Why Direct Primary Care Is Better For Your Health with Dr. Rob Lamberts, Owner, Dr. Rob Lamberts, LLC

Healthcare Podcast

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Why Direct Primary Care Is Better For Your Health with Dr. Rob Lamberts, Owner, Dr. Rob Lamberts, LLC

: [00:00:01] Welcome to the outcomes rocket podcast where we inspire collaborative thinking, improved outcomes, and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners, welcome back once again to the outcomes rocket where we chat what today's most inspiring and successful healthcare leaders if you like what you listen to on the show. Please make sure that you go to outcomesrocket.com/review so let us know and give us ratings and reviews on iTunes, apple podcasts because that's what truly informs me of what's going on with the show and how it's resonating with you. So without further ado, I want to introduce our out standing guest. His name is Dr. Rob Lamberts also known as Dr. Rob and show Dr. Rob spin in the field for quite some time now owns Dr. Rob Lamberts practice and is also the author and writer at more-distractible.org. He is super funny but also touches on all of the things that are important in medicine. And I want to welcome you to the show Dr. Rob.

Rob Lamberts: [00:01:19] Nice to be here. I appreciate you inviting me to talk and putting all that pressure on me to be funny.

Saul Marquez: [00:01:27] Well don't worry about it. I think you just got to be yourself. And it just naturally comes out.

Saul Marquez: [00:01:32] So no pressure. But what I wanted to do. Dr. Rob is ask you why did you decide to get into medicine to begin with.Oh

Rob Lamberts: [00:01:39] Oh, I actually when I started college it started as a voice major vocal performance major way back when and it was the main reason I chose that is because my dad wanted me to go into science and I just was like I'm not going to do what you told me to do. He's a physicist. And so but then I realized that I kind of had this vision of becoming this middle school music teacher. And you know if there's a punishment from an afterlife you either become a slug or you become a middle school music teacher at least and I shouldn't say that.

Rob Lamberts: [00:02:13] Maybe some of those among your listeners and they are wonderful people but to me that was not very nice to my middle school music teachers.

Rob Lamberts: [00:02:20] So anyway.

Saul Marquez: [00:02:21] Yeah it's a pretty rough time right.

Rob Lamberts: [00:02:22] Yeah yeah.

Rob Lamberts: [00:02:24] I have to switch to science chemistry and honestly didn't even think about medicine for a while because I hated the premeds that I had to deal with in my call but they were all just kind of jerky and brain hungry and whatever and they just didn't seem like my kind of people and so I did chemistry and I did some philosophy.

Rob Lamberts: [00:02:44] And I did a lot of this and that but kind of ended up coming to the point where I thought you know I like to be around people I like science. What combines those things and medicine became that thing that just kind of stuck in my brain as being OK well let's say the AMT. Let's see how I do and I did well and that was just like OK well but even even in medical school when I was going from my second to third year the first two years she was doing academics in the third year is all going on though the clinical stuff. And I just remember being terrified that I would either hate it or I would kill a bunch of people or whatever. And you know much to my relief it's kind of exactly what I want to be doing with my life.

Saul Marquez: [00:03:28] That's really awesome and congratulations on sort of following that path based off of the things that you were looking for what you were passionate about and the one thing that I find particularly interesting about your story Dr. Rob is what led you to what you're doing today. It's a nontraditional approach and for the listeners that don't know about Dr. Rob he is solo practice. But there's a story behind that. And so I was hoping then you could share that with the listeners.

Rob Lamberts: [00:03:53] Got it. Well about five years ago I like to say that my sobriety date was September. My five year sobriety date was September 20th of this year. It was the last time I took money from an insurance company or at least billed that to the insurance company. And in that time I have been in a practice I was a senior partner actually in a practice for 18 years. I do board certified internal medicine and pediatrics so I just do primary care medicine and I love primary care medicine. But I felt like I was drowning. I felt like every day I was leaving a little less of myself in the whole equation. And I was leaving a bunch of care on the table and that that feel like I was giving good care to anybody and that kind of drove me to really rethink what I was doing it or try to push to allow my practice to still give high quality care despite a system that was doing the opposite that was wanting me to see as many people as I possibly could that was wanting me to focus a lot more on documentation than on actual care. That's stuff that any primary care doctor and a doctor pretty much knows what it's like. It's this hamster wheel that keeps going faster and it's exhausting. I was with a couple of other docs and they had a whole different way they wanted to move.

Rob Lamberts: [00:05:13] It seemed to me that they wanted to move more in the business side and run that business. Efficiently and I just like taking care of people and I don't want to make it sound like that. I was the Crusader and the good person then there the the sinister evil folks who are always fighting against. I was an idiot in my own ways but ended up basically getting a divorce with my partners in that circumstance which is very much like that and then I had to kind of say OK what am I going to do. I don't want to go into insurance based practice again. It's going to be even worse if I do it solo. And I'm I'm too much of a headstrong alpha I guess to work for another practice and be a junior faute person. I had been senior for a long time and working at the V.A. worked in that for a hospital again seemed like I was going to the dark side. So I ended up talking to David Chase. Dave had read some of the stuff I wrote and Dave's is.

Saul Marquez: [00:06:05] A great guy. Yeah I'd call him had him on a show recently actually.

Rob Lamberts: [00:06:08] Yeah I called Dave my Yoda because he doesn't talk that way he doesn't draw

Rob Lamberts: [00:06:15] Very we'll do that.

Rob Lamberts: [00:06:18] He has though he is very very wise and he actually we were talking I forget exactly what started this talk and I think some of my stuff I'd done on the healthcare blog some of his stuff is gone. Health Care Blog. He just wanted to connect up because he resonated with some of the stuff that I was writing. And we talked and he told me about direct primary care which is have a different take on the whole concierge type of an idea it's still a monthly membership fee but the concierge practices. I like the idea because it was so high price that it would basically price all my patients out.

Rob Lamberts: [00:06:52] So what could I do. And this was a much lower price model that focused on efficiency that focus on using communication tools. Once they started talking about it it just clicked with me it was like This is what I need to be doing. And you know there weren't many practices out there that were doing it.

Rob Lamberts: [00:07:09] There were very few actually. I think it was under 100 when I first started five years ago. Now there's almost a thousand and the term direct primary care yet term direct primary care is what you use and the big features of this type of practice are that first off that you you don't accept any money from insurance at all. You just dump insurance. In fact most of the docs have opted out of Medicare as well which was scary as all get out because there's a two year opt out period that you can't go back. And so if I had wanted to do something I couldn't.

Saul Marquez: [00:07:43] What about just out of curiosity these more consumer plans like you got bright health now an Oscar.

Saul Marquez: [00:07:50] Is it still the same philosophy. Not taking money from them either.

Rob Lamberts: [00:07:53] One of the keys for me is that I work for my customer my patient is my customer. And whoever pays you is the one you work for. One of my favorite ways of looking at this is if you look at the business of normal health care is the normal business of health care is who do I work for as a doctor who is the customer and who is the consumer. Well the reality is in that circumstance who's paying the doctors wants insurance companies OK where are they paying them for health care. No actually you get paid entirely based on your coding. So it's really the ICD CPD codes you submit those. Ian Nemko right. Right. And now there's some data you could throw into that. And OK so the product codes the customer is the insurance company. And so the good customer service is to treat the insurance companies well get their data exactly like they want to documentation simply supports the billing makes. So you don't get in trouble. And so what are patients. And the answer is Well patients are kind of raw material for codes and so they are like cows that you can milk the codes out of. You know they come in and milk from you know and then another cow comes in your milk some more codes and can I get it. And it's a crass idea but it resonates so well because that's what patients feel like when they go to a doctor's office they feel like not at all sure rushing stuff and you're doing stuff. So this idea of taking money from a third party payer the minute you get money from even some of these more quote unquote moral third party payers. To me the minute I do that I let them into the exam room with me. I let them into the exam room to say so let me look at your chart to make sure you're doing everything that you should be doing. And I just want to give them flipping the bird and say Get away from me and my patient.

Rob Lamberts: [00:09:46] I love my relationship with them and the other thing is that it makes it so I'm unequivocally on their side. I am unequivocally that they don't question that I'm somehow their notes are going to go to the insurance company which they can't because there isn't an insurance company involved that you know all of that stuff they know that I am working for them and I'm going to do the right thing for them.

Saul Marquez: [00:10:11] So now that's really great. And appreciate you sharing that because I know that there's you know listeners you're out there and you're feeling what you're feeling today.

Saul Marquez: [00:10:22] You're a physician and the pressure and the charting and everything that you have to do and Dr. Lamberts here was going through what you went through and has decided an alternative method and he feels obviously that this is benefiting his patients and so it's a way of doing things that is more personal and detached from being a puppet of the system. I think it's really cool and very admirable. You're weaning yourself or I forget what you said but you stopped your sobriety. Yeah your sobriety. So congrats on five years of sobriety from the system. So what do you think a hot topic that should be in every medical news agenda today. And how are you and your organization dealing with it.

Rob Lamberts: [00:11:02] Ok. For me one of the problems that we've got a health care reform stuff that's out there totally misses the point at least if you look at the Affordable Care Act or if you look at stuff before that the Hi-Tech act or some of the reasons that the Congress is trying to get through all of this stuff is not addressing the main problem which is the cost of care. How do we decrease the cost of care because if you're not I mean the reason that health care became inaccessible is because we kept spending money and the insurance companies keep jacking up costs jacking up costs and that is if you're rigid Dave Chase's book it just makes you want to take a shower after reading chapters about how insurance companies bent you know they'll let fraud go through so that they can chase it down and earn money for getting fraud. It just eliminating fraud. It's just oh it's just so horrible. And you see all of these ways in which nobody is incentivized to actually save money. And I really believe that the only way you can do that is to flip the equation and have somebody who benefits from actually having people who are well people who are not utilizing the system and people who were avoiding doing extra procedures. And you know the problem is that in the typical practice doctors are paid most by having sick people sick the better doing lots of procedures on spending as little time with them as we possibly can. That's how I earned the best money. And that's one of the core conflicts in my. The reason I broke up with my partners is because they ended up saying kind of gave up and wanted to embrace it and I said Hell no I don't.

Rob Lamberts: [00:12:46] I don't want to embrace that because it goes against their side of what I'm doing. And so I think that this idea of saying OK so how are we going to have somebody who's playing the defense whether it is a universal healthcare plan for everybody. OK so how do you control costs aside from passive aggressively saying OK let's look you up and if you're spending too much we're going to make you not get as much money or whatever. That's part of big problem right now. All of the myths and Macra stuff. I mean it's all basically doctors all feel like that is big brother looking over your shoulder looking for a way to take more money away from you when it's not our fault when the system is taking all the money it's the health care administrators itself that's the plans it's all. It's the drug companies it's the pharmacies all of these people are stealing money and yet we're the ones who were responsible for controlling costs. Are you kidding me. And yet I can control costs when I'm working for my patients in a very different way because if I keep my patients well in the office then I can grow my panel I'm up to about 700 patients now and continuing to grow that reasonable pace as much as I really I want to I can dial it up if I want to and lets me pay attention to them and if if I take good care of them and keep them happy they keep paying monthly payments and I get more patients.

Saul Marquez: [00:14:10] That's really great.

Saul Marquez: [00:14:11] And you bring up a phenomenal point that oftentimes gets ignored.

Saul Marquez: [00:14:16] And with the reform that happened with ACA and even when Romney launched it over in Massachusetts right this cult thing about runaway costs still is not being addressed. And you're calling it robbery on behalf of all these other people the system administrators and plans. And ultimately how do we incentivize right because ultimately things get followed when there's incentives in place. And how do we incentivize making people healthy.

Rob Lamberts: [00:14:45] Well mean the answer is put the patient at the center because as a patient we're all patient everybody here is a patient and they answer the question What do you want. Do you want to spend more on your health care or less. I want to spend less. Do you want to be more sick or less sick. I want to be less sick. Do you want to go to the hospital and get unnecessary procedures. I mean all of the things you want to pay more for your drugs or less for your drugs. Meet the one person in the whole equation who has the most incentive for saving money for running the system efficiently is the person who the system is created for in the first place. And yet it's the person who's become that cow that you milk you know milk codes out of in the regular system. And the one that feels the most disempowered you know it's this whole idea of patient centered healthcare. It's almost like Are you kidding. Patient centered health care. That's like saying number centered mathematics it redone what is should be redundant but it isn't. It's become it's entirely the way that medical records are they patient centered. No they're billing records. They are pure and simple billing records that have medical stuff in there. But there's so much what I call computer vomit of all this junk that's put in the notes to justify your billing. Everything about health care has gone away from patient centered on this and I think somehow and that's that's why I see the success of what I do as being I am very much outcomes based because the person who cares the most about the outcome is the patient.

Rob Lamberts: [00:16:14] They don't want the outcome to be bad. They want me to know that I'm on their side that I'm willing to educate them that I'm willing to do the right thing that I'm willing to answer their questions without forcing them to come to the office to do things in a way that makes sense.

Saul Marquez: [00:16:30] Now that's really interesting Dr. Rob and can you give the listeners any example of what you're doing with your practice has improved outcomes.

Rob Lamberts: [00:16:39] Do I have statistics. The answer is no statistics but boy do I have a ton of vignettes. I have a ton of situations where a person I had a guy in my practice my regular practice for years. And then he switched over. And this is fairly early on and I had seen somebody else recently with the head neck cancer just had a kind of a hard lymph node and we ended up sending him in and he got treated for a head neck cancer and this other guy comes in and says You know I got this lump on my neck and you know that ring the bells in my hand and said Just come on in. And you know I could do that right away. He came straight in and I looked at him and first it was like it's a little early but let's do this but my you know I was in that paranoid mode for sure. It was funny in that circumstance and say you're paying a little bit more attention to it. Turns out that he did have a head neck cancer as well. And he came to me later. And then he sends me a text message which they're allowed to do in my practice and he sends me a text message and says Yeah my wife is thinking I should do alternative medicine stuff for this. And I said Whoa whoa whoa whoa wait a minute. That's why Steve Jobs is dead. He had a curable cancer that he chose to use alternative medicine on in this circumstance and for this type of a problem. I'm not I'm not totally close minded alternative medicine but you know when it comes to a head and neck cancer which are bad enough in traditional medicine to wait six months a year before you start treating it is is asking for a huge trouble. And so we talk about that. And he ended up getting that taken care of and he's doing fine. But he came back to me afterwards and said I wouldn't come in if it was your own practice. I would have waited a lot longer. But you're available. I've had tons of pizza.

Saul Marquez: [00:18:21] Trust be the word additional trust is created additional trust.

Rob Lamberts: [00:18:25] But the truth is what do you know I was thinking about what is my minimum viable product because I talked I've read the whole Lean Startup stuff and the idea of it because I'm basically a startup. I was a startup at that point in time and there really wasn't a model in which I was modeling myself after I was really trying to build it from scratch and figure it out.

Rob Lamberts: [00:18:46] I talked to a few folks but I made it up and the big product that I am selling the thing that people would pay were really willing to pay for is access they want access to me they want access to my nurses they want access and that doesn't mean I have to answer my pages immediately or whatever that just means that they don't feel like people come to the office to the regular doctor's office. They don't feel like they have the doctors attention when they call the office. They go through this tree of people who are trying to play defense to keep patients the doctor away from these patients that are hungrily trying to get free care out of the doctor. That's the attitude of the office staff that most doctors offices. Not all guys sure. Here's the text message thing that you can get a hold of them right away. I had another guy who sent me a text message on a Sunday night and saying I've right lower quadrant pain. It's like oh hey appendicitis there you go. He was there and I said OK so couple of questions first is are you eating.

Rob Lamberts: [00:19:45] Yeah I'm eating fine I'm I'm doing no problem. Are you having problems. Yeah I have. BOB MOON sexually doing fine. I said OK. It's really unlikely to be appendicitis if you're eating well if you are about moments you know people have an illy. Isn't that circumstance and it's much worse it's still possible but in on a Sunday night a guy this guy who had no insurance could I felt comfortable holding him off because I knew him too. I mean that's the other thing is. Not only do they have access to me but they know that I know them and I'm willing to question he came in. He didn't have appendicitis. He had some other stuff going on or whatever but I prevented ER visit and I see that all the time whether it's even just doing a text message within the ER and say show the doctor this and I give them you know whether it's their labs or whether it's they're just saying this is what I did on you before.

Rob Lamberts: [00:20:38] And it just gives that extra level of communication and continuity in my patients feel like I can cut the cost of care improve the quality of care I can do all of those types of things.

Rob Lamberts: [00:20:48] And yeah the improved outcome is the fact that people walk out of my office feeling like they're getting kicked err they don't feel like they're getting the run around which most people feel like.

Saul Marquez: [00:21:00] Obviously you're passionate about it. And for me you know I'm just thinking of myself as a patient too. I definitely would like that access and being able to feel that additional trust. So I think it's really great that you're doing this. And what would you share with other physicians out there that are maybe the fans and maybe fearful of leaving the system. What would you share with them as far as advice and encouragement.

Rob Lamberts: [00:21:26] Well first off my story I started when I started I didn't have a lot of help. In fact there weren't. I didn't even have a good medical record system. You know the medical records systems out there are totally garbage. They're based on billing and they've gotten farther and farther away from good patient care. Question is OK so what would a medical records system look like if the only reason for it was to give patients care which is again it's just like think patient centered medicine it's like patient centered medical record it's almost seems like it should be obvious but it is completely the opposite. And I couldn't find any that I ended up building my own for a while on a database. I am kind of a geek in that regard and ended up finally finding one. But it took several years while I was practicing before those products started catching up with the fact that direct primary care was becoming a thing and there was a company doing billing software that I hooked up with that I kind of helped them get started actually. And there's a bunch of things that have now come along. Communication software other tools that make it much easier. So first off I would say my story is a lot harder for me because I was just kind of trekking across.

Saul Marquez: [00:22:35] You're pioneering it right.

: [00:22:36] A hundred now there's a thousand.

Rob Lamberts: [00:22:38] Now there's a thousand folks and everybody loves what they do and wants to help out. So there's a lot of resources out there a lot of you know whether it's there's a Facebook group on it. There's a company called hint as community about bore or family practice group has a community message board where people communicate and just give ideas. I had a you know just last night got a message from somebody from Chattanooga said while we're in town do you think we could stop by and just see what your practice is like us said sure come on in and you know seeing it in real life is the best thing. But that's the thing it's not smoke and mirrors. I mean I've really done it five years and despite being a doctor I haven't driven it into the ground. I like to say this is so easy even couples do it because we're not. Actually it was the fact that I admitted that I suck at business that I'm not I I'm allergic to decimal points that all of that little accounting stuff just you know makes me have high and I made it so I dumbed down as simple as I possibly can. I don't want copays because that's stupid because that's just one more thing I have to collect on. I don't want other things to complicate. I want people paying six months at a time or a year at a time because what happens if they leave or if I get in a car accident then I've got to figure that out.

Rob Lamberts: [00:23:52] But just do monthly payments. That's as simple as I possibly can. And the cool thing is getting back to the whole copay thing. The cool thing is that if my business model is simply there is one thing that I want in that is more patients paying on a monthly basis then all my motivation is turn to making sure people have such value that they can't afford to leave. So I just started dispensing medications where I'm able to give yeah your blood pressure pill costs a dollar for six months or whatever you know you can give medicine really cheap because the wholesale prices are really cheap or labs are really cheap and I've had people say well why don't you know a few of the cost of those you could earn a little extra like I could earn an extra fifty dollars a month by increasing my fees or a hundred dollars a month or maybe even 200 dollars a month. But that is now because I charge between like you know on average 40 to 50 dollars a month for my monthly fee. That's like four extra patients. That's it. And if I can keep people from leave for extra people from leaving because I have such frickin low prices for medicine because I'm so available because I do things that are patient centered then they can't afford to leave. And people are constantly saying boy you've spoiled me boy you've spoiled this business model. A rate.

Saul Marquez: [00:25:11] I was wondering to Dr. Rob like what does the cost per month and between 50 60 bucks.

Rob Lamberts: [00:25:16] Yeah I actually or it depends on it depends on age.

Rob Lamberts: [00:25:20] And one of the things that I've kind of been an evangelist for within the community because I think there's a lot of folks who do now 50 as your baseline. And 75 maybe if you're older and you know even a little higher but it's under 100. In general for that the problem is that if you're dealing with the population who's 50 and up yeah they see the value in it in general. I say that as a 50 person myself that you know we think about her health a little bit more and we're willing to invest a little bit more in it. But if somebody is in their 20s.

Rob Lamberts: [00:25:53] I mean 50 bucks a month that's a lot. And they're not going to utilize you. And so if you charge those folks 50 bucks a month. The only folks in their 20s who are going to pay it are going to be exactly the wrong patients exactly the wrong customers. Once you want to utilize you as much as possible to quote unquote get their myse worth. And I have kept that price down to 30 dollars in a 30 dollar month range which seems to be palatable in that range and I've even you know I was having trouble attracting pediatrics because there's a whole immunization fiasco with when you don't have insurance you're dealing with. But I've decided that I'm probably going to lower that cost to ten dollars a month than maybe 20 for the other just so that I can get more kids. And honestly kids visits are so easy and they don't have these long big chronic problems that you have to deal with. And again part of it's just I like to mess around with a little kid and that's I have about 10 percent pediatrics malpractice I had about you know 50 50.

Saul Marquez: [00:26:54] And that's one of your strengths right.

Rob Lamberts: [00:26:56] Yeah. Yeah it is so.

Saul Marquez: [00:26:57] And so you're lowering the cost because you feel like the higher cost gets you the quote unquote wrong patient. Right.

Rob Lamberts: [00:27:05] Right. The difference. Yeah. You don't want the folks who are going to call you all the time and need all this help all the time. What you want are the folks who are willing to you know if you have 100 people who are writing you checks every month and don't really care. They don't really think of it. Well. You've got to be careful not to select out the very patients that you want.

Saul Marquez: [00:27:26] That's cool. And we're getting close to the end here. I wish we had extra time but what we'll do. Because this is so interesting and I think the audience will find it interesting too.

Saul Marquez: [00:27:34] Dr. Lamberts I think we definitely need to do a part two and direct primary care maybe within the next couple of months. If you're up for it. Absolutely. But I was curious you know so you're doing all these things that are you know more modernized. And I heard you say check like the people still pay you in checks or do you take pay pal and credit cards like how does that part of your practice work.

Rob Lamberts: [00:27:55] Yeah that's an anachronism. Well people some people do pay checks on people paying cash. You have done some bartering. I haven't gotten I have had people bring me eggs and other produce but that's not been a payment thing.

Rob Lamberts: [00:28:09] But in general I'll do any way that is easy for people I prefer doing the monthly draft and I prefer it from the bank because I get charged less.

Rob Lamberts: [00:28:18] But you know if people want to do it on their credit card if people want to write a check that's fine. I don't really care.

Saul Marquez: [00:28:25] I was just curious you know I was wondering what your thought process was.

Rob Lamberts: [00:28:29] That's just mean I'm 55 years old and when I say write a check it's an anachronism from the days get paid right.

Saul Marquez: [00:28:38] Ok. No. Very cool. Very cool so let's pretend you and I and this is a little lightning round.

Saul Marquez: [00:28:42] Dr. Rob we're building a course on what it takes to be successful medicine today. And it's the ABC of Dr. Rob. And so we're going to write out a syllabus for questions lightning round style and then we'll finish the syllabus with the book that you recommend to the listeners are you ready for it. OK.

Saul Marquez: [00:29:01] So what's the best way to improve health care outcomes?

Rob Lamberts: [00:29:04] Make patients the center because they're the ones who it matters to the most incentivized doctors to care about what the patients care about.

Saul Marquez: [00:29:12] What is the biggest mistake or pitfall to avoid?.

Rob Lamberts: [00:29:15] Making yourself the center of the universe as a doctor and that sounds redundant but were, it's health care. That's about the patient damage. It's about them. And the more we start listening to people so many people who say they're the first doctors ever listen to me and just like that just makes me angry to hear that people go through health care and don't get listened to. So the biggest mistake is not to listen to the people and to see the patient as an adversary rather than the people who were here for.

Saul Marquez: [00:29:45] How do you stay relevant as a physician.

Saul Marquez: [00:29:47] Despite constant change.

Rob Lamberts: [00:29:49] Embrace technology for one I think text messaging is fine. The other is to also be flexible because some people can't do it. But for me it's embrace technology keeping up with you know whether it's making sure I'm reading enough stuff to keep up with the business side of things. What's going on there with the medical side of things but also presently booking stuff with some artificial intelligence to augment my practice using a machine learning type of tools to make it so that that I'm more efficient so that I'm running better and that allows me. It's not that the technology is the center it's that that technology makes stuff so much more efficient that it allows me to sit and chat with people about their kids or sit and do house calls or whatever. And that's the cool thing. So I think embracing technology for what it's good for and that is making things more efficient.

Saul Marquez: [00:30:40] Excellent. And finally what's one area of focus that should drive all else in your practice.

Rob Lamberts: [00:30:47] That is a great question. I'm going to flip it because I'm going to take it from my perspective as a clinician and rather than say a patient centered message that sounds like I'm just being gratuitously nice guy ish.

Rob Lamberts: [00:31:00] I want to have a good life. I want to have a good life as a doctor. To me that doesn't mean I'm going to get a yacht down not a yacht person. I'm not even a new car person. I'm a used car person I'm just as happy as a used car. But for me being happy is that when I leave my office I spend most of my days liking what I'm doing. I spend most of my days. I feel like I've hit the perfect thing where I have a job that I like that pays me well that I'm good at and that does good for people and I walk away every day feeling like I am the lucky I am just really lucky for what I'm doing and the minute I stop feeling that way and that's what happened in my old practice. I think my guiding star is that feeling of contentment with what I'm doing. Again it's not having a huge 401k that's for which it isn't because I went through several years of not making any money early on. But for me my guiding star is if I'm doing the right thing if I'm happy because my patients are happy yes but also because I'm happy. That's really cool.

Saul Marquez: [00:32:07] Yeah I think that's great. And just keeping it simple and keeping your guiding star. I love that and what would what book would you say you recommend to the listeners here on the syllabus.

Rob Lamberts: [00:32:18] Well undoubtedly David Chase says book the CEO what it is called. Just look at Dave Chase's new book that is so educational as to the pernicious nature of a lot of the health care system. The other thing I would recommend to anybody who is starting out in a practice like this would be the lean startup. I actually benefited greatly from reading that book because it got me. I felt like I needed to build the perfect practice. Actually David Chase also taught me to read that book but it's this idea that I wanted the perfect practice and it now all I have to do is do what's good enough and build it from there and then let me know because I still think that doctors do in this type of practice are startups and the more you understand that mindset the better.

Saul Marquez: [00:33:05] Now that's a really great message. So go ahead and check that resource out.

Saul Marquez: [00:33:09] Outcomes rocket listeners and just go to outcomesrocket.com/doctorrob d-o-c-t-o-r-r-o-b and you're going to find all of the notes from this episode along with all the links to Dr. Robbs blog as well as his practice so you could check it out if you're curious. So Dr. Rob I really appreciate you spending time today and before we conclude just wanna open up the mike to you one more time so you could share a closing thought. And then the best place that the listeners can get ahold of you.

Rob Lamberts: [00:33:42] Well the latter is just you can follow me on Twitter under doc_rob or on my on my blog. I mean there are ways to contact me on all those places if you need to. My practice Facebook page is another place people like to follow what my final words of wisdom you know the health care system is this monolith and how could little practices like mine change things really. The answer is in my book. I grew up in Rochester New York. My dad worked at Eastman Kodak Eastman Kodak used to be this monolith this humongous business that you couldn't imagine the world without Kodak because everything was Kodak. But in a very short time using the right technology and the right tools combination of digital photography and social media Kodak has become an afterthought. And it was done so by small companies but better technology better ways of doing things and it seems like how are we going to change things in the healthcare system. The answer is by building an Instagram by building those types of things that can totally revolutionize the system and make it so that these seemingly impossible tasks are now simple because we're utilizing a system that's better designed and a system that utilizes the technology to make it work well. So my hope is that when I look at it and say how could we defeat this monster. The answer is we can. It's been done lots of times before.

Saul Marquez: [00:35:12] Now very encouraging words.

Saul Marquez: [00:35:14] Dr. Rob and what's the best let the listeners get in touch with you.

Rob Lamberts: [00:35:17] On my blog.

: [00:35:18] And you can either do it there. I mean you could send me a direct message on Twitter if you wanted to as well. That's about it.

Saul Marquez: [00:35:25] Excellent. So listeners will go ahead and put posts those things on the website so you can definitely tune in with that. Dr. Rob is doing some pretty cool stuff. All aimed at improving outcomes. Dr Rob thank you so much again for being on the show.

Rob Lamberts: [00:35:41] My pleasure, Saul.

: [00:35:46] Thanks for listening to the Outcomes Rocket podcast.

: [00:35:49] Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

Recommended Book/s:

CEO's Guide to Restoring the American Dream

The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses

The Best Way To Contact Dr. Rob:

Twitter - @doc_rob

Mentioned Link/s:

more-distractible.org

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