Part 3 PE With Eric

[00:00:00] Dr. Bravo: You, created and grew a business that was in the care coordination area. Correct. And you must have used a lot of technology as well as humans to do that well. 

[00:00:12] Dr. Erick Bricker: Correct. And 

[00:00:15] Dr. Bravo: how did you keep the mission when people were investing in your company, not losing sight of your mission?

Because your mission was to help people. Was to decrease cost by taking the rub out of the insurance interaction. Yep.

[00:00:33] Dr. Erick Bricker: Yeah. So the way that you do that is you listen, this is, this is not rocket science. It's to play the long game. At the end of the day, whatever you think Jeff Bezos, he's like, look, we're long-term greedy. You don't go for the money in the short term.

You go for the money in the long game. And if you play the long game, then it causes you, it forces you to make different decisions. So we played the long game at Compass at the company that we started, and what that meant was we didn't make as much money in the short term, but in the long term financially, we made out fantastic.

In almost every aspect of life whether it be from your diet to exercise or whatever, short-termism generally is a bad idea. And long-term is generally a good idea. And so if you look at your decisions through that lens, it tends to work out much better.

[00:01:30] Dr. Rogu: That sounds like the stock market, right? The long, long game is always good. 

[00:01:35] Dr. Erick Bricker: The long game is so good in so, so many ways. And that's true for our patients too, right? Like, and like in the short term, you probably ask pediatricians, you might have teenagers that smoke, but in the short term as a physician, if I have a patient that smokes that might like hurt my, my scores, right?

That might make me look worse as a physician in terms of like my number of hospitalizations because my smoking patient is in the hospital more. Do I fire my patient because he's smoking? No. Because you play the long game and over time you say, you know what? I'm gonna keep working on him or her and maybe I can get him to stop smoking.

[00:02:11] Dr. Rogu: But unfortunately, the insurance carriers, don't see the long game. They don't care about pediatrics. 

[00:02:16] Dr. Erick Bricker: Absolutely. Right? Right. And, and so, so much of being a doctor means going against the grain and doing what's unpopular and doing what you're, what, what society and other people tell you what not to do.

But if you're gonna be an effective physician, by definition, you have to be a contrarian. 

[00:02:32] Dr. Bravo: I'm very interested in this idea of how do we bring capital innovation into healthcare when it's not Medicare or Advantage patients? Cuz that's another game. Correct. And, one of the things, this is an aggregate of opinions that throughout the podcast, so Dr. Munish and a couple other you know forward thinking physician technologists, have come to the idea that the E M R is not going to change because people have spent so much money building these EMRs, but that it cannot continue to be the way it is because it is just worthless from outcomes, worthless from physician satisfaction scores, worthless from the point of view of how nurses interact with it.

So the end user is extremely unhappy. So they talk about putting overlays that will communicate the data with the database so that it's so that it is user friendly and improves the care that you provide your patient at the point of service when they're in the room with you.

So we're no longer slaves to click the clacking or templates that say nothing, but what we're being presented with. The information necessary to make the best choice for that patient and to push the care coordination. 

[00:03:53] Dr. Rogu: Those calls, those are called gaps in care. Right. And it's money attached to gaps in care for value-based contracts, which is the new darling of the year. Quality incentive programs and things like that. The problem is, especially with the managed care Medicaid lines of businesses, they have no idea. They keep thinking that the HEDA scores and all the all value-based contracts are usually adult medicine centric, right? They can be adapted and forced into pediatrics.

 Dr. Espinoza, the vice president of our c I n says, we keep trying to fit a square peg into a round hold in pediatrics. That's right. We need to just make a new peg for pediatrics y yes. But if that information's not being presented to the decision maker, where the care gaps are correct at the time that the patient is there, you can set up a follow-up program that, may include ai, may include texting videos, may include a care coordinator.

You know, there are multiple layers depending on what you're trying to achieve, right? That isn't gonna happen because you're gonna look at a dashboard three months later and be chasing your behind to try to catch up with those patients that are not doing what they need to do to get better. Well, you don't wanna wait three months.

You wanna do it almost in real-time. Can be done through dashboards. I mean, we've done it already with the Ink dashboard. Yes. But, that, is that part of your office practicum emr, when the patient's in front of you is the care gaps in front. No, it's a third party that's on top of that.

Then, the overlay, like as you say. Okay. So that's what I'm saying. Then, the future is gonna be where when you're doing your documentation, in, with the patient, you notice that there's a care gap and that there's an opportunity to either connect that person to AI engagements through video education or a care coordinator that is going to push for a better outcome without Correct.

Having to spend more money on fancy medications. Yeah. Or hospital care. Right. We don't have that. How would we ask a VC who is socially aware, and socially invested to fund such a program? 

[00:06:08] Dr. Erick Bricker: Yeah. It and it would, it would have to come through, so it's a great question. It would have to come through where the money is, which is in where who's bearing the risk.

And so who's bearing the risk financially is the state Medicaid program. So you vc, the VC would have to approach the state of Medicaid 

[00:06:25] Dr. Bravo: program. Okay. Because one of the things I, I thought about this cuz again, the long game wins. Yep. So to me, it would make sense to have, a socially interested VC fund, which there are some out there who says we'll pay ha, you know, sort of what they did with the vaccine.

Right? Building this overlay will cost 25 million. We'll foot the first $10 million and sign a contract for this product for 10 years and then we'll take warrants on your company. If you sell, you're profitable. We will get to buy X amount of your company for a dollar at the time you sell.

Now we're, we're both in agreement. We wanna be together for 10 years. , it may not work, but we want to be together and we might be able to have the time to show that this works. Cuz if you're just gonna dump 25 million, on a business that I have an idea and then two years later you're gonna sell me for 12 million because I'm not doing what you want me to do, then what have we achieved?

Interesting. Your thoughts, Eric? 

[00:07:34] Dr. Erick Bricker: Well I think to a certain extent the venture capital and private equity efforts in healthcare they sort of like have to follow that model because you can't do. Healthcare investing without some sort of, larger social good in mind 

[00:08:02] Dr. Rogu: caring

Yeah. Because it's very simple.

[00:08:05] Dr. Erick Bricker: It's very easy to make a lot of money exploiting sick people, exploiting sick people for money has been around for thousands of years with snake oil. Right? I mean, this is not a new concept, right? So by definition, like you can't, you can't go in the snake oil direction. You can't maximize your income at the expense of exploiting sick people.

And so, my answer to that is, is that every single doctor that is involved in a scheme that financially exploits the sick should refuse to do it. 

[00:08:44] Dr. Rogu: Yeah. Yeah. But, we have plenty of those. What, was the mental health app that was written? Cerebral. Cerebral, yeah. It was a pill mill and steroids.

The hymn is a joke. You know, it's niches erect dysfunction. And they'll sell for $900. All the Cialis you want for a month. If you go on, GoodRx and use it, figure out how much it costs to buy Cialis for a month. It was 20 bucks. Great deal. But they're exploiting, they're exploiting the patient.

Well, how are they exploiting the patient? They're charging them $900 for something that costs 20 bucks. Hmm. Well, I, I think what they do is the patient has to go, how is the patient going to go to GoodRx? , they gotta go to you first to get a prescription for Oh, ahead, sir. Are they gonna pay me a hundred bucks?

They don't wanna talk to you about it. They may feel uneasy. They made this, they made that. So they go to a computer that's not human. They get the prescription, they get the drug, and they're done. So that's one thing. That's how they exploit it. Yeah. I don't know. That's $100 I guess. I don't know. I don't think that's right.

[00:09:53] Dr. Erick Bricker: I think, you know what, when I listen, I am not, I'm not against like physicians providing. Here's how you don't exploit people you do things like you, and you tell them the price upfront. , right? To the extent that it's knowable. You give them the price upfront.

Like, I think, I think that's a pretty basic this whole idea with like price transparency, I'm in favor of physician unionization. Like, I think physicians should unionize because at the end of the day, look. If you're a physician that works at a hospital system that has refused to be compliant with the law and share prices, like as a physician, you should like that.

And like as an individual physician, they'll be like, so you don't like us? Not, you know, not sharing the pricing information as we should. I don't care. 

[00:10:42] Dr. Rogu: Leave. Yeah, 

[00:10:44] Dr. Erick Bricker: go work somewhere else. So, you can leave or you can unionize, right? 

You essentially have the exploitation of labor by management, right? This is essentially what has happened in healthcare. that's why there was a huge movement towards unionization during the industrial revolution, cuz it was an exploitation of labor. The exploitation of. For physicians and nurses and other healthcare professionals is obvious.

 So unionization is not the only way but is a way to say, look, if you are going to do something bad for our patients, which is to completely hide the price of what it's gonna cost them from something in advance when the federal law requires you to do so, then that's harming my patients and I'm gonna protest that.

[00:11:24] Dr. Rogu: Agree. Yeah. Or, when you're when you say, we don't care if you leave Dr. Bravo, we have two nurse practitioners to replace you, and they cost us half of what you cost. 

[00:11:34] Dr. Erick Bricker: That's right. And Dr. Bravo has a non-compete, so you can't practice within 45 miles here. Yeah. Leave, 

[00:11:40] Dr. Rogu: go. Yeah. Go wherever you want.

You're not gonna get even you know a cost of living increase. Do you want to complain? Leave. , you're a troublesome physician. We don't wanna deal with us. Leave, leave, go away. Disruptive physician, you're a disruptive physician. You speak out at the meetings against the health system, leave, go or we're gonna fire you.

[00:12:02] Dr. Erick Bricker: Yep. I do not mean to be doom and gloom. I'm an eternal optimist, and I also believe that sometimes things have to get worse before they get better. I'm sure. Dr. Rogu and you, Dr. Bravo, you've had instances in your life where you're like, why doesn't this just get better?

And things got worse. And then, it took it getting worse until a better solution eventually came around the corner. I honestly think that that is what's going to happen. Like, it's, it's gonna stink. Like honestly, things are going to get worse before they get better. But there is absolutely a light at the end of the tunnel here.

For things to change and for things to get better. And things might have to get worse for like 10 or 15 years. Whoa. 

[00:12:43] Dr. Rogu: It's a long time. 

[00:12:44] Dr. Erick Bricker: They, they, it is a long time. Listen, I've already resigned myself to the fact that it's gonna be beyond my career and maybe even beyond my life. I mean, the labor issues during the Industrial Revolution happened for 80 years.

I mean, from 1850 to 1930 it was going on. So, this is not gonna happen overnight. I mean, this is gonna take an incredibly prolonged effort over a prolonged period. And that's okay. Like, I'm fully prepared for that. And if I don't see healthcare quote unquote fixed during my lifetime, like, I'm okay with that.

But I'm gonna, I'm gonna keep pushing the ball down the field because eventually, it will get better. 

[00:13:23] Dr. Rogu: Okay. I think you're right. I think you're right. You're a genius. You know, when I asked you what do you think about private equity and physicians? You said something straight out, which I think was just, I, I think it was great.

And you said private equities buying highly profitable practices using an aggregated model to improve efficiency and management. This is done to the detriment of younger physicians who are not equity partners at the time of the sale. Correct. Does that sum, does summarize this conversation? 

[00:13:59] Dr. Erick Bricker: It, does.

And so really the message is, is that if you are a non-partner or junior physician in practice you might be aware of talks with private equity. You might not be aware of talks with private equity, but just know that if and when it happens, it most likely would be in your best interest to leave 

[00:14:20] Dr. Rogu: or to negotiate a contract where if the practice sells to private adequately before you are a partner, you get a piece.

Correct. 

[00:14:28] Dr. Erick Bricker: That's right. And, and they're high and they're most likely to gonna say no to that. And, your leverage as a listener, we all need to under, physicians to a certain extent hate taking risks. And so to a certain extent, we as physicians need to be more comfortable with taking risks and walking away.

 If you walk, every physician I've talked to that has walked away, not a single one of them has regretted it. , every single one of them has said it was the best decision I ever made. Yeah. 

[00:14:58] Dr. Rogu: We, we have people like that all the time on the podcast. I left the big health system.

I left the federally qualified clinic. I left the group that was led by this one person who didn't want to change. Yep. And they're making more money and they're happy and they're taking care of the patients like they wanna take care of the patients. That's right. They're doing well. So it is doable.

Doable. You know, in our coaching class today, we had one of our team members present our data and she is doing i, she's only been in business like 18 months and her net receivable ratio is at 97%. Her days in AR are 22. She is financially managing that practice for success.

As a solo practitioner for 18 months. Yep. And yeah, but she's in it for the long game. She knows it. She knows. But you know, she is putting effort into learning and educating herself, watching the financial metrics, and making sure her care patients are taken care of in a compassionate way. Yeah. And she's succeeding and she's thriving at it.

Mm-hmm. Yeah. And people, if you wanna be happy and you're tired of listening to an administrator who doesn't have the best interest of the patient or our profession, leave. Leave. There are plenty of people out there that are gonna help you succeed, but leave, don't buy this. Or you can only work for a big company.

You can do better on yours. Do it. Do it now. Yep. That's the, I mean, that's our long game. Yep. It's, we have to elevate those physicians and they're coming outta the woodwork. It's amazing how we're finding all these people that are leaving and opening up their little shops. Yeah, yeah. It's not gonna be easy.

Yeah. You're not gonna make a whole lot of money in the first month. It's gonna take a coup a year or two or whatever. But I always tell these young doctors, anything that you succeed in was created by your hand. If you fail, it was created by your hand. Also, you know, there's nobody else responsible.

The buck stops with you. Yes. In a hospital, you could fail because of somebody else Very easily. 

[00:17:20] Dr. Erick Bricker: Well, and then, the one final, final piece of unsolicited advice for your listeners is don't chase shiny toys. Yeah. Don't buy a fancy car. Do not buy a big house. Yes. Right. Doctors are notorious for spending.

Yeah, yeah, yeah. Poorly do not do, because then you have golden handcuffs. Yeah. So what gives you the freedom to leave is to not be attracted to shiny toys. 

[00:17:44] Dr. Rogu: Yeah. Yeah. And the banks love, love lending their houses and cars to doctors. Oh yeah. Cause they'll nev never default. And then, you know, they're putting in the news around your neck.

Yeah. You'll never default, but you'll never actually have any wealth. Yeah. Yeah. You're always gonna be a slave to paying the debt. They always want the young docs. They always want to get the big, big house right outta residency and so forth. I remember when I bought my house in 98, we bought our house. We weren't making a ton of money, and then my father gave the advice to us and he's, I thought it was a little morbid.

He said, listen, you buy a house that if one of you dropped dead, the other ones would continue to pay. It's like, whoa. But we're doctors. There are two doctors, double income, no kids, you know? Nope. Don't do that. We're still in that house. It was, it was a nice house. Yeah, it is a nice house, but yeah, you know, 

[00:18:35] Dr. Erick Bricker: it's good.

Yeah. Don't chase. Ever catch it? 

[00:18:40] Dr. Rogu: Yep. Well, Eric, thank you so much for your time. Do you have any parting thoughts before we let you? 

[00:18:45] Dr. Erick Bricker: No, you gentlemen have been fantastic. Thank you for your service to the pediatric community and to all physicians and patients, so thank you, gentlemen. 

[00:18:53] Dr. Rogu: Yeah. Well, thank you.

Thank you, Eric. It's always great to have you on the show, and we hope you come back soon and we'll talk about Medicaid financing in pediatrics or the lack thereof. We'll have an idea of a topic and he'll come, 

[00:19:06] Dr. Erick Bricker: All right, gentlemen. Take care. Thank you. Bye-bye. 

[00:19:08] Dr. Rogu: Take care. Bye-bye.