[S2E18] Dr. Lisa Larkin: Menopause Is Costing Your Company More Than You Know

Your most experienced employees may be quietly struggling with symptoms that are treatable. And your benefits plan probably isn't covering it.

Dr. Lisa Larkin, MD, FACP, MSCP, IF, a nationally recognized women's health internist, founder and CEO of Ms. Medicine, and Past President of The Menopause Society, joins Vincent Catalano to examine what untreated menopause actually costs employers — in productivity, retention, and workforce exit — and what a better benefits strategy looks like.

They cover why the traditional insurance-based model is structurally incapable of addressing midlife women's health; how direct care and concierge models are filling the gap; the limits of telemedicine and AI as substitutes for relationship-based care; and what forward-thinking employers are doing differently right now.

About Dr. Lisa Larkin: Dr. Lisa Larkin, MD, FACP, MSCP, IF, is a nationally recognized women's health internist with over 35 years of clinical experience. She is the founder and CEO of Ms. Medicine, a national network of 30 women's health specialists across 17 practices in 10 states, and founder and CEO of Concierge Medicine of Cincinnati. She is the founder and Executive Director of HERmedicine, an education nonprofit reaching clinicians in all 50 states and 37 countries, and a Past President of The Menopause Society. Dr. Larkin has been featured in CNN, the New York Times, O Magazine, NPR, and SiriusXM's Doctor Radio.

About Vincent Catalano: Vincent Catalano brings over 23 years of employee benefits experience as an independent consultant and host of The CLEARly Beneficial Podcast. His unique position outside corporate constraints allows him to have frank conversations about healthcare issues that others in the industry won't.

Disclaimer: The information provided in this podcast is for educational and informational purposes only and should not be construed as legal, financial, or professional advice. Listeners should consult with qualified professionals regarding their specific situations.

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Website: www.clearhcs.com 

This episode is a reprise of season 2 episode 9.

Transcript

SPEAKER_00 0:04

Welcome to the Clearly Beneficial Podcast, the show where we rip off the band-aid and explore the future of healthcare, benefits, and the people driving innovation in the industry.

SPEAKER_02 0:16

Well, hello everybody. This is Vincent Catalano. I'm going by Vincent starting in 2026. That's my uh my new thing. And I am so excited to have with me today a friend of 45 years. Yes, folks, 45 years, Dr. Lisa Larkin. Uh Lisa and I uh used to be uh lab partners at Skidmore College in both organic chemistry and biochemistry. And um today Lisa um lives in Cincinnati, Ohio, is a healthcare innovator, um, has her own uh concierge medical practice uh locally in Cincinnati, but also has launched uh a national brand um called Ms. Medicine. And we'll be talking about all that today. Hi, Lisa. Thanks uh for being here.

SPEAKER_01 1:03

Hi, Vincent. Thank you so much for having me. It's really an honor.

SPEAKER_02 1:06

I think you can still call me if any of you're allowed.

SPEAKER_01 1:08

Okay.

SPEAKER_02 1:11

Anyway, well, listen, I I want to start just by talking about you know your backstory. I mean, you went to med school. Oh, you went to Yale, I'm not mistaken.

SPEAKER_01 1:23

Yes.

SPEAKER_02 1:23

You went to Yale and got your medical degree, and then I think you went ended up in the Midwest, and then somehow you landed in Cincinnati. How how long have you been in Cincinnati?

SPEAKER_01 1:33

Uh moved to Cincinnati in 1991, right after residency.

SPEAKER_02 1:37

Wow.

SPEAKER_01 1:38

So it's been a home, but a big transition from being an East Coast born, raised, um Long Island girl. Long Island girl.

SPEAKER_02 1:50

That's amazing. And so Cincinnati, um, what was your did you have a subspecialty?

SPEAKER_01 1:57

So right, so my story is, you know, um, I describe myself as a square peg and a round hole always. Um so actually was going to do pulmonary critical care when I was in Chicago, and then for lots of personal reasons with my then husband, ended up moving to Cincinnati right after residency, joined the faculty at the University of Cincinnati, and very quickly, because I wasn't doing a fellowship, found my niche in midlife women's health, menopause, osteoporosis, and really kind of built that very early in my career as a young female academic internist in the general internal medicine department at UC, where I spent the first 12 years of my professional career. And then I've had a very, as I describe it, multi-faceted, kind of somewhat atypical professional journey from there, leading me into private practice. I left academics in 2002. Actually, I was doing women's health already at that point. But that was a very big year because that was the year 2002, about four months after I launched my practice, that the big women's health initiative data broke. Um, and again, that was a day I remember exactly where I was standing in my new little practice that I had launched. And that was really pivotal in terms of helping accelerate my kind of growth in my community in the menopause and midlife women's health space. Um, I spent 10 years building kind of a very traditional multi-specialty outpatient women's health center. I ended up employing four other internists, two gynecologists in that practice. I had subspecialists subleasing space from me. I recruited a breast surgeon and a plastic surgeon and a female dermatologist and urologist to the same building. And I built this really lovely multi-specialty women's center, kind of in insurance and traditional. And I had this crazy idea then that I wanted to do it bigger and better. And so developed a pitch deck around to all of the health systems. And this is now about 2010, 2011, and ultimately decided to go back into academics. I went into the OBGYN department this time at the University of Cincinnati, sold my practice, all of my partners went into academics with me. Um, during my time there, um I opened a big uh 26,000 square foot multi-specialty women center. That was the vision to open a new integrated multidisciplinary center within the academic health center system. And honestly, I thought I would retire there. It was so exciting to go back into academics. I missed the teaching and really was excited by the opportunity. But it was the beginning. And, you know, healthcare, as you know very well, Vincent, right? Like healthcare over the last two decades has been continued to have problems in all different kinds of arrears. And what really became very clear is that the health system had allocated dollars to actually open the women's center, but had no thought or planning about how they actually were going to run the center and give me any kind of financial autonomy to build programs or recruit doctors or have any, frankly, administrative time blocked or protected time for me to do all of the leadership work that I really needed. And it ended up being one of the most frustrating experiences to feel like I was just beating my head against the wall. I had this tremendous vision and um really didn't have the finances or wasn't given the leadership ability to actually execute on it. So after four years, I made a very difficult decision to leave academics for the second time. This was 2016. People thought I was crazy for resigning. I had had breast cancer already by then. I was in the middle of a divorce, and people thought you're crazy, you're a breast cancer survivor in the middle of a divorce and you're leaving this nice stable job. But I just knew that I couldn't continue to practice medicine in the way that I was being forced to practice it there. And I was really not able to fulfill this vision and decided for the last chapter of my career, I was going to try something else. So I resigned. And this is when I opened my practice again in Cincinnati in the concierge direct care model, because my experience at UC again continued to be as healthcare was, continues to unravel, right? And problems with fragmentation and midlife women's health care continues to get shafted, right? We're seeing a real interest in menopause now, but remember, this is now like 2015, 2016. And no one had interest in the menopause world at that particular point. Um, that really midlife women needed and deserved more time and really integrated high-quality care. And that the only model that I could figure out how to do that in was in this concierge direct care model. And I decided I was going to innovate and try to disrupt things from outside. Um, and so people thought I was absolutely crazy. So this was two 2016. I went back into debt, I opened my practice, I yeah, was really the first person to interesting.

SPEAKER_02 7:15

What's interesting is is that story to me, it all as you're talking and I'm listening to what you're saying, all it says to me is that you were 10 years ahead of your time, right?

SPEAKER_01 7:25

Well, in the entire space, I for sure was 10 years ahead of my time.

SPEAKER_02 7:29

Even as even as doctors today, um, I don't want to get off down this rabbit hole, but I mean, even doctors today, they struggle with burnout, they struggle with what do they want to be, they struggle with the pains they have with insurance companies, they struggle with any number of issues just to feel like they can do their jobs well. You 10 years ago said, okay, I'm gonna go do it on my terms over here and open up a concierge medical practice. That that to me is is is insightful and and again, you were ahead of your time.

SPEAKER_01 8:04

But but it was it was hard. And I and I when I say hard, it's because you know, I believe we need, we're a rich country, we should figure out how to deliver health care to all Americans in a way that it's equitable and quality. And the problem is I decided I got to this place of really not wanting to do concierge care and not really wanting to opt out of insurance, but really getting to the place of deciding I'm either going to quit medicine and not practice at all. And I believe I bring value to patient care and I have something to offer here, or I'm going to make peace with the fact that I'm going to try to take care of the patients that are sitting in front of me and do the best I can for them and switch to this model to allow me to continue to practice. And but it's hard, you know, psychologically, right? And we'll get into that, I think, a little bit, right? Like, you know, you're we're seeing more and more this division of very two-tier healthcare system, which is not really what I want for America and wish that we had other ways of doing it. But again, I really, I really came to the place of deciding that I had to do it differently and I had to innovate from outside. But it was a huge gamble and a big risk, frankly.

SPEAKER_02 9:21

And and but at the end of the day, here you are 10 years later. Um and we have we have stayed in touch, you know, off and on over the years. Um, yeah, the struggle is real. Um, you took it on headfirst and you built something, and then I don't want to get into this quite yet, but then and then Ms. Medicine comes along. But let's let's let's let's let's tap the brakes for a sec and let's talk a little bit about concierge medicine in general, because what you started to say about the US healthcare system is is something I want to get to maybe toward the end of our conversation today, because it's a valuable conversation. But let's talk about concierge medicine because when I when you say the words, when anybody says the words, oh, I'm gonna have a concierge doctor, or I'm gonna go to a concierge, all of a sudden people go, well, that's expensive. And and so tell me more about the nature of a concierge practice in general, what the value prop is, and you know why people should consider that as a means to access care.

SPEAKER_01 10:24

Right. Well, there's so much to unpack there, but let me start by saying that first of all, not having concierge, having concierge care does not always mean that it is more expensive care. But the term, and I don't like the term um because it suggests it's something really exclusive and that you're that you know, the the people when I did this said, oh, you know, you really only want to take care of rich people. And that absolutely is not what drives me at all, right? It's I don't care if you're rich or poor. I really believe everyone should have the same quality health care. But the problem is the way that it is financed in our country does not work. And if you think about it, menopause in particular and midlife women's health care, nobody wants it. It's like the hot potato. There's no money in it. Having complex discussions with women about pros and cons of hormone therapy or what their breast cancer risk is or how they should optimize their diet for bone health and muscle preservation, like trying to have these discussions to ensure a long health span for women is not the way we finance medicine, right? It's what you do to people, it's procedures, it's surgeries, right? And so the business model does not work.

SPEAKER_02 11:39

But even the outpatient type care. I mean, I look at what what my wife goes through. She has a primary care doc, she has an OBGYN, but neither one is probably talking to each other very much. Talking to each other or skilled in the areas that you're skilled in.

SPEAKER_01 11:54

Right. Well, and and so again, stepping back thinking, what is the best model of care for my patients? It is a model where I have enough time to do what I'm supposed to do as a well-trained internist, women's health internist who's delivering primary care, right? I need enough care, enough time to assess your problems and manage sick visits and kind of chronic diseases. But you also want me to know you well enough that I understand your family history, I understand your social history, and I'm able to do preventative wellness, right? So, I mean, again, the current model of care does not allow doctors, good doctors who want to provide good care. They're not supported in providing the care that patients need. And I use the analogy that, you know, the most important time for women and men, but really I do menopause, so I'm talking women here right now, to get quality care is between age 40 and 60. And when you think about it, that is the time when women get the least care. They are with childbearing. Now they don't need their pap smear every three years. Yes, maybe they're supposed to go in once a year for an exam. Maybe they do, maybe they don't. They're busy with their career, they're getting their mammogram, they don't really feel sick, they're not taking a lot of medicines. Maybe they have a primary care doctor that they see for a sinus infection, but nobody's pulling it all together. And certainly nobody is in family history and like screening for hereditary cancer mutations and like stuff that's so impactful to how long someone is going to live and what they're going to die of needs to happen and be assessed in that window and that period of time. And then we have all of the impact of kind of menopause and how to navigate that so you have a long health span. Like the models of care do not support doctors to provide that kind of care. And so this concierge model is a solution for that. Now, um, my husband's parents, for example, are in um Detroit and they actually still have very good medical care. They feel like they have good access to their primary care doctor. They feel like the system works pretty well for them. They had a recent, one of them had a recent hospitalization that wasn't so great. But in general, I would say if you're a patient and you do have a doctor you like and you feel like you have access and you're getting enough time, that may completely work. And I would tell you, that's the majority minority of people right now. I mean, if you talk to anyone, my daughter just moved to Austin. She cannot find a primary care doctor that takes her insurance. Like they're just the access to primary care is so poor that um, again, like you have to start to think like it is insurance the right way to get you the care that you kind of need? And that's where the concierge direct care model kind of comes in. And again, I my wish for our country is that we had a solution to democratize this and make good quality care equitable for everybody and accessible to everybody, but that is just not the way we have it right now. This is a model to try to do the best we can.

SPEAKER_02 15:00

It it is, and and it it's it is, you know, I was explaining, you know, I was talking to my wife yesterday and kind of giving her a high level on on we were watching some some shows on on it was like I think CBS Sunday morning talking about a family who was just getting denials. I mean, denials is like the big, the big thing these days, and and how everybody manages through denials. But you know, when when a lot of these big insurers, whether it's United or Ellans or or whoever, you know, Cygna or Etna are all publicly traded companies, there's a profit motive, right? For for them. And um that makes it that makes it tough to to get to an equitable perspective. Now, one could argue, and I can argue this all day long, that we have an equitable, at least uh an equitable insurance platform, and it's called Medicare, okay? But most people don't, I mean, people hospital systems and others couldn't afford to run on Medicare reimbursement, right? So that kind of creates this, again, to your point a few minutes ago, two tiers, right? You have people who could be on regular Medicare and could they act to could they be able to access physicians, or they're people who have some means and can hire someone like yourself, right?

SPEAKER_01 16:14

Yeah, I mean, I I would tell you, and I predict you know this though, too, that um Medicare is not really as as okay as it is right now. It's not a sustainable model going forward either, because we still haven't fundamentally fixed the problem, which is that the cost of care is accelerating at a pace that is not sustainable. And I mean, you can even just look at, and there's so many games now with the insurance companies. My my husband is the chief medical officer for our health system here. And I mean, the health systems across the country are half of them, 50% are really in the red right now, right? But one of the things that he's seeing in his health system, right, is the use of AI now for denials. Like they are getting denials back so quickly about from submissions now using AI that they're now having to, it's going to become like an AI arms war, which is the hospital system is now looking at getting AI to counteract the denials that are coming back immediately from the insurers. Yeah, no, no. And anyone that listens to this, I mean, you have to say like all of that money that's being spent is not benefiting the patient that is sitting in front of me, like, right. And, you know, this concept of moral injury. And if you've seen some of my social media stuff, I occasionally get so upset I do these crazy videos where I complain. But like the moral injury and the amount that we go through that I go through to try to get things covered and the games that are played at pharmacies when patients go to pick up their medication. Like, I mean, the amount of time I spend trying to do to navigate barriers to care is actually part of what I do as a concierge doctor, right? And like, I don't think my patients completely realize that part. It's not a good utilization of my time, right? Right, because we should all be working to the top of our skill set and our training. But the reality is there's nobody there to do it for patients. My older patients, I mean, it is just the barriers to care that we face in primary care to getting our patients the care that they deserve is just enormous now. And this, what you were talking about with um, you know, really burnout and you know, this moral injury concept, like it is really hard practicing medicine right now. And for me personally, I would tell you, I couldn't do it in a traditional insurance-based system anymore. Like even in this model that gives me the time to do it, I can just still see that the barriers are continuing to increase because the financial model does not work well. Um, and you know, I don't know where it's going to be in five years is.

SPEAKER_02 18:53

No, no, no, I absolutely. And you know, so you know, and you know, I I come at this from the employer, you know, employee benefit side of this and employers ensuring their employees, and and and and they're the ones, unfortunately, that that bear the cost brunt of, you know, if if a hospital runs with a payer mix of X X percent of Medicare, X percent of Medicaid, and then you know, maybe 30 or 40 percent commercial, it's the commercial, you know, contracts that are that are bearing the brunt. That's right, you know, and um and and no, and and people don't really understand that. And and you know, there's I I was wondering a couple of years ago, you know, when I was you know still an active broker, looking at the market as as in the insurance rates, a monthly premium for a single employee at a typical company was barreling toward a thousand bucks a month. I remember when it was 150 bucks a month, right? And now you're at a thousand bucks a month. And I'm like, where does where do people start losing their stuff over this? And and I think we're we're only at the tip of the iceberg of companies wanting to create alternative solutions for their employees by Offme. And is there's companies out there offering direct primary care now for employees? There's innovative ways for people to access care that isn't gonna break the bank of the employer, you know, and so that there's a lot more innovation. But let's let's go back to talk about just in general how pay how you work with patients, you know. Help them, you don't have to answer this question, I guess. But I mean, you you've got X thousand patients, whatever you've got, and they have access to you, they get to call you, they get to come see you when they want to see you. We how does that no?

SPEAKER_01 20:40

So thousands, that's what I had when I was in traditional insurance, right? So now I have 350 patients. Wow, that is um, I mean, and they're complicated, like I have many, I think 14 I counted patients that still remember there were were my patients when my daughter was born. Remember me pregnant with a daughter's 32. So we've all aged together, right? Um, but I will tell you, even in this model, having 350 patients with everything else that I'm doing is a lot to take care of. And the typical now in the concierge world, full-time um providers often have 400 to 500 patients in their full-time panel. So I'm deliberately a little bit lower than that. But the reality is that's right, which is we prioritize. I mean, I I time in the office, I have long patient appointments, I do telemedicine weekends and after hours and other days. I'm available by text, cell phone, email through the poor patient portal. Um, now again, I do take vacation and I do travel, and they're sometimes I'm sick, right? So I do have a coverage system with my other partners in the in the in my practice. But in general, you know, if you're my patient, you have access to me 95% of the time, right? And I would be the one that's seeing your visit, doing the doing your visits and doing your Sick stuff. Now, again, that's it's not a hundred percent of the time, but the vast majority of the time is that you really identify me as your physician and my practice as your medical home. And that's what we want, which is like, you know, different than some of the telemedicine platforms who may be doing primary care, right? And not that that's a bad thing necessarily, but um, you know, again, what you get in my practices as your physician and my other partner physicians, like we're the place where you come for questions about preventative care, if you have a new cancer diagnosis, we're the ones you call if you need a referral for your family member, if you're having trouble because the pharmacy is not uh filling your prescriptions, which just recently happened, and they, you know, they're they're absolutely unwilling to just uh let the patient pay cash unless the patient is smart enough to actually ask and they put up barriers like it's two days early.

SPEAKER_02 22:53

That is that is mind blowing.

SPEAKER_01 22:54

But it is it is just the craziest kind of way that this all works. The patients have to understand the nuances of our broken system. But I mean, I'm your medical home, our practice, my staff. We give you IV fluids if you're vomiting, we see you when you're sick, we are a full service primary care office that um wants to be your medical home across your lifespan. And not that we do everything, right? Like clearly, I refer. But the thing that I have time for is referring you to the right specialist in my community. I'm hospital system agnostic because I'm not employed by any health system. I know all the specialists in town, really. I've been practicing here a long time. I can refer you to the specialist that you need, either in the city or outside the city. I have time and the infrastructure to do a lot with second opinions and referrals. I use a lot of the big academic centers across the country to get people second opinion, Mayo, Cleveland Clinic, MD Anderson, Sloan Kettering, right? I've got connections with all these places. And um, you know, again, that's what you want for me.

SPEAKER_02 23:56

That's really what you're paying me for, which is you're the ultimate, really the ultimate time and access.

SPEAKER_01 24:02

Right. Which is what we're supposed to be as primary care doctors, right? Like we're supposed to be your medical home and really a place where you trust us to help you navigate the health system and find the right people and specialists when you need specialists and when you need primary care, that we are good at doing the primary care.

SPEAKER_02 24:21

You know, it's so fascinating to me. And as I as I've been doing these episodes and doing what and be really almost being as an insurance broker in many ways, I was actually a health educator, you know, because I'm standing in front of a group of employees at a at an open enrollment meeting, you know, explaining to them what a deductible is and how to use their plan effectively and all these types of things. And and that's where this whole podcast is sort of, you know, part of the mission that that we're going here is to train people on how to ask the right questions, care navigation, you know, how to be their own best advocate, how to engage with their physician more effectively. And that that's sort of the stuff, you know, we'll see.

SPEAKER_01 24:59

And I think I think to your point back to the pricing just briefly, which is right, like that's part of the education about direct care and concierge care, because what patients I think all know if they've utilized their insurance is that a lot of times they get a bill, even though they have insurance and they don't understand exactly why they got the bill. Like it can be you have surgery at hospital X, which is covered, but the anesthesiologist isn't on your plan and you get a big out of network bill, like crazy stuff that you don't control, right? Or why, you know, why is prescription drug X covered and why is not covered, and you pay this big out-of-pocket, right? So one of the things about the model that I've developed in practice and that I believe in so strongly is that it is price transparent. Like you know what you pay me per year that includes all of your visits in the in the office. It is all inclusive, it is everything. Now you need you don't mind me asking what's that number? Yep. So it depends. Now you can't ask for me because I raise my prices so that I don't so that I'm not taking new patients, so all my partners get patients. But in our practice, the typical in and in in in the Ms. Medicine Network, the price is between $27.50 a year and $37.50 a year.

SPEAKER_02 26:09

That seems that's that's $300 a month.

SPEAKER_01 26:11

That that that's that's I can tell you that across the United States, there are definitely much higher concierge medicine companies and services that have practices that are on the $10,000, $20,000, I've seen $50,000 a year, right? Um, that is not my model.

SPEAKER_02 26:30

Um, but again, well, you just said is mind-blowing, in fact, how how reasonable that number is to me, because like my father-in-law is up in Bend, Oregon, and and he was in just he's had a lot of health issues. And like, oh, I know you're your friends with a concierge doc up there. Why don't you get engaged there? And it was like $5,000 to get started and a thousand bucks a month. And I'm like, okay, that's rich.

SPEAKER_01 26:50

So there, there, there, there are those. And again, like I go back to um the model of primary care, doing it in direct care, and even in my concierge care, right? And there's there's this spectrum of pricing right now that's kind of crazy. But primary care, when done well, does not have to be expensive. And we should, I still really believe we should not be using commercial insurance and Medicare, I don't think, to cover primary care. It's like using your homeowner's insurance to cover your broken dishwasher, right? Which is like it just doesn't make any sense. And the amount that, like, as a primary care doctor, you bill Medicare, you bill commercial insurance, you're spending 30% of that money that you get back just to collect the money in the billing.

SPEAKER_02 27:34

Absolutely.

SPEAKER_01 27:35

The patients get secondary bills. What's happening in the health systems now is this game of creating hospital-based clinics and converting things to hospital-based clinics. And so what happens is you pay a provider fee and then you pay a facility fee, which isn't covered by your plan. So now I have patients who don't even understand why they used to be seeing Jane Smith, the endocrinologist, and their insurance was covering it. And now all of a sudden they see Jane Smith, the endocrinologist, one time and they're getting a $250 facility fee that they didn't expect. And so this idea that we in our model is more expensive than you know, traditional insurance based care, it's not necessarily true. And in fact, the out-of-pocket, ununexpected charges that you can get, even just having outpatient primary care is often cheaper than what we are charging. And again, I just think it is a it's a completely price transparent model. There's there's no games in our price.

SPEAKER_02 28:35

I love it. I mean, the the the notion of transparency, I mean, there's a lot going on. I mean, Mark Cuban's on on a on a tear about drug transparency and and all. I mean, I I use Mark for my drugs, you know. I mean, so I mean, and and the irony is, you know, I mean, God, in three, four months I'll be on Medicare. I I mean, it's just a whole other that's a whole other conversation. But so let's tap the brakes on this because I mean you and I can talk about this for like a year.

SPEAKER_01 29:02

Um, you're gonna have to cut this episode.

SPEAKER_02 29:04

I know, I know, I know. Let's talk Ms. Medicine. So somewhere along the way in 2018, you said-ish. 2019, yep. 2019. I mean, you you created Ms. Medicine. Talk about that.

SPEAKER_01 29:18

Yeah. So remember, um, I had big visions of this comprehensive integrated women's health center in Cincinnati that I was not able to execute. And so left and started my practice, and very quickly it was successful, right? I was able to grow. Like the model of care actually worked. The price transparency, the access. My partners came back out with me. We have a lovely thing going. And, you know, I kind of am like, this model works. Like I want to empower other doctors to provide this kind of care because the only way we are going to do better with menopause care is if we can develop care models that actually support doctors to provide the care. Because, again, like I said, I mean, the health systems don't really want menopause doctors in their care, right? We don't generate a lot of downstream revenue for them. I mean, we generate some breast cancer and some ovarian cancer, like there's some referrals, but we're not a big procedure specialty that makes tons of money for the health system. So, like nobody, again, menopause then and and less so now, but even now still, menopause is kind of the hot potato. And so, two things trying to get to the place of delivering better menopause care, but also wanting to empower doctors to make the change that I did to create a care model in their own practice where they could provide the care to women that they were trained to provide and that they want to provide. And so decided to take this leap into starting a women's health startup company. Well, um, Vincent, you'll remember me from college, which um, you know, I always worked hard at things. Never the smartest worker I was never the smartest person in the room, but I always had a strong work ethic. And somehow I decided that I could be a doctor and enter the startup space, and I just had to work hard at it. Well, I can just tell you, or anyone that's listening, that the day that I write a book, it's gonna be um about all of the mistakes I made as a dumb doctor entering the startup space without really knowing what I was doing. And um, you know, just with an idea and I'm just gonna build this network.

SPEAKER_02 31:29

I mean the world really needs that book right now because there are so many docs thinking that they have a great idea and they're tossing their hat into the the to the startup ring left and right. It's it's mind blowing.

SPEAKER_01 31:41

Well, and kudos to all of them. But I can tell you I had some very, let's just say I had a really steep learning curve and um in all kinds of arenas. Um, and you know, I describe this journey in the startup space as a very expensive MBA that I have gotten, but I don't actually have the certificate from the school that I graduated from. But it cost me a lot of money to have all these bumps and bruises from learning in the startup space. But my the truth is um that um I describe the company now as the little engine that could. And I am very proud of my company, which is slowly growing and expanding and doing well to continue to operate in the space of helping doctors open their own concierge, women's health focused, because I really we have male doctors in our network, but really the core model is that everyone is going to be menopause certified and that we are going to make sure that we are providing high-quality midlife menopause care to women and midlife women's health care that includes all the high-risk breast and all the stuff that I educate about, um, and build this network because despite all the growth in the last years in the concierge medicine space, as of today, Ms. Medicine is still the only company that's really a concierge company focused on women's health and this intersection between gynecology and primary care and really blending and building this network of doctors kind of committed to doing that. Um, I mean, the story I tell all the time. And if anyone from MDVIP ever listens to this thing, they they maybe they were at the meeting when I was leaving academics in 2016. MDVIP recruited me. Um, and I will tell you, I pitched the idea to the chief medical officer then about them trying to do a women's focused concierge service line, and they laughed me out of the room. They just absolutely did not think that that was really a viable thing or a needed thing. And it goes back to again, just kind of the reason that I do what I do is because women's health has been absolutely fundamentally neglected, and women's health care has been neglected. And Ms.

SPEAKER_02 33:55

Medicine and my practice is such a topic today, and and you you have you have I remember seeing you on the Today show two years ago with Maria Shriver.

SPEAKER_01 34:06

Yep, I think three now, right? Before it really hit this inflection peak. Yeah.

SPEAKER_02 34:11

Yeah.

SPEAKER_01 34:12

Yeah. I mean, it it it's again, I I hope um, and largely thanks to a lot of amazing um physician leaders who are very have very large platforms on social media. I mean, and for a lot of celebrities who I think have hit menopause and the time is right, like we finally it's getting a lot of attention. But again, fundamentally, the way that healthcare is financed still does not, and the fragmentation of care still does not provide a national way to provide high-quality care to midlife women. Like we are still navigating that, even with the interest right now, right? Some of the large um telemedicine platforms have tried to fill some of those gaps. And we're doing much more now in the education of clinicians, but still the magnitude of need for improved women's health care and for fundamentally overhauling how the system is delivering care to women across the lifespan, we haven't found a solution for that yet. And again, what I'm kind of doing in the concierge medicine space is a solution for a subgroup of patients across the country, but not a not a national plan yet that we need.

SPEAKER_02 35:24

Hey, the the there's a medical, I mean, as as you're talking, I mean, the the the fireworks are going off in my brain and and and some of those things we're not going to talk about here. We'll we'll take that offline. But um, but if you're you're approaching, and and how many, how many locales in the US do you have for 30 doctors in 17 practices in 10 states as of today? Okay. Okay. And does a doctor have to go all in and call themselves a Ms. Medicine practice, or is that a a part of their practice while they can still do an insurance-based practice as well?

SPEAKER_01 36:01

Well, so they can't do an insurance-based practice because that is a very complicated line to walk legally. You're either in or you're out. But we are not a franchise, very clearly. The practices have their own identity and their own name. We call them a Ms. Medicine affiliate, and they are affiliated with us. We provide the backroom services for them and, you know, support their staff training and their patient transition as they're transitioning and provide longitudinal support over the time that they have the agreement with us. But they're really independent practices and in the sense of they're owned by the individual physician. But they also, and this really was important for me as I was building this model, is that I want providers, all of them, to be empowered to have the practice that meets their interest and expertise, their vision. It's their practice, it's their baby. At the end of the day, it's their asset when they're done with our licensing agreement if they leave the network. Um, and so they're not cookie cutters. Like we are very clearly developing bespoke models for our for our physicians that join, um, which, from a scalability standpoint, right, like that's not what investors love because it's not completely cookie cutter. But I go back to practicing medicine is not cookie cutter. Like that's where we've gone wrong. It's really we need to provide individualized care. And I think we need to empower physicians to provide care the where that the way that they're trained and in their areas of expertise. With that said, everyone in my network is certified by the Menipaw Society because I do think that is such a huge gap. And that's our defining line of our Ms. Medicine Network is that we do high-quality midlife women's health care.

SPEAKER_02 37:50

And and that to me is what a great mission statement for the for the overall you know organization. And so, I mean, there's so many directions this can go. Um, and um I I just feel like you are kind of at the precipice of a generation of of women, um, Gen X, um, you know, kind of, I mean, you know, late baby boomers, you know, and and millennials who take their health far more seriously than later stage boomers did or or care to. Sure. These people want preventative maintenance. They want to, they want to they want to make the right lifestyle choices, and and we can a whole other do a whole other episode on GLPs if you know at some point. But I mean, everybody is taking more care, even even me and my wife, we're taking way better care of ourselves now than we ever did because it's just the right thing to do. I mean correct.

SPEAKER_01 38:50

And and the women, so you know, when I um the WHI data broke in 2002, right? And now literally I have those same women who are coming back saying, shoot, you know, like you told me we could talk about hormones, but I was afraid of hormones and the messaging was wrong, and I never took hormones, and now I'm mad, and now I want to take hormones because I realized that was a mistake, right? Like, I mean, just the the harm that we have done by not prioritizing women's health and not getting the right education of doctors and the right messaging out to women has been profound. And to your point, I think it really is the newer generations coming up who are saying, we're not gonna accept this anymore. Like it's really, it's really time. We have got to, we are going to prioritize our health and we need to figure out care models that support that. The problem, just as I see it though, is that we don't have leadership in terms of figuring out a national system to do this better for everybody. And I really do see that there are real barriers, specifically to, you know, um underserved communities and disadvantaged individuals, socioeconomic barriers, uh, access barriers across the country where the care models are not serving our entire country. And that's really wrong. And I just don't know how to fix it. And I don't see leadership fixing it for us or coming up with ideas.

SPEAKER_02 40:14

Well, it's that's a really and as you're talking, I mean, you know, one of what I have a I have a strong relationship here locally with an FQHC, you know, and and that is certainly one means of of doing that. I mean, there's you know, as you're talking, I'm I'm just trying, I'm trying to connecting a lot of dots in my own brain about the people I know and the people to connect you with, to talk to about these things, because at the end of the day, you're you're absolutely right. And it it takes it does take a little bit of of star power as well to to do this. I mean, you get you get the Gwyneth Powell shows of the world and and others talking about this, it it becomes a thing all of a sudden. And so this is this is kind of the the I think where Ms. Medicine has a has a a long, a long potential reach in in in many ways. And um, and it's to your exact point, you know, AI doesn't replace the one-on-one meeting that you have with a patient with your stethoscope in your hand. You know, it telemedicine never solved that problem. Okay, I I think the telemedicine was a bit of an overreach, in my humble opinion. Um, it's it's good for certain things. Okay, I've got gout in my toe. Here's my toe. Do I have gout? Yes, here, take some take some drugs. But for the other things where you actually need to touch and feel and and and understand a patient, that's that's gotta be done.

SPEAKER_01 41:37

And so I I would love to follow up just quickly on one point about that. It's been in the menopause space, there's been a lot of discussion about the fact that menopause and telemedicine fit perfectly together. Okay. Because for um menopause, for the vast majority of patients, if you get a good history, an accurate history from them, you know, maybe, maybe you don't really need a in-person physical exam at least to start. But I have very strong opinions about this, which is that again, I think it is a stopgap measure potentially for and maybe improves access to underserved communities. But the problem is I still don't think it's the same as comprehensive, longitudinal, evidence-based care across the lifespan. Because the problem is, and I've secret shopped a bunch of these telemedicine companies, they miss stuff, right? And there's you don't get this A, you don't always have a video visit. It can just be a chat bot and an email questionnaire and stuff to get your prescription. But the other thing is you don't have the same person following you up. And where does it happen if some of your symptoms are missed? You start bleeding, you still don't have access to care in your regular system. They miss the fact that you've got a terrible family history of cancer. So you miss the genetic screening. No one has taken your blood pressure to see that your you said that your blood pressure was normal on the chat, but you actually haven't had your blood pressure taken and you're actually very hypertensive, and we're missing kind of managing your hypertension. And the telemedicine isn't comprehensive primary care. So it's um it fills a specific need, but I don't think it is the best long-term solution for quality evidence-based care across the lifespan that people should have. And we don't have good telemedicine, is not that care model.

SPEAKER_02 43:26

Right, right. Well, now, of course, you know, you have Chat GPT Health, you know, uh being launched last week. And now people, I mean, that's like the that's like you know, WebMD on steroids. And and and people are going to try to self-diagnose in any number of ways when in essence your care model is like over here in terms of the evidence-based conversation, and that is all the way over here where someone says, Well, I don't feel good, and I've got these symptoms, and and it's not.

SPEAKER_01 43:56

Well, I will tell you that's that's a whole animal that we'll see how that all applied. Because I can tell you our I already it's escalated very quickly in the last six months of patients who are putting their own symptoms and stuff in Chat GPT and are calling me. And I could tell you one very, I mean, great example of how it's not a perfect solution and it's generating a lot of patient anxiety and a lot of phone calls that, again, really aren't helping us provide good care to patients. So I don't, I don't know. I mean, I think there's advantages to it, right? I mean, knowledge empowers patients to ask the right questions. And certainly knowledge can be a great thing. And that's where AI and Chat GPT comes in, but it also can go the other direction where we terrify patients with. I mean, I just had one this morning, right? Like it sent a rash and in her armpit and she put the picture in Chat GPT and it told her she might have metastatic breast cancer. And so she's sending me the picture to say, does this look like metastatic breast cancer? Right. Like, you know, again.

SPEAKER_02 45:00

Here's some hydrocortisone. You know, I mean, I uh I know I I get it. So, well, listen, I mean, we can go on forever, but I I I just to just to just to save everybody the you know another hour of this, I'm I'm gonna we're gonna we're gonna we're gonna cut this short.

SPEAKER_01 45:13

But we are, but I I wouldn't say short though, right?

SPEAKER_02 45:16

No, no, no, no, no. We're we're at 45 minutes at least, you know. But um, but what I I um I I I wanna ask you, this is an unrelated question to medicine because um, you know, I always ask my guests this, and I don't know this about you. Um, are you do you in art enjoy wine?

SPEAKER_01 45:34

We do, actually. And and so if you know, we're not so can I tell you, we're not supposed to be drinking anymore, right? And me, breast cancer survivor. I know the breast cancer survivor, right? I preach all the time out there that um you know alcohol is not good for breast cancer recurrence and we shouldn't be drinking alcohol for breast cancer prevention. And yes, I still like wine. So I yes, and we have a um lovely Pinot Noir that we like very much. Um uh I get migraines, and so I love red wine, but cabs are too heavy for me, and I struggle with migraines with that. So um we actually have a light Pinot Noir, and I like white Bordeaux often. Um, so but good, good.

SPEAKER_02 46:19

That's that's that's always good, always good to know. I mean, we my wife and I mean, you know, we went out to dinner the other night on Saturday night, just a date night out because she was heading back east for you know the week. And I was like, and and we hadn't drank even through the holidays, our we were at a very low roar. And um, I hadn't had a drink in a couple weeks. And um, man, I mean, not that I overdrank or did anything, put glasses of wine, but you know, you go out to eat, you're you're drinking, the salt content of what you're eating out is bad. All the other things that you're eating out are probably bad for you. You know, your sleep cycle immediately gets messed up because you just even though it's like, oh, we're just not having fun, you're messing up your body because it it had the it's now re-established itself at this baseline of health, and then you throw a wallop at it and it doesn't know what to do with it, you know.

SPEAKER_01 47:08

Yep, I I agree a hundred percent. And honestly, though, you look great, you look fit, you look like you're doing all the right things for healthy lifestyle, so good for you. Okay, occasional wine is good.

SPEAKER_02 47:19

No, trying to. I mean, you know, I lost 25 pounds this year. Um, just I mean, you love this story. I I walked into my wife's into the bedroom about a year ago naked, and I was just like, I was overweight, I was it was just too heavy. And I just said to her, Can you fix me? And she just took me on a dietary journey of cut out the sugar, um, you know, intermittent fasting, more protein, you know, all the things. And the weight, I went from 235, I'm 210 right now. And there's no pills involved. Vinny's epic, you know, and and uh I feel really proud of that. And I and I want to take it down another 10, and I'm good, you know, and um, but in no rush. You didn't Rome wasn't built in the day, and you know, you got to give yourself some grace and and and take a minute. So um listen, I am so happy you were here today, Lisa. It's so good to see you, so good to catch up, so good to hear your story. And um, you know, I look forward to to talking more and um you know, helping the story of Ms. Medicine uh be spread to the to the universe, and uh, you know, we'll uh continue to stay in touch.

SPEAKER_01 48:33

Thank you so much for the opportunity, Vinny. Vincent.

SPEAKER_02 48:37

Yeah, well, don't can you can you know listen, it's really funny. I'm just trying to like, you know, as this is like this is the Vincent era. Thank you, Taylor Swift. You know, I mean we all have our errors. I had my Vince era, my Vinny era, and now I'm just gonna go back to my Vincent era and just uh see how that goes for me. So it's good. It's good, good for you. Anyway, thanks a lot, Lisa. This podcast reflects the personal views of the host and guests, not their employers or sponsors. See you next time.