Doctor Money Matters

Episode 11

Transcript automatically generated by Google Speech, please excuse transcription errors as this has not been corrected. Listen to the episode to hear what was said.

Transcript

Tarang Patel:
[0:51] Hi and welcome to another episode of the doctor Money Matters podcast.

[0:54] As Healthcare professionals we can all agree that the Health Care system in the u.s. is broken it’s too difficult to maneuver for patients and practitioners alike.

[1:04] Today’s episode we talked with dr. Keith Smith and anesthesiologist and a founder of the surgery center of Oklahoma.

[1:11] This practice is a Pioneer in cost transparency and as you’ll hear during our interview they charge a fixed price for many common outpatient surgeries.

[1:20] Dr. Smith and his Partners understood many years ago the challenges of dealing with insurance companies and decided to break free by switching to this model.

[1:29] This episode compliments the direct Primary Care Model episode that we had in episode six with dr. Josh umbehr of Atlas MD.

[1:37] Dr Smith was very straightforward.

[1:40] In regards to his feelings about the intervening parties involved in healthcare today such as government and insurance companies.

[1:48] I think many of you listening can relate to these frustrations.

[1:52] Difference is that he’s able to do something about it and I hope by listening to the challenges that he faced and his Partners face and then that the benefits they’ve gained and their patients have gained over the last few years.

[2:04] We Physicians are inspired to take back control of the health care that we deliver.

Dr. Tarang Patel:
[2:09] Okay welcome to another episode of the doctor Money Matters podcast I guess today is Dr Keith Smith and anesthesiologist of the surgery center of Oklahoma,
a fixed price Surgery Center where patients get transparent pricing information for a variety of different surgical procedure welcome dr. Smith.

Dr. Keith Smith:
[2:25] Thanks for having me.

Dr. Tarang Patel:
[2:25] We’re talking about your surgery center you’ve gotten a lot of press recently tell me first before we get into that about your background and then what made you go into medicine and anesthesia.

Dr. Keith Smith:
[2:35] Well my background I actually grew up kind of musician but my brother went off to medical school and then I started thinking about medicine and I realized I could be an amateur musician but,
not an amateur physician and I had a hard time deciding which one to do and so I thought the other way I could have both of those things sort of part of my life was,
did Percy medicine,
in another reason I was intrigued by medicine much more so than music was fitted so it’s such an obviously mutually beneficial Exchange,
the physician in the patient if everything is ethically organized and I both walk away better from having dealt with each other and I think that’s been ingrained,
in May Since I was since I was little.

Dr. Tarang Patel:
[3:20] So you went to you went to med school and residency at the University of Oklahoma and then you did your fellowship in Arkansas what’s the stock a little bit about your practice than the surgery center of Oklahoma when did you start and what made you decide to go to the fixed price Model.

Dr. Keith Smith:
[3:35] Well we started it seems incredible now but we started twenty years ago next month the surgery serve Oklahoma but I was in private practice like.
Every other anesthesiologist in the country for seven years working in the big hospitals long enough,
long enough to see that something wasn’t right the free market was not at work,
you know that someone did a great job for reasonable price didn’t seem to resonator have any value to the consumers and.
And after the the clintons had their way with Healthcare in the big scare they caused and Medicare,
incredibly heavy-handed in over involved in the pricing of care then.
Dr Steve Monti and I both of who founded this facility we found everything that was wrong with Healthcare with seem to just be getting worse and our fees were dropping and so we we basically walked away from very busy.
Diana seizure practices and thought,
you know we can either complain about this the rest of our careers or do something about it and we started the service of Oklahoma we we just walked out but found this old burnout,
facility that had been mismanaged assume the lease some really good surgeons and Friends followed us we started very small.
And now we’re in this very large very busy facility with a with a business model that is consistent with and really an extension of our free market philosophy with prices online real competitive sort of spirit in a monks.

[5:06] Partners here and with other facilities.

Dr. Tarang Patel:
[5:10] When you started about 20 years ago now talk about some of the the difficulties you face when you first started up.

Dr. Keith Smith:
[5:16] Well when we started the facility we did not know enough,
about how sick the cartel like healthcare system was to be truly as scared of it.
As we should have been and it was our ignorance and naivety going into this that probably allowed us to continue but we found out,
very shortly after we open when we were attacked by various legislative attempts that had obviously been orchestrated by local hospitals and then we were targeted in singled out by insurance carriers initially day you know they wouldn’t contract with us at all and then they began tinkering with,
in and out of network deductible scenarios that ultimately about 2003 that made it almost impossible for patients to.
To come through our doors so,
we we battle at the legislature we battled our own health department and we actually had to sue our own health State Health Department at one point we were we were victimized by the.
Classic typical cronies in healthcare the folks who cannot stand up start kind of Underdog competitors in,
we were able to we were able to win every one of those battles really at the legislature because our message was so pure and free market and I stop,
accepting money from the government in 1993.
I just did Medicare Medicaid cases free I wouldn’t even file a client and in so when I looked across the legislators desk and told him no I don’t want anything from you I don’t take any money from you now and I don’t want anything from you.

[6:53] Except for you not to,
latch onto this legislation that hamstrings us you know please allow us just leave us alone and please allow us to show you that the market can provide better pricing and better quality simultaneously and that was a message that resonated across both sides of the aisle you know the Democrats thank God for the Democrats,
in the early 1990s in Oklahoma because without them we would be closed the Republicans were very in bed with the.
Corporate Healthcare cronies and we’re part of what,
the force that was trying to close us the Democrats us as underdogs as friends of the poor in the uninsured they appreciated our honesty and our,
you know taking care of people who could pay and who couldn’t pay but being honest about our pricing and now,
now it’s really a bipartisan support of what we’ve done at on both sides of the aisle and everybody thinks you know that it’s good too.
You know what’s good for honest people not price gougers to be in the Healthcare System most of the challenges that we Face early on were political legislative challenges there were also some kind of insurance games that the carriers played with us in those became vicious in in the early 2000s,
but our cure for that rather than to continue to fight them was was to really secede basically just to walk away and say you know what we,
we are tired of this fight we’re tired of spending our our time is physicians in the silly fights we’re just going to put our prices online and shove the insurance companies aside in.

[8:31] What’s interesting is even at our prices which are less than what Medicaid pays these local hospitals none of the insurance carriers want anything to do with us.

Dr. Tarang Patel:
[8:40] Interest even though that it would be cheaper for them to work with you guy they still don’t want work with that’s that’s crazy.

Dr. Keith Smith:
[8:46] It is crazy until you realize it’s not crazy the only possible explanation for an insurance company to not want part of cheaper and better is if the insurance company somehow makes more money off,
not cheaper and better and you I mean intuitively you would think okay they collect premiums they pay claims they keep the difference and that’s the profit and it’s actually much more complex than that.
Insurance companies as insane as the sounds they don’t really care what anything cause what they care about is the initial charge,
because then they go to work selling discount.

[9:22] So they basically sell their discounting service in the higher the initial bill the more opportunity there is for them to make money off of that.
Discounting repricing service so you’ll hear one PPO or another say yeah but we get 60% discount and somewhere down the line there’s an employer group who is paying a commission on the discount,
if the actual spend of the insurance company goes up in one year they just raise premiums the next year to make up for it,
in the brokerage houses are a big problem too because they get paid based on how high their conditions are based on how high the premiums are so they don’t want any part of cheaper and better so it’s a very sick set up the insurance company’s is crazy at it sounds they,
all they care about is that initial charge and with my prices online there’s no opportunity for them to sell a discount because the price is transparent to the buyer.

Dr. Tarang Patel:
[10:18] Right so now so you no longer take insurance like you were saying when did you go to that mall.

Dr. Keith Smith:
[10:23] We went to that will we have tapered off in to be perfectly honest we actually have one insurance contract remaining we had a,
the insurance company come to us because it in large employer in Oklahoma City had a gun in the back of their head and said put surgery serve Oklahoma.
In your network or your fired and we signed up with them is biggest mistake we ever met.
I wish we’d never signed up and we still have that contract but.
It’s we probably won’t have the contract for long we’ve been out of network as since we opened in 1997 for the main main reason for that is none of the insurance companies would sign up with us.

[11:04] I later found out that it’s commonplace in the industry for a hospital.
The hospital system to tell an insurance company that you know we will contract with you but only if you’ll explode you know the facilities on this list so really does act 3 much like a cartel.
It’s so we’ve been out of network with everybody and so when,
when we dealt with patients that had Insurance many times our cash price was less than their deductible so we’ve been dealing with people like that,
ever since we opened when we put our prices online the amount of business it started streaming through the door picked up so rapidly that,
we really were able to completely walk away from any notion of dealing with insurance.
Be there in in selling a lot of positions need to understand that the demand for honest transparently price Services is so large,
they cannot possibly be satisfied and the biggest part of that demand comes from the self-funded businesses that have the sticker shock,
on the actual cost of the care we’re at you know the big insurance companies don’t care how much things cost does self-funded company steel companies that typically have a hundred or more employees and,
you know they self insure they really do care what it cost and then that’s a huge part of what we’re doing here now.

Dr. Tarang Patel:
[12:26] Absolutely. Let’s talk about that a little bit you you’re based in Oklahoma which is you know kind of center of the US geographically and now with your practice model and you getting a lot of press National your patience sir,
coming I obviously coming from Oklahoma but you getting a lot of patients from companies Nationwide.

Dr. Keith Smith:
[12:42] Yeah they actually after we put our prices on line 9 years ago the first patients to arrive or Canadian.

Dr. Tarang Patel:
[12:48] Canadian interesting.

Dr. Keith Smith:
[12:50] And you know that these are people who have coverage you know they just don’t have access to the care many of them require.
Everybody who’s a big fan of single-payer in the Canadian Healthcare System needs to needs to really look in the mirror and ask themselves,
why are Canadians flying Oklahoma City you know to have surgery but yeah we treat patients and have seen patients from all 50 states except Hawaii I think the,
states that continue to send us the most patients are Alaska and Wisconsin part of the reason for that is that the market there is so cartelized and there are just a few monopolistic health systems that,
completely controlled the market that the pricing there is predictably much higher so yeah we see patients from all over the country,
you know their employers who will pay all of the travel expenses for a patient and a companion to come to Oklahoma and have their surgery and then fly them home because the Delta on what they would pay if they stayed home is so gigantic,
employer self-funded health plans still better off.

Dr. Tarang Patel:
[13:54] So let’s let’s talk a little bit about the patient experience so you have the price list online so someone wants to come in and you know what you do a fair amount of Orthopedics I think at your place so,
let’s say they want to come in and do you know I can rotator cuff repair how does it work from the patient’s perspective they see the price and that includes what.

Dr. Keith Smith:
[14:13] Everything includes the facility anesthesia and the surgeons fee and the patient can arrive and hand us their credit card they can hand us a cashier’s check.
Some people just pay with cash and we’ve had we’ve had people pay with gold and silver coins until I pay with Bitcoin.

[14:34] Try to accommodate the buyer yeah and they pay us and we do the surgery and they don’t receive any bills later.

[14:40] And if the patient is an employee of a self-funded health plan.

[14:45] Then we treat those self headed Health Plans basically 30 days same as cash so will they’ll receive a series of invoices and pay us at the end of the month.

Dr. Tarang Patel:
[14:55] And so and then if you have a complication or what then that is part of the included cost is that right.

Dr. Keith Smith:
[15:02] No we gave that some thought when we first launched these prices in,
we thought well we could pad these prices by certain percentage and guarantee no guarantee the results and guard against complications but our complication rate here is so small that didn’t seem right to overcharge.
Everyone who came through the door as if a complication was possibility.

[15:26] So we put all of our infection rates online and complications are just very rare so.
What we decided to do was treat any sort of complicated situation individually and.
No one here is attempting unlike the so-called not-for-profit hospitals no one here is attempting to make a profit off of a complication so worst case scenario is that patient might pay the cost of the supplies.

[15:53] As somebody who somebody who runs and surgery center and a large Surgery Center I can tell you that is not that significant but we.
We seek well when all the dust settles we still want patients to feel like,
even if something goes wrong that they’ve had a value experience here but the complications have been so rare we’ve been able to just treat those individually and we had a,
we had an employer in Texas that had a patient come up here in the patient really wasn’t compliant in his wound dehisced and he had to come back and have a couple things done and all I did was invoice for the cost of the supplies which I think was less than $500 for the whole darn thing.

[16:37] And when it was all over with this employer called me and said you need to add more complications.

[16:43] And I said what are you talking about with your we don’t want any complications that he said you know,
there’s such skepticism attached to this idea still this you know too good to be true thing you said you could not have you could not have killed our skepticism in a more powerful way than how you don’t with this problem so he said that the value delivery,
he witnessed as result of marching through this complicated setup,
made a real believer out of him and everyone in his company so that was the nature of his sarcasm.

Dr. Tarang Patel:
[17:12] Bright.

Dr. Keith Smith:
[17:14] We should do this more often to convince people.

Dr. Tarang Patel:
[17:17] That’s true because like you said when you dealing with it with just,
Supply casa mean that that’s that’s a big difference in what we traditionally see which is basically the charge of the you know that the full charge of the procedure and everything else that it entails at other facilities so that’s that’s really good now let’s the price list that you guys have how did you come up with that,
how did you come up with the price of.

Dr. Keith Smith:
[17:38] Well in that and that’s the only thing more radical than our prices being online and I’ll tell you how we did it is that they’re actually bundle debt.
Everyone’s,
prices in that mix so we part of the problem that I had with my practice before we open the surgery center was that,
I had to adhere to prices that were forced on me I had to endure what.
Some insurance company determine my time was were in no other Market works that way in every other Market the supplier of the service or the product,
what is the source of the price and that price changes due to whatever competitive activity is that that,
producer is subjected to so it shouldn’t surprise you then.
the way we started was with a roomful of surgeon so I grabbed a subgroup of my ear nose and throat and Orthopedic partners and sat down and said how much do you want for tonsillectomy how much do you want for Creative instruction.
They had no idea.

Dr. Tarang Patel:
[18:41] That’s true because most of us still outside of the people who are entrepreneur like yourself most of us still don’t know what we are paid on an individual case space.

Dr. Keith Smith:
[18:50] That’s why they didn’t have any concept of you know what is my time Worth or what is my expertise were in so I that’s when,
we kind of had our first philosophical lesson when I said okay you’re either tired of somebody else telling you what your words or you’re not and you guys can bring me prices or I will in flick them on you.

[19:10] But I don’t but that’s the whole purpose of this exercise and so they all came back with this pricing that frankly was pathetic and I padded most of them.
They did not value themselves nearly as highly as they should have keep in mind we,
operate on all the division 1 athletes in the state of Oklahoma the Oklahoma City Thunder players three of us are Pediatric,
Fellowship trained anesthesia so we do a lot of pediatric surgery and all the pricing I was getting frankly was just too low so I padded it and I’m doing all of this dinovo I mean I’ve nothing to compare I just thought that’s not enough.
Where this guy who is a world-class in a surgeon that’s just not enough for a New York to be your cruciate ligament so they gave me these numbers which I could.
Ignored and added to all of them and then it’s an anesthesiologist.
Not basically I basically bill for my time there’s some modifications like before doing a surgery that requires of a regional nerve block in addition to everything else going on but,
we basically built for time,
at the surgery center it’s time and materials so it’d be just like a building contractor you have time in materials so we had to ascertain what,
say 30 minutes in an operating room actually cost and then,
have a marginal profit on that and it’s not even Algebra I mean you just add those things up it’s simple math and we came up with these prices prices that I put on the website 9 years ago have been changed every single case.

[20:43] I’ve lowered so so much for the spiraling cost of healthcare.

[20:47] In nine years we have lowered prices for times I’ve never raise them the only other changes I’ve made are adding additional procedures and I don’t know how many we have online now but I know it’s over.

Dr. Tarang Patel:
[21:00] Okay so let’s let’s talk about it so you you started with it with a small group of surgeons and you’ve over the over the years expanded your scope of the procedures like you were saying how are you guys doing you know without getting into specific numbers financially versus you’re employed colleagues or your colleagues in traditional private prep.

Dr. Keith Smith:
[21:19] Well keeping in mind my just immediately prior comments know this that what a surgeon receives here for any given surgery that they perform in terms of their professional is higher.
Mini X multiples of what they receive from their favorite Insurance carry so even though are bundled fee.
Say $3,740 for a knee arthroscopy even though that is less than what Medicaid would pay one of these local hospitals the portion of that fee that goes to the surgeon here is.
Is that it’s large and so as a result of that.
You know arcgis ility actually operates a bit like a not-for-profit there’s really not much much more so than these so-called hospitals that claimed that status so we’re really not trying to make,
a marginal profit to any degree off of the facility we just want to pay the people doing the work.

[22:15] A very healthy fee so the answer your question is the surgeons who in their 65 of them here now we started with 10 but the surgeons are working here are doing extremely well and if they’re not it’s their own fault.

[22:28] They are the source of their own pricing that’s that is the truth.
Innovation and actually to be truthful it’s not even Innovative that’s the way.
It always was before the government got involved and just messed everything up particularly with the resource-based relative value scale in the early nineties.
Fire that time positions were the source of their own price and so this is really it’s really Innovative in that it’s a throwback,
to the way things used to be done and then you know I’ve started along with a friend of mine J Kempton who runs a third-party administrator that free market Medical Association and we are helping other,
Physicians and Facilities copy what we’ve done in so sprouting up all over the country are these you know these copies or even.

[23:17] Different in some cases in many ways more Innovative models than what we’ve done until I got competitors all over the country that we’ve helped inspire.
Who we collaborate with in if somebody calls me from Virginia and wants to come here for surgery I just point them to Monticello Surgery Center in Charlottesville they don’t need to come all the way here,
so there are these facilities all over the country now and we work together and try to you know get patients to the right place where they need to go so it’s it’s.
Very exciting everybody that’s involved in this loves it there transformed they come to work with a smile on their face they they are the source of their own pricing and value and so it feels like,
the mutually beneficial exchange sort of practice that Physicians used to have before Uncle Sam came in and you know God,
bribed by all the cronies and took off with them in the getaway car it’s just it’s criminal what government is done to Medicine.

Dr. Tarang Patel:
[24:18] Let’s talk about you mentioned the free market Medical Association that you helped start and obviously this is something that costs of medicine or something that are on everyone’s mind regardless of party affiliation this movement is growing I had a guest on a few episodes ago with this type of model in Primary Care,
but honestly I wasn’t really that familiar until we started looking and I saw your Center come up with that being available for all this variety of special,
but do you see that now I mean you’re obviously helping people expand this model,
where do you see this in five to ten years do you think this will be kind of the default type of Health Care that the average person will get for the,
the basic most common procedures that they do.

Dr. Keith Smith:
[25:00] Yes in it it would be the natural order of things for human beings to act in Cooperative ways to wear the exchange is to their Mutual benefit the thing that always gets in the way is some goon in Washington DC,
and then he’s Pals with some Hospital CEO and then they scheme up ways to make sure the market is sported and so the,
yeah you always see this legislation come out that is ostensibly is all for our own good but really is protectionist and a protectionist.

[25:36] And helps the bad guys you know the black hats the price gougers if things if the government will just get out of the way in the natural order will be for.
Massive amounts of price transparency and competition to emerge from this new Marketplace and for prices to simultaneously fall while quality sores.
And that’s the natural order of things I am shocked I’m actually astonished at how fast this movement has already grown in,
and we are not alone there are many facilities in the United States that are embracing this model partly because they have embraced the notion that what happening currently is unsustainable in there has to be.
I’m more stable and better way you can buy heart surgery in Oklahoma City you can buy a bypass surgery for $34,000.

[26:32] Is there oncologist who are charging a flat fee to administer the drug in and lateraling the drug without a Marca.
A lot of the cost and chemotherapy are or hospitals that multiply the cost of the drug by 7/8 or 12 times.
So there’s a lot of very excited,
we have an understanding and agreement with a local full service hospital so whenever I receive a request online for a procedure that cannot appropriately be done on an outpatient basis we can’t keep a more than the one overnight we’re licensed for all,
email the CFO of Deaconess Hospital across town they have got somebody that needs a bowel resection for a signal cancer and next thing I know I’ve got a price that is all in for an anesthesia in the facility,
not find a surgeon you know negotiate price throw him into the mix and.
Now we got you know somebody from Idaho that needs a colon resection that was going to be bankrupted by some so-called not-for-profit hospital and.
He’s bought his entire procedure maybe for 19000 so this is wonderful the free market Medical Association is a vibrant,
growing getting to be a huge organization and we we’ve captured the interest of you know the buyers and in the sellers.
Don’t want to be left out and they’re beginning to understand the extent of the demand and so there’s there is some,
kind of healthy competitive fear that is driving this as well either.

[28:03] Facilities that are sick and tired of patients leaving their Hometown in flying to Oklahoma City and having their surgery and that that’s very creepy for in a hospital to have someone come home that’s had surgery at my place and bragged to everyone in town about how wonderful it was that that’s not a good setup for that hospital if they’re not,
give me a business in slide.

Dr. Tarang Patel:
[28:23] Absolutely so let’s you know so we mentioned your the physicians at that work at your surgery center,
obviously doing well financially even though the costs are low,
how is their overall quality of life I mean you know most docks in in private practice or or even employed models nowadays are.

[28:41] Are just under the under the gun to a procedure after procedure without as much control of the the Ole our time or turn around things like that I’m assuming that the quality of life of the physicians in your practice is much higher than then the traditional model.

Dr. Keith Smith:
[28:55] It it is it’s much higher because,
no one feels controlled or a slave when they have established their own value and their own pricing the other thing is that Dr launch and I run the service of Oklahoma very efficient way where we we basically provide every surgeon.
Tea brands in to cruise to Anesthesia staff and so the surgeons can get here and get a lot of work,
done in all of a sudden just have half a day created out of nothing and they can either go back to their office and see more patients or they can go.
Be with her family or white golf and so their quality of life given that they’re paid a fair amount,
for every case they do and they have extra time on their hands due to our efficiency measures here that’s a recipe for lots of smiling faces and you won’t see anybody he’s not smiling here.

Dr. Tarang Patel:
[29:47] Well that it sounds it sounds fantastic and I think most of my listeners would agree that this is the kind of medicine that.

[29:54] When they first thought about going into medicine they thought that he would be practicing not necessary just to financial part but just happy to work,
and enjoying what they do and not just enjoying the patients but enjoying the whole the other part and that’s the part that is slowly been deteriorating for most Physicians you you read it all about Physicians burnout and stuff like people wanting to retire early,
added it’s when you hear positive experiences like.

[30:19] Like people having your surgery center I think that that bodes well for the future medicine even though there’s all this negativity now.

Dr. Keith Smith:
[30:25] Yeah we we have patience that will walk into a surgeon’s office,
and they can’t afford our website fee and the surgeon will call and say I’ve got this child here and they know they need their tonsils out this is really bad and they don’t they can’t really afford the fee and so I said well what are you going to charge and the surgeon may say well.
You know I didn’t think maybe I would charge him at all.
I said well you know our anesthesia team here always follows the surgeons lead so we don’t charge him either and then I say can they cover the cost of the supply room cost hardly anything to do with me.

[30:59] You know these patients will come and they’ll pay you know some amount that may cover the supplies and then off we go and because we own and control the facility,
because we own and control every aspect of the finances of the facility were able.
We’re able to really practice medicine in the old time way where we could not we’re not just medical Advocates of the patients were also their financial advocates in the absence of.
Some hospital administrator Overlord profit Seeker price gouge or bankrupt or in the organization allows us to.
To work in that way it’s very gratifying it’s wonderful.

Dr. Tarang Patel:
[31:39] Great I’ll let me ask you what advice would you have four younger positions are interested in trying learning more about this model or just as they start their career and want to get involved in some of the changes in medicine like you guys have done.

Dr. Keith Smith:
[31:52] Will the advice that I give I like to give medical students one piece of advice because there they got so much on their mind they can’t,
remember much more than one piece and the one piece of advice I give to Young medical students is never,
under any circumstances go to work for a hospital system and the reason for that is the inevitable dilemma that will emerge where the young physician is in a position having to decide.
What is best for their employer and their job or what is best,
the patient it’s just a matter of time before that conflict emerges whether there’s pressure to order more tests you know to increase their RV use,
it’s just a matter of time before that dilemma emerges if if young medical students are considering primary care which I would strongly consider them.
I strongly advise them to consider then they need to investigate Josh Amber and Atlas MD,
I need to look at my friendly gross and Epiphany Health in Sarasota Florida nice guys are giants they are leaders in the free market movement in and in the direct Primary Care movement,
and there is there’s a real possibility now for someone to walk out of medical school and have really no capital or very insignificant Capital outlay to get their practice started and.
And even serve maybe as an apprentice under an existing direct primary care doctor who would take them under their wing and so the really is less and less reason for a medical student to go to work for one of these.

[33:26] Price gouging Hospital Systems in that that’s that’s the one piece of advice I think that I would drill into a medical student if they would if they would hear it.

Dr. Tarang Patel:
[33:35] No that’s that’s really good I think the counter unfortunately did that part is just most of them are just burdened by so much in loans that I don’t think they actually had to lay anything for their own practice I don’t think they could do it but.
Even without that they’re just you know they have such high loans but they could like you said they could go work for someone else and you know ultimately in the long run I think that would pay off.

Dr. Keith Smith:
[33:57] Yeah I know,
I was in that situation when I finished I think it’s worse now than it was when I finished but I I went to the bank and I borrowed money to buy an anesthesia machine and I had to buy all of my monitors and I had to borrow money for living expenses until I had some cash flow and.
And I lived like a Spartan until you know those things were paid off that with the direct Primary Care movement.
It’s really possible to not have to spend a lot of money to get started and that is really something.
I don’t know a lot of positions who are hospital employees there really glad they made that decision 10 or 15 years later,
most of them wish they could undo it but by then your the hospitals have their hooks in them there they’ve syno competes they have to buy a tail that they,
can’t afford on their practice coverage there’s all sorts of sticky little hooks that you know we’re hard to escape once you make that poor decision.

Dr. Tarang Patel:
[34:52] Well hey thank you dr. Smith I appreciate you coming on or on our show and really really good information really interesting it’s so unique time and medicine I think there’s a lot of build up against the cost and I think that like you said there’s definitely opportunities now that weren’t available 10-15 years ago,
maybe do something different and doctors like you dr. ombre.

[35:14] You leading the way in these in these models so I want to thank you and we look forward to seeing what what comes new from the surgery center of Oklahoma.

Dr. Keith Smith:
[35:21] My pleasure thanks for having me on your show.

Tarang Patel:
[35:32] I want to thank Dr Keith Smith of the surgery center of Oklahoma for being our guest today.

[35:37] He definitely gets you fired up about empowering Physicians to take charge of their own destinies.

[35:42] Ultimately the cost in the US Healthcare System will be reduced and it is imperative that Physicians lead this change rather than have it dictated to us.

[35:53] The Oklahoma Surgery Center model is one type that is producing the decrease price costs that.

[36:01] Patience and all components of the healthcare system are looking for.

[36:07] For price decreases in the last nine years with no increase in Surgical cost and yet the doctors remain well compensated and more importantly are independent decision-makers.

[36:20] Where where else do you in medicine are you seeing that Trend it’s almost always going in the opposite direction pretty much everywhere else in medicine.

[36:31] Anyway great show today please visit our website www.onlinemedicalcard.

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[37:13] Look for another episode of the doctor Money Matters podcast coming soon thanks again for listening.

Tarang