Dr. Sunjay Mannan: Why Health is Wealth

June 15, 2023

Wealth Advisor

Episode Transcript

Welcome to EWA’s FinLyt podcast. EWA is a fee -only RIA based at Pittsburgh, Pennsylvania. We hope all listeners of this podcast will benefit as we deep dive into complex financial topics that we will make simplified for you.

And we hope that this really serves as a catalyst so that you can make the best financial planning decisions for your family and also save time. This week’s episode of the FinLyt podcast, I’m joined by Sanjay Manan.

Sanjay is a family medicine doctor here in Pittsburgh and he is the founder of Health Is Wealth, which is a concierge medicine practice also here in Pittsburgh. So we’re gonna talk about his journey through residency, working for a large hospital, and then ultimately why he chose to start Health Is Wealth and why he believes that concierge medicine is a better alternative to medicine within a large health system.

So if you’re a physician and you’re considering starting your own private practice, stay tuned. We’re gonna go into detail about how Sanjay made that decision and what went into that, making that big jump.

Sanjay, thanks for joining us today. This week we have Sanjay Manan. He is a physician here locally in Pittsburgh. He is also personally my doctor. We have a close business relationship and friend relationship.

So excited to be here and dive into some interesting topics. I appreciate you, Jameson. It’s, we’re gonna have some fun today for sure. Sanjay, give us what we need to know from your early years, childhood up till age 18, that we need to know to understand you Sanjay is today.

I think with anyone, it’s nice to go one generation back to kind of figure out who they are. So first generation Indian American grew up in Southern West Virginia. My parents were from a state in India.

up and job. And dad is a metallurgical engineer, kind of an old school Indian guy. And my mom is a computer programmer who works at Marshall University. And so they definitely, they try to keep us close with kind of a conservative bring up, but then you walk out the door and you’re in rural West Virginia.

So it was an interesting place to grow up. And then to try to get out of the house a little bit. I know my mom wanted me to go to Marshall, but I was a bit of a trader. I went to West Virginia University for exercise physiology.

So kind of tried to get out of the lab a little bit and chose exercise fizz where our labs were working out and nutritional, making nutrition plans and things like that. It was pretty fun time. And then undergrad after that went to MedSquad WVU as well.

Did you, that’s interesting. So the diet and nutrition is in a segue into exactly what you’re doing now, but did you know you wanted to go to med school? I think You can you know immigrant parents from India you had one or two options It was literally like okay, you’re gonna be an engineer or you’re gonna be a doctor and I definitely gravitated towards Math and sciences which didn’t help me narrow it down with those two But then just the long -term relationships and talking to people I enjoyed that so that kind of led me into To medicine and then when did Know you’re definitely a very good you have a lot of very good Like I guess I could say network just like relationships with a lot of just different people very good at that So how so that’s interesting segue then into like family medicine what you do now?

When did you know that you wanted to go into that specialty? So for me it was a process of elimination and even when we talk to med students now We have med students from Drexel rotate through our office some of them don’t know what they want to do And so we just kind of reassure them I reassure them that hey It’s okay in your third year not to know get through your third year and know what you don’t want to do And so for me I kind of knew that I didn’t want to do surgery Then you narrow down population.

So do you want to work with kids? Do you want to work OB? Gine, which is a specific population? And I found that I once I knew I wasn’t surgical. I really liked everything I shadowed with a couple of family practitioners and when you look at their schedules, they’ve got an 18 year old well visit and then a 65 year old visit So you’re never bored and you have to be comfortable not knowing everything Not being the expert in the room, but then engaging that patient and establishing rapport So I like that about family medicine and then I also liked the opportunities outside where When you get into your career, you can work in a hospital you can work outpatient you can work in an urgent care could start your own business and see all populations.

So that not being bored doing the same thing every day, that kind of attracted me to family medicine and then that process of elimination. Cool. And then just being able to connect with people and actually being like face to face, talking to patients.

You’ve got about 20 minutes to establish a trusting relationship. That’s interesting. About the most important part of that person’s life. So yeah, it’s, you definitely have to develop. We had a lot of good mentors in doing that.

That’s such a great skill. I mean, any, a lot of careers, business, that’s such a good skill set being able to like quickly develop a relationship with somebody. So what mentors you mentioned, like what, how did you learn that?

What helped? So there were a couple of docs that I followed early on and the first five minutes of the patients visit just had nothing to do with medicine. Really? Like it really was like, oh my god, the summer, the weather, the sports team, whatever it is.

You just open up with something that has nothing to do with why they’re there. And it’s just so comforting to know that you can just talk like bar stool to bar stool, basically, instead of sitting down and getting right to like, OK, this is what your labs were.

And like, let’s talk about it. That’s interesting. We’ll talk about in a bit some of the pressures put on for production as a physician and being able to. So I guess I’m making an assumption here. It’s probably easy to fall into like, hey, I’m here.

I’m going to get this patient announced quickly as possible. But that five minutes of developing the relationship is so important to the relationship building of the patient. So that’s an interesting paradox, which we can get into in a bit.

Sure. OK, so undergrad, med school, WVU, and then residency, that’s how you ended up here in Pittsburgh. Yes. So I met my now wife, who is also a family physician in med school. And so we had to choose an area that had a lot of family medicine residency programs because she wanted to be in the same field.

And we were also two years different in training. And so Pittsburgh allotted that’s a great opportunity for that. So there are five or six Pittsburgh family medicine programs. And so we chose Pittsburgh geographically also because she’s from Jamestown, New York, and I’m from Southern West Virginia.

So 79. Grandparents are close enough. And then my younger brother, who’s now going to be an obstetrician, is in Morgantown, which is an hour and a half south. So we had everybody pretty close. So family medicine at Forbes Regional Hospital, one of the key in choosing that program is it was an unopposed program, which meant that you’re the only.

residence in -house if something is called. So when you’re shadowing with a surgeon, there are no surgical residents there, you’re the only one. If you’re in the emergency room, there are no ER residents there, you’re the only ones there.

So you definitely get, I think, a higher level of training being the only residents in -house. You got to do more, do a lot of different things. You’re not competing for your education. So if somebody’s looking into programs, I would recommend unopposed programs for family medicine for sure.

And then let’s talk about rate in that timeframe. So you’ve worked with Matt starting out, and then obviously EWA for a long time now. And so through that residency transition from a financial standpoint, let’s talk about first why you’re in residency and then the transition to attending.

So we talked about, talk a lot about, I know you like talking about the money temperature. What’s that like going from? not making any money to then you sign your first contract financially and psychologically to now all of a sudden you’re making you know four times the amount of money.

It’s obviously crazy to see the amount that then all of a sudden is hitting your bank account and you think about all the things that you could use that money for. I’ve seen residents that then go into attendings and they’re buying you know boats and they’re going from their four -wheel their sedan to like a luxury sedan or they’re taking all kinds of trips but one thing that through EWA is the plan and keeping it simple especially when with a marriage we had no idea how we were going to do our finances as far as joint accounts not joint accounts credit cards who takes care of what and so keeping things simple and forming a plan has probably been one of the most valuable things for us going from residency to to attendings like you think about a financial advisor you think about okay stocks and bonds and how are they going to manage our assets but with EWA there was a level of comfort and managing finances and really your life because you think about when it comes to marriage or anything finances can be a pretty one of the the top reasons there can be turmoil and it’s not your wife’s plan or your plan it’s your EWA’s plan for you and you both can kind of agree with that so it’s kind of a cool thing yeah i think the statistics like finances over it’s over 50 or 60 of American families say finances are the number one stressor in their household and we don’t even think about it i mean it’s like between Katie and I there’s there’s literally no thought about what our plan is not the execution of the plan is still up to us but what our plan is there’s no conversation in our house as far as what’s like literally none.

Now we may think about, okay, how well are we executing this plan? But what we’re going to do, there’s never a question. And it was based off the plan that Matt drew up in 2015, 2014. I mean, it’s just been the same plan.

So it’s kind of a review on it. Do you feel like financial stress is like, it’s probably never completely going away, but like for the most part between- It’s the only stress we have is execution. But what we’re going to do, which is often a lot of your stress, right?

You have two- Decision fatigue. Exactly, like are you making the right decision? Are you on the right path? Then you try to seek other advisors. You talk to family member, you talk to the guy on the street, what should you know?

But we always know what our plan is, which has been so reassuring. Yeah, great, appreciate the feedback. So what advice would you give a resident? We don’t, yeah. We don’t work with really any residency anymore, but point to this podcast, Financial Literacy, give financial literacy back to all listeners.

What advice would you give to somebody that’s in residency that’s getting ready to make that jump financially or any advice at all that would help set them up to get into a position like you are where you don’t have financial stress?

So I would find someone who could make that plan for you early just again, because that takes that stress off. You’re going to be so busy in your training that you’re just not going to have time to think about stocks or bonds or what the market is doing.

So having that plan of like, this is how much you’re going to put in your IRA, starting off a residency. There are a couple of tricks that I’ve heard of like filing extensions so that you can put more into an IRA.

I don’t understand all the details with that, but that was something I told my brother to look into from a tax perspective, like extending your tax year, because then you could put more into an IRA. You might know about that.

You can’t, no, you won’t be able to put any more and you could fund it later. If you extend it, so like if you put, if you haven’t, okay, so basically as a resident, obviously you’re not making $50, $60 ,000 a year.

So you may not have been able to fully fund like a Roth IRA for the year, because that’s not very much money to live on. So if you extend your taxes, you can contribute to it past April. So if you’ve made three of the $6 ,000 for last year contributions, then you extend it, then till October you can make the other $3 ,000.

And so this is a perfect example of where as a resident, you might see an article or someone else might say, hey, I’m doing that, and then you need that person to go to to like clarify what is it and then how to execute it.

So those are things that I’ve told my brother to look into after hearing that when he was in residency. One of the main things would be just to keep things simple and live close to where you’re gonna be.

to be working. So I saw residents that were living in Pittsburgh and commuting to Monroeville and they thought, hey, Pittsburgh’s got so many things to do. I can walk around and have tea in the morning and this and that.

But it’s like your life is going to be residency. Just get an apartment or a townhouse that’s right next to the hospital. And basically your life’s going to be stressful enough. Don’t create any more stress living far away, commuting in traffic.

Yeah. You know, we had a great behavioral therapist at Forbes Family Medicine and he always used to say it’s amazing how difficult people make their own lives. And that’s just one example of that. Like if you’re going to be working somewhere and you’re going to be working long hours, just get a spot near there.

Simplify it. Yeah. Yeah. Okay. So then you started a residency and then you since have, which is what I want to dive into, spend a lot of time on, since it started your own, Concierge medicine practice.

Two years ago, a year ago? Yeah, 2022. Okay. Title, I love the name of it. Health is wealth. Before we dive in that, let’s just, yeah, first off, why two questions for you to answer this, why did you choose to name it that, and then tell us about why you made that decision to start a Concierge medicine practice?

So health is wealth comes from something my dad used to say just all the time. He actually had quadruple bypass at like the age of 49. He was a super healthy guy. I mean, your standard Indian sport, he rocked badminton two or three times a week, wasn’t on any medication, and his first sign was that he was just short of breath and he couldn’t walk as many miles as he used to walk.

That was his sign that something was wrong. He goes in and they’re all like, well, we’re putting you into a surgery, you’ve got quite, you know, a coronary artery disease. So after that time, in his low 50s, he just started to say it around the house all the time, your health is your wealth.

That’s awesome. And as an engineer in a computer program or I think a lot of immigrant families might be able to relate, a lot of their money still goes to take care of their families in India. So he was one of 10 siblings, agriculture based family.

So not only was he taking care of us and making us feel like we could get anything we wanted, but he was sending money back to India. And so it wasn’t really even a fiscal thing for him. It was really just, hey, there comes a time in your life, no matter what’s in your bank account, that your health will be your wealth.

And how much you can enjoy your wealth will 100% be determined by your health. And so that just kind of stuck with us and it stuck with my brother too. So Sanjay, as you made this, you’ve made this transition to starting concierge medicine practice.

What advice would you give to physicians that are, you know, employed by a hospital and they want to be in the private practice space, but they’re kind of debating, you know, Should I do this? Should I not do it?

What advice would you give? So I think some of the mentors that kind of pushed me, that we talk about risk when you’re starting a new business and physicians should just remember their value and that their skill set is always going to be needed.

And so the risk of your venture failing is that you just go back to being your primary care provider or you go back to being a cardiologist or you go back to being a pulmonologist. So the risk really depends on one thing for me was like my partner who’s also a family physician just said, hey, she’s a team member, she’s a rider.

Hey, I’m gonna go to full time, you go to part time, we’ll try this venture. If the venture doesn’t work, you’ll just go back to being a primary care provider. So one contract ends, you take some time to build your business and then someone in Pittsburgh still is gonna need a primary care provider two or three years from now.

you choose to go off and do it. So as physicians, there’s less risk when it comes to starting your own venture. Because you’ve went to four years of med school, went through training, and it’s like now you have this very high value skill set that is always going to be needed in demand.

You can always go back to what you were doing before if you want. Yeah, that was one thing that actually led my father to kind of push me towards medicine was as an engineer, he was employed and his patents were owned by the company.

And whenever the company was bought by another company, there were cuts and people were fired. And then another company bought it and they were fired. And so job security in the medical field is something you don’t necessarily have to worry about.

There’s always going to be a need for whatever type of physician you are. So eliminating, just mentally eliminating a lot of the risk and just doing it. And then having that partner has been invaluable in that, okay, you have this dream, you have this mindset of this goal, what you want to do with our family and how we want to live our life.

Sure, I worked part -time for a couple of years while you were full -time. Let’s switch it. I’ll work full -time. You take a crack at this business. And then I think you’re in a similar situation. A lot of people don’t make that jump because if you pursue public service loan forgiveness, you have to be employed by a non -profit.

Obviously, if you’re in private practice space, you’re not employed by a non -profit. You’ve navigated that by still being employed by a HN working the qualifying hours. What’s your thought process around that?

Did you feel, did you and do you feel tied to the hospital for loan purposes? So yeah, there’s two parts to that question. Number one is knowing exactly what the financial risk is with each decision.

So you walked us through the numbers from the get -go that, hey, if you don’t do loan forgiveness, you make 20 years of payment, you’re ultimately going to be taxed on the amount that’s forgiven, which is a huge number.

Now, as we know, there are government influences and political changes that could happen that that may not be a thing. You don’t want to rely on that either way, but you always want to know your risk, which was invaluable.

So then it kind of comes to kind of like your personal ideology, which is like, okay, I’m 36 years old from 36 to 39, which is how many years I have for loan forgiveness. Those are still years of my life that I’m never going to get back that time with my kids.

And now my kids are young, they actually want to hang out with me. So yeah, I could use my loans as a ball and chain and say, I have to work in this job, whether happy or not I have to work in it because of my loans, or I want to take this risk and do this business.

And then you ask yourself, how much money are you going to make in your business venture? So your loans may not be agreeing to sand in which you’re, you’re, you’re going to profit maybe or what you may be making with your business.

So I think there’s a lot of things you want to think about as far as do you know your actual numbers? How comfortable are you with debt? And then kind of like that, I’m never gonna get these years back.

When we’re young, we have a lot of earning potential. So it’s less daunting to me that ball and chain. Some people have student loans and they pay them off within five years because they can’t stand the thought of having debt and the thought of having to pay more by stretching out over years, they just can’t stand it.

And then other people just doesn’t bother them. I just, I don’t think about it. Like I think about after I get home from work, what am I gonna be doing? So it sounds like from what I hear. So obviously knowing, just as a financial advisor, it’s obviously important to know the financial risk in making a good financial decision.

But on the flip side, you’ve kind of adopted the mindset of like, so you are still employee HN, so you’re still gonna be able to get the loans through. But if at any point you know the number of like, here’s what the business revenue would have to be to merit.

Walking away. Walking away and just paying the loans off where it’s like a net even financially. And then that gives you peace of mind to make that decision. I think adopting, like you’ve adopted kind of the abundance mindset of like, that’s not gonna limit you because you could just say, I’m gonna just gonna work harder and make more money too than pay off the loans if I did wanna go that route.

Sure, sure. And then let’s say, you know, the venture doesn’t go through, which you never wanna think about. Three years from now, if I decide, hey, this is something I don’t wanna do, then I go back and work for a nonprofit for three years and they’re forgiven at that time.

But then six years from now, I would be looking back, like, did I take that venture? Yeah. Like, did I take that leap? The iceberg is splitting. Did I put one foot forward and let it split or did I take the step?

You probably would be more upset with yourself. You played out six years from now and you didn’t make that business venture. You’d regret it versus you’d… do it, it fails, then you go back to it. You probably would get more satisfaction in that scenario because you’ve at least tried it, you don’t regret not doing it.

100% because there’s also a timing involved too as far as like concierge medicine is relatively new to Pittsburgh. And when we see the challenges of the modern medicine model, somebody is going to come up with these ideas of how to bridge the gap, how to make medicine 2 .0.

So if you if you see this, hey, no one’s doing this right now, let’s try it. Yeah, you want you want to do it now. Awesome. Yeah, this is such an interesting conversation because I think like, so if you ask somebody, like, what does it mean to be successful?

That’s like a different definition to every person. But by nature, you think that like, you see these people that we deem as successful, they, you know, they’re billionaires, like they make a ton of money.

And like, reality is like, Sure, that some people may say that that’s successful. Like to me, personally successful is like being very healthy, being mentally, physically healthy and money is just like, yes, money is a support system to all of that.

But if you’re so focused on accumulating what we say is like wealth and money and your health suffers or maybe success to somebody or wealth is spending time with your family or being going on adventures and traveling all these things, then like that’s really not wealthy per se.

Absolutely. And then as we age, obviously, some people say it’s the go -go years and the slow go. I mean, just to think about how healthy you are during those years and how to maximize that. We think about maximizing health span over lifespan.

There’s a pioneer in the field of longevity, Peter Atiyah. We try to talk about a lot. We try to take a lot of his principles and just pass them on to other people. And he’s he indirectly probably mentors so many physicians in choosing what they tell their and guide their patients and what they hammer home.

And just this idea of pushing off disease as far off as possible and preventing disease. So that’s something we try to do. Okay, we’ll dive into that in a second here. But I love the name health as well.

I think that’s, I could not agree more. But why did you decide to start a concierge medicine practice? In starting concierge medicine, you have to see how far the patient experiences come in medicine already.

So you have access to your doctor via your my chart that you could send them a message. You have 24 seven video visit capabilities after the pandemic that you can jump on and make a visit. So patient experiences come a long way.

So with the concierge model where trying to figure out how can we take that to the next level. So patients are still commuting to see their doctor, which takes up some of their time. They’re in a waiting room.

They’re kind of governed by the 20 minute, 15 minute appointment slots. So basically, when I was doing outpatient medicine, I thought, hey, we can do better than this. And we saw that patients wanted more.

And that’s where the concierge model, which is not new, by the way. It’s a little bit new to Pittsburgh, but that’s where we thought, hey, let’s bring in here to Pittsburgh. Interesting. Yeah, I think a lot of big decisions just from talking to other people and listening to podcasts, other people’s stories.

I think a lot of big decisions like that come from, hey, I’m doing something, but this could be done better. And you almost have to go against the grain a bit, because it’s like traditional medicine is telling you to do what you were doing before.

And you said, hey, I’m going to try to find a better way to do this, which is. which is really fascinating. Yeah, and I think sometimes a catalyst in that can also be a negative experience that can say, hey, that’ll give you kind of the push out the door.

Wasn’t there one of those? So I think with corporate medicine model, that like we were talking earlier, there’s a lot of pressure to see volume and growth when you mix business and administration with medicine, there’s always this clash of medical doctors wanna spend more time with their patients.

They wanna do less administrative work as far as documentation. So there’s always this clash. And so the other thing is that you’re, where you practice your medicine is at the hold of your corporation.

So they may say, hey, we’re gonna put you in this office. And then based on a certain metric, another office is doing poorly. We need you to go over there and help that office. So there were instances where I was moved from office to office.

And when you enter medicine, you wanna be especially family medicine, you wanna be that old school family doc that you go to the grocery store, you go to the high school football game, it’s like, oh, Dr.

Mannan, you have this great long -term relationship with your families that you take care of. And when your practices move three or four different times. You can never do that. And then your patients are then following you from location to location.

So their patient experience goes down and you being their PCP. And the idea from a network is that that patient is not yours. Yeah, it’s the hospitals. That patient is that network’s patients, right?

There’s no doctor. The doctor -patient relationship is there, but ultimately it’s this network’s patient. And so that was kind of my catalyst for, okay, I don’t want anyone to tell me who my patients are or how long I spend with my patients.

So on a typical day, working for a network, I might see 22 people a day. On my constigated days, I might see one or two patients a day. I’ll go to their house an hour and a half to two hours, spend that with them.

Somebody comes in with a grocery. list, they want me to look over it, I do that. Yeah, their high school student, the son wants me to look at his weightlifting program and how can he put on five pounds?

You can do that. So you leave that experience that two hours with that family so rewarded. And then you spend your time documenting on the one to two patients you had that day instead of the 22. Yeah.

So that’s interesting. So yeah, I mean, just from working with so many physicians, like the con you literally have our VU targets and you’re compensated on volume. So it’s not good or bad, but it just makes I would assume makes it difficult to give that personalized.

Like you can’t see a patient for an hour when you, you know, your paycheck relies on how many patients you see. Yeah, I think a lot of times you’ll see patients having bad experiences with physicians.

And I always wonder what the situation was. So Oftentimes, like we were talking about, a doctor has 22 patients to see for whatever reason one or the other party is late and that just, that the whole day can then go into a spiral of being late.

Typically your lunches are spent doing administrative time. You’re doing catching up on your notes, you’re responding to your MyChart messages. So with the concierge model, you text your doc, you call your doc directly, the concierge physician may have 50 to 200 patients that they’re taking care of, literally.

And in a corporate medicine model, you’re talking about 1500 to 3000 patients. And so that in itself is going to have a patient experience where if you send a MyChart message to your doc, there’s going to be several layers of screening.

Ancillary staff is going to be screening those messages, which one should actually reach the doc because the doctor isn’t being paid to do MyChart messages. There’s no revenue generated in MyChart messages or returning phone calls or doing prescription refills.

So all the staff is trying to offload that and work as a team with the physician. And so that is taken away from the concierge model where you just have direct access. Okay, two things to there. One, I’m going to plug you because obviously I’m a concierge medicine patient.

And I think it’s exactly what you said. So same thing with why people work with a financial advisor is to eliminate decision fatigue. I’m going to use an analogy for an advisor. Realistically, you could go online, spend hours researching.

You could figure out what to do with your investments. Same thing with medicine. You wouldn’t be, you’re not consulting a doctor, but if I spent hours and hours and hours researching, I probably could find a solution to something medically.

Is it correct? You’ll have no idea. You’ll have decision fatigue. You’ll consult people. But having that go to the doctor, you know, is a good thing. person that I can call you with a random, I’ve asked you some pretty crazy ridiculous questions, but calling you with that question on the spot and just getting that immediate decision affirmation saves so much of my time.

And then I don’t have to go to an office anymore. And before, you know, I was driving 30 minutes to go to your office and then 30 minutes back where it’s like, now it’s like, call you, get something done, it makes my life 10 times easier and then I can focus on the things that, you know, actually matter, like working with my clients and doing the things that I enjoy doing.

And it’s been a total, just total life changer. Honestly, I think, I think, uh, yeah, big proponent of concierge medicine for sure. Well, God, God, I appreciate that, James. And I think one thing that’ll be interesting for people to notice is how young and healthy you are.

And you’re still finding value in the concierge model. Yeah. Because one of the biggest things that people say is, well, I’m too healthy. Like, or I’m, why would I, you know, pay a membership fee or get a concierge of medicine physician because I don’t go to the doctor very often.

And so the fact that someone as young as you are, that is as healthy as you are can still find value in the questions that you have that are health related, that’s it’s something. So two components to that.

And this is what the second thing I was going to say based on what you said a couple minutes ago was like seeing 3000 patients or whatever the number is like that answers my one of my questions would be why like how can people be more proactive?

I’ve always felt medicines very reactive as in like you’re not get you’re not getting a test done until you have a symptom which then it’s too late and it’s like it’s just very reactive and so that makes total sense.

So you know if you’re working with 3000 patients like that’s why. And so I’ve it’s helped me so I’ve seen some just personally like family health stuff and then it’s kind of driven me to be like I would be super reactive about super proactive about this.

Super proactive about this from a young age and just like I ask you all the time like what are things that like what are things that I could be doing now that people don’t do you know for 20 years just to make sure that we’re like ahead of the curve.

And that has helped me so much one just giving me peace of mind that like hey we’re screening for everything possible we’re doing all the tests like I get a ton of like once a year we do like intense blood testing which like a 20 somebody in their 20s it’s not generally doing that and so it’s helped me just get peace of mind that you know we’re on top of things and I’m also prepared like I like to I just have like an optimized mindset optimize my health optimize make everything as efficient as possible and so being able to optimize that has just led to like I said you know being able to spend time with doing the things that I enjoy and that you know really matter and it eliminates that stress just like ideally our relationship with clients as a financial advisor eliminates financial stress.

I have one thing that you brought up is like so once a year we do blood tests and it’s extended. I want to point out that the blood tests we still do are still very evidence -based because that can be one critique of a concierge model or even executive health in general is that let’s say you’re the CEO of a company they pay for an executive physical for you.

So that executive physical is anywhere between five and ten thousand dollars. You get sent to the Cleveland Clinic or some other large specialty clinic and there are all kinds of tests that are run on somebody maybe in their forties that they don’t necessarily need to have done.

And in that testing there can be incidental findings which then cause mental stress for that person. And if anything is positive those doctors are ultimately going to say go follow up with your PCP about this.

And then you go back for your executive health physical the next year. So there’s less continuity of care often in executive models that focus on this executive physical. It’s like, hey, we’re going to give you this benefit.

We’re paying for it for you. You’re going to go and you’re this executive and you’re going to get the special physical. And often it’s tests that are very expensive that you actually don’t need. Whereas if you had continuous, your goal may be to lose weight or something else that requires a higher level of touch, a higher frequency of communication.

It’s much more personalized to your situation. For sure. For sure. Rather than, okay, here’s a blanket executive physical that we’re getting for all of our. So it’ll be interesting to see how executive health involves over the next.

Because those executive physicals don’t necessarily reduce your sick days. You’re still having to call someone or go to a doctor’s office if you get sick. So there are studies that show that there are a lot of incidental findings and it’s not evidence base and it doesn’t actually reduce sick days.

So it’ll be interesting to see how that evolves. And then one other story I want to tell about just finding value. So we work out the same trainer. And so he was doing, we did like an intense, I did like a body fat scan, super detailed myself.

And it was, I wanted to be, I had this just belief in my head that I was like, oh, I’m like, I want to be single digit body fat. And so it comes back. I was not single digit body fat. And I called Sanjay like freaking out.

I was like, I need to like lose body fat. This is crazy. And he just kind of just kept peeling the layer back. Like why, why, why? And so I thought about it. I was like, that’s like stupid. It’s such a stupid metric.

Like I’m obviously like, my general health is great. Like why do I need to, it’s like a meaningless metric. So being able to have like, just, I guess my personality is worrying about things that are like just trying to like over, overdo it and worry about things that like don’t really matter when they’re out.

is like my current body fat, my general health would be like probably five X better than it would be as a single digit body fat. Undoubtedly, for sure, unless you’re preparing for some type of meat, like body building meat.

And then even those body builders would tell you that the way they feel on those meat days is often not very good. They can’t wait to get out of that phase of training. So for sure. Yeah, so Sunjay talked me off the ledge and it was point of it is just having somebody to have that decision affirmation and challenge your, honestly, somebody challenge your thought process and your beliefs to question what you’re thinking and really dig a layer deeper has been super helpful.

Okay, so a couple of things. We’ll dive into some more health stuff here in a second, but let’s talk about, so now you’re on this entrepreneurial journey, we’re still a physician, but now you’re building this practice.

I’ve found, so even like financial advisors, a lot of good advisors are. very horrible business owners because I mean even if think about it the analogy of like if you own a gym You start out as a trainer and then eventually realize oh I could turn this into a business and you’re like you’re really good at personal training But you never taught how to like run a gym and so any industry you could find this analogy But so going from like physician actually being a practitioner now to business owner is You’re still doing both both things obviously you’re seeing patients, but what has that shift been like?

So I think the shift there was a little bit of understanding the business of medicine when I was in private practice with that group just listening to their leaders talk I’ve tried to keep it very simple with that transition as far as just a profit some profits and losses What’s my overhead?

What’s the number of patients I need to hit to make up my salary for what I’m currently doing part -time? So just trying to keep it very basic the word entrepreneurial is an interesting one because when I hear that I think of someone who’s capitalizing on like a market and it with the game of making a profit Where I think I had this mindset was just having more control Just having more of a say like it bothered me if there were a group of people In a meeting that were making a decision about my day -to -day life, and I wasn’t at that table So I think that’s that’s the word entrepreneurial now means to me that you’re at the table Yeah, you’re at the table about that discussion Like somebody once said that I think if you’re if you’re not at the table you’re on the menu So that entrepreneurial side for me now is that I’m always at the table when it comes to decisions about My life as far as how much I’m going to work or going to earn So that was the shift not necessarily I didn’t go into concierge medicine thinking that okay.

I’m gonna make a a whole bunch of money. Grow this big enterprise. No, it was more like, okay, through this, I can get more control over my life and do the things I wanna do. Care for my patients the way I wanna care for them.

So that’s where, hey, like an hour and a half visit, however much the patient needs, I could go to their house, I’ve only got maybe one or two people I’m gonna see that day. That to me is priceless, aside from how much I might bring in that year.

Interesting. Has it been a different, have you had a different skill set that you’ve had to learn of the business side of things? So I think the skill set now is all the ancillary members of my team since we’re small right now.

For instance, I don’t have a schedule. People often ask me, like I say, so H -I -W, so health as well. You say we, who is we? And I think I just feel uncomfortable saying I. Yeah. But for instance, right now, I am my medical assistant.

I am my front office. I am the telephone that’s always ringing. So I think maybe as we grow, we may look into ancillary staff, but the biggest adjustment for me is staying organized with, OK, how am I going to keep these appointments straight every six months I’m seeing this person?

This person wants to be texted every week to remember to stay hydrated and to stay within their budget. I got to remember to be on them. So every patient is so personalized in what they want from the concierge model.

And so how I deliver that has been the biggest adjustment. And we learn so much from our patients as far as what they want and how they find value in the service. So for instance, we have one family.

The family is in their 50s. And so they’re dealing with aging parents and decisions to make for their parents’ health. They don’t have relationships with the primary care providers for their parents.

Like you’re saying, they can look up online all they want about their parents’ medical conditions, but they still won’t know whether they’re making the right decision. And so they will call often and we will give them, advise them, as to like you are making the right decision based on the things that you’re telling me about their health.

Or we’ll go as far as calling the doctors for their parents to have that discussion and get more information for them. So how much bandwidth does it take for that individual as an executive who’s trying to manage this company?

But then he knows that, hey, something’s going on with mom or dad that I got to make this decision. So we offload all of that from them as well. So learning from our patients as far as what their needs are has been pretty interesting.

So that’s kind of the adjustment. So let’s get some just general health tips for anybody listening. Let’s start with, and since you’ve been so helpful with giving me a lot of health advice, if we were to like, I love the 80, 20 analysis.

like what’s like 20% you can do that make up 80% of the results. What’s like 20% health change or like just smallest health change that like most people could make that would have a huge impact on their life?

So we can start with just like what would make a huge impact on someone’s life? So number one is gonna be exercised. If you’re looking for a pill that’s gonna reverse disease, that’s gonna lower stress, that’s gonna improve sleep, that’s gonna hit all every check every box, it’s gonna be exercise.

What we found is when it comes to longevity specifically, it’s not going from, a lot of people think you have to do a lot, like you have to do resistance training and you have to do cardio and you should stretch, you should do all these things and do them every day of the week.

It’s not going from three to five days that’s gonna make the biggest difference or from five to seven days. It’s not for those elite athletes who are trying to take their eight minutes split to a six minute split for their miles.

What we found for longevity, the biggest difference in health actually comes taking people to like the 30th or 40th percentile out of everybody. So getting someone from the couch to even just exercising one or two days a week.

So a lot of times with patients, I’ll talk to them about like a loss aversion. That whole idea of like, when you tell people what they’re missing out on, what they’re losing, it can motivate them. I can tell people all day, like, hey, if you work out, you might lose weight.

Well, it’s not going to do anything. But if someone doesn’t work out right now and I say that, hey, even once a week, if you worked out once a week, that would be 52 workouts in a year. If you don’t work out once a week, you’re losing 52 workouts.

How better would you, how would you feel if you just did 52 walks for 30 minutes, whatever it is. So that first quartile and then being active the rest of the day, go for one vigorous walk once a week and then stay active the rest of the day.

Even something like that can improve longevity as simple as that. I think Peter, Tia talks about this a lot, like walking is actually like, if you just said like, what’s the exercise that will improve longevity?

Like literally going on a 20 minute walk. Yeah. We would do it. Well, I love also when he takes it to the next level of rocking. Yeah. I now have two or three patients and I’m talking about these, these women are like mid 70s, never worked out a day in their life.

And they come to me and they’re so excited at their next physical. They’re like, doc, my son, he Amazon me a rocking vest. So I have this one, this one patient. She has a weighted vest and she’s gradually increasing the weight, five, 10, 15 pounds.

And all she’s doing is walking around her neighborhood. And now we’re showing that that can increase bone mineral density because it’s, it’s adding weight and tension on her lumbar spine and her hips.

So walking with weight, rocking. So when he talks about walking and then advancing it for bone mineral. density with that rocking it’s just kind of cool stuff. So basically my takeaway is just if you’re not doing anything, like just do something and you don’t need to.

I’ve adopted with extra less is more like I could get a 10 minute workout in if I’m super busy that day and like that’s still beneficial. And actually you with your wearables, that’s I mean that’s kind of interesting with either whether you have the aura ring or the the whoop bracelet or a drapple watch, you notice that your recovery and your heart rate variability and a couple of other metrics actually improved when you were working out less.

Yeah, we can tell that. Yeah, I’ll get into this. I am like obsess over my whoop probably a little bit too much. I’ve had this conversation with some other doctors of like, yeah, but then it gets to a point where like just in conversation like, oh, you know, then you obsess over it.

Is that good or bad? But I actually so for basically for two years, I was going to a gym that was like classes and it was like. like treadmill weights. It was like an intense workout, like 500, 600 calories you’d burn a day, doing that five, six days a week.

And then just with my busy lifestyle, that’s fine in my opinion to train like that, but then you have to sleep eight hours, you have to make sure you’re eating spot on, you’re recovering. And so I noticed I wasn’t eating enough, I was sleeping enough, but not to recover on that rigorous workout routine.

And so all of my whooped out of HRV, my recovery, all this stuff, I noticed was not getting better. And so we sat down and analyzed it, and we realized, okay, I’m overtraining, I’m not eating enough, I’m eating healthy, just not enough.

And then on that workout routine, I just sleep more. So I totally shifted it. And now I fit it into my busy schedule, where it’s like I’m maintaining the same amount of sleep, which is still healthy.

I’m just diet didn’t change, it’s just making sure I’m eating enough. And then now I’m exercising, I have two long workouts per week with my trainer, but then outside of that, it’s just quick 10 to 20 minute workouts, whenever I can fit it in my schedule.

It’s been like, to directly answer what you said, it’s been my HRV has increased significantly, like all of my actual trackable data is there. Yeah, absolutely. So the number one thing like we’re talking about is exercising, and we see the biggest difference in longevity in that first, getting people to the first quartile.

Interesting. So the second thing actually kind of relates to finance, which is knowing your budget. So if you don’t know your basal metabolic rate, if anyone takes anything from this today. This is it, yeah, you’ve helped me with this, it’s just so helpful.

It’s just go online, calculate your basal metabolic rate, use the sedentary number as your basal metabolic rate and manipulation of that budget, how many calories you take in. is literally all, that’s the number one thing.

The first number we tell people to know is what their budget is. And then from there, we can calculate a deficit if you’re trying to lose, we can give you a surplus if you’re trying to gain, but I’m not worried about your carbon take, your fat intake.

The first thing we do is know your budget. Yeah, that’s been helpful, because like I had no idea and I was under reading and then knowing, hey, here’s like the baseline your body needs to operate and whether you track it or not, it’s just like now you kind of get a feel for how much you, like if you don’t know that, you ever read, I think, a lot.

Just knowing portion control, like how many calories are actually in what you’re consuming. It’s like, big time. You talk about caloric density in food. So we have staff that will have these little Hershey’s things that are sitting there and one or two of those is 250, 300 calories.

And so I have people come in all the time, I’m like, I don’t eat a lot, but what they’re eating is so calorically dense. that is putting them over budget. So often what we’ll do is we’ll have them unadulterated, get an app like Luzit or MyFitnessPal, or just pen and paper, old school, and for seven to 10 days it’s a pain in the butt, but track all of your calories, everything you’re putting in.

And then compare it to your budget, and then most people have that eureka moment, like well no crap, no wonder I’m not losing weight, my budget is 1800 and I’m consistently getting 2200. Well at that rate you’re actually probably gonna gain close to 15, 20 pounds in the next year.

So that budget, knowing what your budget is and doing an unadulterated check, and if you ever feel like you’re not meeting your goals, recalculate your budget. Yeah, so just being aware of, yeah, and I do that with you like probably like twice a year, I’m doing it right now actually.

I don’t want to track my calories all the time, but like for two weeks, Nobody does, nobody does. Two weeks, twice a year, I’ll do it, everything that goes in my body, and then it just kind of helps me calibrate then for the next six months.

And then I’ve found that about every six months I need to just like check it on it. I think just having the awareness has been huge, but so your two big tips would be any type of movement, and then just being aware of what your budget is and what type of food you’re putting in.

Well that’s super helpful. Then anything, okay, so another question, what could people do to be more proactive versus reactive with their health? So the first thing is that once a year, annual physical with your primary care provider and having the conversation of what is your family history?

Because that kind of guides how proactive we’re gonna be. Okay, Sanjay, so this has been super helpful. What if people want to follow you or find you or learn more about concierge medicine where should they go?

So we have a website, hikonsearch .com. There’s a LinkedIn page, there’s a way to message me directly. through any of those. That would probably be the most effective way. Thanks for joining us today, Sunjay.

It’s been super fun. And like I said, concierge medicine has been life -changing for me, so I cannot promote it enough, but it’s been a lot of fun. Appreciate your for having me, Jameson. And EWA, obviously, like I was saying, in the last 10 years, we have never questioned our plan as far as our finances and financial future.

So it’s been reassuring for sure. Appreciate the feedback. Thanks for tuning in to our podcast. Hopefully you found this helpful. Really hope this is as beneficial and impactful to as many people across the nation as possible.

So hit the follow button. Make sure to rate the podcast and please share with any friends or family members that would also find this beneficial. Thank you very much. you

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