Episode 16: Making Medicine More Human

Hey listeners, welcome to SphereCast, a podcast all about technology, technology advice, technology inspiration, and how real entrepreneurs have used technology to build their businesses from the ground up. If you're wondering how technology can support your business goals, rest assured, our guests have been there and done that.

At its most basic foundation, healthcare is human care. Yet somewhere over the past century, even as health research has gotten infinitely more deep and valuable, healthcare has lost sight of that basic truth that healthcare is human care. That patients are more than just a dollar amount on a bottom line, that they are people with real lives, real personalities, real families, and real needs. And our guest this week is hoping to help today's healthcare find its way back home.

Hey, it's Luke with SphereCast, and this week Ksenia and I interview Ryan Grant. Ryan is the founder and CEO at Vori Health, a virtual-first healthcare provider that practices a holistic, integrated approach to musculoskeletal care. On May 7th of this year, Vori Health announced a 45 million US dollar Series A investment led by New Enterprise Associates. This funding round is a huge vote of confidence for Vori Health's mission, which is to care for the whole person and cater to the real problem, rather than throwing temporary and often ineffective remedies onto one-off symptoms.

Having a background in neurosurgery, Ryan is fully aware of the shortcomings of the neuroscience normal, an environment where conclusions are drawn too quickly and medicines are doled out too liberally. However, with enough grit and determination, Ryan is convinced that the status quo of this international issue can be shifted.

On the podcast, Grant shares the story of how his company came to be, educates listeners on the shortcomings of neuromedicine, deep dives on the challenges of entrepreneurship, and sells us on his mission to make medicine human again. So without further ado, here's our conversation with Ryan Grant.

Hi everyone, Ksenia's here with SphereCast, and today we're thrilled to host Ryan Grant. Hi Ryan, thank you for joining us today.

Hi, thanks so much for having me.

Let's start with a icebreaker. Can you share with us something interesting about yourself that most people don't know?

That's a great question. I guess I can just introduce myself as the start: is neurosurgeon by training, entrepreneur, have started several companies, been in medical device development, and so sort of starts and ends there.

Amazing. So let's get down to business. I'd like to start with the most recent venture. In your own words, what is Vori Health and why did you start this company?

Yeah, it's fully integrated healthcare that's holistic starting in the musculoskeletal space, and musculoskeletal being defined as back, neck, hip, knee, shoulder pain. Spine surgeon by training, was at Yale University, and then at a system called Geisinger. Geisinger's well-known in the United States, not as well-known internationally, but for example, Google took Geisinger CEO last year to run Google Health in terms of innovative systems in the United States.

And why start in the musculoskeletal sector is there is a huge unnecessary surgery rate, and nobody really at large across the planet is following evidence-based medicine. So the whole world is really, really good at giving really high-cost, low-value care, particularly in this sector. Musculoskeletal is the leading cause of global disability. Mental health is number two. And so what drives at least the US opiate crisis is heavy musculoskeletal, back, neck, hip issues are very prevalent around the planet.

And depending on what literature you read, for example, spine surgery, there are estimates that at least 25% of the surgeries being done are not necessary. So as we sit here and have this talk here today, one in four people who are currently asleep on the operating room table getting their back operated on probably shouldn't be there. Think about how many people that really is, is a lot of people. Other estimates at least in the US literature is one in two.

Joints is a little better, but there is a very heavy, not unnecessary surgical rate, and the reason for that is it's business model set up from the past and it drives significant bottom lines of of systems. And so what what you see during COVID is a lot of health systems begging for money when elective surgery goes on pause because that's one of the main revenue generators of a system.

And so if we're really going to treat our our patients like true family members, if they're your mom, your dad, your brother, sister, like how would you actually want them treated? Well, surgery should be the absolute last resort. It's not really done that way. And then on the non-operative side, evidence-based medicine is violated very often. Imaging is used like Instagram. Most people don't need an image. The public is under a misconception about what imaging can actually do. And so most people think that if they get an x-ray of their back or an MRI, that it should be perfect.

That's actually not the case. If you have one wrinkle on your body and a gray hair, then you've got arthritis. We're going to find arthritis on your spine, disc bulges, potentially words like stenosis. The best way to think about it is the arthritis of your face is wrinkles and the arthritis of your hair is gray. And so if you already have that arthritis of your hair, one or two gray hair, we're going to find some type of arthritis on a on a knee scan, a back scan, and that's normal. And so having a perfect MRI with no disc bulges or no stenosis after you're 30 is rare.

And so everything gets taken out of context. It's really about what's the patient's needs, what's their symptoms, what do they really want? What does Nancy want in her life? I would challenge everybody listening to this, or both of you, of when's the last time a clinician, a physician, nurse practitioner, physician associate, etc., actually asked you what you thought about the care plan, or what actually you want?

It's rarely it's done. It's usually very paternalistic: "Nancy, you need an MRI." "Oh okay, I'm going to go get an MRI, my clinician told me." "You need to see a surgeon, ma'am." Well, it's not like, "Well, what's the MRI for? Why do you need to see that? What do you think about that? Is that something that's interesting to you? Like you're the patient, like what do you want? What do you think?" The system is not designed that. It's very paternalistic, and that's across the planet.

Even the evidence-based guidelines regardless of this sector or other sectors don't actually bring into what would be called shared decision-making, when actually the the patient's at the center of their care. None of them actually bring into what the patient wants or, "Hey, did you actually have a conversation with the patient about what they think about the care plan?" No. And do clinicians get trained that way? No. It's ordering people around about what we think they need based on training without actually bringing in the patient.

And even the way we write notes and trained at large is dehumanized. So, this is a 48-year-old female who has high blood pressure, high cholesterol, and is overweight, and then go into why she's here. Not like, this is Nancy, who has three children, this is what's most important to her in her life, the reason she came here is she's not able to participate in the activities she likes to do that makes her happy. It's just a list of disease processes with an age on it.

And so medicine across the planet is very dehumanized for a variety of reasons, and I just think that it's it's overdue to make it more humanized, practice what's ethically sound evidence-based medicine, help people, be holistic, and then blend that with a social community so that people can have a much better experience across the planet. So we're starting that type of care in the United States and aspire to be in all countries over time.

That's such a wonderful cause. Truly, I'm just shocked here just listening to the story. Not shocked in a way what I learned from you, but just the sheer motivation behind starting Vori Health. Could you talk to us a bit more about Vori Health? How does it help a patient, let's say, let's say my mum? I mean, she suffers from a bad, she has some problem with her neck, I don't know what disease it is, but it makes her arms numb, and all kinds of pains, and sometimes her head goes round, etc. And this has been her condition for the past 20 years. But she wouldn't go on the operation table. She's like, "No, I'm not doing it. I have to live a normal life. I will just do my exercise, my yoga." So I can relate to these things. And when she goes to doctors, and she stopped going to doctors because they will just push her into like, "Okay, you need to do this, that's it, that's the end of discussion." So I can appreciate what you just said. So how does Vori Health help some patient like this?

Yeah, it's a great question. So most people will enter the medical system by going to their primary care provider regardless of what country you're in, and primary care providers are not musculoskeletal experts. So they they have some training, but just like they have training in being primary care provider, not trained in full cardiology, that's why there's a specialist, they're not trained in full endocrinology for diabetes. They can take care of a smorgasbord of things, but no one's an no one can be an expert in every subspecialty.

And so there's a baseline training, and so usually what ends up happening is given that there's not a huge training in the non-operative musculoskeletal sector, there's just an education gap so there's a high rate of unnecessary images, and just it's a knowledge gap that exists both on the provider side, but also just the patient side of what imaging can really do. And it's not like cancer where, yes, if you see something terrible on a lung, a lesion, then you should take it out.

That's very different from arthritis. Like you don't like, is it is it melanoma in your scalp, or is it just gray hair? Those are very different processes of is it just normal aging that we we don't have to do anything about. It's sort of like do you want to dye your hair or you want to not dye your hair? What it's your life, like how much does that gray hair bother you? It's this is disc bulges and stenosis. Is the person symptomatic or are they asymptomatic? It's like how bad does it bother them? Because the imaging for arthritis when it's just pain is sort of meaningless. We don't have any good evidence that if it's just pain, not to minimize how much pain can be uncomfortable, that you incur any permanent damage to yourself if you choose to live with it.

And so the only person who really knows how bad the pain is is the person experiencing it. Like they're the one living with it. It's not the not the clinician for 20 minutes who's talked to you. You're the one walking around at the grocery store, into the car, in the bed, in the shower, at the gym, etc., etc., on vacation, like wherever you are. Is it bad enough, after you've gone through a non-operative platform—so most people through a non-operative program, about 85% of people will get better—but they require an integrated care team. They need a mixture of health coaching to keep people honest and help them care navigate. They need a mixture of medical care in the background for potentially non-opiate-based pain medications that are evidence-based, try to decrease the utilization of narcotics. And then a movement-based therapy, whether that be physical therapy, athletic training, etc., all blended together into a holistic care team based on, well, we know your back hurts, but what are you really missing? "Well, I want to be able to walk a mile with my children." So okay, well the care platform is really designed to let's try to reach the goal of walking a mile with your children, in turn also helping the back pain.

And then just helping a heavy educational component. And so there's imaging is not the magic. Do you need to have an image most of the time? No. If it's just pain, it doesn't really matter what the image says, it's really up to you. And so we use images, we're supposed to use images for those who do not get better on a non-operative platform after 8 to 12 weeks. The next step down an evidence-based paradigm, regardless of what country you're in, would be they meet criteria for an MRI or x-ray, which is designed to look for potential surgical targets or something more invasive. See if there's something more aggressive that we can do since they didn't get to where they wanted on a non-operative platform.

Now if it's just like going back, if it's just pain, the decision tree is really the patient. Is the pain bad enough to actually have surgery? In your mind, like you're the one living with it. So you didn't get to where you wanted, you're one of those 15% of people, "Well, no, I'm not where I want to be, but I'm not bad enough to even have a needle in my back." So then why do you scan those people or push them to surgery? They just told you that they're not exactly where they want to be, but they're not bad enough to want to be cut open.

I see.

And these so these are quality So surgery for discs discs and pain, surgery for pain are quality of life operations, right? They're try to make your quality of life better, that's really what they're for, right? It's not like you're going It's one thing if you're going paralyzed, which is really rare, or if you had cancer, which is really rare. Those are different, those are different types of things. If it's just pain, having less pain in your life makes your quality of life better.

So really the decision-maker through the guidance of a care team and coaching is the is the individual. Is your pain bad enough, or is your quality of life bad enough to have surgery, or be cut open? About 20, 25% of people will say, "No." So you should not force them or aggressively convince them to operate. They just told you the answer, but that's not how medicine's practiced across the planet.

So just going by this platform that you you have developed, so it was founded, I believe, in 2020 during the pandemic. So could you tell us a little bit how you, what I mean was it data that you found, because you talked about the data that was visible, that the businesses that are in the running in the background, they ran out of cash. And that's kind of what exposed the model, that it's very much based on the services and not the actual welfare of the, let's say, patient, or a person, maybe. So when was this realization, and and how did you go about starting this this business? How did you get the backing, or did you self-fund it yourself? Could you tell us a little bit?

Yeah, that's a great That's a great question. This has been years in the making of just practicing on the front lines of, as you train in surgery, it's realizing how many surgeries actually work, or like how many people actually get better. How many people actually go through evidence-based pathways that we know, like how many people actually go through what's known as best evidence to help people, it's rare. And as you watch medicine get practiced, and you start to realize that it's this is done in every country we have data on, it's literally out of control.

Of getting it starts to starts to just really bother me, it's like, well if this if this stranger who's in my office was really my brother, what would I do for my brother? Like really think about it, like what would I do for my brother? I'm like, you wouldn't do any of this.

This is where the dehumanize, I think, thing comes in. And I mean, you're saying this, but I I always see this look on my mum's face. I keep talking about her because she always gets upset with the doctors, how they treat her, when she's asking questions after question like, "Okay, what does this mean? What happens next?" She's just told to follow something, that's it, and they will treat her rudely and she would come very upset, you know, when she comes home. So yeah, I get it.

Right. So it's it's really it's and it's not that it's not that the clinicians are None of them are They're not bad people. It's just the way we've all been trained. I was trained like that, where there is your patients are a bit dehumanized. Part of that is just you're dealing with lots of emotional things. If you are truly, fully connected to the patient as if it's your spouse, you probably won't perform as well, particularly as a surgeon. They're in your head, like, "Oh my god, if something happens, it's my loved one." Like, you don't want that type of bond with the patient. It's the same reason that most surgeons or others don't want to take care of family members because the the stakes are up if something goes wrong. Now they're in your head versus you don't have an emotional attachment, you're going to just do your best job that you can versus thinking about, "Oh my god, this is my loved one, I'm with them every day," and have that cloud your judgment certainly serves a a basis versus that's not in your head.

But at the same time, I think we can be a lot more humanistic when we help people make decisions or guide them. If the if this actually was my mother, what would I tell my mom? Everything I know, evidence-based, that's the answer that I should actually always give. But that's not how we tend to be trained, and so people tend to be more of a, like I said, a 48-year-old with a bunch of diseases. And based on what we know about these diseases, you need to do this without even even asking your mom, "Well, what does your mom want to do? Does she does she like that plan? Does that make sense for her life, or what does she think about it?" and bringing them into the conversation.

And so all of these types of things was, "Well, you know what, we sort of just need to start over and build a system from scratch that can actually bring in the care teams, can actually do evidence-based medicine well, can care navigate people, can function as a coach, versus trying to overhauling an entire system." Is it like, are you building a new house from scratch, or you're going to try to remodel and redo the entire house you just bought? Sometimes it's better to just start over. And so here, it's better, in my opinion, just better to start over and build from scratch. You can still partner and help those in traditional systems, but really push the limits there.

And then went and raised venture capital dollars to start building a minimal viable product and get an initial team together, get some initial customers moving along, iterate, and then I left my surgical practice full-time to do this full-time. So I stepped down from my practice to give all my focus to this. And then this is capital-intensive to try to get to the end goal, but that's okay. It's really about helping people, helping the world be a better place, and just doing the right thing all the time, and making medicine more fun. And so we just raised additional funds to go a bit faster.

Never heard that before: making medicine or medical profession a bit more fun, so yeah.

Yeah, what I would what I would what I would say is well, think about when medicine's done well, it's boring. It's like I'll just be honest. It's like you might like your individual physician or whoever you saw, like, "That's a great person, love their bedside manner." But the ecosystem around most medical places is relatively boring. Sort of makes me think of like the airport, where it's like it's it's an experience, but you're not like, "Oh, I really can't wait to go back to the airport. It's so exciting." The trip's exciting, and that's just a transaction to get there.

But obviously you're dealing with serious things in medicine, but that doesn't mean that you can't make it more engaging and less boring, and just make it more fun and where you can and more humanistic. And so yeah, I would argue you push where you can to rehumanize medicine, to push the limits of engagement, and where you can, to make to make it more engaging and stimulating. Think about the classes that you took that were super boring in school: you don't remember anything, it's like terrible experience, it's like. But even if it was a subject matter that you didn't love, if you if it was done in an engaging way, you enjoyed it, and you learned more.

I agree. You briefly mentioned MVP. So, Ryan, can I ask you, what was your thought process in selecting the technology solution for Vori Health? Could you tell our listeners about your product strategy? Did you go with a cheap and dirty MVP, or did you use high-end technologies that you knew would scale up and be future-proof?

Yeah, that's a great question. A mixture of both. And so when you think about the various components of what do you build, what do you buy, what do you rent, etc., etc., in terms of being efficient is you need some components that are custom, like you're not if you're going to actually build out virtual care teams, for example, who can actually interact with each other, and actually do care together, pull in and out, push and pull content, actually have a very nice engagement, well, there isn't a tool out there that you can directly use to do that, so you have to build that component.

Now, of those components, let's say the way we like to think about it is you're building an airplane. And so does the airplane manufacturer build every single component? No. Some's custom, and then some they acquire or have suppliers. And so for example, do you need to build an RTC, so for web conferencing, do you have to rebuild the entire Codecs from scratch immediately to just do video chat? No, there's tons of different vendors that you can insert inside of your ecosystem on a white-labeled side around your custom offering, but then have that in a container, meaning you can change them in any moment.

Or depending as you scale and on the economies of scale, does it make sense to have does it make sense to just build it on your own on open-source Codecs, or does it make sense to stay on a vendor as you scale, pros and cons. And so it's like, and then chat interfaces, the underlying code for a chat interface, there's 20,000 people who've done that. The way they put that together and blended it with the rest of the ecosystem is, going back to the airplane, like they don't build the engine. But putting the engines plus the hydraulics plus this plus the interior into an ecosystem is the way that they really put it all together.

And so use things off the shelf that are not proprietary, meaning it's been done a thousand times, like use something off the shelf there, and then build things that are proprietary in terms of the way care teams communicate each other, talk with the patients, the way the content gets pulled and pushed, the data analytics components, things that are truly custom, and then wrap around off-the-shelf technologies is the is the, I think, the most efficient way to do things.

Leaving it open though, that you can replace those off-the-shelf components with custom components if it ever makes sense. And so it might never make sense, like I go back to the airplanes. It still has not made sense for Airbus or Boeing to build engines on their own. They still outsource that to third parties. And so they build a lot of things that are custom, but they don't build the turbines still.

That's great insight, by the way. So my my question is, you said you're a surgeon by profession originally, and you've recently left that, you know, particular part of the profession, and you've left it behind to to go into a much bigger, let's say, calling. So my question would be, just by going by what you explained me, you seemed very dangerous in terms of technology. You've you've learned obviously along the way. So how do you keep yourself sharp in terms of the the technology knowledge, and you know, you talked about Dockerization, or containers, and getting the open-source solutions where you could, and not proprietary stuff, and building some of the core solutions that you want to focus on, and and then you could think about it once you get certain, you know, traction in the market, you could go about repurposing some stuff and creating some of these systems from scratch later on. So how do you how do you, do you listen to a lot of stuff? Do you I mean, are you are you being helped by a CTO or?

Yeah, it's a great question, is I'm definitely not a technology expert. Know enough to have some conversations, but definitely not an expert. And so you need to put expert teams around you, and and so the way you think about it is do you need to know how each individual component of your car works to drive it? No. Unless you're a mechanic or someone who builds engines, do you actually know how each little individual component of your car works? No, most people most people just know how to turn it on, and then it needs needs fuel or charging to keep moving, and then it needs tires every so often, and that's and otherwise they don't really know how it works. It just works. Do you know how your iPhone or your Android phone work? No. But are you able to use it?

And so in terms of those types of things, it's making sure that you have a team who are experts aligned in a vision and a strategy, and then also a team of advisers who, and I think the way you do these things is, one, it's having experts inside of your org, but then it's also setting up mentors who are sort of where you might want to be one day, who've done this type of work. Like so who's at scale, like we'd like to be in all the countries one day, so who are some companies who are in all the all the countries who've scaled up over time, who run a global, national conglomerate with tech teams all over the place that they keep iterating on? And so who are those CTOs, for example, and how many of them would be willing to talk to you or give you time?

And so we have a few who built up global systems on our advisory board who are willing to meet with us multiple times a month, sometimes weekly, to also challenge our thinking, but also just review, "Here's our strategy and pipeline on tech decisions. Here's what we think we want to do," plus other mentors to continuously challenge, does this make sense? Does it not make sense? What are the pros and cons?

There's multiple ways to climb Everest, right? There's multiple trials, different routes. Should we do this one? Should we do this one? What's the tradeoffs? Does that make sense? How do we lower our our our amount of tech refactoring we'll have to do in terms of costs? It's like, obviously as a startup, you don't you don't have the resources to spend an extra $100 million in the beginning, right?

So it's how do you maximize technology that can be scalable, but also decently frugal, but then make tradeoffs of like, "Well, you know what, this might be a temporary container for the next three or four years and serve its purpose. We have the opportunity to build it on its own if we want to, but spending tons of time and resources here to recreate an RTC, so a video chat interface, and burning two years of time to do that, doesn't seem to really make any sense. That doesn't actually drive patient care." And so that type of work.

Ryan, what do you feel are the most difficult decisions for a CEO or an entrepreneur to make? And then also, as a neurosurgeon, what do you think are the most difficult decisions to make?

You never have perfect data of decisions. And so there's there's all sorts of reports or reading an article, I think not not too long ago, I think it was in Harvard Business Review, if I remember, was even when you have the most pristine, quote, "perfect" data you could to make a decision, at best, it's 60% accurate. And so you're always making decisions on incomplete data.

And it also is if you are also building systems that don't exist, then you're making decisions in an unknown frontier about, well, how are people going to respond to it? And so it's how much can you really get into the market to sort of just test like, will people actually use this, or what do they like about it before you pour tons of resources in it to understand that?

I like the Henry Ford quote back in the day of new technology: people aren't very good at telling you what they need or want. They are good at criticizing what they like or don't like after they see something. And so it's like before the assembly line or the Model T came out on Henry Ford, people would have said, "Well, I want a faster horse." No concept that a car could even exist, or a self-propelled carriage. That wasn't in their mind's eye.

And so usually asking most people what they want, like when they did the research back on the iPhone before it came out, and they were talking to the BlackBerry folks, they wanted a better keyboard is what people would answer. But was that really the answer of like what they were trying to do? The answer was no, if you dug a bit deeper. Well, why do they want a better keyboard? Like the five whys. Well, they want something that's more convenient and easier to type on, and they want, but they would also like a bigger screen so it's easier, and it all came back to convenience, convenience and ease of use. So they just want better ease of use.

And their surrogate for that was, ease of use is I need a keyboard that's easier to interact with because this can this can get a bit sticky, or the letters are too small. And so it wasn't really a keyboard that the consumer wanted, they just wanted better functionality. And so that gets back to the drawing board: well, did the keyboard have to be physical? And the answer obviously on the current phones is no.

They wanted bigger keys, that's why they blow up on you, and a bigger screen for convenience. And so it's just thinking outside the box on those types of enterprises about what are people really asking. And so focus groups can have some merits, but it really depends on what you're asking people. Like are you asking them to criticize an MVP or a flow? Sort of like when Pixar makes a movie: here's the here's the scenes that we want to go through, here's how we want it to sort of work, now we have a focus group to get people to criticize it, versus if you're asking a consumer to try to innovate with you, that's usually less helpful unless they're an expert in the space. But if they're really just a consumer of the product and it's going to be something more novel, people tend not to have that type of imagination that you want to innovate with.

And it's the same reason that it's just how we all think: when you walk into a house for sale, does it sell better if it's empty, or does it sell better if it's staged with furniture? People have trouble imagining what things can be. If it's a bunch of empty rooms, they have really have trouble imagining what the furniture would look like inside of it. But if you stage it, "Oh wow, look at," they can now they have a much better idea to criticize that. And so that's why why the homes sell better when they're staged. All of us at large have trouble imagining things in our mind's eye, but can visually or from reading respond to it and criticize, if that makes sense.

You know, thinking about what you just said, I was thinking, so if if I started thinking like this, I think my house will be empty, at least my office, because I wouldn't buy 70% of the things I have purchased, I'll be to be fair. But yeah, I can see your approach. I can see your approach, by the way.

Yeah, and yeah so, yeah, feedback. You want as much feedback as possible. You want as much criticism as possible, the good and the bad. That's the only way you keep making something better is like what what don't people like? You never have 100% of people love what you're doing. There's no there's never been like a bestseller where 100% of people loved it. That's amazing, 100% of the time. But you still want to understand why so that you can still try to get to 100%, no matter what.

And and then it's really just understanding where the who's the who is the feedback coming from, and then and what were they responding to. And so, because otherwise it can be misleading if you don't understand what was the prompt that they responded to, and what is their background to actually understand in context what the data was actually trying to do. Otherwise, it could lead you astray.

I want to jump into the future a little bit. If I may ask, what goals do you have for the company for the next five years?

It's acquiring as many partnerships and customers as you can, and the reason really for that is this sector is so out of control is trying to organize it and drive down all the unnecessary types of procedures you just heard, to try to really do well if all of these people are your family is a big priority. Driving up engagement, and then as we expand across the United States, which is which is where we started care, want to be in multiple countries in addition within five years doing similar type of work because this is a global problem.

And so it's really moving beyond the United States for care. We do have team members throughout North America and now will be entering also Europe and India for additional team members. But in terms of actually delivering medical care, it's every place you go, there's ways to help and drive value. And so the the biggest way we think about it is driving value in as many places as you can where people where everybody wins: the patient's winning because they're getting better, we're avoiding unnecessary care, we're taking in their decision-makings, we're engaging them more. The provider systems that you partner with are also winning, you're making their life easier, or organizing things for them, or X, Y, and Z. And then on the payer side, whether that be the patient, an insurance company, an employer, you're driving down their cost of care.

And so really, I think the way you change the world over time is everybody's got to win in a better way. And so both patient, providers, payer partnerships, the team, and if everybody if everybody benefits and you do it in a nice way, that's how you can start to really, we think, change, start to change the conversation versus somebody has to, you're taking somebody away from something versus how do you actually have each component of the ecosystem let people win. And people like to win, either winning meaning more time back in their day, which gives them more time for their family, whether that be more money in their pocket, whether that be more happiness or engagement. There's multiple different ways to describe winning.

Can you describe us or outline your typical day?

I would say it's managed chaos, but in a in a good way. And so all everything that we all share across the planet is we all have the same amount of time. And it's setting a set of goals for the day or a week. It's usually like what is the what is the overall goals that we need to or, at least in my mind, I want to hit and work on as priorities this week or next week, or within today, because we do get pulled in tons of directions. And so always, I think, can get better at saying no.

It's like you you you could literally be pulled into endless work groups or meetings and actually get no work done, right? Direct work that you need to do on versus are you critiquing, commenting, or doing something else for part of your team, or does this really benefit value for what your goals are for the week, the month, pick a timeline, and stay try to stay really focused on that.

And so it's a mixture of business development. It's I think in these early days, one of the biggest things that you spend your time doing is team building, inspiring team members to come join the cause, so it's it's recruiting awesome talent. But then it's also that same inspiring partnerships to work with you, inspiring investors to invest time and dollars in you to fund these types of endeavors, and inspiring, in essence, a calling of a team. It's not just the internal team, but it's the it's your initial partnerships, it's your investors, it's sort of that same type of And then aligning the team overall on strategy and vision about where we're going. There's like there's 50 different ways to get to top of Everest, but also being helping set up and steer a culture with a team that is transparent and tries to really be open with one another.

And so I would really say spend 60% of my time in these early days on building partnerships and recruiting team members, and inspiring people to either invest in us, partner with us, join our team. And as those functions start to get more into place, the schedule will start to change some. And then in an early-stage startup, you wear many hats, and so there's there's a mixture of finances to do directly until you have a full finance team in place, and setting up the legal legal infrastructure with the help of legal to actually practice medicine across all of these jurisdictions with different rules.

And when like when you first start a company, nothing exists. So well what's the what's the basic policy? Well, when you first start, there's nothing, right? It's like got to start start typing in Word and then have someone iterate on that with you, and then get that stamped by does it fulfill the law, so that you start to really have the foundation. And so you spend a lot of your time on a mixture of inspirational things of pulling a team together, but I think what some people, if they haven't built a company before, would find maybe boring of, well, is it really exciting to set up a bunch of bank accounts and legal infrastructures to drive a corporation and all the tax pack? No, for me, that's it's relatively boring, but it's requirement.

And the way I like to think about it is your whole day isn't like, "Wow," it's like on the movies where everything's amazing. The vision is what keeps you going, or like on a sports team is the championship and the gold medal's really exciting, and your teammates are really exciting, but are all the practices amazing and fun? No. It's like some of them are like exhausting, and you're like, "Why am I doing this? Why am I up at 4:00 in the morning to go do this practice? Why am I at the gym at 6:00 a.m.?" because it has all these other benefits. Or when we went to school, did you enjoy all your classes? No. Did you like all the projects you had to do? Absolutely not.

Would did that fulfill Did you learn something from that, looking back, some of the tasks that you had to do that you're like, "This is really terrible"? Actually, when you look back sometimes, actually sets you up to actually be much more successful and all lead towards that diploma, which opens doors for jobs, which opens a skill set. And so really, it's what do I have to do to get the company to the next step? What does the company actually need that nobody else is working on that even if it's boring, you still have to do it.

And so it's really, I think I think school is maybe a way to think about it, is like you're taking these different classes of an overall theme, focused, and some of it you're just not going to like in the beginning. And as you get bigger and bigger, try to move things to because there's always somebody out there who loves the part you don't like. And so how many things over time can you get people to be 100% of the time working on things where they can say all day long, "I love what I'm doing," which requires open conversations with people about, "Well, what part of the job don't you like?" "Well, I don't like this 20%." Is there a way to move that 20% to somebody else who loves that component to really maximize people's time and energies and love, really requires a different type of conversation with people. Because it's usually in most corporations, if you tell your boss that, "I don't like this part of the job," it's usually shunned. Or some some people will say, "Oh, I'm going to look weak if I don't want to do this part," or, "If I if it makes it In my mind, it makes me feel like I can't handle it." And so it's just a different type of culture setup so that people can excel.

I'm thinking, what do I not like about my work? I can't really think of much right now, so I'll I'll I'll pause myself on that, but I can see, I can see. I will reflect, definitely.

And and I would say of the of the things I do, like day-to-day, like love love what I'm doing overall. It's like the mission, it's the the camaraderie with the team, what we're working on, the excitement. Some of these tedious tasks to fulfill legal regulations and compliances is not very exciting for me, but you still have to do it. It's the it's it's it's it's it's the right thing to do. And is is the pilot going through the checklist on the airplane super exciting for most? No, but it's what you do to maintain safety and able to enjoy the flight.

So, Ryan, we've come to the final part of our podcast. This is where our questions can get tricky. If you were able to go back in time, let's say 10 years, what's one thing you wish you had known before you began your career?

I think one of the best things of advice that or I've learned along the way and also talking to people of what's the most challenging part of a startup or all of these things, or just new endeavors, I still believe it to this day, is managing your own emotions.

And so I think people being more transparent about what they're actually feeling, and the stress that people go through, or what keeps them up at night, that people start to realize that you're not you're not an isolated individual. It's like, what are other CEOs feeling when they're making tough decisions? What are the other surgeons feeling when they're making tough decisions? What does it look feel like to have a complication on a patient where they didn't do well for whatever reason? What does that emotion feel People don't tend to talk about those things. They tend to just keep it all inside and not really open up about the emotional issues that they're running through or the monologues in their head, or you talk to other folks, they're like, "Yeah, I didn't sleep for three weeks after that after that after that, and it just kept me up, and my mind kept going on it." And I think that it's a it's powerful for people to know that managing your own emotions and the things that come, it's a it's it can be a roller coaster. There's excitement, and then there's stress, and then there's, "This is working, this isn't working, we have to change course here," can be difficult difficult for people to manage.

And on I would say on the startup side, I think I've gotten better at it, but I don't think I'm perfect at it, is when you're working and pouring your soul into something, it it is challenging to not identify your own identity with the startup. And what I mean by that is if something's not working, or something that you thought would work isn't doing as well as you want, for you to separate that from your own personal identity of like, "Oh wow, that was well that well that was my decision, well that's super stupid. Am I stupid?" People people jump to that pretty much when they're pouring their heart and soul, or like it's like, "Well, I set all of this up, it wasn't working, it's like like like am I a failure?" That's where people tend to jump to right away. You're like, "Oh my god, I did terrible on that final in school. I'm a failure." And people jump right into that mindset usually.

So it's it's, I think, training people yourself of that things will not work, that's where you learn, and to be open about what's not working, and to understand that that will go through an emotional up and down, and that that's normal, to talk to other folks about it, you're definitely not the Everybody everybody goes through that. But it's better to have folks who've done it before you, and so I would say no matter what what stage you're in your life, people always do better with a mentor and/or a coach. Even Olympians have a coach, and everybody does better. So who do you go to with tough decisions? Who do you go to advice? Who do you go for for the this? Who do you go to just vent? It's like, well, it was just not a great day, and it was a very stressful day, and who do you go talk to to just let all that out so that you can learn from it, but also keep your own sanity? And so it's making sure you take care of yourself at the same time.

That's amazing advice there. One of my mentors, I think five years ago, he told me, "Don't work to, you know, create a bigger bank balance. Work on the emotional bank balance instead. Train yourself to have a bigger emotional bank balance, so you can work with things, you know, a little bit better when there's a setback." And and yeah, I mean, what you just said, we we talked about this with another CEO a few days ago from California who's into Medicaid and medical insurance services in the South Bay Area. And she talked about the same thing. It takes a lot of training to be able to handle setbacks, and how you kind of, you know, when when a thought of failure comes to mind, it's just previous information, memory just repeating itself, how you can shelve it and and not connect your future or your actions that you're taking now with something that's happened in the past, because you know, every time you start something new, it's not like what happened in the past is going to be, you know, the it's not the same result you should expect. You should you should do something different and and take a step and and leave it. You know, the outcome is not in your hands sometimes or always, so you just wait and see what happens and move on.

Absolutely. And so every everything's a learning experience, and not everything's going to work, it shouldn't, not all of it should work. It's more of recognizing as early as possible when it's not working so that we can make decisions about how do we change it? Do we not change it? Do we scrap it? Just like an artist, when they paint, they not all the paintings come out well. A musician, when they practice, not all, they spend a lot of time messing up before they do that performance. Why does athletes do all these practices? Because you're not always perfect and trying to just be better at the game. So it's it's continuous, you will not perform well all the time.

And with those magic words, we are going to conclude this episode. Ryan, it's been a pleasure. What an amazing episode we've managed to record. I hope you enjoyed as much as I did. Ksenia, do you have any thoughts?

I just want to thank you for your time from your busy schedule, and I want to wish you the best of luck in your business and future endeavors.

Thank you so much. It was No, it was a lot of fun, and thank you for having me.

A special thanks to our podcast guest this week, and once again to our sponsor, Sphere Partners, for bringing this episode to life. If you enjoyed this episode, drop SphereCast a five-star review on iTunes, and share this content with your network. For any relevant links or notes from this episode, check out our podcast website at www.sphereinc.com/spherecast. And always remember, when you think you can't, technology can. See you next time.