Physician Entrepreneurship in the New Era of Healthcare with John Shufeldt, Founder and CEO of TribalEM and MeMD: Audio automatically transcribed by Sonix
Physician Entrepreneurship in the New Era of Healthcare with John Shufeldt, Founder and CEO of TribalEM and MeMD: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
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Saul Marquez:
Hey everybody, Saw Marquez here and welcome back to the Outcomes Rocket. Today, I have the privilege of hosting the outstanding Dr. John Shufeldt. He has nearly three decades of experience leading high performance teams and being a thought leader and agent of change in the delivery of health care, entrepreneurism and leadership. He received his B.A. from Drake, his M.D. from University of Health Sciences, the Chicago Medical School, and completed his emergency medicine residency at Christ Hospital Medical Center here in Chicago, then got his MBA and JD. Just an academic at heart, but also a doer in health care, most recently serving as the CEO of Tribal EM and also a board chair of MeM.D.. We’re going to be diving into the future of virtual primary care and exploring access to these types of technologies in communities across the country. And so, John, such a pleasure to have you here with us today.
John Shufeldt:
Thank you. I’m really honored to be on the podcast.
Saul Marquez:
Yeah. So, you know, you have done quite a lot in your your health care leadership career, John. Tell us what inspires your work in health care.
John Shufeldt:
I still practice emergency medicine at a tertiary care center here in Phoenix and then also on various reservations. And, you know, it’s one that’s literally the role I was born to do. And I think I knew that as young as five years old. You know, what carries me through now more than 30 years into it is I absolutely love being able to make a difference in people’s lives, that it’s often, you know, sometimes the worst day of their life. And it could be a difference. You know, while practicing medicine may be a difference, just doing something is making them laugh, putting their hand on their shoulder. I always tell a story about one of my biggest accomplishments was buying a intoxicated homeless guy a pair of shoes. He came in and he was intoxicated and was kind of sleeping and he came in for help. He was a little hypothermic when he was a little too hot. And I ran out and bought a pair of shoes and put them on his lap as he was sitting up in bed. So I always kind of laugh thinking, you know, this poor guy wakes up and there’s a new pair of shoes on his lap and he’s like, I mean, I need to get drunk more often because this isn’t bad. So it’s that ability to even make a small difference in people’s lives that really makes me love practicing emergency medicine.
Saul Marquez:
That’s fantastic, John. I mean, your love for it is I mean, I feel it, you know, and I think it’s fantastic that you still practice, but you’ve gone also and done this on a more population enterprise level. So why don’t you tell us a little bit about the things you have going on now with MeMD and Tribal EM, so thanks.
John Shufeldt:
I really love the one on one in medicine where you can make some small changes. But I also love being able to impact populations. And you know, my, my mantra has always been leave the world a better place than you found it. And so when I would see things in health care or in even some non health care things that I always think, you know, it’s what a lot of entrepreneurs do, huh? There’s a need here. What can I do? How can I make it better? Which that need is gosh, started ten plus businesses in my life. Some of them were just total abject failures, was only I saw the need and no one else did. And then some of them have had you know, they’ve run out and had a little bit of success so far. For MeMD, this started out into the urgent care world. I started the first urgent care is in ninety three and grew. That’s about sixty urgent cares and sold off that. And then literally a week later I started this virtual health care in 2010. And at the time, you know, I got a lot of strange looks and a lot of people go on like that’s weird. And I was going, well wait a minute, you can get education online, you do your banking online. This is the future of health care and not all health care, but for a lot of health care, a lot of patients I’ve seen the emergency department and a lot of patients I see in the urgent care could see them easily, virtually.
John Shufeldt:
You know, a lot of them did not need the laying of the hands. And so we started this to to crickets and it started relatively so slow. But we built it up over time. And before the pandemic, we had about four and a half million subscribers. And then, of course, last year it just took off like a rocket. And it’s still a pandemic has changed virtual health care forever in the USA. It probably accelerated the business by about five years. And it was in some respects prescient that we did it back in 2010. I was probably a little too early to the game, which has been kind of my downfall and a few of these businesses, but but ultimately worked out relatively well. And, you know, now I see hundreds of patients a day that a great group of providers were in all 50 states. And I’d always laugh and say, you know, you can save someone’s life in the emergency department and they look at you. Well, yeah, that’s what you’re here for before you treat a woman at three a.m. with a urinary tract infection so she can get her medications a few hours later. And you’re like Moses because it makes that much of a difference to her as opposed to going in and wait in the doctor’s office or waiting in an urgent care and emergency department, paying a fraction of the price and get it done immediately. So that’s for me.
Saul Marquez:
Yeah, that’s fantastic, John. And, you know, you’re right, it’s all contextual You know, on the one. And the experience versus the the virtual primary care, I need you right now, but it’s not the E.R. experience, it’s fantastic. And the acceleration that COVID has brought about for these technologies is just phenomenal. As you reflect on some of the work that you do, what would you say is the critical way that you guys are improving outcomes and maybe you zoom in to MeMD again, or if you want to shed a little light on Tribal EM, that’s for sure.
John Shufeldt:
Let’s talk about Tribal. So Tribal is a medical management and staffing company that works only on indigenous lands. And it started almost by accident. I was the Chief Medical Officer and they was a facility that went six thirty eight. It’s called the Indian Self-determination Act. And also and that’s when the indigenous population of an area goes to HHS and health service and says, you know what, we want to do our health care for ourselves. We’re going to take it over. And I chose as part of their kind of foundational role, says, OK, here’s what you need to do in this tribe, did it and did a great job. I was hired as their Chief Medical Officer in what I witnessed was that they use these staffing agencies that I always laugh with. Some of the providers would pass the fog a mirror test if they could fog a mirror, that they’d basically throw them up there in some of them.
John Shufeldt:
I would just some of them are awesome, but many of them were less so and most of them were not poor. None of them are board certified in emergency medicine. And it was literally falling apart. And the CEO of the hospital thanked me and said, can you fix this because this is turning into a disaster. And I thought, gosh, at the time I spent twenty five years running emergency departments. Sure, I can fix this. And so we were able to bring on board certified EM physicians up there and then started bringing literally flying in a helicopter specialist up there every week. So instead of these tribal members driving 90 miles down to the valley, the specialist and we had some best in class specialists, everything from hand surgery to pulmonary medicine and critical care to psychiatry. We literally had bariatric surgery. We literally had it all on. These physicians would fly up there.
John Shufeldt:
We transport them up there once or twice a month in a helicopter from Phoenix. And it just made all the difference in the world because one of the hospitals not trying to figure out a way to get folks down to the valley. The providers were coming up in number two. They weren’t the folks the indigenous population wasn’t having to pay to go down there and wait in the office. And it was just a huge hassle for them. And so it really impacted the way care was being delivered for this tribe. And then I started finding other tribes that had the same sort of kind of historical challenges, both getting best in class health care. And I thought, you know what, there’s a business model here. And, you know, for me, it’s probably been the best thing I’ve ever done because again, I really feel like I’m making a multigenerational difference because a lot of the folks have just not had the best health care in the world in it. I thought it was frankly shameful that here they are living in the United States. They were here first, and yet they’re getting care oftentimes not to the same level that we’re getting down in the cities or the suburbs. And so that’s kind of what we do to make a difference. And from my perspective, I was up there providing the care myself and basically hired friends and colleagues and people had that mission driven sort of mentality and brought them up there. And to a person, they’re like, OK, this I love this. I’m doing this practicing medicine and all the other crap to deal with. It’s all about taking care of patients. And so all these specialists who were some of them were literally world class were flying up there in a helicopter, were like, oh, my God, I love this. I’m just practicing medicine. And that’s all I have to do. And they do it once or twice a month and get a huge kick out of it.
Saul Marquez:
You know, it’s interesting. So where did the helicopter idea come from?
John Shufeldt:
Well, so I fly helicopters and so I could take off there myself. But then as we got it got to be more scale. I had a we had to find a professional. I would have their group to take them up there. But when they couldn’t make it on that, I would just fly myself.
Saul Marquez:
That’s awesome. You mix the little passion with your profession, and I’m sure these doctors are getting a kick out of just flying out there on a helicopter too, right?
John Shufeldt:
Well, some of them, Some of them are mildly terrified and they kind of flew back in some bad weather. And I said, well, we’ll play some Buddy Holly songs for you or John Denver. And and they laugh and look at me like, OK, you’re kind of a sixth sense of humor, but, you know, no one throughout, no one got injured. And we canceled a few flights when the weather was bad. But but, yeah, they actually love that because it’s beautiful scenery over the mountains. And they said they didn’t have to do anything but take care of people. And so it was a really cool experience.
Saul Marquez:
And that’s the attraction. And for sure, I mean, kudos to you for having seen this opportunity and and having done something about it. A lot of times good ideas don’t translate into into viable businesses. But what would you say was was the thing that made this one work?
John Shufeldt:
I think just so I’ve had a lot of ideas that I’ve transcended the businesses that were abject failures. And I think that retrospectively probably is still a good idea. But by execution, that was bad. I was ahead of my time. So there’s all sorts of reasons to say I. Here’s probably why this one failed. I think the reason this one succeeded was a couple fold. One, I was super passionate about it. And number two, the hospital was passionate about it, particularly after they saw the outcomes of these folks who couldn’t get in to see a cardiologist for months when they went to the valley. But all of a sudden, one shows up at their door and it’s like, hey, here to help, what do you need? And kind of everybody I brought up there had that same sort of mission driven mentality. So it was kind of seeing the success and then and then taking the ball and running with it and expanding services really quickly. And then that’s been one of the probably the best things I can when I look back at my career doing that was definitely one of the highlights.
Saul Marquez:
Yeah, congratulations. And as you think about all the things you’ve done to improve outcomes and even make business better, what would you say is one that sticks out?
John Shufeldt:
So we staff a couple of emergency departments in the Great Plains, and both hospitals had lost their CMS accreditation that lost their joint commission accreditation. They had all sorts of problems. And we were able to go in there and turn both of these emergency departments around. So when I would go in there and work after a few months, a little as a as these are the easiest, most efficient EE’s I work in and I work in some solid emergency departments and these two are on the reservation. And they had such a long, bad history of poor patient outcomes and poor service to be able to turn those around and say it wasn’t just me. There’s a whole team of people. But the fact that we were able to do this and change the construct of how that population viewed the care they were receiving has been a huge blessing. It wasn’t rocket science. It’s just that someone cared and found a group of people they cared as well and put our heads together and change the culture of how care was delivered. That was a huge blessing.
Saul Marquez:
And so you’re in this situation and these these hospitals are struggling. They’ve failed all the certifications. They’ve their accreditations are out the window. I mean, why would you even take that on?
John Shufeldt:
I have a hard time finding. So I’m one of those people, you know, you’d have to you know, if I was in a fight, you’d have to kill me in the sense I mean, as long as people say, if I see something that I believe in, I will literally go to the wall. And I always say I’m too dumb to quit. And so a lot of this stuff is like it just strikes me as being unfair. And I’ve grown up just totally hating bullies. And I felt like in some respects these folks were getting bullied and it wasn’t by a person or wasn’t by an institution. It was just, you know, it’s just and they just had this experience of like, OK, well, here’s another group that doesn’t really care. And I thought I was inherently unfair to me and I hate stuff like that. So I just wanted to try to make a difference.
Saul Marquez:
Good for you. That’s fantastic, John. And you’ve turned them around and you and the team have turned them around and now they’re cranking on all cylinders. How they doing?
John Shufeldt:
They’re actually both doing really well. We have a great group of board certified providers up there. We have a great group of nurses and, you know, and they still have struggles. They still, you know, solve their share of, oh, my God, I can’t believe that happened. And there’s like much in emergency medicine. There’s a million funny stories that come out of their way and say, well, I never saw that one coming. But compared to where they were, it’s a 180 degree turn for them, maybe one hundred seventy nine degree turn, 180 on some days. But in general, they’re both doing very well. They’ve got their accreditations back. They have a staff that has a lot of pride and taking care of the patients. Their wait times went from hours to minutes. And it’s it’s been a very cool road and evolution for those hospitals.
Saul Marquez:
That’s fantastic! As you reflect on and maybe some of the things that you’ve struggled the most with. John, what would you say is, is one of the biggest setbacks you’ve experienced and a key learning that came out of that?
John Shufeldt:
Oh, God, I’ve had so many of them. And I have to do another show. I think the biggest instead of focusing on one of them, because I there’s so many, I can’t even pick one. I think the biggest thing I’ve learned from setbacks is that every time I’ve gotten smacked in the face proverbially, something good has always come out of it. And so for me, that it comes down to perspective, even though it’s things like hell at the time and you feel like your world got rocked. And I mean, I’ve had a few of the world rocking experiences where you’re one you didn’t see it coming into. It was you know, one was seventeen years of work, which kind of blew up overnight. And then now I can look back and say, got thank God that happened because, you know, if that didn’t happen, then this wouldn’t have happened like me and it wouldn’t have happened, for example. And so for every one of those major setbacks, screw ups, failures, I’ve learned that if you you know, I’m kind of one of those strong believers. If you change your perspective, if you look at kind of the Marcus Aurelius, the opposite goes away sort of mentality. You can make something good out of it and take the learning and apply it elsewhere. And so come to the point. And it’s adamancy, it’s Pollyanna, but it probably is annoying as hell. It’s I’m like, OK, good. All right. Well, that’s good. Let’s see what else. Let’s see what we can make of this now. Let’s see what learning will come from this. Let’s super cool thing is right around the corner because there always is a cool right around the corner.
John Shufeldt:
I take that perspective and I was say, and I’m sure it annoys people if no one’s dying, how bad can it be? And it’s that whole emergency medicine thing, like I’ve seen people dying in these horrible deaths and in losing children and all that stuff over 30 years. And I’ve kind of developed this perspective of, you know, what my worst day is one hundred times better than most people’s best day that I take care of in the emergency department. So I have absolutely no right to complain about pretty much anything as long as no one’s dying. And my kids are fine, my family’s fine, my team is fine. You’re not going to have to complain.
Saul Marquez:
That’s a great attitude and probably a big reason you’ve been successful in your medical career and also your entrepreneurial career in medicine. So kudos to you and and the work you’ve done. Well, you’re here, right? And so MeMD is taking off and it’s time finally came. What would you say you’re most excited about?
John Shufeldt:
So right now, I mean, I have a ton of experience, some of that, but a ton of experience. And I’m kind of in the stage of my career now where I want to do two things. I want to help other, you know, new kind of venturers, new folks who want me in the entrepreneurial world. I want to see if I can help them. Kind of like almost a Y Combinator sort of perspective where you kind of teach them everything I screwed up on so they don’t make the same mistake. So I’m very excited about that. I have a book coming out called Entrepreneurs IREX, The Physicians Guide to Starting a Business that I’ll be out June 1st. You can buy it on Amazon now. So I’m really excited about that.
John Shufeldt:
I’m really excited about helping physicians because generally physicians get absolutely no business training, not always laughing. So the going business class I had before medical school was typing in high school and I flunked them. And so we’re kind of, you know, you’re thrown out there and you’re paid a decent salary, but you have no idea what to do with it. And then, too, if you want to start a business, you’re really just scrambling, trying to figure it out. And a lot of physicians have this mentality. And I don’t think the crowd I don’t think the generation now does, but my generation certainly did and I certainly did. You know, how how can this be? We got through medical school and come to find out. It’s pretty damn hard. And so I want to share what I’ve learned, all the mistakes I made with physicians who want to start businesses or anything and really anybody in health care. So I’m really excited about that. And I’m really excited about A.I. artificial intelligence and its use in health care. And so at some point I’m going to really dive headfirst into that more than I’ve already dug into it and see if we can affect outcomes using an artificial intelligence.
Saul Marquez:
Well, it’s exciting if you’re a physician listening to this and something that John said inspired you or created curiosity, I’m sure John would welcome you reaching out. And so, John, on that note, we like to make things happen here. So talk to us about a closing thought that you want us to think about and then where the listeners can reach out to you to to learn more, to engage and to find ways to partner you about.
John Shufeldt:
So closing thought. I would say or I would have is this if I can do it, anybody can. And if you have the proper perspective, approach it with a great deal of humility and a sense of humor, because God knows I’m the butt of most of my jokes. Well-deserved. And if you can approach it that way and have this kind of constant lifelong learning perspective, the world is wide open for you to be as successful as you allow yourself to be. But that’s really the key, is keeping your ego out of it. Because if you have an ego that’s fragile, being an entrepreneur is a pretty tough place to be because your ego got smacked in the face pretty much daily. And if you can’t turn around and laugh at yourself for the dumb things you’ve done, life’s going to be awfully difficult for you to get in touch with me. My website is johnshufeldtmd.com. You can also find me on LinkedIn. I’m @johnshufeldtmd on Twitter and johnshufelT on Facebook and Instagram.
Saul Marquez:
Outstanding job. Really appreciate that. And make sure to check out the Show notes in the links. We’ll find all the ways that John just mentioned and how to get in touch with them, as well as a link to his new and upcoming book, definitely one that I’ll be picking up. And with that, John, I just want to say thank you. Thanks for all you do and thanks for all that’s to come. And the health care innovation that you’re a big part of.
John Shufeldt:
Thanks, Saul. Always a pleasure to be on the podcast. Thank you so much.
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