How This Surgeon Escaped Predatory Corporations | Dr. Cameron Walsh's Pathway to Peak Performance

This is significant that it will affect everybody in the United States. Well, access to care will become a problem cuz surgery is no longer subsidizing emergency rooms that lose money. We're not talking about small numbers here. We're talking about livelihood of hospitals, right? 75% of hospitals in Alabama are in the red and are closing day by day because the thing that makes money is surgery. And now the surgeries are going to ambulatory surgery centers.

75% of the corporations are controlled by private equity. What is the goal of private equity? Greed ends up leading to problems. When you're a top surgeon in high demand, there's just always going to be those opportunities. If you want to take good care of people, there will always be a place for you in any community.

Dr. Cameron Walsh, my good friend. Good morning. Welcome back to the Pathway to Peak Performance. Man, so great to have you all the way back from Birmingham, Alabama, which is quite a trip. You got in 1:00 in the morning last night because you're so full. You know, your surgical schedule is crazy, man. I don't know how you keep it up and manage a family at the same time. That's like I guess your wife probably manages the family and you just go where you need to go and do the things you pretty much.

She's a huge support. But you've been under We're going to talk about it. You've been under stressful situation recently and we're going to get deep into it and in the hopes that we can help other people understand what that's all about. So that's the goal. You know the deal. Last time we picked a local charity that you and wife are involved with. This time you said that you wanted to do Direct Relief.

Yeah, let's do Direct Relief.

Yeah. Great organization, phenomenal. Helping lots of people where it really needs to be done the right way and without the huge administrative overhead. Something that we're going to bang on hard today.

That's right.

Really just take it to the profiteers in the healthcare world. All right, so you know the show is sponsored by Ketone Aid. So we have last time we did K2.

That's right.

Which is just the the Esther with more water more water volume in it and it's just a little bit easier to drink. And really at the end of the day, it's the one that's easier to drink when you're drinking it right out of the bottle. I never really dilute that. It's just not my style. Some people do. I don't do that. There's K4 which is a little more hardcore. And then there's this this stuff called hard ketones and we we talked about it before and you wanted to actually explain the mechanism of action on this one. So I think it's going to be kind of interesting to actually talk about it.

Yeah, I'm actually pretty curious in this. I've never seen these before, but I think keto, right? I mean it processes in the liver to ketones and then at some point you hit a threshold and you're start to pee it out.

The receptor saturated there's no more desire. You don't have the sugar crash which is going to spike for some people the desire to drink more. So it's a really phenomenal um phenomenal thing. I think you're really gonna enjoy it. So you want to

I'm pretty curious. Yeah, I'd love to do that first.

Okay. So there's two ways to do it where we can just sip it as we go or you can actually just sort of you know imagine you're back in freshman year at Rush and you know shotgun one. So how do you want to do it?

No, I think we enjoy this one.

Okay.

Make a fine wine.

Yeah. Okay. Beverage of choice. Cheers, it is my friend. All right. Piña colada. Pretty good. I like it.

Yeah, actually. I think the flavor on this one's really good. This is pretty good.

I really like it. Yeah, they just such a great job with this these guys at that company. Frank Llosa is the CEO and Travis got the right hand man. They're just great guys.

When did this like come to market or really start becoming more of a thing?

It's like a couple years old now. But it was not really like it's just now really starting to take off. I mean, I think you're going to start to see this in bars.

I mean, I have not seen this at all in Alabama, period.

Yeah, it's it's not not widely distributed. My big fear is that like a, you know, a Pepsi or a Coke, somebody like that's going to get a hold of this and basically start to, you know, mass distribute. It tends to be the way corporate America's going once again. Here we go. Right. Not that there's anything wrong with that. And as a matter of fact, in many ways, if it's beneficial to the to the population, then I guess that's a good thing, right? Let the innovators create it and then let them take it out as a consumer product is probably a good thing. It can be more efficient. Not always.

Well, if you think about it, they've got to distribution much easier to scale very quickly.

Yeah. So, I think in many ways that makes a lot of sense. I love this stuff.

Yeah. This is actually really good.

Yeah. Really good. All right. So you had a lot of stuff happen recently and I think it's a cautionary tale. One in on the pathway to peak performance in in excellence and you know in the way that you operate and everything that you do is about excellence and being the best. If we were to rewind on this decision, there are a lot of data points, decision points along the way that I'm going to go out on a limb and say you probably would have done differently had you known where you would have wound up.

The good news is there's some golden light at the end of this at the end of this thing. It's all good. But let's let's take it back for those that are going to make a decision about where they're going to go in their career. It comes at a point in time where we're seeing hospitals sell off practices that they acquired for the surgical portion. So for instance, Optum getting is offloading orthopedic surgery practices. Hospitals don't want those those practices anymore because CMS, Centers for Medicaid, Medicare are essentially pushing surgeries out of the hospital where there's high cost associated with that. And this hospital can bill the insurance company whatever it is that they basically want.

Remembering that the number one source of bankruptcy in the United States is associated with medical bills. And so CMS is saying, "Okay, no, no, we want you to push these into ASCs, ambulatory surgical centers, where doctors can actually own a part of that surgery center." So, so it's actually a really incredible time. We're about to see some things happen in the surgical world where we're going to see almost a complete reversal of what's happened over the last 20 years, maybe more, and go into a new phase. But let's go back and let's talk about what happened with your practice and everything that's happened thereafter because I got to tell you being there along the ride with you has been really interesting to hear this whole thing.

Well, to go back to the orthopedic group and Optum, I think that is probably a great place to start because it is, you know, a 40- 50-year pathway that is almost completely flipping back to the way it starting to flip back to the way it was. And the real driver was that in the past, hospital systems always got paid more for any given procedure or code compared to a solo practitioner in their own practice. So therefore, private equity groups, hospitals trying to create value, create more money, they would, you know, work with hospital systems, own hospital systems, and the entire vertical and horizontal integration associated with them.

And so as they got paid more, that's when hospital systems decided to let's go buy family care practices and let's drive those patients into the surgeons that work for us at our hospital. And for example, for every orthopedic surgeon, you know, that's making between $500 to a million dollars a year, the real value that that orthopedic surgeon is creating for that entire hospital system is exponential because you've got physical therapy that they're collecting money off of. You've got medications they're collecting money off of. You've got the actual surgery in the hospital they're making money off of. And then all the follow-up care and then staying within the same system.

Oh, and and imagery, right?

And imaging. Yes. And imaging on their imaging centers. So they they they're making money off of every pathway affiliated with an orthopedic surgeon. But what's happened in more recent years now that kind of physicians have really gotten crushed to the point where everybody is looking for alternatives, this whole ambulatory surgery center has really taken off. It used to be very expensive to create one and it didn't have a lot of benefits. But now that doctors, you know, can own it and the alternative is making much less working in a hospital, they're like, "Well, let's go do an ambulatory surgery center."

And in that model, they're making money off the facility fees. They're making money off of the building, right, as another, you know, net worth booster. And then they're also making money off their surgeries. And then what they've really found now is patients are more interested in doing that model because it costs less for them. You can find all kinds of TikTok videos of plastic surgeons, orthopedic surgeons, ENT surgeons, where they'll say, you know, "if this was to get done at the hospital, it's going to be, you know, the hospital's going to bill $400,000. But, you know, if we take it to our ambulatory surgery center, it's, you know, $20,000."

The only real difference ends up being really what is the patient's out-of-pocket portion, right? And yes, in an ambulatory surgery center situation, the patient may have to pay a little bit more out of pocket than at a hospital, but it's efficient, gets done quickly, gets done by excellent surgeons and in a controlled environment that it has extremely safe, has huge history of being safe.

Yeah. And I wonder I wonder if we looked at the number straight line across the United States if the actual cost of actually going to an ASC is actually higher. It may be. I don't know. But I don't have any data to support that hypothesis. But I think that it might be you know if you were to take a look at it by state it may be different. The other thing that's interesting too is the risk for MRSA. So you know this resistant staff that is ever present inside of hospitals where patients you know spend too much time there.

You don't want to be there. Not good.

Yeah. because you know oftentimes very hard to control with oral antibiotics and you can wind up on IV.

Yeah. It can be bad. So I think this model is starting to make a lot of sense.

Yeah. So that's where CMS gets involved, right? CMS is finding that their primary perspective from their side of things is we need to reduce healthcare costs period, right? And so they're saying, "Well, why would we encourage sending patients to hospitals where it costs overall more across the board?" Because hospitals have generally had leverage to collect more, charge more for their work. Whereas if it costs CMS less to take patients to an ambulatory surgery center, it's in CMS's best interest to encourage that flow of patients to the ambulatory surgery center. So that's what's happening with that recent update.

Yeah. And it's, you know, the option, the obvious thing, is, you know, hey, reduce readmission, right? So, there going to be a lot of changes coming. And I think it's going to actually get pretty messy. And the reason why is because the next step is all of the legislation that's state-by-state surrounding certificate of needs, which is the ability to create an ambulatory center, surgery center, and bill insurances to collect facility fees. And you don't have that then you can't bill insurance right and every state is completely different.

In Alabama it's a certificate of need state to get a surgery center is very difficult and very expensive whereas other states it's much easier to get and so I think what we're going to see is we're going to see a lot of lot of politics surrounding this CMS update and who's controlling the flow of patients because we're not talking about small numbers here we're talking about livelihood of hospitals.

Right.

75% of hospitals in Alabama are in the red and are closing day by day because the thing that makes money is surgery and now the surgeries are going to ambulatory surgery centers. So it's not even this isn't something small. This is significant that it will affect everybody in the United States. Access to care will become a problem because surgery is no longer subsidizing emergency rooms that lose money.

And yet emergency rooms cost. It's insane. If you go to the emergency room, the costs on that are just and and not transparent, right? You have no idea what you're paying. You know, you're going to get some sort of crazy bill.

You have no idea who's contracting in that ER or ED. And if the emergency doctor is in network or out of network they contracted with, you never know.

You never know. You just show up and you hope for the best.

So, we're already seeing some of these changes in Alabama. So, the Alabama Medical Board just came out with a new rule that says as of January 1st, 2027, all ambulatory surgery centers, not not just ambulatory surgery centers, any physician doing surgery in outpatient setting, that's anything that biopsies local, anything under local, your dermatologist, anybody, any physician, anesthesiologists, right? Any physician doing surgery in outpatient setting, that facility will have to be AAAHC or Quad A certified anesthesia center, which adds in a massive amount of administrative burden and cost to those centers. And so that's just one way that the medical board is trying to counteract these CMS changes and force doctors and anesthesia providers back into the hospital where that administrative burden is no longer a concern.

And here's the thing on this show today. Timothy Rankin, Dr. Rankin, I think we'll try to see him later. He's great, absolutely awesome plastic surgeon, just got his Quad A certification and the way that they did it was that their consulting group plus the Quad A certification body was on FaceTime and they were going through and they were showing so they didn't even have to send out a Quad A person on site. So this comes this is really interesting, right?

Yeah, this comes at this point in time when there's going to be a massive need for certification. So, Quad A, like, I mean, I think I think what we used to call back in the day JCAHO, but now the joint commission is really relegated to the hospital world. I don't really see that too often in practices. It is going to be a revolutionary time. It is going to be a lot of changes.

Yeah, that brings up the reason why we're here is to really just talk about a bunch of different things that I've gone through that I think every young doctor and dentist and surgeon and anybody in the healthcare profession really needs to just say, "Yeah, I got to watch out for these landmines that corporate America is putting in our way."

Yeah. When you think about 75% of the corporations are controlled by private equity. What is the goal of private equity? We've talked about this before, but at the end of the day, they don't care about you.

Nope.

They don't care about the patient. They care about returning money to their investor. Period. End of story. That is it. I've heard it direct. It's not like I don't know these guys, right? So, the bottom line is, hey, they're doing their jobs. It's not a job I would do. Personally, would never be involved with that. It's not my thing, right? I mean, everything that we've created is all about care. I think what's interesting about what's happening is and you're a Quantum client and you're on the Grace track. So I think what is going to happen in all of this also is we'll see this massive push towards pre-consult, pre-surgical, post-surgical and ongoing recovery education.

Absolutely.

That's delivered in a way that has to be far more efficient for the practice. And oh gosh, I guess we're just in the right place at the right time with the right product in Quantum. So that's that's really, you know, Quantum PRM. I just sometimes you go, those days when you're working on stuff for so many years and you're like, man, I really hope this works out because this is a huge sacrifice. But here we are.

We are. I think it's huge. Yeah.

I think you have some other big things going on right now, too, don't you?

Yeah, there's a lot.

What's going on with Grace?

Ah, so well you know Grace we always say she she could be a woman right because inside of practices typically that's who you see. I think that just generates out of sort of like the motherly role of society. 80% of healthcare decisions are made by women right, it just makes sense. But Grace could also be I mean, Grace stands for Genuine Responsive AI for Care and Engagement, so it could be Tim if you wanted it to be, it can be Robert, whatever. We'll stick with Grace.

We'll go with Grace. Yeah, I like Grace, too.

I came up with the name, so I guess I'm a little partial, but you know, long story short, I think what's happening with Grace is so exciting because in healthcare practices over three decades, what I have seen is that patients don't show up to any visit excited about I mean like maybe in the longevity space so what we see with our cellular medicine clients and they're like excited, they want to talk about hey what are these peptides, small molecules, bioregulators, supplementation, really sort of exercise routines and things that they can do to optimize themselves. They may be an excited group of patient, they're already in the right mindset, they're trying to improve themselves, they're excited about it.

Yeah, we've had many conversations about this.

But the reality is, I think, that people show up to practices, man, they're kind of like, you know, they're kind of freaked out, right? I mean, people don't show up in your practice like super pumped or since we're Californians, super stoked to see you, right? I mean, they've got a problem. And so, the first thing I think that's exciting about Grace is the this is the notion that nobody wants to go through a phone tree. Nobody wants to be on hold. And no practice ever wants to miss a call. So the idea here is that we can just provide a better patient experience. Even though you're dealing with a digital human, it has guardrails on it. It can only give whatever the amount of information that the practice wants to give, but it's an autonomous agent. It actually can run your practice management system. As a matter of fact, you know, we're gonna it's going to be really interesting to see this new framework that you've put together and how it all works together. I think, you know, you're always the guy that's always thinking about, all right, how do I make this thing run smarter, better, faster? So, it's going to be interesting to see how that works.

I think the endgame here is to provide a superior patient experience to patients, to give them the there's a certain, you know, population of patients who just simply don't want to they don't want the small talk. They don't want to do that. Just give me give me my appointment. Right. Let's get it done.

Yeah.

So, that's where we are. And it's now about to really take off and explode. So, I'm just really pumped about it. It's a lot of work. Long, long time, a lot of hard work. And, you know, we put it up against Tesla's agent the other day, side by side, and it just basically blew it away. Now the one caveat I will say is first things first like him or not right, never rule Elon out. I mean he is and I think that comes down to compute and that could be just a demand on the data center, the latency. So what we're always trying to do in any of those situations is beat latency. That's the Turing test, is can you actually create an agent that sounds like a human being. Latency is probably the main factor or tonality, cadence, and inflection, an ability to actually kind of relate to, and it's going to improve dramatically. And we're making improvements as we go. We're in the version one phase of this, but it will become a thing that will free up front desk people to do more patient care related tasks, I think, which is is going to be super important.

Yeah. I mean, if you think about it in your practice, what you want is you want somebody to walk through, be greeted, where, you know, like if you look at a front desk, I've just seen it for years. They're trying to field the phone call, they've got a crying baby, they're trying to bring somebody in who's late, who didn't fill out their paperwork online, throwing off the schedule. It doesn't take much to throw the entire day out. It's like the washing machine where the towel gets out of sync and it's clunk, clunk, clunk for the rest of the day. Maybe at some point, you know, you you get it kind of squared away, but well, the more squared away you get, the less room there is for things being thrown off. A really efficient, streamlined model where you know that the patient's going to get this experience every step of the way, every single time is the goal.

Yeah. And that's the thing about you that I really love is that you want to make sure that you deliver to your patient what they deserve. And when you know you get into a situation where that becomes more and more difficult, it's pretty stressful. Stressful for you, it's stressful for the staff. And then that translates to we always say dogs smell fear. Patients smell sort of like disorganization or stress within an organization and that's not the way that you want to meet a patient first. So with Quantum we're meeting the patient before they ever come in. Grace certainly can help if you're using that and then we can just streamline the entire thing. It's an exciting time. Super pumped about it. We talk about that being like striving for perfection and it being, you know, the perfect pathway, the peak performance of this workflow, but I think we have to also take a step back and look at healthcare practices and dental practices as a whole. Most practices in the country are answering only 60% of their phone calls. I mean, why are we spending all this time worried about marketing and videos and content and TikTok things, all this stuff when the only thing everybody should really be talking about is let's answer the phones, right? In a timely fashion, in the right way every single time. And that would do more for every patient care and for every business than anything else.

It's crazy, right? So, we ran a model just like sometimes I just want to reduce things to the ridiculous. So we said, "All right, if you're operating 42 weeks out of the year, all right, practice is open 42 weeks out of the year, it's generous." I mean, I don't know that many people that take that much vacation, but let's just imagine that you did 42 weeks a year, average case value, straight line across everything, $3,000, a low number. You miss one call per week, you lost $126,000. If you had $126,000 in most practices, you can provide a patient concierge that is basically there with them to help them navigate through. Now, when you go to LabCorp or Quest for lab work, there's no front desk there anymore. It's great, right? I mean, you just go to a big kiosk, right? And that's where it's all headed.

Throw my driver's license in there and then like literally 2 minutes later my wait time is now significantly less every time I've been to Quest, right?

Yeah, way more efficient. So, I made this bold prediction. It may have been a little aggressive because you know Dr. Leonard Pastana says something I really love. "Healthcare moves at the speed of consensus," right? That's around the drug side of things. But I think when we think about healthcare on a whole, the notion of actually moving this aircraft carrier, you know, and turning it around to get to this may take a little bit longer. I may have been a little aggressive in my prediction. However, we're going to get there and patients are going to understand that and they're going to get a better result. The more they get the result that they're looking for, the more the practice adjusts. And I've often said it's not about replacing human beings. It's about providing a better patient experience. So we don't want to lose. I mean, if you think about it, healthcare makes up well this this number is going to change. 19.4% of our GDP is assigned to healthcare in the United States. As these things start to change, I wonder if that number is going to go down. We talked about previously. So who knows, right? This is too early to tell. But it's an exciting time. There's a lot going on. Let's get back to you.

Yeah. Okay.

Because this is really this is the story of 2026. This is the beginning of something that, you know, you're starting to see this thing starting to happen. And it's going to be really interesting to see what happens next. So tell us what happened.

Yeah. So, as I came out of residency, I knew that eventually practice ownership was for me. But obviously, I was very nervous about it, as is everyone because that's not what we went to school to do, right? We weren't given a blueprint. We weren't taught: here is how you run a business. Here's how you set it all up. Here's how you follow all your legal requirements and your city and your state and your federal requirements from a business and healthcare perspective. It's intimidating. And I think the system is intentionally set up that way so we don't learn these things because it supports private equity groups and hospitals and all the people that already have all the control. Right? So I decided to partner with a small DSO coming out of residency.

So for the listener that doesn't know anything about healthcare, a DSO is a dental services organization. It's a management group.

It's a management group that's funded by some outside entity.

Correct. And they're in the business to make more money. It's called the corporate practice of dentistry.

Yes.

They're there to make money. A dental service organization manager funded by some sort of outside money.

Right. The idea is that they are business people that are good at running a business efficiently and helping it do better than it would otherwise. That's the intention or at least what they sell you on. And not everyone is made the same, right? Some do accomplish that goal, right? Some run an excellent platform that drives, you know, increased amount of patient volume care that benefits the society that reduces overall overhead and yeah, they make a profit, but the dentist is doing more volume of work and helping good patients and they don't have to do this other work. So there is situations in which this could be done very well. The reality is that greed ends up leading to problems, right? I mean it's a sin that certainly corrupted the healthcare space. And in this particular situation, right, I partnered with a dental service organization with the intention of them helping me run a better business, get started efficiently and quickly and not make mistakes, right? They also have dentists that I can work with that can help with referrals. That's the intention, right?

Well, it very quickly got to a point where my personality wanting to go through every little thing and try and make everything perfect wasn't quite their standard, right? My standard of how I wanted things done was a little different. And so that started to create some friction. It also kind of led to a point where there was a bunch of things that we set up in the original contracts that I didn't fully understand and those things that I signed for ended up kind of corrupting the business a little bit over time that ended up creating more of like a chokehold and less of a pedestal to support me.

Let me ask you something about that. I hate to interrupt you when you're on a flow, but I think it's important. Do you think that they went into it with the intent of figuring out how to I mean, you would hope that they would prop you up, or do you think that there was maybe the notion of wanting to get control?

This is a great question. So, it's always about control and they will never go into a deal unless they have control. So, you need to know the first thing if you're ever going to work with a DSO in some sort of partnership, right? If they signed that document, they somehow have control. Period.

That's I mean, it's crazy. So, and you know in another business that you're also a client of, another business we have called Nuvaloom is an agency and the long story short is the minute a practice signs on with any MSO or DSO, any kind of organization, those guys want to fly to the moon on the cheapest rocket, right? Not good for the practice, not good for the patient, not good for the doctor. It's actually really bad for the doctor because they're really capping their ability to actually make the numbers that they need to make within that agreement that they've put together. So, because typically they're using I mean I remember the first time I talked to one guy, he's like the director of marketing for this organization. He goes, "Uh, can you explain what NAP information is to me?" I thought for a second he was kidding, right? And then I thought to myself, he's not kidding. This guy doesn't even he doesn't even know what he's talking about. He has no idea. I mean, the very the most basic stuff these guys are coming from, you know, one group had somebody from I'm not going to say the company, but it was like a, you know, consumer products company. Had no clue about healthcare. They don't know how healthcare works at all. And it's just about how do we bring stuff in-house, cut it down, cut it down, cut it down. And so patient experience just goes out the window with that in my opinion.

So it's interesting, you know, to kind of go back to the initial intention, right? Was the initial intention is they create value, they help run a business, they do it more efficiently, there's better for everybody. Well, I think when you were to go get an honest opinion from the investors that have control and own that management company, the real answer is how do we maintain control and drive profit, right? And they have two goals in driving profit. One is recurring revenue from the practices and two is what a potential sale will look like when they sell to a bigger fish. And that is where greed really corrupts the business. All right? And the idea is that when you acquire more and more practices, right, you have a bigger platform that you can sell for exponentially more money on arbitrage value.

Yeah. And I think one thing that has to happen in that equation is that you need to squeeze your expenses to get your EBITDA to a spot where it's super attractive for that acquisition. And they go out and they promise these terms that are like, you know, 16x. I've yet to see anybody I I'm not aware of anybody getting that.

Yeah.

That's like a bail multiple. That's just sort of And so people say 16x, but it's 16x of what? Right. Let's go manipulate those numbers. I can show you 16x, right? But you're going to be like, "That was some funky math that you just did there to to fabricate a 16x multiple because it sounded good." And it's like, okay, you know, I would rather have a 4x but a multiple of one year's net collections than 16x of some chopped down massive number.

But that but that's what they do, right? Is they're going to take your profit. They're going to chop it down. They're going to subtract some things. They're going to say, "Well, we need to add in, you know, when we buy it, we're going to have $500,000 worth of equipment and cost that we have to upgrade." And chop the number down. And they're like, "But we're still going to pay you this much." So, it's actually a 16x multiple, right? So, the multiple really doesn't matter. It's what is the actual number? And I mean, there's no such thing as a free lunch. It it just doesn't exist. You can't make something out of nothing. So, let's let's talk about um let's give credit where credit's due. What's the benefit for somebody? I mean, and we look at people who are coming out of residency, they got massive debt. You paid for everything. You know, I think that's one thing that people when if I'm a person I'm listening to this, I go, "Well, this guy's just thinking about business. He's thinking about healthcare from a business standpoint." Uh-uh. You have massive debt. You did a six-year program, right? DDS MD program. That's a huge what is it? 14 years post high school of just you know imagine high school and then for 14 years you're really living close to the wire. You got a lot of making up to do to support a family. So for a person coming out of residency it makes a lot of sense and I think that's why like there are certain organizations where you know they just offer a ton of money to these residents to get them in, they throw massive amounts of money. And these guys look at it, they go, "Hey, I can erase my student debt."

Yeah.

And but that's not that's nothing new, right? This was done in accounting and investment banking and lawyers, right? There there's always been deep recruiting, right? Get people locked in, the really good ones, when they don't know that they're really good yet, and they would be better off on their own. Well, there are some I mean, if there's a mentorship and that's another huge factor that does that is of massive intangible value that people don't attribute to these situations, right? If there is some really good mentorship, it's worth a lot. You can typically get that in private practice by coming in under, you know, being an associate, then going on to being a partner. Private equity groups corrupted that a bit for a period of time. I think we're kind of past that and we're done with, you know, older doctors, you know, kind of manipulating the situations to benefit their exit, right? I think that happened for a period of time and a lot of younger people got kind of hosed on that, but I think that's kind of swung back to the point where now the remaining doctors kind of tend to want to provide more mentorship and do do what's right long term.

Yeah. Let us not forget that there are a lot of doctors who are in this because they want just want to take care of people. It's right and there that's real.

Yeah.

So it's a great it's a great model for somebody who's getting ready to retire. "Hey, you know what? Buy up my practice. I can start to offload some of the management responsibilities. I don't have to do anything." I think it's maybe a little bit of a shock when I've got to ask you if I can go on vacation after all those years of never having to worry about I can do whatever I want. Now I don't have those options anymore and maybe now my manager, you know, his experience is Enterprise Rental Car and he's saying you got to operate on this kid, but the kid has a fever and doesn't understand why you can't do that, right? I mean, I've heard that before. If you're in a good situation with a good dental service organization that's really supporting you, helping you with education and mentorship and student loan debt and providing good volume of good cases and your happiness, it could be great, right? There are those are out there and those are great, but it's getting tougher and tougher.

Well, it's going to be interesting to see also at the end of the day, you have all it's like it's like the EHR business back in the 2009-2008 era, you know what I mean? before CCHIT. And, I think what we saw was there was all these different EHRs that were out there and what people were trying to do. And I can remember being in the Senate Hart Building sitting next to Patrick Kennedy where he's talking about, "hey, if we had a 737 going down every single day, people would stop flying. But we have that happening with medication interactions and people dying because we don't know, you know, they're getting prescribed stuff from different places from different doctors and there are interactions that are causing these problems."

Even simpler than that, you have people dying every day because of pre-authorizations on insurance companies preventing access to surgery that people need.

Or what about this kid that died of the inhaler thing? Yeah, you heard about that recently. I mean, that's insane, right? The oh, now the formulary changes.

Yeah.

You know, you take a look at the structure of how healthcare really works. I think you know this I don't know how long this can last. I don't really know how long this can last where you actually have an insurance company that owns the pharmacy benefit manager or the CVS owns the insurance company that owns everything. It's all one continuous loop. And then all of a sudden this inhaler that you need is no longer on their formulary and they turn you away and you've got asthma and all of a sudden you just die because there wasn't anybody there to say we switch you off to this alternative.

Yeah, that happened. That's a pretty sad state of affairs. I mean, you kind of wonder like who's making these decisions and and then we have to get into how much will AI play a role in that moving forward. And that's going to be you know the other day mentioning Dr. Pastana quite a bit but he said on the other show that we have "Cell Systems," he said, "you know this year a doctor will be sued for using AI in a treatment plan and this at the same time a doctor will be sued for not using AI in a treatment plan." Kind of a crazy, crazy thing.

Yeah.

All right. So let's get back to your story. We keep diving off into these different areas. It's like I guess these hard ketones are, you know, or they're effective. It's pretty good. What do you think? You like

Yeah, I do. I like these a lot.

Yeah, it's like nice and mellow, right?

Yeah, just sort of

Wow.

Okay. So, you got in with these guys and then things are kind of like you want to do some things your own way. You're a high performance person, peak performance guy, but they're also they've got some things that happened. So during the initial phase, right, as all everything is growing and things are going great, everything is great, right? The issue happens is when there is friction, right, and things start to devolve, right? That's when the problems and the contracts and all these other details start to become a problem, right? And so what started happening was they're essentially insolvent, right? So their side of their businesses not doing that great, right? And there's a few reasons for it. And the reality was is they just didn't have a great succession plan for their practices, right? If you're going to buy retiring doctors that want to retire in 3 to 5 years, you have to have a robust model of recruitment and training to replace those doctors.

Well, that kind of kind of all hit all at once where you have like between five and 10 doctors all retire. Health problems, retirement, all kinds of things all at once. And now you need to replace all those doctors all at once. And if you can't, right, your revenue goes down. And if you replace them with brand new doctors right out of school, dentists right out of school, they're not going to be producing like someone who's in their 50s or 60s towards the end of their career who's really good, right?

And they have no mentor.

And they have no mentor. So now you had all of a sudden this massive change in their profit and loss statement, right? They're now they were in the black and now they're in the red just like that in a few month period of time. And you know, you kind of could see it coming and things were getting, you know, as older doctors were retiring, their total revenue was going down and down down a little bit, but nothing too significant until just this massive volume of their portion of their doctors had to change over. So, as their practice became insolvent, now they're still looking at, well, how do we maintain our business? How do we stay afloat? How do we stay alive? Right? and the current interest rate environment doesn't help. And if you've already overextended on terms of your debt, like there's not a lot left, you can you can't go get more money. So, that's essentially where they ended up was they grew too quickly. They bought too many offices at too high of that keyword, EBITDA multiples, right? They they overbought, they overextended, and then some of the offices had to close because they had no doctors. And then they had this massive changeover that led to them being hundreds of thousands of dollars a month in the red, basically not paying some debts and paying interest only on other things. They're way overextended and then they had a decrease in revenue. That's that's the death of a business.

Yeah, bank calling, everybody's calling.

When your when your oral surgery practice goes from, you know, being very small to then being, you know, more like, you know, a fifth to a third of their business, right, and it's doing fine, but then the rest of their business isn't doing well, you essentially became the only flotation device left keeping the boat afloat. They've and and and that creates more friction. And so now when you go and you look at your contracts and agreements and your business, you know, documents and business service agreements, right, there's there's a management service fee and there always will be in every sort of DSO or MSO model where they charge the practice for the services that they are supposedly doing for the business. And that number just became ridiculous.

Well, and here's the other thing too, right? So, let's go back to one of the fundamental problems in this equation, which is that the tide rises all ships.

Yeah.

Right. But you're landlocked, you're locked in some sort of chamber where you're expected to produce, but their inability to produce the referrals that keeps your tide at that height became a very large mismatch, right? So you have this asymmetrical situation that you're trying to manage and it just is not sustainable.

And you know that gets into the emotional or subjective side of these relationships, right? Doctors are going to think that they're worth a certain amount of money and they provide all this care and they they have expectations about what they think their value is, right? And that partner group is going to have expectations on what they think your value is, right? And those are always going to be mismatched, but they know that they need you. So, they get you in there for whatever you've agreed to. But, when things go poorly, right, you are going to think you're worth more than you're getting, and they're going to think you're worth less than what you're getting. And that, kind of came to fruition in this relationship where I felt like I was doing my share of the work and they weren't doing their share of the work. And that mismatch is just not okay with me, right? I'm not going to come in and put in 110% every day, work nights and weekends, take time away from my family, and, you know, manage all the staff and do all the management and the business work that they're supposed to be doing when they can't even manage their own businesses and provide referrals to help me, right? And that's that's the meat of it, right? That creates conflict. And then that leads to the next year of my life of how do you separate, right? And separation is where the rubber meets the road and is extremely difficult to unwind.

I mean, there's all sorts of landmines that they set up along the way that you didn't know going in. And unless you've got a really astute attorney, oftentimes probably can't afford that particular person when you're going into those agreements initially. But that would be something I would say money well spent, right? Get the best possible, you know, some good advice from some family members. And my aunt told me going into this, she was like, "you know what? At the end of the day, you're young enough, you'll always have more opportunity in the future. And even if all this falls apart, you will have learned more than you could possibly imagine in the next few years." So in terms of personal development and investing in yourself, it was worth every penny, right? The business experience, the interpersonal experience, the relationship building, it was, you know, invaluable in terms of those things, right?

Yeah.

I've seen behind the curtain. I know how they operate. I know how these things happen. So now whenever you want to do business in the future, you're prepared.

Yeah.

And you know what to do.

Yeah. And I think at the end of the day, when you're a top surgeon in high demand, there's just always going to be those opportunities presenting themselves, right?

There always will be, right? If you want to take really good care of people, there will always be a place for you in any community.

Let's let's talk about personal health journey recently. Um, because you you're hitting it pretty hard. The gym is is on on the radar big time for you and that's pretty exciting. I'm pretty I'm pretty stoked for you.

I'm trying.

Yeah. Well, sometimes it's a little you get get going and then you fall back in or you know travel happens or somebody your workout partner, you know, texts you at 5:10 when you're already in the stream of getting ready to get up and get going and you don't see until 5:55 like what happened to me this morning to be at the gym. My workout partner is like, "I've got a migraine. I'm not going to be able to make it." And this is a particular workout that you can't do by yourself. So, that stuff happens. You know, hitting the gym is great. But I think, you know, more from like a longevity medicine perspective, the two most important things is appropriate sleep and sleep hygiene and diet. And so if you have a a certain workout regimen, no matter what it is, doesn't even have to be that much. As long as you're nailing the other two, even a little bit of exercise makes a huge difference. I live in a in a world where at this stage of my life wasn't always this way. I mean, obviously I have done a ton of travel in my career and lots of entertaining and all those types of things, right? So, I I haven't always been perfect, but what I can say is that the exercise routine that I'm on now makes a huge difference for me and allows all of the other things to happen. One of the things that's most important, I think, for people to understand is like hydration.

Yeah.

That's something that's missed oftentimes by people. I was actually writing something about that this morning. and just sort of like what people think is just like, "hey, I can just drink water." Oh, drink enough water. You're just going to flush out all of your electrolytes. You're just I mean, there's only a finite amount of that you can do. So, there's some other ways that you can actually get your cells hydrated so the mitochondria can produce ATP and you can, you know, function with the right amount of energy. But hydration is just like core. I'm wondering like I mean how much water are you drinking every day?

Not enough. Like I I I will work through lunch if I if I'm busy. I will you know that definitely is second nature when I'm at work, but I try and go over and grab water anytime I'm thinking about it. I try and think about it more and more.

I'm going to send you a something. and I'm going to put you on a 30-day challenge and then you're going to go for about 2 or 3 days and I'm going to see after you do this. If you if you go, "Ah, I didn't need that at all. Doesn't matter. Doesn't make any difference. I just..." You know what? You're you're a discerning guy. You're going to be able to tell the difference. I want to see what happens. So, I'm going to send you this stuff. Will you drink it if I send it to you?

Yeah. Okay, cool. I'll try it. I'll look at it.

Yeah, that's good. Yeah. I love what you said. Last time you ran, we were talking about you know sort of like glyphosate and in your neck of the woods, well I guess in the Mississippi River Delta where we see that huge dead zone from all that high phosphate that's been you know run off into the Gulf of America.

The reality is that it's pretty crazy to think, I mean, like you've got to be really careful. Oh, I love what you said before about sourcing your food, really being paying close attention to, you know, we I live in this bubble, right, where everything that we get is, I mean, we have options to get everything at the highest quality and it makes you really realize there are people that are just living in food deserts that just don't have access to a lot of the stuff. It's assumed poison all day.

Yeah, it's terrible. And I think, you know, if we really get down to it, I think you've just nailed the head. I mean, if we really want to call it like it is, it's like, hey, you you nailed it. Sleep, which, you know, obviously travel disrupts your sleep patterns. You know, certain things can put you into a sleep out of whack that maybe you never recover from. Residency has an impact, but sleep is critical and sleep hygiene, which is really that's something that you know, I think people should really learn more about, like, how do you manage absolutely your sleep, you know, and there's all those devices on the market that like kind of try and help track your sleep and things like that and I think those are excellent.

I think some are much better than others and I personally use this Whoop band thing and then I've got like the Whoop scale and yeah, it just provides me a ton of metrics on everything. And so, you know, as I was working on my sleep hygiene, right? There's a bunch of things you can work on, but I found that if I just go to bed at 9:30 every night, I naturally wake up now the exact same time every single morning without an alarm and I wake up like ready to go. And then I do my workout routine and my nutrition routine in the morning. And then I have a big lunch. And then I pretty much don't eat anything after 5:00 PM. And I feel incredible. Sleep and the food. It was a huge starting point, right? No processed stuff. Get rid of all the crap and then good sleep and and appropriate amount of calories of high quality stuff and you instantly feel better.

Yeah. You're probably what, on the 16:8 fasting sort of regimen?

I don't even call it or name it, right? But the part the real reason why I don't try and consume too much after 5:00 p.m. is for like acid reflux. Years of schooling and stress and drinking at nights and things. I mean it, you know, allergies, allergy medication can make acid reflux worse. I was having a bunch of acid reflux improving my health, it's gone now.

Yeah. You know, I fought acid reflux for years. And there was actually I found somebody who helped me and we went through a protocol and completely reversed it and it was like a food elimination. You know, it's interesting there's just more stuff talked about in the gut microbiome now. It's like you know there's this seriously it's like this app that you scan anything and it tells you all of the bad stuff that's in it and gives it, awesome. It's so cool, dude. You got to check it.

Yeah.

So the long story short is like people are waking up to like, "hey, what I put in my body," more are waking up, "what I ingest and also what I put on my skin." Something just really came up. Another thing I was writing about is phthalates and you know, the chemicals, perfume, that basically enables them to like hide all of the things that are the chemicals that are inside of that particular scent fragrance. Those fragrances are endocrine disruptors, massively can cause massive problems for people. You go to these hotels and all these other places that put it in the ventilatory system, then you're just going into these buildings just breathing all this stuff in, control the control the person's experience. It's insane. You know, I would actually take, you know, there at one point in time there was like scent design where they were designing scents for people, you know, they come in, but I think, you know, that's kind of the one-size-fits-all. I mean, anyone could be sensitive to any kind of scents. So, what could be really appealing for somebody could be completely off-putting for somebody else. So, I think it's better to go scentless, right?

I was going to, you know, take you to this place for dinner tonight that is probably the one of the best sushi places, has been for a I mean, it's rare to see these restaurants survive for a long, long time, is because they're just really top-notch. The problem is that they started using what I can smell right away is a product, I don't know if I should actually mention it because I don't want to get in trouble, but it's a, you know what I mean? It's a it's a cleaning I don't want to get demonetized, but the it's a cleaning agent that basically is kind of new on the scene and there's a particular population of people who love to use it for whatever reason. I don't know why. And it's like you seriously just like I mean, like I'm sitting here I'm eating this incredible food, right, that you just are craving, you've been waiting for it, and you're like, "oh my gosh, you know, it's so clean, it's so good, it's like perfect," and then there's this smell, and it's the worst freaking smell ever. It must be cheap, and it's like and it really hides I think the other thing too is it probably hides mold mold toxin, right? So anything that smells moldy is probably covered by that, and there's a ton of mold toxin. I wonder down in the south where you are, I know when I was, don't get me started on mold, it's bad, right?

It's the south. If if a building goes un-air-conditioned for like 3 months, you basically have to tear it down, that it's all just caked in mold insides. I mean, you can't see you, you Everything has to be air-conditioned all the time. Otherwise, mold is a problem.

Yeah. It's funny. When I lived in Houston, they told me to run the air conditioner in the winter.

Yeah.

All the time. Dry everything out. Get rid of all the humidity and the moisture because stuff happens. So, last week my wife was in Europe, St. Harry Styles. And so I'm at home with my three kids and one of the HVAC systems goes out upstairs. And so now it's like 90-something degrees in my upstairs area for a few days. Within like literally two days, the whole ceiling in our downstairs like half bath just turned into a forest of mold.

Wow.

Like in a few days because there was I guess a slow leak for a long time in the ceiling and the walls in that area and it never really came through the walls, but the inside of the walls was just had a ton of moisture and then the moment that the heat happened just grew, right? I mean, you're taking a petri dish from the fridge, you're putting into the into the light, and then just the the mold just grew like crazy.

That mold exposure can be, for some people can be like not a big deal, right? They can kind of like they can handle it. For other people it puts them into like it's like almost anaphylactic sh I mean, that's an exaggeration. Oh, but it can be really bad.

Yeah. Yeah, I'm pretty sensitive to it, but between the acid reflux causing nighttime asthma and then some mold exposure. Oh man, I'll I'll be the worst asthmatic.

How do you deal with that? What do you what did you do? You had to like come in and rip the house.

You pay. You pay and you fix that as fast as possible.

Yeah. You get the HVAC fixed and you rip it all out.

Wow. Yeah. And insurance covers part of it or no?

No. No. It's south. Good luck. Does your insurance cover an implant? No, it ain't covering mold either.

Yeah, that's that's crazy. That is wild.

Yeah, I remember that. That smell. It used to be like when you get off the airplane in places like Miami or Mexico, you'd smell the mold in the you could tell the difference, right? You get there and you go, "Okay, there's there's mold." But didn't even know back then to even think about what the ramifications of it might be.

Yeah. From a neurotoxin standpoint, what are the what are the downsides of mold? As a doctor, when you think about it, what what are the things that people are going to are going to experience from mold exposure?

You can have chronic lung problems, right? You can get, I mean, little fungal balls that grow in your sinuses or your lungs that cause long-term chronic lung damage and it you can have significant long-term side effects, right? You can get aspergillosis, which is a common mold that'll cause chronic like bronchiectasis or chronic lung inflammation that leads to bronchiectasis or dilation of your your passageways in your lungs that then decrease your lung function. So you you breathe more and get less.

Yeah. And then you can have I mean just chronic irritation, chronic inflammation of your immune system, right? Your all kinds of blood levels could be out of normal ranges.

Yeah. Not good.

Not good. Well, let's talk about what is the good news. What's the good news? So, there's some big things happening for you and the good news is you survived all the stuff that took place and now you're back in control of your own organization.

100% owner of my practice and it will stay that way. Local doctors, local care, 100% owned by me. Making sure it's all taking care of patients the right way.

You know, it's interesting. Patients actually know the difference now.

They do. I think they've been abandoned enough now. I think their their doctors have transitioned too many times that people are now like, "If I'm going to do this procedure with you, are you going to be here at 6 months to finish it?"

It's interesting. I mean, I wonder in the marketing if that's something that you just really have to say.

I think you have to. I think it has to be like your subtitle or underneath your name, right? 100% owned by me, right? And and you have to stand behind it. I mean, the good news for a guy like you where, you know, you're going to take care of the patient if there's any kind of look, complications happen in any Dr. Frank Ku was here the other day, he's owner of Progress Pharmacy and co-founder of New BioAge, you know, and he was talking about peptides. It was like, "hey, you know, there isn't, you know, we'll always talk about drugs on a whole, but there isn't a drug that you take that doesn't have some sort of side effect associated with the effect that you're trying to achieve," right? So, I guess when we think about taking like, you know, some sort of, you know, acid blocker, then now there's some sort of thought process that that could have some neurocognitive issues associated with it, right? So, there's like there's pluses and there's minuses. I don't know how much research there is on that, but for you, you know, when the buck stops with you, the good news is you're the guy that's like, "Hey, if you have a complication, I'm going to take care of you all the way, no questions asked." Handled.

That's right.

Right. And that's going to start to trip. That's also I I'm going to make another bold prediction. This time I'm not going to be as aggressive about it. I'm going to go out a little more, but I'm going to say 36 months from now, we're pulling back this slingshot right now. But when it lets loose and people really see that, I really think these corporate practices are going to have a lot of growing trouble. I mean, I already have a handful of friends that have really gone down this more, you know, buy their own office, run their own office, and they are thriving. All right.

Yeah, it's a lot of work to get it set up, but you get it set up and you have a good team and it gets pretty manageable, but they are they're thriving. Everybody I know that's thriving owns their one office.

You did something else recently that I thought was pretty cool, from a tech stack standpoint.

Yeah.

Obviously were involved with you on the tech stack side for just one piece of it, but you left, right? We're not going to say who they were, but you left probably like what at one point in time was the hottest sort of PM EHR in your space and you went to an open-source product, correct? And you put in an entire business intelligence piece, when you connect it all up with Quantum and Grace and all of that, you've got something that's really potent. And actually, the cool thing is you can help other providers with that.

That's right. Yeah. Now, we have it's it's a very low-cost efficient model that's open-source. So, now like, you know, vendors, you can come and go with different vendors, right? You're not signing your contract with AT&T for your home internet and your cell phone and then when you want to cancel one, you can't because it's, you know, connected with the other. You truly can have each of your vendors and really perfect your tech stack and make it ideal, right? So you got your practice management software, we run all the data into our Power BI, you know, data intelligence, business intelligence platform. So now I can have the exact dashboards that I want to show me only the relevant information to make appropriate decisions. I can run all my phone data into there. I run all my expense data from credit card company into there. And then we have a a revenue cycle platform that we work with called Daydream. That's phenomenal. And they they handle everything from the beginning to the end of the revenue cycle. So now with this new tech stack, me and all of my staff when we're at work, we are 100% focused on patients. We don't have to get distracted with all this other stuff. And it's a it's really low-cost, really really solid tech stack at this point. And even the RCM data and the insurance level data, I can run all that into Power BI and have a really robust amount of data.

What's really cool about that too is you start to understand how a payer is actually going to pay, right? So, you know, "hey, CMS is going to pay whatever they're going to reimburse on this amount. This is their fee schedule. They're going to bring back this amount of money to you by this particular date." Allows you to understand like what are the things that you can do within your practice. You're not guessing. You're running your your practice in a way that allows you to really have a good clean insight into exactly what you're going to need in order to be effective moving forward. What kind of equipment can you afford to buy? There's always something new, right? There's always something new that's coming out. I mean, I think you have all the latest and greatest equipment. I don't think there's anything you really need to add, but there will always be something down the road, you know? But like you have a lot of people paying for these, you know, KPI data analytics platforms and you know they're costing like $1,000 a month, $1,500 a month for all this. I mean, Power BI yeah you have to build yourself a little bit but it's pretty easy now that you can use like Claude and other stuff to just program your dashboards and manage your data the way you want. You do it on your own. It's $20 a month. I mean it's super cheap and I have now complete control of my data.

And you know the other thing too, last time you were in going back to this other point, you're like, "Oh, hey, where I can save, I pass that savings on to my patients because I actually want to be able to do more of the cases that are going to be successful for those patients so they don't wind up somewhere, yeah, that may not be as good." I mean, the downside is this is a lot of work, right? It's it's a lot of time outside of taking care of people to build all this stuff and get it set up, but I think it's worth it.

100% worth it. And and not everybody has the fortitude to do it or the smarts. I mean, let's call it like it is. That's a technical endeavor and it's not for everybody. You have that. I mean, I think you come from this family that has like this engineering background. So these types of things are probably, you know, this kind of stuff is like not that, you know, you're a technical guy. This is not that hard for you to do. But for some people, this is like, well, I wouldn't know, you know, they wouldn't know what to do with it.

You just have to start somewhere though, right? I mean, the only you're you're never going to get a solution unless you start. You got to try. You got to start. And you got to make mistakes. You learn more from all your mistakes than you learn from any of your successes. You just have to do it. And I think that's that's the reality where I think most doctors need to get to today is they need to realize, "you know what, I'm not going to let the fear of the unknown and the failure stop me from owning my own practice. I need to just get out and I need to do it and I need to make the mistakes and I'll find a way to survive and then eventually it will be worth it in a few years."

Critical, critical, especially for for, you know, expansion and wanting to actually, you know, do the have the ability to serve more people the right way, which is now going to be a big thing.

It's going to be a big thing. There's no there's no stopping it. That horse is out of the gate. It's gone and there's you can't bring it back now. It's done. So, I guess before we wrap up, we should talk about this. Remember the last time you talked about this one, was it too? You're like, "Oh, yeah. Like, I feel like sort of like what'd you say, like buzzy or something like that?"

We did a pretty quick ramp-up and it feels a little bit more like a buzz, a little vibrating. There were no crashes. It was pretty good, but I certainly prefer this more. It's more like a very slow smooth social lubricant. Makes you, I mean, it's why people drink, right? But it's it's without the kind of the downsides. It's not as it's not as high of a high and it doesn't have the downsides. People are really waking up to the fact that alcohol is not good, man. It is not good. They miss the downsides of whole health thing. I stopped drinking coffee and I basically stopped drinking alcohol. I'll have a glass of, you know, really nice wine every once in a while, but other than that, it's bad. I'm I'm not I'm not going back to the whole coffee and alcohol thing.

Well, there's I mean, the reality is that, you know, the social pressures around that. I mean, it's like everybody's drinking coffee. Everybody's going out and having drinks. Everybody's doing all those types of things. So to kind of be away from that is, but I think a lot of people really just starting to say like, "Hey, that doesn't that doesn't work." I mean, I'm not a coffee guy. It's just not my thing.

Oh, I love coffee more than anything.

Do you?

But it just it relaxes your lower esophageal sphincter. Makes your acid reflux exponentially worse. Right. It allow you know that coffee is in your system causing those effects on increased acid production and lower esophageal sphincter tone 12-24 hours. So you have, you know, a couple cups of coffee. If your last one was at noon, I mean, you're you're going to cause problems. And then the other issue is is like all this massively produced coffee now is, you know, grown too quickly. It's not the way it used to be. And then they mass-produce or mass-package it. They store it. It gets mold on it when during its packaging, it's sitting there. And and then it's also just extremely acidic because they're producing at these low altitudes. And so it's it's the quality of coffee is declined.

Yeah. And how they roast it, all this kind of stuff. I mean, I'm just glad I was just not my thing. Well, the good news is that there are alternatives to all of these things and, you know, the key is to try to stay as healthy as you possibly can. Try to put on as much muscle mass as you can, in my opinion. I think the data is really is really clear. Muscle is like the needle.

You got to have it.

Minimize visceral fat as much as you possibly can, which is totally controlled 100% through diet and exercise.

Yeah.

And you got to have a good balance on cardio and strength, you know, or resistance training. It's just it has to be like there's no way, you know, VO2 max, it is what it is. You have to have it. You've got to you've got to keep that up. And I think when people do that, they start to feel so much better. They start to go, "Oo, I couldn't do those other things because it would affect my training the next day," you know, or when they do it and it does affect their training the next day, they go, "uh, you know what? I'm not I don't really want that. I don't really want it." I mean, even for like people that have like a familial risk cardiovascularly from like the apolipoproteins and stuff, like if you still do all those things, you've massively addressed those.

So, I mean, that that that's my situation, my family on my dad's side. I mean, we've had plenty of people die at a young age from heart attacks. They also smoked, which contributed to it, and they also didn't live a healthy lifestyle that contributed to it. But then someone like my father, who's lived an extremely healthy lifestyle his whole life, very active, always outside, exercising, he's doing great, even though you have we have those apolipoprotein risk factors.

Yeah. The apo stuff people don't really know. They just think LDL and HDL, total cholesterol. They don't really understand a particle sort of relevant but, you know, you got to look at your oxidized LDLs. This contributes to your your atherosclerosis. And you got to look at your apolipoprotein B and your, you know, lipoprotein little a, and those are really also, and the densities of of your molecules. The small dense ones, I mean, that just increases your risk of clogging your arteries, and then also now there's the talk about microplastics playing a role in actually accelerating that. Yeah. Although there's a new thing, I'm sure you're aware of this, the Cleerly scan that can really help, you know, where they can give you this scan and basically tells you how much plaque you've really built up. So, according to a calcium scan

Yeah.

And it really goes through and it shows where the plaque is. And then, you know, there are ways to obviously treat that. How aggressive you get with it is dependent upon We'd love to not We'd love to prevent it. I mean, the problem is we got the standard American diet where people are just doing what they're doing and, it seems like that's not going to slow down anytime soon. But, you know, it is what it is.

I think the good news is that there are solutions out there for those that want to find them. The sooner you start the better off you are. You know, like you're a young guy, so you know, you've got this opportunity to play, you know, not run into those kind of problems that you might, you know, what do they say? Uh, you know, Alzheimer's, dementia, all of those neurocognitive things are are diseases of decades, right? It's what you've done here. I would say the same thing would hold true to heart disease.

Absolutely it does.

Yeah, you got to start now young.

Yeah.

You know, it'd be really interesting to see you in about six months, maybe a year. We'll see kind of like how things go. But I really would love to check back in and talk about this stuff. I know it's a heck of a trip to come out here to be on the show, but I really do appreciate you being here because it's always a fun time.

I love coming out here.

Yeah, it's always fun time and we cover such great stuff and the big changes that are happening are going to be monumental and so you're right in the thick of it. It's just awesome to have you here.

Thanks for having me. This has been awesome. Thanks, guys.