think they’re uniquely positioned to help us navigate this field. So if I’m going to be S uh, if you’re going to start measuring me based on outcomes and quality, then who’s going to help my team elevate their game.

So I can achieve that level of quality. Right. Cause I don’t have the time to go meet with the therapist and the, or staff and the pre-op nurses and, uh, the surgery schedule. And all these folks and all these stakeholders, if I’m expected to see more and more patients, because our reimbursements are getting down, going down.

So then I have to run faster on the treadmill. I’m already out of breath. So who’s going to put all this together, right? So there’s a void that starting to be formed. And I think they are uniquely positioned because they can marry the business and the clinical in a way that others can’t. Um, And so if, if the reps kind of recognize that distributors and they recognize there’s a new way to engage healthcare, and that role is potentially being a consultant or an agent or a coach and expanding kind of their repertoire, if you will, uh, and help the orb better.

You know, I think there’s a, there’s a big opportunity. I, I completely agree. Now I know every single rep is listening to this. They’re like clapping. They’re like, you know, P you know, punching their fists in the air. Like, man, we love you, Dr. Dawson. Hell yeah. But now I’m going to let me shift a little bit, cause you’re right.

There is a void and they are positioned to fill that void, but for every rep who’s listening. You are not at that point of filling that void. And I want to, I want to refer for a second something, you know, there’s actually a very popular, uh, Instagram handle called the mad device rep not med mat, the mad device rep.

It’s hilarious. It’s all. And their hashtag is red hat gang, you know, cause the, the red hat, the Scarlet letter that had you have to wear going into surgery. Right. And that thing came about, it became wildly popular because it creates me. About hilarious things that actually happen, right. Including, you know, uh, you know, dealing with Tufts surgeons or reps who are just coming in and like trying to show up and throw up and sell stuff.

Right. And so I want to ask you about what a rep can do to get to that position, because what I feel, and this has been my criticism of my own industry for many years, is that the vast majority of reps. Have have ha you know, have not earned that right. To be an advisor, a physician. And what I mean by that is that they, they, they did not adopt the one thing culturally in medicine that we all have, which is continuing education.

What do they, what are they reading clinically from a business standpoint? How are they improving on these things? So they can actually fill that void and provide that education because some of them feel that just by having the striker, the Medtronic, whatever major brand behind you, that that is enough, in my opinion, it’s not.

And so there’s a whole lot of areas for them to see. Outside of understanding things clinically, which means you got to read clinical papers, you got to learn procedures. You have to be able to have a peer to peer discussion with a physician from outside of that. What are some other areas that you feel reps need to get started to learning about?

So I agree with you. I think what I’m envisioning probably only applies to maybe 20%, 25% of the reps that are out there. I agree. I think the balance of the reps are what, what you said, that what you say, which is, you know, they don’t get it. And which is fine. I mean, this concept isn’t necessarily for everyone Pareto’s principle in action, not everybody’s going to be a champion.

Right. So, you know, and that’s fine, you know, the market will dictate who wins. And so if you’re an intelligent rep and you’re progressive in the way you think you will kind of, you’re trying to look around the corner and see what’s coming. And this is what’s right. Right. I mean, the system is changing. The shift from fee for service to quality is foundational.

It is so fundamental because it completely changes almost from a 180 perspective, how you should be thinking. So think about this, right? So I did a, let’s say I do a knee replacement 15 years ago in the fee for service model. The patient has a complication. Okay. You know, not that I’m wishing it, but you know, 90 days, 30 days after surgery, 60 days after they have a complicated, they have an infection.

So financially think about that. Not, not from a moral or ethic perspective, but just pure financial. Everybody wins. Right. I got another surgery. The hospital gets another admission implant company gets another implant. Pharma gets more antibiotics and drugs therapy gets more therapy on and on and on. And on the only two people that lose are effectively, the employer who’s paying for that.

And then the patient who’s suffering the complication. Okay. So. Fast forward now. And we’re now 2021 in a value-based world. If you have that same problem, right. Everybody loses now. Right. And you have companies out of that have implant guarantees and I’m in a bundle or I’m at risk. Now I’ve got a direct to an employer contract.

All of a sudden it’s a complete 180. So how do you change? 20% of GDP where thought and culture has been ingrained for 50 years, a hundred years. And all of a sudden change it on a dime, right? And so it’s, it’s a complete 180 in the way we’re thinking and, and, and how healthcare functions and how things are shifting.

So if that’s the case, you know what reps out there are recognizing this change, or do they simply think, I just need to get a Glossier brochure to try to sell another one. Right. Um, because if you don’t understand that shift in what’s happening that fundamental shift, you know, you’re, you, you, maybe you need to go start selling something.

Right. I completely, yeah. I completely agree. And, you know, I think for a lot of reps, it can be very daunting because it’s like, where do you start? And my recommendation, because, and I don’t recommend things that I haven’t done or continue to do. Is LinkedIn is a fantastic avenue. I mean, at least for orthopedics, the business of orthopedics is on LinkedIn and now we’re seeing it also on docs dot, dot social.

And so they can create the content there, connect with physicians and then find ways, even if it’s just sharing an article from Becker’s maybe sharing an article from HBR, because at least it shows that that, that you’re you’re proliferating content and the way the brain works, you don’t see it as HBR.

You see it as oh, salad. Shared these great articles clinically from backers. And then she shared this great leadership thing on HBR. So now you’re actually earning the right to show up and for surgeons who say, yeah, you know what? I should listen to her because she’s, I’ve actually learned something from it.

Yeah, and I don’t and you know, something, my founder told me the other day, which is a nice compliment is that, you know, whenever we want to connect, for example, this is a great example of you and I connecting. I’m sure you get requests to chat and do podcasts all the time. Why did you end up coming with me?

I’m going to put out a theory here and let me know if you’ve, if it’s true, is that I think I’ve done a good job every week. Of selflessly putting out some content to teach people something about business, about leadership, about medicine. And I’ve earned that trust in that, right. For me to reach out and for you to say, yeah, you know what, it’s worth it for me to have a conversation with Omar cuts my off on saying that no, I think you’re dead on.

So for example, if my rep truly valued me, right? How many reps that are listening to this can tell me the average length of stay for their surgeons that they know. Right. That’s a great question. I bet you, I’m willing to bet. 95% of the reps that are listening to this have no clue what the length of stay is for their physicians.

And that’s one simple, easy to measure quality metric. That’s extremely important as healthcare changes. And then you don’t even know that one fundamental point about the surgeon that you’re covering every week for the last 10 years. That’s that’s a great point. And, you know, it’s, it’s, I feel like it’s similar.

It’s similar to a sense of like, you know, like Michael Jordan, I’m watching, I’m re watching the last dance. Michael Jordan had like coaches, right. And assistants. So they all paid attention to their numbers. Here’s what your jumps is like, here’s your percent, here’s, uh, all these things and a surgeon doesn’t have time to be thinking about all these.

So if they have somebody third-party watching and looking at these and saying, Hey doc, I looked at your numbers. I noticed that these are, these are the outcomes. This isn’t like, say, I think you can improve despite this percentage. If we do X, Y, Z, there you go. Who does that? Nobody. Nobody. Exactly. So that’s valid.

Right. That’s huge. And then all of a sudden, now you’re moving the needle clinically. Guess what? The owner’s not going to want you to leave the hospital. Isn’t going to want to leave a surgeons, doc. Nobody’s going to want it. Exactly, exactly. And that’s how you become, like, you become a linchpin, you become indecisive.

Right. That’s right, right. And so, you know, to the extent that obviously I’m important to the system, there needs to be someone or something that helps navigate, you know, these changes in healthcare. Cause I can’t do it myself. Right. Everyone looks to me as being kind of the person. I got to sit in all these meetings and come up with all the ideas and I got to give my blessing to everything and all this stuff.

While at the same time, I’m. So, you know, I don’t have the bandwidth, I don’t have the energy, uh, you know, especially, you know, as you get older, you don’t have the interest and that’s just professionally because I mean, look, and it’s, again, medicine’s more complicated today than when, when I was a kid growing up, my dad practicing, but you know, my dad would come home eight, nine hour long surgeries.

It’s seven o’clock, eight o’clock at night. And he has to sit down, have dinner with his family. You know, you have personal obligations too. So like where do you find the time to do these things right? And then you’re up at five 30 next morning doing it again. Right. So, you know, I think the days of the surgeon living in the hospital are gone.

I mean, I think you see this across all professions, right? I mean, I don’t know if it’s a millennial thing, whatever it is, but the days of the surgeon essentially like just staying in the hospital and then just showing up when these kids graduate, I think those days are gone. Yeah. And so if that’s the case, Then, you know, your, the system, isn’t going to be relying on me to do all the heavy lifting anymore.

It’s just, it’s just not going to happen. And, and, you know, it’s going to happen even less and less as is there’s downward pressure on, on reimbursements and cost and all this stuff. And so I think all the free stuff that the physicians did over the years, you know, beyond this committee and that committee and volunteer for that, nobody’s interested in that those days are gone.

So then, you know, who’s going to fill that gap. Who’s going to fill that role. In an era where it’s getting even more and more complicated. So that’s why I think it’s kind of all hands on deck, but you’ve got to do it in a way that brings value that we say, all right, you’re, you’re a valued part of this team.

And I think they are, I think they’re extremely valuable part of their, of the team, you know, think about it. Is the only person that can tell you best practices in a, in a very practical way. Right? Because think about it. They see how everything is done across multiple surgeons, multiple hospitals within a given health system or across health system.

So, if you want to know how SPD should function or not function central sterile, actually the reps are probably a good place to ask because they can tell you where things work well and where they don’t, but they keep their mouth closed. Right? Because they don’t wanna upset anybody because they’re not mentality is not there to improve the system.

It’s keep the surgeon happy. Yeah. Don’t piss anybody off because God forbid you’re going to get kicked out. So when is a rep ever going to tell me I can improve as a surgeon, right. According to all my reps, I’m the best surgeon on the. There’s no more room for improvement because I’m awesome. Right? It doesn’t help you at all.

You change that, right? Because obviously I’m not. So where do I improve? Absolutely. And, and let me, um, let me give you like a great example. This is for the surgeons who are listening. This is, I think this is where it starts. And gosh, I can’t remember his name. There was a surgeon I used to take care of.

He’s a, he’s a spine surgeon in, I think Tyler, Texas. It’s gonna, it’s gonna drive me nuts. I can’t remember his name, but I’ll never forget at the ripe age of like 26 to 27, I’m covering my first robotic surgery case with him. He’s a big surgeon. I was told many times my manager, you gotta take care of the guy.

Don’t screw this up. And I remember we did our first robotic surgery with them, big, uh, lumbar fusion. And he stopped and looked at me and said, Hey, Omar, um, thank you very much for helping us in this case. But like, you know, we’re, this is new for me. How can you give me some feedback? And he said this in the room, what, you know, in front of everybody, what, what can I do to improve?

Uh, you know, did you see anything? Like, what can we do? And I remember thinking. This guy, who’s the head of the department sponsors in front of, everybody’s asking me for my opinion. And so I think surgeons also have responsibility to empower the rep and say, Hey, I want to hear from you like what I’ve used you have at such, because it is a big portal because it’s not only pissing off the surgeon that they’re afraid of.

It’s pissing off the head of the Orr, the hospital, their manager, you know, et cetera. Everybody’s afraid of getting in trouble. And so I think surgeons have to find a way to do that. And I think that especially surgeons like you, who you are going on, LinkedIn storytelling writing from a point of view, that’s vulnerable and saying, Hey, like we have to get better.

And this is how I think it’ll, it’ll make people more brave. But I think individually that’s where surgery is needed. You’re you’re dead on. I mean, part of it is on us to like, like you said, we have to recognize, you know, Tom Brady didn’t get to where he is just thinking that I’m the best. Right. And he didn’t, he just didn’t show up one day after college and said, I’m off.

Because that’s effectively what surgeons do. Right. We come out of our fellowship, we show up and then there’s no kind of life, you know, we go to conferences and meetings and when we watch videos and stuff, but there’s kind of no individual lifelong kind of organic improvement, if you will. Yeah. I mean, I bet you, there are surgeons that are, have almost done the exact same thing for the last 10 years.

They haven’t been. They haven’t changed one thing. No, you’re right. I know them. You’re telling me in 10 years, there’s been no way to do something better that you were at the top of your game. You were perfect. You hit perfection 10 years ago. No, obviously not. Right. So part of it is on us to recognize that we have to continually improve and continually, I think we understand that at a kind of high level, but then when it comes down to.

Executing on that, uh, uh, that idea, you know, how do we do that? Right? How do I continuously improve? In theory, every case should be an improvement from the one before in theory, right? There should be something to improve after every single session. So who’s helping with that. Yeah, I believe it. And you know, you’re definitely going to be repeat guests.

I can, I already know this, but you know, maybe one of those things, cause I always thought about this as interesting that in the business and technology world, we have these fantastic systems. Weekly, quarterly reviews, setting, uh, OKR objective key results. How do we improve things that do not exist at a hospital?

I don’t think you’d be too far fetched for a rep to talk to a surgeon and say, Hey, this quarter, I’m, you know, I’m going to monitor these two or three things like, you know, length of patient stay, maybe surgery time, et cetera. I’ll I’ll pull this, pull these numbers together. Let’s say the first, you know, month.

And then from there, let’s set a goal as a team to see how we can prove for the quarter and review, like, just take the same thing approach in business. And I would say for the marketers listening to this, because again, I love, I love myself. Uh, sales people, medical sales reps. Aren’t going to do this on their own.

The marketers should put some kind of templates, something together like, Hey, here’s something you can use as a worksheet, work with your surgeon, your team, and how you can improve things. That would be a phenomenal story. And from a company standpoint, how marketable is that? Right? It’s. You know, you know, and so who, so think about it.

I think I, you know, I’m the quarterback, I’m not necessarily the coach. I think that’s kind of what the shifting, where we have to kind of shift mentality is traditionally I was the coach, right? No, no, no. What I’m saying is no, I’m the quarterback. I need a coach. So that’s, that’s the fundamental kind of shift that I think that needs to happen because I can’t be the quarterback and the coach and the defensive coordinator and the offensive coordinator and the manager and the equipment guy and the everything.

Right. So I need to be the quarterback and I need somebody to your point. All right. You know, we’re going to play this team next week. So X, Y, and Z patients, how are we going to execute the game plan? Right. Absolutely true. And you know, here, here’s a good, here’s a good question. So again, like what a perfect, uh, analogy, cause you know, I’m speaking to an orthopedic surgeon, the med med reps, I mean, it’s all sports now.

So this works really well. So kind of playing on that bill, Bellacheck the Patriots head coach. When he got his start as an assistant, he had the job at every, nobody wanted, which is watching Phil. Everybody hates that, but he owned, he owned that and he was so damn good at it. I mean, look where he is now.

My question to you is for the medical rep who’s listening right now, let’s pick like three things, three areas that they can maybe focus on and work with a surgeon to find maybe some data, you know, or manual gathered data and find a way to improve. What are three really big areas that you feel that a rep can fix without pissing off the surgeon?

I guess. Cause not every surgeon is like, So I think that’s, it’s pretty straight forward. Right? So one. So I think there are a couple of buckets and a couple of categories. One is or operational efficiency. Okay. So it’s not just pulling instruments out, taking those PD, clean them, and then just sit in the lounge, waiting for the next case.

So how are you going to improve our efficiency and competency of the staff? So me as a surgeon, when I do the next case, it’s actually going to go more smoothly than the last case. What did you do to move the needle? Did you pull the scrub tech aside and say, Hey, I saw you handle the thing this way a little bit, you know, I think next case you could, you could probably maybe do it this way.

I think that will help Dr. DASA. Okay. As well as just pulling the instruments out and just going to lounge in the sitting there, that’s one thing. So how are you going to improve or competency? So that way I feel the difference of your input case after case after case that’s one number two, where’s healthcare going, can you see where the puck is?

So we’re going to measuring quality and paying for quality. So what are the basic quality metrics that CMS blue cross blue shield, the hospital administrators are paying attention to? Right? So if you don’t know what they are, then you’re not reading, you’re not clinically connected and engaged. So what are those simple clinical metrics?

One of them I already told you was length. Right. So length of stay is a very important measure of the quality that you’re delivering. So if your length of stay, for example, of a surgeon is 2.3 days for standard, total knee replacement. And, you know, people are doing it outpatient. Like where’s the disconnect.

So the rep, uh, the 20, the 75% of the reps that don’t get it are simply going to say, it’s not my. I’m just here to, to deliver implants and put stickers on a box. The twenty-five percent that get it, realize your length of stay of 2.3 is not good. And I’m going to help you get better. Yeah. Yeah. Right.

Absolutely. Absolutely. So, so can you repeat those, those three just to operational efficiency? So I think op so or efficiency and competency. Okay. That’s one where the surgeon will actually feel. And live the improvement. Right? Cause my life, my day becomes less stressful and it gets better as my staff get better.

So raise, raise everybody’s performance around me, right? Elevate the game of my team. And then number two quality metrics. How are you going to improve, improve and look good to the C-suite. So how are you going to look good to me? And how are you going to look good to the C-suite? So if you figure out how to reduce my length of stay from, let’s say 2.5 days to even 1.5 days, and you point that out to me and say, Hey, Dr.

Docile, look, I think we moved the needle together on this. What do you think I’m going to say, I’m going to go to the C-suite and be like, holy cow, you know, Stephanie or whoever just dropped our link. How many drop my length of stay by a day? It wasn’t the CNO. It wasn’t the, or director. It wasn’t my therapist.

It was her. Yeah. Hey, right. And, and what I would, what I would add to that for the reps is that, again, these things are pretty, pretty easy too, because I knew what reps are doing most times when they get to the hospital it’s oh, you know, the or prep time, I think they’re sitting around with the wrong. So screwing around, they’re looking, they’re looking online.

They could take time to start documenting these things and, and, you know, either building a deck or even a Excel spreadsheet, You know, to say, this is where it was before here, where it is now. Dr. So-and-so. Here it is. And the doctor’s going to go walk that into the C-suite and they’re gonna say, where the hell is this covered?

This is great. It’s like, oh, this rep that’s right. So, you know, that’s part of the reason for the site medical stuff, where you can go online. If you go to my flip guy.com, you can actually create a step-by-step surgical technique, a visual technique. Almost like you’re building an Ikea couch for surgery that you can use to teach, educate, and train your staff.

Right? So you can say, you know, hand the instrument to Dr. DASA this way, instead of that way, next time. So now they have a reference, they have a tool, they have a study guide, they’ve got something. So you’re turning into a coach. Right. And you’re helping everybody get better. You’re providing the X’s and O’s.

So that way they know when you call this play, this is how it should go. Yeah. And it makes complete sense. Right. And doctor does it. I want to be mindful of your time. So I want to jump into the last section, which is sort of quick, rapid fire questions. There’s three of them. The sooner you answer it, the sooner we’ll get to the next one and then stay on, make sure not to close your windows.

So we don’t lose this amazing episode by the way. So my first rapid fire question to you is that along the way in medicine, no doubt, especially as a surgeon, you have mentors, right? That got you to peak performance. What was the most painful thing a mentor ever told you that changed you for the better.

So I was an intern and the chairman of our orthopedic department, Dr. Larry bone, kind of this preeminent pioneer. Yeah, exactly. Uh, preeminent, uh, trauma surgeon, uh, called me into his office. I was an intern. I forgot to get an EKG on a trauma patient. Oh, uh, yeah. And you know, obviously it delayed the case by like literally 30 seconds or whatever.

But it was a county and I’m happy it happened so early because it taught me a very valuable lesson that details matter. And when people say don’t sweat the details that drives me nuts because you got to sweat the details because that’s what is defined mediocre from good to great. It’s sweating the details.

It’s whatever you think, all the little things, you know, how you wheel the patient into the operating room, how you move them, how you do this, how you, whatever, all those details matter. And that was a very important moment for me, uh, to learn how important details were, you know, it was a young, healthy patient, you know, there’s really no need to get an EKG.

It was important and it was a detail that mattered, uh, because if he didn’t do it, you would get burned at some point. So it’s, it’s, you’ve got to kind of pay attention to this. So that was one. What did he specifically tell you by the way? Uh, uh, this is a PG show right now. All right, listen to this. You go ahead and let her rip orthopedic surgeons and reps or listen to it.

They’re gonna love it. Go ahead. I’m paraphrasing. But he basically gave me one opportunity to find another specialty. If I didn’t think orthopedics was the right field for me. So, you know, so I learned very quickly, uh, how important details were, you know, the other one was, uh, Dr. King Krakauer. He was another, uh, world famous, uh, which speak total joint surgeon.

Again, pioneered a lot of what we do in total joint replacements. And, you know, he kind of instilled in me, you know, be good at a handful of things. Don’t try to be everything for everybody, you know, clinically pick some things and Excel. You know, and so I’ve, I’ve took that to heart and, you know, I’ve, I’ve kind of fashioned my clinical practice.

So I I’m, I think I’m really good at a very, uh, unique sliver of healthcare. And that’s where I’m planting my flag and that’s where I’ve planted my flag. And I think that’s really helped because now you really kind of can differentiate from everybody else because that’s all you eat sleeping. Right. Is that area of healthcare.

And so you’re able to kind of pull away from the pack a little bit. Um, and because that’s all you’re thinking about. So you can really focus in, in, in and innovate in that space, as opposed to having your brain, you know, in 50,000 places, rotator cuffs, Bunyan’s, you know, ankles and all that stuff. Um, you know, the, the other thing is this concept of persistence.

And actually I learned this in college fraternity thing is persistence. Um, it’s not so much how smart you are. It’s not so much. You know who, you know, it’s, it’s persistent. So if you just constantly stick at something drip, drip, drip, you don’t give up. I know it’s a kind of a cliche. Um, but you know, there’s a lot of people that will get to the, you know, the 20 yard line and say, you know what, it’s not worth it.

So who’s going to stick it out. All the way through to getting across the, uh, into the end zone. Um, and so I think just being persistent, uh, is another valuable lesson that I learned from some of my mentors. Absolutely. Now I’m going to ask you just one more just to kind of wrap up, cause I want to be mindful of your time.

So I want you to imagine that for the next year, Okay. We, you know, I come to you and I say, Hey, I took out a billboard. It’s going to be in front of every single hospital, every single private practice, every surgeon, every medical rep, everyone who healthcare is going to see this billboard for a full year every day.

What message do you put on that billboard?

I think what I would put on that billboard. Yeah. I mean, I think, I think what I said that the idea of persistence. I think, you know, no matter who you are, you know, whether you’re talking about health inequities and racism and health disparities, whether it’s a startup and you’re trying to figure out, you know, do I give up, do I keep going, do I, do I turn the lights off or do I keep going?

If it’s a difficult patient that you’re dealing with, if it’s, you know, issues at home, you know, whatever it is, I think that’s a singular message that resonates, uh, you know, and transcends almost anything anybody does. Fantastic. Couldn’t think of a better way to wrap up. Doc does say, Hey, thank you so much for joining us.

I’m going to leave in the show notes, your handles. We know where to find you on LinkedIn and Twitter. And obviously for everyone who’s watching, if you don’t have a doc.social, uh, account you’re missing out. So make sure you get on there, enjoy the content and engage. Uh, this is another great episode of journey, private practice.

I’m your host, Omar M conceive Dr. Josh to stay on for a second and we’ll see you all next time.