Note: transcription provided by Otter.AI, which is a technology company that develops speech-to text transcription and translation applications using artificial intelligence and machine learning.
Christopher H. Loo, MD-PhD: Welcome, everybody to this week's podcast episode for the Financial Freedom for Physicians Podcast. And I'm your host, Dr. Christopher Loo. And we have this weekly podcast where I bring in guests, physicians, entrepreneurs, investors, that are doing things on the cutting edge, moving the needle and impacting the field of medicine. So today we have a physician, we got introduced through mutual contacts. Dr. Cheng Ruan and he goes by Cheng, and he's a physician entrepreneur, specializing in lifestyle medicine, integrative practice. So it will be a wonderful discussion about how he got started entrepreneurship, wellness. And so Cheng, welcome.
Dr. Cheng Ruan, MD: Thanks so much, Chris. I really love having you interview me. I'm usually the one doing the interviewing. So this is a nice change.
Christopher H. Loo, MD-PhD: Yeah. We got acquainted through Dr. Brent Lacey. And you're based off Houston, I'm based out of Houston. So tell us more about your journey, how you got started, how you got doing what you're doing today?
Dr. Cheng Ruan, MD: Yeah, no problem. So, I started my sort of medical journey with an integrative background, because my mom does acupuncture, herbs and Chinese medicine, she's really well known in Houston. And then, my dad, he's on the scientific side, he's MD-PhD. He's currently one of the Deans at the University of Houston Pharmacy School, and Tech and Biological Developments. So I kind of grew up at the dinner table talking about different things. And even in my first publication, I was such a big nerd, I still am, when I was 16, talking about the effects of herbs on dysmenorrhea, and chronic pain receptors, etc, etc.
So, as I went through training in school, I really wanted to focus on integrating sort of the Eastern Western principles and philosophies, right. And so, being sort of the, the, the ADD type of entrepreneur that I am, I created a lot of structures for myself, so that I'm able to do so. And then out came Texas Center for Lifestyle Medicine in 2017, where I really wanted to focus on bringing more of the Integrative Health type services, to the insured population, Medicare, Medicaid, et cetera, et cetera. And also 2022 started a program to teach other Docs how to do it and really want to scale this, and that's why I'm on the show.
Christopher H. Loo, MD-PhD: Awesome, awesome. That's so wonderful. Yeah, my mom and dad were scientists too. So we grew up around the dinner table, talking about academics and medicine.
Dr. Cheng Ruan, MD: Awesome.
Christopher H. Loo, MD-PhD: But yeah, that's awesome. So you. And so tell us what made you focus? Why did you decide on wellness and lifestyle? Was it something you saw an experience and encounter?
Dr. Cheng Ruan, MD: I think the biggest misconception that I do is actually wellness. So I actually don't let my staff use the W word. We don't use the word wellness. And part of it is the messaging. So early in 2014, I actually started a digital media company for physicians and actually exited and sold that. And part of the things that I learned really about messaging, very strategic messaging, is sort of the understanding of the concept of labeling. And so one of the things I wanted to get away from was what wellness is in the actual United States, which belongs in a bit of a different category. So, instead we use the word collaborative, and there's a reason for that.
So the word collaborative means a lot of different things. We like to collaborate with the patients, we collaborate with the other doctors on the outside, we collaborate with the insurance companies, and we collaborate with their family members. It's a four way collaborative system. And so unfortunately, in the health and wellness space, there's not a whole lot of collaboration. And there's actually a lot of physician-on-physician bashing, which I kind of see on the internet all the time, which is not what I'm really fond of.
And so the concept of collaborative medicine is that we don't stop at finding solutions for your health. So we end up with some really complex physiologies, really complex disorders, diseases. And so much so that we got featured on the North American Rare Diseases Association site. And then we are getting all these sorts of connective tissue disorders and stuff like that. And then nationally became that way, because the actual primary focus is on collaboration.
And so, the way that I even developed the business plan behind it is because I was really following what regulatory statements were doing at the federal level, and reimbursement and CPT structure.
So 2017, when the practice started, was the first time we actually had CPT codes that reimburse for collaboration. And I bet most people don't even know about this. For example, if I'm speaking to a patient's doctor, or my staff is, there's an interprofessional CPT code that can be billed by both sides. And so I started really focusing on, hey, I'm gonna spend half my week just talking to other patients, doctors and the collaboration process. And so obviously, that actually generates a lot of revenue, believe it or not, is the actual collaboration effort.
And so I'm like, there's really something to this. And then making a business plan based on the reimbursement structure allows us to really focus and tune in on what patients are really saying in the messages. And, and I think that created this new sense of core values, is that in all medicine, it doesn't matter in the US or abroad. In all medicine, there is a serious lack of interprofessional discussion, right? And so it's sort of the idea that, hey, let's move on to the next patient, let's kind of forget about this. Whereas for us, it's like, hey, let's put this aside. And let's have a collaborative discussion between the physicians, the dentists, the chiropractors, the acupuncturists, their physicians at Mayo Clinic, whatever, whatever, right?
So we ended up seeing a lot of interstate patients, international patients, Dubai, Kazakhstan, Germany, and it kind of turned into this, sort of this monster's beast, so that was a little hard to control [laughs]. And then from an entrepreneur standpoint, I’m like, Well, how the heck am I going to make this more scalable? And I realized that doctors really need to understand that there's a way to redesign healthcare. And it's not going to be the politicians, it's not going to be administrators, it's going to be the doctors that are going to be taking control, to change what healthcare is supposed to be.
Christopher H. Loo, MD-PhD: That's awesome. So you mentioned a lot of things such as scalability, and you work with insurance entities. Tell us some of the barriers working with these entities and scaling up the company.
Dr. Cheng Ruan, MD: In my company, I make everything to make everyone know that these are just challenges. These aren't problems, right. And so let me tell you the biggest problem, the biggest problem is that the current model of medicine is not scalable, right? Think about it, like a doctor starts his or her own practice. Maybe it's a solo practice, and after 30 years, retires, and then wants to sell the practice. Well, what assets do you really have to sell within the practice? Because the talent is going away, the talent is retiring. And so you have a lot of large corporations scooping up these doctors that are retiring, especially during the pandemic, right, and all they care, but they really just care about buying the list of patients, right.
And this is called purchasing market share. And corporations do it very well. They really specifically go after doctors over the age of 65, who are within three to five years retiring. And they romance them. And this is what I see sort of across the board. And I do advise for VC companies that do that. But the problem is, that it creates a lot of depleted healthcare systems that kind of fill itself on systems that do not work. And so from a business standpoint, this is the checkmark on the box of large corporations scooping the market share, right? The problem is why doctors are so burnt out these days is that the innovation that's required to change the healthcare system, even though it's in a lot of doctors' brains, it's not coming out. It just kind of stayed there. And the patients actually suffer, right.
And so now the health and wellness community, that's a different story. Because a lot of times you know what, I'm going to stop taking insurance, I don't have to adhere to the CMS guidelines and et cetera, et cetera. Right, and then they say, I'm going to engineer the health the way that I see fit, but then what happens is they get burnt out too, because they're serving a population which they may not have a whole lot of passion serving, which is relatively middle to upper middle class and wealthy populations, right. And so, engineering is sort of the system that marries the two together and requires a very, very deep understanding of reimbursement strategies, revenue cycle and business tactics. I got kind of obsessed over it. And now that I've done it, and I just feel like crap, wait, why didn't doctors do this before? And that's the thing that I really want to get out there. Is that we really have to take shape and take control.
Christopher H. Loo, MD-PhD: That's awesome.So for a lot of physicians in my audience, it changed from financial economic empowerment to knowing them starting their company. So tell us some of the challenges you encounter when you start a business? And we'll talk about scaling a little bit later.
Dr. Cheng Ruan, MD: Yes. So first of all let's just kind of address the elephant in the room is that our physicians aren't trained to build businesses, right? We're trained to be very textbook savvy. And then we're also trained to really develop relationships between us and our patients with the concept of entrepreneurship and the things that are needed to get to a process where you're not building the company burnt out, is the opposite of what we learned in residency.
Let's think about it for a second. Let's just deconstruct residency for a second, right, and I talked to Brent Lacey about this before. When we deconstruct residency, what it was, is multiple layers of structures that we had to adhere to, okay, we don't adhere to the structures, we get spanked by somebody, either lawsuit or administrators or something. And then we come out, right, and we come out and we're like, oh, my gosh, I really crave more structure because I wasn't trained to create my own structures, because that's not what residency was all about, nor was the fellowship all about, you know.
And so, what happens is that we tend to get our right brain stifled, our creative brain kind of stifled into this sort of fear phenomenon. And the fear is that if you do things outside the box you, quote unquote, destroy your life. And financially, we're actually tied to, to the conventional structures, because I mean, I came out with $300,000 in debt, I don't know about you, that's a lot of money to pay back. So it needs some sort of security.
And then not to mention, there are physicians listening to this that never matched residency; they have to create their own structure as well, which is a whole other set. So we think about it from that point of view, there's a whole lot of PTSD going on through the residency, especially for the right brain dominant treated type of physicians who are entrepreneurs, which probably the majority of people listening to this podcast, right?
And so and so the concept of entrepreneurship is structure and innovation, right. So even though physicians are really good at creating structures, that could make them a very wise business strategist at structures. But especially startups require some innovation to go ahead. So for a lot of the physicians start your companies out there. The first thing to undo is asking yourself how. And, and this seems so counterintuitive, but a lot of doctors say, How am I going to do this, how am I gonna do this? How am I going to do this? And the question that you ask yourself, How am I? It's not how am I? Right? It's who who's going to do this, who's going to do this, who's going to do this? If you start with the who first, then it becomes a whole lot easier to obsess about the who and that doesn't obsess about the hell?
If you look at a serial entrepreneur, like Elon Musk, for example, right? I don't agree with everything he says. But you gotta admit the guy is kind of a genius. Because he starts with who first I'm gonna hire the best engineers, right? I'm gonna hire the best rocket scientists for this project. And then we develop a neural link. I'm gonna hire the best like, neuroscientists, people, and you're like, well, Elon, you want a self made billionaire, like how do you even do that? Well, he wasn't always that way. Right. But here's the same philosophy that Tesla started, Tesla started SpaceX, and Neuralink is the same philosophy he had since college before he quit college right? With him and his brother, when they created the first rendition of PayPal, right.
And so it's all about who not how and I think that that traditional medical education is not taught that way. It's about how not who, it's about what you can do? How can you serve, and that creates a lot of burnout. So a lot of doctors kind of listen to those who maybe have exited their, their, their medical practice and kind of use their right brain to experience this. And I bet you a lot of you doctors who did your own startup, had that burnout at the very beginning. It's the same type of burnout that you go through in medical practice. How am I going to do this? How am I going to do this? How am I going to do this straight? And that's my one piece of advice is really to like, undo this learning about how am I going to blink? And I was like, No, who are you going to get on your team that can do X, Y and Z? And that is the foundation and the principle of developing business to scale.
Christopher H. Loo, MD-PhD: That's awesome. Who and Teamwork. Yeah. So the next question is, so you've started your business, and now the scalability. So you talked about teams. What other items can you employ or deploy to scale your business, or your company?
Dr. Cheng Ruan, MD: Absolutely, so it doesn't matter what type of company you created. I've owned an auto boutique and marketing, and I've done all sorts of stuff that you can think of, and I failed a lot. And that's really important to do is get advice from people who failed, went bankrupt, had to do it over again, and suffered a lot. And trust me, I've suffered a lot through a lot of these processes.
And so and the second recommendation, is to talk to the people who have completely failed. And ask what their lessons are. And if you ask what their lessons are, they're gonna say very similar things. And which brings me to my second tip is 80% of business is psychology. Right. And a lot of things that we do on a daily basis comes from our subconscious mind. And in fact, a lot of reasons why we chose to be doctors actually come from our three to eight year old development of childhood psychology. It is sort of that hero's mentality.
And I recently posted on this on my social media and LinkedIn is, if we are taught to provide value because we're heroes. In reality, heroes don't scale business, it's guides that really scale a business. So the difference between a hero and the guide is that if you watch every movie, all heroes suffer some source of tragedy, right, Luke Skywalker got his arm cut off, right? Or hand cut off. But Yoda, even though after he died, he was still the guide, he was pretty much chillin. And so if you see every movie, the guide is always there, because the guide is not fully tied to the outcome of the hero. And so we as doctors tend to kind of raise up even in the media, they put us heroes, which I have a big issue with the term “frontline doctors,” frontline is reserved for military personnel.
Not doctors, doctors should really be heroes, and same thing as entrepreneurs. And we should be seen as the actual guides, so that our clients or our patients can actually be their own heroes, right. And so to put ourselves in that guidance, philosophy, then the things that we do from a psychological perspective for a business actually changes, and guides actually have more intimate relationships with other people. When I say intimate, I'm not talking about intimacy in that regard, but intimacy in terms of intimacy, and professional relationships, and we tend to gather more raving fans to feel the actual business. And that guide actually comes out and says, hey what I am going to use as the business, these are services, and whether or not you come on board with these services, it may not be the right time for you, or it may be but I'm not tied to your outcome. But therefore, I will construct my business around my core values, which are to my core values, so that I will not be burnt out because everything that I do is associated with my wants, my own wants and needs and not be tied to some sort of a hero's outcome or romanticizing. I suffered this a lot before in the past, especially with shiny object syndrome, which I think a lot of people can relate to. So yeah, that's my next tip.
Christopher H. Loo, MD-PhD: Yeah, I can, I can totally relate. And so I know you had so many epiphanies. You have a lot of new venture launches. So feel free to tell the audience about that and how to get a hold of you and contact you.
Dr. Cheng Ruan, MD: So, I’m doing two things right now. The first is that I'm scaling Texas Center for Lifestyle Medicine. If you guys are actually interested in practicing integrative health, more than happy to have you on. And the second thing is, if you're one of those entrepreneurial physicians that, we've kind of developed an integrative and collaborative health practice, everything that I learned from developing Texas Center for Lifestyle Medicine, all my brain is actually in a platform called Integrative Practice Builder.
So if you go to integrativepracticebuilder.com I developed multiple online courses And a masterclass and a playbook to let people know how to navigate this and the fact that it's all see me as well. And I have my largest portion of that, believe it or not, is the psychology of business, which I feel like everyone should start with that to sort of flip that mindset, to hear mentality and then also know how to work with different teams expectations, setting outcomes, setting goals, financial outcomes, KPIs, key performance indices, etc, etc.
So it's a very holistic view of business. And it's a very holistic view of how to execute integrative health practices, specifically, specifically for the insured population. There's a lot of online courses that do more like cash practices, which are really great for cash, profit, cash profits, businesses that specifically target a specific market. I think those are great. It's not from me, because if you're like me and actually want to serve the insurance population, it's a lot more complex. But there's strategies on how to do it and learn from literally my million dollars worth of mistakes that I've made in the last four years.
Christopher H. Loo, MD-PhD: Awesome. Awesome. And I know you said you have a LinkedIn profile. You mentioned you're on Instagram. All the references will be linked in the show notes. But thanks so much for joining us. It was a wonderful discussion and we look forward to hearing more about your success.
Dr. Cheng Ruan, MD: Thank you so much. Appreciate you having me on.
Editor's note: This transcript has been edited for brevity and clarity.