045 - The Physician Super Athlete - Others May Score Goals - You Save Lives (Special Video Episode)

December 01, 2022 Pariksith Singh, MD Season 1 Episode 45
045 - The Physician Super Athlete - Others May Score Goals - You Save Lives (Special Video Episode)
Show Notes Transcript

In this special release video episode, Pariksith Singh, MD, founder and CEO of Access Healthcare Physicians, LLC dives deep into the world of Medicare Advantage so you can learn all the ins and outs! You’ll hear deep conversations that discuss the past, present, and future direction of medicine. Dr Pariksith Singh is a return guest on the podcast and one of Coach JPMDs most influential mentors. He discusses what it means to be a physician super athlete and why it should be important to you. Kick back while Coach JPMD gets real in this extended episode so that he can share the journey and the true meaning of his mission. Learn more about how YOU can Practice Impossible by strengthening and empowering not only your colleagues but also new learners to the field of medicine!  Thank you @JoeRogan for the inspiration for this podcast.  You can watch this episode exclusively on Spotify here.

Show Notes
From this special video episode, please see a list of resources from our conversation with Dr. Pariksith Singh. This video is exclusively on Spotify and thanks @JoeRogan for the inspiration.  

  • Stephen Covey Trust and Inspire - Here
  • Joe Rogan’s Podcast - Here
  • Barry Weiss Honestly Podcast Episode - Here
  • The Life Divine - Here 

Coach JPMD  0:00  
Do you see that? The background? 

Pariksith Singh, MD  0:03  
Yep. Practice impossible.

Coach JPMD  0:05  
Flow is on the microphone and on the screen and so we're rolling. I didn't realize that we're on. So today we're with Dr. Singh at the Practice Impossible Podcasts. Dr. Singh, welcome. Welcome to the home, welcome to my home our home. This has been a long time coming. I think. For me, it's somewhat bittersweet because this is coming to an end to my season one of the practice of possible podcasts, where I've been teaching physicians, by managed care, Medicare Advantage, and, and a lot of this, a lot of our teaching, a lot of my teaching has come from you. And so I think because of you, we're here and because of you, I'd like to kind of summarize everything we've done over the past a year and a half with practice impossible podcasts and, and just to let my audience know, I'm not going away, and I'm coming back. But I have to study for my boards. So I don't know if you know, my internal medicine boards are coming up. I also have a license renewal in January. And because of you, I have Mirra U courses, course recording coming. And so we're, we're going to talk about that, and how you've coerced me into recording your own courses for your university, but just kidding you didn't coerce me. So we'll be back with other topics. And one of the things I wanted to do is maybe even do some surveys to see what physicians would want to hear about, because our mission is to help populations live long by increasing awareness of physicians, spiritual, mental and physical health globally. And my idea is to help physicians with the business of medicine and understanding how to how to run a practice. So Season One has been all about Medicare Advantage, and maybe season two will be on something else that you guys decide. But Dr. Singh was one of my most popular downloads. And it was on real estate. And it was a great episode, and I'm sure we're gonna touch on real estate. But being that you are, you are the guru of Medicare Advantage, I wanted our audience to hear you and hear you talk about Medicare Advantage, past, present and future. So welcome.

Pariksith Singh, MD  2:20  
Thank you, Jude, it's always a pleasure talking to you. And I still remember the first time we met with Excel sheets, I think our physicians now in looking when looking back, which physicians need to learn how to use Excel sheet at least understand the concept. Medicare Advantage, we've done it for 26 years, it used wasn't called Medicare Advantage in the US in those days. I think it was Medicare replacement. That's what it was called. And it has changed a lot I think in in many ways it has become better for physicians, if we are able to keep up with the requirements, it is demanding. It was a lot of it requires a lot of focus, attention hard work. But once one understands it and is able to get in the flow, then I think it is rewarding in terms of long term relationships with patients in terms of the satisfaction that comes out of doing good for the patients because you're looking at a patient comprehensively. And finally, it has also good financial return if done right. And if you're consistent about it, if you're systematic and methodical about it, then it can it continues to give you a higher return than fee for service would. At least that's my experience. But physicians who are willing to learn physicians who are not stuck in their groove, who don't dig in heels, were open to learning and willing to deeply engage with patients, if you can, so you have to basically love what you do. And if you're willing to do that, then you can be successful in it. I think it's definitely something that every new physician should explore. Other there are other avenues that we are learning how to develop which can be as profitable and as satisfying as Medicare Advantage, and I'm learning about it. So we are exploring it being of a nature that we always try to learn new things. I think those can be considered too but of course Medicare advantages could be your bread and butter and if you know how to do it. If you tie up with good consultants, if you tie up with good mentors, I think it can be very worthwhile and rewarding.

Coach JPMD  4:44  
Sure. And you know, the word mentor has come up a lot in the podcast episodes from from various different providers and business consultants and I think you have been my mentor over the past 20 years and you know, I want this to not only be an episode to describe what, you know, what Medicare Advantage can do for you as a physician, but also to have fun? 

Pariksith Singh, MD  5:06  

Coach JPMD  5:06  
Because we are, you know, I've watched Joe Rogan's podcast for a while, and I'm trying to say, see how we can kind of emulate that, 

Pariksith Singh, MD  5:14  

Coach JPMD  5:14  
Get people to kind of listen to what we're talking about, because it's all about decreasing physician stress, so that they can make more money. And I think that is a goal that a lot of us shied away from, I guess, in residency and, you know, we want to do it for the good of the patient. And yes, it's true. But if we are not strong as, as physicians as human beings, on the personal side and financial side, I don't see how we can take care of patients. So how do you see Medicare Advantage different from fee for service?

Pariksith Singh, MD  5:46  
It's a multifaceted multi dimensional approach, it's different. That's the difference. So to make it very succinct, it's your entire approach to the, to the model of Medicare Advantage, it is your approach to the patient right from the get go right from the day they call you. A relationship with the health plans, relationships with your staff, your outreach people, your marketers, and then how you treat them, how you work them up, how you document things, how you get all your, their records, so their compliance, the quality, and then as they go, how do you do a follow up? And that's one part of it? And then how do you crunch the numbers? How do you analyze your data? And then how do you use that to build a model? That is self sustaining? And and then it through the process? How do you learn how do you make other physicians as your partners in it, or physicians who are willing to share with you their knowledge, it's a different it's a team work definitely way different from the old fee for service model. And the entire mindset has to change to the the approach has to change.

Coach JPMD  7:05  
But but you have specialists are still doing fee for service. So they're still, you know, trying to see as many patients as they can they're still trying to, you know, turn the system... 

Pariksith Singh, MD  7:14  

Coach JPMD  7:14 some way it may call it, how do we get them on board?

Unknown Speaker  7:20  
It's in this area, at least, it is a challenge. So I think building a relationship having a communication engaging with them. Also, one of the important points of impact is the one whom you refer most of the patients to, and the one whom you choose should have some efficiency and efficacy. First rule is there have to be good doctors, they have to have the skill to take care of the patient. If they take an extra visit a year, that is cheaper than someone who's messing up the patient, and then you have 20-30 visits out of it and 10 more procedures out of it. So I think good providers, good specialists, and then building a relationship with them. Just as like you're building a relationship with your patient or your staff, you have a deep relationship with them so that they start listening to you, as the old saying is you only friends will buy. So you have to turn them into your friends. And that will happen only when you make it a long term relationship. I've heard of primary care physicians yelling at the specialist, that's usually not a good option. Threatening them, that's never a good option. But working with them understanding the needs of the specialist, and the needs of the patient, if the patient needs a certain procedure done, that's good for them, then it may be worthwhile. And so eliminating waste, there's so much waste in it, that if everyone could work together to just eliminate the waste, I think most of the 40% I think is waste. Now if we can eliminate even half of it, then then you have done a good job in the system.

Coach JPMD  9:07  
And I don't think you know, you see a lot of waste. You said it right. But then you see those that are wasting are not often contracted with the insurance companies, insurance companies end up canceling those physicians. And then they end up feeling like they were shunned or they 

Pariksith Singh, MD  9:25  

Coach JPMD  9:26  
they don't really we realize that it's they're doing that's causing them not to have as many insurance plans. And then they turned to doing other things. So how you didn't know all of this when you first started though. So you started access in what 2001 

Pariksith Singh, MD  9:40  

Coach JPMD  9:41  
And I came in 2002 I think right? 

Pariksith Singh, MD  9:43  

Coach JPMD  9:44  
July 22.

Pariksith Singh, MD  9:45  
You were probably the first one weren't you

Coach JPMD  9:46  
no I was I wasn't the first 

Pariksith Singh, MD  9:47  
after the chiropractic 

Coach JPMD  9:49  
Yeah chiropractor

and two other physicians. I think... it was a crazy time.

Pariksith Singh, MD  9:55  
Yes. Yes, it was we just began we had just started at that time. We were learning and I will say we have learned, I mean, along the way, we made a lot of mistakes. But what is the saying now? Fail fast? Fail early? fail often? 

Coach JPMD  10:10  

Pariksith Singh, MD  10:10  
we did a lot of things that...we failed.. 

Coach JPMD  10:12  
I failed that's for sure. 

Pariksith Singh, MD  10:13  
Yes. But I think it has brought us to a point where we can reflect and learn from it and be able to teach others at least don't repeat our mistakes. Make new mistakes.

Coach JPMD  10:25  
Yeah. So you grew fast. I remember growing with you pretty fast. I was income guarantee with the Springhill Regional Hospital, right? That's correct. Jim Baby. 

Pariksith Singh, MD  10:36  
Yeah, Jim. 

Coach JPMD  10:38  
CEO somewhere 

Pariksith Singh, MD  10:39  
Good old Jim. Yes. 

Coach JPMD  10:40  
You know, you talk to him? 

Pariksith Singh, MD  10:41  

Coach JPMD  10:43  
He's a good guy. Probably one of the reasons why I came here. But I remember rounding in the hallway or visiting in the hallway. And they're the one physician would say, Oh, Dr. Singh is great. And he was a specialist. He's no longer with us, unfortunately. But he's a doctor seems great. You know, he loves business. He knows the business of medicine. But then you had other physicians say, Oh, you're going to work for the HMO? Doctor? Why is there this such disdain for the HMO doctors?

Pariksith Singh, MD  11:08  
Well, I must say it has gone down. I mean, in my opinion, has gone down a lot because most physicians are taking it the penetration in the communities, even in Hernando County is 60 to 65%. And only growing. Miami is 80%. 

Coach JPMD  11:23  

Pariksith Singh, MD  11:23  
Yeah, yeah. So where do you go, if you don't take that unless you carve out a niche for yourself, which we can talk about, if you're interested, unless you carve out as another line where the return is higher, or as high, then it makes sense. But see, a lot of those people who kind of, you know, were antagonistic then joined us. Because I think one was one of the important things, good things we did was we worked on the infrastructure. We worked on creating teams and the right people and the technology, infrastructure and the data infrastructure. And you know how, even after all these years of work, we still feel like we've barely scratched the surface. There's so much information, so much data out there. But I think over the years, what we've seen as health plans have become more friendly to physicians, the old approach was, they would hide it, they would not share with us. And so we would all often try to, you know, tweak out the data and try to figure it out, never would make complete sense. But as the health plans have become more compliant, or transparent, now we can break down the data and understand it better, especially partly, and you have been through that. Whenever we used to review crunch the numbers together, we were almost in the ballpark. And then we realized over the following years, discrepancies started coming in, which never made sense. Now they're beginning to make sense again. So I think that effort towards compliance on the health plans is a good thing. The transparency is a good thing. And a lot of physicians who joined us, even though they felt threatened by it, so it was not so much antagonism, it was the fear. And they realize that we have created a compliant infrastructure based on authenticity based on integrity, based on focus on on patients, we spent a lot of as you know, money on hiring the best people, the subject matter experts, creating an education platform, you know, the whole approach towards a master's program, what is it, it's not just, you know, a way to just look ourselves look at ourselves, and you know, kind of put some kind of halo around ourselves. It's an approach towards creating a platform where physicians administrators can learn. And I was told something very nice by a physician who's doing a master's with Harvard. And he said, your program is more intense, more detailed than Harvard. And I tell you why. Because we live it.

Coach JPMD  14:06  
Yeah. I mean, you can't have a Harvard professor professor know the ins and outs of managed care. 

Pariksith Singh, MD  14:11  

Coach JPMD  14:11  
There's no way. 

Pariksith Singh, MD  14:12  

Coach JPMD  14:13  
And if they do, know, they may not be professors at Harvard, because they may be making a lot more money somewhere else.

Pariksith Singh, MD  14:19  
That's right. Once you figure it out, then that's theory. We live it right. So today we did a program on GME. What would a Harvard probe professor in say public health know about graduate medical education that the nits nitty gritty of it the little bit little details. We talked about credentialing yesterday? What would they know of credentialing things that we live what you do in a practical life? So for a practical life, you need people who have practice right?

Coach JPMD  14:49  
Yeah, but you have physicians who just don't want to don't feel like they want to know this stuff. They don't need to know this stuff. If if I have a practice administrator doing stuff for me, why should I know this stuff?

Pariksith Singh, MD  14:59  
And that's okay. but then get an administrator who is willing to learn. So who is loyal to you. Who has the skill set. And most importantly, who has the attitude. See skill cannot can be taught. Attitude? Very difficult to teach. So if you have someone who's in the learning mode, they learn all this. The only problem is, where do you find them, I have never found a perfect practice manager in 26 years. So eventually, I have to supplement it, I have to know what I'm doing. And then I can guide them, it's like, as a physician, I cannot have a just say, okay, the nurse will take care of the patient. Now I have to be on top of it, I have to know what the potassium is, I have to know what the pulse is the vitals. If I'm not keeping my fingers on the pulse, the nurse and God bless the nurses, the the PA the other team members, they're not going to be able to do a great job. So I have to do the same thing with my practice. I have to be the doctor. Don't have to do everything. I have to learn to delegate, just like in medicine, delegate to the best trained people. But you have to keep your fingers on the pulse. No matter what you do. Whether you do manage care, do fee for service. Keep your fingers up fingers on the pulse. 

Coach JPMD  16:16  
Yep. Yeah, that's great advice. For sure. So access grew, obviously to a point where even I branched off a little bit back.

Pariksith Singh, MD  16:26  

Coach JPMD  16:28  
And I don't even know how many physicians you have now. We started at five, I think we were rounding co rounding. 

Pariksith Singh, MD  16:33  

Coach JPMD  16:33  
The hospital systems that were in multiple counties.

Pariksith Singh, MD  16:37  

Coach JPMD  16:39  
How many physicians do we have?

Pariksith Singh, MD  16:40  
I think we're about turning 250 providers.

Coach JPMD  16:43  
250, employee providers. 

Pariksith Singh, MD  16:45  
Employed providers and about 130 or 40 affiliates.

Coach JPMD  16:50  
Okay. And how did that happen? Because did you acquire practices? Or do they did you hire physicians how, what was the bulk of this

Pariksith Singh, MD  17:00  
Strange as it may sound, it was, of course, it was a mix. But what we did in the first few years was just get the right people. And just try to create the right systems. And when you said, right, people, there's no such thing, there's no such thing as a right person coming in, you have to work with them years of working with them, so that they start getting used to you and getting the right added, sometimes you have to get consultants to to kind of supplement your knowledge. And it is a long effort. But if you start building a team that is autonomous, that is willing, that has it's your own approach of challenging itself, of being creative, yet following the rules, not being creative with the rules, yet making sure the regulations are followed. So what we did was we got such a team, and then we started building an infrastructure. So by 2007-2008, as things became difficult, and you know, a lot of changes happen. And Medicare Advantage became very difficult for a while people lost a lot of money on it. They did not do do too well. And specialists were under the gun. So a lot of them joined us the new requirements came with high tech, high tech, and also they could not afford to pay for all this. So they joined because of the infrastructure. And we were generous, we were not very tough on them. We were generous in terms of sharing the profits. And so I think also, we ensured that there was an integrity, integrity through the system. So financials have to be clean. And once that was done, I think more and more people joined us and kind of coalesced around this specialist did not lose by joining us. A lot of them just merged their practices unheard of. They just merged their practices in our group. Then we also brought in new physicians, we purchased a few practices in those days, value of practices was not that high. And then de novo practices, we started somebody novel practices. Now we've gotten now the world has changed 2022. Now purchasing practices almost impossible at a reasonable price. So we go for de novo practices, or we work with our senior physicians, and try to incentivize them and create a stakeholder arrangement where they can do well as their practices grow, which I think is a unique approach.

Coach JPMD  19:34  
But I also see that in that growth, we get reports on physicians coming and going. So there's some physicians leaving 

Pariksith Singh, MD  19:40  

Coach JPMD  19:41  
What is your pulse? What are you seeing his main reason why physicians are leaving the group.

Pariksith Singh, MD  19:44  
A lot of them are retiring, burnt out. Done with it. We had a surgeon who became started working at a port just picking up you know all the overhauling the luggage and all that I mean It's, it's unreal. Yeah he was a surgeon, very good surgeon. He dropped it all. And now he's just at the port makes probably as much money and he's very happy man. 

Coach JPMD  20:09  
So tell me about the burnout though...

Pariksith Singh, MD  20:10  
Burnout has happened COVID... COVID caused a lot of burnout. And then the requirements and the medical legal issues, tremendous pressure on the physician, specialist, general surgeons a lot. We saw that with, with ent, a lot of ent physicians, retired people just don't want to do it anymore. Our primary care physicians, of course, as they age, they are they are leaving, but we are seeing a lot of new physicians come in to we are seeing physicians move from other groups to ours. We have not seen too many physicians leave our group. And again, that is perhaps a good thing, good validation of our outreach and developing long term relationships with them. And our approach has been different different than in building our group, we did not go out and into far flung areas in Philadelphia and Texas and Vegas and California and plopping offices. We did not do that we stayed concentric, very organic, in growth, very deliberate in picking the locations, perhaps to deliberate and picking the physicians who come in. And that's why we've had a steady growth we have not looked for look for an explosive growth. It we did not explode the market exploded. And, and it's a good thing and a bad thing. But we stayed, we have stayed the course we've stayed focused on our fundamentals, we still love what we do. We are not burnt out. But you're right physicians who don't enjoy it, the moment you lose that enjoyment, the moment the journey is not the reward, you get burnt out. So what you're putting out, if you're not getting equivalent, or more than that, you're getting a burnout, burnout. And the equivalent is not just financial, it has to be emotional, too. It has to be professional too. You have to be able to enjoy it. And that we have been lucky we do crazy things we do creative things that most physicians won't. So we love doing new things. And adversities will happen. They have happened. But how do you turn those adversities into an advantage? And so that I think has helped us, but a lot of physicians, they get burned out we have had we had a physician who committed suicide. So...

Coach JPMD  22:38  
Yeah and I was going to potentially bring that up and later on in the episode, because I remember him and yes, and it's something that resonates with me, this is one of the one of my missions, because you know, phyisicians commit suicide 1.8 times more than the general population. 

Pariksith Singh, MD  22:53  
Yes, yes. 

Coach JPMD  22:54  
And there is no way we can take care of patients if we can't take care of ourselves. 

Pariksith Singh, MD  22:58  

Coach JPMD  22:59  
So I think we all recognize it. And I commend you for allowing physicians to do other things. Because, you know, it's not just me doing practice impossible. There's the Jibawi brothers who are doing their their own thing with their

Pariksith Singh, MD  23:15  
Podcast, yes. 

Coach JPMD  23:17  
It allows us to, you know, and if you read the Google way, Google's allows their employees 15% of their time, I think it's right, right, the number of teams, their own personal time to do whatever they want. So it definitely helps in decreasing burnout and, and allowing bigger things to happen, because I think we have the ability to reach more people when we do other things that keep us, you know, happier, I guess.

Pariksith Singh, MD  23:46  
So Jude I absolutely. So this is exactly what we're trying to do a platform where physicians can be entrepreneurs, and even why physicians, even non physicians who are doing something leading, say one line of business, they can be entrepreneurial. Of course, they have to be taught, they have to learn how to be entrepreneurial. We have no one taught taught us how to run a business. The goal is to teach people how to run a business and basics of running a business. You'd be surprised how deficient our education system is in imparting How to Be practical with creating something of value for the society and monetizing it, which is called a business.

Coach JPMD  24:27  
And I know because none of the none of our professors were teaching this. 

Pariksith Singh, MD  24:32  
No, they don't know because they've never done it. 

Coach JPMD  24:34  
I did have one one. I remember what I forgot his name. I have to get his name. But we had one professor when I guess he was a professor. When we used to round. He's has a lowest census in the hospital. 

Pariksith Singh, MD  24:46  

Coach JPMD  24:47  
everyone wanted to be on his team because we didn't have to write as many notes. Why? Because he was efficiently discharging his patients. 

Pariksith Singh, MD  24:53  
That's right. 

Coach JPMD  24:54  
But no one liked him. I remember that even the other attendings. 

Pariksith Singh, MD  24:58  

Coach JPMD  24:59  
Because he's like, Oh, While he's not managing patients, right, and he's discharging them too soon, and they're bouncing back, no, they're bouncing back because we have no clinic follow up. There was no way to follow up on these patients. None of these patients needed to be in the hospital 10 days, 12 days. So it was interesting because he understood it. But even he that understood it was vilified by the system.

Pariksith Singh, MD  25:19  
Yes, yes. But you know, when I was I was fortunate 2001 When my employer was selling his practice, and we bought his practice for ourselves, he introduced me to, if you remember, good, Rich Dad, Poor Dad. 

Coach JPMD  25:33  

Pariksith Singh, MD  25:34  
Robert Kiyosaki. And Robert had a lot of, you know, silly things in there, which is, you know, all fluff, the couple of good things in there, he had the point, you have to build a business, you have to create something that is of its own value, because the business will help you build your real estate portfolio, he was big on real estate, that he is still is. And so that's, that's where we learned, of course, following him, I made a lot of mistakes. So then I had to go beyond him to go to the fundamentals of how to run a real estate business. But that's, you know, we have discussed that in the past. But yeah, I mean, that insistence that you can do work for someone, or you can be more entrepreneurial, and create your own value, create your own space. That is what we are trying to do. Create a platform where physicians who want to do something different, something new can thrive. Because the moment we do that we have brought in creativity, we have brought an energy, we have gotten rid of burnout. And that is our goal. And if I'm successful with it, if that's something that can succeed, and I believe so far, we've been successful with it. I think this will be a beautiful thing. This is probably yesterday, I was told day before yesterday, this is the only model where physicians are considered as stakeholders. This is not a private equity system, or a corporate system where physicians are treated as employees. And I was happy to hear that I felt good about it.

Coach JPMD  27:07  
Yeah. And physicians have to know what organizations are getting themselves into as well. Because some physicians may not want to be that intrapreneur 

Pariksith Singh, MD  27:14  

Coach JPMD  27:16  
but they still want to make half million dollars a year or drive that, you know, fancy car. But I think one of the things that we have to teach our physicians is, hey, if you don't want to be an entrepreneur, then you may not reach this salary cap. You may have to settle for something less, but let's teach them how to get out of debt, how to lessen that, what they what they make, right how to save for retirement, right how to, you know, manage their personal life, their spiritual life, their physical life. We're not teaching that

Pariksith Singh, MD  27:48  
we're not and I if I may, the little that I'm learning right now, I think you can do well for yourself, even if you don't do do Medicare Advantage, there are other avenues through which you can do a great job, love what you do, and still have enough return. Absolutely. And I don't want to put a number to it, but a return higher than the market average, and do well for yourself.

Coach JPMD  28:15  
Absolutely, I mean, if you if you look at the the average income of a physician, and you take that, that monies that they make a you put, you know, 15% of what they make in a retirement fund, over 20 years. You're a millionaire. 

Pariksith Singh, MD  28:31  
That's right, exactly. 

Coach JPMD  28:33  
And if you graduated 30 you're a millionaire at 50.

Pariksith Singh, MD  28:38  
That's not too bad.

Coach JPMD  28:40  
Not bad. And that's if you don't contribute more, that's if you don't buy real estate as if you don't do anything else. But we're not teaching that. So that's one of my missions. And that's a shameless plug to what I'm trying to do. 

Absolutely. And managing the debt. 

Retirement calculators on our website, and you can you can find these resources, it's out there. If you don't know, you know, we'll we'll we'll help you. And, and I think it kind of leads into you know, you right, you are the entrepreneur you are, you're the guru, businessman and Hernando County, if not one of the top I feel managed care business owners in the state. HCA saw that as well then you partnered with them. What happened with that?

Pariksith Singh, MD  29:26  
Last year, we purchased their shares back so it was not it was an amicable parting of ways. So one thing I've learned is one should stay in our one score business even a good to great. Stay in your core, you know, three things, the three circles, remember that what you love most, what you're good at and what makes money for you. These three have to overlap. Once they start overlapping that area of overlap becomes your core. If and if you can focus on that. Then you do well and again, remind HCA is a hospital based organization of good organization. They have great systems how to run a hospital. We are a primary care out outpatient based maybe a specialty group, IPA, doing our own TPA developing our own software education platform, crazy things that to them, which is a waste of time and energy. Why would you do that? Why don't we just focus on building our revenue base, and get more patients. So we've done crazy things, I don't think he would want to do that they have a creative in their own space, nothing when we realize that we we had a good, some good discussions, some not so good discussions. And then finally, we realize it's not a good fit. It's, you know, it's a marriage not made in heaven. And so we parted ways. And I think we are very happy, both are very happy, at least we are very happy. And we have been able to do things without losing the compliance bit. They are graded financial compliance. Without losing that, can you be creative, and that is the challenge. Without, you know, so many regulations are sitting on you. And so you kind of get suppressed and oppressed and you just do certain things. And that's the way you're going to be. And if I were to give you an example, IBM, think of IBM, that was one of the biggest companies in the world at one point. And what happened, it lost its creativity. And then every time I tried to bring that creative, creative spark, guess what happened? The world belongs to the disruptors. If you look at Fortune 500 companies, every year, you're gonna see three to 5% falling off, and new ones are coming in and new ones are coming that are not the traditional entities, you're going to yesterday I was seeing a company Canva 

Coach JPMD  32:02  
Actually we use Canva...

Pariksith Singh, MD  32:03  
26 billion in how to platform how to create a design started from nowhere. She's I think she's an Australian. And now she's she's a massive company, she's ready to take on the big boys. And that's what I'm talking about. Can we disrupt in a manner we find our own space, we don't have to compare ourselves with Canva, or Google or Amazon or, or Facebook, and all these things. These are all exponential organizations that have gone logarithmic gone crazy, because the world has changed. So conservative companies will work their way continue the process, I believe healthcare is going to get disrupted. I really believe that. And someone, there is someone there, who's going to disrupt it. And the companies that are conservative will have a hard time unless they adapt quickly, and change their ways. Right now. They're protected. They're protected by regulations. They're protected by a very strong cover, whether it's pharmaceutical, whether it's PBMs.

Coach JPMD  33:13  
So you're getting into the future. And I we're gonna get there. 

Pariksith Singh, MD  33:17  
Yes. But but so HCA 

Coach JPMD  33:20  
because that's that's a whole other conversation. 

Pariksith Singh, MD  33:23  

Coach JPMD  33:24  
How can you have a disrupter if the things that you need to disrupt are.. own the practices 70% of practices are owned by Hospital Corporation. 

Pariksith Singh, MD  33:35  
That's right. And they're not they're not able to be creative with that.

Coach JPMD  33:38  
No they can't be creative. So why would they want you to be creative? Why would they because if you're creative, that means you're leaving the organization you're going to, you're going to take away their revenue base, their referral base,

Pariksith Singh, MD  33:50  
They didn't do poorly at all, they did better with us. Better utilization in the hospital, less length of stay, less admissions, better quality indicators. We hired our own case managers. They did not give us case managers for our patients. We hired we have our own hospitals program. We are tracking them in nursing homes. We are tracking them at homes, we are monitoring everything we are ensuring continuity of care, they did not lose money. So

Coach JPMD  34:18  
So you're saying they didn't lose money even in hospitalizations, because if you're doing if you're doing really well then you should your hospitalization rate go down.

Pariksith Singh, MD  34:26  
Absolutely. But then look at the GLOS. The your length of stay geometric mean of length of stay, went down drastically, and we had a competition with their hospitalist program. And we would we would match them toe to toe we would go toe to toe with them. And we were better sometimes and they were better sometimes. But think about it. That's a good healthy competition. So when you reduce the waste, even if you're not every day saved, every day saved. If you have 100 patients in the hospital and you're safe In a day on, on average, think about how many admissions you need to catch up to that. You're saving them a lot.

Coach JPMD  35:06  
Yeah, but do they see it? Do the the administrative side

Pariksith Singh, MD  35:10  
I believe they saw it. Look at how many more beds they've added look at from 200 bed hospital. It's now 370 bed hospital,

Coach JPMD  35:18  
but don't they have to catch up to that? 

They're full 130% occupancy 130% 

So you're saying the efficiencies that you created in the system allow them to spend more money to get more beds to then 

Pariksith Singh, MD  35:33  
it's it's

Coach JPMD  35:34  
Wipe the competition 

Pariksith Singh, MD  35:35  
It's busiest Hospital in the entire Tampa Bay in this whole division. It is their busiest hospital. Yes.

Coach JPMD  35:42  
So is that in effect, also of basically taking admissions away from the other local hospitals? Because I know that, you know, I don't know if I can mention I'm gonna mention hospitals, Spring Hill - Brooksville. Their 30% down?

Pariksith Singh, MD  35:56  
30% percent of their admissions are with from us 38%. So think about it. 62% at HCA 30 to 38% at Bravera. Well, it's now Bravera. And, you know, I always believe in competition, spread it out, spread out the patients. So if you do that, then you you get you get the best service from all everyone is on their toes. And that's what makes America great country competition. So you know, there's no focus on sending everyone to one hospital. It's always good to spread it out. And that's why we did not concentrate only around at hospitals, we have spread out and we are working with everyone. Advent, Advantest. adventhealth, we are working with even BayCare I'll work with anyone just take good care of our patients. That's all 

Coach JPMD  36:49  
Yeah. So So you went. So the HCA deals done, which I've now got closure, because I wasn't 100% sure 

Pariksith Singh, MD  36:58  
Done, last year. 

Coach JPMD  36:59  
but they also had a partnership in the IPA. So explained to me what the IPA does, because you know, we have a money tree series that kind of explain things but hearing it from you, I think my kind of might might kind of will solidify some of the things maybe the holes that I may have had and the processes so you have the HMO that distributes money to the IPA. How's your IPA doing?

Pariksith Singh, MD  37:26  
Alright, in terms of quality, compliance, evidence based medicine, patients? 

Coach JPMD  37:34  
As a business. 

Pariksith Singh, MD  37:34  
Fine, it's okay. No problems. It's doing. The goal is to keep improving every year goal is to keep measuring yourself. Metrics are better, quality is better.

Coach JPMD  37:44  
So what is number one thing that you do for physicians as an IPA?

Pariksith Singh, MD  37:49  
Number one thing that we do for a physician first, I think, I think I hope that they will agree to it just being there. For them, I think is a good thing, just talking to them, making sure that they're they don't feel they're alone. And ups and downs have happened with physicians, but we support them, we because we are physicians, we work I work as a physician, even now, I love doing what I do, understanding the pain of a physician. And I think just giving them the resources. And more importantly, even just being there and kind of helping them navigate through it is good is a great thing, I think so whether it's through our ACO, whether it's through our IPA, whether it's not even IPA, we have physicians calling you are not part of our IPA, and they'll call and you'll say, Okay, I'll give you a, you know, we'll give you our resources, because there's always somewhere somehow that you're connected.

Coach JPMD  38:43  
So So you say you give them the resources, what what are those resources? What would you say?

Pariksith Singh, MD  38:49  
Basic resources, technology, right? We have software programs that we six HMOs in the country are using platforms for them, they're using it IPAs can use it, we have some unique software's that others don't have or others don't give at our rate. So technology two is, is clinical services like compliance quality, a UM.

Coach JPMD  39:15  
You're helping them with reports?

Pariksith Singh, MD  39:17  

Coach JPMD  39:18  

Pariksith Singh, MD  39:19  
Data is a big problem. Data is a huge... is the is the problem.

Coach JPMD  39:23  
So but if they're if they're a managed care physician, shouldn't their their HMO or shouldn't the insurance company be helping them get these reports? I know that they have portals?

Pariksith Singh, MD  39:34  
Yes, but think about it for a moment. Does an HMO really know what a physician's practice is? Just like your professors in Harvard, what do they know about about a physician, the person who's sitting there sending you the data, what do they know about your practice? Very simple thing. You see a patient you bill for it. Who is the biller? I know there is an outside company. Usually you will get an outside company who will do your billing. Most of the billers are fee for service billers, they do not know manage care. So I had a, I went to this conference of billers, they invited me think they were 100 people and I asked him how many of you know how to do manage your billing? Zero. How many of you do manage care bill billing? Almost 90%. So think about it. So what happens that very practically, I write, I see the patient, I write eight codes, a lot of them will send only four, okay, I educate them, they send aid, they send the claims Clearinghouse goes to the HMO HMO sends to CMS. Normally, if it's fee for service, and they give you the denials, you get the denials. What is the billing company going to do is going to work them right? Because every time they get more money, they get a percentage. Now, the HMO gives you the denials, who's working them, not one billing company that I know of, is working on them. First of all, they're not read the reports to they don't care because they got a third, they don't know the value of it. And who's looking at is the physician looking at it physician doesn't have time to to take a break, and chill and relax. So who's looking is the office manager looking office managers don't know how to look at it. Someone has to look at the data. Data is the new oil. Right? Someone has to look at the data and leverage it to increase the profitability. Every affiliate that whose billing we took last year. You we improved their graphs score by 15%. Look at the look at the leakage. These are physicians working hard busting their jobs. They don't know why they're not succeeding. They're angry at us. Why are you not I said, Okay, let's look at your data. How many claims went through? You sent 10,000 claims? How come CMS has 7000? What happened here? Oh, our biller knows he's my friend. Okay, I know he's your friend. Let me take over the managed care. Okay, you take a we don't care. They don't care about managing the moment you take it you find 500 codes that have been read that have to be resubmitted, just resubmission they've already done all the work, you just have to send it again. So this is what I'm talking about. Basic fundamental understanding what is called EDPs. Now, right EDPs it used to be raps EDPs, encounter based data that is sent to CMS once that who's going to manage it was going to look at your data

Coach JPMD  42:51  
Yeah doctors don't care about that. 

Pariksith Singh, MD  42:52  
No, no. 

Coach JPMD  42:54  
I mean, I'm talking to you now. And I thought I knew managed care. And I'm now having to learn what EDPs

Pariksith Singh, MD  42:59  
Yes. And so maybe you should do one, one session just on EDPs premium billing, who's looking at your premium billing? Patient is on dialysis. are you ensuring that CMS has that information? Who's going to check on it? You're not checking on it? Someone is checking on it right. There is no someone. You are that someone. So we have to give you the resources to check on that part D was checking your part D. Part D is a killer.

Coach JPMD  43:27  
Yeah. So I'm just going to pause right now and let people know that if you have no idea what Dr. Singh is talking about, right now, you need to go on to learn about Medicare and sign up for the free course. So you know, because there's a lot of terminology that yes, we've been talking about this whole year, this whole year and a half and if you haven't, that's a place to go to to learn some of the stuff but I had shameless plug. 

Pariksith Singh, MD  43:54  
Yeah, absolutely. So there is I mean, these are nuances to things that need to be done. Look at your revenue cycle management, doctors, we look at specialists they are punctilious about their billing, we know specialists, you know them. Any denial that comes the biller goes right to the doctor, this colonoscopy got denied because you wrote only screening you but you did it three years ago. Okay, colitis, right. Form sent right back within half an hour it has been responded to is someone doing the same with your managed care. I guarantee you know,

Coach JPMD  44:30  
because there's no revenue, there's no revenue coming in. 

Pariksith Singh, MD  44:33  
No one is tracking it. No one is watching it. So you need and now you're talking about big data, it is no longer patient by patient. You're talking about big data. How many doctors know the word Big Data, and we're talking when we say big data. We're not talking about five files. We're talking about a terabyte of data coming and who's going to put it together. Organize that data, put put fields, every health plan has a different field and send it back. You know, our numbers were so good that two of the best plans in the country said, your your system is great better than ours, you just submitted directly to CMS? Oh, yeah, you just give it just give us the file, we'll send it to you, for you. So, so the biggest health plan in the country takes our files and descends it. Because you have to get the subject matter experts who do this for a living, you have to reach that point of excellence. And you know, this, just one thing you can be if you're good at one thing in life, that's it, that's all you need. So our goal is to be good at that one thing that will change your life. All those affiliates are happy. Doing nothing extra, they get an extra 10 grand a month, 15 grand a month. That's your 15% right there for the next 20 years. Just do that. And they're kicking themselves. Why didn't I use their billing three years ago? Because I that billing company is my friend. You can have friends, this is something that is rigorous. It is demanding Big Data, brooks. No friends, big data is numbers. You crunch the numbers. It's objective. It's Excel sheets, Excel sheet, making sure things are done, right. And you send the data back.

Coach JPMD  46:35  
So obviously, you know this well, you knew this well enough to even have started an HMO.

Pariksith Singh, MD  46:42  
Yes, we did. I didn't know anything what I was doing 2004. But we when has that stopped us from doing something? You don't have to know something.

Coach JPMD  46:51  
Yeah and that's the beauty of having known you and having, you know, seen what you've done over the past couple of years and optimal healthcare was at HMOs. Right. So what happened with optimum?

Pariksith Singh, MD  47:02  
Well, we passed it on in 2007. So it was probably too early for its time. The physician it was set the approach was the physicians in the community would come together and create a plan. That was the original idea.

Coach JPMD  47:17  
I remember, I remember the meetings. 

Pariksith Singh, MD  47:19  
Yes. and I remember when it was sold in 2018. We had physicians come to me angry with me for not asking them forcing them to put more money into it. But when we started it, they scoffed at it.

Coach JPMD  47:36  
You're the HMO. Doctor, what are you doing?

Pariksith Singh, MD  47:38  
What are you doing? They not only scoffed at it, they call the other all of their health plans and told them what nefarious designs I was up to. So the other health plans knew about what I was doing. And they kind of tried to pressurize us and and destroy it. Fortunately, we are we have we are a little tense, thick skinned, we don't bow so easily. But in 2007 you know Dr. K Patel took over optimum, then he did a great job, his teams, and 2018 he solid and did very well for himself. And we became passive investors in it. Small but we all did well for ourselves. But I'll tell you the greatest return Jude. The learning. That learning is being used for your big data and EDPs today that we can talk that learning is being used to create platforms for HMOs. Think about it. You would know your viewer will never know you are using our platform to run their organization. So we know what they get. In the past you couldn't break that data. You couldn't take that data and crunch it. Now you say oh yeah, we know this data, give it to us? Well, we do we'll do it better than you. Problems with HMOs are they're so big. There is no person tracking it organizational memory, there is no such thing. People move all the time. They don't know what happened last year. So fortunately, we have kept the same people the same systems. And we are more tech savvy than most conservative entities, shall I say? So we can do crazy things we can someone compared us to what is that a Swift Boat compared to an aircraft carrier. And we can go so run circles around the Swift the aircraft carrier. Yeah, we have our own strengths and we can move fast and we can make changes and we can adapt and we can learn and we can share that knowledge. So that is the goal to be what is called a lighthouse organization if you're used or heard of that term. A lighthouse organization is an organization that is used by all the boats, all the ships to navigate to set their standards, okay, this lighthouse is here, we're going to move in this manner so that we can reach the port. That is our goal to be the lighthouse.

Coach JPMD  50:17  
And so what what metrics are you using to to determine your success now that we're moving away from the medical practice? It looks like a new looking at I guess IPA Software and Systems platforms are you selling to the public? Are you using? What are the metrics are using to show your success and that that avenue

Pariksith Singh, MD  50:41  
um, we I mean, metrics in the sense, we have six health plans. So that's a good good metric, that's a good validation, and more are coming and people come and ask for us we have private equity coming to us and wanting to partner with us. Because believe it or not, we are very customer friendly, client friendly. We are not those big boys who say this is the way it is take it or leave it, we are going to charge this much. We will work with small clients, small HMOs we love working with small HMOs because at one time, we ran a small HMO 600 members, people scoff at them, you can you don't deserve us? No, we like we like you, we'll work with you. It's high risk that will work with you and help making them successful, I help help them grow. That is very satisfying. So the metrics I would say is more non transactional now? What is the satisfaction? What is the satisfaction of challenging yourself and creating that answer to the challenge? And probably, I guess, when you have reached a point where you're not looking so much for financial returns, but you're looking to create something of value, you wanted to create a technological breakthrough. You're trying to disrupt if not anyone else disrupt yourself, then the matrix becomes have I created a platform this year that is better 20% Better have i Has my revenue is my claim system automated for 95% of the claims, can I move faster, can I move from 30 seconds per claim to 10 seconds or point or just two seconds per claim? Those are my metrics. So, I believe when when such things are created, that is a lasting value. Similarly, data management, a lot of effort has gone into managing all our data and you have worked with EMRs you know, you started one of the in the early days, you created your own EMR as a physician created EMR. And we still see we are still EMR 1.0 We have not reached EMR. 2.0 we have we have reached web 3.0 web 4.0. But EMR still stays in the old, you know, antediluvian stage. So now we have to bring it up to speed. Now if we can crack that that will be my challenge. If I can crack that in the next 12 to 18 months, not so much to sell in the market, but just to improve our own care for our patients. Can we improve our data so that physicians immediately get a response? And physicians are help? It is customized, individualized for the patient personalized for the patient? Can we do that? So those are the metrics? Is my health care platform incorporating education in it? So can I wanted to create a university now that's a challenge I've set myself, and I'm happy to tell you that our first course in a master's in healthcare got approved. We are now driving everyone crazy. Everyone around us wants to kill me, I think because we are pushing it. But if we can create all the content in the next 60 days, and we have a master's program, how many physicians create a master's program? So those are my metrics have I created something of value? And can it any what you're doing is in your practice impossible is something similar, or we are probably more accredited and more you no university based, but I think it'll Jive very well and you're going to be part of the process as faculty. So it will be a beautiful thing. I mean, academics, I love academics. I love teaching. Academics itself has to be disrupted.

Coach JPMD  54:44  
Yeah. And if we continue to do the same thing, we're doing, we're not gonna get anywhere we're gonna we're going to be ruled or we're going to be told what to do by larger organizations. So we've gone this has been in about an hour you...

Unknown Speaker  55:00  
Is that right? There's so much there's so much.

Coach JPMD  55:03  
I'm only on one page. Of notes. I don't know how this is gonna happen. You want to you want to take a drink before

Unknown Speaker  55:08  
I can have I will love your kombucha so I'll have some

Coach JPMD  55:18  
So Arif, we took a small break and we're just going to come back and so we're back talking to Dr. Singh, the practice impossible podcast and, you know, during the break, we he actually mentioned something you mentioned, physician athlete, though what was it that you're saying 

Pariksith Singh, MD  55:34  
physician athletes 

Coach JPMD  55:36  
physician athletes? I thought I was a physician athlete. Yeah, I play soccer every week.

Pariksith Singh, MD  55:41  
Yeah. Yeah. So when you were growing up, who are your heroes? Michael Jordan, 

Coach JPMD  55:48  

Pariksith Singh, MD  55:49  
Really great. Really great. Soccer player football,

Coach JPMD  55:55  
football. From Brazil.

Pariksith Singh, MD  55:57  
Right. But did you have a physician you held in as a superstar you wanted to be? And I'm not talking about? You know, what is that show with? Dr. Oz I'm not talking about now. Think about it. How many years did Pele spent playing football? 

Coach JPMD  56:15  
All his life? 

Pariksith Singh, MD  56:16  
15 years. 20 years before he became famous. He were played in the streets. 

Coach JPMD  56:19  

Pariksith Singh, MD  56:20  
Played with those balls made of cloth. 

Coach JPMD  56:23  
Yeah, he used to play with socks. 

Pariksith Singh, MD  56:25  
Right? Played 15-20 years and became a master and then he could do things with the ball football that no one else could.

Coach JPMD  56:34  
Well, I'm thinking some people might think Dr. F would be one of those. Those superstar...don't don't mention Dr. F

Pariksith Singh, MD  56:41  
Who's Dr F?

Coach JPMD  56:42  
We're not mentioning his name. 

Pariksith Singh, MD  56:43  
Okay. So look at how many years you put in to become a doctor. How many hours did you put in? 

Coach JPMD  56:51  

Pariksith Singh, MD  56:52  
11? And you did things you could do things that saved lives? 

Coach JPMD  56:58  

Pariksith Singh, MD  56:59  
In the ER, you did not do ALS. You did? You went far more than that. Right? 

Coach JPMD  57:05  

Pariksith Singh, MD  57:06  

Coach JPMD  57:07  
That's trauma life support.

Pariksith Singh, MD  57:08  
You could save people. Right, right from the the edge. You could bring them back. Obviously, you know, it's not in our hands. It's in God's hands. But you could do almost everything humanly possible. Put tubes wherever you wanted to bring them back. 

Coach JPMD  57:26  

Pariksith Singh, MD  57:27  
So I have a question for you. Would you consider yourself a physician super athlete at that time in the in the ER running that show? And you bring someone back to life? Was that a high or not? 

Coach JPMD  57:39  
Yeah, it was a high. 

Pariksith Singh, MD  57:40  
It was a high for you. Why are you not held in the highest esteem in the society for bringing back that life? Rather than someone who does college and plays football and gets 20 million $30 million? As a help me here a quarterback? 

Coach JPMD  57:59  

Pariksith Singh, MD  58:00  
So have we are our priorities a little mixed here?

Coach JPMD  58:03  
Absolutely. They are. I've always had that. 

Pariksith Singh, MD  58:05  
And you had more debt? 

Coach JPMD  58:07  

Pariksith Singh, MD  58:08  
Right. Well, you know, that super athlete could do things that and he's always famous, and you can sell shoes, and you can sell kombucha, and you can sell whatever he wants. So, and this is an idea I actually got from one of our financial consultants who was in Tampa. And if I can mention his name, yeah, right. Odd Missouri. I learned from him, he says you are super athletes. We don't realize that. And so first is we have to realize our own worth. And then we have to realize the worth of each other, we put each other down. Self awareness, self awareness and awareness of the other, right? So it's critical. And only then will the society begin to learn to appreciate us. Now not talking about in a negative way. You don't have to do anything crazy. Don't go on a strike or anything, but realizing who you are realizing who your peers are and what you do. That shift in the in the ER is more important than that Super Bowl game, because you have saved one life to live three lives. That Super Bowl game has not saved any life.

Coach JPMD  59:24  
Alright, so where do you think it comes from? What is the basis of the society, not valuing human life? Or the work of someone that saving human life?

Pariksith Singh, MD  59:33  
While the society does value it when it comes to the crunch? Right, it does. When when it's your own family, it's your own loved one in trouble. I think it's multifaceted. We don't respect ourselves enough. We don't help each other enough. We don't respect each other and I'm talking about the physician, community, medical community. We don't help each other. We don't respect each other. So what you're trying is is a great paid thing. And then the the approach, the presentation to the community has to be what is more important than than a physician or a teacher? For the future of the of the of this community? You save a 15 year old kid who becomes tomorrow, a Steve Jobs, what is the value of it? You deliver a baby who becomes the next? I don't know. Some Mahatma Gandhi or Martin Luther King or some great man. What is the value of that? So the value of a life is not something to be looked down upon. So we I, I like that physician, super athletes, we are super athletes, we maybe we don't have the muscle maybe here, although we are training for it. A muscle here. What about this muscle? What about this muscle? What about this muscle in the gut. So we need to realize that and I think you need you are bringing that out. But I think you may want to put a little more oomph in it now and let others know people need to know what they're doing. They're doing great job, we just need to strengthen them and empower them. And if you can do that, more and more people, the smartest people will want to become doctors will want to become neurosurgeon will want to come and do primary care with us. Why not? And so that motivation, inspiration that positive burnout happening? It's a shame, it's an absolute shame, how the hell can you have burnout? You're doing the best job, you have the best job in the world? Can anything be bigger than this? And you having burnout to something is wrong somewhere? No, we have physicians doing MBAs and leaving the practice to become I wouldn't say lackey but getting a job in some corporate entity What the Hey. So I think this is a unique position where you are doing good, despite even wanting to do so, this writing that prescription someone comes to you with severe back pain, and you just smile, and you talk nicely. You've brought cheer to that person, what is the value of that? So we need to look back and not become arrogant, but in a humble way acknowledge what we are doing, you know, the and I take inspiration from some of the greatest healers in human history. You know, Christ himself was a healer. Right. So we exalt Him. He was a healer at multiple levels, but he was a healer even at the physical level. Right. So and every great teacher is a healer in some way or the other. We are many healers. Yeah. Well, as doctors, we are athletes.

Coach JPMD  1:03:06  
Yeah. And and, you know, when you when you bring in Christ and to the forefront, you know, you're saying exactly what I think he has told us. And there's two things He tells us to do is to love him of God, and love everyone else. We're not even loving our own colleagues. We're bad mouthing our colleagues. 

Pariksith Singh, MD  1:03:26  
Yes, that's exactly.

Coach JPMD  1:03:28  
We're disparaging them. We're competing with them. Yes. We're not loving. And that I think, for me is what I try to teach my kids I try to teach them love and respect.

Pariksith Singh, MD  1:03:39  
That's where burnout happens. That's the secret of burnout. 

Coach JPMD  1:03:42  

Pariksith Singh, MD  1:03:43  
Yes. That's the secret of fear. Secret of anger, secret of all negativity. If you can get rid of the negativity, you realize what you do. You can never have a burden. Now, how can you have a burden? I can't because the return is so is an X. I'm using 10x. Sorry, return is 10x.

Coach JPMD  1:04:04  
Yeah, and I've truly believe it starts in medical school. Because yeah, it I remember a an intern telling me as a third year student, if I wasn't sicker than the sickest patient on this ward, my butt better be here at 4am Changing dressings. And I looked around I'm like, Wow, this I'm sick patients here. And so if I'm listening to him, and he's one that's grading me, he doesn't care what I'm going through. He doesn't care. He just wants me there regardless of what's going on. That's not showing love.

Pariksith Singh, MD  1:04:37  
No, no. And you're right. And the stress in medical school is you know, my eldest child is in medical school the stress they are under, because we have created medical the medical system as a as a system of carrot and stick.

Coach JPMD  1:04:56  
Command and control

Pariksith Singh, MD  1:04:57  
Command and control 

Coach JPMD  1:04:59  
Steve Covey says it right, right. In his book, trust and inspire. 

Pariksith Singh, MD  1:05:05  

Coach JPMD  1:05:06  
So there's you could have the command and control style of leading 

Pariksith Singh, MD  1:05:09  

Coach JPMD  1:05:10  
Or trusting inspire, leading, and

Unknown Speaker  1:05:14  
It's very stressful medic medical school is very stressful, but we're not helping it in. And we made it very painful. But that's, I mean, we were talking about student debts earlier and 250,000-300,000 debt you've got, you better be very motivated to become a doctor. Yeah. And one reason why one physician who committed suicide was his debt, it was a million dollars in the hole. And he had no way out, he could not his practice would not make the money that he needed to pay off the debt. And, and, of course, then the emotional pain and all the thing about failing himself, and all that guilt comes. But that should never happen.

Coach JPMD  1:06:00  
But it's also it's written at the borrower is a slave to the lender. 

Pariksith Singh, MD  1:06:06  
It's true. 

Coach JPMD  1:06:07  
So if you owe someone money, you become that person slave until you pay him back. 

Pariksith Singh, MD  1:06:13  
That's true.

Coach JPMD  1:06:14  
You will be beholden to him. And whatever he tells you to do. 

Pariksith Singh, MD  1:06:16  
That is correct. 

Coach JPMD  1:06:17  
And so the quickest way to get out of that is to get out of debt as quickly as possible.

Pariksith Singh, MD  1:06:22  
Yeah, yeah. And then that's why they have to be successful. 

Coach JPMD  1:06:25  
Yes. And that's why we need to teach them. 

Pariksith Singh, MD  1:06:26  
Okay, that's another pitch for your show.

Coach JPMD  1:06:29  
Spiritual habits, because now we kind of, don't tell them the spiritual aspects of what are your spiritual habits? And how do you feel that those habits are helping in longevity.

Pariksith Singh, MD  1:06:45  
So I've been very fortunate since medical school, I was I had two educational paths as I entered medical school, one was medical school proper. One was medical school proper. And the other was literature, poetry, art. And through that coming into a world of spirituality number nine, say spirituality, not what I was very nondenominational. I didn't go for any, you know, partisan or parochial system, I just wanted to know how to approach myself, how to approach the truth to the capital T. And so that journey allowed me it gave me that space, so that medical school did not become the biggest thing in my life. And despite multiple failures in life, although I don't claim to have suffered as much as so many others, that kept keeps kept me going. And so reaching a point, one is contentment, but to also looking at every moment as a new opportunity, every moment is entirely new. Dropping the past, not being hung up on the past, or projecting into the future, living in the present, living in the glorious now. And seeing the beauty, the enormous potential of life, the joy of everything that life gives you the joy of being yourself, joy of friendships and your family enjoy of taking care of patients. I've derived more from my patients than they have taken from me. That's simple. I'm just not ashamed to say, when I see a patient, I get more. They're getting they're short getting shortchanged, they don't know that I won't tell them. But it's all well, yeah, but you know, hopefully not many will patient will be listening to this. But it is the truth, you know, 90 year old guy looking in your eyes with that, with that sinking feeling that he's losing control, and you talk to them, and you strengthen them, and what is the value of that, and I see my own parents at that age. So somehow or the other I see a similar situation. So who's getting more. And so I think we have to go back to the fundamentals of being a human being and being a doctor. And if we can find that point where I'm not going to pitch for any religion or any denomination, but learn from our greatest spiritual teachers, if we can find that point of compassion, point of love from point of caring, just deep caring and deep listening. And being in the in the present, being available, being open, being aware, that itself is a path towards spirituality, I think.

Coach JPMD  1:09:42  
Yeah, and I think if someone is listening to Dr. Singh right now, and is considering medical school is considering going to school I think you have to understand that the the wisdom that's in what he just said, because if you don't have that compassion, and if you don't have that in you Maybe medicine is not for you, if you're going into it for other reasons, because a lot of people say, oh, I want to go in because I want to be the certain best surgeon, but you have to go in and to help people and be compassionate and, and love people. But if you don't, and you're doing it just because you want the prestige of being a physician, and you know, then you're going to burn out, because you're not going to get that

Pariksith Singh, MD  1:10:22  
yes, yes, true, that is true. You there is a fascination with the subject. You can love the subject deeply, then better go into research the or go into a non clinical side. But on the clinical side, where you're going to touch people every day, every 5-10 minutes, then you have to have that, that joy out of meeting people. And if you don't have it, you have to realign yourself. Now, I'm not saying those who are doctors leave your field, if you don't get that job, we need to make sure that they have the joy. And oftentimes the negativity that this pressure, the stress of being a doctor that takes them away from the joy of being a doctor.

Coach JPMD  1:11:07  
Yeah. And so that's why we're doing this is to show them how to get rid of that negativity, how to manage the practice, how to increase your revenue, how to do things that are going to help you remain in that joy.

Pariksith Singh, MD  1:11:19  
Yes, and financial success is an important thing. If you're under stress all the time, when you can meet your bills, you're not going to be happy, no matter how spiritual you want to be. So a hungry, stomach, find will find it difficult to be spiritual. But if you are, you have sufficient and you're not prone to too much greed, then you have a greater opportunity towards finding that contentment, finding that inner happiness in the heart, that joy is critical. I think, if you have to define spirituality, to find the spirit in things and the spirit and life, whichever way you take, take the spawn spirit can be the, you know, the Exalted, Holy Ghost, or spirit can be just the essence of a thing like the Greeks. And that itself is fine. If you can find that joy out of the touch of things, which in Sanskrit is called the rasa. If you can find the joy of every little thing that you do, you're going to discover the bliss of existence and Indian metaphysics says, the world was created out of Ananda Ananda is bliss, ecstasy. So the divine created out of Ananda not out of anger or, or some negative feeling. And so we need to recover that joy. And once we recover, that, if we are happier every day, we are on the spiritual path no matter what name you give it, if you're unhappy, or every day, you're not on the spiritual path. So that is, I think, one way of testing it.

Coach JPMD  1:12:58  
So spiritual, mental, 

Pariksith Singh, MD  1:13:01  

Coach JPMD  1:13:02  
What are some of your practices that you to improve your knowledge base? Because I know that you're a reader, and I gave you a book to trust and inspire actually we mentioned that book. And I think in a week or two, I asked you did you read it? He goes, Yeah, I read it. I'm like, how do you read so fast?

Pariksith Singh, MD  1:13:20  
Yeah, I speed read. I like to read very fast. I love to read. I've been reading since since medical school, I love to read. I'm not an audio guy. I'm not. I love to hold a book. I want to go to the bookstore. I want to open the pages I want to smell or touch it and touchy feely guy.

Coach JPMD  1:13:42  
I'll listen to an audiobook. And then I go in and buy it. Because I'm like, Okay, I want to see through the pages. And I feel it just just as subtle, right?

Pariksith Singh, MD  1:13:50  
You got to make friends with it. 

Coach JPMD  1:13:51  
I think we're too old. 

Pariksith Singh, MD  1:13:53  
It's okay. Old is good. I like oldest is the best. So I like to hold the books, but I read fast. And there's a trick to speed reading if someone gets interested someday. But things that I love, I'll go back. I'll go back and keep reading them. And also find a hobby, find something that you love. Find something where you have a space that is all your own. Whether it's reading, fishing, go to the gym, you exercise, you run the marathon, something that is your own, something that you where you have no stress, but you create your own own challenges and your own dimension, where you are yourself where you are most yourself. And that itself will I think takes away a lot of the baggage of the past we carry too much baggage we need to lighten up and let go of things. Yeah, I love to read. love to spend time with the children. Whenever I can find it. I love to write. I love to talk about these things. You know I am there was a time when I loved To be in theater, but I don't have time for it because that takes a long lot of effort and you have to have a lot of commitment. So the vicariously the way I fulfill it is I read and I write.

Coach JPMD  1:15:12  
So, children, you mentioned children and I'm Serena. So Serena is in medical school?

Pariksith Singh, MD  1:15:17  
Medical school. 

Coach JPMD  1:15:18  
She's at NYU? 

Pariksith Singh, MD  1:15:19  
Yeah, no, she's in USF.

Coach JPMD  1:15:21  
USF. Oh, I didn't realize that. Yeah. Okay. And I'm gonna try to remember his Shawn. Sha Sha.

Pariksith Singh, MD  1:15:29  
Sha Sha has taken is in cameras. He wants to make movies. He does drone photography. He wants to do real estate. He's a real estate Maven. That's, it says everything that I want to do in real estate. He thinks I'm too slow.

Coach JPMD  1:15:45  

Pariksith Singh, MD  1:15:46  

Coach JPMD  1:15:46  
So he's graduated college?

Pariksith Singh, MD  1:15:49  
He graduated his course and in moviemaking and we all have different tastes. We argue about them all the time. But he loves. He has Stanley Kubrick and strategy dry and he loves them and some shared interests. And then there's Lenora. There's Lenora, she's in college.

Coach JPMD  1:16:10  
Where she in college? 

Pariksith Singh, MD  1:16:11  

Coach JPMD  1:16:12  
USF also, okay. I can't really I didn't realize your kids were that much older than mine. And then there's Nathan. 

Pariksith Singh, MD  1:16:18  
There's Nathan. 

Coach JPMD  1:16:19  
And he's still with you. Or is he in college?

Pariksith Singh, MD  1:16:21  
yeah, he's still with us. Yes, he's in high school now. Okay. Fit enough to be my grandfather. But that's how children are.

Coach JPMD  1:16:33  
But he's the last one too. So so he's gonna have he's going to be smarter than all of them probably put together?

Pariksith Singh, MD  1:16:37  
I think so. I think you know, that's, that's what I was told by a physician. If you remember Dr. Lamba, used to tell me that the youngest one is a politician always he knows how to manipulate everyone else and get the best out of all of them. The eldest one is kind of the simple one too trusting. So he says always have three children don't have only two, because they have to learn the politics. And so.

Coach JPMD  1:17:01  
It's your fault that I have four. 

Pariksith Singh, MD  1:17:03  
So yeah, we were competing with each other for a while.

Coach JPMD  1:17:06  
I made fun of you. And then I had my my four.

Pariksith Singh, MD  1:17:09  
It's good, though. It's good to have four.

Coach JPMD  1:17:12  
So physical health. You mentioned this morning, you worked out, what's your workout routine?

Pariksith Singh, MD  1:17:17  
So you know, I got a trainer. And we he does, he makes me do what is called Pio. And it's Pilates and yoga, and intense workouts. I mean, we have sessions, usually 30 minutes, Tuesday and Thursday, and then Friday, an hour. And he just draws out every ounce every ATP molecule there is in me, and that's good for me. 

Coach JPMD  1:17:44  

Pariksith Singh, MD  1:17:45  
I feel energized after after the sessions.

Coach JPMD  1:17:51  
So let's get into politics a little bit. Because I know you're, we shouldn't mix medicine in politics, or what is it a religion and politics...

Pariksith Singh, MD  1:18:00  
Religion and politics

Coach JPMD  1:18:01  
With medicine? But the current climate of healthcare? Where do you see it going? Because, you know, you're talking about loan forgiveness for people go to school and health care where it is now? ACOs? 

Pariksith Singh, MD  1:18:16  

Coach JPMD  1:18:17  
trying to get everyone who have health insurance, what do you think about the current climate?

Pariksith Singh, MD  1:18:22  
So I was told by someone who is deeply involved in healthcare, he says there is no politician in this country who will reduce your benefits in health care, the sole approach of a politician no matter which party they belong, is to keep increasing the cost and keep giving more and more, and they have no concern about how to optimize the cost. They have no concern, they don't even understand what health care on a bigger scale is.

Coach JPMD  1:18:55  
So So I see two things. I mean, those is feed right into what my thoughts are. What are the two biggest expenses in our population? That's hospital costs, and pharmacy costs? Yes. Those are the two things that are not being addressed.

Pariksith Singh, MD  1:19:10  
No, no one no one wants to because they're afraid. 

Coach JPMD  1:19:12  
Is it because of the lobbying?

Pariksith Singh, MD  1:19:14  
The lobbying. So who would remember? I've only two words for you. Remember Hillary 1993 She came with this universal health care platform? And you can argue yes and no, there were good things, bad things. You can you know, that's a different discussion. She was destroyed. They portrayed her as this evil person who's going to take away your rights take away your freedom. Every time of politician tries to do something in healthcare, they get chewed out. So what did President Obama do? He took the safe course. He got to deal with the pharmaceuticals first and the hospital industry first, and then guess who he charged for all his insurance that was offered to the Uh, uninsured? You do you realize who paid for it? We did We did physicians did yeah because then sequesteration, then Medicare payment and then the hit tax. So they were supposed to pass it on to the insurance companies the insurance companies promptly passed it on to the doctors. No hospital took that 2% Cut, because it was part of the negotiation with all health plans that we will not pay for sequestration. So guess who paid for that? Physicians paid for it? The fundamental dishonesty in that whole initiative is what annoyed me. Was it the right thing to do? Yes. Should people everyone have insurance? Yeah, absolutely. Should people who are working have coverage? Do it. But why put it on shoulder on the shoulders of those who cannot protest and notice? Doctors did not protest. 

Coach JPMD  1:20:52  
Wait a minute. Doctors didn't understand. We don't understand what anything in the business of medicine. 

Pariksith Singh, MD  1:20:56  
Of course we don't. Why should we because we are busy taking care of patients while the lawyers and accountants are running our life. Who becomes who are the senators and the congressmen and congresswomen not doctors

Coach JPMD  1:21:08  

Pariksith Singh, MD  1:21:09  
Lawyers. finance guys.

Coach JPMD  1:21:12  
Okay, so I think we're on the same page on this one. 

Pariksith Singh, MD  1:21:14  
Yeah, yeah. I'm always on the same page with you. It's just you missing off a few. You haven't flipped it..flipped onto me yet.

Coach JPMD  1:21:20  
I haven't caught up to you. 

Pariksith Singh, MD  1:21:21  
That's right. 

Coach JPMD  1:21:22  
It's It's, uh, your, your the end of the page. You're a speed reader. 

Pariksith Singh, MD  1:21:26  

Coach JPMD  1:21:26  
There you go. So so in that same line? Yes. You're talking about hospitals? Am I correct? In my understanding that DRGs which are payments paid to hospitals based on diagnosis and diagnosis related groups? 

Pariksith Singh, MD  1:21:40  

Coach JPMD  1:21:42  
Is it tied to the hospital's infrastructure expenses on a year to year basis or cut it at work?

Pariksith Singh, MD  1:21:52  
There are nuances to it.

Coach JPMD  1:21:54  
So let's say a local hospital decides to build a new wing. That's going to cost $50 million dollars to build...don't tell me tell our audience. Yeah, because the DRG is gonna go up because of orthopedic expenses.

Pariksith Singh, MD  1:22:20  
If you have orthopedics, everything else gets paid more. 

Coach JPMD  1:22:25  

Pariksith Singh, MD  1:22:28  
Ask the people who created the system. who were pushed on by the lobbyists who helped them create the system and who are the lobbyists? The hospitals, right? 

Coach JPMD  1:22:37  
Yes, yes, of course.

Pariksith Singh, MD  1:22:39  
What happened during the hurricane? 

Which hurricane?

Hurricane Ian, yeah, yeah, Hurricane Ian. So we had patients children born they said, this patient can this child cannot be discharged in you know, neonate preemie cannot be discharged until he is able to take 50 ML every feed, hurricane comes, you can go home right now. Immediately, patients were discharged to accommodate new patients from other hospitals, admissions from ers dropped for those three days, because the hospital got 60 patients from other hospitals. Now that those 60 patients have been discharged, suddenly the number of admission starts going up. Are you telling me that post hurricane admissions go down for three days? Is this a new study? So humans being humans, systems being systems specially where finances a huge incentive. If hospitals are not going to go empty, so you can fill them up.

Coach JPMD  1:23:54  
So you can fill them up. And then when you fill them up, the payments to your hospital system go up? As if an HMO was contracted with that insurance that house yes. Don't they pay that hospital more compared to the hospital across the street that is not increasing their, their infrastructure or having an orthopedic Institute?

Pariksith Singh, MD  1:24:15  
Most everyone with half a brain will have orthopedics will have general surgery will have other toys other way another way of hospitals increasing their earnings GME program.

Coach JPMD  1:24:26  
yeah, well, we're gonna get we're gonna get to that. 

Pariksith Singh, MD  1:24:28  
So there are a lot of ways to milk this. Hiring your own physicians. What do you think that is about? 

Coach JPMD  1:24:36  

Pariksith Singh, MD  1:24:38  
Paying your own physicians more than the market? What is that about? Even when they're running a loss?

Coach JPMD  1:24:45  
Yeah, because it's a lost leader. It's a they want to admit patients to the hospital.

Pariksith Singh, MD  1:24:50  
You want to fill up the beds. So a perverse system of incentivization has been created across the whole field, and it is biting the country. At the end of it, the taxpayer is suffering. And when we say taxpayer, it's us, it's all of us. Everyone, the whole country is being taken for a ride, no politician to this date, last 35 years, has had the courage to say, This needs to stop has had the gravitas or the leadership that the country would listen. It has the ability to tell the country, this is unsustainable.

Coach JPMD  1:25:33  
So how do we change it? What's the future? value based care? Medicare Advantage doctors owning hospitals? How would you fix it?

Pariksith Singh, MD  1:25:41  
All these are ideas value based care, precision medicine, customer driven medicine, but the costs are not going down, you see that costs are only going up. The drug costs are only going up.

Coach JPMD  1:25:54  
Did you hear about the colonoscopies? The colonoscopies have to be done in the hospitals. If a patient has an AICD? I, I get a Muftah, Muftah sent me a patient and said the patient has had a routine screening colonoscopy at the hospital, like no I'm denying this. I call them he said no, no, no Jude. Because the patient has cardiomyopathy AICD they are no longer paying for the surgery centers to do colonoscopies is it has to do with the hospitals.

Pariksith Singh, MD  1:26:24  
Yeah so this is all manipulated, right? This is this is..

Coach JPMD  1:26:27  
Medicare won't pay for it. 

Pariksith Singh, MD  1:26:28  
Yeah, so some genius. I mean, so this is all cooked up. Unfortunately, I'm just saying it the way it is, is all cooked up. And it is no one is paying attention to what is happening to the country. The cost of drugs, look at chemo drugs. Oncology, it is absurd.

Coach JPMD  1:26:46  
It's not even chemo, it is immune therapy. They're touting everything as immune therapy.

Pariksith Singh, MD  1:26:49  
Immune therapy and just wait for the newer drugs to come in. Yeah. And so how would you control the costs, no one is willing to take on the pharmaceutical industry. So if the VA can control the drug costs, why can't the country control the drug costs, and it's something that people are unwilling to come together about. It's it's sad, we have taken positions, and we've dug our heels without caring about what what is right for the country and sanitation. And the patient.

Coach JPMD  1:27:22  
I mean, these patients have copays, they have to have to be able to afford some of these things, and they can't afford and so they're gonna go without crazy, crazy town. So we're spending more money on Medicare Advantage plans than Medicare itself? Do you think Medicare Advantage is going to continue to grow? Or do you think it's going to, it's going to decrease?

Pariksith Singh, MD  1:27:48  
I think it will continue to grow. There are good things in Medicare Advantage. There's a lot of wastage and Medicare Advantage and it is being abused. And I can say this. And if you look at some private equities over the last year or two years and certain businesses doing their Spax and the value of a patient, I mean it's $150,000 per patient. It's crazy. It's ridiculous doesn't do ...

Coach JPMD  1:28:19  
it's not sustainable. So so the private equity comes in, scoops up these practices.

Pariksith Singh, MD  1:28:24  

Coach JPMD  1:28:25  
What happens to the doctors in three years?

Pariksith Singh, MD  1:28:28  
the doctors have to start all over again. Private equity is not it's not like private equity is coming in taking 10% of your practice and giving you some money that buy 100% of your practice now you have to work for two years after that you're thrown

Coach JPMD  1:28:40  
so what happens is what have you seen happening with those those practices then do they dwindle away? They go back to their other doctors in the community or

Pariksith Singh, MD  1:28:51  
Yeah, so depends on depends on who's who has taken over I mean, look at the big entities that were coming doing Spax two years ago, a couple of them have run out of money. They're bleeding, hemorrhaging money and yet they're valued at two three $4 billion and some of this is public information so I can share with you look at Bright health right health of the last I read was Cigna was going to buy it because it was hemorrhaging money. They had some good practices they had bought in I think the villages and they had some good CI ends and they were good but they went and spent money cin WhatsApp Clinical Integration Network Okay, so it's like an IPA but like an IPA national bigger. Yeah, the new rules are allowing CINs to skirt you know from the stark laws and anti kickback and that's something that's another discussion for another day. But yeah, the new rules are allowing the CINs and making making it help making it easier for them to function. So those entities look at your Oak Street to look at your Clover Health.

Coach JPMD  1:30:13  
But are those are those in the Northeast or non Medicare Advantage prac locations are they are they down here in the South?

Pariksith Singh, MD  1:30:22  
They've down they've done Medicare Advantage we without talking too many about too many, but you can go online and check them out. I mean, we had seen in Miami you know condo healthcare had gone down a SPAC

Coach JPMD  1:30:40  
and so a SPAC so so for those who don't know what SPAC is, can you tell

Pariksith Singh, MD  1:30:44  
us special purpose acquisition companies. So it's, that's another topic that we can talk about. But I don't recommend you do a SPAC, don't do SPACs. I don't recommend it.

Coach JPMD  1:30:54  
too speculative and speculative. Spaculative.. 

Pariksith Singh, MD  1:30:58  
yes. yes. Don't do it. Focus on fundamentals, focus on the infrastructure, do the right thing. If you don't like Medicare Advantage, there are other ways to make money. But don't do this.

Coach JPMD  1:31:10  
Yeah. So but that's what they're doing. That's what all these private equities are doing. They're taking these SPACs 

some bankers, bankers are taking our practices and running them. Physicians are not getting the touch they need. They're leaving the practices. They call us. Can I come and join you? We take them. And then the question is, why did you sell your company? You idiot? I'm sorry. I'm sorry to say this. Why you? You you love medicine? You are doing well with it? What was the immediate need to sell it? While you're still going to practice another 15 years? 

Pariksith Singh, MD  1:31:14  

Coach JPMD  1:31:14  
So now you're going to start all over again?

Pariksith Singh, MD  1:31:16  
Yeah, but wouldn't. Okay, so I'm going to be there on the the devil's advocate and say, Hey, so that's my exit, I'm going to take this money and put it in the bank, and I want to travel the world

Do it. But then you want to you get bored and you want to practice another 15 years. Now what? You're going to start all over again, the way you did 20 years ago, there are better ways to exit so so what's

Coach JPMD  1:32:05  
your what's your exit?

Pariksith Singh, MD  1:32:08  
My exit is a different exit. My exit is multiple meals.  

Meals, okay? 

Yeah. It's, you go to the restaurant, and you're not done with one meal, you're gonna go again, and you're gonna go again, you're gonna go again, and you're gonna keep eating, and you own the restaurant. And you can have maybe some minority partners, and you can have some people with steak holding and, and then,

Coach JPMD  1:32:36  
so a private equity can come in and offer you. 

Pariksith Singh, MD  1:32:39  
Yeah, offer me 

Coach JPMD  1:32:41  
half a billion dollars for access.

Pariksith Singh, MD  1:32:44  
They can offer me, but why do I would? So if I want to have a good time? Right, so I'll sell 10% 20%. So half a billion they offered right? How much did you make? How did you go? 

Coach JPMD  1:32:57  
Half a billion.

Pariksith Singh, MD  1:32:58  
Yeah. So if I sell 10% of it, what else do I need? Why would I sell the whole thing? I love doing what I do. I love it. They're not going to allow me to do a master's program. They're not going to let me do these crazy things. I've been through this before.

Coach JPMD  1:33:14  
Yeah. So So you mentioned master program a couple of times. And we haven't even touched on that. So what is this master's program

Pariksith Singh, MD  1:33:19  
Master's in healthcare, the practical guide a pragmatic approach to being in medicine, how to run the business of medicine, how to either be a physician or an administrator who can manage and

Coach JPMD  1:33:35  
so is this a healthcare? It's an MBA, or is this a...

Pariksith Singh, MD  1:33:38  
Yeah it's a masters in MHC similar to it. I mean, it's a master's similar to an MBA. 

Coach JPMD  1:33:45  
Masters in healthcare administration?

Pariksith Singh, MD  1:33:47  
Yeah. It's called a master

Coach JPMD  1:33:49  
because I mean, I know I'm doing the courses, but I haven't really, we haven't really sat down and understood, at least for me. The end goal is it to have a university? 

Pariksith Singh, MD  1:33:59  

Coach JPMD  1:33:59  
Or just to have the Masters

Pariksith Singh, MD  1:34:01  
We have to have the university 

Coach JPMD  1:34:02  
how did you set a university up? That's just

Pariksith Singh, MD  1:34:08  
how did I set it up? Yeah. How did you become a doctor Jude? Let me ask you this question. This is a very important question. How did you become a doctor?

Coach JPMD  1:34:16  
I went to school I learned to 

Pariksith Singh, MD  1:34:18  
stop. When did you know you're going to become a doctor? 

Coach JPMD  1:34:22  
Four years old, five or 

Pariksith Singh, MD  1:34:23  
four years old? 

Coach JPMD  1:34:25  

Pariksith Singh, MD  1:34:26  
You wanted to be a doctor. 

Coach JPMD  1:34:28  

Pariksith Singh, MD  1:34:29  

Coach JPMD  1:34:29  

Pariksith Singh, MD  1:34:31  
So I'm gonna give you some Indian metaphysics about Indian psychology. Time, we take time as fixed linear, right. And if you've read Einstein and I think you have read Einstein, time is not that linear as we think it is. Time is quite relative. Ninian concept is when the root when the cause and the cause decides to manifest. And the thing has already happened. It's Only Time is only the unfolding of that, cause. Now let me explain that you have a seed, if I give you a seed, and I say, this is a tree, you're gonna laugh at me, this is not a tree, there's no branches, nothing is growing. But I say, Okay, I'm gonna plant it, I'm gonna water it, I'm going to protect it, I'm going to take care of it. And I time I fly you in the future like that movie, you know, back to back to the future. 10 years ahead, what are you seeing? 

Coach JPMD  1:35:43  
It's a tree. 

Pariksith Singh, MD  1:35:45  
So the cause when it's manifesting, then time is only the unfolding of that cause. Psychologically, when we decide you decided to become a doctor, you became a doctor, the rest of your life was an unfolding of that inner seeking. Now, this is an important thing. When you decide that something is going to happen, really, truly, you know, it's going to happen. It's already happened. The rest of it is just an unfolding. So when, and of course, it's not as simple I don't want to make it just, you know, cookie, I'm not doing a self help book here. But understand the how the psychology works. Everything you will do now is focused towards that end, right? Everything you can see, you can connect the dots, I went to school, I planned it, I did my course in medicine, I went to this professor, I did one year of internship I did one month in a lab, then I took botany or chemistry or organic no matter how difficult it was, in your right mind, you will never do organic chemistry. But you did organic chemistry, you went through it because you had to become a doctor, everything, all your energies came together. And then you became a doctor. And so my question is, when did you become a doctor? You become a doctor when you got this degree? Or did you become a doctor at four years of age when you said, I will be a doctor? Now suppose I reverse it? So is the tree a seed? Or is the seed a tree? If you're a time lapse photography, you know, you're that you're those things that you have you time lapse, but the seed is the tree. So bringing that into psychology, your willpower has tremendous impact in the world. What do you envision what you see, you see it, you don't say I'm going to make something and but it's really not you. And when you say I can go on to make it something really deep comes out, then it will happen. In fact, the Indian position is the Indian psychological spiritual position is it has has already happened. Rest of it is just unfolding, you have to have that what we say about faith.

Coach JPMD  1:38:15  
Faith is believing without seeing

Pariksith Singh, MD  1:38:19  
it is already there. Everything now is going to have you're going to do is going to go towards that. So if doctors you know as a forget doctors, anyone once we realize the power of faith of knowing Faith is an inner knowing you know it once you can catch on to that, because we have too much you know, all the static is there. And we are told to distrust ourselves, our education system, our whole culture is cynical. It's just look skeptical beats us up. We have to reach back that ability to trust our own instincts and our own inner knowing. And go back and get rid of all this junk knowledge that we got. And we go back to our inner knowing what is that inner knowing? Once we know that things happen? So University, how do you do that? I don't know. I don't really care. I know it's gonna happen. I know it has happened. People will come people are coming. If they don't come I make them come. Who was that famous theologian who said, sometimes the spirit shakes you. And sometimes you got to shake the spirit. With all due respect to the spirit, but we can make things happen. Shake the spirit. 

Coach JPMD  1:39:38  
That's powerful. 

Pariksith Singh, MD  1:39:39  
Yeah, and I'll get to them was a famous theologian. Great man. I have I used to read them a lot.

Coach JPMD  1:39:45  
Shake the spirit 

Pariksith Singh, MD  1:39:46  
You got to shake the spirit with respect, humbly.

Coach JPMD  1:39:53  
So what's the one thing you could tell a physician such that by telling him that one thing it would make their lives easy and have them not do the unnecessary things that they they're doing in their lives.

Pariksith Singh, MD  1:40:05  
Time management

Coach JPMD  1:40:06  
time management 

Pariksith Singh, MD  1:40:07  
yeah, manage your A time, the B time, the C time, get rid of your seat and get rid of even if your B time just

manage your a time

a time, you know what a time is your most productive time 80% of your work is done in 20% of your time

Coach JPMD  1:40:23  
Pareto Principle 

Pariksith Singh, MD  1:40:25  
Pareto Principle so I added to it I created a sync Pareto Principle obviously, now, if 20% of your work does 80% of your things, find 20% of that 20% is doing 64% of your work. Because 80%, right, are you with me? 

Coach JPMD  1:40:41  

Pariksith Singh, MD  1:40:42  
And then another 20% of that which is 1% is doing 80% of that 64%, almost 50% of your work is being done in 1% of your time. Now, if you can build that 1% of your time and bring it to five, you've already multiplied yourself to 250 Are you with me so far,

Coach JPMD  1:40:58  
most people don't even go to that one thing. So they never get to the 50%

Pariksith Singh, MD  1:41:03  
Again, going back to your core, do what you love most. Do What gives you joy. You'll find your bliss, Joe Campbell used to say to find follow your bliss. Of course, he was a mythology, Mythologian and all that you may agree or disagree with him. But this was a beautiful thing. Find your bliss, similar to our ancient Indian concept of joy, finding joy, you know, let the journey be your reward. So find your bliss and follow it. So that 1% Where you are maximally productive, creative, joyful 50% of your work is being done in that 1% 90 I give you 99% Time off Jude. 

Coach JPMD  1:41:43  

Pariksith Singh, MD  1:41:44  
And half of your work is already being done. What else are you going to do? Delegate? 

Coach JPMD  1:41:49  
But that's part that's part of time management. 

Pariksith Singh, MD  1:41:52  
That's absolutely the part of time management. What was that Peter Drucker, the only management is time management. Remember that famous thing? Well, of course, I had to add something to it. The only management is self management. If you can manage yourself, which just time is intimately involved with yourself, time is not separate. You can manage yourself, you have it made. So that Pareto Principle has to be modified into a single Pareto principle, and that's just a joke. Pareto Principle has to be deepened. And even the essence of that, that 1% gives you 50% of your work in 1% of your time, grow that. And you're going to multiply yourself at several levels, happiness, time, exercise, meditation, spirituality, mental health, writing books, reading books, climbing, hiking, whatever, you know, you whatever you soccer, and you will find you, you can grow that 1%. And then all you have to do is make that 1%, your 5% You've already cloned yourself, you're doing two and a half times the work that you were doing before. So anything is possible. Who is that Bernard Shaw, right? Remember George Bernard Shaw, people look at things and say ask why. I look at things that never were and ask why not? So beautiful.

Coach JPMD  1:43:23  
That'll be that'll be the title of the podcast.

Pariksith Singh, MD  1:43:26  
I look at things that never were.

Coach JPMD  1:43:29  
So this was great. I mean, I've gotten more out of this than I even imagined. I guess I envisioned this to be like this is almost two hours by the way. Sitting here is crazy. But we're not done.

Pariksith Singh, MD  1:43:42  
What what is time?

Coach JPMD  1:43:44  
What is time 

Pariksith Singh, MD  1:43:45  
time itself is a relative phenomenon.

Coach JPMD  1:43:49  
Or if loves to listen to this podcast, honestly, I think it is by Barry Weiss and at the end of her podcasts. She goes through a rapid fire of questions. And you're only allowed to answer the one answer one word 

Pariksith Singh, MD  1:44:02  
one word?!

Coach JPMD  1:44:03  
One word or a few words. 

Pariksith Singh, MD  1:44:05  

Coach JPMD  1:44:06  
so ready for rapid fire. 

Pariksith Singh, MD  1:44:07  
Oh my god

Coach JPMD  1:44:07  
I haven't done this yet. This is first time 

Pariksith Singh, MD  1:44:10  
first time 

Coach JPMD  1:44:12  
favorite sports team.

Pariksith Singh, MD  1:44:14  
Indian cricket team. 

Coach JPMD  1:44:17  
Favorite book. 

Pariksith Singh, MD  1:44:21  
The life divine. Or you wont relate to it. 

Coach JPMD  1:44:25  
Last book that you read. 

Pariksith Singh, MD  1:44:26  
Last book. I'm reading the Rigveda 

Coach JPMD  1:44:29  

Pariksith Singh, MD  1:44:30  
Rigveda the oldest literature of mankind

Coach JPMD  1:44:38  
first thing you do when you wake up in the morning

Pariksith Singh, MD  1:44:45  
Be quiet.

Coach JPMD  1:44:48  
What time do you wake up?

Pariksith Singh, MD  1:44:52  
Three o'clock. Three o'clock. 

Coach JPMD  1:44:54  

Pariksith Singh, MD  1:44:54  

Coach JPMD  1:44:57  
biggest pet peeve in medicine And in general, something I like irks you.

Pariksith Singh, MD  1:45:07  
Mm hmm. That's a tough one. I don't have any 

Coach JPMD  1:45:14  
You dont have any pet peeves?

Pariksith Singh, MD  1:45:16  

Coach JPMD  1:45:17  
Interesting. Favorite animal.

Pariksith Singh, MD  1:45:21  
Dog. Right now. 

Coach JPMD  1:45:23  
favorite child.

Pariksith Singh, MD  1:45:24  
Oh, ugh. I'll go the safe route. The youngest one. 

Coach JPMD  1:45:29  
Oh, now you really gonna get them upset at you.

Pariksith Singh, MD  1:45:32  
They all know I'm partial, but the youngest one plays with me tells me that I'm partial to the words the eldest one, but I think the eldest one will understand. Its safe.

Coach JPMD  1:45:42  
Oldest age of your, the age of your oldest patient?

Pariksith Singh, MD  1:45:48  

Coach JPMD  1:45:51  
First job. 

Pariksith Singh, MD  1:45:54  

Coach JPMD  1:45:54  
Your first job was a teacher

Pariksith Singh, MD  1:45:57  
yeah, I was in medical school. I used to go in loved teach in middle school primary. Yeah, I used to love teaching.

Coach JPMD  1:46:05  
Most important character trait and someone or some someone else.

Pariksith Singh, MD  1:46:11  
Happiness. Oh, is my can I change? Gratitude?

Coach JPMD  1:46:17  
Graduate? Okay. Political Party, US political party that you're affiliated with. 

Pariksith Singh, MD  1:46:23  
I'm an independent.

Coach JPMD  1:46:25  
I thought so.

Pariksith Singh, MD  1:46:27  
I could go libertarian. I could go green party. I don't know, depending on positions.

Coach JPMD  1:46:34  
And I haven't done this before the podcast. So I haven't done this. But I'm going to ask you to ask me a question. If you have one for me. Please be nice.

Pariksith Singh, MD  1:46:48  
ask you a question 

Coach JPMD  1:46:49  

Pariksith Singh, MD  1:46:52  
When would you have a million followers to practice impossible?

Coach JPMD  1:46:59  
As soon as a million followers sign up?

Pariksith Singh, MD  1:47:02  
Ah, but is that? Okay? Can I follow up with a question? Is that a goal?

Coach JPMD  1:47:09  
I'm not follow. I don't have a goal. 

Pariksith Singh, MD  1:47:11  
No goal 

Coach JPMD  1:47:12  
I have my goal is to reach as many people as I can that I can influence.

Pariksith Singh, MD  1:47:16  
Good. So good goal. I think that's better than having a million followers. It's better to have say 100 who are deeply immersed in what you're seeing and got impacted then have a million followers. Okay, that's a better round. It's a great answer.

Coach JPMD  1:47:29  
Dr. Singh, thank you so much for being on the practice impossible podcasts. Our last edition last last episode of the season. And there'll be more and you'll be invited again, by the way.

Pariksith Singh, MD  1:47:42  
It's my pleasure. I just love it. I especially loved the rapid fire