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Jim Jordan:
Welcome to the Chalk Talk Jim Podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I’m your host, Jim Jordan.

Jim Jordan:
Our guest today is Dr. Jude Pierre. Dr. Pierre has an incredibly broad background. He’s been a practicing physician, he’s done startups, he’s a managing partner, an executive coach, and also advises many companies. So with that eclectic background, doctor, please tell me a little bit about yourself.

Jude Pierre:
Well, thanks for having me, Jim. So I’m a practicing physician, still practicing after 25 years. I graduated in medical school in 1997, actually did my medical school at Albert Einstein College of Medicine in New York. But prior to that I went to Howard, did my undergrad there in microbiology and virology. I like microbiology and virology and did some research work in Haiti as well. So that’s where I grew up; my parents are Haitian, but you know, they came here, migrated here, and then went back to Haiti to raise us, and it was a great experience. So I always thought I was going to go back to Haiti to help in the healthcare industry, and things got really bad down there, and they, unfortunately, continue to get bad, but that experience allowed me to see things that I would never have seen in the healthcare here. I was able to set up a hospital registry in Haiti, and that’s kind of where some of my computer background comes from, and was able to write a research paper on that and review HIV in Haiti. So, a lot of my background kind of helped me and put me in a situation where I can share some of that knowledge to the physicians and understand different aspects of medicine that some physicians might not understand, given my experience. And so now I’m actually practicing in the Tampa Bay area. My practice is actually in Spring Hill, and I’m part of a large multi-specialty group practice. And a couple of years ago, I moved here from Miami, I did my residency training at Jackson Memorial Hospital, and I found myself really doing managed care and geriatric medicine, and we were doing managed care risk contracts. I don’t know if your audience would understand.

Jim Jordan:
Why don’t you take a second to explain that? That’s great.

Jude Pierre:
Thank you. Yeah, so risk contracts or managed care contracts are basically capitated arrangements where we would have a group of members that we managed in our group, and I started off with a small group and grew to probably over 800, 900 member lives now, and we take care of the whole patient. So from the government giving us moneys, or giving the HMO moneys, and then we partner with an IPA and a physician association provider association that distributes the monies to care for that member. So let’s say they give the HMO, I’m just throwing out a number $1,000 per member per month, we then would take that $1,000, receive a capitated payment for that member, whether it be $40, $50 a month, regardless of whether or not we saw the patients, and then anything extra, anything that was saved in the patient’s care, anything that we did to help prevent certain things from happening, we would get paid cut or a bonus payment for that management of the patient. So we think about that model, and we use the term medical loss ratio. So if we have a patient that we’re managing and we’re spending 80% of the moneys that we are given, then we make 20% profits on that member, and that becomes a bonus and can be fairly lucrative. And so we were doing that in 2002, and during that timeframe from then, then, and now they moved to risk adjustments and risk, Medicare risk adjustment codes, so sicker members got more money, and then they also introduced Haiti’s measures and preventative care measures, all of which are trying to incentivize us to care for the patients, care for members, decreased hospitalization, and decreased use of brand name medications, and really hope to improve the overall healthcare costs. So we were doing that for a while, and we’ve been doing that for a while.

Jim Jordan:
Can I pause for a minute? Because you’re just bringing up something maybe for our audience that’s important, because you just did the evolution of healthcare reform in about 40 seconds, so I just want to point out that you talked about HMOs. And the great thing about HMOs was that you were managing the patient’s journey, but the downside of HMOs is it didn’t have the countermeasures of quality and outcomes. And I think you talk about Haiti’s measures and these other measures. So, as part of healthcare reform, the left and the right came together to have the rewards and the measurements to attempt anyways to balance these things out. Am I correct in that?

Jude Pierre:
Yeah, absolutely, and what also happened during that time, or at least initially prior to all of that, was electronic health records. So that came into play where we were one of the first e-prescribing provider practices in the county, if not the region here. And we actually partnered with Relayhealth and McKesson, and I saw in your bio that you actually worked for McKesson. And so, McKesson had a e-prescribing division called Relayhealth, and at the time, I was setting up an electronic health record for our practice using an open source software, and we needed an e-prescribing service, so we used McKesson’s product to be able to e-prescribe for our patients. And what that did was it allowed us to understand what we were prescribing to our patients, how often we were prescribing it, improved efficiencies in the office. So that was one of the things that I think meaningful use, that started meaningful use, and it turned into MACRA and MIPS and all these acronyms that came about. So the evolution continued with, from electronic health record to then being able to track data from preventive care measures, hemoccult cards, whether or not the patients had certain medications, if they were diabetics, if they had high cholesterol, were they on cholesterol medication, so things started to be able to be tracked, which I think for the most part is a good thing. The problem is the electronic health records were not keeping up with how the workflow of the physicians, and so it increased the burden of documentation to the point where some physicians actually, talking to a physician recently who’s looking to exit, and he admittedly said he didn’t have an EMR, he didn’t have an electronic health record. And I’m like, whoa, you’re trying to exit without an EMR? So how do I gather your data? It was just an interesting thing. So there are practices that have resisted but are still doing well. I guess he’s still practicing, he’s still seeing patients, but it definitely incentivized and pushed us to use electronic health records, but I don’t believe it helped the efficiency in caring for patients. And so that’s some of the things we can talk about that some of the things that I’ve done in the practice that has helped that process and employed certain processes, like having a scribe. I know that people are looking at scribe services and helping document patient visits, and that’s something that I’ve done. Messaging services, patient portals, referral portals, those are some of the things that I’ve created in the EMR or implemented in the electronic health record to help decrease the stress of having to document things.

Jim Jordan:
So that’s interesting, so maybe we should pause and gather perspective on that. So you said something I think that’s really important as the electronic health record doesn’t necessarily work with the physician flow of the work. And I think when you go back in time, and you think about it, it never actually was intended to do that. It was supposed to be a warehouse of information, and it sort of morphed into it. So how have you adjusted to that? You were talking about how you’ve adjusted to that with scribes and stuff. So what are some of the strategies just to share maybe with other physicians on how you’ve been able to, I’m assuming, bring down your administrative time by doing some of these things?

Jude Pierre:
Absolutely. So one of the things that, actually, is three things I would say in the past 10, 15 years that I realized that if I could fix it would help decrease my stress, one was messaging. So if you look at physician surveys, if you look at health grades, you look at some of the online websites, and you look at the negative reviews, I would say 90% of the reviews are related to physician communication or physician office communication. They didn’t call me back with the results. They didn’t listen, doctors didn’t return my phone call. So those are things that I said, how can we improve that so that … get negative reviews, right? So I had my medical assistant review all my messages, and twice a day I have them review my messages, come to me in my office, in the hallway, go over the messages. I respond to those messages. They call the patients, they respond to it, messages are done by the end of the day.

Jim Jordan:
May I point out too that, I just read a study from the malpractice insurance industry that spoke to a lot of the beginning of malpractice suits are basic communication issues. So I think what you’re pointing out is not only the benefit to you administratively, but I just want to point out to the audience that there seems to be some benefit too on malpractice.

Jude Pierre:
Yeah, and so if you have a patient that’s been calling multiple times, what I do also in the practice is we have a phone operator now that will take a message. And initially, we were only taking one message, Oh, the doctor has that message, he’ll get back to you. Well, I want them to take multiple messages because if they’re calling and interrupting the office multiple times, and I think we should have a conversation with the patient and say, hey, I’m not going to return your message in five minutes. I’m not going to return in ten minutes, I will return your message, but don’t keep interrupting the office. Some physicians don’t even know that patients are calling that many times and don’t have that conversation. But I’ll have the conversation with them, and it helps improve the overall workload of the patients, of the staff as well, because if you can stop that from happening multiple, multiple times, then that improves efficiency. So from my standpoint, I used to have to come home and return messages. I used to have a whole 20 messages to return, I’d come home going to have dinner with my wife, I have to return messages, I’ll be back. That’s not acceptable. So if we can stop that, and I tried to stop that with my medical assistant doing that with me, and it’s really transformed the office. The second thing was documentation, and documentation is a bare with managed care. So when you’re looking at risk contracting and managed care and how document risk scores, you have to document all the patient’s chronic conditions, and you have to address them in a certain way in the EMR. And it is very difficult to document 10, 15 problem lists in a 15-minute visit or even a half-hour visit. So a couple of years ago, I hired a scribe that followed me in the room, and that scribe, we went through the notes right after the visits, she would take care of the notes, I would do other things administratively or other things that I had to do during the day. The notes are done by the end of the day, within at least 24 to 48 hours, my notes are pretty much done with a scribe that knows my flow and knows what was said in the office, and that really transformed everything for me because then I didn’t take notes home anymore.

Jim Jordan:
And I imagine when you get out in the hallway that he or she is also, if they’re accustomed to working with you on a daily basis, they might be an additional question they ask you that could fill out some documentation that you thought you answered in your mind, right, during.

Jude Pierre:
Yeah, yeah, yeah. So also, what she was doing is, we talked about the, is the quality measures. Well, she will review in the chart while I’m speaking to the patient, she’ll remind me, hey, she hasn’t had a mammogram yet, she hasn’t had a bone density yet, as opposed to me searching through the EMR looking for these reminders, which is, in my opinion, a waste of time for a physician. That should be done automatically, right? So by the end of the visit, she’s already ordered the mammogram and the bone density of the colonoscopy, the hemoccult cards, and I’m able to have that face-to-face with that patient without having to be distracted by the electronic health record.

Jim Jordan:
And your third, you had a third item?

Jude Pierre:
Yeah, I did. And I’m thinking about it.

Jim Jordan:
…, let me, I had a follow-up question, so I’ll ask you that, and then maybe we’ll get to the third. So when we think about the promise here of artificial intelligence eventually helping out in the office, how do you think that will work with that person following you around? Do you think that that will replace that person, or do you think it will give that person more information so it’s a more fruitful visit?

Jude Pierre:
I think it’s probably going to be a combination of both. I am a highly relational guy. I’ve learned over the years that it’s all about the relationship, whether in business, whether in healthcare, whether in families, whether friends, it’s that face-to-face, eye contact that AI is not going to replace. People may want it to replace it, but it’s not going to replace it. And if it does, then you’re pushing people like me away from the practice of medicine and doing the things that I like to do because it’s going to be non-relational. And so, yes, it could help in predicting who’s going to need a mammogram or bone density and ordering that automatically sending an email to the patient, Hey, you haven’t had your bone density, go ahead and schedule it here, or I can schedule it for you. Those are efficiencies that are great, but not everyone wants a mammogram, not everyone wants a bone density, not everyone needs one. So how many rules are going to be in place? Who is going to program those rules to allow that to happen in an efficient way? I’m not sure.

Jim Jordan:
So you’ve talked about your role in the organization, the group that you’re with, is it independently owned, or is it?

Jude Pierre:
It is independently owned by a physician and his wife, and I was recruited by that organization in 2002 and been with them in the organization for, since that time.

Jim Jordan:
Imagine being independent versus part of a group. There are challenges around getting access to patients, getting access to hospital privileges. Can you share some of the pros and cons of being independent?

Jude Pierre:
I think the biggest pro is independence. Independence to practice and to manage your practice the way you want to manage your practice. Independence to being able to do things that I’m doing now that I would not have done or been able to do if I was working for a large organization. Podcasting, I have my own podcast doing my own thing, and it would be difficult to do that if I was part of a large organization.

Jim Jordan:
So plug that podcast because I listened to it before we were talking earlier, how wonderful it is. So please share with the audience your podcast.

Jude Pierre:
Well, it’s a Practice: Impossible, Practice: Impossible is my podcast where I teach physicians of business of medicine and learning the ins and outs of population management. And what I’ve researched and what we know as physicians is we actually commit suicide 1.8 times more than the general population, and it’s a staggering number. And I’ve known at least several physicians who have done that and died by suicide. And so I understand the stress of medicine, I understand the stress of not doing well in your practice, and many of the stresses that are related to those actions are related to not understanding the business of medicine. So I found myself trying to figure out what’s the one thing I can do to help physicians in that aspect, and that is basically to share my story and to help physicians become aware of their spiritual, mental, and physical health globally. So what are the things that we can do to help them spiritually, mentally, and physically? We need to exercise, we need to, we were talking about a physician who didn’t have, felt like they were up to speed with their talents, and because they were doing more paperwork than operating. Well, we need to take care of ourselves physically. We need to be strong in our physical selves, be able to care for patients in our mental self. What are we doing to de-stress? Is it only one vacation a year? No, it should be several vacations a year, and it should be things that you do regularly to connect with other colleagues or to connect with other people, and so that’s what we teach on the podcast. And second season is going to be about practicing medicine free of corporate medicine. Yeah, so the coaching business is another ladder of what I do, and it’s more so for healthcare leaders that are looking to step up the game. And really it’s around the idea of how do we help physicians understand population management. My, I think my expertise is Medicare Advantage, I’ve been doing it for 20 years, and I can help physicians understand how they can manage their populations and make a lot of money. And I know some people may say, I make a lot of money, that’s not what we’re doing this for. But in order to, I think to have a stress-free practice, you have to make money. You can’t worry about your finances, you can’t worry about, once those things are taken care of on a personal level and a professional level, everything will flow. And so I find myself happy doing what I’m doing, patients tell me that, they tell me I look better, I know I feel better, I’m able to play soccer twice a week at 51 years old. These are things that I can help teach and coach physicians on. So we do have a couple of physicians that we like to coach and help them both personally and professionally. So it’s not just a business coach.

Jim Jordan:
So, is there a different profile between the independent practice physician and the physician that’s working for practice?

Jude Pierre:
There is, and I think I’m still learning, especially in the younger physicians coming out, what they really want. So my idea is to find out what does a physician want these days? Do they want to be able to go home at 5:00 and not have to take calls or not have to go to the hospital and not have to have privileges, or do they want to make tons of money and retire in ten years? So there is a difference, but I think what I’m seeing is a lot of the physicians that are coming out don’t understand managed care, don’t understand geriatrics, don’t understand a lot of the things that I do because they’re not exposed to it, because the hospitals don’t teach managed care. They don’t teach this stuff. As a matter of fact, I think they don’t want to hear how we can save costs by not putting patients in the hospitals, because if you do that, then they lose out on their revenues, and so there’s a fine balance. For me, there will be a 10%, 15%, 20% subset of patients going to the hospital that need hospitalists, that need specialty care. But then the 80%, do you, as a patient who has COPD and exacerbation of their breathing problems have to go to the hospital for treatment? I say no because I’ve learned how to manage that patient in my office with IV infusions, with IV antibiotics, with steroid treatments. But some physicians who don’t understand that the minute they see a patient that’s having difficulty breathing with the low oxygen, go to the hospital, because that’s what they’re trained to do. So my idea is to help these physicians understand that there is a difference. If you want to be in the hospital, you want to take care of the most the sickest patients in the hospital, go ahead and do that, but know that that’s not the only way to care for patients.

Jim Jordan:
Well, it’s been probably two, maybe three times major adjustments coming out of residency.

Jude Pierre:
I thought I was going to stay in Miami. I was in Miami and had a lot of medical school debt. I went to one of the most expensive medical schools in the country, and didn’t really work well. It didn’t work at all during that time, so I was able to, a lot of debt. So I thought of working locally to accelerate my debt payments. So I ended up taking up a job in the ER at one of the local emergency rooms, level two trauma center in Miami, and I realized that I had no control. I was working for a large hospital corporation, I’ll leave it at that, and I remember one time, two years in, the CEO of the hospital came down and said, you don’t close my emergency room to rescue traffic unless you call me at home. Like, I’m the only physician here. We have 24 beds, if there are no beds, I’m closing this emergency room. In my head, I’m like, what can you tell me? If there’s a 400 beds in the hospital, all of them are full, how can you come down to my ER, and it was my ER because I was the only doc there, and tell me what to do? And I realized this guy was serious, and I said, I can’t be here anymore. So that was the first transition, that was when I left the emergency room and put my resume out, and I got recruited by Dr. Singh, my current friend and partner in Spring Hill. And lo and behold, about three months after I moved, that contract was canceled, CEO canceled the contract, so I would have been out of a job and looking for another job. So I finally found the medical practice here and didn’t know anything about managed care. I was creating spreadsheets on how many patients I needed to see to make this amount of money, and I was on a recruitment contract with an income guarantee. So physicians out there that might know what that means, but basically, you’re stuck in the area for three years, and they will pay your salary and forgive that salary as if you stay there for three years. I thought it was a great deal. I ended up blowing through that guarantee, really accelerated my practice growth, ended up purchasing or at least splitting off from my employer, set up my own practice, and opened up another practice in Tampa, which is about 45 minutes away from my original practice. So I then continued to grow, hired several physicians, several nurse practitioners, and then healthcare reform came. And that’s when I said, Whoa, I can’t do this anymore. And I had a couple more children, and life stresses hit, and I ended up moving back and coming back to the same employer that I split from and then started to grow the practice again. So that was the second transition point. Just, I was able to understand what it meant to run a medical practice, but also realize, boy, it is hard. Then, now being part of a large organization with the resources that I had, it was a lot easier. And so that’s what I would recommend to physicians who are looking to go solo, if you think you can go solo, know that it’s a lot of work, and just you have to have the right resources behind you. Then, as you grow your practice, it’s either you sink or swim, right, with the resources that you have. I ended up sinking and going back with Dr. Singh and his practice and growing again. And at the time, I actually went through a life transition, I got divorced, and that was another huge, huge, huge transition point. That was about 8 years ago, 8 or 9 years ago now. So I would say that the stress of everything that was going on, the habits that I had were created in me, really pushed me to the point of no return. My wife said, no, I’m done with this. I’m out of here.

Jim Jordan:
For those in our audience who aren’t physicians, one of the challenges that came with healthcare reform was the need for private practices to invest heavily in electronic health records and various other software systems, and this was really expensive and complex undertaking, and not typically within the skill sets of many of these physicians. And although the HITECH Act offered substantial financial assistance, in some cases up to a quarter of $1 million for larger practices, those costs were still not supported enough, and this became the initiation of the wave of physician consolidation, and hospitals were motivated to participate in this consolidation too, with the introduction of accountable care organizations. These regulations stipulated that these organizations had to be predominantly physician-based, and this meant that if hospitals bought up the physician practices and ensured that physicians owned a majority stake in the company, they could meet these requirements and control that new organization. I recently had a conversation with a gentleman in New Jersey who held a very unique perspective on this trend. He didn’t believe it would continue, which really surprised me. When I asked him why he pointed to the rise of cloud computing-based systems, and this allowed practices to access high-quality assets without the need for extensive infrastructure or highly specialized technology employees. This viewpoint was unexpected. I’m curious, as a physician, if you’ve noticed this trend or you have thoughts on this matter.

Jim Jordan:
When you say quality assets, what do you mean?

Jude Pierre:
The ability to get a cost-effective electronic health record and e-prescribing system, any sort of intelligent-based infrastructure for their physician practice instead of buying it, now, you could actually, in some cloud-based way, rent it for lack of a better word.

Jude Pierre:
Yep, yep, and that’s what we do. We went to a cloud-based system, and it was something that we had, it was homegrown, and that, we kind of merged with another company. And for sure, the cost for that was much less than having your own servers and your own IT staff in the office. And the problem with what I saw was that, I don’t know if the efficiencies in the workflow ever improved to the point where we got rid of the paper. We’re still using tons of paper, and it is faster for me to sign off on a piece of paper than to log into a chart and sign off on different tasks and tabs and …

Jim Jordan:
… Write a note that’s not maybe a little unstructured compared to a pull-down menu, which I think, you know, you can write a note that on a pull-down menu might cover three items that you have to do, but you could write it down. I agree with you.

Jude Pierre:
Yeah, so that’s the inefficiencies of the efficiency side.

Jim Jordan:
Do you think that’s just part of the nature of the development of this software and segment will be in a different place in a decade, or do you just think that it’s, the administration of healthcare not looking out for the workflow of the physician?

Jude Pierre:
I think it’s too data-driven. I think it’s not relational. I think we’re moving so fast and furious to getting the data, getting the data, getting the heat exposures, getting this, getting this. We’re forgetting about the patient and what can we do to touch the patient more. So I’m not sure where it’s going to go in terms of how more efficient it’s going to be, but I can tell you that I still write a lot, and I write notes to every single patient that leaves my office. This is going to sound weird, but that’s what I do. Every patient has a handwritten instruction sheet of 1, 2, 3. This is what I want you to do. How are you going to do that in an EMR?

Jim Jordan:
Not so long ago, I had the privilege of conducting some qualitative interviews with several neurologists, and this was distinct from this podcast, but it provided me with some fascinating insight. What struck me was the enduring relationships that these physicians had with their patients, spanning sometimes 2 to 4 decades, particularly in chronic conditions such as Parkinson’s disease. And these physicians are not just focused on the symptoms presented by their patients, but they’re also very keen observers of the subtler signs that may not be directly related to the patient. For instance, they might notice that the patient’s spouse is appearing fatigued and would begin asking questions about how they’re feeling and maybe even inquiring if they’ve injured their back by lifting their husband, per se, and getting them some assistance. And I firmly believe in the importance of recognizing the softer skills that you mentioned. This brings us to the crux of our discussion, the irreplaceable value of physician spending, quality time with their patients. And in today’s fast-paced world, physicians often find themselves pressed for time. However, it is these insights, these prolonged interactions, that can actually lead to more complete understanding of the patient’s condition and enhancing the quality of the care that’s provided.

Jude Pierre:
That’s key, that is key. And how do you document, how do you assess that in an electronic health record?

Jim Jordan:
Yeah, and so, that fearful of doing it, right? So we’re now starting to add since COVID, a lot of behavioral health information into our electronic health records, mental health. We’re having a stigma on these mental health issues, and so until we sort through it and as a society, we get more comfortable with it, I imagine that some of these things are being kept from physicians. So how do they make decisions, and where does that information go, and people have privacy concerns?

Jude Pierre:
Well, I think what you might be bringing up in my head, I’m thinking about this, and that’s the transition from some practices, and some physicians are moving away from the traditional medicine. And that’s what I’m looking to investigate a little bit more in season two of the podcast, but how can you get away from it? Well, not having to document, not having to submit claims, not having to worry about insurance companies paying you for the diagnosis or the heat measures, all that. If you have a practice where someone is paying you X amount of dollars per month or per year, and they have access to you, they can talk to you about anything, and you don’t have to worry about the government oversight and all that, that is what I think we’re moving towards, especially physicians who understand the population management side.

Jim Jordan:
Health inequity is indeed a significant aspect of this discussion. Let me share a personal story, shed a little more light on this. I’ve been seeing a wellness doctor completely separate from my regular healthcare routine, and a friend of mine was diagnosed with Hashimoto’s, which is a condition I wasn’t familiar with, but I knew they were grappling with some health issues. And so I had a conversation one day where they revealed that they were consuming only about 750 calories a day, and they were still gaining weight, and they complained about tingling in their fingers, which actually led them to fear that they might even have ALS, and eventually, they consulted an endocrinologist and discovered the real issue, and, however, they struggled to find a consistent treatment. And for those in the audience who may not know, Hashimoto’s is a condition where your thyroid gradually deteriorates, and this process is unique for each individual, making it easier for doctors to actually treat someone who has completely lost their thyroid because you can do a weight-to-drug ratio. And the challenge here is twofold: firstly, getting an appointment with an endocrinologist is tough, primarily because they’re so occupied with diabetic patients, and secondly, these specialists were more focused on T3 levels rather than T4. And in a surprising turn of events, when I was talking to my wellness doctor, he actually had his spouse having Hashimoto’s and he said, you know, it’s important to balance the T3 and the T4. Long story short, my friend saw this doctor, had dramatic improvements within months actually, and they’ve remained healthy now for decades, it’s truly amazing. However, this is not the conventional medical system operates, which leads us to the health equity issue. Not everyone can afford a wellness doctor, fortunately, my friend could. Many might view this as an example of concierge medicine exclusive to the wealthy or those with substantial resources. But consider this, my friend has maintained control over their condition for decades, avoiding so many other potential costly health complications. And this is an example of the health system isn’t paying for any of those additional issues right now, it’s a big cost savings. And it raises the question, are we being penny-wise and pound-foolish? When do you think we’ll gain the wisdom to see this broader perspective, or do you believe that we’ll, what do you believe we will even attain this within our lifetime?

Jude Pierre:
When we look at it the right way, when we look at medical education the right way, when we understand that the reason why we rank 46th in the world in terms of life expectancy is because of the things that we’re doing to our population. That’s how I feel, and others might not feel the same way, but if we continue to eat the junk food that we’re eating and wonder why we’re getting obese and diabetes and all these other problems, whereas countries in the blue zones or Okinawa, Japan, …, Italy, they eat healthy, they exercise, they don’t eat processed foods. Those are the things that we have to start to make people aware of. Because even when I say that number to most, they’re like, Really? We rank 46th? Yeah, and we spend the most money than any other country in the world on healthcare.

Jim Jordan:
We also are, in any given year in terms of what is perceived as quality, we’re what, 13th to 11th, and our physician per capita is number 13 worldwide. So you’re right, it’s scary. So what sort of places do you go to keep current on all these rapid changes that are happening? What are the places that you read and maybe share our audience, places where they can keep current?

Jude Pierre:
So I’ve been recently looking at more, I don’t want to say alternative, but more, more physicians that are looking at the cellular level of things, the cellular functions of your, I had it on here, the Krebs cycle. The Krebs cycle is something that we study in microbiology and biology in general, and that’s, the cell cycle is a cycle of a cell that allows us to function. Every cell goes through this Krebs cycle. They have the NAD, NADH, hydrogen molecules, water molecules, all these cellular things that are happening on a daily basis. And I find myself gravitating to physicians who are looking at things on a cellular basis and then taking it on a macro level in terms of what nutrients we can give our bodies to help those cellular processes. Mindy Peltz is one of them. Mindy Peltz is a PhD, I think, and she has a podcast and a course that my wife actually started to take, and I started to listen to her podcast, and she talks about fasting, she talks about time-restricted eating. And she had an interview with Dr. Mercola, who’s also a prolific naturalist who looks at a lot of things on a cellular level. Some people may not agree with the things that he’s saying, but when you look at the things that he’s researching and studying, they make sense. Vitamin D is one of them. I’ve been telling patients for the past three years since COVID that vitamin D is important. Vitamin D is important, and now they’re coming out with studies. I mean, this is very important in preventing COVID. So I try to listen to some of these naturalists, some of these docs who are actually doing things that are different, and then taking their research and researching it on my own, finding the sources that they’re going to and researching those sources. The Blue Zones is one of them, Dan Buettner, he’s done a lot of research on longevity, and the foods that people eat, in the blue zones, they’re the areas in the world that, where they have the highest concentration of centenarians. And there are five countries in the world and they do nine things, or I think seven things, that are similar in each of those zones. So you can share those notes in the notes.

Jim Jordan:
You do that off the top of your head, you know?

Jude Pierre:
So the five zones are Okinawa, Japan, Sardinia, Italy. … in Greece, Nicoya Peninsula in Costa Rica and Seventh Day Adventist community in Loma Linda, California. That was the only one in the United States.

Jim Jordan:
And what are the things that they do that are in common?

Jude Pierre:
They live socially, grandparents live with their grandchildren. Many of those areas, they eat rice and beans. They don’t eat processed foods, processed meats. So it’s eating, spirituality, they have a spiritual rituals that they practice. They may not be all Christians or Muslims, but they have some type of spiritual ritual that they go through.

Jim Jordan:
So changing subjects. What’s the biggest lesson you’ve learned on your journey with healthcare?

Jude Pierre:
I think the biggest thing that I’ve learned is, and again, I’m probably going to get in trouble for saying this, but doctors are lazy. Doctors, in general, are lazy and learning new things or learning things that they should have learned in medical school. And so when they come into something that’s new, they’re really stuck in their ways. And I had to learn this myself, and a lot of my colleagues, or one of my colleagues in particular, Dr. Maria, used to tell me about the things that I was eating, that she changed her diet and did things differently, and she’s always been a beacon of health, and I was resistant to that change. I didn’t research the things that she was researching, and I’m now realizing that a lot of things that she was saying were true. So that’s because I have decided to do the research and do the work myself. So I invite physicians to not be lazy and to take some time to learn different things that they may not have been taught in medical school that they could experience themselves that might transform the way they’re caring for themselves. And then, once they see that change in them, then they can give it to their patients, because that’s what it’s all about. It’s about transforming the lives of the patients that we care for. And for me, it’s been fun taking patients off of medications. I have a patient recently I took off of diabetes medicines, and I said, We’re going to continue. We’re going to start dialing down your insulin as you lose weight, and it wasn’t a long visit. It didn’t take me half an hour. But the work I’ve done over the past year is the courses I’ve taken, the forms I’ve done, I’m able to coach patients on how to transform the way they do things, and it’s showing in their lives.

Jim Jordan:
So when you look at the next decade, what do you see as the biggest opportunity for growth or the biggest threat to the healthcare industry?

Jude Pierre:
I think the biggest opportunity is going to be education, education on the business of medicine, population management, and the biggest, that’s opportunity. The biggest threat, I think, is going to be physicians not understanding that opportunity and continuing to do the same things that they’re doing, not collaborating with other colleagues, not learning new things like you’re speaking of, and feeling trapped. One of the things I think hinders physicians growth is the fact that they feel like or they think that they need to make as much money as they’re making. That surgeon needs to make a half-a-million or $1 million a year. If we were to teach our physicians that they don’t have to make as much and they can retire early and live a life where they can see as many patients as they want to see, then I think their stress level goes down, and their patient care goes up, and their satisfaction goes up. But we live in a world now where we’re saying, go, go, go, go, go see as many patients as you can, we need to do this, but that’s not serving the physician, that’s serving whoever is telling the physician to do that. So I tell a friend of mine, my best friend, it’s like a brother to me, he owns an Amazon business, a driver delivery, the Last Mile. I can’t remember the name of the structure that they have, but they basically deliver packages to your house, and every couple of weeks Amazon asks them, We need you to, can you take more routes? Can you take more routes? Can you take more routes? Take more routes, you make more money. He, I think, has 30 trucks. 40 trucks. I said, Phil, do you need it, or do you want it? Yeah, you can take more routes, but then that means you need more people, there’s more accidents that could happen, there’s more things that can happen. So do you need it or do you want it? So, as a physician, do we need to see 30 patients a day to make that half million dollars, or do we want it? So we have to ask ourselves that because if you look at the top three professions that are everyday millionaires, as per some research that I did with Dave Ramsey, it’s the accountant, the teacher, and the engineer. So those are the top three everyday millionaires. It’s not the doctor, not the lawyer. Lawyers think third or fourth, so seventh or eighth. So if you look at a physician and his income potential and what he can do, he can retire in 10 to 15 years. If he doesn’t have the expenses that he has, he learned to live within his means and does what he needs to do to take care of himself personally, which will then translate to taking care of his family, and then it’s taking care of his patients in a powerful way. You know your audience and, you’re relatively new to the podcast world or?

Jim Jordan:
Yes.

Jude Pierre:
So what do you want to do, or what do you envision for your audience in terms of the education or the information you’re giving them?

Jim Jordan:
Thank you for posing the question. My vision for this podcast and its audience is deeply rooted in my personal journey, particularly in experience that started in 2005. I initiated a dialogue with Carnegie Mellon University while predominantly working on the manufacturing side of the healthcare industry, handling pharmaceuticals, devices, diagnostics, things like that. And there’s a saying the tail that wags the dog, which suggests that the minor aspect of the system can control the major one, and that is historically how things had worked. And I was anticipating some significant changes. I foresaw healthcare becoming an increasingly critical concern, and the integration of various components would come together somehow in the future, this is before healthcare reform, and it led to my engagement with Carnegie Mellon University. And before I knew it, I was teaching a course called Health Systems, and this course was designed for students pursuing degrees in biotechnology management and healthcare policy management, and the aim was to help them understand the diverse business models within the broader healthcare system, whether it be insurance or medical devices, hospitals, private practices, retail. And so, I established a website called HealthcareData.Center to hold this information. It’s out there today, it’s public, it’s a nonprofit activity that I pursue, and the objective was to provide a comprehensive understanding of the business models associated with the entire healthcare system. And so during my academic journey, I started to interact with various individuals, and I realized very few beyond the academics, explored all the business models and aspects of how the healthcare system operated, and came together as a whole. And this realization forms the basis of this podcast goal, to help people understand these intricate aspects. And our guests shed lights on the unseen elements of the healthcare system and provide thought-provoking conversations, and we aim to assist the incredible leaders we have in our healthcare system, helping them to enhance the business of healthcare and serve patients in the most effective, compassionate way possible. Is there anything else you’d like to share with our audience?

Jude Pierre:
Thank you. Thank you for having me.

Jim Jordan:
Thanks for tuning in to the Chalk Talk Jim Podcast. For resources, show notes, and ways to get in touch, visit us at ChalkTalkJim.com.

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