Dr Andrew Greenland: 0:03

Hello everyone and welcome back to Voices in Health and Wellness. This is the podcast where we explore what it really takes to build, grow and sustain meaningful healthcare businesses in today's changing landscape. I'm Dr Andrew Greenland and each week I sit down with clinicians and operators across the health spectrum, from functional medicine to surgery, to talk about the reality, the real world side of patient care, business ownership and everything in between. And today I'm really pleased to be joined by Dr Jason Jones, an orthopedic specialist and the founder of Nashville Knee and Shoulder. His clinic has been serving the Nashville community for over 12 years, with a strong focus on delivering personalized, high quality care for knee, shoulder and other musculoskeletal conditions. So, Jason, thank you very much for being here. Are you calling from Nashville today?

Dr Jason Jones: 0:46

I'm calling from San Antonio today.

Dr Andrew Greenland: 0:48

Okay, wonderful Okay.

Dr Jason Jones: 0:50

Yeah.

Dr Andrew Greenland: 0:50

So maybe start a little bit at the top. Can you just tell us a little bit about Nashville, knee and Shoulder and what inspired you to create this clinic?

Dr Jason Jones: 0:58

So my roots are based in Tennessee. We, so my roots are based in Tennessee. This is a very southeastern story, but I kind of grew up in southeast Tennessee, went to high school, college and everything there, and then moved to New York for a long time. I did all my training in New York and then, when it was time to start a practice, to kind of move into the real professional world, I very much wanted to be back in Tennessee, in the landscape at that time. We're very large groups.

Dr Jason Jones: 1:28

There's not a lot of hospital focused physicians, at least in the orthopedic world in middle Tennessee, especially in the Nashville area. So in order for me to kind of pave my own way, I started a small clinic. It was initially just me and one other physician, a gentleman that trained at the same hospitals as me, just, you know, 15 to 20 years prior. So it was just us for you know, about 10 or 11 years. And then just recently we've kind of started the next phase of the Nashville Knee and Shoulder Clinic, where we're actually starting to grow and add in some additional clinicians. Right now we're at a total of five clinicians, including our mid-levels, and actively trying to expand across the Nashville landscape.

Dr Andrew Greenland: 2:14

Amazing. So I think you are a rarity when you said orthopedic physician. It's not something we have in the UK. So where's the separation between an orthopedic physician and orthopedic surgeon? Obviously there's the surgery involved, but in terms of the way they work and operate and kind of interface with each other, yeah, that's an interesting question.

Dr Jason Jones: 2:32

When you say orthopedic physician, I think our term would be a sports medicine physician or a non-surgical orthopedist, and there's definitely both of those entities operate. They both exist in the United States. The biggest difference is in our training. Whereas the sports medicine or the non-operative orthopedist will go through three to four years of medically-based training focused on soft tissue injuries, rehabilitation non-operative soft tissue injuries, rehabilitation non-operative means to improve the patient and get promising results, whereas the majority of our training I would think about 60 to 70% of our training is in the operating room or in the surgical world.

Dr Andrew Greenland: 3:20

In the clinical side, it's really about 30 to 40% of what we end up doing during our residency okay, so in terms of what a typical week looks like for you in practice, from clinic hours and managing the clinic, how does it pan out for you?

Dr Jason Jones: 3:35

so I'm in the operating room about 60 of the time. I'm in the clinic about 30 to 40 of the time. Um, seeing that I do own and operate a business, there are some administrative tasks as well, so that takes up, you know, whatever little bits left over. My OR days typically run from, you know, about 7 am to about 5 pm and we do about 15 to, you know, 20 surgical cases a week In the clinic. It's a mixture of my partners or mid-levels sometimes seeing urgent cases acute injuries, that high school football player that twisted his knee so they're managing kind of the more urgent issues. And then we have scheduled follow-ups with myself during my clinic time, which for me is about, on average, about 10 hours a week that I'm in the clinic, got it?

Dr Andrew Greenland: 4:28

Okay, and what sort of population or types of cases are you typically focusing on most today, and how has that evolved over the years that you've been doing this?

Dr Jason Jones: 4:37

So we're called Nashville Knee and Shoulder and it's very poignant. We're very much directed at the type of patient we're recruiting. I do 90% knees and shoulders and that's kind of A to Z in that world. So within the knee world, I'm doing everything from meniscus tears to ACL tears, all the way to joint replacements. In the shoulder world, same idea. I'm doing everything from the more minimally invasive shoulder type of surgery all the way to shoulder replacements and the shoulder world same idea.

Dr Andrew Greenland: 5:06

I'm doing everything from the more minimally invasive shoulder type of surgery all the way to shoulder replacements all right, and how do your colleagues complement them and do they have a different sort of skill set, see different things, or are you focused primarily on anything to do with those two joints as a team?

Dr Jason Jones: 5:21

we we have kind of divided and conquered. I have a partner that just does hips, I have a partner that currently just does non-operative sports medicine, and then we're actively kind of recruiting to fill in some other gaps, such as hand surgeon or foot and ankle.

Dr Andrew Greenland: 5:41

So you're going to become fairly holistic in terms of treating the whole body at some point with your team.

Dr Jason Jones: 5:46

We are, yeah, but we're piece-milling it together right now. But we have taken the specialist approach where we all stay in our lane, do what we think we're really good at. For me, that kind of lives in the knee and shoulder world, for my primary partner, dr Ferguson, that's just hips, and then we're filling in the gaps in between. So we want to provide the best quality care at what we think that we are the absolute most qualified at doing.

Dr Andrew Greenland: 6:15

Amazing. And what shifts are you noticing in the orthopedic field today, either from a clinical or an operational perspective, or a patient expectation standpoint? What are you kind of seeing?

Dr Jason Jones: 6:25

Yeah. So orthopedics is changing quickly. Orthopedics has always been evolving because orthopedics gives physicality back to patients and that's especially in our at any point in our life and especially in our later years. That might be the most important thing is giving the patient the ability to be active and do what they want to do, and the way that we've accomplished that is changing. And if you rewind 40 or 50 years ago, it really was more based off mechanics. So if there's a problem with the joint, we're going to mechanically fix that joint. If your joint is broken, we put a plate and screws on it to fix that. If you have arthritis, so the end of the joint is worn down, we'll resurface that joint and put a new metal surface on it and allow the patient to resume. You know a improved and much less painful. You know speeding up is there's a lot more focus on conserving joints, being a little bit more conservative and maintaining the integrity of the joint as long as we can. So saying that in a different way, we're not trying to push directly to joint replacements, where we we would like to try everything in between. So if the patient has arthritis, we might start with some sort of injection and even when we start talking about the injectable world.

Dr Jason Jones: 8:00

There's so many options for injections. You have the tried and true injections, such as steroids, which which have a place but have kind of very much kind of fallen out of favor in the mainstream. You have things that have some data behind them, like hyaluronic acid, but then you really have the more regenerative type of medicine and the more regenerative type of injections that are starting to become well-known within the community. Patients are coming and looking for these and the data and the potential capabilities of these injections just seems to be improving as the science behind them improves. And when I talk about those injections most specifically in the clinic, we use PRP, which is platelet-rich plasma. We use BMAC, which is a bone marrow aspirate. Those are the two primary ones that we use and these are kind of stem cell like dots. Stem cells is an incredibly confusing term, um, but, but those are the ones that are most accessible and easily used, at least in the united states. So those injections have a much bigger place than they did 10 years ago, um, and patients.

Dr Andrew Greenland: 9:07

Do patients have an expectation? You know they arthritis. They're coming in with the expectation of having a joint replacement and are they receptive to these other more conservative, preserving treatments, or how do patients perceive this?

Dr Jason Jones: 9:22

Patients tend to know what they want when they come in, which is also, I think, another shift that I've seen, where patients come in almost asking for a service now more than they did 10 years ago when they came in looking for a diagnosis. I think there's a lot more self-diagnosed patients, if you're following my train of thought here. So a patient comes in with knee arthritis. This is an incredibly common visit for me, so the way that conversation typically goes is hey, you have knee arthritis. It's this on a scale from one to 10. So let's just say it's a five on a scale from one to 10, which is not how we medically would diagnose arthritis, but it just makes sense to a patient. So that's your diagnosis and what options do we have? What treatment modalities do we have to treat that? And some patients are at a point in their life where they've dealt with this problem long enough and they just want it to be over with.

Dr Jason Jones: 10:17

And those are the patients that tend to seek out just a resolution or a cure, if we can call it that, and that tends to be the more aggressive approaches, such as the knee replacement.

Dr Jason Jones: 10:27

Or there's a whole other half of our patient population that would want to do everything possible to avoid a knee replacement. Those are the patients that sometimes will clean the knee out with a camera, which you know that varies wildly from patient to patient on the effectiveness, but it is an option. Those are the patients that we might go down and try a few injections with. Those are the patients that sometimes we do the in-between surgeries, the surgeries that exist between the kind of very basic sports medicine injectable world and then the total knee arthroplasty world. And that's a space right now, like the kind of in-between arthritis world that we don't have a good solution for. And it's just that the world is just waiting for a surgery to come through, I think, and change that game to bridge the gap between the patient that has that kind of five out of 10 arthritis that's limited but isn't quite ready for a total knee replacement, and do you have on your team things?

Dr Andrew Greenland: 11:32

like physiotherapists or manual therapists, to sort of support and integrate with what you do, or is it primarily orthopedists?

Dr Jason Jones: 11:38

Well, we have physical therapists that very key component of what we do.

Dr Andrew Greenland: 11:43

Okay, what about pandemic and how that affected things for you, and has it changed sort of patient behaviors and expectations after that whole pandemic thing settled down?

Dr Jason Jones: 12:03

The pandemic it caused a in America. So when the pandemic hit there's a lot of just uncertainty. They're a very you know kind of worried and scared population. So the practice of medicine, at least in the private sector for what I do, which is elective procedures, you know nobody has to have a knee replacement the access in the patients seeking that care dropped off significantly because everybody kind of went into like a duck and cover type of mentality. The hospitals themselves became extremely busy. That affected us somewhat, but not nearly as directly as the frontline medical providers, not nearly as the ICU doctors and the emergency room physicians.

Dr Jason Jones: 13:00

So our patient population it kind of it changed for a short time while patients just made sure that the world was going to be okay. And then when they came back, I think the biggest differences were there's a big focus on telemedicine. That very much changed during the pandemic. Patients wanted to have Zoom type of consultations because that became a real valid way to have patient interactions and that stemmed in the United States from the pandemic and this wasn't really to the pandemic. But in the last five years just really the emergence of AI has changed the way patients gather their own information and that's changed a lot of patient interactions because they will come to me with data they're showing. They're showing me data that they've discovered and asking this is this is what I have, this is what I know. Help me make sense of this. And and that's not necessarily a direct cause of the pandemic, but that is very much something that's changed in the last four to five years.

Dr Andrew Greenland: 14:18

Interesting. Are you seeing more cases related to sedentary lifestyle? I don't know how aging and sporting injuries are playing in these things that you specialize in. I just wonder where you've seen any trends in this direction and how that's kind of altered your model of care the sedentary lifestyle.

Dr Jason Jones: 14:34

I, I'm a, I preach activity. Um, my whole job and philosophy is focused on on being out, doing things, doing the things you love, because if you're not being active, your body is actively declining and that becomes more and more important the older we get. So do I see injuries from sedentary activity? Absolutely, it's the patient. I mean, one of the most common injuries I see is the 40-something that decides to go play basketball and hasn't played in 10 years and tears their Achilles, tears their patellar tendon, like this. This happens surprisingly often, um, and that's a form of sedentary lifestyle, absolutely.

Dr Jason Jones: 15:20

I think the other end of that is, you know, the patient in their seventies that has just kind of lost the motivation or they live with a degree of pain that prevents them from being active during the day and that leads to a type of physical decline. I also think it leads to a type of mental decline when you lose that ability to do what you want to do, to be active and to pursue hobbies and activities that you love. And does that lead to joint problems? Yeah, it does. Disuse of your joint leads to active thinning of your bones, loss of some of that structural support. It leads to muscle wasting and all that plays into degeneration of joints. I think, more than people sometimes realize, one of the biggest protective agents of our joints is actually muscle strength, and I think physical therapists have known this for you know centuries. But that's something, I think, that gets overlooked with general medicine fairly often.

Dr Andrew Greenland: 16:25

And presumably your work includes sort of exercise prescriptions and everything else to try and keep people out of trouble and also to optimize them when they've had any particular surgery that they've had done.

Dr Jason Jones: 16:35

That's correct.

Dr Andrew Greenland: 16:36

Yeah, interesting. What about staying up to date, sort of clinically and strategically? Obviously, orthopedics is a huge speciality and I know you've narrowed down on a couple of joints, but you and your team are covering more and more. How do you guys keep up to date from from in this, in this kind of ever-changing world?

Dr Jason Jones: 16:52

it's hard? Um, it is, and you so? It's funny because I actually am lecturing today on this exact same topic like what? Like how do I stay up to date on certain in my world? It's implants, like what? Because there's so many options, there's so many vendors, there's so I think that's worldwide, but especially in the United States. So how do I stay up to date on what's changing, either technically, which is, you know, a surgical technique, or with the types of implants that I'm using, you know, in patients in surgery? And it's changing rapidly, not one from a business perspective, but secondly, just from patient demands. Patients are looking for quicker recoveries, they're looking for smaller surgeries, they're looking for better outcomes, and those are three pretty bold requests. And, amazingly, like medicine does continue to progress and for the most part, every year there's some sort of advancement in my world that changes the game, so to speak. So how do I personally stay up on it?

Dr Jason Jones: 17:57

The most common way that I will look into or potentially adapt a new technique, a new treatment for a patient, a new implant for surgery, is discussing with my other colleagues. So a lot of this is communal. I discuss what my shoulder surgeon friend in California is using versus what my friend in New York is using and when they have a good experience with the product they've noticed a quicker recovery, they've said that it's easy to use Then I look into it. That is probably the most common reason that I start to look into a new technique or new product. The second most common reason is if just data supports it.

Dr Jason Jones: 18:40

It's rare, if ever, that I'll even consider using something that doesn't have some sort of peer-reviewed data behind it.

Dr Jason Jones: 18:48

So if there's and I read the orthopedic journals, you know, fairly regularly so if there's something that seems to be changing with the dynamics of care, potentially improving patient care, and if there's a series you know one or two potentially more trending articles that kind of show that this, hey, this is potentially a difference maker, that's something I definitely look into and whether or not I implement that, that's kind of the third step of this. So I I have ideas from colleagues, from journal articles, sometimes just from the community, I implement into my practice after doing my own research. And then the last part of it is how do my patients do? So generally I see how a treatment does over the course of six months, let's say kind of doing them on a basis that I wouldn't say limited, but just very particular about the patients that I'm using the treatments on, and then I evaluate how those patients did and if there's an improvement, then it's something that I consider incorporating on more of a regular basis into my practice.

Dr Andrew Greenland: 19:56

So this whole thing of using colleagues and journals and all the good stuff that we do in medicine, it is hard to keep up and, like you said, the rate of change in all specialities. I mean, my day job is emergency medicine and then I do functional medicine as well, so I've got double the amount of things I've got to keep my eyes and ears open for. So I think you're right, chatting with colleagues and all those things are the only way we can really stay afloat with all the sea of information that we're kind of bombarded with. But interesting to hear how you do so. What's currently going well for you in Nashville, knee and shoulder, from either a business or patient care perspective, or both. What's going well? Yeah, I mean the practice is going well.

Dr Jason Jones: 20:41

Owning a small practice is difficult, especially in the ever-changing landscape of the United States healthcare system. The benefits that I have are the ability to kind of run, operate, make my own decisions. If I want to incorporate a new system into practice, I can do it. If I want to change locations, expand locations, pursue a different patient population, but there's no limitations on what I am able to implement in the medical world based out of a small practice.

Dr Jason Jones: 21:19

The difficulties, though, are being a little guy. My ability to communicate and to negotiate with insurance companies is somewhat limited. We've been able to do it, but it's much more difficult for me to come to an insurer and say hey, I have, you know, n is 1,000 here. Like I have 1,000 cases and I need for you to change my rates in some degree for this 1,000 cases, whereas the hospital comes and they're like we have 1 million cases. So the insurer is not nearly as interested in working with a small number that has a very small change on the whole ecosystem as they would be just working with a hospital system and potentially making one change that affects what would considerably be a thousand of my clinics. So that's the difficulty.

Dr Jason Jones: 22:12

The other difficulty is keeping up with the current technological landscape, because the technological side of healthcare is shifting rapidly. That involves improving EHRs, but right now, in the moment we live in, it's the development of AI and how AI is kind of it's on the doorstep of taking over small medical practices, not in a bad way I don't mean to take over in a negative effect but just to implement it in a small medical practice. Even midsize medical practices. It's there and we're kind of at that stage where the implementation part is starting and everybody is not really sure what the best route to go is. You know, what is this product worth? How do we use it like? What does this mean for our employees? So that that's a current challenge that we're working with.

Dr Andrew Greenland: 23:14

So my next question was going to be specifically around sort of bottlenecks and challenges, and you just mentioned about the whole insurance thing. I think every conversation I've had with North American practices the insurance thing has come up. So have you got a solution? Have you found ways to kind of ease that rather bumpy path or relationship's?

Dr Jason Jones: 23:33

the relationship with insurers is very third party. I don't have real direct communication with the insurers. Everything kind of runs through portals and billing submissions. So the it's a tricky landscape and that ensures that it's a business they're trying to make. You know they are looking for a profit. So sometimes there's a direct conflict between patient care and being paid and that can be tricky to navigate.

Dr Jason Jones: 24:23

You know, as a clinic our first allegiance is always to our patients.

Dr Jason Jones: 24:25

But you know we do have to have some kind of like financial security to run the office. We have rent, we have infrastructure to support, we have employees and that comes from our payment system, which is the insurers. So when we negotiate with insurers it's generally a six to nine-month process of just discussions, kind of back and forth on you know what's worth, what like how do we handle certain you know, either emerging treatments or even just, you know, changing how we've handled past treatments or kind of the more tried and true treatments. And then the other side of it is sometimes being judged by the insurance company that you know this was worth it. Like you checked these boxes, like you know we'll pay you for this, and then sometimes the opposite happens. You know we're not going to pay you for this, and our recourse, when we don't get the answer we want, is generally sending in some sort of you know, rebuttal or following denials is what my biller would call it, and it's a slow, tedious and sometimes unrewarding process.

Dr Andrew Greenland: 25:42

Yeah, I'm hearing the same thing from so many and it's something we don't really have in the UK. So I find this whole thing very interesting, but it seems to be, almost like a universal challenge. So, speaking of numbers from another perspective, were there any particular business metrics or performance indicators that you, as a business owner, operate on, whether that's patient related things or things related to running the business per se?

Dr Andrew Greenland: 26:05

Numbers as far as patient encounters or Just in general, the metrics that you want to keep an eye on, as a business owner, in your practice.

Dr Jason Jones: 26:13

Yeah, I mean, I think the most common thing that we really look at is just our new patient volume. I think as long as we have a healthy new patient volume, then everything else seems to fall into place. The workload theoretically should continue to increase if we have the same new patient volume because we have our established patients returning. But you know, every month there's, you know, 100 new patients. So that just, I think, resembles a healthy practice, a growing practice, and as long as we see that, then we can continue to kind of slowly evolve the clinic, which is the stage that we're at right now, to grow in regards to administrative staff, as far as providers and then as far as honestly just services offered.

Dr Andrew Greenland: 27:08

I was going to say so you say you're growing in terms of healthy patient throughput. Are you managing to keep up from a sort of staffing and systems and admin perspective in your clinic?

Dr Jason Jones: 27:21

We try. It's a changing landscape and when you make a technological decision in medicine, it's a big deal. If we adopt an electronic health records system, it's a big deal. It's going to affect your practice for 12 months. It's a very costly financial investment and it will change the way the clinic runs fairly drastically for 12 months and it's very hard to undo. So any decision we make on the infrastructure and the technological part is incredibly well researched and thought out because it's a very big commitment. Well researched and thought out because it's a very big commitment.

Dr Jason Jones: 28:02

From that standpoint, are we able to keep up? I don't know if anybody's able to keep up. Things are changing so quickly. We do the best we can with the information we have and try to make the best decisions, but there's literally something new out there every single day. That is that is intended and promises improved, you know, clinical function, either for your administrative staff or the physicians. Um, so to to weed out what's real, what's not real, what's valid, what's what's invalid, like it's, it's gonna be tricky, um. So I think we do the best we can interesting.

Dr Andrew Greenland: 28:37

So if you were starting Nashville Knee and Shoulder again tomorrow, what would you do differently, based on what you've learned in your experience over the last 12 years or so?

Dr Jason Jones: 28:47

Tomorrow. I think that the way that we built this practice was really focused on people, that the way that we built this practice was really focused on people. Um, which is in some ways I don't know if this is true, but like it's somebody that almost feels archaic that you build a practice off of people. Um, because everything now is is is focused on removing human interaction. Um, and when we started this practice, like, we kind of handpicked like honestly, I was handpicked by my partner at the time, who, who was like this is the, he has the personality, he has the work ethic to fill this role, and then, from there, I began to handpick out employees, and those employees have committed to the practice and helped grow the practice, and we couldn't have done this without them. It took everybody being on board. It took a whole lot of heart and a whole lot of hard work and a whole lot of attention by a lot of handpicked employees to make this grow the way it did.

Dr Jason Jones: 29:59

And if I was doing this again right now, I would do the same thing. I think an easy answer is hey, you know you. Just you change the infrastructure from day one. That's an easy thing. Now, because you know one thing I might have done differently is looking back on it now is maybe I would have used a different technological infrastructure, maybe I would have set up on a different part of town, maybe I would have, you know, changed negotiations with insurers or hospitals from day one, like, yeah, maybe like that, that those things might've been helpful, but I think what we really focused on was just building a practice around good clinicians, good people, people that really cared, and that's why I think we've been successful and I wouldn't change a thing in regards to that.

Dr Andrew Greenland: 30:47

I think people are the center of any good clinical operation. So I completely concur with you. If you had a magic wand and you could fix one thing in the business tomorrow, what would that be? And you may have already sort of mentioned it, I just want to really get some sense of what that kind of big thing is for you. You'd love to kind of fix overnight.

Dr Jason Jones: 31:05

Well, yeah, I think the answer for all you know US clinicians is the insurance struggle. We're very much valued, rewarded, um, our ability to provide care is very much directed by insurance companies. Um, not that we can't provide, because we absolutely can always do what we think is best and like, and we that ability, and I think every good physician in the United States is always going to do the right thing at the right time. But they make it hard. They make it hard to run a practice, to provide the care that we want to, and I wish I could change that. I do want to, um, and I wish I could change that.

Dr Jason Jones: 32:02

I I do, because what we're the financial aspect of medicine, the united states it's, it's stagnant for clinicians right now. Um, we continue to be devalued every year from a financial standpoint, which is hard when you're at an inflationary period. That's been going on for four years at this point. The cost of living, the cost of running a practice, just keeps rising and we kind of keep being devalued by the payment system, which is difficult. And not to complain too much because we're we're, we do fine, but it just it does make it harder to run a clinic.

Dr Andrew Greenland: 32:48

It makes it harder to run the business side of it yeah, I hear this from every conversation with your colleagues across the usa. This is interesting, everybody having the same kind kind of same challenge and all the things that you mentioned. So where would you like the clinic to be in, sort of around six to 12 months time? I mean, I think you kind of talked a little bit about growth and taking on more colleagues, but any other directions that you're looking to take the clinic in?

Dr Jason Jones: 33:13

No, we're trying to add in a few extra physicians now. That will happen over the next one to two years, because even from the time that we identify somebody until we are able to actually bring them into the system it's very much 12 months there's always licensures that need to be applied for and received. There's planning with, you know, movement for the incoming physician. Sometimes that physician's finishing a training program. So, um, my hope would be within two years we have two new physicians working with us. I think that that's that's our current goal, um, and we are continuing to kind of slowly add locations across Nashville. That's our other kind of more focused directive.

Dr Andrew Greenland: 34:09

So it's interesting. You're saying it really takes two years to grow a new colleague, as it were, from the conception to actually bringing them in, which is interesting. So when you talk about new locations, is this to serve patients in more local communities or the demand for your services is such that you need to expand and you don't have the space where you are? It's both.

Dr Jason Jones: 34:30

Nashville is a very booming and thriving city, which is very fortunate that the population grows. So, just as a reaction to that, there's more injuries. So our clinic continues to grow as well, and then the boundaries of what is Nashville continue to change as well. It's not just kind of this city center, it's the suburbs are rapidly expanding. So when we grow, what I mean by that is, yes, we make more, we increase our ability to accommodate patients at our kind of primary downtown location, but then we add clinics in and more of the suburb areas to go to the patients when needed so that's a satellite clinics and going to other places got it, I understand yeah, yeah and finally, what are you most excited about as you think ahead, in terms of the future of orthopedic care in general in your speciality, in your niche?

Dr Jason Jones: 35:29

the um. I mean I, I love orthopedics. It's um, I. I think activity, the ability to kind of socialize, be active to, to play sports, to go on adventures, I think it's so key to people's happiness. So what's the biggest change in orthopedics right now are focused on improving those outcomes and getting patients back quicker. Now, most specifically, like what is happening, I have to look to the surgical world right now.

Dr Jason Jones: 36:08

This idea of stem cells like regenerative type of injections. It's there but it's not really it hasn't reached its potential yet. There are some other emerging kind of conservative treatments out there. There's some data resolving around exosomes right now, which is interesting. That's just kind of another way to kind of make the body heal itself and I think that that kind of Wolverine type technique where you know the body can like repair from injuries, that's been a focus in orthopedics for 20 years. But is it actually here yet? It's not where we keep making steps in the right direction every year. But I think in my practice is there going to be a time where we can inject a joint and the joint heals itself, like truly heals itself, not that we're removing pain, not that we're providing some kind of temporary relief, that the joint. Truly, I don't think it'll happen in my lifetime. So when I think about innovation, orthopedics and what really is going to make a difference, it really it still focuses on surgery for us. So our ability to kind of go in and very directly and very manually manipulate part of the body to improve the function and, to you know, remove pain and get patients back to activity, that's still during the next 15 to 20 years during my career. That's going to be the route that I'm, I think, able to make the biggest differences in patients' lives. Going to be the route that I'm, I think, able to make the biggest differences in patients' lives. And then what is on the horizon right now?

Dr Jason Jones: 37:50

With surgery, we keep moving towards joint conserving treatment. So there's a lot of more excuse me, there's a lot of more minimally invasive options now for restoring or improving damage to joints. There's a lot of new ideas for treating arthritis and the need that aren't joint replacements. It's kind of that intimate intermediary area that I think I touched on very briefly at the beginning of our conversation. That's what I'm excited about. I'm excited about this like filling the gap between these patients that maybe have just started to have joint pain. Maybe injections work for them. And then the patients that need the knee replacement and this applies to the shoulder too. You can put the same concept and just put the label shoulder on it and have the same discussion. But those surgeries that are going to feel, that are going to fill those gaps, that's what I'm really interested in right now. And what are those surgeries?

Dr Jason Jones: 38:48

Um, something that I'm a very big fan of, which is not at all new, is meniscus transplantation, where you take a cadaveric meniscus and put it in a patient's knee. The ability to use that and the indications to use it in a patient are extremely narrow, but the idea is, you know, we take a damaged structural portion of a patient's knee and we put a new one of those same biological structures in, and that idea just makes so much sense to me in a joint preservation sense. Now, meniscal transplants aren't the right answer for everybody, but there's some new surgeries coming into the market that are kind of substituting, that they're filling that same void that the meniscal transplant fills, and those are things like there's a hydraulic joint replacement which is still needs, uh, some time before it's effective. But this is a new innovation in the last 18 months that it's hit the market. Um, there are some early designs for artificial meniscus which are still having mixed results. But just the fact that that's the direction we're moving, that's what I'll be watching the most closely.

Dr Andrew Greenland: 40:08

So the future is bright, exciting and orthopedics never stand still, is what I'm hearing.

Dr Jason Jones: 40:13

It is. There's always innovation.

Dr Andrew Greenland: 40:15

Amazing. Jason. Thank you so much for your time this afternoon. Really appreciate hearing about what you do at Nashville Knee and Shoulder, your clinical work, the way that you operate and some of the challenges and things that are going on in your business. I think it's a very interesting conversation. I'm sure our listeners are very interested to hear about what you do. So thank you very much for your time. Really do appreciate it. You're very welcome.