Empowering Physicians Through Telemedicine

[00:00:00] Jared: Hello everyone, and welcome back to another thought-provoking episode of the med+Design Podcast, where we're gonna uncover the narratives and wisdom of healthcare innovators. And today we're incredibly honored to have Dr. Brittany Busse as our guest. Dr. Busse, a distinguished physician and entrepreneur, has carved a unique path in the healthcare industry, striking a crucial balance between technology, patient care, and physician wellbeing.

From her early days as a resident physician at UC Davis Medical Center to her current roles, as a co-founder, president and chief medical officer at ViTel Health, Dr. Busse embodies the innovative spirit that drives the evolution of healthcare. She's an ardent advocate for independent physician practices seeking to infuse digital technology into healthcare to enhance patient outcomes and bolster physician autonomy. Her experiences rooted in an unwavering commitment to equitable care have sculpted her into a dynamic leader in the telemedicine industry. She is poised at the intersection of medical expertise, technological innovation, and executive leadership, navigating the future of digital healthcare with a keen intuition and passion.

We're thrilled to delve into her journey, explore her transformative initiatives, gain insights from her vision of a digitally integrated physician friendly future of healthcare. So without further delay, let's dive into our conversation. Dr. Brittany Busse. Welcome.

[00:01:20] Brittany: Hi. Thanks Jared. That was a really good intro.

Can I like steal that from my pitch deck?

[00:01:26] Jared: I can send it to you.

[00:01:28] Brittany: Thank you. Thanks. I'm really happy to be here with you guys.

[00:01:32] Jared: Yeah, really excited to jump in and I think let's just jump in and talk about ViTel Health or Vital Health. I don't know how to say it correctly. Yeah.

[00:01:39] Brittany: ViTel. Yeah, for telemedicine.

[00:01:41] Jared: ViTel Health. And so, can you share with us just, about your role with the company your main areas of focus, cuz there's a bunch of 'em, and then maybe about ViTel Health's mission and just your vision for the company as a whole.

[00:01:53] Brittany: Of course. So we founded ViTel Health in the summer of 2020 ,2021, leading into that.

I would say its official founding was 2021, but we started working on it back in 2020. My role at the time was working for an occupational telehealth company and I was extremely overwhelmed at the time with the amount of patient intakes that we had to do, and I was really starting to feel like a worker in a factory.

It was like that episode of I Love Lucy. If any of you have ever seen that I know date myself a little bit here, but her and Ethel are working in a chocolate factory and the chocolates are coming down the conveyor belt and then there's more and more chocolates coming. They're like shoving them in their shirts and like going as fast as they can trying to handle the chocolate.

And this was like not chocolate. Okay. It was like the opposite of chocolate. And every day I would sign onto my computer to do these patient evaluations. And like at first there would be like 10 to 20. And then one day I signed on and there were 300. And I was like, how am I gonna get through 300 patient evaluations in one day?

And then the next day there was 500. And I'm like, I'm gonna need some help here. And trying to pull in any other physician I could get to help me. Like we were very understaffed and I wasn't able to dedicate any care to these individuals at that time. Like they're going through some of the toughest situations of their lives, like whether they're isolating from their families, or some of them were actually in the hospital taking my phone calls. I had a father answer the phone at his son's ICU bedside, and I couldn't, I didn't have the time to be there for that person, right? Like I literally had two minutes to get this phone call completed.

And onto the next phone call and just to try and give a little bit of empathy, a little bit of compassion in that space was like the best I could do. But at the end of the day, I was just drained and I just looked at my partner. I said I can't do this. Like I cannot work like this anymore.

And I know the pandemic's not gonna last forever, but this has been my experience like at four different healthcare entities where my role was seen as expendable, as like a resource that could be used up and tossed out and not valued. And I'm sitting there as a human trying to have human to human interactions to promote health on a daily basis.

And we wonder why the healthcare system is failing. So I went to my good friend and a former coworker, Doug Sumaraga. And I said, let's start a new healthcare company. And I'm really passionate about helping empower independent physicians because I think independent physicians are gonna just give better care to patients cuz they'll have more control over their time.

And he's that's amazing. I'm really passionate about improving preventative medicine in primary care because he actually lost two brothers to preventable healthcare complications. And he's if we could really combine those two things, then we could have this really innovative new healthcare company, which actually isn't all that innovative.

It's actually more of a throwback to the prior days of healthcare, and so we're more of a nostalgia company than an actual disruptor, but I would like to think of it as disrupting through nostalgia and by improving patient physician relationships. So my role is really as a physician connector, also as a chief medical officer.

I oversee all of our healthcare coaches and we can talk more about those, but they are our patient advocates who interact with patients in our preventative care program. And yeah, and interacting with our physicians, getting the word out there, helping them build a practice that represents who they are and what their values are, so that at the end of the day they can feel amazing rather than burned out.

[00:05:52] Jared: That's incredible. It's interesting something that Ty talks about a lot as well as Innovation coming from the physicians themselves like, like you and your business partner, where you both saw a need, you have a passion for it.

I am curious about how you said this sort of nostalgic, this is a nostalgic business more than innovation. Can you delve into that a little bit? That was interesting. Yes.

[00:06:13] Brittany: I think it's funny, like I actually don't know this one, so like maybe I'm not as old, but my partner always talks about someone called Marcus Welby md, who was like on tv.

It was like your family physician doing house calls and like having a great relationship with the patients and part of the community. So when we think of what happy physicians look like and what their healthy patients look like, it's those people who are in community with you, who understand your background.

Now, that doesn't mean necessarily always the same geographic community as you, like your community that you belong to may be geographically, non centric. So if I identify as a person of color or a person from, the LGBTQ community, my community is spread out all over the place. And there are physicians out there who also represent those communities and can provide the best, most intimate care to those individuals so that they feel seen, they feel heard, and they feel represented.

And that's what I love about digital health and telehealth is it really geographically dislocates physicians and allows them to practice in their area of expertise, in their area of passion no matter where the patients are located.

[00:07:27] Jared: I love that. So yeah, taking the expertise right to the person. We had another participant in our past as well, discussing how he was able to help rural health systems that, just needed that added expertise.

And so it's interesting to hear how you discuss it as well. There's so many use cases for digital health and telemedicine in particular. So I guess what I also am curious of is what are the different, product offerings that ViTel Health has to offer?

I saw that there's quite a few different things going on and just like maybe what's your flagship thing that you guys are going after?

[00:07:58] Brittany: Sure. So we are an all in one platform as a service model. So we wanna meet physicians where they are in their health delivery journey. So many of our physicians, are still employed.

They might wanna join in at a free membership tier. So we employ a freemium model. We do have free level where physicians gain access to community. They can house their credentials in a transferable blockchain that they own and they can actually start to interact with other physicians who are on different paths from themselves and get an idea of what it looks like to start a private practice, if that's something that they're interested in.

At the higher membership levels, we actually offer services as a digital health platform. Our EHR ,electronic health record is fully integrated for telemedicine, but can also be used in person. So it's interchangeable. It's been in use in production and fully integrated with Zoom since 2013, back before anyone knew what Zoom calls were or even had really a lot of experience in using telemedicine.

I used to speak to Uber drivers, and they asked me what I do for a living. I'd say telehealth. They were like, what is it? Telehealth? I'm like, oh, it's when you have a Zoom call with your physician. What? I'm like a FaceTime, like people, FaceTime physicians, and no one had any idea. Then the pandemic happened.

Now people obvious, they're like, oh, this is so obvious. Of course, we could FaceTime a physician. Can we text message them too? So we integrate all of those things into our platform, whether it's hipaa, secure video, hipaa secure text messaging. And data communication that's shared with both the physician and the patient through their patient portal as well as interoperability so that we can communicate back and forth between outside health systems because the last thing we want is for the physicians to feel like their care is isolated from the care that the patient receives in other healthcare systems. So it was really important for us to make sure that we could pass data back and forth to the qualified Healthcare Exchange networks so that our patients could always feel comfortable knowing that their data could be accessed by their physician remotely.

So that's like the main offerings. And then beyond that, for physicians already in practice, we want to help them to continue to thrive and build additional revenue streams. So we looked at the remote patient monitoring and chronic care management aspect of digital health and saw that there was a need for that beyond the monitoring to actually make a difference in the lives of patients so that they were motivated to take the readings and to continue to improve their own health and to really give the patients more agency in the health journey.

So we added in the healthcare coaching as I spoke of before. As an added component of that. So when a patient comes into our remote patient monitoring and chronic care management program, they get their digital equipment, which is based on a cellular hub. So it's super easy to use. No additional apps.

They just plug it in and start taking their recordings, and then they interact on a weekly or biweekly basis with a person who is their healthcare coach. And after a few readings that person develops a relationship with them, starts to talk to them about their smart goals, what they can achieve, and helps them realize that health really is within their grasp.

I think so often we're overwhelmed and flooded with all this information about like how to live healthier, right? And if you look at this list like. Go on TikTok or Instagram and you're like, oh my God, I'd have to wake up at 3:00 AM and like only eat lettuce. Like I've seen like the funniest videos.

This guy's like eating kale. And then he reads a TikTok, says, Kale's bad for you. He's spits out all the kale. And you don't, you're overwhelmed. You don't know what to do. So I think sometimes people just don't feel worthy of health because they think they can't dedicate that amount of time, effort, money, whatever it is, it's just simpler for them to take their pills if they remember and can afford it.

And not to try and look at all of these other things. What the healthcare coach can do is give them one small thing that they can do, and then they see the impact on their monitoring, and the health coach celebrates that with them and says, Hey, I'm really proud of you. Okay, now I am important to this person.

Like my meeting, my goals made them feel good. Maybe I can feel better about myself too. And the more worthy we feel of our own health, the more impact we're gonna have, the more small changes we're gonna make. And those small changes do add up. So our patients are living such amazing lives, like even into their seventies, like telling us they feel better than they did in their fifties, like coming down off of meds.

So we're de-prescribing medications for patients. Patients are losing weight and like overall, they just feel better and they're less stressed in their lives. So I just love the results that our healthcare coaches are able to get, like above and beyond the monitoring and the information that the doctors receive about patients.

[00:12:55] Ty: That's so encouraging. It's Peter Attia in his book Outlive talks about Medicine 3.0, which is about improving your health span. Sounds like your coaches are doing just that today and like it's so different from modern medicine, which is around treating acute care.

[00:13:08] Brittany: Yeah, and I think one of the issues, you know, like even talking about Peter, who's an amazing, physician and out there doing this longevity science, I think for most people, again, that feels inaccessible, right? Like Peter's clinic is incredibly difficult to get into. It's very expensive.

Most of this longevity science, like it feels like it's for the rich people, and our system is billable to Medicare and Medicaid. And depending on the state that you live in, this is all reimbursable from your insurance company. So health suddenly becomes accessible and equitable for everyone.

Like one of our clinics that we're launching right now is located in downtown Detroit. Okay. Not known for, its wonderful health outcomes and thriving population. But we wanna change that. We want people there to feel like there are people in their community and healthcare coaches who we found and identified within that same community who are there to listen to them, to talk to them, and to coach them from where they are and not to talk to them down on them from some other level, right?

It's so lofty sometimes for us to, who are in good health to say to someone else, don't eat fried chicken every day. It's, I don't eat it every day. It's okay, maybe you're just eating it once a week with family is after church like, could that be okay if you're meeting your other health goals?

Yeah, 100%. That's a living a life in balance that's treating joy as a nutrient, right? This stuff is so important when it comes to people's health. It's not just adhering to one strict. One size fits all plan. That's what equity is about. It's not equal, it's not all the same. Equity means that we tailor a plan that fits each individual so that everyone can achieve healthier lifestyles.

[00:15:04] Jared: I am curious also cuz I know that you are into meditation, into yoga eating well, fasting is any of that also integrated into what you do from, or not you do personally, but what ViTel Health does or your health coaches do? Or is it more focused on maybe just closer to lifestyle and diet choices, I'm just curious.

[00:15:24] Brittany: Yeah. So we're not officially connected to the American College of Lifestyle Medicine, although I love them. I love what they do, and I'm a member myself. But they have the six Pillars of Health and, unbeknownst to me, we've pretty much fallen into alignment with those because I know, a lot of the things that it takes to feel better and live healthier.

And one of the major things we always look at first and foremost, are the things that are simple for people to make an impact on, that actually underlie all of those other things, right? So if someone isn't sleeping well, it's like the first one, right? So you wanna identify like, why aren't they sleeping well, because if they're not sleeping well, they are probably making bad food choices during the day.

They're probably too tired to exercise. And so like really looking at that from like the cognitive, behavioral coaching standpoint and helping them make real change. So it's actually a. CBTI, which is CBT for insomnia, we can actually coach the patients on how to sleep better. And sometimes it's super simple.

Like one patient wasn't using her CPAP machine cuz she like didn't understand it, didn't like it, and her blood pressure was way up and she was not feeling well. And it's let's just try using your CPAP machine. And she was able to see the difference that made. On both her blood pressure and then on how she felt, and then when she was sleeping better, it was actually easier for her to make healthy choices and to lose weight.

Then someone else who's not sleeping well, it could be due to a stressor in their lives. So we work with many elderly people who are actually taking care of grandchildren, and they didn't realize that they were going to be full-time caretakers for grandchildren and that is causing them an immense amount of stress.

So we try to connect them in community, give them resources, try to find a way for them to manage that stress better. And like from a meditation or breathwork standpoint, like for me, sometimes it's as simple as when our patients start feeling overwhelmed, our coaches just teach them box breathing.

Like super simple. Breathe in for four, hold four, breathe out for four, hold it over four, and just do that five rounds of that. And like surprisingly, they feel better afterwards. Like it's very quick. It's very simple. Anyone can understand what it is. And it really works to down regulate your nervous system from that state of fight or flight down into a more parasympathetic or restful state.

And that really helps set a better baseline for you if you're trying to sleep or focus or whatever it else you need to do during the day. So we do try to integrate really simple tools. Like I said, it's not, I think, breath work, meditation, yoga. I think all of that's for everybody, but you have to find that accessible point again, where most people do think of those things, they think of them as like they're very lofty.

They're for people with extra time on their hands, where like a meditation and breath work can literally be done in two minutes. So it's what do people have the capacity to do and what time do they have to do it? I think a good one, even for me in my personal life was like, I love running, but after my pregnancy and then I had a C-section and it took me a long time to recover and when I pushed too hard and I thought I needed to run seven miles a day like I used to.

And if I couldn't run seven miles a day, I wasn't a runner and I couldn't do it. And then I saw a lot of posts and I actually heard a podcast by talking about do a small, achievable goal every day. A five minute run is still a run. So I have a little park. It has about a half mile loop.

I do two loops around the park. I walk back home, it takes 10 minutes. I don't have to wake up at 4:30 AM in the morning and then try to take care of my son and run a business. Like I can wake up at quarter to six, walk outside, do a quick run, come back to the house, meditate, and be ready to start my day.

And it wasn't such a huge jump. So it's even setting those goals for myself and realizing like that every little step you make is important and it should be celebrated.

[00:19:41] Ty: It sounds like it's also important to you to model good, healthy behaviors as well as be able to be a health and wellness coach or like leader of health and wellness coaches within ViTel Health.

[00:19:51] Brittany: Yeah, definitely. I think, like I said, when people ask me, when I talk to a lot of lifestyle medicine doctors because most of them are actually in private practice. There's not like a lot of space for lifestyle medicine in academic practices or even within clinics because you can't practice lifestyle medicine in 10 minute increments like you can, but it's really difficult.

You have to have a long time to spend with the patient. You have to be able to talk to them about these interventions and I talk to 'em a lot and they'll go, oh, do you practice lifestyle medicine? I'm like, no, I never really have actually practiced it. I actually started in surgery and then transitioned into an urgent care.

I'm like, but from the beginning it's always been more in alignment for me to talk to patients about lifestyle interventions than to prescribe medications, because personally I don't take that many medications, like maybe some ibuprofen if I have a migraine. But I'm always trying to find other ways like to manage my migraines, by staying hydrated and getting enough magnesium and all of those things that people just don't know about.

So when people would come to talk to me at clinic about anxiety or any of those things, and I was in the urgent care, I didn't care. I'd just sit down and pull up a chair and be like, Why are you anxious? Tell me about your life, and I didn't care if I sat there, for 30 minutes, 40 minutes, whatever, that's just what I wanted to do that day was to find out what was going on with that person. Rather than to just oh, you need some benzos. Okay, here's your Xanax. We'll hopefully never see you again because this is an urgent care. And the funny thing is, I actually got a note one time, like on my Facebook of all things.

The patient looked me up on Facebook. I was like, you probably don't remember me, but I came into your clinic because I wanted some Xanax. And when you first told me you weren't gonna gimme any, I was really mad at you. Then you sat down. And you started listening to me, and by the time I finished talking to you, I realized I didn't need the Xanax.

I needed to change my life. And she's thank you. Thank you for sitting down and listening to me. It was not what I wanted at first. It was not what I expected, but you made a difference in my life. And we don't always get that feedback, right? As doctors. But the more personal relationships we can cultivate with people, the more we can have those opportunities.

Like I said, this is why I'm so passionate about independent practice because the CEO of that urgent care did not like that I sat with patients sometimes for 30 or 40 minutes, like they were all about volume and billables. And I just was like, I don't care. This is how I practice. This is how I'm authentically myself.

This is how I'm in alignment so that I leave here feeling good about myself at the end of the day. And that's what I want more and more doctors to feel at the end of their workday. Like they practiced in alignment with themselves and with their values and their beliefs and their authenticity.

And if they need help figuring out what that authenticity is I wanna help them. I wanna listen to them and be their advocate.

[00:22:53] Ty: And you mentioned earlier the I Love Lucy scenario where you had 300, 500 patient visits in your inbox and I guess how have you structured it so that you've been able to fix that situation so that you can give the patients the time that they need order to have that changed outcome consistently happening or like having more of a shot for that consistently happening?

[00:23:16] Brittany: You know what I love about what we look at as like direct care or membership based practices that the physicians can really tailor their practice and how much they charge. Like how much time they wanna spend with patients. So I always counsel, the physicians they work with to work backwards.

If you don't wanna have, 100 5 minute interactions a day. You actually don't have to do that. Like you can have a really booming practice with a panel of a thousand patients and those patients aren't seeing you every day that month, right? Or even once a month. Like some of them maybe only seeing you every few months or once a year.

And so if you look at that, most direct care practices charge between $50 and $90 per patient. You have a thousand patients, that's $50,000 thousand dollars a month that your practice is bringing in. Pretty nice with our digital health platform. Your overhead is extremely low. You don't need a physical location.

You don't need a bunch of staff. You can have that. You can have patients doing health coaching, potentially. That's an additional revenue streams some people are willing to pay for. Or it's hard legally like to talk about this, cuz I'm not a lawyer, but there are still ways to have concierge practice and still be able to bill insurances.

And we actually do have a lawyer on staff who can talk to those things a lot better than I can because like Stark law and all this stuff that actually makes it difficult for physicians to provide extra services that will help their patients. Whereas like hospitals and healthcare systems can sell you as many services as they want.

Look at even something like Concentra, which was an occupational health company or is an occupational health company within a Concentra or most urgent cares, they have radiology. Okay. When I worked at Urgent Care, they expected me to x-ray every single back injury. And when I asked why, they said, because we billed $500 for it.

And I was like, yeah, but on a 23 year old woman of childbearing age, she doesn't need an irradiated pelvis. They're like, Nope, don't care. And so those types of systems exist, right? They have radiology, they have PT in-house, they have medications in-house. They're making money off of all of those things.

But if you're a physician and you quote, self-refer to something else that you make money off of, then you're in violation of Stark Law. It's very difficult and there's a lot of things that we have to do creatively to meet legal guidelines around that. But it is possible for physicians to have additional passive revenue streams that help their patients, right?

We're not just doing this to make extra money. The health coaching actually improves the lives of the patients as well. So really getting back to that, it's looking at like, how many people do you reasonably need to have on a membership plan with you or insurance billable to have the lifestyle that you want after you've paid out all of your expenses.

And, if you only wanna work three days a week, that's possible. It's really what is your end goal and how can we help you tailor your practice around that?

[00:26:38] Jared: You're making me want to switch. Number one I'm in the market for a new physician. Currently the office

that I've always just gone to what's most convenient to me, and there's one just down the streets. So I just always went there, and like they do a lot of these sort of I don't know how to call it, shadier practices, kinda like how you're mentioning, and I can remember when I was 25, 20, I was, no, I was 24. And it was actually opposite of how you talked about it, I was a grandson taking care of grandparents. And not ready for the stress that kind of puts on you. And so I was having I don't know if you wanna call it mental breakdown, just I was having an a week long anxiety, panic attack episode, basically.

And so I had convinced myself I had all these illnesses on off of WebMD and I think that me convincing myself of all these illnesses made it even a bit worse and stuff. And so I went to my down the street doctor office and sure enough, they did they did all these like tests on me that I'm sure were very billable, on the spot.

And one of the physicians finally talked to me and was just like, so what's going on in your life? And then I got to actually talk about myself, but they put me on and I told 'em, I don't want any of this anti-anxiety drugs that, I'm not trying to do any of that.

They're like, oh, they, we have new age ones now where they're not as bad and they're not as addictive and all this stuff. And they're like, just try it. Just try it. And I was like, okay, I'll try it, try it. Horrible. Oh my, I couldn't even believe that people can function off of that kind of medication on a day-to-day basis.

Like I was like, I felt. Okay. This is a whole different rabbit hole. But anyways, I'm a I don't wanna say victim, but I've experienced some of that, of what you've, been discussing a little bit. And now I'm okay, I need to find somebody more with your sort of perspective for even my own life.

Sorry, just thinking about that now.

[00:28:28] Brittany: Yeah. I think, like I said, what happens a lot of times in these situations is if it's a local urgent care, at least in my case, I worked at that urgent care three days a week, right? So there's four other days of the week that I'm not there.

And there's also my physician's assistant or nurse practitioner, and there's four or five of them or more that cycle through. So when you come into those situations, even if it's the same place that you always go to, you're not necessarily seeing the same practitioner, the same clinician, the same physician.

And so you don't know, you don't have that relationship with them. They knee jerk order a bunch of things like I worked at one clinic. And the doctor I worked with, another doctor one day, he would order tests before he would ever see a patient. If you come in with a fever, you were getting a chest x-ray and a urine culture, and a flu test, and a strep throat swab without like him even seeing you or asking what was happening, right?

Like you could really narrow those things down. Yeah, if you just took two seconds to talk to the person, Yeah, if they have the flu, they don't need a urine culture, right? Or probably even a chest x-ray if they've only had it for one day. And I was like, why do you do that? I was like, cuz I make more money if I do it that way.

Because as a physician there, we were actually paid a percentage of the billing which was really even more shady. I never cared. Like I just cared. If I got my hourly rate, whatever, if I had a busy day, I got a little bit of a bonus sometimes. That stuff just never made an impact on me.

I just wanted to, I wanted to sustain my level of lifestyle. And sometimes for me, that often meant working more hours. I guess that's what I grew up doing, right? Like I didn't grow up with a lot of money and I started working when I was 15 because I wanted a car and I just started doing all the things that I needed to do.

And when I was in college, I was like, I need three jobs because I can't possibly make enough working at one of these jobs. To pay for going out every night. Like one has to cover my rent and one has to cover my car and one has to cover my lifestyle. And that was always my solution. Right?

Work more to make more and that's not necessarily what you need to do, right? Sometimes you can work less and still make more if you can find these passive revenue streams that are available to you. So like as far as your experience goes, like when you have a personal relationship with a physician and you're paying them a monthly fee and you're like, Hey, I'm like really overwhelmed right now. And he's Hey Jared, you know what's going on? Like obviously you're overwhelmed, like you're taking care of your grandparents and you're 25 years old. That's hard. Let's talk about, what we can do for you and maybe there's some community resources or even groups of other people who are in a similar situation as you that you could reach out to that's facilitated by either a health coach or a mental health professional, and you can start to talk to other people in your community and gain information and resources from what worked for them.

Like all of those things are really important part of healthcare that we haven't been exposed to because most of healthcare that we see practiced right now is like not just money and billable base, but a lot of it's also what we call defensive medicine. And so when someone comes into emergency department or an urgent care with chest pain, the last thing that you'd want is to miss a heart attack, even if the person is 25 years old, right?

So you are going to throw everything at them just to make sure that it's definitely not a heart attack. Even if the history doesn't fit and there's a logical other explanation, you just can't miss these things. That will harm the individual and potentially then come back and harm you and your license or through a lawsuit, you're gonna, lose money.

And so I think that like people have been so conditioned to provide this type of medical care out of fear, like we're living in this age of just like mistrust and fear and violence. Now there's so much violence against healthcare providers and were afraid to say anything to somebody. Like for me, the worst thing that ever happened to me when I practice urgent care people didn't like me, they'd write a negative review on Yelp. I'm like, oh, Dr. Busse is Yelp review is like the medical assistants loved reading them like I was blonde at the time, so everyone always just said the blonde doctor or Barbie doctor, they would be like, Barbie doctor wouldn't give me oxycodone for my ear infection.

Like these are hilarious. And like then other people would be like, oh, I only go on days. The blonde doctor is working, so gotta go to the urgent care, call first and ask that the blonde doctor is working. So it was like really funny to read those things, but, now we have, a lot more serious situation.

People are really taking, emotional abuse, mental abuse, like so much further and like they felt so enabled to do that I feel like during this past political cycle especially, and they're like really emboldened and then covid hit and there was all this like mistrust and anger and violence that came along with that because people were scared.

We were living in this fear cycle and we're taking that out on the people who are actually just trying to help and when we associate a negative experience with the face of that negative experience, right? The doctors, the nurses, they're the ones like when you go to a restaurant and you yell at the waitress because your food was bad, like the waitress didn't prepare your food.

I've worked as a waitress. I do not know how many times people blame me cuz they don't like their meal. It's not my fault if you didn't like the meal. Thats the cook's fault or maybe even the restaurant's fault because they don't have good ingredients, but I'm the face, I'm the person that they feel like they can shout the abuse at.

And I just reading an article the day, it was extremely tragic that a surgeon was actually shot in a local hospital when a disgruntled patient came in there and just acted out against the healthcare system, and that's incredibly scary. So not only do we have to be afraid of ourselves and our own mental health and how that will affect our licensing, and physicians committing suicide just to avoid reprimanding and, I'm trying to forget the word right now, when they,

sanction you and your license and they take you out of practice and they send you off to rehab and all of these things that they do to you just because you're struggling with your mental health. And now on top of that, we have to be afraid of what else could happen to us if others come into a healthcare setting

and wanna attack us. Like all of this is a symptom of the disintegration of relationship. Right? If you know your doctor, you know them as a human being and they know you as a human being, these situations are much, much less likely to happen.

[00:35:31] Ty: Yeah, I know of at least two ER docs who have gone through and gotten like high level belts in Juujitsu.

Just because they're confronting physical, altercations in the emergency room where like somebody's too violent for other areas like the mental health hospital, they get sent to the emergency room. It's just the catch all for the community and you're having to be on the receiving end of that.

So yeah, healthcare workers, they're having to catch so much of what's, both like mentally ill and also like health wise illnesses in the community. And it's just such a hard job to be able to manage and structure.

[00:36:04] Brittany: Yeah, and it's interesting because structurally and organizationally there are a lot of things to look at in any corporation employment situation, and I'm actually writing a book for employers right now that looks at that, like how do you structure your corporation, your healthcare center, so that your employees are getting their needs met.

So we look at Maslow's hierarchy of needs like you have first your physiological needs, and then physical safety. It's like immediately after that. And so if you're not even structuring your workplace to take account of people's physical safety. And then you wanna jump all the way up here and say, we need a meditation program for our employees because they're burned out.

Okay, I'm sorry meditation falls up here at self-actualization. Like the guy who actually introduced mindfulness as a concept for the workplace and was like the biggest proponent of mindfulness in the workplace has actually come out like a year ago and started saying no, mindfulness in workplaces is no good.

It doesn't work good because mindfulness actually makes you more aware of everything. The good and the bad. Oh, now employees are actually more aware of all of the stressors in their workplace, and they're more mindful of those things and they're getting overwhelmed, and you didn't actually give them a way or an outlet to manage those stressors.

And organizationally, you are actually responsible, in my opinion, for eliminating threats to safety, whether that's physical safety, mental safety, emotional safety, social safety, spiritual safety, like those are all different aspects of holistic safety paradigm, and you need to look at those areas within your organization and say like, where are there unmet needs for my employees?

Because stress is really a symptom of an unmet or a threatened need. So whenever your needs are either taken away from you, like you're low on food or low on sleep, or there's a threat of that happening, like your family could break up, you're in a stressful social situation where you may not belong in your group anymore, like that's a threat.

So you're gonna perceive all of those things the same way. The brain doesn't recognize the difference between a bear charging you and a physical safety threat, and the fact that you are in a relationship where the conversation's bad, and you think you might be headed towards separation or divorce, right?

Like your brain's processing all of that the same and it's sending it through your body and you're getting flooded with stress hormones and that's what we would call quote unquote burnout, right? Like your cortisol levels and your adrenaline levels have been peaked for so long that you are no longer physically capable of reacting to additional stressors in your environment, like your resiliency is literally tapped out through no fault of your own right?

This is a physiological situation that's occurred. And what happens in that situation is you're either, your body starts attacking itself, so you get autoimmune diseases, cancer, all of those things, or you die. That's where we're headed here. Like burnout is not some innocuous thing that we just wanna talk about all fluffy, like it kills people through suicide, through disease, through cardiovascular disease, through cancer. This is a real problem that we need to talk about because our bodies are not just mind and like body, like mind is actually chemicals within our body coming from a physical thing, which is our brain and all these neurons interconnecting our whole self.

This is a whole entity. It's not some soft science that we're out there trying to better for people so that they can, they live in wellness and feel better. This is real.

[00:39:53] Ty: So I wanted touch a little deeper on that is when the causes of burnout, and I imagine some of them are simple of have increased security to make sure that people's physical safety, that might be a more like direct solution.

I'm curious like simple solutions to it versus like complex causes where you had to go start a new company in order to address some, like deep, adverse incentives that are in place in the healthcare system.

[00:40:23] Brittany: Yeah. I'm curious how you're thinking about that. Yeah. It's a cultural problem, right?

Like the culture of medicine. So Dr. Robert Pearl wrote a book called Uncaring about the culture of medicine, and he's been in the culture a long time and led, Kaiser Permanente Medical Group. So he knows what he is talking about when it comes to culture, but you're looking at a culture of medicine that essentially, like I said earlier in the conversation, like we treat healthcare workers and physicians especially like were expendable.

And that's from the time you're a medical student, like all the way through to becoming an attending. So you're a medical student, you're like, I got in, I'm here. I'm like, yeah you could fail out and we just replaced you with somebody else. And if you don't do well on your board's exams, yeah who cares?

Attrition is a real thing, especially for women and people of color, like there was a study recently published on Stat News and published through JAMA looking at the attrition rates of women and people of color in surgical specialties. And there was a significant difference between those groups and white males.

And so we're really told from an area that like we're just not worthy to be here. And then the same thing comes, you become a resident and you're working, you're supposed to be working 80 hours a week and having 16 hours off between shifts, but that doesn't account for pager time or home call or running back and forth between the hospital in your car.

And all of those other things that you're doing and doing notes in your off time and getting prepped for the next day's surgery and reading about all of the things that could go wrong so that you can explain 'em to the patient. Like all that stuff is work. That is your job and it's happening to you all the time.

And then you come into that surgery you've worked so hard for and the attending surgeon yells at you so hard you cry because they can't see the field because you're the one driving the camera and they're not giving you clear instructions, right? That's. Happens. It happened to me. It happens all the time.

So how can we grow up in a culture that's not caring about us and our wellbeing and even our own humanity and is stripping us of our humanity, and then we're supposed to go out there and nurture the humanity in others, right? That doesn't happen that way. So you really do have to think about, can we just throw the whole thing out, I think eventually we can, right? Just like eventually Netflix demolished Blockbuster. Nobody thought that was gonna happen. We thought we'd be going to the video store every Saturday for the rest of our lives and having family movie night, but then it just went away one day. We still need to have training like physicians do need to see and experience caring for people with the guidance of somebody who's already done that.

But it needs to be done in a kind way. It needs to be compassionate. It needs to preserve our humanity so that we can all move forward together and then continue to provide that compassionate care to patients.

[00:43:28] Ty: I'm just struck by that the approach that you see that's maybe legacy healthcare culture treats healthcare providers as disposable.

And yet there's such a significant labor shortage of nurses, physicians who are willing to work in those conditions. And so the bargaining power is significantly changing and as it's getting to seems like it's getting to a tipping point, like you say. Where that could lead to significant disruption in just the overall healthcare industry.

[00:44:00] Brittany: Yeah. We lost 17% of the physicians from employment in healthcare just in the fourth quarter alone of 2022. Like, where did they go? They just left. They disappeared. And that's where we're coming in as ViTel Health, saying this isn't okay. Like we went into medicine to help people. Those people are still out there and there's more and more of them.

Like the elderly population is growing. People are actually getting chronic diseases at younger and younger ages. So this chronically sick population is growing and expanding. And not only do we have a shortage of the physicians, now we're losing physicians and nurses on top of that. This just can't happen.

We have to come up with a different path for them, right? Like you have this highway of people going through the normal healthcare system and right now you have this little foot path of people who have broken off and are doing their own direct care practices. But I see it like this becoming the major

traffic provider, right? Like we don't necessarily get someone said to me the other day, like, why does car insurance not need reform? Because car insurance works the way it's supposed to. You have a catastrophic event, you can't get your car fixed, it's gonna cost $19,000 to get a new car.

Your car insurance comes in, replaces your car. Yeah. Health insurance, but they don't pay for gas and they don't pay for like maintenance and all of those little things that you need on a regular basis. You pay for that out of pocket when you need it. Health insurance, on the other hand, wants to include everything in one giant bundle, and it just doesn't work well that way.

Like you have exorbitant prices, you have hospitals inflating the cost of care, whereas like a CPT code for an office visit usually is billable, like 90 to $120. My doctor bill for my son's well child check was $450. And I said, why? And they're like facility fees. I'm like, can you take those off cuz I'm paying out of pocket?

They're like no. I'm like, but the CPT code says I should pay $97. They're like, yeah, we know, but it's $450. We'll give you a 25% discount for cash pay. And I was like, Yeah, that. Yeah. So how do you deal with that? When everyone's inflating the prices to make up for the fact that any insurance companies won't pay them what they're charging.

So in order to actually recoup the $90 that they want from the insurance company, they actually need to charge four times as much. It's crazy, but yet everyone's still paying out of pocket because all of us have like high deductible insurance now, or we have really high copays before our insurance kicks in.

And all that stuff is just leading to the consumers having to pay more and more for healthcare. So you see these physicians are really poised at, like you said, this tipping point that if we were just providing our care at a transparent price to patients and to the employers, who are the gatekeepers of healthcare premiums, and we can come in and say Hey, we'll just handle all of your primary care needs for $70 per employee per month, and then this much for their family members.

Hey, sign me up for that. I don't wanna be paying, $500 per employee per month. Why, and then they can go and get catastrophic care at a quarter of the price. It makes sense for everyone. It makes sense for the employers. It makes sense for the patients, it makes sense for the doctors.

The doctors now are doing what they love. They're having that relationship with patients and I feel like when we start to see that shift happen in a larger, more sustainable way, we'll actually start to see better he health outcomes in the United States. I look forward to that.

[00:47:55] Jared: We're getting close on time here and we had so much more that we wanted to talk about.

But something that I was curious about, we're still talking about, physicians going into private practice for themself. And for a lot of folks that are running businesses today, Ty, yourself. Running a business is a time intensive thing.

And so my curiosity lied around. How does a physician save time? From I guess where they were. By starting a private practice? Or do they save time or is it just more that they have more control over their time?

[00:48:29] Brittany: No, that's a good question. Like it can definitely save a lot of time. So that's where the technology aspect comes in.

So Kel Newport has book called Deep Work where he talks about eliminating shallow work so that you can actually focus on the things that you're good at. And for doctors that includes working at the top of their license and actually diagnosing and treating and communicating and having relationship with patients.

We're in this AI era, right? AI is everywhere and it can actually eliminate a lot of shallow work. And we're seeing that now, like whether that's note transcribing, help with a differential diagnosis, helping to tailor and pre-order tests for patients so that they don't just show up with a battery of things that you threw at them, but things that were actually tailored for who they are and what they're experiencing, and then you can make your next recommendations based on that.

I think that we're gonna see more and more people interacting with digital assistants. Swope Health is a group I've been working with and they have an amazing like, Digital AI interviewer who really gets to the core of the information with patients, like all of those things can actually be achieved well in advance of the patient visit.

AI could be utilized to read their record, and then spit out a one page summary for you of what it thinks was important in that record based on the chief complaint. Okay, chest pain. All right. Do. Oh, they've had an EKG done this many times. Oh, they wait. They actually had a stent put in back in 2001, I might not have found that right in the thousands and thousands of pages of the person's health record. And they might have forgotten to tell me, and maybe they stopped taking their Plavix or their aspirin, so their chart's not gonna tell me that information anymore. Like sometimes people, when they're in certain situations, they just don't remember to tell you things.

And having the ability to have technology. Recording what the patient is doing, synthesizing that information into something that's easily readable. And then on the other side, we want high tech, but we also want high touch. So again, that's where the healthcare coaches come in.

They're able to do things like scheduling as well, like some may duties coming up with, getting labs for patients, put back into the system, radiology reports, communicating updates to patients during those health coaching visits. So they're also taking care of that administrative work that the physicians just simply don't need to be involved in.

Like I said, when I was doing these phone intakes, my biggest question was like, there were five questions. I would answer them, yes or no, and then at the end, the computer would spit out a green screen if they could go back to work or a red screen if they couldn't go back to work. I'm like, why is a doctor doing this?

Yeah. Why is a doctor involved in this at all? There's so many things that a doctor doesn't actually need to be involved in so that we could dedicate our time to doing those things that really matter.

[00:51:17] Jared: It's fascinating. So the era that we live in is part of the reason why we're able to have physicians that have a better work-life balance essentially because of the technology that's available.

Yeah, golly we're already basically out here at the end, something that we always like to ask as well is just, especially the work that you're doing in particular I find it to be more unique in the industry. I don't get to hear a lot of people talking about it.

The sort of like whole person care. And so for, the youngsters that are coming up and they want to fall in your footsteps and take the flag behind you and hopefully carry it forward as well.

What are some of those things that you would tell to maybe an earlier stage entrepreneur and just early stage physician that is trying to practice in a way that you have.

[00:52:00] Brittany: I would say like really identifying why you wanna practice medicine. What is it about medicine that gets you excited about it?

Because I think for so often, we were just signed up, like medical school residency, go practice in a healthcare system. Nobody actually cared about what makes us unique as individuals. Like maybe your grandfather died of COPD and lung cancer and you really wanna help people with, lung issues, or you have really bad asthma and you're really passionate about helping people manage their asthma better.

Like you can have that type of tailored practice as an independent physician and you could deep dive into all of the things that really, have positive outcomes for people who have those conditions. Or you can be a generalist, like maybe you just love general practice. You just love to be the person that people come to when they're overwhelmed by the rest of the healthcare system, right?

That's the beauty of a primary care physician who knows you and who cares about you, because then you do go into the hospital and you're scared and you don't speak hospital ease and you have no idea what's going on. And you can actually text or call your primary care doctor and say what they're saying to me, I'm scared, and get their opinion, get their feedback, and have them have that conversation with the treating physician for you on your behalf, just like you would employ any other interpreter in those situations to make you feel more comfortable, like you wouldn't struggle through a conversation with somebody who speaks French. When you don't speak any French, you'd ask for an interpreter. Like why should people struggle in those situations when they're primary care doctors who are passionate about helping them navigate these issues, telling them the reality of what their options are and how those options really apply to them as an individual.

So I think that's probably one of the main things that the people are missing out on when they don't have a primary care doctor. Especially like a young person like yourself. Like you're like, oh, I don't need healthcare. I'll just walk into the urgent care when I don't feel good. But then you end of the situation, you're like whoa, I didn't know that this was gonna happen when I walked in here.

So maybe you have this membership just like you have your Netflix membership. Maybe you forget to use it most of the time. Yeah. Who cares? I'm feeling good. Or I don't have to watch tv. I'm busy. And then when you do wanna use it, it's there for you and that person knows you and they can make recommendations that are specifically personalized to you.

[00:54:27] Jared: Yeah that's the path I'm going down, as you can tell, after this call, I'm signing up. Dr. Busse, thank you for the work that you do. You're incredibly inspiring. I'm really excited for the future of the field that you're in and the future of ViTel Health as well. Yeah, just thank you so much for your time.

We really appreciate it.

[00:54:42] Brittany: Yeah, course. Thanks for having me. It was a really fun conversation and maybe we can get onto those follow up questions some other time. I know you guys have lots of amazing guests, but I'm always happy to share any insights that we have. Absolutely. We'll have to have you back again.

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