The Prognosis Episode 21 | India’s Healthcare Problem: Rethinking Care Beyond Metros

“If you’re not solving for access, you’re not solving healthcare”

That conviction led Dr. Suchin Bajaj to build where most wouldn’t.

In this episode of The Prognosis Podcast, Dr. Shuchin Bajaj, Founder & Director of Ujjala Cygnus Hospitals, shares how he built a hospital network focused on India’s most underserved regions, tier 2 and tier 3 towns where access, affordability, and outcomes are often the hardest to solve.

His journey is driven by a clear idea: that healthcare in India cannot scale by extending metro-centric models. It needs to be rethought for a very different reality, one that combines scale with affordability, building hospitals designed for smaller towns without compromising on quality or outcomes. 

In this episode:
- Why Sachin chose to build in underserved towns when most providers focused on metros
- The thinking behind a high-volume, low-cost model without compromising on quality
- How financial outcomes shape healthcare decisions for patients and families
- The role of Ayushman Bharat in enabling scalable access
- Why preventive and primary care remain critical gaps in India’s healthcare system
- What it takes to build a mission-driven, market-minded healthcare business

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Transcript

SPEAKER_00 0:00

Our guest today is three personalities rolled into one. Please join me in welcoming and an entrepreneur, the founder director of Jala Signus Hospitals, Dr. Sachin Pajaj. Welcome to the show, Dr. Sachin. Thank you very much, VG, for having me. It's a pleasure to be here. You chose to build hospitals away from the metros in markets where the larger hospital chains had written those market offs. Where did you derive that conviction? There are already 20,000 doctors in Delhi. I am becoming one more. What difference will I make? I wanted to really treat that community which I came from and who were suffering very clearly due to either non-availability of healthcare or too expensive. Your cost structure should be very, very different from these larger corporate hospitals. What's different in your case? A hospital. If you can provide good quality outcomes, you should not be forced to sell your house to save your life. One is we don't own any land or building. So the real estate doesn't cost us. Even in equipment, we take our CapEx very seriously. So we follow the Pareto principle ruthlessly that 80% of things can be done at 20% cost. Even though a doctor would definitely say that no, no, I would love to have those machines. As a doctor, I also love to play around with expensive toys, no fancy toys. But if that does not serve treating my patient affordably, I have to take the tough decisions. I was reading somewhere that in India, for a lot of families, 70% of their lifetime's earnings goes away in the last 10 years of their life because of diseases. What needs to be done to change that situation? So, of course, Aychman has helped a lot, but again, doesn't really address the entire cost of the disease. You can't really go back to the factory you were working in, right? So your future earnings that are lost run into much, much more amount. Yeah. 20-30 years of earning you've lost now. So this cost nobody understands. This is something that as a country we have to do. Insurance is very good as a bandit, very well needed, right? But who is incentivizing the whole system to make sure that we do not have the preventive and primary care has to come in a huge focus somehow. This man runs a hospital change that has over 20 hospitals in tier 2 and tier 3 cities in the northern part of India. His focus is on healthcare for Bharat. So basically, solving not just for quality but also solving for access. Please join me in welcoming uh the founder director of Jala Signus Hospitals, Dr. Sachin Pajaj. Welcome to the show, Dr. Sachin. Thank you very much, Vivekji, for having me. It's a pleasure to be here. I've been following your podcast for a long time. I've been a great admirer, so it's a great privilege for me to be on the podcast. Oh, you are very generous, sir. Let's start with uh uh that note itself. So, you chose to build hospitals away from the metros in markets where usually uh the larger hospital chains had written those market ops. Uh and uh you know I have hosted a lot of uh uh hospital operators and owners on this platform, and the constant feedback that I keep getting is that the economics don't work out in uh smaller towns. Uh where did you derive that conviction to take a very, very non-conventional route and go to smaller towns? So actually, there was no economics behind the decision when I started out, right? I had no idea what economics meant. And uh when people in those early days used to ask me what my business plan was and what my BMC was, business model canvas, and what the cash flows looked like. I looked at them with completely blank expressions. No, I'd never heard of those terms. So I was uh down a very traditional medical path. I come from a very resource-constrained background to put it in polite words. Uh so I did my MBBS and my MD. Luckily, I got through the government medical colleges, so the fees was I mean almost zero. I remember my annual fees was like 415 rupees or something, and that is how I could afford to study. And I was pursuing to study gastroenterology, and I was back in Delhi after a long time. I was I had been studying first in Bombay, then Haryana, then Rajasthan. Came back to do gastroenterology after finishing my MD. And since I was in Delhi now, which was the center of attraction for all North Indian patients, right? Everybody had to come to Delhi to get any sort of critical care or tertiary care. So I used to get a lot of calls from my family members, friends who were living outside, mostly in Haryana, that somebody's had a heart attack, somebody's had a critical illness, head injury, accident, and they're bringing the patient to Delhi. And could I help them in some way? No, because I was the doctor of the family, the first one, and at the one end, of course, it felt very good for me that you know I was now at a position where I could help all of them. But on the other hand, it was always a troubling thought that why were these people traveling five, six hours in hired vehicles, jeeps, and bringing serious patients to Delhi. And one particular week, two of them didn't make it. And uh, so when you go to funerals, uh, family members, what do you do? Usually you just sit and chat around, right? And then I heard stories like, oh, maybe it's good that this guy didn't make it to Delhi because the last one from our village that actually reached Delhi had to sell off the house and the fields to pay for the treatment, and then you know he died. And look, now his widow is begging on the streets. So at least this family has something to live by. So I just thought that you know there are already 20,000 doctors in Delhi. I am becoming one more. What difference will I make? This same story will continue. And at that time there were 20,000. Now I think there are 65 or 70,000 doctors just in Delhi registered. So one fine day I just quit. I stopped studying and said, you know, we should go and do something in the small towns, that's where the need is. There was no financial thought behind it. I didn't even have 10,000 rupees in my pocket to start off. I borrowed the first money, and um this is how this model of very asset-light, lean hospitals came in, came out of constraint because I had no money to buy a land or build a hospital. And this is where this entire model came out. So there was no conviction, there was no financial planning, no thought. So it was super highly unrecomended way to start any venture. Wow. On that note, I will actually want to go back uh a few years in time and uh discuss about your upbringing and your life experiences, your childhood experience, because we were talking off camera, and I I believe that the path that you eventually chose had a lot to do with where you came from. So, why don't you, for the sake of our audience, uh, talk about your upbringing, your life stories? Yeah, I mean uh I come from a house where I have had a lot of scolding. I remember one day because that particular month our electricity bill was more than 100 rupees. So we stood in line while our father scolded us, you know, that you don't have any sense and you leave the lights on. So uh my parents both came as refugees into the country, they were very young. Uh, my father used to, I remember, live in a horse stable, that is what they were allotted outside the haweli. They were allotted one horse stable for the refugee when he came out. Yeah, so they lived in a stable outside, so there was this big haweli in Old Delhi. Eidgar Road is the place where the big Edgar is, and the Haveli had a lot of servant quarters, rooms, haweli stables. So each family was allotted some part of the Haweli. So they got in their share one horse stable and they used to live there. And at one point in time, I think there were 17 of them living in that horse table, like a 10 feet by 10 feet kind of a space. And in his early days, he used to make kites for a living. So very early on, he decided that the way to climb out of poverty would be education. He said, I will educate myself and I will climb out of poverty. Everyone chose different ways, some chose entrepreneurship, some chose jobs. So he chose education that I will study and get myself out of education. And he was very passionate about education. So we all studied at the peril of death because he was a very strict father. And he said, you know, everyone has to study because I studied and brought myself out. And uh but he could not study in that small stable because 17 people already there working all day, making kites. And at night, when he tried to study, of course, the other ones would, you know, shut him down that you know you can't disturb us, you can't light a lamp because we are sleeping, and if the kites catch fire because of the lamp, we won't have anything to eat for the next week. So he literally climbed out of poverty by climbing onto the roof of that stable. He got a rope from somewhere and hung it, and then he used to climb up and made a house for himself there with some tin shed and tarpaulin and everything, and he used to study there. Stayed a long time there. He got married there on that roof, and my sister was born there. So he stayed for a very long time on that rooftop, and that is why his uh favorite dialogue was if you want a roof over your head instead of under your feet, like I had, you have to study. That is the only way. So, yeah, I mean that is how education came very as a very important part for all of us, and uh and that is why he was not happy at all when I quit the gastroenterology program to start this. So, till the day he was alive, he was always unhappy about this fact that you know if you've left education to do something, that is not the correct decision, and you should not have done it. So yeah, but uh yeah, we all are family, some of them are still struggling to get out of poverty. Some of my family members, uh many of my cousins still are, you know, one of my cousins runs a auto repair garage, one of my cousins is a car driver for a person, one is a bus conductor, one runs a fruit stall. So the extended family still not everyone has managed to climb out of poverty yet. But it's only I think education that helped us to do that. Wow. How did uh medicine happen? Was it serendipity? Was it planned? So my elder sister uh studied medicine and uh she was she became a doctor and I wanted to follow in her footsteps. But my father uh wanted me to be an engineer, so he said you should go to IIT for sure. That you know so but my interest was always that I should follow my sister and become a doctor. So this is how so I appeared for both. Uh at that time it was called uh engineering entrance, IIT JE exams, joint entrance exams, and uh PMT, all India PMT exams. So luckily I qualified for both, and luckily I was not getting a very good branch in IIT. So I could convince my father that you know it's uh good you let me go to uh medical only. So it was a process of elimination rather than the choice. I didn't want to be an engineer for sure, but you know, my father was very vehement in his ways that you know you have to follow exactly what I say. And in our days it was very unheard of to question your father that you know I will not do this. So you had to quietly follow and try and make your way according to what you could. But I wanted to be a doctor from the very early days of my life. Wow. So Sasha, when you come from a background, when you come from nothing, uh you generally one of the reasons why it becomes very hard to climb out of that kind of a situation is that the people around you, uh, all of them are not very ambitious or aspirational. For example, I had a I would say, I mean, of course, not as uh as hard as yours, but I had a very humble background myself, and uh the issue was that my closest circle of friends, people around me, they were not thinking about getting into engineering or medical colleges, they were just thinking about getting a second division and let's say getting a clerk job in government that used to be the highest level of ambition, and that was true for me as well. Uh, what happens is there are some life events which may seem very mystical at that point of time, but that has such a huge cascading effect that it changes the whole trajectory of your uh career and life from thereafter. For example, in my case was that I appeared at the Cynic School entrance exam and I was I was supposedly very poor at studies, but I did exceedingly well, and that's that was the time when my family realized that they should focus on my studies, they should put tuitions because I can possibly do something. Uh very small instance at that point of time, but I think I am where I am because of that one small uh incident that had a snowball effect. Can you reflect on your life and think about one or two such instances that had a very profound effect on uh who you are today as a person, and of course, uh the position that you hold? So, uh the point that you raised about your peer group not being uh ambitious enough. Luckily, I had nothing of that sort because, as I told you, my father was very intent on education, and he said, I will send you to the best schools, even if we don't have food to eat, but you will go to the best schools. So I went to the top school uh of the city. Uh it's a different matter that uh he would not pay for the bus fees, so I had to cycle down. I mean, in these days, I don't know if you know the Delhi topography a bit, but we live in West Delhi, way out West Delhi, and the school was in South Delhi. So I used to cycle down from West Delhi to South Delhi every day and back in the afternoon in the blazing heat. I don't know if any parent would risk their child doing that these days, but I would do that because uh you know getting onto DTC buses was very tough, they were always overcrowded, and I just preferred cycling down because I didn't go in the school bus. Uh, but I was at the top school, and my father never compromised on that. He would send me to school each and every day, even if it was a Bharatvan at that time and everyone knew everything is closed, but he would say, No, I haven't got an official notification from your school. Wow, okay. It's not in your albanac, and at those times there was no WhatsApp or internet or instant communication, right? So he said, No, no, you have to go, whatever. I remember actually reaching the school on a Bharat one day and the guards laughing at me that why are you here? Don't you know it's Bharat Band that's all over the news? I said you go and tell it to my father. So he was very strict in that way that you know education is the prime importance, and he always used to tell us that the money that you put into education is never an expense, it is an investment, and it will give you back a thousand million fold. So, luckily, I had no problems there, and I studied the best, and luckily, as I said, got into a government medical school. If I hadn't qualified for that, then definitely I wouldn't have because we there was no way we could afford a private college fees. I think what really turned the career around was as I said, that moment when I really decided that two moments I think one was my sister became a doctor, so I was really impressed by her and I wanted to become that. And second, I went the other way, the wrong side, as she always never tires of reminding me that ulti ganga, so she studied to be a doctor, she completed her MBBS and promptly went off to the US because that is the way to go, right? You clear your MLEs, go to US as a doctor, you earn a lot of money there. And she said you have to follow me. And uh first didn't want to go to the US, so I devised some sort of again, you know, elimination plan that I kept studying in India that I'll do my MD then thing, then I'll do my gastroenterology then thing. And then finally I decided that even a big city is not good enough. I mean, going to the US is a very uh kind of an unthinkable thing for me, and I should go the other way that you know they were like, you are crazy, people stay in small towns, they come to Delhi, then they go to the US, you are already in Delhi and you are going back to a small town, Ultiganga Bahariatu. So that was the second point. I think one when I decided to follow my sister, and one when I decided to go completely against what she was doing. But uh, I was very happy when Uttar Khand was formed out of Uttar Pradesh because you know now we have a UK here, so we have four hospitals in UK. So the standing joke in the family is okay, you went to US, but I went to UK, so not so bad. Amazing. Take us through the the first year and the first hospital opening. Uh, what were the challenges that you faced? Uh, of course, you already mentioned that you did not think as much about uh the commercial trade-offs, and some of the best ideas or businesses come up when uh when there is you know real raw passion driving those ideas and not um let's say solid business plans backed on Excel sheet. But I'm assuming must have been very difficult convincing investors that uh quality care provider can be a hospital can be built in in a Hesalar or a Varanasi or in those kind of areas, then hiring doctors, hiring good quality staff must have been a challenge. Uh there must have been moments of doubt as well on your own ideas. So take us through the first few years, uh session. Yeah, moments of doubt are still there. So always it's I always sometimes I always feel it would have been much better if I'd just been a gastroenterologist, no. So that would have been uh much easier, I think. But uh yeah, I mean uh as I said, no money to start off with. So borrowed the first 50,000 rupees to you know, and literally rolled off the first hospital in 50,000 rupees. Wow. Uh I remember so Naveen and I were there. Naveen was my co-founder, and uh we were both uh we got out together, and but he uh at least finished his senior residency, he didn't burn all his bridges. Yeah, yeah. I just burnt all my bridges. But he said, no, no, let me complete the senior residency at least. So that was a smart thing, I think, for us to do. One person at least completes the senior residency. So I remember he and I used to sit on very serious discussions on you know how uh we have diabetic patients coming in and how we have children with asthma also coming in. So we need a nebulizer also, and we need a glucometer also. But this month we can afford only one because glucometer is 1100 rupees and nebulizer is 1400 rupees. So this month we can buy one of these two, let us decide which to buy. Serious budget discussions happening. No, I would laugh at this. Now, if I think of it, what were we doing? But we used to have very serious discussions on which one to buy. So at that time, if somebody had told us that you know your organization will be doing a thousand crore kind of a top line, we would have laughed in their faces. Even one crore was unthinkable for us at that time. This was which year? Yeah. We started in 2008. Okay, yeah, that was the first one, and uh so yeah, obviously, as I said, no money to work with, that was the biggest challenge. Both of us were doctors, so no business experience, never made any business plans, no projections, cash flows, we didn't know what a balance sheet was. So, all of those things, and then luckily, my brother who was working in a big MNC at that time and had done his NBA, so he suddenly got convinced by our passion, and you know, he was like, Okay, looks like you guys are on to something. So he resigned from his job and joined us as a shareholder and CO. So he was a business guy. Yeah, he was the business guy. And then he taught us that you know this is how you have to put your money in the bank, and then you have to open this, and you have to make a company. At that time, we didn't even have a company. The first hospital we started. We didn't have a company at all. Just started on word of mouth with the landlord that okay, we'll run your hospital for you, and this is what is needed. Your hospital is not doing well. And the landlord was, I'm going to shut it down and give it to a bank because you know we are not doing well. And we said, No, no, we realize what is the problem. We'll uh you're addressing the wrong population. So sort of a management contract. No management contract, but no contract also. Okay. So just word of mouth. And the money used to flow into his account. We didn't even have a bank account. Okay. So money used to flow into his account, he used to make the expenses, and at the end of the month, if there was anything left, he would give it to us. Sure. And we would take out personal loans to buy equipment. In our name, the loan was in our name, but the equipment was in his name because we had no entity. I remember the first time we thought of hiring a professional person before my brother had joined. So he came to us, saw the operations, and asked these questions which I keep, where is your business plan? What is your cash flow projection? I was like, I don't even know these words. And then how are you doing this? Okay, where is the contract? I said, We have no contract. We just talked to him. He said, Okay, you can run my hospital and see if it works. And then he said, What if he chucks you out tomorrow? The machines are all in his name. What if he says you can leave now and I am not allowing you inside? I said, Yeah, that I didn't think of, but I don't know what happens in that case because so he said, Either you are too brave or you are too stupid, but whatever these two situations are, I will not be able to work with you. So this is how it all started, but luckily just went well. The right people kept joining in, you know, as sometimes God ordains these things that He helps the stupid and adventurous people. You know, you He takes pity on you that you know you don't know anything. Okay, let me help you somehow. So we got the right people coming in, then the right investors joined us. The model was a very new model, right? Nobody believed that you could have a cath lab, a neurosurgeon in a town like Sonipath, in a town like Kathil, Karnal. Because generally the thing was if you became even a little serious, let alone a cath lab, there was no ICU in that town at that time. You became a little serious, they would say go to either Chandigad or Delhi. We cannot treat anything there. Very basic secondary care happening in those towns. And some investors actually told us this is the wrong model. They told us that you know, I won't name that investor, but we had a very detailed conversation with a very established big name investor, and he said, I will write you a hundred crore check right now. If you agree that you will only do small secondary care hospitals and not talk all these idiotic things about having cath labs and ICUs and neurosurgical centers in these small towns because they will never be working. So I will write you a hundred crore check right now. But if you talk about having cath labs, etc., I will not give you even a rupee. And at that time I was this idealistic, stupid person. So I said, no, no, if if you don't agree to this model, your money will also sink and our time will also go. The model has to be a full-fledged hospital in these small towns because these small nursing homes are already there doing secondary care. What difference will I make? You know, offering more secondary care. People will still die on the road because in a heart attack or a head injury there will be no one to treat them. So yeah. Now I think if I was today, you know, smarter guy would have taken the money and then done my own business model. But but at that time I said, no, no, I can't take your money. I think it's about the stakes. When you have something to lose, you become risk averse. When you have nothing to lose, then that's when you pursue your true passion. Yeah. So I completely refused him on his face saying I can't take your money because the model has to be this, otherwise, there is no success. So uh how long did you how long did it take you to onboard your first institutional investor? So from 2008 to so institutional investor very early. In fact, so as I said, the first round I borrowed the first money to start off with, then second, as traditionally, you know, everyone does the triple F round, the friends, family, and fools. So one we got uh very early on Believer in Us, and uh he put in some money, uh and he was actually the same age as me. He went to IIT, I went to medical school, so and then as all uh uh you know traditional good IITs, he founded his first company in the hostel room, and then he went to the US to work, big made a very big company, exited out, made a lot of money, came back to India and said, I want to do something good in healthcare and education. So healthcare he luckily chose us and invested his first money. And since he had uh shown that you know he could actually make all these things and make big companies, so his first initial investor actually put in some a small amount of money, a crore rupees, based just on his recommendation that you know this is what uh uh he is recommending as an angel investor, so we should put the money into uh this company. And they made good returns. So when we got the first proper institutional round like uh series A in 2012, so four years after we had started, uh then that uh uh VC made an exit at that time and very good, I think 4x returns within four years. Uh but uh the angel investor Rajul he continued with us for uh seven more years, so he stayed with us very patiently for almost 11 years before. This is Rajul Gar. Rajul Gar, yeah. Okay, he runs his own uh fund now called Leo Capital. Of course. So he was the main reason uh why we could scale up because he showed us very in the very beginning that whatever business you think of you should think of as a big business, not one hospital. Think of it as a hundred hospitals, five hundred hospitals. And uh he came because uh of my brother. So my brother used to work for him in his early days, so he knew so you know all these family connections and friends and known people, that is how luckily things moved. So uh the the group has been around for what 16 years now? Yeah, 17 years always where were where were you in 2016? Let's say midlife. What was the starting as usual? So 2019 uh when uh Amarujala made the investment into us, we were a hundred crore revenue company. Got it. So 16 we would have been say 70, 80 crores, maybe. So it's I think healthcare is a very time-consuming business, and uh sometimes I think of it as this you know famous story that you have that you put one rice grain on the first square of the chessboard, then two, then four, then eight, and then by the time you reach the end of the chessboard, uh you are putting more wheat on it, the rice grain, than it than the entire world's production of rice. So I think it takes time, and the inflection point came in, I think, in 2019 when Amarujala came in and we developed the confidence to go to Uttar Pradesh, Uttarakhan, more states than the one state Haryana that we were in for the first 10 years of our lives. So for the first 10 years, we built 10 hospitals, 10 small hospitals only in Haryana. And then when Amarujala came in, then we ventured into Uttar Pradesh. And in Uttar Pradesh, there was a need for much bigger hospitals because it's a hugely populated state, so more than 10 times the population of Haryana. And uh so we made 200 bed hospitals, 300 bed hospitals, ventured into new specialities, cardiac surgery, cancer. So I think that really turned it around for us. And I think that time also, with the increasing production of doctors, uh, with the you know urbanization due to the internet and everything, so doctors were not that unwilling to go into these small towns where earlier it was very difficult for us to get, you know, so cardiologists, neurosurgeons, we would scrape around and find somehow, but we never thought we could get cardiac surgeons, endocrinologists, cancer doctors. And because these were not really truly the golden hour emergencies, as we call them, where you will die if you don't get the treatment in the first hour, like cardiology and neurosurgery. We were not focusing on them also, and we couldn't get those doctors. Uh, but uh the the revenue potential of these specialities is much higher, right? And the need is much higher for the community because the community really slips into this financial morass if they get stuck with a cancer diagnosis in a small town because you know then they have to come to the big city, and the big city hospitals don't take these government schemes, etc. Yeah, the cost becomes much higher. So, as I said in the very beginning when we were talking, right, there were these two problems. One was the poor physical outcomes that people were dying on the way, but then there was poor financial outcomes also. They were worried that even if we reach, we'll have to sell our house, sell our land, and then you know it becomes a much bigger problem for us because then the entire family goes down the drain. Yeah, so cancer, etc., there is a lot of these issues of poor financial outcomes for patients. I mean, that disease can clean out your bank account very quickly. Yeah, so I think the fact that we are doing it and honoring the government schemes, Ayushman, Bharat, etc., while doing it is uh having a lot of uh benefits for the community. So I think we turned around very uh you know for the better. So we've had like a 10x growth in the last six years. Wow, and we are aiming for an even bigger growth after that. Wow, actually, that story is consistent with all the corporate hospitals group that I see. For example, Narayana took six years to just operate one hospital, and the next six years they opened ten, and the next six years they opened thirty. Uh, I'll have a few follow-in questions on that, and um you made a very interesting point about Avishman, Bharat and these government schemes. Um, the common consensus among specially among corporate hospital chains is that those schemes don't work. What's different in your case? Uh uh, how I'm I'm assuming your cost structure should fundamentally also be very very different from these larger corporate hospitals, and that's why you are able to honor that and cater to that segment. But how what what powers that lower cost structure? So there is a need for all sorts of hospitals. I'm not saying that the big corporate hospitals there is no need, there's definitely a need if if a patient has enough money and can afford you know luxury. So if you want to stay in an obroi hotel or a Taj hotel, you should be able to live there. I I am nobody to say that those hotels are not needed, right? They definitely they are needed, but you should not sell your house to go and live there, right? There should be an option for you to live in a three-star hotel, in a dharamshala, or wherever, as long as you are safe and there is a neat and clean hotel. I mean you don't fall sick or nobody attacks you or steals your belongings if you go there, right? That is the basic nature of a safe place to live. Similarly, in a hospital, if you can provide good quality outcomes, you should not be forced to sell your house to save your life. So you should have an option. If you want to go to a big hospital, definitely you should go big city hospital. But if you cannot afford that, you should not die for lack of access. And even if you can afford it, even if you have a hundred crore rupees in your pocket in a town like Catholic, if you have a heart attack, how can you make it to Chandigad or Delhi like four hours each way, right? So you should not be dying because your pin code is you know in a town, small town. So these two things. So we have structured our costs. As I said, the model started as a model of constraint because I had no money to start out with. It was not an intentional thing, it was just the circumstances that were like that. Second, I wanted to uh really treat that community which I used to talk to, which I came from, and who were suffering very clearly due to either non-availability of healthcare or too expensive healthcare. So the model is uh very simple, it's not a difficult model to follow. Uh one is as I said, we don't own any land or building, so the real estate doesn't cost us. We stay on a lease rental model. So your capex light. Very capex light. Even in equipment, we take our capex very seriously, and as doctors, I can understand that what is making a patient outcome difference and what is not really is merely gold plating. Sure. We don't gold plate our assets very clearly, right? So we follow the Pareto principle ruthlessly that 80% of things can be done at 20% cost. Sure. So we know that we are equipped to treating uh emergencies, life-saving things, you know. So uh we will have a 16-lice CT, which is more than enough for us to diagnose head injuries, treat head injuries, and if a brain tumor, etc., comes, we can get the MRI done outside because it's not an emergency. We don't need to invest in a big MRI machine or a 256-like CT scan machine, even though a doctor would definitely say that no, no, I would love to have those machines because as a doctor, I also love to play around with expensive toys, no fancy toys. I should have the latest equipment. But if that does not serve treating my patient affordably, I have to take the tough decisions. So one is we equip ourselves appropriately, we don't over-equip, we don't under equip. So whatever machines make a difference, so like the laparoscope would be best quality, endoscope would be highest quality, microscope would be highest quality because they're making a difference during the procedure. But beds we will buy locally, monitors we'll buy from a say a country which manufactures them in bulk, you know, bed sheets, linen, etc., will be local. So all of that, and we build many of our things ourselves. So, like modular OTs, we will build ourselves because we know the supplier of supplier, we know the cogs of the cogs, so we can source directly instead of handing it over as a contract to a third party and then you know incurring extra cost. So, all of that we spend a lot of time in these nitty-gritty details and working on the ground, and the the financial model for doctors, nurses, etc., is also geared towards that, so that we flip the traditional private healthcare model that has always been very high cost, low volume into a very high volume, low cost model. So try and flip the model uh towards higher volumes and lower costs, and that is what we are trying to do to private healthcare, and that is where Ayushman etc. fit seamlessly into our scheme. Sometimes you know, I get taunted by my friends who run the other hospitals that you know this Ayushman, you've brought the scheme somehow, you know, it's tailored perfectly to your model. Because earlier, when we started out, the ethos of the organization has always been that this was started because of a certain story where people were losing their life on the road, not able to access healthcare. So the ethos was we will treat each and every patient that comes in, we will save their life, regardless of finances, geography, social, we will not think of that because the organization has been started to do this, it's not started to earn money, otherwise, I could have earned much more money when I was a gas trainer. By doing a lot of other things, yeah. So that ethos stayed, and then luckily the Saishman Bharat scheme came in, where people who could not pay for themselves, the government was paying for them. So we could honor that ethos and at the same time not be treating people completely for free because somebody was paying something at least. So that worked very well fitted into the so is it fair to say that your product sits slightly above the charitable hospitals or public hospitals and slightly below these corporate hospitals? Yeah, so see, we have a variety of products. So, like if you want to stay in a single deluxe room, we have that as well. Okay, if a third party payer is paying for you like an insurance or a government panel, uh definitely happy to take that. But if you are okay to live in a general ward with air cooling instead of air conditioning, then of course you pay a much, much lower price compared to anything. And uh quality will be top of our mind always. So we are non-negotiable on quality because it is very clear to us that if you're building for the poor, you cannot build poorly, right? Healthcare is a very sensitive thing, and in a small town, the world gets around very fast. Yeah so if you start having poor outcomes, your hospital will shut down very quickly, no doubt about that. People will not risk their life to save money, right? So all our hospitals are NABH accredited, which is the highest possible accreditation you can get in India for quality. In fact, me and myself, I am an NABH board member. Okay, so that because you know NABH says that the way you have driven quality in small towns, we need much more of that now. So you should go and talk about this and lead the quality drive in small towns, and uh we walk the talk, so it's not like me myself, I will go to a big city hospital and then ask the community to access our hospitals. So my daughter was born in one of our hospitals, my son has had two surgeries in one of our hospitals, and my wife is a gynecologist, so she understands all possible complications that can occur in a cesarean section, right? The fact that she chose to get it done at one of our hospitals tells people very clearly that what we think of our quality and our ability to manage complications. I was going, I was when I was doing some research for uh this podcast, I read a statement uh that you made some years many years ago, somewhere on in an online blog that you are a doctor first and uh and uh businessman later. But uh the way you explained uh your business model, I think of course that's a very sharp business argument. So, when did that transition happen? And was it forced or natural? I don't think it has even happened now. So I still think of myself as a doctor and not a businessman. I'm not very good at making business decisions, and uh I almost hate the you know, the grunt work of Excel sheets and you know presentations. I've never been able to do that very well. You would rather be working with patients, yes. So so I think uh that is where I think I got lucky, as I said, always getting good people. So Naveen I started out with Naveen was very good at these finer details and you know things that finances and and all of that. Uh then all the people who have joined me later in the journey, come in, gone out, they've been extremely good at these, you know, the boring work as we like to call it, but which is the most important work, right? The day-to-day operations, the day-to-day management, cash flows, uh, quality parameters, statutory compliances, all of that is the most important part of healthcare delivery. This is where the rubber hits the road and you deliver quality, or are unable to deliver quality in just you know making big statements. So I think I've been very lucky in that way that I've got the right co-founders, the right people, uh, the right uh CEOs to work, and they've been instrumental in delivering what the vision has been. So I I clearly tell you I'm not a good businessman, and uh, if left to me, I think the organization would not have grown the way it has been. You made a very interesting point about uh poor financial outcomes for uh people coming from these uh let's say uh not very well off families, and God forbid, if if uh if something happens, then seven. I was reading somewhere that in India for a lot of families, 70% of their lifetime's earning goes away in the last ten years of their life because of uh uh diseases or or if if something happens or medical condition happens. I think an out of pocket expense is also unusually high compared to uh normal. That we have seen anywhere in the world, and and of course, uh government is doing a lot of things, uh, Nayushman Bharat is one such step to uh address that issue, of course, in your own humble capacity, coming up with a fundamentally low cost or one-fifth cost offering and almost the same quality is one way to address it. But uh what are some other things that you believe that uh, and of course, not lofty ambitions or statements, but what are some practical implementable ideas that we as a developing nation uh on the public side, on the private side, what needs to be done to change that situation? So you totally hit it on the nail on the head when you said that financial outcomes and that is what drives me every day. So before uh Ayushman Bharat came in, and at the time when we had started, at that time six crore people in India used to slip below the poverty line every year just due to a single healthcare shock. And uh at that time, every third patient admitted into a hospital, regardless of whether it was a government hospital or a private hospital, had to either borrow money or sell some asset to pay for the hospital bills. That was the situation when we started out, and it was a very uh you know problematic place to be in as a country with the healthcare system. So, of course, Ayushman has helped a lot, but again, Ayushman doesn't really address the entire cost of the disease, sure, and we underestimate the cost of the disease by a huge margin, right? So, for example, say uh we know we have about 80-85 million known diabetics in India, must be a much higher number. Uh we don't really know exactly how many, but 80-85 million estimated. Out of that, we know one third will end up into kidney failure for sure. And we are amputating one foot every minute due to every five minutes, sorry, not every minute. So we are amputating one foot every five minutes due to diabetic foot complications, gangrene and etc.

SPEAKER_03 46:25

Right.

SPEAKER_00 46:26

So now imagine a patient comes to us with kidney failure and diabetic foot and says, I want treatment for this. So I can pat myself on the back and say, Oh, yes, you've come to the right place because we are affordable, because we can treat you under Aishman, even if you don't have Aishman, we'll treat you for free also, doesn't matter because we have to save your life. Otherwise, if you had gone to a big city hospital, you would have spent 5 lakh, 10 lakh rupees on this surgery and dialysis and all of those rigmaroles that you would have gone to, and your family would have had to spend time in the big city, all that cost, etc. Right? But is that 5 lakh or 10 lakh that I saved to the patient doing the dialysis and Draishman, doing the surgery and Draishman or free of cost or whatever, is that the true cost of the disease for that patient? Clearly not, right? Yeah, because now I have cut your leg, because now you have to come to me for dialysis twice a week, you can't really go back to the factory you were working in, right? Field job that you were doing. So your future earnings that are lost run into much, much more amount than that. Yeah, 20, 30 years of earning you've lost now. And the scariest cost in addition to this indirect cost of lost earnings is the completely intangible cost, which nobody quantifies, is because now you're out of a job. You will pull your children out of school and start sending them to work. Yeah, and this is very close to me because one of my colleagues who drives me around a lot because we have hospitals all across North India, so I keep going there. And he drives me and he says, till he was in sixth standard, he used to come first in maths and race in school. Every went, every maths test he would score, you know, highest marks, every race he would come first. Like you said, you know, you went to a good school, started studying. I went to a good school, I started studying. This person's father suddenly passed away, he doesn't know what happened, must have been some heart attack or some disease. He said he suddenly passed away. I don't know. Kya waiting, school chodo start doing something. So he started doing odd jobs, and now he's a driver. If he had stayed in school, maybe he would have done something with maths or sports or something else, you know, you never know. And this is close to me because luckily my father survived. If he had died early on in my life, who knows I would have been making kites or doing driving or what would I have been doing? I don't know. I don't know if I'd gone if I had been able to complete school or not. Because he was there and he was pushing us all the time that whatever it takes, whatever money it takes, you have to go to the best school, you have to study, and I will ensure it. So luckily he survived. Yeah. So that I wouldn't have been sitting here if he had not been there, right? So he did not get a disease, he did not get complicated, he could earn money till his very late days, and he ensured that the family studied. So this cost nobody understands. Yeah, this is something that as a country we have to do. So insurance is very good as a band aid, very well needed, right? If you have an injury, you have to have a stitch and a bandage and then everything. You cannot live without that, you will bleed to death.

SPEAKER_02 49:59

Of course.

SPEAKER_00 50:00

But who is incentivizing the whole system to make sure that we do not have that injury? There is preventive and primary care has to come in a huge focus somehow. Yeah. And I don't know the financial model for that yet. Because right now it does not pay you well enough. Every doctor wants to be a super specialist, wants to play with the fancy machines. The government wants private care in only complicated diseases, saying that that is where you know we'll pay you the money, otherwise, primary preventive care, we'll have our own primary health centers, PhCs, subcenters, I are Ogimandirs. But I still don't see that working very well for now. So when we open a hospital in a small town, we usually are the first ones in that town to have this cath lab, you know, fancy machinery, cardiologists, neurosurgeons. And at the inauguration, the whole town gathers there, and this is the only question I ask: that would you rather have a heart attack and be treated very well at with this senior doctor and this German machine we have here, or would you prefer not to have the heart attack at all? Yeah, so unsurprisingly, everyone says we don't want that heart attack. But in our system, who is working towards that? Yeah, yeah. So we definitely need insurance, we definitely need good quality hospitals in each and every district. We have more than 800 districts now, and tertiary good quality emergency care is available at I think less than 350, 400, so we have more than 500 districts still underserved. Each district has an average 2 million people, so we have like uh you know a billion people still underserved, so that we definitely need, but we need somehow to use the massive wave of technology coming in to address preventive and primary care and make sure that hospital visits and admissions are reduced rather than increased. I think you made a very pertinent point, and I'm I'm not bringing the examples of US obnoxiousness because of course the public we don't have 17 trillion dollars to serve the population of 300 million. We have five times the population. So if we have to go down the US model, yeah, we will have to have 85 trillion dollars for a 3 trillion dollar requirement just in healthcare. That is I think the expenditure itself in uh in uh in absolute terms is one twelfth of what it is over there. But uh you mentioned something about outcomes. Uh, what some other uh geographies have been able to really crack is the value-based care model where a provider is incentivized not only for the procedure but also for the outcomes. Uh, otherwise, the point that you made, I mean, how many business healthcare providers are also at the end of the day business? How many businesses will be self-motivated to optimize for the outcomes? That generally doesn't happen, right? Because it's at the end of the day, the moment you grow, uh, you become uh you become a uh a business. Uh, and unless the financial incentives are aligned in a manner that forces you to think about optimizing outcome first. Uh that doesn't come naturally. Long-term method, of course, take care of a few patients are not happy to low learning anything, but that's like uh brand building over ten years. Uh I think people have been able to solve for uh, for example, you mentioned dialysis. Uh dialysis provider getting incentivized if the outcome of the hemodialysis is better. This endemic problem and uh I think uh uh I may be slightly wrong, but the five-year mortality rate for a pro for a for a thing like CKD, a personal dialysis is 95% in India, and the primary reason is affordability. People are not able to continue now, still dialysis is covered, but let's say some years ago even dialysis is not even covered with uh uh these things. Um do you think it's purely a function of uh the per capita GD in dollar terms, or it's also political will, or or uh let's say lack of uh ideas from both public as well as the private uh sector? So let me start by talking to the point you made about businesses. So when you grow big you become a business. I inherently, deeply, passionately, and strongly feel that the only successful models that will scale are businesses. So, but they have to be businesses with a heart. So you have to be market-minded and you have to be mission-driven, both. Sure. Because if you're either, then very soon you will cease to exist. Because the pure capitalistic models that have been successful over the past 200, 250 years, I don't see them being very successful going down the line into the future because people are much more aware now. People want meaningful businesses, people want B Cops. So that pure capitalistic model will not succeed. Pure philanthropic model that like an NGO or a charitable hospital will also not succeed. Because what happens when the grants stop? Yeah, yeah. Do you leave the community high and dry saying that Are Bhayapto Mira grantoga strict and you finish the project? That will not work. So a market-minded, mission-driven organization is the future of business. I strongly feel that way, and even at current situations, I think more than 5 billion people are the market for such organizations because only 3 billion are served by either purely capitalistic or purely philanthropic, and both are on their way out. So, even in current situations, 5 billion people. That is future of business for sure. So you can do good for the community and for yourself both, and there is a clear difference between profits and profiteering. Profits are good for everyone because they allow you to invest in new technologies, they allow you to be sustainable, they keep everyone motivated in the organization, and they allow you to do much better and bigger things for the market you are addressing or the communities you are addressing. Sure. So that is imperative, but of course, profit tiering has to be clamped down on with a heavy hand, especially in healthcare and education, it is not sustainable. As I said very early on in our conversation, that you should not be forced to sell your house or your land, or you should not be forced to die because you could not afford or access healthcare. So that agency everyone needs to have. Second, as you said, outcome-based models, uh, capitation models, there are a lot of models all across the world. So I I was really impressed by the Israeli model, although the population there is like even lesser than you know one of our cities. I you know, we work in Uttar Pradesh, and it's funny that you know places like nobody really hears of like John Pur, close to our Varanasi hospital. 72 lakh people there, right? No hospitals, etc. So the Israeli model may not work for us because we are too big, but that model deserves consideration, right? There, you have like we have um uh cell phone providers, like so they have four providers there, okay, and those four providers do everything, so they insure you and then they treat you also. So you buy my plan and then you pay me a subscription, and if you fall sick, I will have to treat you. Oh, so the provider and the insurer is the same. Same. Okay, so you are on my plan, so it is I am incentivized to keep you healthy. Wow. Because if you fall sick, I have to treat you free. So I will send you daily reminders. Did you do your exercise? What did you eat? This is a free dietitian for you, you know, a free gym membership for you. I will make sure that you do not fall sick. Okay. And now the complication in this plan can be okay, I'll sell everybody this plan, but when you really fall sick, I won't treat you because it takes money. So if you come to me with a heart attack, I will say, no, no, you'll be okay with this medicine. You don't really need an angioplasty. Lie down, take this medicine. If you die, you die. Then the outcomes come into play, and then this plan portability comes into play, right? Like a cell phone provider, you can actually port your plan to any other provider if you feel like if you feel the quality is not good enough, their hospitals are not good enough, they will not save my life if I'm sick. Go to another provider. Like cell phones, you know. You buy a cell phone plan, you don't get good coverage, you don't get good quality, you go to another one. Not necessarily you're stuck with them. Sure. So they have to provide you good service because otherwise your customers will run away. You have four in such a small population, so very you know, they have to get more and more customers, so they have to provide you better services, and then they are incentivized to actually keep you healthy and not let you fall sick. So they do a lot of predictive medicine, a lot of preventive medicine, a lot of genetics. They are doing everything in their capability to make sure nobody falls sick, which works perfectly, right? Now, both all players, payer, provider, patient, all are on one side now, instead of a place like ours or US where there's a fee for service model where each one is fighting. Yeah, incentives are misaligned clearly in this model. Sir SM model is unhappy. Yeah, truly broken model healthcare. Everybody is unhappy, patient is unhappy, rules, doctor, doctor, they are unhappy, I am overworked. Hospital. So each and every stakeholder is unhappy. There's something truly broken about this system, right? So we have to make sure that we correct it. How we correct it, how the regulations come into play. Can we actually do a Kaiser permanente kind of a model where you know you go from this Israeli model that go from birth to death, we will hold your hand and take care of everything. How do we prevent bad actors coming into this model and actually denying treatment when needed because they want to save money or providing shoddy, poor quality treatment? That is something needs to be worked out, but I think it is solvable, it's not impossible to do. Interesting. Let me now touch upon uh one aspect of healthcare uh that uh that we have an overlap with, which is the manpower and scaling. I'll tell you a very funny thing. When uh initially I had a very tough time explaining to my investors and early employees about what we are doing and why we are doing, because it's very counterintuitive that in a country of 140 crore people, how are hospitals and diagnostics chains not able to hire people? I mean, we read reports that there are more than 20 lakh or vacant position for nurses, so many lacks of doctors, lacks of allied allied healthcare staff, which is very counterintuitive because in India, if we have one thing in abundance, that's people. Raw materials are low gain. What's the reason for a nation like India, which has 140 crore people and that two of the right uh demographic that's a chabisal median age? Why are uh providers like like you not able to hire retain quality people? I think it's uh mostly due to a deficiency of organizations like yours. So if we had more organizations like Ember City coming up, we would have much better train. So it's not the lack of people, it is the lack of appropriately trained and motivated people, right? So, for example, uh by the way, I'm gonna include this in my investor page absolutely, so see the number of medical schools we have artificially constrained, not just the number of medical schools, but the number of seats per medical school. So the number of patients we see flowing into our government hospitals can easily train, if not 10x, at least 5x the number of doctors that a medical school currently trains. Or look at an American medical school. The number of patients they see. I have many friends who are working as doctors there, who are working as faculty. The day they see 8 to 10 patients, they're like, oh, we had a very heavy, busy day today. We saw 10 patients today, right? So the training that they're getting is seeing like seven, eight patients a day. You sit in a government hospital OPD today, each doctor has to see at least 80 to 100, yeah, if not more.

SPEAKER_02 1:03:49

Yeah.

SPEAKER_00 1:03:50

So can't you train 10 students in a similar load? You can, but the regulations don't allow increasing the number of seats. And it's not actually a problem of infrastructure because uh we were thinking of an expansion in Mideast, and uh it was very funny that actually I can rent a space in a shopping mall in Dubai and I can get all the requisite approvals to run a medical school for versus in India. You need to own land, you need to have buildings, you need to make it. Yeah, yeah, yeah. So it's not necessarily an infrastructure constraint. No, and so definitely not. So uh one of our very uh able Stanford professors, I admire him a lot. He he had this favorite dialogue that best is the enemy of good. Yeah. So if you keep aiming for you know the best, that each college should have 25 acres of land, this much infrastructure, this much classrooms, this much, then you know we don't get even good schools. But see, this government that has come in post-2014, we've seen that changing. So now our medical seats have doubled in the last 10 years. They had been static for almost 40 years. The number of medical schools have increased by almost uh 1.5, 1.6x. And now the policy of having one nursing college in every district that is a huge, huge uh you know, uh way forward. Yeah, so I think these things help. Now the quality of people coming out of newer schools, of course, will not be as good as those old established schools that have their processes, pedagogy, culture in place. So the newer schools, for some time, we all will have to get together in the private sector and see how we can upskill them, unlearn them, retrain them, and make them ready for the job market. So, for that, I think organizations like yours are very important. We need well trained people, and we're very happy that at least someone is thinking. Of that, the number of people are very high, but the number of adequately trained people are something that really needs to be worked on. Sure, sure. If you personally observe, and you would be able to relate it, relate to it because you also operate in a sector where making money is a taboo. So now, but healthcare must still. I mean, you look at I have observed one thing, you look at the analyst calls of the top corporate hospital chain, nobody will very loudly say how much bottom line they are making. Because if you are in healthcare and if you are let's say making 25-30% debit, then basically you would be perceived as a vulture making money on people's misery. I think education may be India for the because it's a non-for-profit subject, or until 2020 new education policy, there was no carve out for a private player to work with institutions in a legal or a compliant framework. So that creates a disincentive or a lack of incentive for the existing incumbents to actually let's say do a better job because you are sort of in a protected kind of an environment. Do you think that would also contribute to how should I put it? To actually let's say less less efforts on the part of the existing incumbents. So wherever you have protection, of course, uh you know the incumbents uh when they are confident that no new people are coming in, will not really put out the best services or products. And we saw that a lot when we were growing up. Uh of course, you are much younger, but I have been the generation where we had to apply for a telephone connection and get it. If we got it in eight, nine months, less than a year, we were considered very lucky, and people would ask us that approach a phone connection. And then you know, to maintain that phone connection in a working way, we had to, you know, do a lot of so we come from that time where BSNL was very secure that you know no player is coming, I can do pretty much what I want. There were two or three vehicle manufacturers who were producing the same 1948-50 model of a car or a scooter that had been existing for the last 40 years because they were very confident that no new player is coming to disrupt. And uh that always leads to finally a lack of quality, a lack of happiness amongst everything, and then again makes this whole system where everybody becomes unhappy. So I think that is something that the uh regulators must definitely look at. That if we want the best uh for our community at the lowest price, then we need to have very fair competition amongst as many players as possible. And we've seen that happening in telecommunications very clearly, of course. When I was growing up, as I told you, my sister went to the US, and I could not really speak to her at all because making a phone call to her meant my entire month's saving would be gone in one or one and a half minute of speaking to her, right? Like I used to get like 1500 rupees a month to get through all my expenses in the you know, mess food, uh come uh going and coming and transport and stay in everything. I used to get from my family 1500 rupees a month for my subsistence. And if I had to make a phone call to the US, it meant like 1500 rupees in two minutes of call. My whole money would be gone. I could never speak to her. And at that time, a very wise person said to me, Don't worry, one day all communication will be free, and you will be able to speak as much as you want to anybody in the world. And I laughed at him, and he was my brother-in-law who had come visiting, and I was telling him, I can't never speak to you, and you can never call me because I don't have a phone here. You know, I have to go to the STD booth and make that call. So he said, Don't worry, one day all communication will be free. And I laughed at him, saying, How are you saying that? And it actually turned out to be true. So now you can have 10 phone connections delivered to your house in less than an hour and start talking and do whatever you want with them. So I think that uh widening of the industry is needed for each and every sector that anybody can go and set up and offer services to the community, and if they like it, they should encourage that person offering those services. Yeah. Uh now we are coming towards the end of the podcast. So uh so let's go on a section directly, which which is my favorite the rapid fire. So uh, first thoughts that comes come to your mind simple rules. If you were sitting across the table with the health minister of India, what would be that one reform uh you would ask for? Uh government panels should pay all hospitals on time, you know, without like a tatkal passport that you do post facto checking, and if you are obviously caught doing any fraud or mistake, you should be penalized very heavily. But your money should not be stuck because you know there is checking going on or validation of your claim, and you are paid in eight months, a year. Because, see, what we are doing currently is putting a vehicle at a better point than a human life. So, my car got banged up very recently and it went to the workshop, and they did not release my car till the time the insurance did not pay them. Like insurance money will come and we'll release your car. Sure. Here we treat a patient, release that patient, patient goes home, and one year later we are still waiting for the money to come in. So, is that human life lesser important than the car? Because the insurance pays the car repair person before the car gets home, and here you treat the patient and then keep waiting. So, I think one immediate reform uh every third-party payer, whether it be private insurance or government, pay immediately as soon as the claim is lost and then do post facto verification heavily. Of course, we need to eliminate bad actors, frauds completely from the system. That is very important for players like us. But uh yeah, quick payments is something that a lot of hospitals will be very uh benefited by. Uh, one healthcare leader that you admire the most? A lot of them. A lot of them. Dr. Trihan, uh Dr. Eddie Apolo, Dr. Shetti, uh Dr. Prelad, I mean a lot of them. I I keep looking at healthcare leaders, admiring what they're doing, Dr. Dharmindanagar at Paras, uh, Dr. Azad Mupin. The work they've done is quite amazing, and you know, I really, really admire a lot of them. Too many to count. If you were put on a time machine and sent back to 2008, uh, and you can give only one advice to your former self, to Sachan of 2008, what is that advice going to be? Don't drop out of gastrendering. Finish your studies first and then Oh, I thought that advice is going to come from your father. No, no, no. I think that you know completing your education is very important, and uh this uh you know, thought of romanticizing, dropping out of college and starting entrepreneurship and becoming successful, it has been romanticized too much, gives all the wrong ideas to kids, you know, not necessarily the right way to go. Finish your studies and then do whatever you want to do. But yeah, I would have finished my education, completed my education, I think. Amazing. Uh, thank you for uh coming on the podcast session, and thank you for being super candid and super honest. It was an absolute pleasure to host you on the show. Thank you very much. The pleasure was entirely mine and uh really happy to be finally on your show. Thank you so much for having me.