Episode Transcript
[00:00:00] Speaker A: Do you have any in person care whatsoever or you're 100% virtual?
[00:00:04] Speaker B: I actually do have a location here in Manhattan that it's kind of like the coworking of medical spaces where like I can literally rent it out by the day if there's any in person care that I need to do. I almost have that more as a stopgap for if anything does pop up, but very seldom have I had to use it. There's been a few occasions, but I can literally, you know, count those on my hand at this point.
[00:00:34] Speaker A: Welcome to skin group. I'm Dr. Ana Chacon and today we have a very special guest joining us. Get ready for some expert insights you won't want to miss.
Thank you for joining. Go ahead and tell the audience who you are.
[00:00:49] Speaker B: My name is Dr. Joshua Engel. Have a virtual first medical practice. It's called with UMD.
Our focus is on primary care and chronic care management and we specifically work with Medicare and Medicaid population.
[00:01:08] Speaker A: So we both went to USC for part of our career. What led you there? Where are you from? Kind of go into your childhood and upbringing a little bit, family history, all that.
[00:01:18] Speaker B: So I'm from California originally, so I grew up in the Bay Area, so usc, it was on top list. It was actually my first choice. I really just wanted to be in LA and was fortunate enough to get in. And one of the things that really drew me to it, I'm not sure if they still have this program now, but when I went there, they had a program called the Health Technology and Engineering program, which paired medical students with engineering students to tackle challenges in healthcare. And so I thought that was just so cool and, you know, just maybe gravitate towards that med school.
And I ranged the director of that program to let me in. And I was one of the med students selected for that program.
[00:02:11] Speaker A: I follow you on LinkedIn and you're big on virtual care and virtual entrepreneurship and chronic care. Tell everybody a little bit about your practice, how you got into telemedicine.
What was your pathway into that?
[00:02:26] Speaker B: Well, it actually snowballs from what I was actually just talking about.
I've been really big on medical technology and that's really been a strong interest point of mine for a while. So when I was at usc, I was actually working with some of the engineering students to create and test out pediatric seizure device, nighttime monitoring seizure device.
And so that was kind of like my original foray into like medical technology and also like really outpatient ambulatory, you know, monitoring technology. And that interest continued and you know, obviously with COVID you know, that really launched a lot of the telemedicine, you know, just acceptance that we see today. So, you know, like fast forward a bit, you know, like did some of my postgrad training work, actually had eclectic career in which I did an intern year, then postdoc research.
And from there though I circled back to primary care, really on the entrepreneurial end, like actually launching a medical practice.
And what I noticed was that there was this.
So first of all, telemedicine had gained a lot of acceptance and there really was because of COVID and the advent of a lot of the billing codes around Covid, there really was an opportunity to serve an underserved population that never really been treated well or gotten significant attention before.
And I could provide a higher level of care to folks in the Medicare and Medicaid population, specifically utilizing CCM and to some extent RPM CPT billing codes. What that allows me to do and allows us to do is really provide a hands on level of care to a vulnerable population that has historically been marginalized and provide care in a way that, you know, in my humble opinion, historically just haven't been able to do.
[00:04:53] Speaker A: What was your trajectory after residency? Did you work for a big hospital group? Did you work for a university center? Did you go out on your own?
And what's your kind of combo right now? You know, are you hybrid here? Are you hybrid private practice? How'd you structure your after education life?
[00:05:10] Speaker B: I completed an intern year over at Loyola McNeil and then really just from there decided, okay, like the traditional practice of working for a large hospital wasn't going to be for me. I knew I wanted to do something more entrepreneurial ship. It was important for me to finish the intern year just because I had worked so hard to get there up until that point.
But really after that I was like, okay, this isn't really what I want to do. So then I transferred. I was like, okay. I knew medical technology was of interest to me. So then I actually got a postdoc over at Beth Israel, it's like one of the hospitals of Harvard.
And I was actually out of all things neuroradiology postdoc, where we're like actually analyzing various imaging techniques for being able to predict very various just disease states, neurological disease states earlier and essentially looking for metabolic markers and various neuroimaging to be able to detect neurological diseases earlier on. And that was medical technology heavy. So feel part of me loved it. But then I realized, okay, as much as I love the medical technology piece, research isn't necessarily my jam.
So, you know, finish the postdoc and then from there was like, okay, I really am an entrepreneur, it's time to stop fighting that. Let me go ahead.
But I want to be able to operate in healthcare and I want to be able to do it in a way that's really going to make a difference in a way that's going to be able to improve the lives of patients and people that really need help. I looked at ways that I could utilize my love of medical technology as well as my entrepreneurial passion.
After I really dug into a lot of what I was personally passionate about, but also some of the challenges in health care, I was like, okay, I can use this engine of virtual care, telemedicine and you know, like virtual like medical technology and monitoring technology to, you know, solve some of the challenges upstream of some of the disease states that I find, you know, particularly around metabolic health and really design a solution around that.
And so that's kind of how I ended up where I am now.
[00:07:57] Speaker A: How long have you been doing telehealth?
[00:08:00] Speaker B: So about two years now.
[00:08:01] Speaker A: Yeah. I also felt the hospital life is great, seems secure, you know, corporate, but it also wasn't the path for me. So I felt the same exact way. Do you have any in person care whatsoever or you're 100% virtual?
[00:08:16] Speaker B: I do have some in person care. Honestly I didn't some more of that at the earlier stages just because like right now we're really focusing on partnering with like primary care clinics for like a lot of the in person care that's required. And so like, so for example, the more bread and butter primary care, I'll actually reach out to primary care clinics or you know, like in a lot of cases the like our patients will require cardiology care and so I'll reach out to a cardiologist to partner with them and just make sure that our patients, if they haven't previously seen the specialists that they need to see that we're connecting them with those specialists. But do I provide any in person care? I actually do have a location here in Manhattan that it's kind of like the coworking of medical spaces where like I can literally rent it out by the day if there's any in person care that I need to do. I almost have that more as a stopgap for if anything does pop up, but very seldom have I had to use it. There's been a few occasions, but I can literally, you know, count those on my hand at this point.
[00:09:34] Speaker A: Where do you Patients usually find you. How do you usually get patients? I know that that's a question that comes up a lot in telehealth or when you're in private practice. You know, we don't have the marketing strategies or capital that a lot of these big hospital systems have. Where would you suggest and where, where did, how did you get them?
[00:09:54] Speaker B: Initially I've been big on social and so I've actually, you know, in addition to what you've probably seen which is on the Instagram end but that's like honest or sorry. On the LinkedIn end but that's actually more on the provider facing end of things, on the patient facing end of social. We actually have both a Facebook and Instagram account and I post regularly to those. I don't get much direct patient flow from the organic content I put out. But what does work is it ends up being a really good backdrop for when I do run social media ads.
There's this body of work that patients come across and it makes all the, it makes the ads that I do post a lot more effective.
So what I would say is what's worked for our practice specifically has been posting organic, creating that good body of work and then actually creating social media ads to actually draw the patients in towards that good body of work.
So that's been me personally, but there's tons of different strategies out there. If you're a specialist, what I would recommend, get to know your primary care physicians because they're going to be really strong referral sources for you. You'll literally what you can do is go to LinkedIn, post, you know, like direct message 10 to 20 of them and invite them out to dinner. Don't make it salesy, just be like hey, you know, I'm just trying to get to know your like primary care providers in the area, you know, just so that I can have those strong physician ties. And I'd love to pick your guys brain on what you guys are, you know, just seeing like let's just say I was a dermatologist. You know, just what types of concerns that you as a primary care provider are running across in the dermatology field that you know, either I can help answer or that I can brainstorm with you in terms of how to provide better care to patients. I'm literally just making that off the top of my head so you can so obviously play with that. But something around those nature, that nature. I've talked to other physicians that have gotten involved in the speaking circuit and you know, literally by speaking and you Know, kind of, and inviting stakeholders to that.
That's worked well for them. Other providers, podcasts have actually worked well.
So, you know, there's a whole host of different things. I even, you know, the, my podcast, My First Hundred literally addresses this very topic just because it really is a complicated topic. And that is really what holds a lot of providers up, especially around launching, is how do I get my first set of patients.
[00:12:57] Speaker A: How long have you had your podcast? Tell the audience. I had my podcast too, since January actually. And I felt like, you know, because you and I, we have these similarities. We're both virtual. I'm a specialist, you're pcp. It was just kind of a natural unfolding of my virtual presence, you know what I mean? How did you end up doing your podcast? Does anyone help you? What topics do you cover, guests and the audience and things like that.
[00:13:23] Speaker B: So at first it was, the podcast was to scratch my own itch because like a lot of providers, I had a lot of anxiety about getting the, you know, the first set of patients.
And I figured that the best way to get advice was, you know, if I had a podcast, that would be a great way for, to get folks to actually have a conversation with me. From there, it actually evolved. While I still do interview practice owners around getting their, their first hundred patients and that type of thing, I just made it more and expanded it into more of a general medical entrepreneur podcast. I interview, you know, like physicians and other healthcare practitioners about, you know, like other type of medical ventures that they started.
So for example, one of the guests was retired Navy SEAL turned doctor that launched a sleep supplement company. That was something where, you know, I had the pleasure to interview him on just how he got Joe started with his sleep supplement company and of course couldn't help but touch base on some of his heal training as well. And then in terms of the help, I would say that I'm starting to get that really, I am still really exploring help around editing because like when I first started I was like, okay, I'm just going to let it be a straight conversation.
Whatever's in there, I'm just going to let it fly, you know, that type of thing. But what I found was like, okay, number one, I'm not trying to be the next Joe Rogan where I have like a three hour conversation. Like a lot, you know, my podcast, it's a lot more informational. Folks just, you know, want to hear what works and get the information out there. And a lot of the times whittling, you know, like a podcast of like 45 minutes to an hour, down to 20 minutes to 30 minutes. Works perfectly well and, you know, gets all the details across and also makes my guests look a lot sharper, you know, like, you know, being able to just cut a lot of those just natural brain farts, a lot of the natural dead ends that the conversation goes down, that sort of thing. So I got much more involved into editing. And what I've noticed is the editing takes like way longer than the conversations actually do. So I'm starting to, you know, like literally go on upwork hiring an editor just to actually get help on the editing front. So that's the current thrux.
[00:16:04] Speaker A: Where else can patients find you? So you're on LinkedIn. That's how I connected with you. You have a podcast. Where else can people find you if they want to learn more about your practice or connect with you as a professional?
[00:16:18] Speaker B: So our website is with you. MD.com unfortunately the U like you and me was taken. So it's literally you just like the letter U. So with the letter u.
MD.com is our website.
If it's a patient that wants to reach out, it's just feel free to send an email to infowithumd.com and we'll get you squared away.
[00:16:46] Speaker A: What is the name of the place? Just curious because we don't have this in Florida. I'm sure New York has it where you can just rent a room. As a physician, is it like salon suites or what kind of.
[00:16:58] Speaker B: So the place around here, what it's called, is Nylo. So N Y L O.
And then you can kind of go to their website and check them out. Apart from that, you know, if you just Google medical coworking and then your area, you can probably find some places. It's not super, super common everywhere. So it's not like as common as like we work per se, but generally every area will have like at least one or two of these offices. And just check it out.
[00:17:34] Speaker A: What platform do you use for your virtual clinic? EMRs can be really, really expensive for doctors. And just a rip off, which one do you use?
[00:17:44] Speaker B: We use an EMR called Healthy H I E A L T H I Y E. You know, I just like it just because it's simple, neat, and it has like a good amount of features as well. Like once you get to learn the platform. I also like the fact that they have, you know, essentially a centralized task list.
So rather like most EMRs, you to see the what's due for a patient, you have to open up that Patient actual profile.
So that can get hard to keep track of, like what you have to do for each patient in terms of tasks versus the like when you log into Healthy, they just have a centralized list where I can be like, okay, these are all the to do's for our patients that essentially we have to execute on.
So I really like that.
So yeah, and you know, they're pricing wise, they're reasonable. So I like them. The ones that I don't think they're a rip off. I actually really like epic. It's just expensive for new practice. So, you know, I mean, I would just say EPIC is something where if you're a large hospital system, by all means have at them. There's lots of features that I like, especially around wearable integration.
Um, it's just if you're getting off the ground for the first time, I just don't think the juice is worth the squeeze in investing in like epic.
[00:19:16] Speaker A: Yeah, no, I, I, I'm kind of terrified or scared of seeing how expensive they would be. Do you have. The other pain point with running a practice that I've personally had is staffing.
Whether it's virtual or in person, it's just difficult. Like HR stuff helpers.
Definitely your time's really valuable as a doctor and you want to maximize your time. You know, see patients, help people out, not be spent doing administrative work, which we're so overburdened with in today's world and healthcare. Do you have staff? Do you have support?
Because I figured if you're editing a lot of podcasts, which is important, but I can't imagine spending a lot of time doing that. Do you have a support staff or is it just you? One man show.
[00:20:05] Speaker B: Yeah, so I do have a virtual receptionist.
And then, you know, in addition to that, just because of the nature of the care that we provide, you know, I have actually, we do like some behavioral health care.
So, you know, I have actually a counselor as well. The short and skinny of it is that not just for running a medical practice, anything entrepreneurial, the people is the hardest part.
[00:20:35] Speaker A: Yeah.
[00:20:35] Speaker B: You know, just because it's table stakes for someone to come in, give a good interview and not seem like a psycho. But, you know, then they, they join and you know, maybe the first two weeks they do okay, and then you start to notice the cracks appear and then you're like, okay, they're not executing the way that I thought they were. And so what I learned is that, you know, I'll be actually pretty liberal about hiring someone, but what I'll do is I'll make it part time and on a trial period, sometimes it'll just be like, I won't even allude to a longer period, like a longer, more permanent position. Sometimes I'll just air for a temporary position and if they do well, then I'll offer them a longer term position. And if they don't, then I'll just be like, oh, oh, thank you so much for your service over this last two weeks.
So if I even allude to a longer term position, I'll just be like, hey, just so you know, we're going to have check INS at 2 weeks, 4 weeks and 6 weeks and we'll see how you're doing from there. And like, listen, if things go well, then I'm happy to work with you longer than that. But if not, it doesn't mean that you're like a bad employee or a failure. It just means that, you know, there were, you're just not necessarily best fit for here. And then just go from, from there. See how they perform over, you know, a two week, four week period and if they can actually execute, then great. If not, then you just move on to the next. And so what I'm doing is just getting tighter and tighter on that initial hiring period and really setting expectations just because I feel like people will hire someone and then one of the things, they'll know that they're not right for the role, but because they didn't really set that expectation up front. And I'm this way as well. Like the last thing that I want to do, the thing that sucks the most, is having to fire someone. But if you set that expectation up quickly that like, hey, this is, this may or may not work out, that takes the sting out from both sides.
If they don't work out, then you can essentially move on gracefully from there. And so, yeah, you know, I would say that being very liberal in hiring, but also very setting that temporary expectation up front is how I've been able to navigate that minefield.
[00:23:12] Speaker A: What about in person staff? So sometimes you see patients in person.
That's been probably the biggest challenge, largest expense for me. Do you have anyone that helps you in person?
[00:23:24] Speaker B: In person, I haven't had that need just because I do so seldom, like I do it so seldomly. You would be amazed at how rare it is for people to do what they say they're going to do and follow through.
[00:23:36] Speaker A: I've had people quit the same day actually in less than an hour. Yeah.
[00:23:40] Speaker B: Wow, that's actually really impressive. Nice. But yeah, I would say that first of all that's not uncommon, unfortunately. It's just goes with the territory. Set those expectations early and I'm a huge advocate for starting off with a temporary work and then going from there.
[00:24:00] Speaker A: Anyone in your family in medicine or kind of what led you to study this field from the get go?
[00:24:08] Speaker B: So actually my mom's a retired physician. In many ways I look at to her as a trailblazer, you know, even though she downplays it, you know, African American physician, that, that was a woman, you know, in the 80s couldn't have been easy.
So I have a incredible respect for her. It's kind of funny because she actually did everything she could to discourage me from medicine.
[00:24:35] Speaker A: You know, she said my parents too,
[00:24:37] Speaker B: they also, she basically said if there's anything else you want to do, do that. So but you know, sometimes you, you take the lessons you learn from your parents aren't always what they tell you, it's what they do sometimes. And so I take incredible inspiration from her.
[00:24:59] Speaker A: What kind of physician was your mom?
[00:25:01] Speaker B: So she was a primary doc as well.
[00:25:04] Speaker A: Do you do just from your profile any angel investing into healthcare entrepreneurship?
[00:25:12] Speaker B: I myself am pretty much focusing. So for folks that don't know, angel investing is like being an investor in startup companies, primarily using your own funds. So I myself am pretty much focusing all my funds into my own personal ventures these days. And so I have a list a mile long of things that I personally would want to fund of ideas that I have.
So I currently am not active as an angel investor. I am an advisor for what's called Medical Venture Studio.
And so what that is the venture capital as opposed to using your own funds as an individual investor, Venture capital also invests in startups, but they use other people's funds. They go out and fundraise to draw funds from limited partners and essentially pool those funds and then go out and invest in startup companies.
So a ventures studio is actually an entity that instead of just investing in startups that already exist, they actually both, they ideate and launch companies.
And so this is actually a firm that is in the medical space that ideates and launch launches actually medical startup companies and I'm an advisor for them.
[00:26:41] Speaker A: What advice would you give to clinicians starting their own healthcare venture?
[00:26:47] Speaker B: So there's a few things like if you just want to do more of a traditional like medical practice, you know, that's something that's been very a path that's been well trot.
So I would talk to, you know, get advice and talk to Providers that have done it before.
I would also start the credentialing and legal process very early because that takes, you know, those are some of the longest pathways, especially if you want to see Medicare and Medicaid patients.
So I would definitely start that early and then talk to people that have done it. And then if they want to do something that is a medical venture but not like a medical practice, I would do what's called customer discovery, which is you interview different stakeholders. You know, believe it or not, you want to interview like a minimum of like 100 different stakeholders and not just your potential customers. You want to interview, you know, the WHO folks that would pay manufacturers, get a sense of how much this all would cost and that type of thing. And if you want to, if you Google customer discovery, there's a lot of great resources on that. So I would say don't be afraid to get started and then really start by interviewing people that have done it before.
[00:28:10] Speaker A: What's next for virtual care and AI and virtual care? Where do you see this going next in terms of just trends like health tech trends in the space?
[00:28:22] Speaker B: I'm going to give you a really, really nerdy one. Okay, so this is because I could easily say, like, well, you know, telemedicine is going to continue to grow and you know, like that's going to enable rural care and that type of thing. But I actually think, I have a silent bet that I think is really going to take over.
So there's this technology out there called Remote photo slimography.
So if you know the. So the technology in your Apple watch is actually just photo slimography. It's essentially a light based technology that enables basically all the wearables. Remote Photo Slimography, RPPG for short, is actually technology that utilizes just your cell phone camera that you can just like point at your face and it gives you a full set of vitals. It's not quite there yet. It can give you some pretty accurate reads. But I still think there's a little bit more R and D that's needed to be done. But once it really is ready for prime time, I think a telehealth provider like ZocDoc is going to acquire one of those companies and it's just going to be the way that telehealth is done where you can, where folks will just log into their telehealth visits and just by virtue of the platform they're on, providers will be able to get a full set of vitals of the patients that are using the platform. And I about Two years ago, I wrote an article about this technology that warmed my very, very nerdy heart.
It's on LinkedIn. Probably got about a total of 10 views, but I still really love it, and I'm proud of the work.
[00:30:13] Speaker A: Awesome. Thanks, Dr. Engel. We'll talk soon, and I'll keep connecting with you on LinkedIn. Okay.
[00:30:18] Speaker B: All right. Thank you so much,
[00:30:30] Speaker A: Sa.
