Welcome And Guest Context

Dr Andrew Greenland 0:00

So, welcome to another episode of the Voices in Health and Wellness podcast, where we explore honest conversations with clinicians, founders, and innovators who are rethinking how healthcare is delivered. Today I'm joined by Dr. Frank Okerson Jr. Frank is a board certified internal medicine physician and medical director at Brazos Primary Care in Texas, where he spent years treating complex chronic conditions like diabetes, hypertension, and metabolic disease. But what makes Frank particularly interesting right now is that he's reimagining how primary care should actually look. After years inside the traditional insurance-based model, he's transitioning his practice towards a smaller prevention-focused model designed to address the root causes of disease rather than simply managing the symptoms. So with that, Frank, I'd like to welcome you to the show and thank you so much for joining us today. Thank you so much for having me, Andrew. So can you give us a little bit of um background into your journey into medicine and specifically um primary care?

SPEAKER_01 0:56

Oh, for sure. So my name is Frank Ocoson, I'm a board-certified internal medicine physician. I've been a physician, I've been in practice now for 20 years, private practice 11 of those 20 years. Um I've always been attracted to primary care because I like developing longitudinal relationships and following people over time. Um I like curiosity, I like solving problems, and internal medicine gives me that avenue to solve problems. Internal medicine, I deal with a lot of complicated patients, um, patients with um difficult to control, high blood pressure, diabetes, COPD, cholesterol, and uh other conditions. And I have to stay on my toes every time. I have to, about 30 or 40 percent of the medications that I use a lot now on a daily basis are medications that were not available during my residency or medical school. So every day you have to learn something new and keep up with all the changes and advances that is happening in in medicine. So I love what I do in primary care. It's just that I don't love how I do it because unfortunately, with the insurance reimbursement models, the reimbursements are not keeping up with inflation. So the cost of doing business is definitely increasing. So physicians are having to see more and more and more patients, and in the process of seeing more patients, you're not able to go in debt and really get to the root cause of a lot of these conditions that are affecting these patients. So a lot of times you're just prescribing medications, or you're just putting things off, or you're just putting temporary band aids on bigger problems.

Dr Andrew Greenland 2:50

Thank you. We'll come to that business model shortly because I think it's really interesting. But over the years of working in primary care, what started to shift your thinking towards prevention and root cause medicine? And was there a particular moment where you thought the system just isn't set up to deliver the kind of care that our patients actually need?

SPEAKER_01 3:06

Yeah, so I began to notice a very common thing that a lot of these patients have conditions that are very preventable, like diabetes, high blood pressure, strokes, heart attacks, peripheral vascular disease. But unfortunately, we were intervening at the tail end of these conditions where a lot of things at that point to prevent further catastrophic events cannot be done. So if I've already a patient comes to establish with me and they're already going to dialysis three times a week, or they can't see out of one eye from diabetes. Um, there are only so many limited options that we can do at that point. But a lot of these patients, if we can intervene at a more earlier stage where they are in that pre-hypertension phase, or they're in that pre-diabetic phase, or they are in that insulin resistance stage. Um, there's so many things that we can do to prevent these patients from further progressing to these more dangerous um stages of their disease process. So I went into medicine in order to be able to make a difference in patients' lives and not just to check boxes. So I decided I started doing some research, and I felt like we could do better for a lot of these patients than what we're currently doing in this assembly line model where we're just passing people through and and then just checking on boxes.

High Volume Medicine And Burnout

Dr Andrew Greenland 4:39

Thank you. So tell us a little bit about your practice as it currently stands. What does a typical day look like for you in clinic? And I dare say there probably isn't a typical day, but it just gives us some kind, some kind of indication of a typical day, perhaps the kind of conditions you're seeing most of right now. And I guess you probably referenced those just now, but be interesting to hear.

SPEAKER_01 4:57

Yeah, so in my total panel of patients, I have about three to four thousand patients, and on average, I see about 30 to 35 patients a day, and I see them for a variety of conditions, but um majority of the patients um have high blood pressure, diabetes, obesity, elevated cholesterol. Um, I have some patients who have um depression, anxiety, COPD, perivascular, vascular disease, strokes, um, congestive heart failure. So I see um very complicated and sick patients. So my clinic hours typically go for about seven to eight hours. So if you if you divide eight hours into 30 or 35 patients, you can do the math and see the limited time that I have to take care of patients who have these multiple conditions. And a lot of times, one patient might have four or five um comorbidities that need addressing during that visit, so it can be very time-intensive and um intellectually consuming.

Dr Andrew Greenland 6:05

Got it. And you've just alluded to the fact that the insurance reimbursement model pushes physicians towards these really these very high patient volumes. That is correct. How does this actually work out then? If you've got a panel of three to four thousand patients, I mean you've just alluded to the difficulty of managing multiple conditions in the time that you have. How does that work from a quality of care point of view from a sort of physician burnout point of view and the doctor-patient relationship?

SPEAKER_01 6:32

Yes, it's it's very difficult and very, very complicated. So a lot of times I end up walking through lunch, and a lot of times I have to stay back um an hour or two after the clinic is closed. Um, sometimes catching up on appointments or catching up on paperwork, and then obviously um two to three hours when I get home at night, and also on the on the weekends. So I try as much as possible. So a lot of times you have to end up triaging the patient. Okay, they come with five or six problems during that visit. You have to now triage and say, okay, what's the one to two most important pressing problems that we need to address today? And you try to focus on those, and then the rest, they might have to make another appointment to come back at a different time to address it. Or a lot of times, if they have three or four pressing issues, then the schedule gets back behind because then I'm spending the extra time to take care of these patients, and then people who are waiting in the waiting room, the the waiting time could go up to an hour or an hour and a half, depending on the day and depending on the patient.

Dr Andrew Greenland 7:44

Wow. So, I mean, this is a bit of a loaded question, you don't have to answer it. But I mean, do you think the system is structurally incompatible with prevention-focused medicine as it stands?

SPEAKER_01 7:54

It is not. In its current state, it's very, very, very difficult to practice um prevention-based-based medicine. Um, there was a research article that came out not too long ago and said that if a primary care physician was to ask patients all the preventative questions and all the healthcare questions for their particular case, um, each primary care physician would need 29 hours every day to be able to do that. Yeah, and we know that there are only 24 hours in a day. Yeah.

Switching To A Smaller Panel

Dr Andrew Greenland 8:28

Yeah. Okay. That's a very stark observation. And the 29 hours doesn't even include sleep and all the other things that we need to do. That is correct, and family time and other things else, yeah. Yeah, for sure. So I know you've mentioned that you're transitioning towards a much smaller patient model, close to around 300 patients, and that's a fairly dramatic shift based on what you've been talking about. How does this new model look like in practice?

SPEAKER_01 9:03

Yes, so with those patients, I will have dedicated ample time to really diving deep and get to the root cause of a lot of conditions that are affecting them. I'll be able to address non-pharmacological therapies like stress management, proper sleep hygiene, um, diet, exercise, um, compliance with medications and other specialist follow-up. So we'll have time to really dive deep into the causes of a lot of these issues and not just prescribe medications and find out um what the what the effect will be in two to three months from then. So instead of seeing 30 to 40 patients a day, I will average, on average, see about eight to ten patients a day, and I will have the dedicated quality time to really spend with these patients. And uh if patients need close follow-up and I need to follow up, see them again in two to four weeks, as opposed to seeing them again in three to six months. I will definitely have that time to follow up with them and see their progress. I'll be able to coordinate better with their specialists and other doctors who they are seeing to make sure that they are getting the right care and they are keeping up with all their scheduled appointments.

Advanced Screening Beyond Standard Labs

Dr Andrew Greenland 10:26

Sounds like a really utopian model, but how how do you get from where you are to that model, or do you have a hybrid where you're doing a bit of things?

SPEAKER_01 10:36

No, so I'm currently in the um transition process of going uh into that model. So the slots on that program are available on a first-come, first basis. So I'm explaining the model to the patients. So I'm letting them know that it's not a direct primary care model where insurance is not accepted, and it's not a concierge model where you're just paying for access. So in this model, we're going to be doing a series of 18 advanced standardized screening tests that go into a little bit more depth in testing on things that are currently available that are allowed by insurance currently. So instead of just doing a basic lipid profile where we're just looking at LDL and HDL and total cholesterol, we'll be doing advanced lipid screening, looking at apoprotein B, lipoprotein A, myeloperxidase, NDA, things that can tell us the actual lipid physiology going on with that patient at that time. And with that, we can predict their risk for having a stroke or heart attack in one year, five years, ten years. We're going to be doing um tests to look for inflammation and insulin resistance. We've found out through the studies that about 30 to 50 percent of people who have an adverse cardiovascular event in the form of a stroke or heart attack, they have a normal lipid profile. If you go by the standard lipid profile, which we're checking right now. So that tells us that there's something that we are not checking for. There are things that we are not evaluating that we are missing that's putting these patients at risk for adverse cardiovascular events. So we'll also do advanced hearing tests, vision test, um, pulmonary function tests. It's gonna be pretty much an executive level physical from head to toe. We're gonna do be doing ankle brachial index to assess the blood flow in their um extremities. Um, we're gonna be doing a sleep questionnaire, a sexual health questionnaire, um, among other tests. So it will be a very, very comprehensive test that will be done annually that will throw more light on the actual physical and about chemical condition of our patients.

Dr Andrew Greenland 13:05

But the model sounds fantastic and for everybody from patient point of view, um patient satisfaction point of view, physician point of view, but it's a fairly dramatic business shift. So, how do you kind of work through the business angle of that kind of shift from you know three to four thousand patient panels to the 300 model that you're talking about?

SPEAKER_01 13:24

Yes, so it's all about education. So, our transition to this model is taking us about 16 weeks. So, this is 16 weeks of patient outreach, patient education, um, explaining to them why we are making this change, explaining to them the benefits to them as well as their physician and how it improves the physician-patient relationship. We also focus on letting them know the benefits of having this advanced testing done that would otherwise not be available to them on a traditional insurance, wellness, physical model. And it's all about being patient and and um educating these patients, and we'll say that the response so far has been has been great.

Resistance And Emotional Trade-Offs

Dr Andrew Greenland 14:14

Brilliant. I mean, have you encountered any resistance, whether that's from patient staff or even your own thinking at times as you as you progress through this?

SPEAKER_01 14:22

Yes, so um I actually came across this model about five years ago, and I took my time um and did my due diligence, and I was also waiting to see from a regulatory or government perspective if anything was going to change and if some favorable legislation or laws were gonna be passed to reverse the dangerous trend which we are heading to in healthcare. But after waiting and waiting, I've discovered that nothing is gonna change and it's actually only gonna get worse and worse and worse. And it has gotten to the point where patient safety is actually being jeopardized right now under this current system. Because if you're rushing and you're not able to spend the time, that's how things fall through the cracks, you're not able to do a proper exam, you're not able to take a more detailed history, and uh, before you know it, you've missed something, a patient has had an adverse, adverse outcome, or the burnout as a physician continues, and that's why a lot of physicians now are going into pharma, academia, and other models and leaving the bedside. And uh, we're kind of having some brain drain of some of some sort right now in that um regards. Some of physicians are even going to go work for insurance companies or moving into cosmetics.

Dr Andrew Greenland 15:52

Wow. And and as you make this transition, what's harder about the transition than you perhaps expected? Because it all does sound wonderful when you look at it in the cold light of day. But what were the harsh realities of doing it?

SPEAKER_01 16:05

So I would say it's been an emotional and psychological roller coaster because even if all our patients wanted to sign up for this program, we unfortunately um will not be able to take all of them. And these are patients who I have developed bonds over the years taking care of them. I've been to funerals, weddings, um, and so many events of my patients. So I consider them as family. So, in a way, it breaks my heart that some of the patients are going to have to seek care elsewhere. But unfortunately, it's the harsh reality of things. So that's why the transition is taking some time because at the end of the day, even if patients are not staying with us, we don't want anybody scared to be interrupted. So we are also assisting people who cannot stay, helping them find new doctors and transfer their care and transfer their medical records so that they cannot so that they don't have any interruption in their medical care. So it's been an it's been an emotional and a psychological uh roller coaster for sure.

Dr Andrew Greenland 17:15

Thank you for that insight. And how are you deciding which patients stay in the new model versus the old one? Is there a sort of criteria that you're using? How are you how are you making that decision?

SPEAKER_01 17:24

No, so it's all up to the patients. So we are letting them know about the switch, the change, the reasons why we are doing it, the benefits to them, and the patients make the decisions. The slots are available on a first-confessed basis. So we are not picking and choosing, we are we are letting the patients know what we're trying to do, and they have the ability to sign up as soon as they want to. And the slots are filled on a first-confessed basis. As soon as we get to the desired number, um, we'll start a waiting list of patients who can join later if somebody drops off or moves.

Dr Andrew Greenland 18:06

So, I mean, I very much subscribe to this model because the functional medicine that I do, I have very long um intake time with my patients for all the reasons that you said to really get to the full understanding of what's going on and how we can help them. But do you think this kind of model is scalable? Um, or is it going to always be inherently more boutique?

SPEAKER_01 18:27

I think it's um scalable. So the network which I'm joining, um, which is called the MDVIP network, they've been in business now for 26 years and they have close to 1,500 physicians nationwide in uh pretty much, I think I want to say 48 of the 50 states in America. So it's definitely scalable, and that is why also um our patients' memberships follow them across the country. So if we have a patient who is visiting family or vacationing in a different part of the country, and they call me, and I feel like they need to be, they need to have an in-person visit. They just need to give me their address. I find an MD VIP doctor close to where they are, and they can walk into that practice and be seen like if they were seeing me. So it's a definitely a network that is scalable on a national level. And I think that is where healthcare is moving towards, because the current model is just not sustainable long term.

Dr Andrew Greenland 19:35

And in terms of you, I mean you're as a primary care provider, you're working on the coal phase, as it were. Have you noticed a shift in what exp what patients are expecting from their doctors over the last few years? Have there been any changes that you've noticed?

SPEAKER_01 19:47

Yes, I would say that uh patients now are more educated and more knowledgeable about their conditions, especially with the advance of the internet and everybody having information on their fingertips with their phone and their computers. So patients have more questions. Um they are advocating for themselves more better than in the past. And they want a full accountability from their doctors. So they want to be able to have access to their records online, they want to have access to telemedicine appointments, they want their doctors to have availabilities on nights and on weekends and on holidays, and um that is what healthcare should be. And in our smaller panel of patients, we are able to deliver those services. So a patient can call me on the weekend if they have a question or if they have a medical condition going on, they will have the opportunity to um assess me directly and get a clarification on what they what they need to do. Um, if it's on the weekend, on the holiday, or if they're traveling. But I can't do that when I have three to four thousand patients, yeah, unfortunately.

Dr Andrew Greenland 21:01

And do you think patients are fully valuing prevention or are they still much more reactive to a problem that's kind of arisen clinically?

SPEAKER_01 21:10

So I would say it's a mix, it's a mixture. Healthcare, unfortunately, in this country is very, very expensive. So at any time when you mention a medication or you mention a procedure or you mention a test, the first question they ask before they ask about the benefit to them, or what are the complications or the risks, the first question they ask is about the cost. Because um it's a saying over here that everybody is just a medical complication away from bankruptcy because healthcare is very, very expensive. An emergency room visit or something as simple as an ankle sprain or cold and flu could easily cost anywhere from$3,500 to$5,000. So people are always worried about the cost and anything. You're seeing patients too, you also have to factor in cost, so you always have to think about generics versus branding medications, um, non-invasive and cheaper investigations or tests than going for high-dollar expensive, expensive testing. So a lot of people are very, very much concerned about the cost, and then the secondary gain comes in, talking about now the value to them and all that. So that is why we're having to educate these patients that hey, I know there's an additional cost for this program which we are presenting to you, but if we are able to save you from going to the emergency room for just one visit, you've already paid for the program and some. If we're able to prevent you from having a stroke or diabetes or congestive heart failure down the line, we have saved you so much money and we have also improved your quality of life. So it's an investment which you have to make today in order to reap the rewards tomorrow. And um you you just have to explain it to patients in that format. Unfortunately, some people see the value, but financially they are not just able to make it work. And um, in those in those cases, you you you feel really, really bad for those for those patients.

Dr Andrew Greenland 23:29

So, how much of your role is um essentially behavior change management? Uh, things like you know, addressing overvalued ideas about cost versus actual clinical decision making.

SPEAKER_01 23:42

So I would say it's about a 70-30 um clinical decision making versus the cost, but you always have to talk about the cost in order to gain compliance. Because if you discuss a new medication or a new treatment option to the patient and you don't discuss the cost, the patient is just going to assume that it's gonna be expensive, and they're not even gonna call the pharmacy or go to the pharmacy to go pick up the medication. So you have to educate the patient on what to expect when they go to the pharmacy to do the pharmacy. So a lot of times we look for co-pay cards for them, we sign them up for discount programs where they can get those medications at an affordable price. Because, like I said, um, some of these patients they have multiple conditions, so they can easily be on 10 to 15 medications at the same at any given time. And when you pay$20 for this medicine here,$30 here,$40 here, it does it does add up. And like I always say, the doctor's job does not end with writing the prescription, your job ends with the patient actually picking up the medication and taking it. So if you don't factor in the cost and make sure that the patient can afford and take the medication, then you haven't you haven't done your job.

Dr Andrew Greenland 25:09

Thank you. Now, thinking of your practice as a business, because you are running a business as well as a practice, I guess. Um and you've talked about your model and all the advantages that brings. But what are the biggest sort of challenges and bottlenecks in maybe the practice or the the transition that you're making at the moment that still kind of impact on what you do?

SPEAKER_01 25:31

Yes, so as much as we hate insurance, we still need insurance, unfortunately. But insurance is moving towards a more of a catastrophic model. So if you have cancer, chemotherapy costs a million dollars, unfortunately, you're in an accident and you break 20 bones in your body, and you need like 10 complicated surgeries. That is kind of the model that insurance is moving towards. For everyday care and preventative care, insurance is not really the way to go. So trying to educate these patients because they assume, oh, I have health insurance, I have insurance, and they always think they have the best insurance. Oh, I have the best insurance. Why do I have to pay extra for this care? So, what we describe to them is like it's like having car insurance. If you need to um change your oil, do an oil change on your car, you don't wait for the insurance, the car insurance company to write you a check to change your oil. If you need a new set of tires, you don't wait for the car insurance company to write you a check to get a new set of tires. You go ahead and do it on your own. But if something happens, if your car is stolen, your car is in a fire, or you are in a significant accident, then the car insurance um policy kicks in and helps you deal with that situation. And that's kind of the way healthcare is going. Healthcare is not for daily routine preventive um stuff because unfortunately, the insurance company is a for-profit model, and obviously they want to make more money than they have to spend because if they spend more than they take in, then they're gonna be in the red and it's not gonna be a profitable business for them. And unfortunately, with that model, there has to be some cost containment um measures put in place, and in that process, some people unfortunately are gonna suffer because they're gonna have their care affected. So, explaining this to patients because over time patients have had to pay more for their insurance premiums, their out-of-pocket cost, and unfortunately, the services that they receive from the insurance companies, the level of services are going down. Patients has they have more responsibilities than they used to in the past. So in the past, it used to be very common to only have a deductible that is only$500 or$1,000 max. So if you spend$1,000 out of pocket, then the insurance kicks in and pays for the rest. But right now, it's not uncommon to have patients who have deductibles that are$10,000,$13,000. So what that means is that they have to spend$10,000 out of pocket first before the insurance kicks in. And also too, the monthly insurance premiums are also going up as well. So patients are feeling the pressure saying, hey, we're having to pay more for healthcare, and now we have to pay an additional premium for this program. Um, please help us navigate or help us make it make sense. And um, that is the education that we are doing. And we are letting them know that, hey, if we can catch these conditions at an early stage, we're improving your quality of life and we are preventing you from progressing to these terminal illnesses that will have devastating uh long-term consequences. And at the end of the day, we are sending the patient and the insurance company a lot of money because with this model, it has been shown that patients with MDVIP they have less hospitalizations, less emergency room visits, they have less incidence of strokes and heart attacks, and also their conditions like high blood pressure and diabetes are also well controlled, and that reduces their risk of long-term complications. Because with this more in-depth relationship, we are able to catch a lot of conditions before they get out of hand, and we're able to intervene before you have a hospitalization for COPD or congestive heart failure that can easily run anywhere from$10,000 to$20,000 for a five to seven-day stay.

Paperwork Time Drain And Growth

Dr Andrew Greenland 29:54

Thank you. And um, what's the biggest time drain for you in the work that you do? And obviously, your your move to this new model? What's what sucks up most of your time?

SPEAKER_01 30:07

Right now, in the current model, I will say that paperwork um takes a huge amount of time because for billing purposes with insurance companies, there are so many boxes that need to be checked, and so much information that needs to be provided. And a lot of time gets spent too on doing authorizations for medications and procedures because now you have to you have to um provide evidence of notes and labs and documentations for insurance companies to get medications covered, to get procedures covered. So it takes a huge amount of time to provide to provide that those those services. So I can say that I easily spend anywhere from 18 to 20 hours a week on paperwork alone. And that is the extra time that I could be using to see patients and actually delivering clinical care instead of just being a clerk on a computer or filling out forms.

Dr Andrew Greenland 31:12

Got it. Well, 18 to 24 hours a week. We were just talking about your 29-hour days of moments ago, it really puts things in perspective. Um thinking about growth. So we'll, as businesses, we're trying to think about growth and how we expand, but how do you think of it? Because you know, you've set this um model as being optimal with around you know 300, 400 patients. Um, that's kind of a ceiling, but how do you think about growth with that in mind?

SPEAKER_01 31:39

Um, definitely. So what we plan to do is that when we get to our maximum numbers, which we know we'll get to very soon, um, we are thinking of bringing other like-minded physicians on board to be able to provide this level of care to a larger, larger amount of patients. We also have ideas of um reaching out to companies and corporations to offer this to their employees because if you have employees who instead of having to take off a whole day of work, can do a televisit with a physician in 30 minutes and get back to work, as opposed to having to take the whole day off and then miss two days of work. Um, it will definitely improve the productivity of that business because the research has shown that about two to three billion dollars are lost every year in productivity from employers losing employees due to sick days or doctor visits or illnesses that could have been prevented or um avoidable. So, in the long run, it would boost their bottom line to offer services like this to their patient and to their clients. And if we are able to decrease the emergency room utilizations, keep them healthy, um reduce their rates, their rates of progression to terminal conditions, it will definitely be a win-win for everyone.

Dr Andrew Greenland 33:19

Thank you. So I'm gonna give you a magic wand, and if you could fix you know the top three things in the practice or the wider field that you're in, what would those things be?

SPEAKER_01 33:30

Definitely the top one will be increasing the reimbursement for primary care because primary care, the way the system is built right now, it's procedure-driven. A lot of infrastructures and payments are tied to procedures being done. So there's an incentive for patients to get more procedures, and also for young doctors and medical students to move more into procedure, procedural-driven specialties like orthopedics, neurosurgery, cardiology, and all that, because it's a system tied to procedures. And intellectual specialties like rheumatology, endocrinology, and primary care, they don't get reimbursed enough because enough credit is not given for the intellectual complexity that is required to manage these patients. So if the reimbursements were definitely increased, there will not be so much pressure on primary care doctors to see as many patients, and they will be able to focus more time on the current patients that they have and give them optimal care. And if the documentation boardings and the peer-to-peer reviews and the priorizations, if a lot of these obstacles and red tapes can be removed so that doctors actually have time to focus on patients and clinical care instead of being on a documentation clerk. And if I'm a board-certified physician who went to medical school and who went to residency, and I have determined that a patient needs a certain test or medications, who is the insurance company to come and overturn my decision when I am the one that has physically evaluated the patient and come to that conclusion? I call it practicing without a license. They have not seen this patient and they don't know the condition of the patient. I am the one seeing this patient and I'm advocating for the patient, and I say that this is what they need, and now they come in with all these obstacles to prevent the patient from getting the care that they need. And there's no um accountability or repercussions for their actions or inactions.

Dr Andrew Greenland 35:58

This is kind of a universal. I've had lots of conversations and podcasts with people in America, and the whole insurance, reimbursement, paperwork, arguments has been a massive thing. So you're just really consolidating what I'm hearing everywhere. Um finally, where where are you looking to take things over the next year? If we look at them, say the next 12 months, where would you like to be with your clinic, your practice going forward?

SPEAKER_01 36:22

So I would like to um have my full panel of patients and um continue to keep them healthy, keep them out of the hospitals, give them a great quality of life. Because sometimes I have patients who say, Oh, but I'm very young and healthy now. I don't think I need all this preventative and extra testing. And my answer to them is you don't know you need a plumber until you need one. So we want to continue to keep you healthy and need things in the board, but you won't know unless you go looking for things. And I use I use the analogy of a car. You don't drive a car until you can no longer drive it before you go take it for maintenance or to go find out what is wrong. You want to keep the car going in a great state, and that requires maintenance, that requires evaluations, that requires inspections, and then I have older people who say, Oh, I already have COPD, I'm on oxygen, I'm on dialysis and all that. What will these preventative tests do for me? And I tell them it will help your chronic conditions to stay stable and give you an improved quality of life. Because at the end of the day, when you are that age and you're dealing with all these conditions, you want to have a high quality of life. You want to be able to go for a walk in the park, you want to be able to play with grandkids, you want to be able to lead them up, you want to be able to spend time with your loved ones, and you want to be in the best state of health that you can at that time. Having cancer or having congestive heart failure or having a chronic kidney disease, that shouldn't be a life sentence. We should still be able to advocate for them to have the best quality of life possible with whatever time they have left. If it's five years, three years, ten years, whatever the case may be.

Dr Andrew Greenland 38:18

With that, Frank, I'd have to thank you so much for joining me today. This has been such a great conversation. Really valued your insights. Really excited by your new model of moving to a smaller prevention-focused practice model. I think it's fantastic. So thank you so much. It's been a real pleasure to have you on the show.

SPEAKER_01 38:33

Thank you so much for having me, Andrew. I've really enjoyed my time here.