The Future of Private Practice: Innovation, AI, and Patient Care

Dr. Michelle Nguyen, MD, is a Gastroenterology Specialist at Unio Specialty Care, a multi-specialty physician practice. As a board-certified gastroenterologist, she has over 15 years of experience specializing in esophageal diseases and quality metrics in colonoscopy. Dr. Nguyen has held leadership positions, including Chief of Gastroenterology in Santa Cruz and an Infusion Site Lead at the Palo Alto Medical Foundation.

Here’s a glimpse of what you’ll learn:

• [2:16] How Dr. Michelle Nguyen’s fourth-generation physician background shaped her career path
• [7:22] Dr. Nguyen’s early years in practice and how she transitioned into private practice
• [14:03] Tips for acquiring patients when transitioning from a large healthcare system to private practice
• [19:33] Dr. Nguyen talks about her entrepreneurial ventures to enhance patient care
• [28:36] AI’s impact on medical efficiency and colonoscopy procedures
• [34:49] The economic and competitive landscape of healthcare and future trends in the space
• [43:16] Advice for aspiring physician entrepreneurs on embracing risks and opportunities

In this episode…

Healthcare professionals often face a difficult choice: stay within large, structured health systems with financial stability or take the leap into private practice, gaining autonomy but facing business uncertainties. How can physicians make this transition while prioritizing patient-centered care?

After noticing limitations on physician autonomy, patient care, and new technology, seasoned gastroenterologist Dr. Michelle Nguyen transitioned from working in a large multidisciplinary healthcare group to establishing a private practice. Physicians can navigate this transition by focusing on patient experiences, leveraging technology to streamline operations, and embracing entrepreneurship to create sustainable and inclusive healthcare models. Dr. Nguyen highlights the importance of maintaining a strong reputation to attract patients organically and collaborating with other independent practitioners to strengthen negotiating power with insurers.

In this episode of Transaction Healthcare, host Zak Eisenberg interviews Dr. Michelle Nguyen, Gastroenterology Specialist at Unio Specialty Care, about the challenges and rewards of private medical practice. Dr. Nguyen shares insights on building patient trust, adopting new technologies, and navigating shifting trends in the healthcare landscape.

Resources mentioned in this episode:

• Zak Eisenberg on LinkedIn
• Merritt Healthcare Advisors
• Merritt Healthcare Advisors email: contactus@merrittadvisory.com
• Dr. Michelle Nguyen 
• Unio Specialty Care 

Quotable Moments:

• “I found that if you always prioritize patient care, everything else — finances, operations, and business — falls into place.”
• “The biggest myth about private practice is that you won’t get patients. If you’re good, they’ll find you.”
• “AI in medicine isn’t about replacing doctors; it’s about helping us focus on what really matters: the patient.”
• “Healthcare systems are structured to limit physician autonomy, but private practice gives us the freedom to truly serve.”
• “If you’re thinking about going into private practice, just do it. You can always go back, but you probably won’t want to.”

Action Steps:

1. Consider private practice if you value autonomy: Large healthcare systems often limit flexibility in patient care, while independent practice allows more control over treatment decisions and the patient experience. Private practice also enables physicians to tailor their services to meet the unique needs of their patients.
2. Leverage AI and new technologies to improve efficiency: AI scribes and diagnostic tools can reduce administrative burdens, allowing physicians to focus more on patient care. Implementing scheduling, documentation, and patient communication automation can further enhance workflow and reduce burnout.
3. Explore business opportunities in healthcare: There are many unmet needs in medicine; physicians can develop innovative solutions that improve patient care and generate additional revenue. Identifying gaps in the healthcare market can lead to new ventures, such as specialized clinics, digital health platforms, or patient-centered service models.
4. Build a strong reputation for organic patient growth: Positive patient experiences lead to referrals, reducing the dependency on traditional healthcare networks for a steady flow of patients. Engaging with local communities and maintaining a strong online presence can further boost credibility and attract new patients.
5. Embrace calculated risks: Physicians transitioning to private practice should approach it strategically but confidently; business success often follows excellent patient care. Surrounding yourself with mentors, advisors, and a supportive professional network can help mitigate risks and provide valuable guidance.

Sponsor for this episode…

This episode is brought to you by Merritt Healthcare Advisors.

Merritt Healthcare Advisors is an investment bank with a unique focus on healthcare providers and their businesses.

Merritt leverages the healthcare industry expertise of its owner-operators, clinicians, investors, and advisors to develop surgical facilities that perform safe, efficient, and cost-effective procedures.

To learn more, visit https://merritthealthcare.com/.

Episode Transcript

Intro  0:04 

Hello and welcome to Transaction Healthcare. I’m Zak Eisenberg, Vice President at Merritt Healthcare Advisors. Merritt Healthcare Advisors is an investment bank with a unique focus on health care providers and their businesses. Transaction Healthcare is a podcast focused on addressing questions and concerns at the intersection of healthcare transactions and business.

Zak Eisenberg  0:25 

I’m Zak Eisenberg, a partner at Merritt Healthcare Advisors, and your host for transaction healthcare, where we address concerns and questions at the intersection of transactions healthcare and business. This episode is brought to you by Merritt Healthcare Advisors. Merritt is a full service investment bank with a unique focus on health care, Merritt leverages health care industry expertise of its owner operators, entrepreneurs, advisors, clinicians and investors to advise owners, physicians and entrepreneurs in the health care sector about maximizing growth and running successful transactions. To learn more, visit www.merrittadvisory.com. I’m joined today by Dr. Michelle Nguyen, a seasoned gastroenterologist with a wealth of experience in both patient care and improving health care systems. She strives to form partnerships with her patients that honor their individuality and dignity with a medical journey that spans from Yale to Stanford and passion for serving underserved communities. In addition to her clinical work. Dr. Nguyen is an entrepreneur and enjoys building businesses that bring all your care to patients. Michelle, great to have you on the podcast. Thanks for joining me.

Dr. Michelle Nguyen  1:29  

Thank you, Zak. I’m really honored to be here.

Zak Eisenberg  1:33  

Oh well, the honor is mine. I know we we had some scheduling difficulties getting this set up, but I’m so glad to have you on here. I’ve been excited for this for a while, so I’d love to just dig in, starting out with with asking about your background. I’m I’m always curious about how people end up where they do in life. How did you end up studying medicine? So if you can go all the way back to the beginning, how did you you end up deciding to study medicine in college and then continue to pursue it, go to medical school, internship, residency, and especially and eventually specializing in gastroenterology. Let’s walk us through your story.

Dr. Michelle Nguyen  2:16  

Well, thank you. Yeah, so I, I’m actually a fourth generation physician, so it was a little bit in my background. My family always expected me to go into medicine. I rebelled a little bit in college and ended up with a religion minor in Buddhist studies. And I thought, I thought that I knew I wanted to do service. I didn’t know what kind. And so I was thinking of going into some kind of theology, religion job, but I found that the actually, the best way to serve people would actually be in for my side from medicine standpoint. So that’s how I ended up in medicine. I initially chose Yale for internship because it has primarily an underserved population, and so throughout, throughout my internship and residency at Yale, I did away electives in in third world countries with with medical vans in inner city suburbs and and, and it was just a passion to try and help the community. When I came back to to California and did fellowship at Stanford, there was a large Vietnamese population, and so I tried to serve them that way, and worked in in that respect, also as the president of the Vietnamese physicians Association. But I then, having gotten a job in sort of a HMO type of setting, I found that you’re really limited in what you can do to serve people without without health care, which is partly why I kind of transitioned over to private practice.

Zak Eisenberg  3:53  

Interesting. And so just going back to the beginning, it sounds like it all started from a not just a family commitment to medicine, but your upbringing and the desire to give back to the community and care for those in need, which is how you really also studied. I think you said your minor was in Buddhist religion studies, yeah, essentially, an interesting trajectory, and ultimately it led you back to medicine, even though you were maybe maybe leaning towards other things. So, so were you thinking at one point you were going to go off and study religion full time and philosophy, and then you okay? So tell me about, yeah, tell me about that transition time and how you ultimately decided that you wanted to to go back towards your, your family legacy of medicine.

Dr. Michelle Nguyen  4:56  

Well, so I went to University of Michigan, and they haven’t. Really strong Buddhist studies program there and exposed really young, young college kids to everything from meditation to mindfulness to to a concept called emptiness and bodhicitta. So in Buddhist and bodhichitta means that we we see everyone from your enemy to your friends as having food in nature. And so when, when you have that kind of view of people, and if you try and adopt that kind of view of people, then, in general, your your goal has to be to serve. And I really, really viscerally struck me that that this was what something that I wanted to do, I’d always wanted to serve whatever kind of capacity or career I ended up having as a the problem with with being a Buddhist, having a Buddhist career, though, is it? It’s very theoretical, like you mentioned philosophy in this, right? So, there’s, it’s almost an academic career, or it’s a career where you’re always, constantly teaching, but there wasn’t, there wasn’t a a way to actually serve directly to people who are not already Buddhist, who are who are always, who are not, I guess I should say underserved, right? So, so because of that, I thought the best way to do this would be, ironically, to go back to medicine. Interesting,

Zak Eisenberg  6:28 

yeah, it seems like and we were talking about this before we jumped on to the recording, but it seems like the drive to serve and care for others is really what has propelled your career throughout and it’s taken you to places that I think most, most MDS would not go, in the in the in the drive to actually achieve bigger and bigger goals of of serving larger communities. So maybe, why don’t we fast forward again to your fellowship. So you did your fellowship at Stanford, and what happened after your fellowship? What? What? How did you start practicing medicine? Tell us about your early, early years in in practice, and how long were you were you kind of in this post fellowship phase, yeah,

Dr. Michelle Nguyen  7:22  

so I was recruited pretty quickly after fellowship to a multi disciplinary group in the Bay Area that had multiple locations, Palo Alto, Mountain View, Santa Cruz, all the way down to Gilroy. And it was just a very collegial, lovely group to be in with smart physicians who also had a also had a goal of us, of service. And what I found, though, is that when you’re in a multi disciplinary group like this, your your autonomy is completely limited, and you end up maybe having less of a chance to serve patient populations, but, but there are always goals in a multi disciplinary group, right, productivity, lifestyle, end result. And so because of that, you end up, I guess you should say you end up serving the the the administration, not or or the the bureaucracy, more sometimes I felt than you actually serve the patient. And because of that, I kind of wanted to step back and go towards more of a a direct, a direct career path, which is why I left that, that group, after about 12 years of being in it,

Zak Eisenberg  8:44  

yeah, and that’s that’s quite a long time to come to that realization. Do you feel that from the beginning, or did it take you, take you a while to start to really start thinking about it? Or was it a gradual process where you came to that, that conclusion or a sudden, sudden change. I

Dr. Michelle Nguyen  9:04 

think it was definitely a gradual process, and I think it also reflected health care change right from from the early 2000s all the way, because I entered that practice in 2004 and it was the change in health care between 2004 and 2015 where these physician owned groups were being bought out by by large companies, in essence. And so once that, like

Zak Eisenberg  9:30  

health systems and for profit companies, yeah, yeah.

Dr. Michelle Nguyen  9:32 

Health says exactly. And then once that kind of occurred, the goals of the the the whole system changed, really, you know? And I can understand that, because you need standardization, you need healthcare outcomes, and you need productivity to sort of feed the system. But I found that that oftentimes took away from the patient, like whereas before you could spend 20, 3040, min. With the patient. Now you were scheduled for 15 minutes, whereas before, it was your discretion, if you had a patient who couldn’t pay, you could waive their payment. And now it was entirely, you know, collectors calling patients and that type of thing,

Zak Eisenberg  10:16  

right? So did you feel it was stymieing for you? And obviously, at some point you you concluded something similar to, this is what I’m hearing, but it was sort of stymieing your flexibility and how you wanted to practice medicine and serve serve the patient community you were working with. Is that a fair? Yeah, completely.

Dr. Michelle Nguyen  10:40  

And you know, as I mean, when I was there, I went, I was at I was on multiple leadership roles, from Chief of Internal Medicine to Chief of Gi and even big roles. Even with those roles, I couldn’t affect any change. If I wanted to get a new technology, or if I wanted to try and help a certain patient population, there was really nothing you could do except sort of be in your position, because it was really administration and the system, the health care system itself, from way up top that dictated how we practiced,

Zak Eisenberg  11:17

right, right? So once you decided that you were going to leave this system, this group. Did you have an idea in mind of where what you did want to do, or did you leave and then take a year off to figure it out? Or did you you have a very clear direction when you when you left that you knew you wanted to do, x, y, z, no,

Dr. Michelle Nguyen  11:44

I actually took about six months off to sort of to interview with other groups and see who was the best fit. And I chose to join a group that of four other physicians, actually five at the time, that had practices in East San Jose, which is a very indigent Vietnamese population, as well as practices in Mountain View and Los Gatos. So there was that collegiality that I always wanted from the big multi disciplinary group. But then there was complete flexibility, because this was a small practice, and I have to say, I got lucky because these guys were really ahead of their time in terms of technology entrepreneurship. And so you have to have that kind of open minded mentality when you’re when you’re doing this type of thing, and, and, and not a fear of risk. I would say, I mean, I was lucky because my husband was also a physician, so I didn’t. We were always going to have an income somewhere, you know, but, but it but, but, but this said, I think, you know, if you I found that if you go in the slant of always doing the right thing for the patient, eventually everything fall, falls into place monetarily, you know, and all the other businesses seem to fall into place as well. Sure,

Zak Eisenberg  13:07  

sure that that that makes, that makes a lot of sense. And so you joined this small practice and and once you joined there, what? How did your career continue to evolve, because that sounds like a I think, for lots of doctors probably who will listen to this, that’s a very different environment to be working in with you, from only hundreds of colleagues to just just four, and maybe you had a lot more flexibility, but there was probably also more pressure, because it’s a small business that was growing in some ways, but you know, there are pros and cons to it, but how did you think about that, and what what happened to that practice over time, and your role in it, and How did you think about continuing to treat patients

Dr. Michelle Nguyen  14:03  

well. When you’re in a a large multi disciplinary group, you’re always being force fed patients. So there’s, there’s no question, like, if I opened a slot tomorrow, it would be filled within 10 minutes. And I had this huge fear that when I went into private practice, where would I get patients? You know, because Gi is a specialty field. It’s a referral field and and so what I what I found, though, is that this is a whole new world, right? Patients are on the internet. They’re on there, on Google. There are online appointment scheduling options and so, so as long as you, as long as you as a physician practice optimal patient care and had, in essence, good reviews and a good reputation, patients would come to you and it didn’t. We didn’t really need a referral service. In fact, I’d say about 80% of our patient population now are self referred.

Zak Eisenberg  14:59  

Well. And was that that must have been a real surprising fact of working in private practice, especially after working in big health system. I hear this from physicians all the time too, that there’s a real fear that they’ll be able to it, you know, again, create enough or see enough patients to really support themselves and their family monetarily. So there’s this big fear of being out in private practice. Do you think that’s a generally, a miss misnomer? Or, how do you, how do you think about after again, after having kind of been in that position, maybe your view on private practice totally changed after you when it actually did for a few years. I mean, clearly it has, because you’ve you haven’t looked back. But, yeah, I’m just curious how you when you speak with physicians now who are still working at systems or at large groups and and I’m sure this comes up for you, and they bring up their fears about being in private practice, how complicated is, etc, etc, and the risk. Do you? Do you feel they’re justified in their fear, or do you think it’s slightly overblown?

Dr. Michelle Nguyen  16:21 

I understand their fear, and it’s something that the health care system kind of instills in you, right, because they don’t want you to leave, but, but at the same time, I think it’s completely overblown. I mean, within six months, I was filled and I was booking out three to six months in advance, and and again. As long as you have a good reputation, your patients going to tell their friends. And it just sort of grows organically and with with this, these old online scheduling systems, I don’t think a lack of patients is ever going to be an issue for for for private, private physicians, you know, I would really encourage them to have the confidence to do this, because it’s, I’ve never seen a single person who goes out into private practice fail actually, you know, even like people with personalities where I wouldn’t want to go out and have a beer with them, You know, they’re still full and busy. And then the autonomy is amazing, because there are, there are certain technologies that I always wanted to try and my old health care system, which would not, it would have to go through multiple committees to be reviewed. And here, obviously, these are things that are validated by the FDA and things like that there. It’s always in the old healthcare system. I should say technologies were not tried because it was monetarily not helpful to the system. And here we can try it if we want to, and if we think that the data is there and it’s for the benefit of the patient, we can take that chance and try it on patients. And I would say that it’s definitely helped patients throughout the years. In fact, every every business that stemmed out of our practice has been created with a goal because we saw a niche that wasn’t being fulfilled in the normal mainstream, and that niche could be fulfilled by doing a technology or creating another business that would help patients.

Zak Eisenberg  18:22 

Yeah, why don’t we jump in to that? That’s a great transition to another topic we were going to discuss. So you you’re in private practice, and you’re really starting to see the benefits of of running your own business, but also being able to make decisions about which patients you see, which patients you don’t see, et cetera, and it’s giving you more flexibility what else is. Again, just going back to this, I think, thematic in your life, it sounds like of, how do we continue to serve patients better? What other pursuits, or, as you said, businesses or technologies. Did you start implementing to do this? And again, I don’t think all physicians in private practice, to your credit, Michelle, are quite as adventurous with their what I would call entrepreneurial spirit and pursuits. But yeah, maybe you can tell me a little bit about the the other adventures and endeavors you undertook in service of patients.

Dr. Michelle Nguyen  19:33 

So we wanted to, you know, we’re competing against like Sutter and Kaiser and Stanford in this area, and we, what we, what we had always going for us was that we tried to create, like a perfect, streamline patient experience, from when they step into the door to the time they get their procedure on the aftercare as well, and almost like a Disneyland. You know, how that that type of experience, but, but it’s hard to, you know, when I was at. My other health care system, the overhead there was 80% and it’s hard to to do this kind of perfect patient experience with that kind of overhead. And so one, one way, one business that we started is this business called Med gather. And what it is is it’s we, we outsourced nurses in the Philippines, so that anytime you call our office, you get a licensed RN in the Philippines who answers your calls, tries to answer your questions, and then triage it to me or any of the other physicians and and, and it just has created, I like to say it’s created a Mercedes Benz experience for like, you know, a Kia experience, a Kia price, because we can offer that kind of perfect patient experience to patients, but not go bankrupt, you know, in our business as well. So, so that’s, that’s been a huge help to patients. I think this, this outsourcing business, you know when, when you call another physician practice, you get a high school diploma receptionist, they might not really understand service. And here, when you when we really wanted, when you call us that you get a RN who is there to care for you. Basically, another business venture that we did was, we could, we opened up our own surgery center. So, and with that surgery center again, we’re, we see, I think, about two to 5% of patients free of charge. You know, we were able to streamline that experience. So right now that center has over, like, I think, like, 605 star Google reviews, you know, and I

Zak Eisenberg  21:46 

was possible for you when you were working in a large system, you know, seeing, seeing patients who couldn’t pay. And also it sounds like there was just, just the juxtaposition is because margins are very tight at large, at large health systems, there’s, there has to be cost cutting somewhere. Yeah, and what I what I’m hearing, and correct me, if I’m wrong, is that in, from your perspective, some of the cost cutting was really at the patient experiences, expense there, right? So, yeah, maybe, maybe just Yeah, talk to that. I think advantage a little bit. You know, of course, there’s also the benefits of being your own entrepreneur. If things are going well, you you are benefiting as well personally from it. But I think what’s so interesting to me is that, like many physician entrepreneurs, my firm comes across, most of them start from a similar place to you, which is that the motivation for going into private practice really started from the desire to be able to treat more types of patients and give them a much better quality of care than they were able to deliver when they were under, I think, the thumb of some larger corporate or nonprofit system that was dictating how they they worked and solve patients. So yeah, on those two points, you know, seeing seeing patients free of charge, and I think that’s a material benefit to the community, as as we were talking about earlier, lots of patients still have insurance. So yeah, yeah, is that? Is that a core part of your practice today? And are you doing lots of charity cases?

Dr. Michelle Nguyen  23:47  

Yeah, we are. I mean, I’m still doing a lot of charity cases for for the Vietnamese community. And then, in many respects, even if they do have health care insurance, they can’t pay for their deductible. And so we create plans that are feasible for the patient so that they can pay at their own time for that time frame, where, whereas that would not be available at a large health care system at the same token. Like, when patients are happy, you’re happy, when patients are happy, your staff is happy. So we, we really honed it into the staff and that when when someone calls or someone asks a question, their job is to make a solution and to solve an answer. And so I think that by doing that, the everyone overall becomes happy. The patient’s happy, you’re happy, the staff is happy, and so it’s a very, very pleasant place to work. We don’t get, like, patient complaints all the time about, you know, where’s my refill or anything? Everyone’s there to solve the problem. In other words, right,

Zak Eisenberg  24:51  

right? Yeah. Patient centric, patient first. And I think you said that earlier, if you you found in your I. Your career review, as long as you were putting the patient first, everything else fell into place. So it’s like, that’s that’s really, yeah, continued for you. So yeah, I appreciate you going through that background. That’s always interesting for me to hear how people kind of end up where they do in life and what drives them to make decisions, and it’s always different, right? People have very different motivations. I think that’s a great place for us to transition to. I think one of the other advantages you were bringing up about being in private practice, which is less about the types of services you can give patients, and more about, I think, what types of, well, it’s intertwined with that, more about what types of things you can try as a clinician. So I’m thinking technology, new procedures, things that I think in your previous experience would have ended up in committee for years before a decision was made. So maybe we can talk about, talk about that. What are some of the things that you’re you’re doing today, that you’re really excited about, or things you’ve tried in the past that worked out that were were not, you know, generally adopted at the time.

Dr. Michelle Nguyen  26:23

Yeah, so I think so, a couple things. I remember when I was in the big healthcare system, I had a lot of patients with fatty liver, and I really wanted to do sort of a patient centric weight loss clinic, and that sat through committee for a long time and never got through. And here we were able to create a a multi disciplinary group with a dietitian, a trainer, and then myself, as well as an endocrinologist, so that we can offer weight loss options to patients who have fatty liver and who have acid reflux or complications secondary to obesity. And so that has been, again, that was, that was patient centric in the beginning, but that’s totally taken off. And now we’re getting patients who want to just pay cash for this, if you’re looking at, looking at it from purely an entrepreneurial standpoint, and that’s become, I’d say 10 to 20% of my patients are coming just for weight loss discussion, you know? Oh, interesting, yeah, I think especially with these new GLP one GLP two injectables, like we go V Manjaro, Z bound, there’s a whole niche there where we can change populations and obesity epidemic, right? The the from a technological standpoint, though. I mean, AI has been a like, a great advantage for physicians, both from lifestyle and also for for patients as well. I can’t say that there’s a single day that I’m not using AI constantly to help with the patient experience.

Zak Eisenberg  27:59  

So, yeah, that’s interesting. You brought it up because I know we’re talking about this earlier. Yeah, I think it’s an area that is impacting everyone’s lives, inside and outside of health care. But yeah, you said it’s improving not just your life, but also patients, lives, mind sharing some of the ways, just in your day to day, how you’re using AI to, you know, improve your efficiency or help you provide better care for patients. How are you how are you using this in your life? Yeah,

Dr. Michelle Nguyen  28:36  

so I think this the we used an AI scribe, which I don’t think is novel. I’m pretty sure that Kaiser is using it as well, as well as Sutter and and this, you know, the the bane of the existence of all physicians as notes, right, and paperwork. And the AI scribe has really taken that away, so that now, now I can see patients, look them in the eye, not be typing on the computer the entire time. And the entire time the the AI scribe will will transmit the note, and then even input orders for me. And then I just have to go with the end of the the clinic visit and review all of all that’s done, double check it, and if it’s okay, I can just click a button and the patient has all their instructions and all the orders done. Interesting. I think that, um, the health care systems adopted this because it allowed people to be more productive. I We adopted it just for lifestyle. But I did find that now I can see three patients an hour over, whereas before I would see two patients an hour. So it’s improved productivity about 30% and it’s, you know, at the end of the day, I my computer’s done, my inbox is done, and, and, and I don’t have any notes to write, which is huge, right? Yeah, we, we also use AI during colonoscopy. I said that to a patient. He’s like, Oh, is the AI doing my colonoscopy? I said, No, no, oh, we’re still. Do it. So the physician still does the colonoscopy, but on the video screen, AI will just put a little square anywhere they think there’s an abnormality, like a polyp. I in studies, it showed that this has improved adenoma detection by about 3% I don’t know if it’s that high in my personal experience, but it certainly makes me feel a little bit less worried that I’m missing anything when I’m doing a colonoscopy, you know,

Zak Eisenberg  30:26  

sure, sure, because you have another set of eyes that are checking alongside you, and it’s just going to continue improving. Right? Totally, totally. Yeah, yeah. Interesting. And so do you do you think this, this type of technology, for example, what you’re using, intro, intra operatively, is this, do you think this is something that’s been adopted at some of the larger systems, or is that maybe an example of where it’s not so clear that that improves productivity, and so maybe it wasn’t jam through committee. And instead, it’s, it’s, it’s just about patient care, right? So 100% only about patient care. Yeah, I don’t know if you have any insight into that, and maybe you don’t want to comment.

Dr. Michelle Nguyen  31:17 

I think this is, yeah, I think there you hit the nail on the head like it would only go through committee at some of these larger healthcare institutions if it increased productivity or money, basically, right? So this is something that doesn’t it just a cost on on us, but at the same time it, it’s, it’s only about patient care. So we’re using a company. I don’t know if I should mention their name or not, but they’re a startup company, yeah,

Zak Eisenberg  31:43

if you want to give them, if you want to give them some some, yeah, it’s

Dr. Michelle Nguyen  31:49

called scouts, Scout AI. And so they are a startup, and they only have about 50 or 60 practices using them right now. And and I Yeah. So I think that they were, they would love to get into these bigger health care systems, but I don’t think it’s going to happen for them unless they can show some improved productivity. On the flip side, what I realized, though, is that I’m taking out, I’m doing a lot more biopsies, because when the AI makes us square on something, I think, Oh, I maybe I’m wrong, even though I’ve had 20 years experience, maybe I should just biopsy it, you know? And so our practice, personally, is starting a and this is another way that private health care is help, helpful. Our practice is going to do a study on a cost effectiveness of this, AI, you know, because if we’re taking more biopsies, is that actually cost effective to the healthcare system? And so one of these side businesses that we have is a, it’s called Los Gatos research group, and it’s a research company that where we just do research on things that are interesting to us. So we’ve, we’ve published. We we have abstracts. We have undergrads and med students working for free from sorry, we can’t pay them. They’re basically doing research, and they’re getting published through this company, you know, so

Zak Eisenberg  33:15  

very good, very cool. Does, does the research institute Do you also do? Does it do clinical trials, or is it? Yeah,

Dr. Michelle Nguyen  33:22  

IRB. IRB approved clinical trials. Very cool.

Zak Eisenberg  33:30 

Wow. Michelle, you are you are very busy,

Dr. Michelle Nguyen  33:36  

but that’s what keeps it fun, right?

Zak Eisenberg  33:37 

Yeah, no, absolutely. I love that. I think zooming out from your practice a little bit. I’d like to talk about more the macro landscape and how, how you see the I’d say economic not just economic landscape, but the competitive landscape and the patient care landscape in health care, how it’s changed over the last, let’s say, decade, and where you think it’s going over the next 10 years. And part of this is also thinking about how private practice will survive in this environment. You know again, we know each other because my firm helps sell some businesses that you were involved in. But I think we always, we always connected over some of the more philosophical underpinnings of what is driving a lot of health care change, not just here in the US, but but globally. So maybe, maybe you can talk about that a little

Dr. Michelle Nguyen  34:49  

bit the Yeah, I think the one downside in private practice is there’s only so much money in the pot, right? And so when you carve out when, when Congress carves out money. For for health care systems, it seems that it gets always the bigger health care systems that get more of the more the money. Whereas, for instance, Medicare cuts are down 3% this year already, and whereas inflation is up significantly, I’m not quite sure why health care reimbursement is going down right, considering everything so, so we, and I, when we went into partnership with Merritt, there was a little bit of trepidation and worry on our part that if we were bought by another system, that this might be, we might be sort of going back to, like to a Kaiser Sutter or Stanford type of system. What we realized, though, that is that there could be a best of both worlds here, because if we were to join with a system that had, let’s say, better, better insurance contracts, right? We could, we could possibly take on their insurance contracts, but at the same time maintain our autonomy. And so I think that’s the the one risk and in private practice and ends for for clinicians like myself is like, if, if our health care contracts don’t, don’t continue to rise with inflationary pressures, it will be an issue for us and and as a single group, and makes it difficult to have bargaining power with insurances. And that’s where we that’s why we kind of went to Merritt to say, what can we do so that we can maintain this and and maintain our autonomy, our patient care, but at the same time be competitive,

Zak Eisenberg  36:39  

right? Yeah, if I can, if I can distill for the audience what I’m hearing as a driving theme over the last decade, which I think you’ve experienced firsthand, but is applicable really, across the healthcare industries, that high level costs are rising faster than than revenue is increasing, which is driving two things. It’s driving businesses to fold or to go out of business, and it’s driving consolidation. To your point, the larger groups are able to negotiate better, or they’re able to protect their margin better. And there’s a reason for this, which is that health care costs in the US have been spiraling out of control for a long time as a percentage of our economy. So it’s, I think, necessary to some extent, but it’s from a macro perspective. It is what’s happening, and I, I wonder, as you’re kind of looking for trying to read the tea leaves the flow bit, as you know, an entrepreneur in this space trying to navigate this, this evolving landscape, how do you think about where, what do you think will happen to this industry, not just here in the US, but you know, globally, especially as you have some of the things we’ve already talked about, AI becoming a much larger per of patient care and patient delivery. And also you have, in most Western countries, developed countries, the twin problem of rising health care, disease, so increasing obesity, etc, on top of an aging and oftentimes shrinking population. The US escapes this trend a little bit because we have such a large percentage of immigration, but are Americans who are born here. We are shrinking as a as a country from a population standpoint, and so it’s applicable to us as well. Curious your thoughts about how this impacts, particularly, again, in developed countries, that we’re sitting here in the US, how? How these, I think, really global scale trends that are impacting really every country, everyone are going to impact you, in particular at the micro at the micro level,

Dr. Michelle Nguyen  39:18  

right? I think this is a really big question, right? I was recently in Japan, for instance, talking about a first world country that has a population that’s just basically stalled, right? There’s no in Japan, I think there’s really the population is definitely shrinking and and they are having to outsource their care health care practices with other countries. So for instance, a lot of nurses from the Philippines are coming over from digit Japan to care for aging patients. I think that it will be interesting to see if we develop a global economy where certain kind. Countries import certain fuels, for instance, health care that can support other countries, like Japan, Italy, the US that have aging populations that don’t have that kind of employment opportunity, you know. If that makes sense, you know. So that’s one, one possibility. The other possibility is AI, like, you know, can AI or robotics help with with some of this? I think I saw like a Tesla robot at some point, you know, is, is that going to be, what’s going to happen to our aging population? So that’s, that’s one thing, just from a just from a health care standpoint, though, I think if private practice wants to stay in business, we have to consolidate with private practice. So for instance, we our surgery center has consolidated with about 15 other surgery centers, and because of that, we’re able to negotiate contracts. We’re able to negotiate not only insurance contracts, but contracts with vendors that make it still profitable for us to maintain our business and and deliver that kind of seamless patient care that we want to, you know, and so I, I, I don’t think any of us ever want to turn into a healthcare system, but there are advantages to being big, and I think that’s where we have been partnering with Merritt for, like, entrepreneurial money and things like that. You know, yeah,

Zak Eisenberg  41:34  

yeah. You know, it’s interesting. Some of the just, just listening to you about some of these challenges. As as the world grows smaller and smaller, in some ways, I wonder also, if you think that, if you’re if you’re just looking ahead, your businesses, obviously, and the businesses you build, are not quite, you know startups anymore, right? You’re they’re more mature businesses, and so you have different challenges. But if you think about new physicians or new healthcare entrepreneurs who are thinking about entering this field, and as we talked about, there’s lots of need for this, particularly in countries like the US that have a aging, increasingly aging and sick population, there’s a need for more and better types of services. What do you think are the biggest challenges today, and as you look for it over, let’s say the next 234, years, for someone who is thinking about, you know, either maybe it’s an MD who’s thinking about making this transition, who is maybe in a similar place to where you were previously, or someone just Coming out of residency, or out of out of their their fellowship. How do you think about, how do you think about this, and what would you, I guess, what advice would you be giving to some aspiring health care entrepreneur?

Dr. Michelle Nguyen  43:15  

I would, I would say that don’t be afraid, because with an MD degree, you can always go back. You can try this, and if you don’t like it, you can go back. At the same time, I would say, call me, because I have about 20 ideas right now where I see needs in this niche. I don’t mean I mean that favorably, but there’s like, literally, I can tell you 20 fields where I can see someone coming in and finding a niche that isn’t being satisfied already right now. And my for me, personally, I have a daughter entering college. My partners were just too old to be doing this anymore, so we haven’t fill that niche, you know. But there’s like, tons of opportunities out there, and I would stress that they shouldn’t be afraid, because, I mean, as physicians, we’re always sort of in awe of business and we’re in awe of startups, but it’s not as long as you’re willing to put in the work. It’s going to it’s going to be successful like you got your MD degree. You’re going to be able to do this. You know, if this is what you want, the challenge will be capital in many respects, but again, it’s not. It tends to fall into place organically in a weird way.

Zak Eisenberg  44:33

Yeah, yeah. Well, I think that’s great. A great advice for MDS going out. Just, just do it. Nike, yeah, just do it. Well. Michelle, this has been a great conversation. I think it will be helpful for lots of aspiring physician entrepreneurs out there in particular, but even probably non physicians who you know might be thinking about the. Starting a new business in health care. You have quite a varied background, which I think is helpful for folks. But with that, really appreciate you coming on the show. It was such a pleasure getting to chat with you. and I, appreciate the time. Thanks.

Dr. Michelle Nguyen  45:18  

Thank you. Zak, take care,

Zak Eisenberg  45:19  

and that wraps up another episode of Transaction Healthcare. Hit the subscribe button to get notified when we release new conversations. And if you are someone interested in learning more about these topics, visit us@Merrittadvisory.com or send us an email at contactus@Merrittadvisory.com