Dr. Paul Szotek: “Flexible delivery care model = Optimized business”

We have to recognize that most dissatisfaction from our consumer is coming from barriers that have been put up and disrupted the doctor-patient relationship which is what we all want as a patient. As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful […]

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We have to recognize that most dissatisfaction from our consumer is coming from barriers that have been put up and disrupted the doctor-patient relationship which is what we all want as a patient.

As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Paul Szotek.

Dr. Szotek is a Board Certified General Surgeon specializing in all aspects of hernia repair as the founder and CEO of the virtual Indiana Hernia Center. Dr. Szotek is leveraging technology for patient care enhancement, performing the full range of hernia repair from traditional open to advanced DaVinci robotics, offering patients unprecedented choices using shared decision making, and has grown the practice to unprecedented levels. In doing so, Dr. Szotek has grown a focused factory virtual hernia care delivery model into the largest deliverer of hernia care in the State of Indiana for a single surgeon.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?

I grew up in Valparaiso, IN, attended Indiana University for undergraduate and medical school. I trained in General Surgery at Indiana University School of Medicine and also at Massachusetts General Hospital. After finishing training in 2010 I joined a private practice in Syracuse NY. Shortly thereafter I was recruited back as faculty for the Department of Surgery at Indiana University School of Medicine in Indianapolis. Here I practiced Acute Care & Trauma surgery with a focus on hernia repair/abdominal wall reconstruction. During this time, we went from being a private practice to employed physicians. It soon became clear that I would not be able to practice as an employed physician and still maintain my Hippocratic Oath and integrity based on employment contract restrictions. Hence, I left Indiana University Health in 2015 to start my own private practice and do my Healthcare MBA at the Kelley School of Business in order to take on the business aspects of private practice and be successful. It became clear early in my MBA training that I would need to be ready to disrupt the entire care model to be successful, so we modeled the virtual Indiana Hernia Center in the image of such disruptive companies as Uber and Airbnb. This model has been wildly successful and has driven the virtual hernia care delivery model that we established to unprecedented success and patient satisfaction.

I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?

My father has been my biggest mentor my entire life. He was drafted into Vietnam and then on returning built a boat in his garage on the south side of Chicago from a kit they purchased through popular mechanics. From there he built a successful private mom and pop boat sales/marina that he has operated over the last 50 years plus. The most valuable lesson he taught me was believe in myself and never give up.

What made you want to start your own practice? Can you tell us the story of how you started it?

I started my own practice because of the restrictions of employment contracts and their results on my integrity as a physician. As physicians we take an oath to “do no harm” yet the instant we sign an employment contract with large hospital systems as they are today we are guilty of violating that oath through complicity. Most of these contracts have non-compete clauses, non-disparagement clauses, referral control language, and language that make us accept the use of personel and products/devices provided by corporate administrators with little focus or insight on actual patient care or the downstream affects. By complicitly accepting to use the product/device provided by the hospital we are not using our best judgement to do what is right for our patients but doing what we are told. The prime example is hernia mesh in my field. We are often told what product we are going to use and conditioned to use only the cheapest products that are obtained by large scale contracts. It is amazing how this usually results in the cheapest product possible being forced on surgeons to repair hernias.

Can you share the most interesting story that happened to you since you began your career?

I was fortunate enough to be selected as an early Google Glass explored and performed the first surgery using Google Glass as a rudimentary AR guided surgery in 2014.

Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?

We address the business aspects by leverage technology that provides value to patient in order to optimize the hernia care delivery pathway while minimizing wasted cost. We have leveraged the secure messaging application Klara to eliminate extra-staff and centralize care between myself and my office manager/assistant. In doing so just like uber is the largest deliverer of taxi service yet owns no taxis, we are the largest deliverer of hernia care in Indiana, yet I own no office. Instead of wasting overhead on an office space that is rarely in use, we lease by the hour when needed and leverage telehealth for the majority of our consultations and follow up visits. This provides a continuous and seamless care experience for the patient with involvement of me as the surgeon from there very first contact with our practice. Patients are astonished that they are in direct contact with their surgeon 24/7 and other physicians cannot believe that I give the patients direct access to me 24/7 through this platform. Actually, it really is not that intrusive in my life and has brought back the joy in caring for patients that has been sucked out of healthcare by large vertically integrated out of touch healthcare systems that do not value the doctor-patient relationship despite claims to the contrary. I call this like being back on “Little House on the Prarie”. When my patients need me they call and I can be virtually there anytime. It really has been rewarding to re-invent the doctor-patient relationship in this manner.

Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?

The key to managing both roles is outsourcing most of the management. I rent my space to see patients in multi-specialty clinics and thus outsource the space management to the landlord/hospital. As a surgeon this is the least they can do since I bring hundreds of thousands of dollars in revenue to the hospital each month that is incremental revenue for which they have no real skin in the game except collecting the fees. Another example is outsourcing billing and PA work to our EMR company who manages this team. By outsourcing the business aspects that require the most oversight and direct employee management I minimize my exposure to these time-consuming parts of the process. At the same time we leverage Klara to allow me to have complete oversight over the patient experience while working in a team manner to provide that to every patient. Every time. This works because we have eliminated the high turnover positions like receptionist through technology while allowing me to pay my office manager more and improve her work satisfaction.

From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?

The greatest struggle was making decisions early on regarding branding, HIPAA, management needs. We are no longer trained in business and do not get these experiences on the job anymore so I needed to educate myself. In order to overcome this I took courses in all these areas online in addition to my MBA courses. I leveraged Udemy to take courses on social media marketing and others to learn about every aspect of business and leveraging this knowledge we have built the successful virtual hernia center.

Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)

Customer Value:

  1. Doctor-Patient Relationship = Good Social Media Presence

We have to recognize that most dissatisfaction from our consumer is coming from barriers that have been put up and disrupted the doctor-patient relationship which is what we all want as a patient. We have to focus on bringing that back to healthcare as it is the fundamental tenant that drives our profession and will build a practice. Same as being a mom and pop boat dealer versus a conglomerate. Learning to leverage an excellent doctor-patient relationship into a world class online presence through Google Business pages and reviews as well as other online review systems will grow your business and this will be a direct result of improving your doctor-patient relationship with your patients.

2. Shared Decision Making = Marketing 101 (word of mouth)

There is plenty of data out there that if we talk to our patients and explain the choices, they are 3–5x more satisfied with their care. As awareness has grown secondary to litigation surrounding synthetic mesh placement in hernia repair and our desire to enhance the doctor-patient relationship we implemented shared decision making in our practice. This was driven by patient demand and our core value “Your Hernia. Your Choice”. Since implementing the shared decision making process we have found that the majority of our patients choose a newer technology of a reinforced biologic material called OviTex from TelaBio and our robotic ReBAR (Reinforced Biologic Augmented Repair) technique. As a result our business has continued to grow with word of mouth spreading quickly on this non-synthetic mesh based repair and the ability to choose the repair that is right for that particular patient.

3. Disruptive Technology FOR patients. Not OF patients. = Value

This is one of our core values and has been a central driver in our education of patients as well as communication with our patients across the continuum of the hernia delivery care process. When I started the virtual hernia center I looked at all the steps in the process from initial contact to the practice, first consultation, surgery scheduling, day of surgery and follow up. I looked at the process and realized that all the bottle necks in the process are mainly do to poor communication between the doctor/practice and the patient. Hence we looked for a technology that the vast majority of patients could leverage without additional training to remove these bottle necks. We settled on Klara because it integrated direct texting to me/office staff, telehealth, and forms so all paperwork and information can be completed remotely and seamlessly without long waits in the office and wasted time. This model was driven even further by the COVID19 pandemic. Unlike traditional EHRs and computer systems in healthcare this technology disrupted the norms of hernia care delivery while making the patient experience better and improving customer value.

4. Telehealth = Efficient & Enhanced Patient Care

Integration and comfortability with telehealth will grow your business exponentially. The entire virtual hernia center is based on this and we were fully functional during the pandemic crating unprecedented demand. This has carried over to our daily business and has enhanced our patient experience so that between the mobile registration capabilities and a brief telehealth visit we can optimize any in office consultation needed by making sure that we have everything ready to go prior to the appointment. What this also does is keeps us on time which we all know there is never a doctors office that is on time when you go into the office. In addition, we are redefining the post-op follow up visit into a continuous care model by remote monitoring after surgery. This has a lot of value if an issue arises to triage it faster and also to patients who do not need to come sit in the office for hours for a 5 min look and see. I cannot stress how much adoption of telehealth and utilization in the correct aspects of one’s practice can truly optimize your care delivery and in doing so improve patient satisfaction. In addition, this allows a flexible schedule for patients that they appreciate. I regularly see folks in the evening or on weekends when it is convenient for them.

5. Flexible delivery care model = Optimized business

We cover all the delivery care models from full telehealth consultations to in office care. This allows us to minimize the time in the office and use a model of space rental by time in multi-specialty clinics instead of paying a month at a time and not utilizing the space most the time. Our EMR is completely mobile compatible with Apple or Android and being platform agnostic enhances the ability of us as well as our patients to access the platform and eliminates the need/overhead for an office with dedicated computers lowering our overhead and a need for 24/7 brick and mortal office. Our messaging system does not require a patient to download an app just comes through a normal text message and then opens on a HIPAA browser page when the link is clicked. Hence we are not wasting staff time in training patients to use it. Office utilization is minimized by leveraging tech to provide post-op care and eliminate answering services that are merely placeholders and barriers to patient access to their physician. Our ability to flex and pivot quickly in response to the changing environment of healthcare has proven priceless. Early in healthcare physicians carried their practice in a black bag, now they can carry all their tools in the palm of their hands by means of a black smartphone if they choose. This philosophy is essential to success of a private practice in todays healthcare.

As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?

This one is answered by retorting that you need to learn to NOT spend most of your time IN your practice seeing patients by leveraging technology that efficiently frees up your time for other aspects of working ON your practice. At the same time you must leverage your technology to work ON your practice at the same time as working IN your practice. Marketing — We give patients hats and key chains on the day of surgery and ask them to post with a #indianahernia. We have the online review link within out Klara text the patient gets after the visit. Hence we are integrating the working ON the practice into the daily business of hernia care delivery. I would say that we spend about 10% of the time now on business related stuff because we have integrated the essentials for growth of the practice into the delivery of the care. At the same time we have chosen a web based EHR that does not require upgrading systems as it is continuously upgraded, we have outsourced billing and obtaining Pas for a nominal fee, and our practice is growing organically through word of mouth.

I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?

Take time for yourself/your family or healthcare will take all you have mentally and physically and keep wanting more. Over and over again we feel pressured into doing it for the team or just one more shift which becomes a revolving circle. What we learn with time is that we get burnt out and healthcare systems really do not care. They say they do but they really do not. Physicians have been turned into replaceable parts that are being chewed up and spit out at an alarming rate. We cannot be there for our patients when we are not there for ourselves or our families.

Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?

“A Journey of 100 Miles Begins with a Single Step” — Unknown

This quote was relevant to me many times in my life. As we set goals and reach for dreams we have to take that first step no matter how small or how scary to get there. For me, I had a goal of delivering quality hernia care to my patients with all options available to the best of my ability. I knew I could do it better than I was as an employed surgeon just towing the party line and not speaking up against the injustice that is being done in healthcare by vertical integration and IDN takeovers. However, it was uncomfortable and scary to go where I have not gone before. It was the first step that was the hardest but was the way I had to begin this journey to get where we are today.

How can our readers further follow your work online?

Thank you for these great insights! We wish you continued success and good health!

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