0:00:02 - Mark Henderson Leary

Welcome to Practice Freedom. What if you could hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth? Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, get the most out of your people and, most of all, how to live the healthy life that you deserve. I'm Mark Henderson Leary. I'm a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice and, ultimately, live your best life. Let's get started. Welcome back practice leaders. Another good one coming to you Better try something different. Usually, I kind of wing the bio and I always feel like man did I tell a good story, so I'm going to make sure I look at this and give me some feedback if reading this sucks. But Dr Jonathan Bektari is a CEO of E-National Testing, e7 Health and US Drug Test Centers. He's got 20 years of clinical, administrative and entrepreneurial experience, triple board certified physician specializing in internal medicine, pulmonary and critical care medicine. He's a preeminent national business thought leader. Interviewed the Washington Post, usa Today, forbes, barron's and other national publications. He's also an opinion writer for the Hill, the Toronto Star. He's the host of a highly rated podcast, victariamd, as well as a guest on over 70 podcasts. He's formerly the medical director of the Valley Health Systems, anthem, blue Cross, blue Shield and Culinary Health Fund. He's also served as a clinical faculty for several medical schools, including University of Nevada and Toro University. Hope that tells a story because we had such a great conversation. When we first talked, he and I just kind of had this connection and I thought in fact I was supposed to interview him to kind of make sure we could talk about stuff and I had a very tight timeframe and so we had like a five minute conversation. I was like, oh man, this is going to be great. My intent was to have a 30 minute interview with him and we got to 30 minutes and I could not shut up. So I think there's a lot of value. 

In the second half. We talk a how it's different in a healthcare organization. We talk about the roles. We talked a lot about the genesis of the role split of as a founding physician, founding leader of an organization, what it is to have to learn new skills, and I really kind of poked in on like well, if you're learning new skills meaning like a management skill and the things you have to do to run a business, if it's P&L, if it's profitability, if it's hiring and firing skills he really asserts things about you're forced to learn those things, and I kind of assert that sometimes you have to do those for a while, but you also have to sort of uncover your superpower, and so I thought that conversation with the back and forth was really interesting, and so the roles anyway, leadership from a healthcare perspective. 

Take a listen, give us some feedback. Love to get the feedback on it If you find it valuable. I found it very interesting, especially in the second half. I hope you get the same kind of excitement and fun that we both had on the conversation. Don't forget, though, the point of this is to give you access to the vision, the tools, the ways to grow a great healthcare in any form of healthcare even adjacent industries, manufacturing of supplies and things that really can help the healthcare world and help people. 

If you envision a great organization where everybody's on the same page, everybody executes everybody's part of a healthy team, where everybody loves the work they do and they're helping patients and the patients love it and you just love showing up there and so proud of what these people are doing. But you're stuck. You don't know what the first step is. You don't know how to get out of your own way. Man, I would break my heart if you didn't reach out. So please reach out, get a few minutes with me and we can talk about what a first step or next step looks like to get you unstuck on the path to that practice freedom Without further ado. Dr. Dr Jonathan Bactari, md. It's good to finally get together and talk. Man, we talked probably a month ago, I think. We agreed that we had shared passion around entrepreneurial healthcare and now here we are. 

0:04:18 - Jonathan Baktari MD

Great yeah, I've been looking forward to it. 

0:04:20 - Mark Henderson Leary

So I'll just kind of dive right in. Some of the things that I saw just went right to what I consider one of the foundational pillars of really best-in-class, entrepreneurial healthcare, and that is the human brand, the human purpose, the human self, the real human maybe oftentimes vulnerability, the personality must be shown to really be best-in-class and I think historically in healthcare it's white coat. You know, I'm a doctor, we're all the same. We got your answers and I'm seeing that there is a really important ingredient that as a healthcare leader a real leader, not just a practitioner we have to be way more human and be ourselves. And I think in your stuff you know your historical stuff you had to kind of put yourself out there, put some opinions on it. You've been risky in putting your opinions. What's your take on being your true self and being a doctor, physician leader at the same time? 

0:05:13 - Jonathan Baktari MD

Well, I think it's an evolution because I think, looking at my journey when I started you sort of as a medical student, as a resident, you have this perception of how you should conduct yourself and the aura that you need to convey, because that's somewhat important, because patients need to have a certain respect, they have a certain expectation. But I think as you progress and get into more leadership and you have more experience, you realize the authentic person is actually the best product and as the years roll by, that becomes more obvious. And as the years roll by, that becomes more obvious, you initially think they want to have this real. You know, like you said, white coat and speaking. You know lay jargon combined with medical jargon and conveying the sense of authority. But I have found, you know. I'll give you a perfect example. 

I remember when I used to be late to see a patient. Yeah Right, I mean I was like how do you deal with being late? Because you know they've been waiting in the waiting room and this and that, and at first I didn't know how to handle it. Maybe I don't say anything, just assume they're going to be okay with me. I'm a doctor, I can be late. I would go in there and didn't worry. I tell them the truth. 

Listen, I got to be honest with you. I got stuck at the hospital. There was some really sick patient and I don't want to get into specifics, but I couldn't walk away from that. But look, I'm here now. You got my attention I want to apologize for that and I was shocked. You just become genuine and people are like, oh, and my staff would say what did you do to that patient on the way out? Because they were, they're about to kill us and they're leaving saying, oh, you know when's my next appointment. And I found just being genuine and that extrapolates into leadership and health. Just being the real deal and explaining yourself in an unpretentious way goes so much further. I mean, I know when doctors are late for me or if I'm seeing a dermatologist or whatever, I don't you know. I kind of feel like wow, I didn't really sense why that happened. So just being to your point, authentic, actually, is the best course. 

0:07:18 - Mark Henderson Leary

Yeah, I think it's something that's so broad too. Being authentic, being real there's a lot to it. I think that being taught to be the answer person, your entire education as a physician is look, we're going to pound you full of information and you're going to have all the answers. You're going to ask just enough questions to know what the problem is, give the answer, send them on their way and to be able to be in a position to say hey. By the way, I'm a human being. I make mistakes. I don't always know the answer. I might have to do some research. I got to ask you more questions. Oh, this is the one that I think has got to be the biggest, the hardest one. Hey, what I told you last time turns out to be wrong. Like, how does somebody handle that? 

0:08:06 - Jonathan Baktari MD

Especially when the ego gets so high and the training gets so high. Yeah, so before I answer that, one thing I learned real quickly and it's a statistic that's true at almost every field of primary care or even some specialties that one third of all visits to a doctor is for reassurance. So there's really nothing wrong. So if you think you're going to be the answer man for that one third, you're wrong. There is no answer other than you're fine, this is nothing, it's not serious, you're not dying, it's not cancer, you know whatever. 

And so when I was teaching in medical schools with residents and fellows and interns, what I would teach them is that sometimes the patients really just want to be heard and then they want to be reassured, ideally. And there's where the art of medicine comes in right, because, coming out of training, want to be heard and then they want to be reassured. Ideally. And there's where the art of medicine comes in right, because, coming out of training, you might be good in the science of medicine, but the art of medicine. You can take two interactions where the doctor says the exact same thing in essence, but one the patient's smiling and and the other one is just fraught with concern. So the art of medicine is what happens to you with either time, or if you have great mentors, or if you can park your ego in the parking lot and just say I got to learn how to deliver the information, how to listen, stuff like that. So it's the reassurance part that you can't just have the answers when there's really nothing wrong. 

0:09:27 - Mark Henderson Leary

Yeah, and so I'm seeing in my mind this mental bridge between the evolution of the practice, because I believe in the system I teach EOS there's two main leadership roles that we're always sort of teasing out the visionary leader and the integrator. And the visionary is that usually founder, who has all the passion for where we're going and the importance of this. And the integrator is that sort of master execution, like we know what all the players are doing on the field, we're managing the budget, we're hands-on and executing at a high level. And those two leaders are very much different. Dna In healthcare there is this elevation of the individual healer. 

Like a lot of industries. You know, you start as a welder, you become a manager and then you start a company that's a welding company. Most welders are not like attached to their welding craft. Once they become this president, founder of a welding organization In healthcare not the case you really bring that craft forward. 

It's like, hey, you know, I started as a surgeon, I started as a family practitioner and I started as this and I really have a hands-on obligation. And if nothing else, you know, a plastic surgeon can put enough surgeries on the books to actually float all the financials that can actually make the profit of the organization. So there's an obligation potentially to wrestle with these three roles in a very different way the individual healer, that business administrator leader and that visionary leader. And there's a strong connection between elevating the craft as an individual healer, which is largely what we were talking about just now, but then it bridges over into the visionary leader of like well, what are we doing as an organization, as an entrepreneur, when there's more hands rowing than just mine and we've got a real obligation to get everybody on the same page. So how does that elevation we're just talking about translate to the entrepreneurship side? 

0:11:07 - Jonathan Baktari MD

Well, as I'm hearing that question, I'm thinking that doesn't always translate, because one of the things I do, for example, in my podcast and stuff I do when I'm speaking, is talk about that you need to acquire additional skill sets. What was good enough to make you a great doctor is not necessarily going to translate into being a great entrepreneur or a great leader. You have to acquire certain skill sets 100%. 

0:11:31 - Mark Henderson Leary

That's very much Michael Gerber. If you're familiar with the E-Myth and all that, like you know you were inspired by making pies and you suddenly feel like you're going to be the boss and you open a pie shop and suddenly you realize your pie making skills are the absolute least valuable skill today because you can get somebody to make pies. You need to do everything else you've never done before. 

0:11:50 - Jonathan Baktari MD

Right. Well, it hits on the Peter principle, if you're familiar with that, where people get promoted to the level of incompetence. So just because you're a great engineer doesn't necessarily mean you'd be great at running the engineering department, because there is, like you said, additional skill sets. So what I talk about is look, that doesn't mean you can't be running the pie shop, but at least spend some time, acquire some new skill set that you're going to need Because, just because you're amazing, like you were saying, and making a great pie, invest and learn the leadership. 

Learn how to hire, learn how to fire, learn how to promote, learn how to enroll people in your vision, learn how to build a culture On and on and on. You know. Learn how to negotiate, learn how to handle vendors, learn how to, you know, seek out help when you need it and figure out ways how to grow from inside, where sometimes you need an outside person to come in. You have to calibrate all that. You have to become good at all that and how good you become is going to be a big part of whether you're successful or not. So if you just say it was my idea, it was my money, so I naturally should be the leader. Now it doesn't mean you can't be, but you just have to go get the skill sets. 

0:13:04 - Mark Henderson Leary

Yeah, a hundred percent, and I think that there's two forces at work there. One, in the healthcare space in particular, there is a legacy, cultural belief that, like you said, it's your name on the shingle, it's your responsibility. This is not delegable. You have to do it, and what we've experienced is that is wrong. That will keep you stuck with. You know the mom and pop size practice, which is very difficult to make viable. 

And so, if you're going to be entrepreneurial, as you said, enroll people in the vision. It's not just enroll them, it is also give them a piece of the vision to carry. And you talk about hiring and firing. If you're a medical geek, you may need to really live in that world and understand what parts of the business you need to bring into play that are not yours. Do you need a true business manager, true leader, that you can trust at the highest level, and my experience with this is that healthcare, and legal in particular, are really bad at under-horsepowering this, like, oh, I need somebody, I'll take my front office coordinator and they're running the business Like whoa, whoa, whoa man. 

Do you realize this is a real business and you really need somebody who probably you've never experienced working with, who really is a manager leader of a PNL and a business and can hire and fire people with skill and confidence and so bringing that person in and understanding how to work with them and then taking your role as a leader of that visionary leader. I command the vision. I'm not really good with the P&L, but I know what profit is and I know what the vision looks like in creating this ecosystem which, before I turn it back, I'm kind of on the soapbox. I think a really critical question to ask is are you up for it? Because you say you got to learn these skill sets, do you? 

have the appetite for that? Do you have the appetite for that? Do you have the appetite for learning how to delegate? Do you have the appetite for learning to have a conversation with a business leader in the organization? Can you unplug and subordinate your hands-on work to creating a vision so three or four or five associate positions or 50 or 100 other people in the organization can now carry a vision forward? Is it going to be so powerful for you? You would gladly overcome that knowledge gap, especially after already giving up a decade of your life to learning. You're like I got to start over. 

0:15:16 - Jonathan Baktari MD

Yeah, I think that blocks so many physicians from getting to the next level, because I think they feel that they put in their dues, they've gotten where they need to be and then say, oh you know what, learn a whole new set of skills to basically do another residency, do another fellowship in leadership, entrepreneurship. 

0:15:39 - Mark Henderson Leary

You're in finance now, oh my God. Okay, I haven't heard of that in nursing. 

0:15:44 - Jonathan Baktari MD

It depends where you catch them in their lives. 

You know, if you catch them in their lives where they're ready to kind of cruise and you know, just grow a family and just you know, focus on cranking out the revenue and doing what they do, getting into like a routine and this is what they're up for, yes, it becomes very hard to say and it's unfortunate, because what happens is the only time they then will break out of that routine, that comfort is when they're burned out, which is not the time to do it right. 

The time to say you know, I need to become an entrepreneur is not when you're burned out. Yeah, because you're already in a certain mindset. You know you got to walk out of the top of your career, I would say in medicine, where everything's going well, you're a senior partner, blah, blah, blah and you say you know what I think I want to do. So, yes, that's going to take a special time, a special person, because if you're making a good salary, you're at the top of your group or whatever, and you're not burnt out yet. But you're going to say but I want something else. It becomes hard to want more when you're at the top and you've got this income coming in, and the only time it does happen is when you're burnt out, but then you're probably not in the best shape to do that anyway. 

0:16:56 - Mark Henderson Leary

Yeah, that's another thing that I guess I was surprised and humbled to encounter. The burnout is real and predictable. The burnout is real and predictable. Institutions burn out people like a factory and it happens so fast and it's permanent, like within 10 years. If the hope is gone, it's permanently gone. And there are people who leave the industry within five years because they can't find hope, and so it's kind of like a double-edged sword. You've got like a $5 window. It's like, hey, I'm disillusioned and I want something better, and if they don't find it in the next five years, you're ruined, and that's terrible. Yes, I see it a lot. 

0:17:38 - Jonathan Baktari MD

What was your journey through this? Mine was a little bit different because I went through the traditional thing, became a fellow and then finished and got into a group, became a senior partner. But then I started teaching in medical schools. I got a couple of administrative roles. The more I would do, the more doors that would open. I would be head of a department or accept being a medical director of a department or eventually a hospital. Eventually I was medical director for Blue Cross, blue Shield, for our state, and had a lot more experiences and it seemed like every time I had those experiences, my curiosity and wanting to go a little bit past that. So for me it was an evolution. It wasn't one night where I just said to myself oh, I got to go a different direction. It was simply one door opening up another door and next thing, you know, we're starting these healthcare ventures and what have you. So it was much more sort of like grass growing. Very, very. You didn't notice it was happening until it happened. 

0:18:31 - Mark Henderson Leary

It sounds like you had a bit of a fortunate path that got you to opportunities, as opposed to people who have a lot of the unfortunate you know positive feedback. 

0:18:39 - Jonathan Baktari MD

Well, I tell a lot of my colleagues, you know, accept those positions that you don't think are that crazy, my colleagues, you know, accept those positions that you don't think are that crazy. Now, be on a committee at the hospital or be on something when they ask you, because those experiences open other doors. And if you look at it well, why should I spend an hour or two beyond that committee? You'd be surprised. Sometimes it closes doors. You're like, oh, I don't want anything to do with that type of administrative medicine, but you'd learn skill sets. You know, when I was head of a department, you know you have to then talk to people, discipline people, whatever. You start to acquire skill sets that you didn't have. So even these simple opportunities can translate into more opportunities. 

0:19:21 - Mark Henderson Leary

So what's a typical when somebody comes to you and they're needing some help? You know what's their story Meaning. So what's a typical when somebody comes to you and they're needing some help? You know what's their story Meaning. Somebody says I want some help. I'm like I think I'm an entrepreneurial healthcare leader and I'm stuck. You know how are they showing up for you? 

0:19:34 - Jonathan Baktari MD

I mean, most people that I encounter are unfortunately at this stage of they're burnt out or whatever. 

They're not leaving in an optimal situation. So when I have a chance to talk to people where things are going well, I encourage them to say, okay, things are going well, but hey, do you want to just be doing this for the next 30 years? I mean, is there something more? And those are the people that I think have the best opportunity when you're not burnt out or searching. 

That's why you see, like so many doctors doing weight loss and selling vitamins and you know, botox, and you know these are all burnt out strategies that they've, you know, given up and they want some whatever outside revenue. But it's more optimal when things are going well to say, ok, this is going well, but my career can have more than one chapter Right, so what's my next chapter that I can do? My career can have more than one chapter right, so what's my next chapter that I can do? So speaking to physicians who things are going well and trying to make an impact on them is probably the most fruitful because they're in a position where they could theoretically and from a healthy space, go into this other world. 

0:20:43 - Mark Henderson Leary

Yeah, I think my model on that is scarcity-minded versus abundance-minded. And once you're locked into a mindset of scarcity, it's like, well, these Q-tips cost too much, I'm paying my lab techs too much, we've got to get cheaper space. How do we sell something different? You know, add it on. I don't think that's not the kiss of death, because to me, I understand a lot of times you're frustrated, but there has to be some kind of belief in holding inside you of abundance. Somewhere inside you you got to feel like I think I can give a lot more. 

You have the teachers the same kind of thing it's, you know, 20 years in the system. If you can't go back to that first day and feel like you really wanted to help kids, that's terrible. If you're a physician, you're a healer of some kind. If you're thinking like I just need to make more money, I just need to have more vacation, my wife's always irritated at me and I just need to find a way to be at the office less. I hate refracting eyes and I don't want to go to that place again. I don't have to. That's a tough place to be, but if you're like I thought, I would make a bigger difference, that's enough. 

0:21:41 - Jonathan Baktari MD

Yes, yes, that's enough. That is so true. This idea of doing things out of desperation works, I guess, when you're super desperate, but wouldn't it be better to have that sense of desperation when you're not desperate? And the analogy I give some physicians is you know, we've all seen this interview with this guy who's a billionaire, and they're interviewing him in 60 minutes and like, well, how did you come up with this IT or this tech idea? Because you know, I mean some variation of the story. 

I was working at IBM and I was 45 years old. And one day I come into the office and they're like Bill, you know, we're getting rid of your position. And so I went home and I sat down on the couch with my wife and I said listen, I'm 45 years old. You know who's going to hire this 45-year-old middle-level manager? Blah, blah, blah. And you know I mean what should I do? And the wife says you know, honey, you know that idea we, you know you and I have been talking about all these years. You know why don't we try that? You know why don't we start our own? 

But then when I hear that story, I always say, well, what happens if he didn't get laid off? It took that layoff at 45 or whatever age. So what I tell people is pretend like you're about to get laid off, pretend someone's going to take your medical license in 12 months, pretend like you're going to lose your job and start making decisions and listening to opportunities in a way as though that is going to happen to you, and then you have the beauty of it not happening. Of course you're not really in that position, but start acting like that might happen or that will happen, with the backup that it's not happening. So if that's sort of the mind trick that I tell people when things are going super well, just pretend they aren't or they won't be, what kind of decisions would you make? What kind of opportunities would you entertain? You know, how would you want to grow your skill sets? Those kind of things? 

0:23:38 - Mark Henderson Leary

Yeah, I like that question. It's a little bit of a memento mori kind of concept. It's an understanding that you don't have all the time in the world and things can and take control of your life and it might be forced freedom, and I think that's what you're doing. 

You're sort of putting the hand of freedom, responsibility in somebody else, like, oh, they're going to fire you. Let's just say you don't have to do that. And suddenly, now what do you have? You have agency over everything. You actually have all these choices. Maybe the 10year thinking approach of okay, so you've got a bunch of choices. You can be a barista, you can go back to the job you had yesterday. 10 years from now, looking back, what choices might you make in a way that, regardless of the outcome, you would feel great about 10 years from now, and that's so hard, right. And so I think what we're pointing to here is we all like to think that we do that, but we don't do that unless we're kind of there to do it. 

0:24:28 - Jonathan Baktari MD

It's funny you use that analogy because I reverse it. I'm like, let's say, you could have a conversation with yourself 10 years older. So if you're 35, imagine you can talk to yourself at 45, right now. What would the 45-year-old be telling you and what would you be telling the 45-year-old? Just imagine you're having that conversation, be telling you and what would you be telling the 45 year old. Just imagine you're having that conversation and you know, are they going to be happy with what you did, like these decisions you made at 35, or are they going to tell you, no, no, I wish you had done that. 

0:24:55 - Mark Henderson Leary

Yeah, that's exactly right. So you know, one of the things that I I try to get people thinking about is successful private practice is a real thing. We can have a great culture. We can have everybody in the organization treating their role as a privilege to heal somebody in some way, even that front desk coordinator, whose job is maybe making it a little more convenient and a little more possible for that patient to fit their hell. You know what? We found a spot for you. You can come in today. You don't have to wait till next week, which is a very powerful. Think about that, right. That's a very powerful role in healing, like you know. 

Mr Smith good news I found a spot for you. You don't have to wait till. 

0:25:41 - Jonathan Baktari MD

That's missing, though. That's exactly what they don't train for, because it's so frustrating when you go into any kind of office and you get this robotic response where they're not processing you as a person, like would you say, oh, we can squeeze you in, let me see Like they're really like absorbing who you are and what your situation is, versus some line that they've repeated 40 times that day and you're on the receiving end of one of those lines. A hundred percent. 

0:26:09 - Mark Henderson Leary

I mean, I've been to the best hospital systems in the world and seen some of the best doctors in the world and and been staring at a front desk coordinator who I'm sure is one of the worst employees at any job for anything, and I'm like how did these people get together? This makes no sense to me. 

0:26:28 - Jonathan Baktari MD

Can I give you an anecdote, if you don't mind, I do so. I was taking my teenage son to the orthodontist and we had like a two o'clock appointment. Got stuck in traffic, got there at 2.15 and wanted to say hey, listen, I'm sorry we're late. Should we reschedule or what do you recommend? And because you're late, they will fit you in on the next available. So we can't tell you, but we'll fit you in. So I said, okay, we'll sit down. 

Half hour goes by and I'm like, listen, I got the part that you'll fit us in, but I do have another appointment at four o'clock, so would you at least be able to tell me, more than likely, how long it might take? And then she just robotically repeats when you're late, you have to go in the next available. I got that part. I'm just asking at the rate that it's going, can you at least give me a sense so I can decide whether to just bail or stick around? And then she goes back to the back, comes back and goes. You know, our policy is that we fit you in and the next, okay, this is obviously. She's just repeating. And so this is what I teach my staff Always take the human element, understand what their issues are, understand what they're trying to accomplish. Don't be a robot where you just repeat policy or procedure. Of course that's necessary too. You should always convey that. But beyond that, try to put yourself on the receiving end of all your conversations. Yeah, and then try to be empathetic. 

0:27:56 - Mark Henderson Leary

I have a vision for over the next 10 years helping personally a thousand entrepreneurial healthcare organizations be successful, living the dream, creating high value organizations that heal, that have great loyal cultures and great loyal patients, or something in that vicinity, because I think in the entrepreneurial healthcare space, 900 out of a thousand of those practices are going to be just regular practices that do what you said, that actually have great customer service and training and a culture who's like oh yes, mrs Smith, we can work with you, no problem, we'll reschedule you and here's what you can do, or we can't work with you, but this is what we can do instead and we're aligned with our values and we're helping people. We've got marketing strategies that bring in the right patients. Oh, you're kind of a pro-am athlete, yeah, yeah, we're working more with people who have these kinds of situations and we build a business like every other business where we figure out who our best customer is and a great culture and all that. But it's the same idea, except we're actually getting it right. We're doing the capitalistic approach of going to market, figuring out who our buyer is, building a culture with core values and target market attributes that serves them in a way that they're delighted by a service that we've had for a hundred years, but now it's actually awesome. But 100 of those organizations are obviously disruptors technology, supply chain, you know the Uber of healthcare, and I think that's amazing. 

But I do think that just doing the job we've tried to do for 100 years, except in this capitalist sort of actually you have to do this right now. You actually must compete and provide who you're serving and serve them well and get the whole organization, and that just really drives a lot of burden to that entrepreneurial leader, which I think has got a double-edged sword, because I like to think of it as, do you realize, no one's ever tried to get good at this before, and which means if you do, you can race out way ahead. You know we've got a hundred years of people not even trying, and so when you try, it's great, but it does become hard because you got a lot of choices to make. You got to figure out who your customer is, when you could kind of choose them all, but you can't. You have to choose yours, and so it becomes kind of hard. 

I got so many levers to pull, so many choices. It's a lot of burden to try to choose the agency, but it's. But I just love the idea. There's so much abundance, like we haven't even figured out how to get good at this yet, and so there's plenty untapped. It's just sometimes tricky to find the discipline. 

0:30:12 - Jonathan Baktari MD

Yeah, if I can add to that, I think part of that is how do you get an organization to think like that? And I talk a lot about this on my podcast, which is you know, your staff is your front line. They're the ones that touch everybody and the one distinction I've noticed that really makes a world of difference is are you treating your staff well and have you worked with them so they feel like they're owners in the clinic? Because someone who's clocking in and out, you can tell them all they want, they're going to just repeat some line, whatever, but if they feel that that clinic is theirs and they own it and they have that mentality, that's when you start to see the kind of behavior you're talking about. 

You know, we at E7 Health we have 10,000 positive reviews in the last three years. That's almost unheard of by a third party called Listen360, where they get an email after they leave. To get 10,000 positive reviews in the span of three or four years means we have to have our staff treat everybody like they are the owners of the clinic and they're not there as a paid employee. And only when you get that mindset, that culture, can it translate to people. In fact, if you read our reviews that it says the same thing over. You almost think the same person wrote all the reviews Easy, kind, friendly, friendly, friendly, kind, friendly. It literally, and that's I like to say, that's because we did great training, which we do, but it really means that the people who they're touching it is their clinic, they own it, it's their company, and so it's the same thing. 

Like sometimes you walk into a pizza shop right and immediately you know the guy behind the counter owns the shop. Why? Because the way he answers the question is like you know the guy owns the pizza shop. Because you're like no, an employee would never say that. You know, like hey, but you know, if you want, I could make that, you know, double crust for you, like, like, no, no employee's going to say that. 

So I think if you figure out a way to get people to give you that product which is one of the analogies I always ask my senior leadership I'm like you know, let me ask you a question If I sold you the company tomorrow, would you come to work and give me a different product? Like, if I literally like every penny or everything was impacting you? And you know, luckily, some, you know my senior leadership, who we've worked on a lot, you know I really believe they couldn't give me a different product. 

But the flip side is you got to take care of them. You got to be very respectful, you got to grow their career professionally, financially, you got to take care of them. So it's not be just like gimme, gimme, gimme. You got to be giving, giving, giving, and you got to spend time with them, mentor them, be involved, help them. But if you can do that and get that product where everybody comes to work and says this is the same product I would give if I just owned the whole thing, then you're onto something Because then they're going to treat patients and clients and vendors a certain way and that's going to be transparent. 

0:33:14 - Mark Henderson Leary

So I obviously have shared those feelings and why that's important and have a process to do that. When you think of what you've done to create that sense of ownership, what are the top one, two, three things that come to mind that made that possible? 

0:33:29 - Jonathan Baktari MD

Number one. Obviously, you have to hire right and fire right. I mean, so you got to. You know, when you hire someone, you got to hope and you got to basically say, hey, did I catch you at a time in your career or life where you want more? Or because sometimes you're interviewing someone that they've had five jobs in eight years? I mean, yes, there may have been a reason for why they left any one of those, but you're starting to see some sort of pattern, and if they think you're just number eight on the road to 10 jobs, you're not going to get that product. You have to catch them at the right time of life, and you got to let them know that. 

The expectation, though, is that we don't want someone who's just going to come in, clocking in and out. We want someone to grow, you know, and whatever position you're in, we want to promote you, we want to get you into leadership, and we want to reward you professionally and financially, but we're going to need more from you and so, but then, once you hire them, then the most important thing is to invest time in them. I see a lot of people who hire a director of marketing, do the interview, hire them and then put them in an office and a month later they check in on them. There's no way they're going to become an owner by hiring them and putting them in an office and a month later, coming by and say how are things going Initially? Yeah, this is the part that leadership you know when you go to leadership school. 

You may have to, you know, meet with them for an hour a week. You may have to occasionally walk into the office, say, just checking on you. How's your first week coming? Let's sit down. Is there anything I could help you with this? Micro mentoring, as I call it? 

I have a whole topic on micro-mentoring instead of micro-managing, where you don't hover over them and tell them what they did wrong, but be in that position where you will help them make decisions together initially, where you're just mentoring them instead of just criticizing them when they do something wrong, and be involved and if they can view you as a mentor, as someone who wishes the best for them, right. So when you're giving critical feedback, is that critical feedback coming because they feel you're trying to maximize their chance for success, or you just like criticizing people? You can give the same criticism two ways. I mean the same word but one person's like oh, some people get their jollies by putting other people down or just criticizing whatever. No, this person wants the best for me. He's giving me this critical input because he's trying to maximize my chance to be super successful. How you do that, it's going to matter the world. I mean, you can't go and give critical feedback and help mentor someone if they don't believe you have their best interest at heart. 

0:36:17 - Mark Henderson Leary

Yeah, there's a lot in what you just said and so you know, kind of starting with the first thing was time, and everything you just described requires time. And if that's not your role, if you're just that rainmaker, individual healer, or you're just the visionary of the organization, I mean obviously there's a continuum. I used to use a small practice it's probably you until it can't be. But as the time demand exceeds that capacity, your leadership team needs a leader and manager. You need a leader to handle really leading that leadership team. 

0:36:50 - Jonathan Baktari MD

So can I add to that? So as you mentor these initial set of leaders that's exactly the point you want them to then do that to their group. But you have to teach them. So there's no way to getting around that. You have to put that time so you have. There's no way to getting around that. You have to put that time in your higher level leadership. Yeah, so, let's say, your top three people. You have to spend an hour a week with them and then teach them how to do the same thing below them and teach the tier below them to do. But you have got to say you have to invest. You can't just hire someone and pray, right, you got to hire and then hold hands, promote, encourage, be there. Because, as we know people you always hear this thing. You know people never quit a company. They quit their boss, right. If their boss is someone who genuinely cares about that, genuinely wants to make sure they're super successful, and they believe that, I promise you you're going to get a different product, you will, by definition. 

0:37:51 - Mark Henderson Leary

And I, you know, I want to keep pushing on this point because I agree with what you're saying, but my caution that I want to make sure doesn't get lost is that you have to know your limits. If you are really not a manager by DNA and you're more of that visionary leader and you're more individual healer, you can do this to a point and get out of your comfort zone. But at some point you're gonna have to say like look, I really need somebody who has the DNA of this and I need this person to be the leader of this team, of the department or even the entire organization, which I think that administrative role often held in the largest or fastest growing organizations by non-clinically trained, non-healer backgrounds you know a lot of former military actually are great leaders of these organizations because they understand mission driven, they understand respect and hierarchy and all these kinds of things. One of the things that I'd love to just highlight is the doctor, whatever certification license holder, this healer is rarely a manager license holder this healer is rarely a manager. They are a high value individual contributor, which is to say that criticism, that tough love, that French chef kind of mindset that teaches the craft, does not inherently care for people and grow people in the way that they need to be. That criticism may be associated with the. 

So I generally say like the last thing I want is doctors leading people. So if you are a doctor and you have to lead people, my urging is understand your limits and start with taking off the lab coat and drop the doctor for a second, because that doctor is really valuable with the patient. But you're about you gotta humble yourself, because doctors, like I said, have to know the answers. But a good manager and a good leader has to ask great questions How's it going? Where are you stuck? Have I given you everything you need to know? What do I need to know? How could I be leading you better? What does this organization need that it doesn't currently have? And that is not a doctor. You've got to switch a hard switch into manager. You've got to leave that ego and that lab coat at the door. 

0:39:51 - Jonathan Baktari MD

And if you can't do that, you got to find somebody who can. Oh, there's so much truth to what you just said you can't imagine. The other thing, if I can add to that, is I don't know if the doctors can't do that. I think there's also one other mitigating factor that they're spending 80 hours a week doing something else. You know, listen, if you can get through organic chemistry, if you can get through physics, you can take them cats. You can get through internship. You know, not sleeping and getting a residency and fellowship you can do all that. You can learn leadership skills. But you can't do it while you're working 80 hours a week, because no one. If I did anything for 80 hours a week, I'd be good at nothing else. 

So I think the doctors get a bad shake because reduce their schedule to 20 hours a week and then say, hey, we want to give you some leadership skills. They're not stupid, they're not idiots, they survived all that other stuff. But what happens? You know? People say, oh, doctors are horrible in real estate. No, they're not horrible in real estate. They just like give someone their money and pray because they're working 80 hours a week. I bet you you took a doctor and said okay, you're only working 10 hours a week, get good at real estate. They would get good at real estate, oh for sure, because they're smart guys and gals, I mean. So I think they're at a massive disadvantage, because if I was doing anything else for 80 hours a week, I would be no good at whatever else you asked me to do. So our doctors, naturally. I think part of it is they want to get good at real estate or be good at leadership, but they want to keep their 80 hours a week and that's just not good. 

0:41:25 - Mark Henderson Leary

Well, and I'll challenge one piece of that. But they want to keep their 80 hours a week and that's just not good. Well, and I'll challenge one piece of that. But I want to be clear on the doctor idea. The doctor who's a human. I'm not saying the human can't do it. I'm saying that the role of doctor is not programmed and taught to be a manager. 

So if you happen to have a doctor degree, if you think that the lab coat and the doctor degree and degree in the role of being I'm Dr Smith and so you're like, no, that is not the manager persona we need to bring to the table you as Jonathan Smith who has a doctorate degree, you may have it in you to be a great leader, great manager, which probably involves you checking your ego and your medical degree at the door and so you can be there. But that invites the question of who are you and what is your superpower. And if you have always wanted to be a real estate guy, then man, yeah, get the schedule down to 10 hours in surgery and learn real estate. That's going to be you. But if you are just looking across the hall and, in jealousy and envy, going, I want to have a Lamborghini and I want to be a real estate mogul and I want to learn this stuff, and you are not wired to be good at that. You should know that you should be cautious. 

0:42:27 - Jonathan Baktari MD

Right, no, I get it. I think what I try to tell people is if you want to be good at management or whatever, you have to view it as another residency. What I'm trying to tell you is like, yes, I know they're horrible at it, but if they park their ego I don't say the hallway, I say the parking lot you park your ego in the parking lot and you come in and say being a doctor at its core is not who I am, I just happen to be a doctor. But yes, you're right, so many people like their doctor defines you, take their career away. Their ego would go to nothing because that's who they define themselves as. 

But if you can get past that, you know big analogy about 10, 15 years ago my wife bought a small healthcare, a little gym, and she was getting going on it and she just opened that. I said you know what, let me come in. I took a couple of months off. I said let me come and help you get it started. And I went to and I was, you know, selling gym membership. You make it a good commission, commission only I trust. 

But it was interesting because you know and of course I didn't tell people I'm a doctor but I was selling like gym memberships and you just have to set whatever the task is like. 

Nothing is above you, nothing's below you, right. But I think if you give doctors this thing like we're going to give you a residency in being a leader, understanding other people, how to interview, how to hire, how to fire, how to motivate everything we just talked about, maybe if they take your courses or whatever, if you actually task them with that, you're right, maybe certain people they can't get off that persona, their ego thing, but I would imagine a certain percentage of them could theoretically, if they viewed it as a course, as a set of skills. They're going to need potential. But you're right, some will never, they're hardwired to be the doctor and they can't get past it. But others, I would argue that if you gave them a course and opportunity, mentors, so I don't think we're disagreeing. I'm just wondering if they would be willing to do that, could they learn those skills? I think everybody's different. 

0:44:25 - Mark Henderson Leary

So the reality is there's a time dimension. We're agree. I'm just wondering if they would be willing to do that. Could they learn those skill sets? I think everybody's different. 

So the reality is there's a time dimension we're not really talking a lot about and maturity. And you want to go out on your own and you're going to fire up an entrepreneurial practice. It's you by yourself and just a small staff. What are you going to have to do to get through that? Well, you're going to do exactly what you said. You're going to have to humble yourself. You're going to learn some stuff. Now, if you have a big vision and you're like, well, I can see myself in a 20 doctor practice, that means you're going to let go of something. What is it? Are you going to hire a visionary to run this practice and you're going to be one of the 20 docs, or are you going to be involved in research and leading the vision of this and to be out of patient care? If you learn management, if you learn P&L, if you learn finance, at some point you'll have to choose. Is this a superpower? Because this is a real job now. 

0:45:13 - Jonathan Baktari MD

And I'm gonna have to let go of clinical care. 

0:45:14 - Mark Henderson Leary

I've seen that happen. I've seen, like you know, CRNAs. They were like you know, I used to put people under and that was cool. And then I'm like I've done that enough, I'm good a patient under in 10 years. That's a choice, because now you're a business leader. 

Plastic surgeons, like are you kidding me? Like this is my art form, Like my, my, my work is all over the world. I would never let go of that. And I managed to suck it up to learn a PNL for five years. But, man, as soon as I got hired a full-time CFO, like, thank God, Same thing with all things alive, right? So, like I love healthcare, it's my passion. 

It's like, no, my family are all doctors and I actually hate it. Like, can I do anything else in the practice? I love marketing, I love whatever you know. That's be honest with that. And this is a long 10 year vision. Like 10 years from now, where are you going to feel like you made the biggest mark and chart a path to it? And I love the connection between look, a doctor who got their degree has proven track record for doing hard work. I love that. It's an ingredient for success. It's not the destination, though. So, using that mechanism to say like, yeah, I can do very, very difficult stuff, I can learn and digest anything, but let's not get stuck there. Let's not like learn a skill we hate and think that that's how we're going to die. We don't want that. Use it to get to a better place. That really does give us this return on energy and feeling like we're living our best life, making the biggest impact that makes a lot of sense. 

Look, man, we covered a lot. I was trying to get you out of here in under 30 minutes and we couldn't stop talking. This is great stuff. Did we miss anything on this particular topic you want to throw in? 

0:46:47 - Jonathan Baktari MD

No, I think we covered it. I think, from my perspective, what I focus on as a physician who's doing other stuff is to cultivate other people to have the same vision you have. So you're not the one that is going to be the main force. You have to create other people who then can exponentially carry out. I read this great book called Tribal Leadership and what they say is we don't care how good you are, we care how good you make other people. In essence, there was more to it than that. 

0:47:19 - Mark Henderson Leary

No, that's absolutely the essence of leadership and that's that I'm an individual healer Like. How many patients can you help in a day as an individual healer? How many patients can you help in a lifetime if you create a bunch of other people who care about what you care about and are able to do that Right so powerful? 

0:47:36 - Jonathan Baktari MD

Right, yeah, that's what we try to do. We try to get other people to get enrolled into the vision and to exponentially have impact on other people in the organization and, of course, the people outside the organization. It's a challenge. The other thing I think we didn't touch upon, which I'm sad to see a little bit we talk about healthcare workers and doctors and whatever. You know, as we know, 25 years ago, 20 years ago about 25% of doctors were employees. Now 75% are employees. 

So I think some of this is really becoming moot because there's less doctors in private practice. So it's interesting because now I kind of feel like they're being given a choice Either you come up with some creative way to keep yourself private and entrepreneur, or you're going to slowly become an employee, because healthcare consolidation is not stopping anytime soon, and so the forces are marching against you. So when I talk to physicians who are still in private practice, it's something that, whether they want to deal with it or not, they're going to have to. You know a lot of them holding out are doing a great job, but that force is out there and I think they can sense it, so it forces them to make some decisions A hundred percent. 

0:48:47 - Mark Henderson Leary

Now I choose to take the abundance mindset approach on this and I understand that people don't receive it as abundance. It's scarcity. They're like man, everybody's institutionalized, you know, and man, I got to work for the man now and all these loans and like I'm getting pressure on the comp and all these kinds of things. But here's what I see. I see humans are, especially in the United States. One out of a lot of people is born an immutable entrepreneur who's like I got to start something, no matter what the consequence. 

So I'm going to throw myself into hell and become an entrepreneur, and those are the people that I'm helping. Those people are absolutely obsessed with creating a great culture. It's high value and need people who want to be a part of it. And what they're saying is I need more people. And all those 75% employees in the institution is like well, I don't know where to go. You know it's either I open up my own shop, which is so hard because of reimbursements this is terrible and so I just rather have this job or leave the industry. 

It's like no, no, there's entrepreneurial organizations all across the country who want to find you, want to know you, and you don't have to be entrepreneurial to start that organization. You could just want to be part of a great culture who cares about you too, and that's awesome, because we really only need you know one out of a hundred healthcare graduates to be like I'll start something because the other 99, there's a great organization that they would be happy to be a part of, and so I think the opportunity is just ripe, and what we got to do and one of the reasons this podcast is a thing is I just want to create the awareness Like there are entrepreneurial healthcare leaders everywhere and they want you. If you don't want to be entrepreneurial and you don't want to be institutional and it doesn't appeal to you to be a mom and pop, you know single shop, I promise you ask around and those conversations need to be had. 

0:50:39 - Jonathan Baktari MD

And I tell you that's how my journey started, because I just asked around, like what administrative things can I do, whatever? So if you're not, if your antenna is not up, seeking those opportunities, you know, I always give like this analogy you could be at a cocktail party and this other physician could be saying oh, by the way, you know I'm doing this and this and this. And if you're in the mindset was, I'm getting a paycheck, I'm happy. I don't want to hear You're like oh, that sounds really great, by the way, what'd you think of the football game? You just move on. It doesn't even register. 

The guy just gave you an opportunity. Instead of saying whoa, whoa, whoa, whoa, tell me more about that. So how does that work up? And you're like I'm getting a paycheck, we can't disrupt that, and someone brings up an opportunity or something, instead of exploring it, asking more questions, you're like oh yeah, that was nice, by the way. What do you think of this dinner? You just move on. So I always say, when you're in that mindset, your antennas are up for opportunities that you're suggesting, antennas are up for opportunities that you're suggesting. But if your antenna is not up, you could, they could listen to. You know, see your podcast for two minutes and just like move on. Like that doesn't relate to me because I'm getting a paycheck and we can't disrupt that. 

0:51:50 - Mark Henderson Leary

Yeah, absolutely. And I think the effects that make that hard is the crawfish effect, of course. If you've ever heard of this, it's like your bucket full of crawfish, one of them starts to almost get their way out of the bucket. The crawfish are in the bucket, reach up and grab and pull them back down, and so it's like why would you do that? It's crazy. You know the peer like, you know we're safe in the hive. You know, don't leave the hive, we're here. 

And and then I don't think there's enough role modeling to see like, hey, I know somebody who got out of here and loves it is. Most of the people are like yeah, I don't know, I just try to do more research, to try to one one less day in clinic, you know, and that's better, right. And I think that I'm even thinking of somebody right now who is in that exact spot. It was struggling with the career and I'm like I don't know why I'm not like not yelling at him, but like sort of flashing the beacon, like hey, there's a lot of great opportunities out there. It's a big world, really big world. And so ask around and there's somebody who's like man, I only had a guy or a girl who had this skillset, who wanted to really get their hands dirty and do some fun stuff man, wouldn't this be amazing? So got to ask those questions. 

0:52:51 - Jonathan Baktari MD

But how do you convince them to give up that steady paycheck for the unknown? I mean, think about that initial leap. You're getting whatever you want to call that $10,000, $000, whatever month and usually like, hey, walk away from that. I can't make you any guarantees what's going to happen. You're going to somehow get this dynamic thing that you're talking about. The toughest thing is saying you know how many people can walk away from some relatively good lifestyle for that other thing that involves more creative juices, more you know. Just push their limits and what have you? How do you convince them to jump into the deep end? 

0:53:31 - Mark Henderson Leary

Two ways to answer that question. I think the first one is you don't. In the life cycle of burnout, there's somebody who's like I'm ready to leave the industry, I'm going to quit, I'm walking out of here today, going. I don't know where that person, somewhere in there, it's in that life cycle. They're ready. The risk to pain tolerance is like I'll do anything and so that person can do it. The rest of those folks are like they're in the hive, they're not moving, they're fine, not fine. I can't save them all. The ones that have to self-aware. We got to get the word out. If you're ready to burst into flames, then let's have the conversation. If you're ready, you're ready. If you're not, you're not. 

But I do, from all the sources that I talk to the graduates, very different appetite for the life they're walking into, their tolerance for oppression very low. Like I'm going to work 80 hours Doesn't sound fun. Like, oh, I want to be a jillionaire and work on weekends Nah, not really in for that. I am perfectly happy for a 40, 45 hour work week where I work for a cool boss. Those people are the ones who are changing the tide. They're the ones when, as from an entrepreneurial perspective, it's like go find the new graduates. 

Their lack of appetite for suffering is actually your advantage, because they understand the tradeoffs better. You don't have to be paid like an owner. You can be paid appropriately for the work you do and you'll fit into our culture. And a lot of those organizations I work with have very big variances in terms of, like, we're a work hard culture and you're going to produce and we're only going to hire those people who understand sort of revenue share type of arrangements where they're working hard, and others are like no, you know, we're totally fine with the work-life balance approach because we actually need flexibility in the schedule and that allows us to really kind of ramp down and so we've got so many things to work with. 

But I really do think that the silver lining ironically what used to be the millennial problem is actually the flexible healthcare provider advantage. Like hey, how do you want to work? Where do you want to work? Like hey, virtual, remote, local, whatever. We got all these options now where it used to be just like one one form. This is what a healthcare provider looks like, this is what they're paid. 

So, I think we got lots more to work with, which, again, double-edged sword, because it's you got options, but you now have to know what you want and because, if you would, I see this all the time we hired somebody we thought was a great doctor and we wrote the job description down as doctor, and now we got a doctor, except that we're saying good news, doctor, I got a comp program that's going to get you paid big time for every hour after 40 hours you work and how many procedures you go through. But we never asked that doctor if they were high performance or not. Now we're like oh, you didn't want that Shoot. So now I've got to understand what our model is, what our culture is, ahead of the game, and so we're setting expectations going in hey, we're a work hard, play hard culture. If that's you, you should be here. Hey, we're a work-life balance culture. We're a lifestyle medicine practice. 

0:56:26 - Jonathan Baktari MD

We're very thoughtful, we're very collaborative and we get paid very reasonably, but not a lot of Lamborghinis in the lot, and that you now have to answer those questions. I love how you distill those two ideas and that makes a lot of sense as your job as leader to communicate which one of those cultures you're going to be and to manage those expectations. That makes a lot of sense. 

0:56:42 - Mark Henderson Leary

And I think the hardest thing about that is the frustration of realizing it. God it's so, it's heartbreaking. The leaders go oh shoot, we can only hire doctors once a year because the way the classes and man, three of the five doctors we just hired don't fit. So I'm always sort of sad with that realization and I know. But now we know and luckily this is not like a turn and burn business we don't have to turn the ship around. Over the next two, three years we're going to really change the culture and you're going to get doctors who think like you and feel like you and it's going to be a loving organization where you get to the office and you're like man, these people are amazing but it's going to take a hot second to get there. 

0:57:23 - Jonathan Baktari MD

Yeah, and it makes a lot of sense. I think what you're saying is screen people off for those things. And there's a middle group that I think can be molded, based on mentorship and enrolling into vision, like, hey, we're here to do something really exciting, we're going to take over the world, and so the ones that just want the 40-hour work week, that's one the ones that want to kill themselves. But there's also something in the middle where, if you work with them and say, listen, I know you didn't think about it, but we're about to do something really special here, oh yeah, 100%. Let me tell you what that vision is. But that's going to require you to be a little more dialed in, a little more of an owner. 

0:58:07 - Mark Henderson Leary

But if we do things correctly and you're part of it. The sky's the limit. Yeah, a hundred percent. And I say I teach this to my clients who are rolling out their core values for the first time. So you're going to have three categories across all your employees. So you got 20 people, 50 people in the organization You're going to roll these core values out. There's going to be one group that says, yeah, I knew that. Obviously like no news to me. I knew we were all about high performance and you know like of course you were that that's why I'm here. Second category is like huh, never really thought about that, but that sounds good, I could do that. 

You know that's that's fine and that's a lot of what you're talking about like these people were kind of rudderless and they were just doing what they thought and they're like, oh, it's a belief system I can plug into, at least for a time being, sounds great. And then there is a third category which is like oh, so you're ruining the place, got it? So the problem with that? Well, the good news about that is that if you've got 50 people in the organization, you can save a lot more people probably than you think and you're going to have to do some firing, like you said, or letting some people go and freeing people to the future. 

The part about healthcare, that's really unfortunate. Law of small numbers 50-person, 100-person healthcare organization, how many associate physicians, depending on your practice, could be two or three, could be five or 10. But if it's in the middle three, four, five, law of small numbers you may jackpot this, you may have a total folding hand and so that you might get everybody oh, shoot, that year we hired all we weren't thinking and we hired a bunch of X, you know, and they're all of the mindset that we can't live with. So that's the unfortunate reality of that one. 

0:59:33 - Jonathan Baktari MD

But you talk about the higher level people, but also the medical assistants and that administrative staff. If they're dialed in, what I have seen is their impact, even on the few stragglers that are deciding which way to go, makes an impact. I always get this analogy, like if I got a job at the post office tomorrow morning, right, which is all unionized government workers who are just like you know. Obviously they're nice, but they're just trying to get through the day. If I got a job there and after one week said listen, guys, I've been looking at our processes here at the post office, I've come up with some amazing ideas to revolutionize, make our post office more efficient, you know they'd be like hey, just sit down, we're good. Yeah, I mean, it's because the majority have that mindset that we just need to get through the day, do a good job, but we're not here to take over the world. But if you get a job in another company where eight out of the 10 have the mindset you described, that puts a lot of pressure on the one person who's clocking in and out to either conform or leave. Right, because they know the majority have already bought in. 

So I always say that when people come to me and say my organization is at a crossroads. I tell them well, let's take a head count. If you have 50 people, how many are bought in? And if it's less than 50%, I would say you have a challenge on your head, because the majority of people are not bought in. So how are you going to bring in people into the organization where they look around and say, well, nobody else is bought in here, the majority are not bought in. 

So I think that there's a critical number at which, when you get enough people bought in, that will then sustain itself as you bring in more people. Yeah, you're 100% right, it's a great point. So you have to really look at that number because, let's say, you hire one of those people you talked about, but you bring them into an organization that eight out of 10 are clocking in and out. So what I teach in my podcast and what I teach in my organizations is we have to build a culture that all of us are on the same page. We all understand that good things will happen to all of us as we move the ball forward, and anyone bringing the organization should subliminally get that message. 

1:01:45 - Mark Henderson Leary

That's an absolutely great point. The nuance I want to add to that is that, yes, the numbers, the community, if we get everybody on the same page, that's great. When we realize that our culture is off track, sometimes it's a bit of an overwhelm. Oh my gosh, 50% of the people, 80% of the people, aren't there. I got to replace my whole staff. I'm like, okay, I understand the sadness, I understand the feeling that goes with that. 

However, the good news is there is a way out of that and it starts one person at a time, wherever the biggest problem lies. Which. The good and bad of that is that what we're saying is all these people are not equally influential. And so, again, the good and bad like you might find that my director of nursing is really the biggest problem, and so if we can solve that man, the nurses will be so much happier and wow, what a level up that will be and what the director of nursing will suddenly bring all the nursing staff to the next level, and that that can absolutely happen. If we can just do one at a time, you will start to see these large portions of the culture sort of light up. Like, well, I got one person out of the way, one bad apple, one cancerous person. But I guess the caution in that is that we do find observationally that especially in high-skilled, high-demand, scarcity specialties like ophthalmology for example or somewhere, we got like the best researchers in a particular, I got the number one, whatever specialist. 

There's a lot of ego associated with that. There is an awful lot of cultural power in that person. I say they're not managers, but they are leaders and they will lead and people will follow them. People pay attention. They know by their mood and their attitude and how they treat people that people pay attention. They know by their mood and their attitude and how they treat people. Totally the biggest influencers. So you may find that, like you said, let's just not boil the ocean, let's try to get the whole culture turned over, one at a time. Biggest influencers might be the front desk, might be a manager here, might be a person there, one at a time and watch the culture transform. 

But we do oftentimes kind of go oh, it's dr smith. Yep, how easy is it going to be to replace dr smith? Not very right. How big a problem is this huge? Oh, no right. So we gotta. 

We gotta call it out and then sometimes just balance. I mean, you're like we're gonna suck it up for six months a year, whatever, but you got to address it. And then you got to move the pieces. You can move to get the culture, and sometimes you can, by raising the pieces, you can move to get the culture, and sometimes you can, by raising the rest of the culture up a little bit, put some pressure on Dr Smith. 

But man, it's very inefficient way to do that, and so I just, if nothing else, empathy, like as a leader. If you're listening to this and you've got a Dr Smith, you're thinking oh no, you got to just deal with the truth and you got to build a plan to work towards it. And if you can kind of build the rest of the culture around that and it's not going to be till next spring, until you can find a replacement for Dr Smith I will urge you, though nine times out of 10, getting rid of Dr Smith and runninga person down is way better than running the toxic person at higher capacity. That's my urging. 

1:04:37 - Jonathan Baktari MD

Yeah, sometimes it's not even a Dr Smith, sometimes it's just someone that is a part of your organization that there's no redundancy in. So, like there's this one person that knows all the vendors, there's one person who you know, knows whatever, and you're like, well, we can't, you know who would, we can't have anyone replace them easily. It will take six months or a year. So there's a tendency to want to put up with that person more because you're thinking there's no redundancy in their position. They're the whole marketing department, they're the whole this department. 

And so then what you were saying and I kind of concur then you need to have an eight-month plan, a 12-month plan, a 16-month plan to make the change. Okay, slowly, we're going to have to have other people learn some aspects of what they do over a long time. So at a certain point, like you said, dr Smith, it may take six months, 12 months, may take a year or two, but if something has to be changed, it doesn't mean you can't come up with a one, two-year plan to make the change. Yes, the lack of redundancy buys them immunity over the next few months, but it doesn't buy someone immunity over the course of a year or two, and you should be able to, in theory, come up with an action plan to make that change theoretically. 

1:05:57 - Mark Henderson Leary

Theoretically, so I guess you know to sound like I contradict myself. I do understand the rationale of like yeah, we can't Sally's, we're whomever, like my Sally and my other people that I refer to as, like my generics, you're so dependent upon them. And when reality, though, two things are true Sally may leave anyway, sally might not be happy, and she's gone in a week. And you had a two year plan, or a one year plan, or a six month plan, and she's gone. And now what are you going to do? I'll tell you what you're going to do. You're going to be surprised at how nice it is to not have Sally around, and you're like you know what, we got more work to do, but golly, isn't it nice to not have to deal with that toxicity and issues. 

1:06:39 - Jonathan Baktari MD

Yeah, but you know what You're making me think of something else, which is sometimes Sally is so toxic because she is irreplaceable, and so no one's been able to have that real accountability. 

1:06:52 - Mark Henderson Leary

She stopped telling her the truth. We stopped telling her the truth a year ago. She's been doing a terrible job for a year and we say good job, sally. 

1:07:00 - Jonathan Baktari MD

Right. It's so funny because if you're like the 10th accountant in an accounting department, we can call you in and say listen, bill, things are going to have to change. And I'm telling you right now blah, blah, blah, blah, blah, blah, blah. These are the feedback performance I'm getting blah, blah, blah. But when you have one accountant in the accounting department, you can't have that conversation. So you hit the nail on the head. I mean, you actually reinforce the bad behavior. I like what you said. We've been lying to you for a year Because that's, in essence, what you have to do. You have to lie until it comes a time where you can then. But then it's sort of like where did that come from? Why haven't you told me that? If that's the case, you know what? How come nobody sat down with me over the past? You know you're saying this has been going on for years. Well, the reason we did was because you had a non-redundant position that we couldn't. 

1:07:52 - Mark Henderson Leary

Man, we have covered so much. We're trying to get this in a half an hour. It did not work at all, and so I loved the conversation and failed experiment on that, but it's such a great conversation. I love what we covered, so powerful, and I'm sure we should have future conversations because it was just so fun. 

1:08:08 - Jonathan Baktari MD

Oh, thank you so much. 

1:08:09 - Mark Henderson Leary

It was a blast so if somebody wants to continue the conversation with you and know what you're up to. Obviously we'll put some stuff in the show notes. What's the simple way that people find you Well? 

1:08:17 - Jonathan Baktari MD

BactariMDcom is our website, where a lot of our material is on, so that's a great place. We also have a podcast BacteriMD on YouTube and all the platforms like Spotify and, of course, on LinkedIn. You can message us and get in touch with us and, of course, all our websites and everything is on BacteriMD, so you can find what we're doing there. That's a great resource. 

1:08:40 - Mark Henderson Leary

Awesome man. I'm grateful for the time I got to cut this off and we'll have future conversations for sure. So if you, as a listener, enjoyed this, please subscribe, give some feedback, share it with your friends. If you think this is useful to somebody else, get in their hands, because that's what we got to do. We talked a lot about this in terms of a lot of the awareness of entrepreneurial healthcare. 

Entrepreneurial leadership is not out there. People keep thinking it's institutional or old school mom and pop. But you know there is plenty of room for you to either lead and grow your entrepreneurial health organization and other people do the same thing, or have people come join it and be a part of it and you can join somebody else's, and so let's create this awareness. There's too much opportunity here. The opportunity's never been greater to add value and have great healthcare organizations out there of all varieties. So give us the feedback and thank you again to Dr Jonathan Bektari. That was awesome stuff and we'll talk in the future and we'll see you next time on Practice Freedom with me. Mark Henderson, thank you.

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