Episode Transcript
[00:00:00] Speaker A: The thing that's concerned me as an attorney for years and as a physician as well is, you know, I always use the saying, if all you have is a hammer, all the world's a nail. So a case that we just wrote up and I was tangentially involved in was a case where a person was in with a bad sore throat to an urgent care drooling and hoarse voice. Now to any EM physician, the person you think about is Perry Tonsil abscess, epiglottitis, maybe retropharyngeal abscess. But the hoarse voice and the drooling, you have the epiglottitis and it was completely missed. And you know, 12 hours later the guy was dead. And when asked he was an apc, when asked at the deposition about epiglottitis said, oh, I thought only kids got that.
And so there's in some folks a level of depth that they don't quite have because they don't have the, they don't have all the training that physicians have so they don't always pick up on the nuances.
[00:00:54] Speaker B: Welcome to skin deep. I'm Dr. Anna Chacon and today we have a very special guest joining us. Get ready for some expert insight you won't want to miss.
If you can tell the audience a little bit about yourself and start with just introducing yourself please.
[00:01:11] Speaker A: Sure. My name is John Sheepelt, I'm a board certified emergency medicine physician and I've been an entrepreneur for probably 30 plus years.
[00:01:18] Speaker B: So I invited you on the podcast based on an article I read on Medscape. I was very impressed if you don't mind telling our audience who's generally a mixture of, I want to say physicians and patients and some influencers, but tell everybody basically your trajectory after medical school.
[00:01:35] Speaker A: Sure. I did a emergency medicine residency at Christ in South side of Chicago, stayed there for a year, kind of had two full time jobs, one there as an academics and one in a suburban hospital. Moved out to Arizona, took a job as a medical director for an emergency department in Casa Grande. Three years later started the first urgent care in Arizona and one of the first ones in the country called Nexcare went back, got my MBA at the same time grew Nexcare to 60 locations in seven states. Along the way had a couple of the business startups, got a law degree as well, left NextCare in 2010, sold it to private equity two weeks later. I started me and was an early tele telemedicine company which we sold to Walmart in June of 2021 along the way at a number of other startups as well. Got back to school a few more times and right now a business called Tribal Health where WE staff about 50 plus Native American facilities across the country. I own a venture capital company called Accelerant and the managing partners and I'm a partner of a pharmaceutical company called Viva Med Biopharma.
[00:02:40] Speaker B: And you had your own podcast. It seems like you're constantly working on stuff and studying. How did you have time for all these things?
[00:02:49] Speaker A: You know, emergency medicine is very shift oriented. So when I was in law school, I'd go to school during the days in work leadership and the weekends.
It's, you know, emergency medicine is relatively easy to have multi careers.
[00:03:01] Speaker B: I read in the article and I think on LinkedIn you still work as a physician, correct?
[00:03:07] Speaker A: I didn't work. Yeah, I was in Eagle Butte, South Dakota over New Year's working in the emergency department.
[00:03:12] Speaker B: That's amazing. And do you work in a couple ers or one mainly?
[00:03:19] Speaker A: No, we staff a number of emergency departments and I'm always the physician of last resort. I have the ability to fly, so I can get there in a moment's notice. For a lot of the places, if the physician misses a flight or is sick or something, I can go there and work.
[00:03:32] Speaker B: And where are you based out of now? Where do you live now?
[00:03:35] Speaker A: Scottsdale, Arizona.
[00:03:37] Speaker B: And so a lot of the ers that you kind of serve as backup for overseas, are they tribally oriented? Tribal health?
[00:03:46] Speaker A: Yeah, they're all. It's all through a company called Tribal Health. And so we have probably 400 doctors and nurses that work in all these different facilities around the country.
[00:03:54] Speaker B: If you can tell the audience just as a physician, let's say your MBA and the JD was useful or why you went back specifically to get those degrees.
[00:04:05] Speaker A: Well, for the MBA, I did that first 93 to 95. And you know, I did not have any really business training. I'd been entrepreneurial my whole life. I realized when I started Next Care, I started the EM practice group. So we had four emergency departments that I really needed some business. I really needed some business background. I mean, it's a whole new language to learn. And so went back and did that full time and really enjoyed it, loved the learning process.
And then 10 years later went back and got a law degree. And I thought at some point I won't want to be in the emergency department on nights, weekends and holidays. And so I defend positions in front of the medical board, which I did for a little bit of time. Enjoyed it. But it was just not something I wanted to spend the majority of my time on.
[00:04:47] Speaker B: You specialized in physician defense in front of the medical boards?
[00:04:51] Speaker A: Yes, I did contract review for physicians as well.
[00:04:54] Speaker B: Wow, okay. Do you practice any law now?
[00:04:58] Speaker A: I just look at contracts for friends occasionally, but I don't. I don't advertise myself as an attorney. I, at one point I had a Shufel law firm, so where I would do a lot of speaking and writing and then contract review and then some position defense.
[00:05:12] Speaker B: And in terms of the medical board, because they can be very difficult on physicians, what advice would you have to, I guess, physicians facing complaints or in that aspect?
[00:05:25] Speaker A: Well, the first thing is don't do the wrong thing. I mean, that's the easiest thing. The problem is a lot of people do what turns out to be the wrong thing with very clean hands. They don't know it's the wrong thing. It seems obvious at the time. I could tell you hundreds of stories of people where on the surface looks like it's an appropriate thing to do and then it turns out not to be. If you do get a medical board complaint, take it incredibly seriously. If a patient makes a complaint, don't call the patient and try to explain it once. Once it's to the medical board, don't talk to the patient again. I'd hire an attorney to work with you. As experience with the medical board, they have the power to take away your license. Their duty is to protect the public, not to protect you, the physician. And so you have to treat it very seriously. And not everybody does. And then I would say is be very candid. I mean, if you screw up, say screwed up, here's what you need to make it better, here's what you've done to make it better. But definitely seek the advice of an attorney.
[00:06:17] Speaker B: There are cases where, and I found that this to be really interesting when I learned about board complaints. But there are cases where you can get your license revoked and it seems like you can't ever go back to work. What advice do you have to people facing that or just learning that for the first time? And what can you do as a physician? Because we spend so many. I felt like I spent a lifetime in school and I probably wouldn't know what to do if that happened.
[00:06:45] Speaker A: You know, there's not many things you can do with if you had a permanent revocation of your license. I mean, there's certainly something you can do, but there's not a lot. But I always like to think of ourselves as, I mean, I think Physicians are born entrepreneurs because, you know, what does it take to be an entrepreneur? It takes a lot of grit, takes some creativity. You have to be a good communicator, you have to have a modicum of intelligence. These are all qualities that we all have, particularly the grittiness. You can't do what we've done without being frankly, gritty as hell. And so I always, I always like to say I'm a physician. And so it's what you decide is an and. Maybe your and is painting. I mean, maybe around is surfing. That's great. But I've had a lot of hands that were able to provide a living for myself. And I always try to look at things that I want to say, kind of dent the universe, make a difference. And so I try to have some kind of big and along the way, and I failed multiple times trying to begin.
But I think as long as you have an and, it prevents burnout. Because now you're not a one trick pony. Now when I go back to practice, I look forward to it because, you know, maybe five shifts a month or no shifts for a couple of months. And I really enjoy going back and getting, you know, getting back in the swing of things and working elbow to elbow with people that, you know, we were on the same team. What I have my advice to young physicians, we find your aunt, figure out what that's going to be in terms.
[00:08:04] Speaker B: Of starting your urgent care. How were you able to grow so quickly to all these states and 60 clinics?
[00:08:13] Speaker A: Well, it was 17 years, so it wasn't all that quickly. You know, I had three mortgages on the house, I worked seven days a week. If I wasn't in the urgent care working, I was in the emergency department working or going to school. And it just sort of takes that level of grit. I started with two other emergency physicians. One bailed out within two weeks.
Been a lifelong friend, said, look, I'll do one of these with you, but I don't want to do more. This is way too stressful. And so I just would build one, get it up to speed, start building the next one, get up to speed, circle the next two and kind of go like that. And you know, there's failures along the way. And I learned a lot. Back in the day there weren't any urgent care, so we had to convince the health plans the value and we had to convince the patients about value and safety. So it was this first couple of years was pretty slog, much like in telemedicine in 2010. You know, no one could believe you could see a physician on the Internet. And so it was, you know, probably about a four to five year grind of getting people comfortable to doing what we're doing.
[00:09:12] Speaker B: Did you use just because I, you know, we talked about how I have a private practice and it's extremely expensive, I think much more than telehealth to run an in person business.
Were you able to get funding to expand to all these places or how.
[00:09:28] Speaker A: It was all debt and mostly, you know, where I had to sign the house was, you know, collateral. You know, one time I had to sell a helicopter to which I used to train, which I used to transfer. You know, I used to commute in and to sell the helicopters, make payroll ones. It wasn't until 2008 that we had private equity back and then I stuck around two more years.
[00:09:49] Speaker B: Where was the urgent care or how did you choose strategically to locate an urgent care?
[00:09:55] Speaker A: Well, I mean, I learned a lot along the way. You know, we stayed away from things like strip malls. We had corner locations with good ingress and egress, preferably at a light with great signage. Highly trafficked areas. Those clearly work the best. I owned an urgent care franchise for a while called Doctors Express. They started out in a strip mall and the guy who ran it was this great guy, had a big patient following, but he had a pace about it because he was a great guy. When they tried to replicate that model, it didn't replicate well. So they asked me to consult and then I ended up buying the company and then selling it a few years later.
[00:10:28] Speaker B: Was it mostly emergency physicians or advanced practice practitioners?
[00:10:33] Speaker A: That was all at the time we started, it was all physicians. We sometimes had double coverage with APCs, some EM physicians, but mostly family practice physicians who had a, you know, kind of had the interest in walking, walk in care.
[00:10:47] Speaker B: And then how do you think the landscape is changing now with you know, the advanced practice practitioners and versus physicians both in hospitals practices, urgent cares, clearly.
[00:10:59] Speaker A: They feel a need and I think in some practices they're great for the level of care. The thing that's concerned me as an attorney for years and as a physician as well is, you know, I always use the saying if all you have is a hammer, all the world's a nail. And so a case that we just wrote up and I was tangentially involved in was a case where a person was in with a bad sore throat to an urgent care drooling and hoarse voice. Now to any EM physician, the first thing you think about is peritonsal absence, epiglottitis maybe retrofringeal abscess. But the hoarse voice and the drooling, you gotta have the epiglottitis. And it was completely missed. And you know, 12 hours later the guy was dead. And when asked, he was an apc, when asked at the deposition about epipharatitis, said oh, I thought only kids got that. And so there's in some folks a level of depth that they don't quite have is because they don't have all the training that physicians have, so they don't always pick up on the nuances. And there's many times, I'm sure with yourself too, you come up with a diagnosis, it's just incredibly rarely a cavernous vein thrombosis or something really odd that but for your training, you would have completely missed it because you wouldn't even know it existed. And that's the one concern about advanced practice clinicians. They just don't have the level of training.
[00:12:17] Speaker B: I wonder if they have to do. And I'm not sure if you know this, but maintenance of certification, because I know through AAD I have constant questions, you know, or the abd, you know, that, that just resurface. And now they don't have this, you know, 10 year retake of exam. It's pretty much continuous and quarterly. But I wonder if that exists because those questions are still pretty difficult.
[00:12:41] Speaker A: Yeah, I'm sure they do. I know APCs do. I suspect nurse practitioners do as well.
[00:12:47] Speaker B: And then empower emergency physicians.
Was that your practice?
[00:12:51] Speaker A: That was one of them. So I started out with another gentleman in 2000 and that we have now four emergency departments in Phoenix.
I stopped practicing emergency medicine there and I just managed a business for them.
[00:13:04] Speaker B: And did you come from a line of physicians or entrepreneurs?
[00:13:09] Speaker A: No, my father was a 40 hour a week attorney who worked for the Same company for 40 years. He did not have an entrepreneurial bone in his body.
[00:13:20] Speaker B: That's funny. And what about your mom and where are your parents from?
[00:13:25] Speaker A: I'm adopted, so birth parents are from Iowa. I grew up in Chicago area. I'm not sure their level of entrepreneurism, but you know, the one thing I always credit being an entrepreneur to is I failed a ton as a kid in pretty much everything.
So you know, one of the fears that people have about being entrepreneurial is they're afraid to fail or afraid to look stupid. And I grew up that way, looking stupid and failing. And so for me it was just like, you know, get up, shake yourself off and try again. It's that old Proverb, fall down seven times, get up eight. And I kind of grew up with that just being self taught. And so all these crazy stupid mistakes. I've made some of them a couple times. It was just like, oh, this is a learning process. This is, you know, if you want to be the man in the arena, you have to be. Get covered with dust and blood and dirt and pick yourself up.
[00:14:13] Speaker B: That's very true. Yeah, you kind of can't be afraid of failure. That's kind of my motto as well. What about your family with all these entrepreneurial pursuits? Do they travel with you a lot when you go to these places or are any of them in medicine as well?
[00:14:30] Speaker A: My wife's in medicine, she's an internist. But my son's a fighter pilot and venture capitalist with me. My daughter has a master's in sustainability. They're both parents, so two little grandkids. But no, I, you know, I've been flying for 35 years and I'll take a helicopter around Arizona and I'll take the plane around the country when I go to work.
[00:14:49] Speaker B: You fly yourself?
[00:14:50] Speaker A: Yeah, I have an airline transport pilot rating, so I fly all over the place.
[00:14:55] Speaker B: And did you have to, I'm guessing, go to school, get a pilot's license and all that other stuff?
[00:15:01] Speaker A: Well, yeah, you start with a private pilot and then you do an instrument rating, then a commercial pilot, then what's called your airline transport pilot. And it's just a matter of hours and steps and tests you take along the way. And same, same with helicopter.
[00:15:13] Speaker B: I know in Alaska, you know, let's say we have really bad weather a lot of the times. I mean, are there times that or any sort of thing that you look at that tells you it's not a good time to fly or.
[00:15:24] Speaker A: Well, yeah, you certainly research the weather before you go and you do a plane, you fly in a jet at 45,000ft. So you really spend a lot of time. Looks like a commercial airline spent a lot of time analyzing. I landed in Bemidji, Minnesota last like April 30th. It was end of April to the worst blizzard, snowstorm I've ever landed in, where I couldn't see the Runway side to side, not, not the length. I couldn't see the sides of the Runway and the sea almost right at 200ft, which is right. The reps and saw the minimums. And I remember breaking out and seeing the Runway and I'm like, what the hell am I doing?
So I've had a few of those experiences where Retrospectively probably would have been smarter just to say, yeah, I'm not coming or I'm going to wait.
[00:16:06] Speaker B: Oh my gosh.
And where do you park these helicopters and where do you keep it?
[00:16:13] Speaker A: I have a hangar office.
[00:16:15] Speaker B: You kind of built it next to your house or something like that?
[00:16:18] Speaker A: No, it's. It's 10 miles away up at a kind of a major, not major, but pretty busy airport in Scottsdale.
[00:16:24] Speaker B: Cool. That's very, very.
And then a couple of things. How did you eventually get into telehealth?
[00:16:31] Speaker A: I was just working one day and thought, well, this is weird because a lot of patients I see probably don't need me to touch them. You know, want to touch. But that's another story. And a lot of it is just this communication. And it dawned on me that a lot of things be solved that way. And then also there's a dearth of behavioral health providers. When I recently started, me and B, I thought we'd angle it more towards behavioral health. And then people are like, you know, never heard of that, can't imagine doing it. So then I kind of pivoted to more urgent care, since that's what I knew. And we started doing urgent care via behavioral telemedicine in late 2010 and then just grew from there. And it was. We built out our own site. We kind of leased a system first and built it ourselves. But it was a slog. I mean, it was, you know, we're at the time, you know, points out that we're seeing, you know, thousands of patients today. But you know, initially I was, I had a lot of licenses. I was the main provider seeing patients 24, 7 doing telehealth.
[00:17:29] Speaker B: Yeah, it kind of reminds me of what I do a lot of the times, but. And then were you store and forward or was it video virtual?
[00:17:37] Speaker A: No, it was, it was all real time video. It was not asynchronous.
[00:17:41] Speaker B: Yeah, because I know that.
And you took mostly insurance for both the urgent cares and the telehealth.
[00:17:49] Speaker A: We did, we did a lot of cash. It was 49.95 at the time. We did, we also did insurance and we also had a SAS model. A lot of our patients were SAS model where they paid, you know, whatever dollars per month, but some of it was just straight out cash.
[00:18:02] Speaker B: What is a SaaS model?
[00:18:04] Speaker A: It's software as a solution. It just means that you're paying as you go. Subscription model. It means you're kind of paying as you go.
[00:18:10] Speaker B: How did you. Because one of the challenges being in private practice for Me is getting on insurances, you know, south Florida is very challenging and I actually tried to get on insurances nationally and I found out you need an address in every state. Now it could be a virtual address, you know, like a regis but I kind of found that out like here in California you actually need an address here, like an address to put on Medi Cal and all these insurance, you know, credentialing applications.
How did you guys manage to get on insurance plans?
[00:18:46] Speaker A: We were in all 50 states. We would have providers in those states so they would have addresses to put on them. When we started that wasn't a requirement because when we started there was. We started it was cash only because insurance wouldn't cover it. So we kind of grew along with the laws that came out about it and sometimes tried to influence those laws since we were one of the few doing it.
[00:19:07] Speaker B: And then it was purchased by Walmart. If you can go into how that happened, how that sort of marriage happened with Walmart. Do they still use it so.
[00:19:19] Speaker A: No, they actually sold it recently they dropped pretty much all. They pretty much dropped their entire healthcare platform. Both inpatient or both on site clinics and virtual.
Yeah, we had been out to market, hired an investment banker who introduced us to Walmart. They went through about eight months of due diligence. Six, seven months of due diligence.
They were the proverbial 900 pound gorilla and we were the little ant but they were the consummate professionals. Very hardcore but very professional employee and got along with them just famously. Most of our staff, all of our staff really went over there and worked for Walmart and their telehealth. I was consultant with them for a year but you know, could not have had a better experience with Walmart. Very, very bright, hardworking people.
[00:20:07] Speaker B: How about accelerant ventures? Did you get into that and venture capitalism and what do you focus on with that?
[00:20:16] Speaker A: I wrote a book a few years ago called Entrepreneur Rx the Physician's Guide to starting the Business with the idea being two, two fold. One, physicians should be entrepreneurs and two, if you're in a practical camping then you should be investing in other physician entrepreneurs. The whole idea of the book was to start a. It was my lead in the start of venture capital company. So I met with two other gentlemen. One who's a former dean of law school at ASU, he's an intellectual property attorney, the other is a PhD out of Yale who's entrepreneurial, Chris Yu. And the three of us started accelerating ventures. So we raised the first fund, 25 million made about 12 investments so far. We're starting our second growth fund which will be a lot larger later stage fund. All health tech, med tech, a lot of position CEOs and that was called an interval fund, which is one for non accredited investors. Put in smaller amounts of money which would be an early stage fund as well.
[00:21:07] Speaker B: Also how you got into tribal health and Native American facilities and health care.
[00:21:12] Speaker A: I just by circumstance I used to do a lot of flight medicine. I was medical director for two flight large flight companies. And the former CEO once said, hey, we're up at this hospital San Carlos outside of Phoenix and you the chief medical officer, they just built the hospital which would be interested in. I had little experience in tribal health other than taking care of indigenous patients and inner city ers. So I flew and said, sure, I'll try it. So I went up there to meet them and flew up there and fell in love with the people and the community and the hospital and brought in. And it started because I was appalled at the level, the quality of care that was provided. People generally weren't board certified. That was the problem. And so I thought, well, gosh, this is 90 miles from the fifth largest city in the country. This problem may be endemic. And so we started doing some research and it was endemic. So we bid on a large contract in the Dakotas and the Great Plains, won that and then have grown since then. And it's been a labor of love. You know, it's. We're large and you know, every day is a challenge. But we have ride or die staff and they're all, they're all very mission driven.
[00:22:23] Speaker B: Is there a role for dermatologists there? Because I'm always interested. At one point I did want to be a dermatologist, kind of like you are. That goes to a lot of tribal facilities. In fact, what fascinates me a lot is their culture. You know, it's just such a pretty culture. And they're usually in really remote, pretty areas, like beautiful areas that, you know, are actually hard to get to. But really, really pretty.
[00:22:48] Speaker A: Yeah, I mean, you know, some of it's not all that pretty. They. A lot of these folks live in very, very rough environments and things that we take for granted. They don't, you know, they live in food deserts. They have a high incidence of diabetes secondary to their diet, high incidence of abuse, substance abuse, because the unemployment rate 70%. There's not a lot to do.
And then they have all things that go along with them. So they're a wonderful population to work with. They have some medical problems that they don't deserve to have and that one of the things that we try to do is do whatever we can to help lighten the load.
[00:23:24] Speaker B: And how do people present a venture, just wondering, to Accelerant Ventures? How does that work with someone that has an idea and then just presents it to your company for investment?
You know?
[00:23:38] Speaker A: Yeah, they go on our website and fill out a form. It's just accelerant ventures.com and it's X C L seller Ventures. You know, we invest in companies that are. If it's a device, it's. They should be near or post FDA approval. There should be pre revenue. We don't do much pre revenue things. They have to have some revenue coming in the door. So it's got to be more than an idea. I've worked with a lot of providers on ideas that they've gotten to the point, then we invest in them. But generally speaking, we invest in post revenue, post fda.
[00:24:08] Speaker B: Is there a lot of investment in virtual care or where do you see virtual care heading?
[00:24:14] Speaker A: Virtual care is, you know, it's like urgent care. It has time. It's kind of come and gone. Virtual care is kind of the same way. We'll always have virtual care, we'll always have urgent care. But the time to invest in it was years ago. Hard to invest in it today. There's very little new that's coming along in virtual care. You know, we've invested in a number of AI companies that help with diagnosis and data aggregation. But there's not too much left to invest in virtual care.
[00:24:43] Speaker B: Well, thank you so much. And then I don't want to take too much of your time because I know you're probably very, very busy. But thank you for joining me and I really look forward to. We should keep in touch. So if you ever need a dermatologist in tribal health, I would love to be. Dr.
[00:24:59] Speaker A: Thank you.
[00:25:00] Speaker B: Thanks. Dr. Schufelt.
