One Anesthesiologist, 108K Followers, and Zero Filters

In this candid and wide-ranging conversation, we sit down with Dr. Brian Schmutzler — anesthesiologist, social media educator, and Executive Vice President of Medical Affairs at CCI Anesthesia — to unpack what it really means to lead in modern anesthesia. From the realities of staffing rural hospitals without anesthesiologists to fighting burnout, navigating private equity, and fiercely defending provider scope and safety, Brian shares hard-earned insights from both clinical and corporate perspectives.

We also dive into the power of humor and education on social media, his 108K-strong Instagram following, and how his content brings awareness, advocacy, and levity to patients and practitioners alike.

If you're a CRNA, MD, administrator, or just someone trying to understand where anesthesia is headed — and how to lead within it — this is an episode you can’t miss.

Keywords:
Leadership, Anesthesia, Social Media, Burnout, Independent Practice

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Transcript

Joseph Rodriguez (00:00)
But how do you navigate those waters? Are you unpopular at the ASA? Do people not like you? You seem likeable. There are multiple counties in the state of Indiana, multiple counties in which we have contracts, where there are no anesthesiologists even credentialed in that county that live in that county. How could I possibly do medical direction at those facilities? I fiercely defend our providers against things that they shouldn't be doing. Making the expectation that an anesthesia provider

is doing some of these things that they shouldn't be doing. That's where I go in and fiercely defend. 108,000 followers on Instagram. My goal was to send everybody to my Patreon page to learn how to teach blocks. That morphed into a couple of funny ⁓ reels and Instagram posts and stuff that got me a lot of followers. People like me being self-deprecating and funny. And who's the best person to make the decisions? Well, the people who actually work in that hospital, not somebody in Washington, D.C.

But what does it look like for you in five or 10 years for you? What's next for Brian Schmutzler?

Hey everyone, real quick, if you're listening to this, you're probably the kind of anesthesia provider who wants to understand more than just how to push drugs. This podcast is about understanding what's really going on, whether it's legally, clinically, or financially, and the often small but powerful ways you can protect and advance your career outside of the OR. Anesthesia Deconstructed is already one of the top podcasts, at least in anesthesia.

Out there, we get a few thousand listens per episode, but subscribing helps us keep that momentum and it helps us bring on more compelling guests that are commentary and the kind of insight that actually moves our careers forward. Subscribing is free. It helps us keep doing what we are trying to do and it means you'll stay sharp, connected and stay a step ahead. So please hit the subscribe button and enjoy the show.

Joseph Rodriguez (02:02)
All right. Dr. Brian Schmutzler. That's a good German name. Yes. All right. I got it right. You've got our super cool background. I'm excited to talk to you. I had you're an MD, PhD, right? Focusing on neuropharmacology. We could we could, we could stop there. And that would be a biography for most people. ⁓ I know you're the way I first

Dr. Brian Schmutzler (02:06)
It is. It is, yeah.

Thank you. Yes. Yes.

Yep, that's my background, yep.

Joseph Rodriguez (02:28)
became aware of you, you're VP of Medical Affairs at CCI, Anesthesia. You also, okay, okay, you got promoted.

Dr. Brian Schmutzler (02:32)
Yep, correct. Yeah. Executive vice president of medical affairs. Now actually I got, I got promoted cause my, my,

my boss is like mo or former boss is like moving towards retirement. So he took sort of a sort of more of a, what do you, what do you want to call it? More of a, ⁓ a high level role where he kind of gets to direct the company where, yeah, exactly where I do. And so I'm doing, yeah, I'm doing more of the operations now. So yeah. Yeah.

Joseph Rodriguez (02:42)
Okay.

Pontificate. Something like that.

Okay, awesome. Awesome. And then

also acupuncture, right, which is, which is a fascinating blend of, you know, old school or Western and Eastern medicine, old school and new school. And then I think the way most people know you is you have 108,000 followers on Instagram. So for those, you know, who don't know you, and that's a very divergent ⁓ background, right? What is the fundamental thing that you're offering?

Dr. Brian Schmutzler (03:00)
I do, do, yep.

Yeah. Yep.

Yeah.

Joseph Rodriguez (03:24)
to those people. I imagine it's offering different things to different audiences, but what is Dr. Brian Schmutzler all about?

Dr. Brian Schmutzler (03:31)
Yeah. So just, just a little background. I initially started this social media sort of foray into social media about two, two and a half, three years ago. And really my goal was to like send everybody to my Patreon page to learn how to teach blocks. I'm, very passionate about regional anesthesia. And so when, when I, when I started that, ⁓ I had just come off like COVID had just kind of getting back to travel after COVID and it just sucked. So I was like, all right, I want to travel anymore. Let's just teach regional anesthesia remotely. ⁓

That morphed into a couple of funny ⁓ reels and Instagram posts and stuff that got me a lot of followers. People like me being self-deprecating and funny. So I'm cool with that. I'm in anesthesia, you're in anesthesia. You know, we have no pride, right? Blame anesthesia or whatever. So it sort of moved that direction. But what we like to do is we like to, I say we because I've got a team that kind of helps me with making sure the filming's right and doing the right things.

Joseph Rodriguez (04:12)
Of course.

That's right.

Mm-hmm.

Dr. Brian Schmutzler (04:31)
What I like to do is I like to insert some humor but also teach something, right? So we talk a ton about NPO status, right? Please don't eat before you have surgery, right? But we do it in a funny way. ⁓ Or tell your anesthesiologist if you have, or CRNA if you have all these medical issues and that sort of stuff. I try to blend being funny with being a little bit educational. ⁓ And then we've, you know, I've got a buddy who's a.

Joseph Rodriguez (04:38)
Hmm.

Dr. Brian Schmutzler (04:57)
⁓ orthopedic surgeon, Dr. Adam Cien, who does videos with me. And so we kind of play off the orthopedics versus anesthesia, you know, surgeon versus anesthesia thing. So we're a little funny there, but also again, try to be educational.

Joseph Rodriguez (04:59)
Yeah.

Of course.

Okay, very good. What's your goal with that? Like, that's a lot of time and energy. I think that's, as I've talked to other creators, right, and I do not have the energy to do it. I'm just like, wow, this guy is creative. You know, I'm seeing you and others. What's the goal with what you're doing there on social media specifically? Like, beyond, you know, education and entertainment, right, but also where do you want to see that go in five years? What would you like it to turn into?

Dr. Brian Schmutzler (05:30)
Yeah.

So I want to drive as much ⁓ awareness towards anesthesia as I possibly can. we can't do, I can't do what I want to do on a podcast, like with you, like my podcast, other podcasts I've been on. I can't do that in social media, but I can drive people to the podcast to talk about the real issues. I mean, we talk about big things like,

Joseph Rodriguez (05:42)
Okay.

Hmm.

Dr. Brian Schmutzler (05:58)
you know, health insurance and I'm sure we'll get into kind of the CRNA ⁓ anesthesiologist discussion here as well. But we talk about that too. You know, we talk about things like, ⁓ you know, new medications that are coming out. And so my passion is for education. The social media stuff is fun though. I mean, I enjoy it. People ask me questions on social media. So I try to respond as much as possible. But some of the social media stuff we see kind of, I kind of see what can, what's

Joseph Rodriguez (06:00)
Yeah.

Stuff. Yeah.

Hmm. Okay.

Dr. Brian Schmutzler (06:26)
popular or what kind of drives people's opinions and stuff and then try to move that into YouTube and the podcast and that sort of stuff to try to really talk about it. Yeah, yeah, more long form, which you can't do in 90 seconds on Instagram or right. Yeah, swiping, right, right. Yeah.

Joseph Rodriguez (06:35)
More long form. Okay.

Right, well, people are swiping.

Okay, so and

what's the name of that podcast? Because I didn't mention that in that very long biography, which is impressive. But what's the name of that podcast?

Dr. Brian Schmutzler (06:51)
Yeah, no, no problem.

It's called going under anesthesia answered. So we do, no, no, you're fine, go ahead, ahead.

Joseph Rodriguez (06:57)
Okay, Julino, and is the, go ahead, please.

The primary audience there is the public or clinicians or a little bit of both.

Dr. Brian Schmutzler (07:07)
Little bit of both, yeah. We dumb it down, not to be disrespectful, but we kind of dumb, yeah, we simple, yeah. Exactly, exactly. We simplify it so that a lay audience can understand it, but it's also informative enough for a medical audience, particularly anesthesia. Yeah.

Joseph Rodriguez (07:12)
sure, simplify it. This is long form content we can get away with inappropriate speech here so it's all good. You're fine.

Okay, all right, duly noted.

So flipping gears to the anesthesia side, VP of executive vice president, correct? Medical Affairs, right, for CCI. So CCI, ⁓ maybe you can help make sure I understand first that that organization, they do a lot of small community hospitals, correct? I don't see them taking on contracts in like, you know, Philadelphia or New York or places, you know, very congested markets like that. Why don't you...

Dr. Brian Schmutzler (07:33)
Sure. Yeah, there you go. Medical affairs,

Mm-hmm. Yep.

Joseph Rodriguez (07:56)
Give a little bit of background on that company and then what you do there.

Dr. Brian Schmutzler (07:56)
Right.

Sure, yeah. So CCI Anesthesia is a national anesthesia management company. Been around for about 20, I think 21 years now. I've been a part of the company for eight or nine in different roles. ⁓ Like you said, very community focused, very ⁓ rural hospitals, critical access hospitals, and then kind of smaller.

Joseph Rodriguez (08:06)
Mm-hmm.

Dr. Brian Schmutzler (08:20)
suburban type hospitals. We do have a couple, we do have a couple big hospitals, Terre Haute, Indiana, which is not a huge city, but it's a, it's a decent size hospital, 25, 30 providers a day. ⁓ But yeah, like you said, we're not in, we're not in Cook County, Illinois, right? We're not doing Chicago, right? We're not doing New York City, like you said. So we really focus on being a part of the community ⁓ and making sure that the providers are part of the community. What I really like about the company is a few things.

Joseph Rodriguez (08:22)
Sure.

Right, right.

Dr. Brian Schmutzler (08:50)
One, there's one owner of the company. He's the one who makes the ultimate decisions. There's no private equity. There's no venture capital. There's none of this stuff out there that's going to make me do things that I don't want to do as a clinician, right? ⁓ He's a super honest guy. Everybody in the company's, you know, above board, honest people, ⁓ which I really like. And then I like that we all, you know, at a certain level, all the way from

Joseph Rodriguez (09:02)
Sure.

Dr. Brian Schmutzler (09:16)
You know, the, person doing the low level recruiting all the way up to the CEO, everybody has a voice in the company. So, you know, they may not take my advice, but at least I get to say like, this is what I think. ⁓ and, and so I think that, I think that's really cool and different than a lot of other companies that I've worked for. And even in private, when I was in private practice, I was did private practice for about five years before I joined CCI. ⁓ you know, the president of my private practice group got the final say and didn't really care what anybody thought.

Joseph Rodriguez (09:22)
Mm-hmm.

Okay.

Dr. Brian Schmutzler (09:46)
You know, they might say like, exactly, exactly, exactly. And there was a lot of, how do I put this gently? There was a lot of fear-based leadership in that private practice group. So I knew I didn't want that. ⁓ I also, you know, I really liked that CCI is very provider friendly, right? So we, I say we now, but even before I was in leadership at CCI, you know, I could see when they went out and talked

Joseph Rodriguez (09:46)
Yeah, was a ruler by fiat, just dictator style. Okay.

Yes.

Dr. Brian Schmutzler (10:15)
to hospitals, they would say, listen, you know, I know the current group does X, Y, and Z, but we're not going to do that. It's not safe. It's not healthy for the providers. You know, that's not enough time, whatever. It's not enough time off. It's too much call.

Joseph Rodriguez (10:17)
Hmm.

What's a

specific example of something like that? Is it the time off aspect, the avoiding burnout culture? Go ahead.

Dr. Brian Schmutzler (10:33)
Yeah,

I think that's huge. think avoiding burnout is huge. you know, most of our contracts have the providers have somewhere between 13 and 26 weeks off. That's kind of our standard, right? I think that that helps quite a bit. I think that the way that we do call. So, you know, when you're in a critical access hospital, you don't have a whole lot of night nighttime call, right? So you might be on call for long stretches in a critical access hospital, but some of our places are busier.

Joseph Rodriguez (10:45)
Sure.

Dr. Brian Schmutzler (11:00)
And we just don't, we don't put people on call too much. You're not doing, you know, Q2 call at a place where you're getting killed all night long, right? So we're pretty creative about how we do things in terms of making sure that lifestyle ⁓ is an important thing. So the work-life balance. Now, I will say, we expect you to work hard when you're there, right? And this is what I tell providers when we talk, right? If you're there for a 10-hour day or a 12-hour day or an eight-hour day, if they ask you to do something,

Joseph Rodriguez (11:06)
Rise.

Yeah.

Dr. Brian Schmutzler (11:27)
and it's safe, right? It's within your scope of practice. I expect you to do it, right? ⁓ Right, exactly. Exactly. And we don't want to get commoditized. That's the big issue that I see in anesthesia is if we just become a commodity, then those health systems are just going to go to the lowest bidder. And that's not good for healthcare in general. That's definitely not good for us as an anesthesia community. And it's not good for quality of care and anesthesia. So we've got to be a service.

Joseph Rodriguez (11:31)
Sure. It is a service. It's a service business. Yeah.

Yes.

Dr. Brian Schmutzler (11:57)
but we've got to really be a good service. White glove, make sure that we're doing everything well for the patients and the facilities.

Joseph Rodriguez (12:04)
This is why I wanted to talk to you because like I was like, I was watching. I'm like, who has who makes these videos? my gosh, it takes a lot of like, these are creative stuff. But I was like, then I heard you on other ⁓ media outlets. And I was like, this guy, this guy is not, you know, he's not just a pretty face doing funny videos, right? So you said two things that are really interesting to me. And I want to take them one by one because I think they're important. So you worked in a private practice, typically private practice, you kind of working your tail off, right? I actually started in a

Dr. Brian Schmutzler (12:06)
Ha ha

You

Yep. Eat what you

kill.

Joseph Rodriguez (12:35)
Yeah, totally, totally. And

you mentioned PE, right? For the ⁓ anesthesia professionals, whatever type who are listening, could you tell that audience what it's like, what the difference is working for a independent, privately-owned organization versus PE? What does that mean? Because there's a lot of people out there that are signing. Yeah, exactly. What does that mean to them?

Dr. Brian Schmutzler (12:39)
huh.

what it's like, the difference is.

Yep.

who worked for PE, yeah, yep, yeah.

So private practice, it was big when I came out, so I'm out, geez, 12 years now or something like that, so that was big when I came out. Everybody that I went to residency with went into a private practice, hey, you can make all this money, right? You work really hard, you make a lot of money. ⁓ Exactly, exactly, and I did, there was probably two or three years where I made a lot of money, I worked a lot, but I made a lot of money. What they don't tell you about private practice,

Joseph Rodriguez (13:15)
Gonna crush it.

Dr. Brian Schmutzler (13:26)
as anesthesia has, as the supply of anesthesia providers has decreased, the ability to maintain a private practice is almost impossible. I mean, you look around, I'm in Indiana, one of the biggest, actually it was probably the biggest private practice group in the whole state in Indianapolis sold out to the hospital because they just couldn't do it anymore. You can't recruit enough people. And if you don't have a big net, right, at least regional, if not national net,

to pull people in, you end up not being able to provide the services and then you're working a ton, right? We got to the point where we were losing people and I was on call 22 times a month. Some of that was self-inflicted, but some of that was like, well, there's only four of us who do open heart, so we gotta be on call. There's only 10 of us who do OB. There's only a small portion of us who do thoracics, right? So there were some things that you gotta do it, right? Or you don't provide services and then you lose the contract. So that's the private practice world. ⁓

Joseph Rodriguez (13:56)
Hmm.

Right?

Right? So you have to do it. Right? Right.

Dr. Brian Schmutzler (14:24)
You know, I think if you're a very small private practice, you may still be able to survive, but it's hard. You get to 10, 12, 15 sites of service and it's almost impossible anymore. Yeah.

Joseph Rodriguez (14:30)
Hmm.

gets complex. a lot of, there's

so many, I think in our organization, we did the math. It's been a little while. There's like 60 data points for every single professional that comes through there. And then you have to constantly, and not just getting the data, managing the data, sending it to the right people. All of this is fairly sophisticated, right? And that's hard to do if you're, yeah. Yep.

Dr. Brian Schmutzler (14:44)
Yep. Yep.

Yep. Oh yeah. Yeah. You got to have a big, big back office too. Right? I mean, you've

got to do, you got to have somebody who does all the scrubbing of the charts to make sure that you're generating revenue. You got to have somebody, right. You got to have somebody who's interacting with the patients. You got to have somebody. I mean, yeah, there's, it's, it's a whole organization. And if it's, if it's one to 10, up to 10 sites a day, maybe you can get away with it with a smaller office, but you get to an inflection point where you have to say like, I got to, I've got to

get a bigger team or I've got to sell out to a bigger company. When it comes to private equity, so I don't know, I'm not totally familiar with who your audience is, but private equity is basically people who come.

Joseph Rodriguez (15:22)
Mm-hmm. Mm-hmm.

Primarily, CRNAs,

some anesthesiologists, tend to be younger. So they don't really, and I'm on a similar timeline to you, they don't have that background. A lot of people don't even know what private equity is per se, so maybe start with that background in mind. Go ahead.

Dr. Brian Schmutzler (15:36)
Okay.

Yeah. Yeah. Yeah.

So, so private equity and venture capital are sort of a, on a, on a continuum of money put into the system. Right? So, so private equity in particular is, is a big focus. They look at an anesthesia practice or whatever medical practice and they say, okay, if I inject $5 million into this practice in the next three to five years, I'm likely to generate 15, 20, 25 million in profit. So great. I'm to put money into that.

And then their goal is a three to five year turnaround. So a private equity company, usually a small private equity company is the first private equity company that buys a practice. In three to five years, they want to turn around and sell it to a bigger private equity company and then a bigger private equity company. And then eventually, you know, the gigantic private equity companies that own some of the big national anesthesia management groups. So, ⁓ you know, that's the way private equity works. They inject money and then their stated goal

Joseph Rodriguez (16:18)
Hmm.

Right.

Dr. Brian Schmutzler (16:44)
is to ⁓ drive efficiency. So inject the cash, inject the capital, drive efficiency to pull more money out of the system, streamline care. ⁓ My fundamental issue with private equity though is that they don't have any incentive to really provide good care. Their goal is strictly financial. And when your goal is strictly financial, then you're going to cut corners. And I've seen it before.

Joseph Rodriguez (16:48)
Mm-hmm.

Mm-hmm. Mm-hmm.

Right?

Dr. Brian Schmutzler (17:14)
Right? You're going to cut corners for patient of on patient care. And when you do that, everybody suffers. And you also end up with more burnout in your clinicians, whatever you call dermatology or anesthesia or whatever. You end up with more burnout because you're asking those people to do more and more with less and less. So, I mean, and this is a big topic in, in medicine in general and the whole kind of really everybody's this moral injury thing. And I, and I think again, personal opinion, private equity, ⁓

Joseph Rodriguez (17:40)
Sure, sure.

Dr. Brian Schmutzler (17:44)
creates an environment where more moral injury occurs.

Joseph Rodriguez (17:48)
Wow, that's a compelling statement because private equity is everywhere, right? Napa, USAP, Norstar, there's different types of private equities, right? There's the Warren Buffets of the world versus the whatever company, you know, gobble up Red Lobster and fed it to a machine, right? If anybody's really nerdy, they can look up the Red Lobster story. ⁓ And then, you know, since you're in leadership with CCI, which is privately owned,

Dr. Brian Schmutzler (17:58)
Somewhat, yeah, yeah, right, yeah.

Yep. Yep.

Yeah.

Joseph Rodriguez (18:16)
I guess what's the everyday difference? What's something that people, anesthesiologists, CRNAs don't know about being in leadership in those private equity companies versus CCI or other more, not mom and pop shops, but privately owned.

Dr. Brian Schmutzler (18:30)
Yeah.

Yeah.

Yeah. So I would say the biggest difference and I wasn't in as high a level leadership in, I was sort of in my private practice group, but yeah, when it comes to private equity and stuff. So I haven't seen it quite the same way as I see it in CCI, but what I can tell you in talking to people in leadership and private equity, and then even having at one point of discussion about a private equity company purchasing a portion of kind of what I do.

Joseph Rodriguez (18:50)
Hmm.

Dr. Brian Schmutzler (19:02)
Private equity is 100 % about revenue, right? We have to take on this next contract because it's revenue, because we need to make sure that our bottom line goes up at an incremental level, otherwise we're not gonna meet whatever random benchmark. In leadership at CCI, is never the primary thing, right? So no money, no mission, right? This is a common thing that people say. It's not like we're going out, right, right, yeah, it's not like we're going out and saying, right.

Joseph Rodriguez (19:11)
Hmm.

Right?

But you need, yes, you need a bottom line, just like everyone

needs to be paid on an individual level, the organization needs to be paid as well. You can't support all those back office functions.

Dr. Brian Schmutzler (19:34)
Exactly. Exactly.

Yeah. So we're not taking things that are going to lose us money. At the same time, you know, we're not just saying, ⁓ look at that. That's that's going to be a lot of money. Let's go do that. If the the cultural fit isn't right, then we just don't do it. We just say, yeah, you know, that's probably not going to work. And I've and I've seen our business development team say in particular to ⁓ private equity backed ⁓ organizations like we're just like we're

Joseph Rodriguez (20:03)
Hmm.

Dr. Brian Schmutzler (20:04)
we don't have any interest in this. You're not gonna be a good partner. I don't wanna take this, we may make good money for three years, but I don't wanna take this contract for three years and then lose this contract because somebody else underbid us and all you care about is money. And I appreciate that. I appreciate that we're not just going out and doing what's gonna make the most money, we're doing the right thing.

Joseph Rodriguez (20:15)
Right. Right.

Okay. All right. That's pretty, ⁓ most people don't know this, but I'll fill you in on our experience with private equity very, very briefly. So in city of Phoenix, you can share this at your next leadership meeting at CCI. You all get a kick out of it. ⁓ So private organization that a part of, right? a ⁓ hospital says nameless hospital won't share their name. Says, Hey, lower your subsidy. And we say, ⁓

Dr. Brian Schmutzler (20:35)
Sure. Yeah. huh.

Will do. Yeah.

Yeah.

Joseph Rodriguez (20:55)
I'm not sure if you're watching the news, but we can't, right? We can't, right? We don't, we, we're not asking for an increase, but we can't lower it, right? And and ironically, ⁓ there is a pro, you know, that organization is actually owned by private equity. So they have that pressure, right? Lower your subsidy. We can't, are you sure? Yes, for sure. You're fired. Are you sure? Yes, we're sure. At, so a private equity group came in also nameless, but you would know them and said, we'll solve this problem for, you know, some major discount or whatnot.

Dr. Brian Schmutzler (20:57)
We can't do that. We can't do that.

Yeah.

Yep.

Joseph Rodriguez (21:24)
Two months later, they didn't hire a single person and that hospital called us back. And then it became, it became even more expensive because then it's like, right, because then we had to work hard to get everybody back and convince them it was stable.

Dr. Brian Schmutzler (21:31)
Of course it did. Yep. You destabilize the

system. Yeah, I've had this conversation with multiple hospitals. You don't want to term us because you're going to destabilize the system. And when we go and pitch a contract against another group, whether it's private equity or not, we always say, like, you should not do this to try to save a bunch of money. your problem is

Joseph Rodriguez (21:51)
Yeah.

Dr. Brian Schmutzler (21:57)
You know, you don't have staff, we can help you with that. If your problem is you're not happy with the quality, we can help you with that. But we don't step in and say, you know, hey, we're going to be much cheaper unless we change the model, right? There's places we've gone in and they're very heavy MD, and I'm sure this is something we'll talk about too, very heavy MD where they don't necessarily need to be. You can't recruit enough MDs anyway. So let's change the model. Let's give the CRNAs some more independence. Let's do, you know, whatever. Let's go from

Joseph Rodriguez (22:13)
Sure.

Dr. Brian Schmutzler (22:26)
50-50 MD to CRNA to maybe 25 to 75 MD to CRNA. And that's gonna save them a ton of money, right? So that is a way that we come in and save money, but we don't ever underbid. We're not gonna say, hey, we'll get you a CRNA for 40 % below market value, right? I mean, it's just, it's not good for anybody. So yeah, and I've seen this a hundred times, you know. Oh, oops, we can't do it anymore. Like, well.

Joseph Rodriguez (22:43)
Right.

Dr. Brian Schmutzler (22:52)
Yeah, the price just went up because you destabilized it. exactly. Yeah.

Joseph Rodriguez (22:52)
Yeah, we told you so. Yeah, yeah. That's, ⁓

so when you were in your practice for, by the way, back then, when you were in that private practice, were you running your own cases? Were you doing your own ⁓ rooms? Okay.

Dr. Brian Schmutzler (23:04)
Yep.

100%. Yeah, we had no CRNAs at all in that practice. that was pretty common in Indiana at the time. ⁓ And I think, I'll toot my own horn a little bit, I think we, myself, and then a couple of CRNAs that I work with have really pushed it to say, listen, no matter what you say, no matter what you want, there's not enough anesthesia providers, period. If you take every

Joseph Rodriguez (23:08)
Right, so you were hustling.

Please.

Dr. Brian Schmutzler (23:32)
anesthesiologist, every CRNA and even every AA in the state of Indiana because they practice in Indiana. We still don't have enough to cover everything. So let's not do this goofiness about we're MD only. Like it's just not going to work, right? So let's open our eyes a little bit. We're behind a little bit from the rest of the country. And so we, think we were a pretty big part of that.

Joseph Rodriguez (23:44)
Sure.

Dr. Brian Schmutzler (23:55)
probably about 2019 into COVID and then coming out of COVID, just saying like, this has got to change in Indiana. And I think it's expanded as well in the rest of Indiana. We're kind of located, me personally, in the northern part of the state. CCI's got contracts kind of of the northern going into the northeastern, a little bit into central, but obviously not Indian Indianapolis itself. And so we really helped move that needle, I think.

Joseph Rodriguez (24:01)
G'day.

Okay, yeah, that's a fascinating topic in and of itself. I'm enjoying this conversation on the CRNA and MD thing, right? Because CCI has a lot of independent CRNA contracts, right? I don't know if they have, they probably have MD only contracts as well due to, is that right? Okay, so.

Dr. Brian Schmutzler (24:33)
Yep.

Nope, nope, don't,

no MD only contracts. have, I think three, I think we have three contracts where the MDs do like a 26 week ⁓ opposite of a CRNA and then ⁓ the Terra Ho contract has a lot of MDs because there's a ton of open hard and all that kind of stuff. So the MDs do a lot of that there, but we don't have any.

Joseph Rodriguez (24:53)
Right.

Yeah.

Dr. Brian Schmutzler (25:04)
fully MD practices and we have no medical direction practices. where the MDs and CRNAs work together, they're either side by side or a very loose supervision. So, yeah.

Joseph Rodriguez (25:09)
Okay, that's interesting.

Okay, duly noted. How

is that received? You know, obviously when you look at the ASA, I assume you're an ASA member. When you look at the ASA website, it's effectively medical direction is the standard, right? That is the standard which should not just be the, and I think this is an important distinction for those who are a little more nuanced, not just the practice standard, right? And like an academic medical center or something like that, but the regulatory standard, the statutory standard. And those are two really different things, of course.

Dr. Brian Schmutzler (25:43)
Yeah,

absolutely, yeah.

Joseph Rodriguez (25:46)
But how

do you navigate those waters? Are you unpopular at the ASA? Do people not like you? You seem likeable, you know?

Dr. Brian Schmutzler (25:55)
As far as I know, I'm not unpopular at the ASA. I guess what I would say is ⁓ there are multiple counties in the state of Indiana, multiple counties in which we have contracts in the state of Indiana where there are no anesthesiologists even credentialed in that county that live in that county. So how could I possibly do medical direction at those facilities? It's just impossible. And so what I've kind of said before, maybe

I try to say it as kindly as possible. If you want if you want physician-led care in a medical direction type model, then I need more of you to move up to Bremen, Indiana, to Goshen, Indiana, to South Bend, Indiana, to Jeffersonville, Indiana, right? To these places, it's a different issue inside what we call the loop in Indianapolis, right? 465 loops Indianapolis, right?

Joseph Rodriguez (26:23)
Please, yeah, be very honest,

Dr. Brian Schmutzler (26:48)
There's a ton of anesthesiologists there because that's where they want to live. Right. And so I don't have any contracts in Indianapolis. I don't really work in Indianapolis. I do some hospitals work in Indianapolis, but I don't work down there. I work in rural small communities. It's just not practical. There's not enough anesthesiologists, even if you and I'm not making any comment whatsoever about what the ASA is saying. So I'm not going to get in a fight with the ASA, but it's just completely impossible for us to have a medically directed model.

Joseph Rodriguez (26:48)
Hmm.

Hmm.

Yeah.

Dr. Brian Schmutzler (27:17)
in these small areas that we practice in. So that's what I would say. So I'm not going to argue with the ASA, but I'm just telling you practically, there's not enough.

Joseph Rodriguez (27:26)
Right. Yeah, makes sense. I mean, it sounds like you're dealing with the realities of the situation in front of you. Right. And what do you say to the kind of because I think both you and I probably live in the reasonable middle, right? I'm a big tell me what you think of a statement because I say it often now, which is I'm not a big fan of the United States government, state or federal deciding anesthesia models. They're having trouble figuring out the budget.

Dr. Brian Schmutzler (27:31)
Correct. Yeah, absolutely. Yeah.

Joseph Rodriguez (27:54)
I'm not sure they're going to be experts on anesthesia delivery, right? So I'm a big proponent of local experts, medical executives, committees, anesthesiologists, surgeons, CRNAs, et cetera, looking at the talents of the people involved in the clinical need and then making the decision from there. That seems, I don't know, what do you think about that?

Dr. Brian Schmutzler (28:08)
Absolutely.

Correct. Yeah.

Yeah. So, I mean, I agree with licensing boards looking at it we need something to say like, you you're dangerous. Don't do that. But certainly I think that the best way to do that, like you said, is at a local level. ⁓ You know, maybe a state by state level depends on your state, though, right? So Wyoming is a totally different state, right? Because Wyoming is pretty consistent all the way across the state versus a state like New York or

Joseph Rodriguez (28:22)
Yeah.

Dr. Brian Schmutzler (28:45)
Illinois, right? So it's way different in Southern Illinois, you know, in the middle of nowhere Illinois than it is in Chicago. So yeah, definitely in that instance, I think, yeah, facility and even facility by facility, like I said, so we've got a we've got facilities in Northern Indiana that are one side a day, minimal OB, ⁓ you know, that site is going to be totally different than the level one trauma center in downtown Indianapolis. So yeah, certainly.

Joseph Rodriguez (29:11)
Right.

Dr. Brian Schmutzler (29:12)
center by center, hospital by hospital, the decisions should be made. What is the right way to do medicine in general, right? And not just anesthesia for sure, but not just anesthesia. What's the right way to do surgery? What's the right way to do pain management? What's the right way to do, you know, don't know, dermatology. I bring that up from time to time because I really wanted to like dermatology, but it made me itchy. they're big, they're big private equity, right? Private equity bought a lot of dermatology.

Joseph Rodriguez (29:30)
Yeah.

Okay, I did not realize that actually.

Dr. Brian Schmutzler (29:40)
Oh yeah, huge,

Joseph Rodriguez (29:40)
Okay. Interesting.

Dr. Brian Schmutzler (29:42)
yeah, I agree with that. I think it should certainly be facility by facility. And I think in some ways they do that, but you're right. are, federally there's the opt out option. So I would say the feds are sort of out of it at this point, but it's certainly state by state. I'm kind of with you, right?

Joseph Rodriguez (29:55)
Sure.

Dr. Brian Schmutzler (30:06)
you know, who's best to make decisions for your family, your family, or somebody in Washington DC, your family. So, you know, same thing when it comes to medicine, who's the best person to make the decisions? Well, the people who actually work in that hospital, not somebody in Washington DC.

Joseph Rodriguez (30:13)
Right. Right.

Yeah, I think it's a nuanced view. doesn't. It's not a Fox News or MSNBC style view where we're shouting about it. know, there's a little runner underneath the screen saying this group is dangerous or this group is bad. It's more like, why don't we work backwards from what's best for that patient and surgeon and facility, like work backwards from that and see what the outcome is and go from there. Because I think this is a good segue in leadership.

Dr. Brian Schmutzler (30:27)
No. Yeah.

Yeah.

Yeah.

Right. Yeah. Yep. Yeah.

Joseph Rodriguez (30:49)
⁓ This is podcast right so I can say in this way there are some anesthesia practitioners from both camps so to speak that are dumber than a bag of hammers like really really bad You know where they should only ever do cataracts where they're monitoring patients and not giving any drugs Right and obviously I'm being extreme there, but I think being yeah Yeah, so it's like not all not everyone's suited. You know I think it's very unwise to say

Dr. Brian Schmutzler (30:58)
Absolutely. Yep. Correct. Yes.

I think it's true. I think it's true. Yeah.

Joseph Rodriguez (31:17)
You're an MD or you're a CRNA and as such you will be you will be able to do all these cases forever That's not how real practice works. I mean you've got your skills I know what I can do and you know kind of a hallmark of a professional is being able to say No, someone else should do that refer that out Anyway, no, I appreciate

Dr. Brian Schmutzler (31:27)
Hmm.

Yeah, yeah, absolutely. I don't

do obstetrics anymore, right? So you don't want me to come put an epidural in because I haven't done one in five, six, whatever years. So yeah, certainly, I totally agree with that. think the other thing is I've worked with a couple of surgeons who have said, I don't care what your credentials are. I care, are you able to take care of this patient? Right? So to me, it doesn't matter. Like you said, I work with amazing

Joseph Rodriguez (31:40)
Yeah.

Dr. Brian Schmutzler (32:03)
CRNAs and amazing docs. I've also worked with awful docs and awful CRNAs that I wouldn't let take care of my dog, right? So it's really not what the letters after your name are, in my opinion. It's how well can you take care of that patient? So I agree with you 100 % on that.

Joseph Rodriguez (32:23)
Yeah, well

said. If anyone at the ANA and ASA is listening, I volunteer both of us to do a panel talk at all of their conferences. Because the vitriol, I once did a, I once actually researched all the PAC money that's spent every year and the lobbying money. I'm like, this is such a waste, right? Like reasonable people could come up with policy that, but anyway, I digress. Let's flip, yeah.

Dr. Brian Schmutzler (32:28)
Yeah. Yeah. Yeah. Yeah.

yeah.

yeah.

Yeah, well, mean, that's

federal politics too, right? I mean, the right, way right, the way left, right? Most of us fall in the 75 % bell curve in the middle where we agree on almost everything with some nuance, like I said, nuance, some nuanced differences in how things work. But yeah, sorry, go ahead. You were flipping to another topic.

Joseph Rodriguez (32:53)
Sure, sure.

Yeah.

No, no, no. It's

great. I should ⁓ have you ever considered running for political office?

Dr. Brian Schmutzler (33:12)
So that's an interesting question. ⁓ So I have a family, well, so I will say equivocally, unequivocally, no, I'm not running for office. I have a family history. I come from a political family, and my wife, my wife when we got married said, you will not run for politics or I will not be your wife anymore. So I will not be running for any political office. But I'm happy to talk about it.

Joseph Rodriguez (33:15)
Yeah, that's not a no. That's not a no. Yeah.

Okay.

Okay?

Okay.

Yeah, that's it. tell me about your family. I'm curious.

Dr. Brian Schmutzler (33:44)
⁓ So my grandfather, Southern Indiana, my grandfather ⁓ was the county coroner of one of the counties in Southern Indiana and a state senator. that we had and he had some brothers and stuff that were sort of in in local politics as well. So ⁓ we were a very political family. he had a lot. had a lot of downsides. He did some good things, but he had a lot of downsides to him to, know, you're talking about the the. ⁓

Joseph Rodriguez (33:53)
Okay, yep.

Dr. Brian Schmutzler (34:12)
40s and 50s in a ⁓ predominantly, one idea, one race area of the country. you know, there's some, yeah. So there, I had a.

Joseph Rodriguez (34:24)
Yeah, whatever do you mean? I have no idea what you're Yeah, don't worry. My

family, my family are a bunch of Nazis, though, like literally, fascists, Italians and Germans, and then the Puerto Rican side, like, so they're all I have deep inner conflict over this. So no, I'm picking up what you're laying down. It's, it's fascinating how those certainly not be on on today's, you know, episode, so to speak, or this even this podcast as a whole, how those familial trends, right, you're a good, you're a good communicator. And I'm sure you've worked at that over time.

Dr. Brian Schmutzler (34:30)
Yeah, okay, fair enough. Yeah, fair. Yeah, yeah. Yeah.

Joseph Rodriguez (34:54)
Right. You've probably worked on. Yeah. Yeah, of course. ⁓ But it is interesting how like my father was a minister, a lay minister. He got some formal training and whatnot, but regularly publicly speaking. Right. And I picked up some of that as well. But it's not, ⁓ it's certainly not. We're not beholden to that past. Thank God. ⁓ Okay. So yes. See, really deep down inside, I want to talk about broader societal issues, but my scope of real education expertise is.

Dr. Brian Schmutzler (34:54)
I appreciate that, Yeah.

Yeah. Yeah.

Yeah.

Joseph Rodriguez (35:22)
really on anesthesia. So flipping back to the leadership aspect, what is being the executive vice president? Because there's more and more clinicians, whether they're PE or private or employed, ⁓ more and more clinicians are getting into these types of corporate roles. The market's becoming consolidated. Like you said, it's hard to run small practices. So these roles are becoming more common. What does that look like on an everyday basis? And what would you tell

Dr. Brian Schmutzler (35:23)
Yep, anesthesia, yep.

Right.

Joseph Rodriguez (35:48)
aspiring CRNAs, aspiring anesthesiologists who want to get into leadership, who want to make that difference.

Dr. Brian Schmutzler (35:54)
Yeah, so I would say my day to day is running the clinical end of the company. So I don't, I don't really dabble much anymore in the true operation side, right? So I'm not calling a CEO and saying, we need to renegotiate this contract or, ⁓ you know, this is how many providers we need each day, right? I really deal on leadership on the clinical side. So what does that mean? That means that I set policies and procedures. set expectations for our clinical leadership. That's probably one of the biggest things that I've had to learn over time is

how to manage managers. And it's funny, I picked this up actually from one of our chiefs, he's actually a regional medical officer as well. He said, I've been managing people. I know how to manage people. I don't know how to manage managers. How do you teach me to manage managers? so that, yeah, experience is probably the biggest thing, but I guess probably what I work on is I try to as much as possible, as we're on a podcast and I'm talking the whole time.

Joseph Rodriguez (36:38)
That's great. Yeah, what? How do you do that?

Dr. Brian Schmutzler (36:50)
I try to as much as possible listen to people and try to pick out what they actually care about. I don't know if you've ever read How to Win Friends and Influence People. What's his name? Don something or other from like the 20s. Yeah, Carnegie, yes, yes, yes, yes. Dale Carnegie, Dale Carnegie, yeah, from the 1920s. I mean, a lot of that book is really manipulation. But one big thing he says is listen to what people say and try to figure out what they actually want.

Joseph Rodriguez (37:01)
Mm-hmm. Is it Carnegie? Yeah, yeah, yeah. Yes.

Dr. Brian Schmutzler (37:20)
Right. So I think that's probably one of the biggest things is just stop talking and listen. And again, I know that that's very, very rich coming from. Yeah. Yeah. Fair enough. Fair enough. So I think that's one way to do it. And then just the experience of seeing like what, worked in the past, what didn't work in the past, ⁓ you know, and, and making sure that you're addressing, like we talked about, we're a service industry, right? We can't go in with a big ego.

Joseph Rodriguez (37:26)
It's ironic, but yes, you're the guest here, so I'm listening to you. So no, this is great. This is great.

Dr. Brian Schmutzler (37:48)
and say, I'm not doing that because I don't want to, or this is the way I've always done things, so I'm not gonna change it. So a lot of it is kind of helping people get to the point where they understand, be safe, but if the hospital asks you to do something and it's within your scope, then let's do it. ⁓ But on the flip side of that, I fiercely defend our providers against things that they shouldn't be doing. So for instance, I had one facility who said, hey, since you guys use the ultrasound,

We're just going to have you. There's a thing called a trofan which cleans the ultrasound off, right? They're like, oh, we'll just have you guys clean the ultrasound. And I was like, no, no, we're not. We're not going to spend our time to take an ultrasound over to this machine, get trained on this machine and do the cleaning of an ultrasound on this machine. This is not, this is not within the scope of what we do as an entity. No, of course not. Yeah. Yeah. So

Joseph Rodriguez (38:34)
It's not a good use of resources, right? I mean, that's what I was, we

can clean everything, but there's not enough of us already. You know?

Dr. Brian Schmutzler (38:41)
Right, right. Yeah,

exactly. Exactly. And it's one thing if you say, Hey, like, we're really slammed today. And could you help us do the wipe off the cords of the anesthesia machine? Absolutely. Making the expectation that an anesthesia provider is doing some of these things that they shouldn't be doing that. That's where I, you know, I go in and fiercely defend. But if it's something like, Hey, we'd like you to see, you know, a certain percentage of these preoperative patients because we're this surgeon's worried about it or

you we'd like you to take on another service line and maybe that means that, you know, you have to do an extra half an hour of work a couple of days a week. Like those are things that I think you give on. But again, I'm going to fiercely defend you against a hospital who, ⁓ or a whatever, who comes to you and says, I expect you to do these things and doesn't treat you like a professional. ⁓ you know, I think it's just helping leaders understand that

Joseph Rodriguez (39:23)
Mm.

Dr. Brian Schmutzler (39:38)
There are some things they need to give on and some things they don't. but it's really experience. just takes time, you know, and a lot of listening and mentors. mean, I've had several mentors. ⁓ obviously my, guess he's my, he still works for the, he still works for the company as our CMO now. but he, I really looked up to him for a lot of things. And then our CEO, ⁓ is, is really good at managing managers and, talking to people in a way that makes them feel important. And so I've tried to pattern myself after him as well.

Joseph Rodriguez (39:54)
Mm-hmm.

I make sense. then for people aspiring to leadership, both in terms of mindset and practicality, what advice would you give them? What should they know?

Dr. Brian Schmutzler (40:18)
Just get involved. mean, there's always as a CRNA or a doc, there are always ways you can get involved, right? Whether it's, you know, I think the first leadership position I had was the liaison between the anesthesia department and the OB department, just because I took a bunch of OB call. So, you know, it's not a lot of responsibility, but you at least kind of get your name out there and you learn how to take on leadership.

Joseph Rodriguez (40:41)
Hmm.

Dr. Brian Schmutzler (40:41)
And then, yeah, just listening, learning how to be a leader in those types of roles and then kind of moving up. And the other thing is just saying to whomever is in leadership in the company you work for or whatever, hey, I have an interest in leadership. What do you recommend? Can you mentor me in being a leader? So if you're looking to sort of shift from that clinical only role to clinical and leadership or leadership only role, you just gotta start asking people.

you know, what do need me to do and how can I be a leader?

Joseph Rodriguez (41:14)
Yeah, why do you enjoy it? I'm curious, because leadership, in my view, you know, they're never paid enough, right? You're never going to get, right? It's a lot of energy, it's a lot of communication, it's off hours, calls, all that sort of thing. Why do you do that? Is it enjoyable for you?

Dr. Brian Schmutzler (41:27)
Yeah.

It is, yeah, I like it. ⁓ I like all the aspects of that. like, ⁓ I mean, even in some ways, I like sort of coming in and saying to a clinician, like, hey, you can't do that, and here's why, and trying to get them to come in and really see that. ⁓ I definitely like telling surgeons they can't do things. That's a lot of fun, especially when it's not a practice where I actually am doing the anesthesia and I can come in and say, hey, like, listen,

Joseph Rodriguez (41:52)
Yeah, exactly.

Right.

Dr. Brian Schmutzler (42:00)
That's not an acceptable thing to do. You know, Dr. Smith, we're not going to do that anymore. ⁓ and, I support, I support my team that we're not going to do that anymore. So that's fun. ⁓ you know, I like, ⁓ creating an atmosphere and a culture in, in the clinical end of the company. you know, we've done a lot of regional anesthesia, workshops. I've got an awesome, sort of team underneath me who does a lot of the, ⁓ we've got somebody who does, ⁓

Joseph Rodriguez (42:04)
Right. Yeah.

Yeah.

Dr. Brian Schmutzler (42:29)
preoperative testing and evidence-based medicine stuff. So she's always out, you know, doing seminars and that sort of stuff for the company. You know, I've got a, Bronson Taylor's the VP of clinical affairs for us as well. So he handles a ton of the recruiting. He handles basically, ⁓ you know, CRNA kind of specific issues and he'll take care of all that kind of stuff. So I've got a great team underneath me who does a lot of that stuff. I enjoy the business development end too. I love going in and talking to a potential client.

Joseph Rodriguez (42:49)
Sure.

Dr. Brian Schmutzler (42:59)
being honest with them and saying, we're a better choice and here's why. ⁓ And I think being a clinician that kind of holds some weight more so than a ⁓ business guy. ⁓ So I'd like that end of it too. Yeah, right, I mean, I'm on the phone 9.30, 10 o'clock at night with issues that if I was just strictly a clinician, I probably wouldn't have to do. But I think the positives outweigh the negatives and I really do enjoy just the day to day.

Joseph Rodriguez (43:02)
Sure.

Definitely. Yeah.

Mm-hmm.

Dr. Brian Schmutzler (43:27)
thinking about things, talking to people and that sort of stuff.

Joseph Rodriguez (43:30)
There's a creative element, sounds like, and it sounds like you enjoy that. I think that's part of reason you're on Instagram and whatnot. ⁓ So two last questions, right? Because you're an interesting person because you see the industry from lot of different aspects. So 10 years from now, what is ideal? If you could change the specialty of anesthesia and make some changes now to impact.

Dr. Brian Schmutzler (43:33)
Yeah, definitely. Yeah.

Yeah.

Sure.

Yeah.

Joseph Rodriguez (43:59)
10 years in the future. And I'll ask you this on the personal side as well. But 10 years from now, what is an ideal world for anesthesia services? What are the things we could change now to impact positively for the specialty in the future?

Dr. Brian Schmutzler (44:02)
Yeah.

Yeah, so more of us, know, anesthesiologist, CRNAs, we need more, right? We just need, we need to figure out how to, I don't think that there's a lack of interest. I think there's a lot of interest, right? I think there's more CRNA programs being created. I don't think they're getting filled completely. And some of that's that there's not always clinical capabilities, right? So we don't always have, right, that we don't always have sites to send them. ⁓ There is no more funding for anesthesiologists from

Joseph Rodriguez (44:33)
clinical sites. That's the big.

Dr. Brian Schmutzler (44:40)
from CMS, right? So we've been flat, have that, it's gone up five or 10 anesthesiology positions over the last 15 years. So we need more of us, right? So we need to improve the supply side of the supply demand curve. We need to decrease the demand side, right? So we function in some surgery centers, but there's a lot of just, there's too many sites, right? You just, don't need

Joseph Rodriguez (44:42)
Hmm.

Dr. Brian Schmutzler (45:08)
as many sites of service as we have. So I think that's a problem too. And you look at hospitals too. Some hospitals, yeah, everybody can have a 7 a.m. start. So we're gonna run 10 rooms from 7 to 11 a.m. And then the operating rooms go down to one room at 11. It's like that's just a waste of resources. Yeah. So I think the supply and demand issues, we need to increase supply and decrease demand at least a little bit. So that's a big thing.

Joseph Rodriguez (45:11)
Hmm?

Right.

was crazy town.

Hmm.

Dr. Brian Schmutzler (45:36)
I think honestly, we need to, and this is something that I say every time we talk about the whole debate between anesthesiologists and CRNAs, the real enemy is the insurance companies, right? I mean, we should be getting together and fighting the insurance companies who keep driving down, driving down the amount of money that they pay us. ⁓ You know, I look at, when I first came into anesthesia in private practice, the rates that we were getting from the private insurers,

Joseph Rodriguez (45:43)
Sure.

It's wild. Yeah.

Dr. Brian Schmutzler (46:05)
we're about 30 % higher than we're getting now. And you've got inflationary demands in the last 12 years, what's our inflationary rates? Probably 60%, right? From 12 years ago till now. So it doesn't make a whole lot of sense that our reimbursement rates have gone down 30 % when inflation has gone up 60 % and the supply demand has driven salaries up probably at least that much too, 60, 70%. So we need to lobby better.

Joseph Rodriguez (46:11)
Right. It's like.

Dr. Brian Schmutzler (46:32)
we need to fight the insurance companies. That's huge, right? Because if there's more money flowing in from where it should be flowing in, which is the insurance companies, not the hospital subsidies, right? Hospital subsidies are because the insurance companies aren't paying us. So if there's more money flowing in from there, I think that improves things as well. And what they pay for, how they pay for it, that's the huge issue. We need to fix that.

Joseph Rodriguez (46:40)
Sure. Yes.

Dr. Brian Schmutzler (46:58)
fundamentally at a federal and a state level. And then you've got Medicare cutting us 3 % this year, right? I mean, we in anesthesia operate, it depends where you are, but you're somewhere between 30 and 90 % government insurance. If you're taking 30 to 90 % government insurance and you're taking a 3 % pay cut, that's huge when it comes to an industry where we're already underpaid for our services. I mean, that's, we have got to do something on that end.

Joseph Rodriguez (47:19)
Mm-hmm.

Dr. Brian Schmutzler (47:27)
or we're going to collapse anesthesia in general. And I don't know what we do from there.

Joseph Rodriguez (47:31)
Yeah, I think that's, you for the average listener, they think, well, why would we increase supply? I'm doing great. Right. But at some point, the market folds in on itself. It's Porter's five forces. Yeah. At some point, things begin to fall apart. Hospitals close and all of a sudden we have a much bigger problem. Much better to have, you know, it's personal finance and organizational finance. Smaller margins, nice and steady. Right. Everyone's OK. Not all the insanity. No, good. Very good commentary.

Dr. Brian Schmutzler (47:38)
Yeah.

Right. They're going to run out of money. Yeah. Yes. Right.

Correct, correct. Yes, yeah, going up, yeah,

yeah. Going up a ton year by year. It's not sustainable. It's not sustainable in any industry, especially one that relies on a hospital or a ⁓ medical system that's already broke to pay for it. So, yeah.

Joseph Rodriguez (48:06)
No. No.

Right, right.

That's a whole, I have so much to say on that. on the personal level, right? Where, so obviously you're a talented guy, you're hardworking, I admire what you're doing, because again, it takes a lot of time to put that kind of education out there. And you you have a really reasonable approach on things. But what does it look like for you in five or 10 years for you? What's next for Brian Schmutzler?

Dr. Brian Schmutzler (48:21)
yeah.

Mm-hmm, yeah.

Thank you.

Yeah, I mean, I'm gonna keep doing what I'm doing at CCI. I'd like to expand that role in CCI. I'd like to sort of, no, no, I'm not asking for a raise. CCI pays me very, very well. Yeah, thank I appreciate that, but they pay me very well. I do not need a raise. So what we're really working on is quality initiatives, right? So that's what I'm.

Joseph Rodriguez (48:48)
Are you asking for a race? Do you want me to get the CEO on? We can do it right now. I'll just, you know, I'm just kidding. Promotion. I meant to say promotion. Yeah, that's it. Yes.

Dr. Brian Schmutzler (49:07)
I'm really pushing is quality. So over the next five years, I would like to have the most robust quality measurement and quality indicator system in the industry. That's my goal. So we've got a quality, ⁓ a director of quality, and then I've got a couple other people on the clinical side that are helping with this. And so to do that, there's a couple of things we have to do. One is figure out what we want to measure. And we're working on that. We're kind of pushing MIPS and MACRA.

I'll be honest, it's pretty meaningless. Those are just things to check boxes. So we're looking at things that actually drive patient care and drive cost savings. So that's big for me. ⁓ And then the other side of that is self-report, right? Because all of our quality is essentially self-report. Our complications and our lack of quality is all self-report. So I'm trying to figure out how, in the company and then as an industry in general, how do we promote

Joseph Rodriguez (49:40)
Hmm.

Dr. Brian Schmutzler (50:04)
a culture of safety, just like in the airline industry where you can say, like, I messed up without being, you know, persecuted for it basically, right? So like, hey, I made an error, even if it was not a significant error, I made the error and I gave two cc's of the medication when I meant to give one. Let's report that and figure out how we fix it in the future, right? And that's not a great example given one.

one cc too much medication, but the principle, right? Right. Right.

Joseph Rodriguez (50:32)
The principle is there, right? It's where people feel safe. They know they're not going to be punished for saying something

happened that was suboptimal.

Dr. Brian Schmutzler (50:39)
Right, right, exactly. Yeah, and I'm not saying, you know, true negligence, right? Like I just didn't do something or I did something I knew I wasn't supposed to do, but things that just happen. I mean, there are things that happen in the operating room at times that are suboptimal. Like I probably shouldn't have done that. I did what I thought was best at the time, but I probably shouldn't have done that. So let's look at how we can go back and fix that in the future without punishing people. So I think those two things are kind of where I'm heading. That's where I'm.

moving ⁓ my career ⁓ focus. ⁓ We'll continue putting stuff out on social media. I enjoy that as well. ⁓ My kids are starting to grow up a little bit, so I'm doing some things like coaching football and trying to spend a little bit more time ⁓ doing things that they enjoy instead of making them do things that I enjoy because they're getting to that age now. ⁓ Yeah, spending time with my family and trying to ⁓

Joseph Rodriguez (51:10)
Focus.

Dr. Brian Schmutzler (51:37)
trying to get things off my plate that I don't necessarily have to do so that I have the time to do that. That's probably what I'm looking at in the next five, 10 years. I'm gonna remain clinical. I'm not full-time clinical, I'm part-time clinical, but I'm gonna remain clinical probably for the next seven to 10 years at least, I would say. So, I do, yeah, definitely, definitely.

Joseph Rodriguez (51:41)
Hmm.

Yeah, you enjoy it. sounds like. Yeah,

well, I love what you're doing, man. I hope to I hope to see the yeah, I hope to see the platform grow. And yeah, this you have really good answers. I enjoy the there's a lot of different ways we could have taken the conversation. But hopefully it's enjoyable for you and hopefully we have you on again.

Dr. Brian Schmutzler (52:00)
thank you.

Yeah, I love talking about this stuff. So absolutely be happy to come back. Thank you.

Joseph Rodriguez (52:16)
Very good. Awesome. Thanks, Prime.