In this episode of the Telehealth Heroes Podcast, we interview Dr. Medhavi Jogi, an endocrinologist and co-founder of the practice Houston Thyroid and Endocrine Specialists. We discuss why he started his own practice, how he redefined endocrinology appointments, and how he used telemedicine to increase his income.
Episode transcript
Brandon:
Welcome to the Telehealth Heroes Podcast, a show about healthcare providers doing amazing things with telemedicine. I’m your host, Brandon Welch.
Today we’ll hear from Dr. Medhavi Jogi, an endocrinologist in Houston who started his own practice in the midst of the economic downturn of 2009 and totally redefined the patient experience. As a result, Dr. Jogi has created a successful and growing practice that revolves around the life he wants to live. Let’s check it out.
Dr. Jogi
My name is Medhavi Jogi. I’m a private practice endocrinologist in Houston, Texas. I have graduated from Baylor college of medicine and couldn’t find a job because nobody was hiring in the economic downturn 2008, 2009. And so I just started my own practice and you had to figure it all out since then. And since that time we’ve grown to five or six doctors and we’re all practicing endocrinologist private practice. So we are beholden to nobody but ourselves. So we don’t work for other people in other words. So we have figure figured all out ourselves.
Brandon:
Awesome. Okay, great intro there. So the first question I’m going to ask is why medicine? Why did you get into medicine?
Dr. Jogi
So the reason I got into medicine had a lot to do with the desire to help people in a cultural background where medicine was one of the very few options that a young Indian male in the eighties would have been choosing. My sister was already going into medicine. She’s much older than me, 10 years older than me. And, and so I thought, well, this is naturally what I’ll do. And I kind of fell into it. What I didn’t know was I don’t like emergencies. So when the show ER, came on, I kept thinking, I don’t want to do any of that. And, but everybody says, I want to be doctors because I watched ER, and I loved that stuff. So I realized very late into a training that there are several areas of medicine that don’t have too many emergencies and endocrinology is one of those. So I like talking and I like preventing things before they happen. And I don’t like uncertainty. And so, so that’s where endocrinology fits in and why, when I picked medicine, it was mostly to make people’s lives more certain and sort of, that’s kind of my approach to things.
Brandon:
So did you, so you went in and, and did you residency in endocrinology and then when you finished that, what was your next step?
Dr. Jogi
So I finished internal medicine. Then we did, then I did a fellowship in endocrinology. So diabetes and thyroid and other hormones is what I specialize in. And so the next thing was well trying to get a job. Like I couldn’t get one. So that was the, like a few months after everything went terribly to head in the economics of the U S in 2009. And so I asked a co-fellow of mine, Hey, do you want to start a practice? And he said, let’s talk in six months. I don’t think he wanted to, everybody wants to just get a job. That’s what we were trained to do. And I don’t have any family members that own businesses, so I couldn’t get a job. He couldn’t get a job. We met up for a year and said, okay, I guess we have to start a practice. And so I guess a few months later we had to figure everything out from scratch. We had very few connections in business or medicine. And so I’m glad we did it that way. So the two of us started it and then we’ve grown since then, but it was basically trial by fire, which is probably the best way to learn anything.
Brandon:
So you, you, you decided one day to start a business, put your shingle up on the door and said, all right, come on in patients. What was that experience like, as you said, all right, this is putting it all out there. I’m going to be a doctor independent. And what was that experience like as you enter that? Nope.
Dr. Jogi
At that time I would say it just seemed like a cool little adventure that I had. I had no understanding of what really, what I was getting into. I thought this is just something people do, but it’s really hard to find information. This was early internet times. It was not, you know, the iPhone was just coming out. So it wasn’t that easy to, and nobody wanted to tell you how to do it. So I didn’t really think of the financial burdens or how difficult it would be. I’d already been in debt and it wasn’t like another a hundred thousand dollars or so would mean much. I mean, so I just showed up at the bank. I was like, Hey, I’m a doctor. I need money. They’re like, yeah, here’s a bunch of money kiddo. Pay us back when you can. And I’m sure they were happy to just, you know, give it to me.
Cause I guess doctors or suckers were a good bet, I guess. So we, when I got a great banker, it worked out well. So he w we took a little bit of money, opened up really small office, like 1300 square feet at the time. It seems so big. And I had to figure everything out, how to clean the floors, how to pay the rent, how to hire staff, how to fire staff. I mean, everything that a general business would do and quickly I realized that. And now many years later, I realized that I have a lot of friends that go to get an MBA. I had friends at the time med school friends that did an MBA and did further studies in whatever that is and masters of business something. And I realized that I learned it all in one year for much less than they paid, but I can go, I’ve realized over the last 10, I’ve been doing this since 2009.
So I’ve realized it’s, it’s, it’s best to start a business and figure it out yourself rather than have them send me somebody else to tell you how it should be. So it was really hard at the beginning though. So the first two years, I thought, why am I doing this? What did I get myself into? An example is at the end of fellowship for endocrinology, I don’t, I don’t know if they still do this, but they have something called endocrine university, which is basically everybody travels to Mayo, every graduating endocrinologist for that year. And so there were hundreds of us in the audience and myself, the future partner of mine, a business partner and several hundred they’re in a crunch. And they, they, they asked the question. We’d like to ask everybody to raise their hand. Who’s going into, we’re going to ask, who’s going into private and four hands out of, I don’t know how 300 people it was me.
And then a couple of random people who I now know. And I thought, oh my God, everybody else is going to be employed. And what am I doing? This is insane. And I thought, how did they get jobs? And I couldn’t get a job, but, but I realized that day that I kind of liked doing the opposite of what everybody else says you should be doing. So, you know, everybody says, go get employed. And I was like running the other direction. Let’s just figure this out. And everybody kept saying, why are you doing this? It’s the end of healthcare. It’s all the good times are over. You can’t do it. You can’t do it over and over. And so I guess that stressed me out for a while, but it seems to have gone pretty well so far. And I feel super happy about that decision now because nobody, and I’ll say it over autonomy in healthcare is a big deal for me. And I don’t think I could work for somebody, or I don’t think I’d want to at all, because of what I know now, it’s it doesn’t require that much effort. So being your own CEO, essentially, and CMO and COO and CFO, all in one is kind of, kind of daunting, but we figured it out. So tell
Brandon:
Us about your practice now, as it exists today, we talked about how it started, but where’s it at today?
Dr. Jogi
So now we’ve gotten to two offices in, in different parts of Houston. We we’ve added w w we now have partnered in a, so we have employee doctors. And then we, I feel like it’s important to let everybody into this kind of world. That was the norm 25, 30 years ago, which is you, you work somewhere, you build a trust and, and you become a partner. You become, you put, put some skin in the game. And so we partnered in two other doctors so far, we’ve got a couple, we have several other employed doctors. And the expectation is that we eventually would, you know, everybody’s in it. I don’t want exclusions, essentially. Why would you work for a large corporation versus me? Well, it’s because you want to have control of your destiny, of what your time is like and how you treat patients as much as you can’t.
Now, granted insurance companies are still breathing down our necks, but we’re make it difficult, but you know, so, so now that’s where we were. Are we we’ve grown. We have several doctors, a couple of locations, a lot more than 1300 square feet. Now, I think we’re up to 5, 6, 7, 7,000 some large number. And, and I say, we have been pretty lucky with telemedicine a bit. I was super interested. And that’s when we met, you were probably the third company I had or 10th company I had worked with or interviewed at the time. I forget, what year was that? 20 14, 20, 15, 8 years. And I, I had this thing, like, why are we even adding off of it? Why do people even have to come to me? I don’t want to go to the office to anybody. And so somehow I thought I need to be a telemedicine guy.
I didn’t even know what it was at the time, but it just seemed logical. I think I had just watched star wars. And there was a scene where the Jedi council are all holograms. I don’t remember something like that. And I was like that, that is, you know, at the time ACS was where I was like, that’s an ACO, there’s the cardiologist and this person, that person, I thought, well, why do we have to go anywhere? And already, when patients come see me, anybody under the age of 30, 20, they don’t even look at me hardly. So there’s a lot of, you know, on their phone and, you know, but what did you say? Yeah. So I realized, man, if they’re already on their phone, they’re mentally not even here. Why do they even have to be here? So telemedicine was a no brainer to me. And so a large percentage of our practice now, and 95%, 90% of what I do is tele. And I think it should be a hundred percent. I have a lot of strong opinions on that. The other people in the group, there are traditional. They go, but they, they do, you know, a fair percentage, maybe 20, 30% telemedicine, but pre pandemic, I was doing 30%, 40%. And that was unusual. So yeah, that’s what our practice is now. Yeah.
Brandon:
So let’s talk a little bit about what were some of the problems that you faced that really prompted you to start looking for something different and in providing care different?
Dr. Jogi
So that many problems, well, one is I see all the money coming in and all the money going out and the money going out was, you know, so I can’t solve healthcare. I can’t solve delivery. I mean, I can’t solve many things in healthcare that are beyond my pay grade, but what I could see was patients are frustrated. Doctors are frustrated. Why? Because there’s a lot of wasted, duplicate effort. There’s a lot of time spent on the road in a waiting room. And then there’s, you know, we took classes on, you know, how to make sure your patient feels like you spend time with them, make sure you look them in the eye. And if these were things that you learned in med school, you know, things that seem like total common sense, but, but because you only have sometimes three minutes with a patient, these things have been documented everywhere.
So I kept thinking, I feel so bad. These patients are coming in and they’re waiting forever to get in, to see me cause to see an endocrinologist. Sometimes it takes awhile. And then once they, it takes them forever to physically get here than to wait in the waiting room. And then for a very short visit, you know, and then they leave and it’s so quick. And I kept thinking, my mouth is dry at the end of the day, I’ve said the same thing many times, but there’s not enough time to do what I need to do. And so the biggest problem I had was I, I looked around at my fellow doctors and they, what were they doing? And the large hospitals they were saying, well, we need to just jam a bunch of people into the clinic and push them out. It’s all volume-based but that’s how healthcare is structured here.
The whole value based stuff. I’m not going to go into it. But I think there’s a lot of problems to that that I can’t go into now, but I can say, well, how do I take this structure that I’ve been thrust into? And now I have to compete with these big boys in town. And how do I make it make sense for me ethically to do what I want to do and survive, right? I mean, how can I as a two or three your group compete with, I’m not going to name names, but corporate a, B and C who have billions of dollars in subsidies. Cause endocrinology, honestly, it’s a money loser for any, any organization. Other than we just talk we’re w we don’t get paid for doing things. We get paid for talking, and that’s not considered valuable, I guess, at least the way we can pay it.
So I would say, how would I survive and do what I felt was right? And so I decided I need to be able to have one and a half hour visits, meaning that’s what my, my, my visits were really long. So if you look back at my 2009 schedule, I was going to do everything the right way. I was going to spend an hour and a half of the patient. I was going to call them afterwards. I was going to write portal messages until I was, you know, my fingers fell off and I was going to emphasize this technology. But as I was doing that, I realized I’m okay, you got a business patients, actually, weren’t listening to me for honestly, I made a PowerPoint for every visit that I would see. I would, I would create one and I’d say, well, this is what you need to know.
So yeah, just take it. I just give a clap. And then I read a book by so Mon Khan, or if you’re that guy, the fun academy guy. And I read his book and I’ve been using Khan academy for my kids. I kept thinking this guy’s a genius. And it just hit me. I was like, why, why are we doing it this way? Why, why am I talking king over and over? And just lecturing, because I noticed people’s eyes glaze over and the next visit they say, okay, can you, I don’t remember what we talked, but can you send me that PowerPoint thing that you did? And I kept thinking, why would I send you the PowerPoint? I just did it whole hour with you. I was about to go out of business from my perspective. I mean, seeing five patients a day doesn’t work for, you know, finances.
So I, I felt like they were learning. And then I said, you know, I’m going to flip the table here. You know, how do you accomplish empathetic, solid care by going faster? So one option, when you look around your competitors is let’s hire mid levels. Let’s hire faster, more, maybe less effective, whatever, whatever you want to call it, that people, but it’s all based on the bottom line. And I thought, well, it’s not about inefficient doctors. I mean, it’s not about lack of doctors. To me, it’s about a lack of efficient doctors who can system systematize what they’re doing. So I turned all these PowerPoints that I’ve been using for years. I had like a diabetes, PowerPoint, PowerPoint I was meeting. And it was already kind of weird to do that. My staff out until the book, open the PowerPoint and have it ready, and then I’ll go through it.
And I think the other doctors thought it was kind of weird too, but I thought patients liked it. So I just converted that to a video one day after watching Khan academy, reading his book, the Samoan guy, and I flipped the classroom basically. And I said, well, I need to get these videos to, to the patient before they even see me. I already know where they’re coming. And I’d already started using technology in funny ways. So at the time there was no such thing as a new patient packet, right? You’ve come to the doctor’s office. And then part of your visit was just filling out duplicate forms. And by the time you figured things out, you know, I didn’t even have the form. So I had required since very beginning, you have to fill out these forms. And I started creating intelligent forms at the time.
And so this all leads into the telemedicine part here, because it was already digitized. I already knew everything about why they were coming and I’d made these forms incredibly complex, essentially. They were okay. If you’re coming, they were choose your own adventures for the history of present illness that we learned in med school, how to take the entire history was taken before I even talked to them. So then I thought, well, so mom, what was someone conduit? And he, I think he would take that information, make a video out of it and say, here’s what you need to do. And so it kind of, so I had to create a system and it was just taking this technology and that technology could not this existed. I said, well, how do I make it all one thing? And we kind of, I kind of made this patchwork of technology and patients notice it now.
I mean, 15 years later, it still doesn’t exist, but it’s a lot of other people have started to do this now. So, you know, I was trying it in 2010 nine, where they fill out a very intense packet online and finding a HIPAA compliant, anything, or none of that existed at that time. So how do you, my challenge was, how do I get a patient to understand what’s wrong and to know why we’re going to do what we do, and then understanding what we did in the amount of time that the structure of healthcare allows, because I couldn’t do it in the hour and a half. I mean, I could, but I, I wouldn’t be here. Right? It’s not sustainable. And value-based healthcare, which is a buzzword, even in 2009 is still not even, I don’t even know what that is. So, you know, can’t wait for that.
And it, the happiness of my fellow endocrinologist was already, I mean, I’ll be honest. We’re not a happy group. So, or at least many aren’t, I I’m very happy. So I changed it around and we started delivering. So after we received the information, we, we, we delivered videos that I made. So I created a video library of all the conditions that I treat. And so I send homework messages to people, literally homework. It says, you have homework, text message, read the portal message. Here’s your homework, here’s the video there’s questions at the end, make sure you get them right. And just like Khan academy. And so, and then I do the visit and the visits turn out to be more about the discussion, about what they learned from what I talked about. And I learned a lot about a patient there. I learned were they interested?
Are they committed? Do they want to really help themselves? Because I can spend an hour and a half with everybody in the world, but some percentage of people don’t want to be helped. And that helps me understand how to treat them. And then there’s some people that are so motivated, oh my gosh, they’ll take my video and they’ll analyze it to no end, which is great. I love it. And so the discussions are much different than they would have been otherwise during our visits. And I would say way more productive. And honestly, it’s faster. And I are, they already feel like they know me, or at least I think they do so. And that’s where doxy.me came in. That’s where telemedicine came in. And so by the time I figured that all out and by 2014, I thought, well, this has made my life easier.
It’s made patient’s lives happier. They understand where I’m going with everything. They can revisit those videos anytime they want and ask questions based off of it. So why am I going to the office? And that’s where I said, I could make this. Catherine and, and doxy has been amazing since that time. And, and you know, that we, we we’ve been using you guys pretty heavily. And right at that time, our diabetes educator, who I had trained and from scratch from our office, Katie dispense, which maybe you remember her, but she said, I’m moving. I have to move to Dallas. And I thought, I can’t, I just, you can’t leave. And so I had to create a solution right away. I can’t lose a good provider. And then I trained. And, and so I remember a conversation either you or somebody at doxy early on said, it seems like you’re the number one user of doxy bandwidth, you know, this year. And that was mostly Katie and me. We were constantly on here. And so
Brandon:
Did Katie stay on work frequently down
Dr. Jogi
To Dallas? So let me say that Katie, he was like, my, I trained her to become a diabetic educator. She was a very smart girl. She has type one diabetic herself. And so she was perfect for the job for the role. And she wanted to be a diabetes educator. So I spent the time to teach her and get her certified. And so it’s hard to find people that are really good in general. Right. You know, people is the hard part. And so she moved to Dallas and I said, no, you’re not leaving. She’s like, can you help me find a job? I was like, no, I’m not going to be like, you can stay here too. And so I connected her via doxy to the office. So she was still interacting with her office staff. This was before slack and all that stuff. So, and then I use Doxy.me to help her connect to patients, but there’s no difference. I sent her all the super expensive equipment, multiple screens at that time, it was weird. And, and then I envied her position cause she, she didn’t have to leave. She was just in her house all day. We had several kids. She ended up moving to Colorado for awhile. No change. Yeah. Just with the computer, move the server, she moved back to Dallas and then her house flooded in a recent freeze in Texas.
But, but nothing changed. She’s in a hotel. She did another rental. She’s in a VRVO this is all recently. And, and her, and she’s still working. I mean, it looks just whatever the background is. So I know she’s been happy with it. And so every time I look at her, so hers is a hundred percent tele and it has been for many years now. And so, so I’ve been kind of looking to create that. And some people will say, isn’t that weird? Don’t you miss the patient interaction? Well, to me, this is a lot of interacting. Anyway, other than physically touching you. And honestly, I had little buttons in pre pandemic that said, sorry, I don’t shake hands because I felt like that wasn’t important. That was my thing. So now with Corona COVID, I mean, honestly it might as well be telemedicine in the room too, because you have this mask you can’t see, anyway, this is better. I’ve had deaf patients that say, I can’t understand in the middle of the pandemic, I was like, well, I can’t take my mask off, but you know what? We can do. We, we can just do tell it. And I go to another room next to docs. He was in the room and I thought, well, you know, it’s not that hard. We could just do this from home. But
Brandon:
So, I mean, so this deaf patient will come into the physical office and then you go into another room and talk to them by video.
Dr. Jogi
Yeah. So like, let’s say March 20, 20, so many interesting things I can do with a tele that cannot physically be done or mentally be done. And I can give a lot of examples. So one of them is, I don’t know if a patient coming in is deaf or not. Right. I guess I could ask, but I, it’s not on my packet. I already got too many questions on my packet. So when they get there, they’re like, I can’t hear you. And I’m like, oh. And so normally that wouldn’t be an issue pre pandemic because you can, they can read, not read my mouth now it’s March, or I think it’s April and I was getting nervous to be in the office. And the mask is on there. I have not only do I have a mask on, I’ve got N 95, then another thing on top, and then this helmets now it seems so crazy.
I wish I’d taken a picture of it. And I was doing that for six months. She was like, I have no idea what you’re saying. And so I was like, I didn’t even realize you were deaf. And I’ve been seeing her for a while. And so I just went to in the room and I said, you can take your mask off in this room and we could do it. And then from then on, I just, I said, you know, there’s really no reason for you to come in. We could do this all by Thomas. And then she sees my mouth. Of course, does it went fine? And she was somebody that was in there’s many people. I’ll just say age 40. Plus it will say, I don’t know about this tele thing. And she was one of them. That’s why she was coming to physically see me.
And then she’s like, yeah, let’s just keep, let’s just keep doing this. So she was very clear about it because she was having a hard time with all of her doctors, something else though. So Katie Smith, our diabetic educator at the beginning of this, I said, you know, why don’t we take of the fact that you’re, you’re wherever and they’re at home. So these, these patients are at home or you’re talking about their lifestyle. Why don’t we just take pictures of their lifestyle? Why don’t we find out what are they really doing? So she’ll be, and doc, she’s so great. And there’s no app, right? It’s just, you’re on your phone. You’re walking around the room and she’ll say, and I told her, like, have them go to their kitchen. Okay. Have them open the kid, just say, Hey, let’s, let’s take a walk to your kitchen, open your, open, your fridge, open your pantry, turn the phone around 60 pictures.
Oh man, that changes some behaviors. You know, when you’re seeing your diabetes stage and they’re like, no, no, I don’t eat cookies and I don’t eat this. You know, it’s more, I’m not eating, you know, like something wrong, but it’s useful to say, well, you know what? Granola bars are a form of a cookie that’s, you know, or cereal is not the best. And maybe we could change this or that. So those are things that, how could that be done? In fact, when you look at the physical world of seeing patients, the diabetes education classes that are done at the hospital, for example, it’s, it’s literally a person’s fictitious kitchen. Like you go to this place. And I don’t know if you’ve seen these things before, but they all have cereal boxes and food, all kinds of boxes. And I always thought, well, I don’t eat any of that stuff.
That’s weird. I have different things in mind. And so I’ve always thought that’s weird, but okay, that’s how you do it. And they’ll talk about food and grocery shopping, but why not just look at their kitchen, look at the grocery shop, go with them, grocery shopping, cook with them. You know, these are all ideas that can occur. Now we’ll tell it now, depending on how you get paid for that, I don’t know again, beyond my pay grade, but those are the things that didn’t exist. Three, tell them at the same time can be done. And that’s one of the headaches. One of the other big headaches or problems to overcome here is an understanding that that makes sense, right? Why wouldn’t you go into somebody’s house to do things, or why wouldn’t you send a video at a time to make sure that the specific to our patients’ questions, if they’ve already filled out a month ago, that they texted, you know, why are we waiting to have everything done in five minutes?
What about your paperwork? Is this an, the doctor learns something, take a medicine and get out the door. Did anything to me that makes no sense. If it’s already out there to get health care companies, insurances, to pay for it. Where’s the biggest challenge. And I did a lot of this for free for a while. So, cause we couldn’t pick her out. There was no playbook for this. And so we did a lot of weird things like, okay, we’ll build the insurance and see if their code work and that code work and its billions of codes. So we had to create this mind map of what insurance is paid for, what? And our health are our local societies, their recommendations were months behind. It would change every five minutes. The pandemic has made things easier and I hope it does not roll back. And I don’t plan to undo that percentage to telemedicine.
I’m doing good. I think it’s better for patients. And sometimes I don’t think they a patient realizes it, but I think it’s way better for compliance and ease of access to your doctor and comfort. Right. And I also do, you know, I went to the bank, the banks never open when I’m available nine to five, no lunch. Okay. When do I get to the bank? That’s how dark then I realized when it that’s my hours. So I can do unusual hours. So I start at 5:00 AM and I finish at 10:00 PM and, and know who does that now I couldn’t have done, I can’t get staff to come to my office, but I have, I have Maria, my, my, my nurse, she will show up now after many years, she’s now like excited about it. And she’ll when I am in the office, she wants to be there, you know, but I can do telemedicine with no staff.
Right. It starts super early. And so I’m seeing shift workers that would not have seen the doctor. Now I’m seeing lawyers and doctors and engineers at 9:00 PM to say, thank you for doing this because otherwise I couldn’t have made it at all. And people say, oh, I can’t do Wednesdays ever. And I was like, well, how about 10:00 PM or after work? Okay, great. I mean, and it no longer matters the day of the week. Right? Right. So I don’t need to work as many days. Not at all. I work two days a week, I work the same number hours and two days a week while the other staff people do the doctors do. And what do I today I can awful day. I’ve been hanging out with my daughter and talking about schools and go pick up my kids. And so I, you know, the freedom or two days a week offering incredible hours. Right. It doesn’t matter that the Wednesday or the middle of the week, because maybe at 5:00 PM, 6:00 PM, 8:00 PM. So it’s amazing how these things that you would think are just the way it’s done. I don’t think it should be that way anymore. I think things should change.
Brandon:
Yeah. No, that’s great. You’ve been practicing telemedicine for years and now going on six, seven years. And so you were really ahead of the game and then COVID came and everybody else jumped in the telemedicine pool. And so you’ve experienced telemedicine before COVID and now post COVID. What have you seen as then the major shift or change in your time practicing telemedicine?
Dr. Jogi
I would say nothing for me personally. You personally, nothing changed the day that the pandemic hit and everything was shut down. The state of Texas said, don’t see patients. We honestly just went to our EMR and just said, flip the facility to tele. And the system was already there. Well, so all this tinkering and I mean, it’s kind of just my own little adventure. Mostly the doctors weren’t that interested, but I was just so into it for the previous five to six years was very, very useful, I think. And because we went from a hundred miles, so like almost no patients, but suddenly a few weeks later, maybe people were like, well, yeah, wait, why not, dude? I’ve been doing telemedicine with this guy already. Why not? And so it didn’t affect us as badly as it should have. And cause we already had the infrastructure in place.
Now my wife is a dermatologist. Rena. You mean as a dermatologist who also had doxy and there’s a difference there. So she’s in a field where you have to physically touch people and look, and, and so that was much more difficult for her, but for a talking specialty like mine, he was amazing. And so there was no transition, honestly, it was like, okay, change this change that it’s done. And so I didn’t think we had a hiccup. It is very interesting to me, the, the, the light speed at which all the, all the mountains that I thought were impossible regulation that will never go away. Like, you know, doesn’t pay it healthcare. There’s a lawyer waiting to go get you, you know, you, you screw up on telemedicine and you did what did that differently in the office, right? Doctor, and they’re going to come get you all these Phantom, you know, problems just disappeared with the stroke of a few pen strokes.
Right. And that’s what I’ve been telling patients. The only reason I can’t do it up with you all the time is somebody in government has to sign something. So call your Senator. It’s not me. And it’s all about liability and payment. And so neither of which I can control. So at least with COVID, I’ve seen not only in our group, things didn’t change, but it was easy. And it’s easy to flip the switch. I saw a lot of stress from other doctors. I guess a lot of people would call me that were not part of the C at the time and said, Hey, I was looking up doxy. I saw your face on their page. How do you do this? And I tried to explain it to them. And there was a lot of, I can’t believe you’ve been doing this. I don’t understand. I don’t know.
Just it’s simple. It’s free. Just try it. And the acceptance of tele as a, even a concept that should be mainstream. Amazing. Right? I’m sure you’re experiencing it as probably exponential growth. And the funniest part is I still work. I still volunteer on the volunteer faculty at Baylor college of medicine. And I teach the fellows and eight months in the pandemic, nine funds paid the clinic and I, and they were using a very large health EMR. Right. You know, whatever it is. And, and I show up and I, and I was like, where, where is the patient? And they’re like, oh, there’s no patient here. And I was like, oh, we’ll do a phone call. We’re going to, we’re going to use this online thing. You remember Brandon, when I met you, I mean, we were this, this is what the very infancy, I guess, of doxy.
But I was. So when I walked in the room to see the patient with the fellow and a get out of their big box EMR and it’s doxy, and I was like, oh my God, I know this program. They’re like, oh, it’s an amazing program. It’s not part of this. I mean, I was like, I can’t believe it. It was right there. So a large systems are using you guys. And so it didn’t require much intimidate, made no sense that all of these healthcare things are siloed and so expensive. And that’s part of the reason we had was that at the time, the, and you’re well aware of the choices at the time. And still the choices are paid a lot of money. We’re very rudimentary services and we’re not really not that interested in making them any better. And when I talked to you, I was like, this guy knows what he’s talking about.
It’s, let’s make it available for everybody. Cause it’s a no brainer and let’s keep making it better. So I’ve been, I’ve really enjoyed it. So to me, the acceptance and the ability of the rapidity at which the doctors that I’m around and the healthcare systems and the politicians and the political atmosphere has been amazingly fast. So I thought what was happening now is going to take another 15 years. And I was ready for that. I was ready to wait it out, but I couldn’t be happier with what has happened. And I really hope it doesn’t reverse. I mean, I I’m sad that it took a pandemic, but to me, this is the way it should.
Brandon:
Oh, that’s great. So where do you think you would be, or your organization would be if you didn’t adopt tele-health
Dr. Jogi
I think it would be done honestly. Or we would have, I think we would have really suffered a lot more. I mean, I’m not saying we didn’t, there was a good four, eight weeks that things were really terrible in terms of volume, but this, I would have had a lot less hair. So
Brandon:
I would say, yeah,
Dr. Jogi
That’s my wife. She keeps injecting you with all the stuff that’s here. So, but anyway, I remember thinking I’m not stressed at all. When people were calling me and asking, what do I do? How do I do it? I was getting calls from people at large institutions to, how did you do that? How did you, did you know, there’s so many things from the, they check in, how did they pay you? Or, you know, how, how do you give a refund? How do you all this stuff and healthcare that doesn’t even when you think about that, when you see somebody take care of it, how do you get your insurance card? How do you get your license? How do you get anything? We had already figured all that out years ago. How do you get that? So the part that blew me away was the new patient packet kind of get them to fill out the card.
So like online forums, you just do that. You still use paper. And everybody said to me that the fact that all my friends that did it, I know they were very stressed out. I mean, this is unfamiliar territory with technology that you don’t understand where the large array of options that were popping up left and right. Like not only did they already do this, but everybody, no matter if you didn’t know anything about tele-medicine and I’m putting in all the memoirs and be like category, we’re trying to make a buck off this. And it was so obvious to me. But if you didn’t know anything about telemedicine and suddenly, you know, I have to just do this, you’re going to take the leap. You can see a sprout, which you can probably pay somebody and hope that they know what they’re doing. Unfortunately, there’s just a lot of players.
I feel that are doing it for the money you can. And I feel anytime you’re doing something for the money, it can only go wrong. And so you could tell the way that things are structured. For example, through the waiting room and doxy is, is this concept that this doesn’t exist in the time spent and then chatting with the people. It’s like a real waiting room. It’s how it should be. So I think that is the number one benefit of having looked into this early, early adopter tends to have less stress when things happen after. And I tend to be an early adopter and a lot of things when things become mainstream, you think, wait, did I, am I behind now? I got too comfortable, but I don’t feel that we would talk to get into. And tele to me is just, it’s here to stay. So
Brandon:
How does, how has your perspective of healthcare change from the time that you started as a young medical student till now?
Dr. Jogi
I will tell you it’s changed. It changed on August 9th, 2009. So up until that day, which was the day I physically unlocked the door to see my first and only patients for the day as a private practice doctor. And I still remember his name and he never came back and I spent three hours with him. Cause I thought that was the right thing to do. Right. I would say it all changed then, because up until then, you’re part of a machine. You, you are just being pushed in a conveyor belt of big healthcare to do what big healthcare wants the government, pharmaceutical health delivery machine, whatever that is. And you don’t even realize it. So I had never really thought about private PR or what it meant to own your patient, right? To own everything that happens. Not just what happens with the patient, but all aspects of healthcare.
Cause it’s not just, did you give them the right medicine or did you talk to them? Did you feel them wrong? Did you, were you being treated in a fairly, did you, could you do something for free things that you just have the autonomy of running your own thing changed everything for me. So my perspective healthcare changed that day because I had to learn, I, it was like the wizard of Oz where you were, the guy was the guy behind the curtain and you’re like, God, is this really how it is? I couldn’t believe it. Like every day for the first two years with everybody, my crisis, I thought, I cannot believe it’s. This is what is really happening. And as a fellow, I had an, a resident and a student, you just don’t see it. And you don’t see it because it’s not, it’s intentionally not true to you because there’s some guy in a suit that has nothing to do with health care. Does it takes care of that stuff. Right. But it is the reason healthcare is so difficult these days.
Brandon:
That’s great. So going back, what is one thing you would have done different as you were working on your practice and getting that set up and I’m sure you made mistakes along the way, but what is something you’d go back and do different?
Dr. Jogi
So I think I would do almost everything. The same, several things I would have done differently. One is I wish I had a thought, I dunno if I could have done that to myself. I wish I had thought of telemedicine day one, right? Because I didn’t know what it was. It wasn’t, it wasn’t one. I never even one day of my, how many years of training I had never been exposed to understood or had a concept of what tele anything was telemedicine, telehealth, tele, tele visits, whatever these differentials are. Cause I’d only read about them. And those academic articles are so like, they don’t mean anything to me. And so one thing is that why, why expand physically, if you can expand virtually and I’m now wrestling with that, why, why do we need an office in every corner of town? Right. What purpose does that serve?
And so one thing I wish was, you know, because once you start doing that, you kind of have to support this system that you created and that’s then to the nth degree with how hospitals do it, why do, what, why do we even have hospitals? Why aren’t we prepare all the time? You know, if you physically need something like what’s happening with the ICU is okay, fine. But what about why can’t all this other stuff be done virtually and then just go to the hospital for the procedure and leave this day. You know? So if I had thought about that earlier, I wish I didn’t print it earlier and maybe I wouldn’t have needed to stress out even about rent. Right. Do I start it today? Maybe I would’ve just been virtual and just done a done, you know, once a month rental, somewhere, you know, this, maybe a little weird to say it out loud, but it’s a startup costs would tele were, would it have been much less?
So that would’ve been probably my only thing that I wish I did differently. A lot of people will ask if I would have just gotten a job and just taking a salary and be done with it. And I had do it. Oh, one of the things, my wife, she, I didn’t, I was scared. I didn’t want her to start a private practice because I thought this is a lot of work, but she ended up doing it and it’s been the best thing ever for her. And I kind of wish I had done it earlier for her during your own thing. And so I guess I don’t have too many regrets. I just wish I did things. Sure,
Brandon:
Sure. I mean, that’s, that’s valuable in itself. What do you see as one of the biggest keys to being successful today in running your practice?
Dr. Jogi
So to expect that the next day we’ll hold some unknown challenge and be fine with it because you give is roaring something. Cause it’s, everything’s changing so fast that you can get approached to what you think is dogmatically. Always going to be that way. It’s always that rock will never move. Those rocks are crumbling throughout. And everybody agrees on all levels of society. These, these monolithic thoughts are changing. And so you have to be ready to run with it. And so I would say that embrace, that change, embrace the change. And yeah, it’s kind of like the Silicon valley way. When you see these reality shows or whatever, the way they interact with society, you know, roll with the changes and then try something. If it doesn’t work, try this. And even that’s a dog, that’s a dog, might healthcare. Oh no, you can’t play with people’s lives.
That way you can’t try something different. And I think that there, and then it comes down to liability. And so my license is now, you know, at risk for anything that I tried, it’s new, even telemedicine is so new that I was worried about my license six years ago, would I would somebody from the board come and say, you’re an evil, terrible person. If you were going to take your license away for trying something new. So there’s a little bit of just hoping for the best kind of attitude so that I think that just being ready for the new and the change, it’ll keep your hair on. So I, I remember the first time I lost my manager and a bunch of staff left for whatever reason, I was like, oh my God, it’s the worst. And literally my hair fell out. I mean, it got really thin the next day.
And I was like, what am I doing to myself? That’s why my wife started to go into she’s a dermatologist, but she does mostly hair is that day. She’s like, why are you so stressed out? It’s why you shouldn’t run your own practice. It’s so difficult. And I can’t be married to a ball guy yet. And I was like, and you can’t add to my stress. He was like, no, no, no, I’m going to go. And so anyway, she she’s now like 90% hair loss and that’s funny to have it. But since that time I realized that wasn’t worth it. You know, it was actually good for me, but that, that kind of change, whatever that change has happened. And so I’m excited about change in general, but it makes a lot of people uncomfortable including myself. But the more I kind of lean into the discomfort, I guess. Yeah. But
Brandon:
That is the key to being successful is the world’s going to change where they’re without you. So you got to run with it. I’m
Dr. Jogi
I’m only going to get older. And, and part of the reason I thought telemedicine was a no brainer was remember that there’s a 20 year old on their phone at the time, because nine, what’s it going to be doing this? Why are they being so rude and not looking at me, you’re talking to me here. But that was, that’s just, that was whatever the social media thing was the time and people it’s going to be connected their brains at some point. I mean, I’m going to be 85, 90, a hundred years old at some point. I like what I do. So that means my patients will be 50 years younger than me at some point. Right. So what would that be like? And I feel like you just have to accept the change because you can’t stop it. I’m no longer the, the decision maker in the, in the world.
It’s the 20 to 30 year olds. So I’ll just accept it. I mean, I have young kids too, so they do things that I think are weird, but I’m like, oh, okay, let’s go with that. No, I feel like that’s been the best. That’d be the best advice. I’d give somebody, just go with the change and don’t feel bad that it’s not the way it always has been that moved my, who moved my cheese, that book, I read that in like the fourth, I don’t know, in middle school or something. And it’s, it’s true. Don’t just keep going for the same cheese. Yeah. Yeah.
Brandon:
And so speaking to that, what do you see the future of health care to be?
Dr. Jogi
Well, my crystal ball is really accurate. I don’t know. I think that, I don’t think, I don’t think anybody yet has seen what it’s going to be, but I can tell you what I wish it would be. Because if you think about my grandmother who, when she was born, there were horse and buggies, right. And we know over the next whatever period of time we’ve gone from that to, you know, customers taking trips to the moon or is it outer space? I mean, that’s, and it’s accelerating. We all can agree on that. So I feel like whatever we’re doing today will look so primitive. And so this, I go back to star wars and I say, and that’s how I wish it were. And that’s how I know it’s going to be because it doesn’t, it doesn’t there’s the stethoscope was the advanced of the century, right.
Physically hear something in the body. It’s the set. The scope is the model T of, you know, the physical exam, honestly, as much as it’ll came to my old, my old teachers who spent, you know, I could do a physical exam. I know a lot of new doctors that can’t, but I don’t. I, the value of that technology is the physical exam. Stethoscope is far diminished now. And in the future, it will be almost useless because once the cost of things go down and then there is no impediment to just knowing everything all at once to it currently, there’s the dogma of don’t order. So many tests because of the expense, but that’s not how 20 year olds thing you want as many tests as you can get. I mean, so I have to take my license and put the liability and miss something to me that doesn’t make any sense from my perspective.
And from that patient perspective, they don’t care that you just save healthcare $5. It doesn’t, to me that that, that discussion is so out there, it makes no sense. So I think once prices go down, then holograms will be a norm. It’ll be groups of physicians working together that aren’t working physically under the same building that are independent. And so I come back to the independence of medicine. And the only thing I worry about in terms of competition is how do I compete against the robot, the other robotic hologram that, you know, I’m in a group talking to five different hologram doctors and the patients there as well. That’s what I’m imagining the future is. And we don’t have to leave. And so I think the robot parts is the, or the automated, the fear of artificial intelligence that overblown, because you still need the human touch, or, I mean, I’d say touch the human you or empathy. That’s, that’s the currency, it’s empathy. And so that’s why I think AI is not as threat as much as we think it would be in healthcare. And I think that holograms should be the norm, right? So everything should be working. No, this is great.
Brandon:
So what is The most satisfying aspect of your career today?
Dr. Jogi
So I should say that I love seeing patients and making them better. And I should say that I’m happy when they smile and we connect. And, but I’m not gonna say that because that is true. I do love that part of my job, but the most satisfying part of what I’ve been doing since I started with practice and my, I helped run. My wife’s practice is creating a system that runs on its own with minimal effort on the part of the user or the creator. And to me, that is not something I understood about myself until I had my own autonomy. And I think that’s one of the problems with education in general right now, is it, it breeds to this autonomous people. We are just following a cookbook and a test and what, but, but I feel like that is what I’m most excited about is if I, I can create a platform essentially that, so it’s not the healthcare, it’s the delivery of it.
The systems, you can go out, whatever you want. There’s okay. You know, the protocols, the algorithms, these are the other names for it, but that, that’s what I get excited about because it automatically translates into the happy patient, the patient that feels good about what their care is, but that’s what gets me going. And I didn’t know that maybe if I said that in my med school interview, but, but medic medicine needs that, you know, we need people that are willing to think about a process and make the process better because the process of medicine hasn’t changed in several hundred years. And I hope there are more people. And I know there are lots of people like that in healthcare probably is. Most of them are doctors. Most of them are not. And this is why I feel physicians are losing, are complaining. They shouldn’t be complaining, but they’re, they’re complaining about the lack of the more, the changes that are occurring without their consent or whatever you want to call it with part of this. If you don’t, if you don’t think about it, then somebody else is going to think about it for you. So that’s what gets me going. So in my practice, I have to be that guy that does, somebody has to do it. So I enjoy it. It’s kind of what I, it gets me up in the morning. Yeah. What advice do you have for other providers stop working for somebody else now that timbrel
Can, because when you’re not in charge, things will happen that you didn’t want and the patient didn’t need. And, and number two would be tele anything virtual, anything is probably better for the patients than the carrier delivering. If you do it the right way, in a way that’s completely different from what you think should be on paper, things are done one way, but you can do it 20 times better and probably different, definitely differently online. You can’t think about it as a paper process. You can think about it as a new process. Like it’s a completely new thing. So, and if I was a brand new doctor that didn’t know anything about where to go, what kind of job to get, I’d say start your own thing and figure it out on your own because you don’t need people figuring it out for you. You, you can do it yourself.
And if you are in an institution that’s large and you know, they’re telling you what to do, push back and tell them I want to do something different, you know, because if you feel like it’s the right thing to do, and it’s what you would want as a patient, then do that. What would you want is kind of, you know, the golden rule. So I think I would want to have quick access to my doctor with lots of information, education, and feel good about what they’re saying and understand it. So that would be the advice I give. Great. Do you have any final words I wanted to thank doxy for being there and not selling out? I hope I hope that’s not going anywhere strong. Yeah. I want to say that without doxy. I don’t know what I would do. I won’t name names of other places, but I’d say that the, the, of what I am doing is your company.
Like, literally, if you guys didn’t exist, I know I’d be having a really hard time and a way. So I really want to thank you, Brandon, that, you know, when people read about your story, it’s true. I tell people, this is the real deal. I mean, this guy is doing it for the right reasons. And so that’s another thing I’d say, if you’re not doing things for the right reasons, non-market hopefully non-monetary reasons you can’t really, you really aren’t going the right direction. And so I feel like you’re, I mean, just, I don’t know you personally, but just reading about you and how, how things have gone with doxy in the last 10 years. It just, it speaks to the fact that you’re not in it for the money or the fame or you’re here for right.
Brandon:
Reasons. Yeah.
Dr. Jogi
It’s working, it’s working great. And I really want to thank you. I I’m con I used to send you guys random emails once every few months say great job. It’s amazing. But now you guys are so big. I don’t know if you get those emails anymore, but so I’m so impressed with doxy and the telemedicine world. And I feel like you guys are really leading it and that really speaks to the why the, why you’re doing it for the right reasons. And the other guys aren’t there yet because it’s just, you know,
Brandon:
I’ll tell them the secret. All right. Well, we’ll, we’ll just keep it between ourselves.
Dr. Jogi
He quit, but that’s what I would say. Thanks for all you do. And I appreciate it. Cool. Well, Dr., Jogi thank you so much for your time today. Oh, thank you. I hope that went well.
Brandon:
Dr. Jogi. Thank you for joining the show today.
