Why Elite Surgeon Rejected Millions from Wall Street?

The kids call it biohacking, but I call it not eating a bunch of crappy food, you know, not eating stuff that will kill you. The efficiency of what you’ve created as a practice is remarkable. You think of it as a system, but it’s really choreography. Everybody knows the dance, and they know it so well that sometimes it feels like they’re reading my mind. There are cues, and there are ways we know exactly what to do all the time. It’s nice because it’s teachable. We’re starting to see more medical practices breaking away from private equity groups and doing concierge medicine and things like that, which sounds like rich-guy stuff, but really it’s kind of what medicine was 50 years ago. You provide service to somebody else, and if you always think, “I’m going to provide service to somebody else that’s valuable to them,” it will be good for you.

Dr. Russell Lieblick, welcome to the Pathway to Peak Performance Podcast. So great to have you here, my friend. Thanks for coming down all the way from Oregon. On the show, the first thing we have to talk about is your charity. Which one did you choose? Make-A-Wish. Phenomenal charity. All the proceeds from the show and all the views will go to Make-A-Wish. We’ll put the link in there so people know we’re going to send that stuff to them, and if people just want to donate, they can donate directly from that link to Make-A-Wish. They do such great things for people.

The show is sponsored by Ketone Aid, which I have to say is the Ferrari of ketones, as I always say. There are two different versions here today to try: the K4, which is a little more concentrated and has a real flavor, and the K2, which is a little easier and has more water in it. You pick one, put some caps in the water there, and we’ll drink them. At some point through the show we’ll go, “Hey, how do you feel?” This is fun. I’m a big believer in this stuff. You really made a huge change in the way that you eat and had phenomenal results with that. Yeah, I was getting into my mid-40s, early 40s, and I just realized it was going to be hard to keep up with my kids, who were pretty young at the time, so I decided I needed to do something better and turn myself around. I feel younger than I did then, and that was a long time ago.

Pop the top, push it down in there, and pour those capfuls right into the water. How much? I think you could do three or four. I’m not scared. I think you’re more capable than most people. This is a cooking show. Coconut macaroon. Cheers. You can barely taste it when you put that much water in it. Normally Zach loads us up with a lot of water. I can taste it, but it’s actually pretty good. When it comes to supplements, there are a lot of things that don’t taste that good, so you just do it. But that one is actually pretty good. And they make you feel amazing. They’re fantastic. I’m excited to try this out.

This show isn’t built for casual scrollers. It’s designed for people who are pushing their mental, physical, and professional boundaries and want to go to the very top, the peak performers. If that’s you, hit subscribe and let’s get going. Back to the show.

We go back a long ways, almost a decade and a half at this point. You are a true peak performer. I remember the first time I met you, I thought, “Wow, this guy is so dialed.” I remember you had your team read your mission statement in your huddle before surgeries every morning. I was thinking about that: how many operating days do you think you have per year? You’re reading that every single day, and you’re still doing it, right? Yeah, either our mission statement or our vision statement gets read every morning. Mission statements matter. A lot of people think they’re just something you do when you set up a business, but they’re really the guiding principle that helps you make choices every day. If your choice doesn’t match what the statement says, it’s the wrong choice. People need to know what we’re about. Some of our people have been with us for a long time and have heard it many times, but we all need reminders, and new people need reminders too.

What I loved about that was the notion of setting the day right. You may have heard it a thousand times, but the point is to come back to center and get refocused on the mission: why are we here? We’re here to serve and make sure we produce the best outcomes for a patient. That’s something I’m honored to know about you, because your success rate is so high. You’ve put so much work into being the best. The other thing that impressed me when I first met you was that you had a system. You have four locations in Oregon, Portland, out to Dallas and the Vancouver, Washington area, and you were able to standardize so that every team knew exactly what to do. You told me something that really stuck with me: your surgical assistants need to know exactly what you need in the moment. They have to be trained to that level of specificity so you never have to look up. If you’re looking up during surgery, you’re wasting time. The efficiency you’ve created as a practice with Brandon and the staff is amazing, and they’ve been with you for so long. It’s really incredible to see that.

Yeah, we have a great crew. A lot of times we’ve had people come in and visit. I’ve had surgeons come in and visit, and dentists come in. We have dentists in our practice all the time, whether they have a patient, a case, or just need to see something. I try to explain that there’s a reason why we can do multiples of what the average surgeon can do in a day, and it’s because we have a system. It’s really choreography. Everybody knows the dance, and they know it to such an extent that sometimes I feel like they’re reading my mind. It’s nice because it’s teachable. A lot of places have institutional knowledge, and somebody leaves and that knowledge goes with them, which isn’t sustainable. We want something teachable. It’s interesting how just by being inside that organization, you can feel the rhythm, like one, two, three, four, five, six, seven, eight. It’s not an assembly line. We treat humans, and every human is different. Every person brings their actual problem, their hang-ups, and whatever else they’re struggling with, so you have to have flexibility. When you have something more structured, it makes you more effective. Systems are predetermined answers to questions. There’s a sequence. That frees you up to do something better, like provide a better experience.

That’s why you have such high ratings. You’re able to do all the things you need to do while also addressing the individual needs of the patient in that moment. A lot of people are freaked out when they come in. Some are nervous, some are annoyed because they have better things to do. You see everybody from CEOs to traveling musicians, and being there is a disruption in their world. Mom has to be there, and it’s a disruption in her world and everybody she takes care of. I always think of each of our attention and focus as a pizza. If you’re the patient, you deserve the whole thing. If you’re thinking about other things that are going on outside our interaction, you’re taking slices out and giving them to other people. So we try to set it up that way.

When people see you there, you’re completely present with them. As much as you possibly can. Sometimes I meet someone for the first time and they say, “Look, I know you’re busy,” because they see people coming and going. I tell them, “I’m not busy. You have all my time right now.” I may have lots of things to do today, but right now this is your time. I want people to feel that way. I’ve been told before that I talk too fast, and I like to point out that it’s a personality problem, not because I’m busy. I’m not in a rush. I just talk too fast. Once people get to know you as a real human and realize you’re not just trying to run around and get things done, it becomes a much better interaction and a better experience for people.

I remember one event in particular in Valley, now Palisades, where you were giving your presentation and the room was full. Those guys were just trying to keep up. It was a room full of super smart guys, but you were just circling around everybody. It was a little tricky because I asked what the topic was, and you said it was about office infrastructure. Then I asked how much time I had and you said about 90 minutes, and I thought, “This is like two weeks worth of stuff.” I try to pack it in as much as I can. Guys came up to me afterward and said they didn’t think they could ever do that. I told them, “No, you can. You just have to slow down and figure out how you’re going to implement it.” That’s why I always think you’d have a great career in consulting when you decide to stop practicing, because so many people could learn from you about how to get it done the right way.

I want to talk to you about tough times, because not everything is always perfect. You recently built a new practice location. What was that like after being in one place for so long? It was expensive. We had one location that we inherited from the doctor who owned it before us, and we outgrew it. That was a long time ago, around 2008 or 2009, and we outgrew it in a year. We started looking for another place, and southeast Portland isn’t Manhattan, but it’s pretty built up. From the standpoint of any medical practice or dental practice, you need a big enough facility, but you also need parking. We have an army of people showing up, and all of a sudden our staff is taking up all the parking in the area. Some practices are on the second or third floor of a building. If I have to take somebody down the elevator in a wheelchair, I just lost a staff person for 10 minutes. Those kinds of efficiencies are hard. It’s very hard when you have an inexpensive physical plant that’s old and you need to make that jump and say, “In order to do more and serve the population we’re servicing, we had to do it.” We finally found a place and decided to build it. The regulations are incredible, and the construction costs are massive. There were several times when you wonder whether you’re going to be able to pull it off. But when it’s done, you just keep pushing, keep grinding, keep figuring it out, and when it’s done it’s great.

You’ve always been a guy who doesn’t seem too bothered. You almost regulate that. Is that the perception, or how are you operating internally? I’m a pretty even-keeled guy. There are things you can’t get upset about. I’m a mix of my parents. My mom is very black and white, right and wrong, correct and incorrect. My dad was more like, screw it, none of it is important, the only important thing is how you feel and how you relate to people. A lot of people get really upset about things. Even when we teach with our mini residency, we teach doctors how to start systems and develop systems in their practice. I tell them all the time, if you work on a system and wait until it’s perfect, it’s never going to be ready. It’s always the 80/20 rule, but in our world it’s probably the 95/5 rule. This is five-star service for 95 percent of the people, and there are a few people who just aren’t going to want that, so you have to flex and do it differently to provide the service they need. When you’re developing something, there are speed bumps. You just drive over them. Sometimes there are hard impediments. You have to retool and restructure, and that’s not something to get mad about. It’s just another challenge. What gets me fired up is how well we execute. If we’re not up to what I think is important, I get pretty upset about that. But people think I’m getting upset about small details. No, that’s execution. That’s where you have to do it right. Everything else is just keep moving.

I can relate to that completely. There are days when you just have to remember that people are human beings and they’re doing the best they possibly can. You’re not going to hit every ball that’s thrown at you. You try to do the best and then learn from it. In our world, what we do has really high success rates. It’s crazy. If we’re at the top of our game right now and we’re hitting 98-plus percent success rates, that’s really high. Compare that to other professions. Baseball players are the best in the world at 66 percent failure. Nobody remembers Babe Ruth’s strikeouts; they remember his home runs. It’s okay. When you’re doing your work, somebody’s anesthetized, you’re managing the airway, and you’re making sure they’re going to have a great outcome. That’s one of the things I love about you: you really care about the end result, and that’s probably why you have such a high success rate. A 98.5 percent success rate is phenomenal. That’s probably top-tier national benchmark territory.

Back to the practice: you made it happen. You moved to a bigger building, and it’s been so much easier and so much better. Out of that one location, you can do more. Patients get a better experience because even though you’re seeing more people in a day, they’re getting a better experience. My staff has less stress because the physical plant actually works the way we work. You were able to design the space by looking at what wasn’t working in the old one and asking what would be optimal. In ad strategy, I think I’ve even done this with you before: take the really beautiful thing, then realize it’s not working, and go the exact opposite direction. It’s not always intuitive. In your world, it’s especially not. You test something and if it doesn’t work, you do something else. That’s one of the beauties of the business world versus the medical world. You can’t just try stuff on people and see if it works. You have to practice in an evidence-based way and evolve carefully. In business you can succeed or fail and change fast. I look at my social media as a good example. I’m the crash-test dummy. I test new ideas on my own accounts because I can’t do it on client accounts. Sometimes it hits, sometimes it doesn’t, and if it doesn’t, you scrap it and start over fresh. That’s what you need to do sometimes.

You cover a large swath of territory. I remember being at Disneyland talking to you and hearing about going out to Dallas, and you were basically describing a gorgeous drive. It’s not that far from your furthest east metropolitan practice. It’s about an hour. It’s one of the most beautiful drives in the country. Usually we get coffee, I take a few staff people with me to fill out the crew that day, and sometimes they’re lively and talkative and sometimes they’re sleeping in the car. But it’s a beautiful drive, the community is fantastic, and it’s worth being there. The dentist community is great, too. They probably really appreciate having you locally instead of having to make that drive out.

So how do you get there when you’re focused on being the best? Is it a plan? Is it never ending? You’re always thinking about it? It absolutely has to be a plan. You have to think about it. You have to have a vision, and you have to work to make that vision a reality. You also have to communicate that vision over and over again because you can write it down on paper, but people don’t really understand what that looks like in your head. It’s not going anywhere if you don’t communicate it. You have to illustrate what that looks like to other people over and over so they really truly have a sense of it. You have to create your own reality and your own environment, and to me that’s planning and executing. I try to take away the term marketing from my practice because it’s not really marketing. Marketing is saying, “I’m going to do this,” or “We are going to provide this.” You’re making a promise, and you have to fulfill that promise. If I’m working with a dentist and I say, “We’re going to help you do this and that, and we’re going to make your world better inside your bubble,” then we have to deliver on that. You have to have a vision, an infrastructure to accomplish that vision, and then you have to fulfill the promises you make.

You always do that, no matter what. You have to follow through and get the job done. Not everything works out perfectly, but you can take every action afterward to try to write the ship. You have to think about it all the time, restructure and retool. I’ve retoled things multiple times. That refinement is part of growth. If an average practice grows 50 percent, you’re probably stretching them; if it grows 100 percent, you don’t have the infrastructure and systems to deal with that in the same way you did when you were half the size. So you have to continually retool for growth and always be retooling for where you want to be, not necessarily where you are right now.

I want to talk about something a little controversial: private equity in healthcare. We’ve seen a massive influx of private equity buying up practices. Their goal is to make as much return as possible for investors. I had a friend say, “Do I care about X company? No, I don’t care about their employees. I can’t afford to care about them because my job is to get the biggest return for my investors so I can get that money back to them and go do it again.” Philosophically, that doesn’t really align with healthcare. It misses healthcare in my opinion. And yet we’ve seen so much of it. You resisted it. You said no. There are reasons for that. They don’t have to be misaligned, but they do. If private equity would slow down a little bit and truly align with healthcare instead of just caring about return, it would be different. But it’s another business. I’m in a service business. They’re different animals. In general, we see a race to the middle. As a practice owner and provider, I want to do the best things I can all the time, and that’s not always the most profitable thing. But that’s not the business we’re in. Capitalism, in its purest sense, says if I provide something valuable to you, good things will come back. In a service business, you have to provide the service people want or need. Sometimes they don’t want it, but they need it, and that’s what they’re there to get. They’re there for a great result, and sometimes that isn’t the most profitable thing. That’s not how private equity works, and that’s why it never really fits. It can look like it fits, but the puzzle pieces are a little off, and that matters because people come to you placing their trust in you and expecting a great result. When you have a high success rate, that becomes the norm in your practice. If you have a low success rate, the initial disturbance only gets amplified because you have to do it over and over again. I love that you’ve spent so much time and energy on education and training the people you work with. Those mini residencies have been successful for around 20 years because the level of excellence is so high.

Would that have been possible under private equity? I’ve been around this a bit, and they do leave the opportunity to do things like that, but the motivation starts to die. If I’m not motivated to make something really great, it’s not going to be worth a dentist’s time to come learn and absorb, and the follow-up required is significant. It’s not just a classroom where you go home and do your homework. You need the training environment and support layers underneath that, because what dentists do every day is hard. Developing systems so they can do it at a really high success rate takes a lot of effort. It takes more than hiring a guy to come in and teach what he knows. It takes a lot of effort, and if I don’t have the motivation to do that every single time, it’s not worth their time. That’s where I think doing something like a residency under private equity would be difficult. You’re effectively an employee, and that changes everything. You’ve invested so heavily in creating such an incredible experience. I’ve been there. I’ve seen it. It’s an incredible event. You have a number of them every year, and they work in succession. It’s a real experience, even for someone like me who isn’t a dentist or oral surgeon. I was blown away by the information. I also love how you bring it down to a level where nobody is trying to sound super smart. Everybody is there trying to convey information so everybody gets it, and it creates a flow where people feel comfortable asking questions. In larger hospitals there’s something called M&M where complications are discussed, and it can be intimidating. In dental school I had a very good experience, but I came out feeling like I was supposed to know everything. Then in residency you quickly learn you’re not supposed to know everything. You’re supposed to know everything you need to know right now and be able to find the right answers if you don’t know. We try to create that environment.

We have experts in the room who will quickly say, “Ask me how I know not to do this.” We’ve tried things, they didn’t work, and we had to do something else. It was expensive and difficult, and the patient’s outcome took longer, but we got them to a happy place. If you can go to the happy place in the first place by learning from all of us, that’s great. We try to show people that we’ve been there, done that, and seen a lot of things, though not everything because there are new things all the time. We create that environment because it builds community and trust. Dentistry as a whole is often not very collegial, so we try to create a better place to live. It is hyper-competitive. Even if you weren’t there at the time, you don’t know what happened, so don’t cast judgment. It still happens, and we try to get rid of it.

One thing I think is great now is that we’re seeing more of a holistic thought process around healthcare. People are really changing their diets and exercise and the way they take care of themselves. There’s now awareness that this system is absolutely critical to overall health. The ability to chew your food is the beginning of digestion, right? Get the saliva around the food before it goes into the stomach. That’s how it works. Keeping bacteria out matters because of the deleterious effects on the systems of the body. It’s great to see more medical doctors recognizing that and giving it credit.

After 20 years of doing this, you’ve raised the IQ, EQ, and overall capability of an entire community. What does that feel like? That’s what I’m supposed to do. We have a lot of people come and get trained, and the standard of care is very high, but not every dentist comes and gets trained or tries to do those things. We’re moving in the right direction, but until all dentists come to the conclusion that they have to do things at the highest level all the time, we’re only scratching the surface. It doesn’t mean every patient has to choose the highest level treatment, because there are costs involved and it’s not always easy. But we have to be offering it, and we have to have the ability to treatment-plan and execute that plan. That’s our responsibility.

Not everybody can afford what would maybe be the best solution. You’ve done a lot of giving back to the community. We give stuff away all the time. You’ve been doing that for a long time, and I think that’s a blueprint for others in the community. It says, “Hey, we’ve got to take care of each other. We’ve got to think about the bigger picture.” One of the things I love about working with you is that I’ve got an idea and I can say, “Let’s try it.” We’ve become close friends over the years, and it’s been a relationship I’ve truly enjoyed. One of the things that makes it fun for me is that I can bring an idea to you and explain it, and for some reason we’re able to connect and you go, “That sounds cool. Let’s do it.” We’ve done so many things together. The latest one isn’t quite done yet, but it’s going through final finals and is going to be pretty cool. A ton of energy, time, money, whatever you want to call it, has been invested to provide patients with a faster path. There are certain patients who just don’t want to engage in small talk. They just want to get stuff done really quickly.

A lot of people see the world from their own perspective, and we all do that, but you try to look at everybody’s perspective. Outside my practice I’m incredibly motivated by convenience, and a lot of people are too because they don’t have a ton of time to mess around with long, laborious things. If I need to go to the DMV, I don’t want to go downtown Portland and get stuck in a long line. I try to see it from their perspective, and they’ve had it up to here. You ask for what you need and they’re like, “Did you even do the paperwork?” It’s a long, painful process. Some people are motivated by connecting with other people from a service standpoint. You have to have all those different experiences available for the right people at the right time. I think that’s going to be pretty cool. At the end of the day, if all the options exist, you can get whatever it is you want. We even put it up against Tesla’s agent yesterday or the day before. Creating a digital human is not easy. The Turing test is about convincing somebody the machine is actually human, and we’re still a ways away from that. It’s a latency issue, and how it responds and emotes and all of that. But when we put ours up against Tesla’s, ours was massively faster. We’re not that big of a company, nowhere near Tesla, but our product could compete in that way. It’s not a fair comparison, and if anybody is probably working on it, it’s probably those guys. But it was great to see.

It’s been great having you in. I really appreciate you coming down because I know every day you’re not in that practice, that’s a big sacrifice to go somewhere and do something. I truly appreciate your time. Before we go, if someone were young and thinking about a career in healthcare today, what do they need to know? Healthcare is still great. It’s a necessity. It’s not going to be immediately taken over by AI and all that stuff. It’ll be helped, I think. But remember, it’s healthcare. We’re starting to see more practices break away from private equity and do concierge medicine and things like that. Concierge medicine sounds like rich-guy stuff, but really it’s kind of what medicine was 50 years ago, before managed care. You came in, saw the doctor, and they knew who you were. It’s hard to think about that as a younger person when you have no health problems, but at some point life happens and you need somebody helping you manage it. Do your research. Pick a field of medicine that correlates with your personality and who you are and what you want to do. Not every medical doctor needs to be a hand-holder or a super empathetic emotional person. There are radiologists who read X-rays, there are researchers, there are people who need to be in fast-paced environments, and there are surgeons who need to be hands-on. Different countries do things differently. Make sure whatever you decide fits your personality as closely as possible.

And the last part is this: remember it’s a service organization. What you do is service to somebody else. If you always think, “I’m going to provide service to somebody else that’s valuable to them,” it’ll be good for you. Stay focused on the care part. That’s the reason you’re there. I couldn’t agree more. AI and robotics may play a role, sure, but they’re never going to replace direct human care. My daughter is on track for psychology and maybe med school to become a psychiatrist, and I think that’s perfect. They’re in high demand, and it’s going to be really difficult for a machine to truly empathize with you in that way. In healthcare where you have a direct line of doctor to patient, that’s going to be tough to replace, though it can assist. On the radiology side, being able to double-scan a patient and ask, “Did I miss anything?” is pretty cool. But beyond that, healthcare is going to be here for a long time. One in every five dollars spent in the United States goes to healthcare. If I were doing it over again, I’d do it over again. I don’t think I’d change anything. There are other parts of medicine that are super intriguing to me, and as you go through your career it’s not the same from when you start to when you finish, but it’s kind of the same. There are similarities. You’re in a specialty and you’re doing whatever you’re doing, but there are always aspects that are interesting outside your own practice.

The wellness space is one of those. The kids call it biohacking, but I call it not eating a bunch of crappy food, not eating stuff that will kill you. I’m always joking with my staff when they’re having breakfast croissants or whatever, and I say, “That’s killing you.” They laugh and think I’m joking, but I’m not. It is killing you. What we put in is what we’re going to get back out later, and a lot of times you just have to be a good example for the world. I’m glad that social media people, even the wing-nut influencer type, are at least creating awareness. They may not be right about everything they’re saying, but they create awareness. And if you’re curious enough to seek out the right information, we have another podcast called Cell To Systems, which I’ll leave here and go shoot right after this in a different studio. But the reality is it’s all about the idea of cells to systems of the body to help people understand exactly what you’re talking about. It’s an input-output system, and everything changes as we get older. It’s pretty wild.

All right, so we’re a little ways in here. What’s the outcome on the ketones? So far, I feel pretty good. I’m not a breakfast eater. I usually have a cup of coffee, and sometimes I drink coffee a lot through the day depending on how busy I am in the morning. But I like this. I don’t feel amped. I don’t feel jittery. I feel clear. I feel clear, too. It’s very clear. I can hear what you’re saying, I can hear your tone, and I’m focusing on what I need to focus on. It’s really fun. It’s really good. I’m in. I’ll send you on your way with some today and then I’ll send some up to you. They’re a great company. They really focused on being the best at what they do, and I’m pleased to have them be the first sponsor of the show because it’s something I use every day and truly believe in. I wouldn’t do it otherwise. You know that about me. You showed me this, and the first thing I did was look at the ingredient list. You know how many health food companies have sucralose in them? Not a drop, man. This is good. I like seeing a product that actually, even though their goal is this, is also going to do it the right way. I’m in. That’s great. Awesome. Great to have you in, man. Thanks for having me.