Anesthesia Deconstructed: Moving Anesthesia Forward
Anesthesia Deconstructed: Unraveling the Complexities of Modern Anesthesia Practice
Founded in 2018 by Mike MacKinnon, DNP, FNP, CRNA, FAAN, and later joined by co-host Joe Rodriguez, DNAP, CRNA, Anesthesia Deconstructed is an award-winning podcast that consistently ranks as the nation's top-downloaded anesthesia podcast, with two of the most well-known CRNAs in the country as hosts. We feature industry experts from across the spectrum, exploring scientific issues, policy matters, and the day-to-day realities of anesthesia practice.
Our mission is to deconstruct complex topics, recognizing that the truth often lies in the nuanced middle ground rather than at extremes. We bring unique value to our listeners by examining the nexus of clinical practice, education, and policy, offering insights that go beyond any single perspective.
Join us for thought-provoking discussions that bridge the gap between theory and practice in the world of anesthesia.
Anesthesia Deconstructed: Moving Anesthesia Forward
Meet Scott Becker JD CPA of Beckers Healthcare
On this podcast we talk about how Mr Becker decided to get into law, healthcare law and his journey to Harvard law school. We talk about how important family support is and how his was there for him. Additionally, we discuss physicians and allied healthcare providers roles as we continue dealing with the challenge of access to healthcare in a fiscally responsible manner. Lastly, we talk about ASCs, HOPDs and where Mr Becker sees healthcare headed in the future. This is an amazing man with great insight into the future of our industry and you do NOT want to miss this one!
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Speaker 2:Welcome to anesthesia deconstructed science politics realities. Listen and miss medical professionals join industry expert Mike McKinnon to discuss the latest science and medical advancements, the effects of our political climate and the realities of today's changing healthcare environment. Let's get started with your host, Mike McKinnon.
Speaker 1:Today in the podcast, we're excited to have Mr. Scott Becker, J D CPA. He's a 1989 Harvard law school graduate, author of four books and a leader in the healthcare profession as a partner in a national law firm of McGuire woods. Scott Becker provides legal and strategic services exclusively in the area of healthcare. In addition to all that, he runs Becker's healthcare, which is the go to source for healthcare decision makers and one of the fastest growing media platforms in the industry with over 3.4 million subscribers. Welcome to the podcast, Mr. Becker. It is our honor to have you here.
Speaker 3:Well thank you so much Mike. We appreciate you having me. Thank you sir.
Speaker 1:So tell us a little about your journey into lie and your back.
Speaker 3:Sure. So great question and I see some of the questions you pose. I feel so non-direct and so non linear. So I ended up in law school. Goodness. I grew up in a community where the concept was you have three choices, you can be a doctor, a lawyer or an accountant. Those were the three choices. I ended up wanting to be in business and slash an accountant and then went to university of Illinois as an undergraduate, which is in the middle of the country. Champaign-Urbana ended up applying to law school and doing sort of double business major in college and accounting, applied to law school, applied to business school inadvertently got accepted to Harvard law school, ended up in law school, but it was sort of a very secondary choice. But one of those kinds of things were once you got into Harvard law school was hard to turn down. So when our law school, it wasn't some great planner design. This sort of inadvertently ended up there.
Speaker 1:It's crazy. And I mean Harvard law school is huge. That's a, it's where people want to go. So once you get the acceptance, it's not like you can turn it down.
Speaker 3:And that's really how it worked. Like I came from a family. My parents are wonderful people and they struggled and that the company my father worked for went broke when we were in high school. So he ended up having to find a new profession, new job, new business and sort of they to the great credit and a chance to go to another law school on a total scholarship. And my parents to their great credit were like, no, no, no, no. We'll find a way to make this work. And XOs. I ended up at Harvard law school and sort of as you said, I had no visions of going on to law school and end up being a wonderful, wonderful experience. I had the chance to be a teaching assistant with Barack Obama, one of my classes, people like that much brighter than myself. It was a fascinating experience. And again, what cards? My parents who basically stepped up when they really didn't have the finances to do so and said, we'll help you do this. You got into Harvard, we'll go. So it was a great experience.
Speaker 1:That's amazing. I mean, it's amazing when parents take that much, you know, put that much work into their children to give them the best opportunity. And that's basically what happened in your case,
Speaker 3:it's really true.
Speaker 1:And how'd you end up getting interested in healthcare and healthcare law?
Speaker 3:You know, it's so funny because each of these questions end up being somewhat inadvertent. I practiced my first two years after law school in a large farm and like many people did the first few years of law school practicing in a large firm, it was just, you know, 2040 500 hours a year of billable time. It was sort of very, very challenging but brutal. I was kind of burnt out and sort of the one lesson I came away with and I started to do some healthcare corporate work, was that if I was going to practice for the long run, I had to sort of figure out what I wanted to do. And so I ended up joining a farm that had quote unquote health department and health departments were different than the typical departments. Most departments in law firms are built around a specialty like litigation, corporate work or securities work or malpractice work or whatever they are. Healthcare was built differently. It's built as an industry group. So the great thing about is you had the chance to explore do I want to do transactional work, regulatory work, you could choose amongst those groups. So I sort of inadvertently ended up in healthcare department because it gave me the option to sort of figure out what I wanted to do. And I ended up focusing a practice in sort of the business side of healthcare. And that's where we, where we evolved through this. And that was sort of how I ended up in healthcare. It wasn't because of, I could say that I was like Jonas Salk and wanted to solve, you know, create penicillin and solve healthcare problems or, or, or treat polio or fix cancer, whatever it is. It wasn't that, it was nothing that was altruistic. It was really me trying to find myself at the age of 28 and I tell my kids whenever they're trying to figure out careers and they're so worried about it. And I say, Oh my God, your father did fine. And I couldn't figure out that was 2030, you know, and I think that's not atypical.
Speaker 1:I think that's really common. And so basically healthcare gave you the opportunity to explore a whole bunch of different options. It was a huge umbrella for you and opened it up.
Speaker 3:That's exactly right. And when people are so scared to make choices, I was able to make the choice. I was like, okay, 20% of the economy and not knowing myself so much. But ultimately in life you have to narrow yourself to do well. So it is what it is. And then it'd be a great specialty grade area.
Speaker 1:Oh, that makes total sense. It's interesting. I think a lot of our listeners will not know that about law and how that works under an umbrella with so many different options within healthcare. So that'll be interesting for people listening that may have an interest in the future.
Speaker 3:100%.
Speaker 1:And then, you know, you develop this amazing resource, which I've been reading for years. Um, Becker's healthcare, which is an umbrella organization to which you have Becker's Ayers ASC, Becker's hospitals, CFOs, um, the whole thing. It's a, it's a large consortium of stuff with a lot of employees. You guys are seeing there like 1.8 million views a month, over 3 million subscribers. I mean it's huge. Tons of people to your conferences. I know you just finished one. Uh, how did you end up going from that to creating this huge resource, which I mean it's literally millions of people are relying upon.
Speaker 3:Sure. So it really happened in two sort of core steps. The first step was early on, we're in our 27th year of one of our conferences. It's in the surgery center area and I was trying to build a name in healthcare law as, as a lawyer who was a leading lawyer in, in the area. So we started doing a very simple newsletter around the surgery centers and simple conferences around surgery centers really to be at the intersection of the world of health care surgery centers and walk nicely, sort of unexpectedly, almost like deciding to be a lawyer side of me. And healthcare unexpectedly started to go well, people started to be attracted to it. We started to be able to track audiences and it was really a pleasure and a lot of fun. At some point. This thing I've been able to do, I've made some nonlinear decisions is once I've made those decisions, I've been able to sort of recognize patterns and double down on what seems to be working. At some point in the great credit goes to Jessica call our CEO and why did the editorial leadership and our team at some point I started hiring people directly into that company to expand that company being Becker's healthcare and so about 12 years after really starting yet, I was outsourcing everything. To that point about till about 15 years ago, 12 years ago, I started it. We started to hire folk come in place and we started to expand. We were just in surgery centers to begin with. We grew into two different areas at that point. Hospitals and health systems in orthopedics and spine, and then finally you fast forward about five to seven years ago we got into the health key area, so it's really four core specialties, hospitals, health systems, health it, surgery centers and spine, and then within those there's different different publications in those four. But this way ended up being sort of starting to fully the marketing purposes and grew into real business.
Speaker 1:It's pretty amazing. I mean you started this essentially at a time when the internet was in its infancy, so it took some vision to move it from this newsletter you created into what is now this huge online content creator with a lot of information that's accessible for everybody.
Speaker 3:Well, no thank you and I don't think of it as great vision. I think if it, I liked the compliment, but I think of it differently. We got into this and we're just doing some small things and as we grew into the hospital sector, there's a magnificent publication in the hospital sector called bottom health care, which was the great print publication in healthcare. There's also a great print publication in surgery centers at that time called outpatient surgery. And there was another one called the surgery center. And what essentially happened was we didn't have the resources to win in print. You know, starting a print publication is a very expensive endeavor. You have to print it, you have to publish it, you have to mail it, you need all the writers itself. So we made a decision early on, and this was the smart part of it, but it wasn't a vision. It was, Oh my God, we can't win in those areas. We can't be the best plant. It's too expensive. I needed the resources, I was funding it myself. And so we ended up deciding we would try and be calm in online publications and in events, and that was really the direction of the company. So we're able to focus very clearly, almost on necessity, not out of brilliance and not at a vision without a necessity. We can't win there. Let's pick things we could win at.
Speaker 1:Right. That makes sense. And also hard work. I mean, that's the other side of it, right? It's not just a, it's not just that you fell into it, it's more that you put the effort in in the work and cause it certainly was bootstrapped by you guys.
Speaker 3:A lot of work, you know, game takers was, you know, in the first couple of years I started hiring full time people must have hired 10 or 15 in sort of sorted them out to be left with several magnificent people. And those people have really been, you know, there's only, you know, what I've learned in life is nothing gets done without teams. So whatever you do, nothing great gets done without teams. Anybody who says differently is either extra ordinary or a liar. And for me the difference maker in my law practice and in this business was hiring and developing great teams that go with having a plan and developing a direction. Once we sort of clarified the direction.
Speaker 1:All right, find the right people, put them in the right positions and give them the ability to take ownership.
Speaker 3:Yeah, it's really true.
Speaker 1:And now you guys are just coming off of, you mentioned at your 26th annual meeting for the ASC side, which is your oldest one, how many people did you have there? And I just want people to get a sense of how huge these meetings, I mean people should attend is what I'm trying to tell them.
Speaker 3:Sure. So we have our core business model. I mean the core way we reach our audiences on the meeting side is we have two big houses, two meetings a year, two big health I team meetings a year and two big surgery center meetings, meetings a year. A big surgery center meeting might be 1500 people. So it's not, it's not thousands. Our big hospital meeting is 5,000 people. But even in our surgery center meeting, which is in 26 year 1500 people, but highly focused on the business of surgery centers. And then we try and have this concept, lots of sessions to learn and then a handful of fun keynote sessions at the meeting. So at this meeting we had people like Kevin O'Leary from shark tank. When you saw Dr. Berg and sort of a famous radio personality and the sister of Mark Zuckerberg, terrific woman leader and speaker sugar Ray Leonard, the boxer who was just fun to have in person. Just a pleasure of a person. And then we have Tucker Carlson, the Fox TV show host, uh, and we try and be completely nonpartisan. So talk to her. Carlson spoke at this meeting, our last meeting team meeting, Hillary Clinton spoke at, you know, former secretary of state Clinton. We try and be totally nonpartisan, but we do try and make this mantra in all of our meetings. It's a lots of learning, lots of education, lots of networking plus entertained. So we try to have fun keynote. So it's really become a labor of love and a great team supports all of it.
Speaker 1:Yeah. Meetings like that are really where you get an opportunity to interact with those who are just as interested as you are in that sector. And that's where the experts are going to be. To put all this together. It's just been a huge undertaking for you and your team. And, uh, you know, I, I want to say it now. So the people here, I talked to people all over the country and people are very thankful that you have created this resource. I mean they don't know the process behind it and I've only recently learned all of the information between how long it was and all the different functions. But it is pretty amazing to have put this together. People are pretty excited to have the availability just to read some of these articles. I mean, you can't get that information easily anywhere else and it's all in one place. So Becker's has been huge.
Speaker 3:It, kudos to editorial team, editorial team, great leadership, the two editors and chief Malik gamble or not to give him a quick shout out and a lot of greater sort of leadership and then the core mission of being short and concise to the point, you know, giving people what they need to know, a quick sense of what's going on in the old days. I think of myself as very bright Harvard lawyer, all this kind of stuff. I write long articles that I thought was interesting, but no one would read them. And so we moved towards was the short concise method of writing and it took a long time to get an editorial team that was willing to get on board with that concept. And we've got great leadership there because what we really moved towards was away from the writing that I used to think I wanted to do in terms of writing their audience actually relates to and wants to read. It was a fascinating sort of education for me of writing very deep softball articles and nobody read that, you know? And then we moved towards short, concise, giving you what they need. Here's what's going on in your sector, here's what's happening. And that's what people want to know and want to know what's going on here. What's going on there? Do I have to worry? Do I have to think differently? They're not interested in Scott's long thoughts. They're just not.
Speaker 1:Absolutely, it is an art form to shorten something down. It's way harder than writing a lot. I'm the same way. I want to write a long thing, a soliloquy about my thoughts and no one cares, but they just want the bullet points. Right? And those, and we're in a, we're in a world of sound bites and that's what people are looking for.
Speaker 3:It's true. And what happens is we had enough data and analytics, I mean, we talked about, which is get very clear. You get great clarity of this way to read that article, this move. We're at that article. I better write more like this,
Speaker 1:for example. Yeah. Yeah. It tells you, they tell you what they want essentially.
Speaker 3:Exactly.
Speaker 1:Well, awesome. It's an amazing story, certainly for sure. And then one of the, you know, one of the questions that I had, I had mentioned to you is about this executive order that came out from president talking about removing regulatory barriers and States and federally, and it kind of relates, um, in part to APRN CRNs like myself, nurse practitioners, physician assistants. How do you see in the future that rolling in to impact the industry?
Speaker 3:Sure. So it's a great, great question. And I personally try and completely stay out of this fight that goes on between serenade and the medical doctors, the MD anesthesiologist in the turf way that's there. The thing that I will comment on is there was no way around it with the growing population that lives a lot longer, soon, 25 million people and living longer, more people coming into Medicare every single day. There is no other way to address the shortage of physicians then to allow people to practice the top of their license. It doesn't mean that I'm on one side or the other, but there's gotta be this movement to allow where you can people rising to the top of their license because you just, you just, there's just not enough doctors in the country. There's just not. It's a problem that we need to address for our nation needs to address. The doctors are critically, critically important to the delivery of healthcare. If you ever need a specialist, you're in a small town, a large town. It's just very hard to find them. Medical school should be shorter. There shouldn't be so many weed-out types of things for doctors. There's a lot of brilliant people that could be doctors that are weeded out stupid way. Uh, we need more doctors or countries, doctors to the back, one of the systems to go with their nurses to go with the allied health practitioners. So I don't have a side of the issue. I do believe that people need to practice sources of top of their license and that we're gonna face horrible shortages in our country.
Speaker 1:Right. Effectively we need everyone to do everything they can that they're trained to do, to try to mitigate the risks that's coming with so much shortage for everybody.
Speaker 3:That's about right. There just is not enough physicians, et cetera in the country, in the log run access is problem. Now I'm in the middle of the healthcare business and to actually get the back or I need to get for a certain thing for a family member and you'd use every connection I hae out and I can't even imagine we're building out in the middle. The healthcare business.
Speaker 1:Right, exactly. I mean I live in a small rural town here. There's only so many people. If I wanted a specialist, I've got to travel to somewhere where I don't know these people, I don't have, my connections don't exist there in the way that they might here. And so it definitely becomes complicated. Access is a huge deal.
Speaker 3:No, 100%.
Speaker 1:And when you're looking down the road of all, all this time you've spent looking in healthcare, the healthcare industry dealing with Beckers, what are you see as head in in the next five years to 10 years with surgical services in general in the healthcare system? Do you think this is going to end up in a bundled care Medicare for all something totally, totally different,
Speaker 3:right? So that's a great question. There's three different sort of core options people talk about. They talk about Medicare for all, they talk about a public option and they talk about the free market as, let me start with the free market is not a thing. And what I mean by that is the percentage of care provided by Medicare, Medicaid is no matter how you look at it, getting you to be a bigger and bigger percentage regardless of Medicare for all or a public option, 40 50% of all carriers provided the Medicare and Medicaid now and it's just simply going to grow given the aging population. So do I believe in how savings account, consumerism, transparency. Absolutely. What do I believe that the entire healthcare is going to be a free market. It's not now in campy. It's a highly regulated industry that the government pays for half of it already. So then you end up so saying, okay, you could have a bifurcated pre-market. We'll never going back to a true free market. It's just not happening. We're not going to have Medicare and Medicaid at this point. At least my perception is then you look at public option and some of the other issues like for example, whether you, Hey president Obama love president Obama, everybody agrees they want to be able to get care regardless of preexisting conditions. There's certain things, Republicans, Democrats, porn, rich, whatever ethnicity you are people want. That's one of them. The other thing that I think people uniformly or ultimately want is some sort of public option and maybe the public option is a, you know it certainly is something that's wanted by the wealthy and the poor. The rich and the not rich people want an option. They don't want to be held hostage by an insurance company works just an insurance company. There are only choices and so at some point I assume those two platforms and maybe I'll have more consumerism, more transparency, more health savings accounts when adoptables as well, which already have a lot of that, but at some point I think you'll have this, these rules on insurance that allow to get coverage regardless of preexisting condition and you'll probably go public option. Some States are starting to have a public option. It just seems just like you have the post office as opposed to FedEx and ups. It seems like at the end of the day you're going to end up with some kind of public option at some point.
Speaker 1:Yeah, I absolutely agree. I mean, we're at that point where people have insurance but they've got a$10,000 deductible and they make$30,000 a year. Well that's not really insurance. That's, that's disaster care insurance. Effectively.
Speaker 3:That's exactly what it is. And that's okay. That's what insurance was ultimately supposed to be in the, in the, in the, in the, in the first case. But it is, it depends on income. You know, the insurance companies will say to you, we haven't raised your premiums that much. Yes. My premiums are still 10 12,000 a year for a family of four, et cetera. But what they've done is my deductibles come from 1000 to 6,000 so the reality is my true health care costs have gone up to 16 70,000
Speaker 1:exactly. Exactly. And it's unattainable for some people frankly, to pay it.
Speaker 3:Oh, hot episode.
Speaker 1:It's just brutal. Yeah, I agree. It is. It's been different for me. I'm Canadian. So originally I came from Canada, moved to the U S to see that that different type of system has been, it's a stark contrast. Very different from what I'm used to.
Speaker 3:Yes. And then you get questions of access, quality and cost. And so, you know, you get into issues, I mean, it's different for a country of 350 million versus 50 million. You get all these different issues that are out there. Like you get into very interesting cost access and quality issues. You know, quality here is very solid. There's lots of great things in our system. There's lots of fantastic things. But when you end up with a relative with a, you know, a life threatening disease, you find that there's great care in other countries too, that there's places where they're better than us. I mean, there's all kinds of things that are good about our country's healthcare system. There's places where we need improvement.
Speaker 1:When you're looking down the road at anesthesia, uh, my profession, what do you see happening within AFCs and hospitals down the road in the future? How do you see that whole thing changing?
Speaker 3:Yeah, no, it's a, it's a, it's a great, great question. It's a fascinating question. I mean certainly you see this great movement towards outpatient surgery that's begun and continues to begin and continues to push forward and it's just more and more consistent outpatient. Now all of those cases that move outpatient, some of them moved to physician offices, some of them moved to surgery centers, some of them moved to hospital departments. So it's not as though it was great one with the outpatient and they're all flooding surgery centers, surgery centers this past year actually in terms of total numbers of surgery centers, still numbers of procedures, but it's not, it's not 12%. It's a couple percent. And so you continue to see this movement. It's bifurcated between hospitals, surgery centers, and really, I shouldn't say bifurcated, it's more than that. And practice offices.
Speaker 1:Absolutely. There's some, there's some big shifts changing and uh, you know, you're certainly seeing more surgery centers open and I think there seems to be a trend toward HOPD. These are hospital outpatient departments shifting toward the ASC side, transitioning to ASC, eh, have you been seeing a lot of that? I've read a few things on Becker's about a HOPD shifting to ASC. Is that something that you've, you've been seeing?
Speaker 3:We don't see that much of it. We see some of that, I mean still get paid twice as much as surgery students get paid for about the same procedure. All kinds of historical reasons for that. The med tech CMS goal is to pay surgery centers enough. They cases migrate out of hospitals to surgery centers, but not so much as there's excess profit leftover. And so I don't know where those numbers will end up. Um, you know, and, and hospitals are trying to, there's some building of surgeries and so many hospitals, but they're also trying to keep the reimbursement they get in the hospital outpatient department.
Speaker 1:Right. And that's a lot of money. A Medicare pays, like you said, about twice as much for the same procedure or an HOPD versus an ASC. And at some point you would expect the government will be looking to change that. If they can do a cheaper than ASC overall savings, more efficiency assumably then will there be a push to decrease HOPD reimbursement?
Speaker 3:Well in the end. This is the great question. And of course the hospital systems are very, very important. Our country's infrastructure is the biggest employer in lots of places. There's a lot of huge positives about what the big hospital health systems do. And so it's a very cautious political game between how you work through politics of pushing cases out of hospitals. Well, sustaining our hospital do still do we want to work to take care of their 325 million people. So it's a great political balance,
Speaker 1:right? And you're not seeing those privately owned ASC has taken all the no pay patients or they're doing all the indigent care that the hospital's going to do.
Speaker 3:It just is the reality of the different businesses. And some are for profit business, some are not for profit businesses and the hassles need some margin to keep on doing what they do. And what they do is critical. You could bash them all you want, but when you have a relative that needs hospital care, we want them to be around.
Speaker 1:Exactly. You want that place to be there
Speaker 3:and we want it to be good. We want it to be good at what it does.
Speaker 1:Exactly. Not just there. Yeah, that's a good point. So now as we're moving forward, you know, ASC is obviously privately owned or are for surgeons. Physicians as a group are attractive because you know they can get a piece of the facility fee. It's good business, you know, they, they are incentivize then to do more cases there. So overall the model works pretty well and we have a couple of surgery center contracts and we see that, you know, surgeons are, are running, they're trying to make it happen. Is there a way that hospitals can structure and HOPD in a manner that will have that same thing? Because you know, if you're a physician and you can get a piece of this facility fee and you're doing a lot of cases in an ASC, but then you want to get involved in this HOPD right now you can't. So how do you attract those people and keep them at the hospital?
Speaker 3:Yeah, there's, there's, yeah, there's, there's two or three questions on that, that are there. So it's very hard for hospitals to legitimately give physicians part of the money that comes from the HOPD. It's just very hard to do it legitimately. People try all kinds of different things and there's variation, but at the end of the day it's hard to duplicate what you have in a surgery center economically. The other big problem is not just economic, it's clinical as well and it's convenient as well. You hear, you know, a surgeon is doing seven cases a day, eight cases a day in the Catterick position, it might be 12 cases a day if he or she has to fight the hospital operating room to do that. He or she now is spending two days doing what they could do in four hours. And so there are huge convenience issue and in a world where we have shortages of physician shortages of allied health practitioners and great burnout and great burden, the surgery center provides a huge offset to some of those problems. I mean, imagine you would do it in a CNA. Sometimes instead of getting 10 cases done in five hours, you've got something that's gone wrong. You have to be there for 10 hours, you know, and it, and it's extremely exhausting. Everything else. So surgeons, they get used to practicing in an environment that they get relatively good control over and move the schedule along. Don't want to go back to hospital, you know, unless they have to.
Speaker 1:Absolutely. Absolutely. I think, I think that's absolutely correct and that's what you hear from them effectively. Now in the bigger picture, do you see healthcare starting to contract a little? One of the things that was different from Canada where I came from is that things are centralized and that saves money. Right. Do you think that's coming for us? I noticed I'm just reading both on Becker's and other resources that a lot of smaller hospitals have closed across the country over the last few years and so rural facilities kind of like the one I'm at. Do you think that's there? We're heading down that road more as a trend. Decreasing access again?
Speaker 3:Yeah, I mean it's a great, great question. The smaller facilities in rural areas, community hospitals and cities, all of the ultimately after the side, what are they going to be great at and what are they not going to do? So it's, you know, if you're in a rural community, there are two kinds of rural community hospitals. There's those that understand this is what we're doing and we're going to do a great, and there's those that are trying to do too many things. And so the great example of the rural hospitals trying to do too many things, you could literally sit in a board meeting where none of the board members will take their family members to that hospital for care. You follow me? And the ed is typically a rural hospital that unfortunately due today's world is trying to do many things. They just can't stamp it. There's not enough physicians, there's not enough staff, there's not enough anything to keep those things going in the right direction. So you will see more and more of this where people travel for more advanced care, for tertiary care, for certain types of things. The world has become over the last 50 years, more urban than it was. And it's an unfortunate thing, but it is what it is. I mean, it's almost like in the old days, all these positions would graduate. They'd come out in the army and they'd go anyplace in the country to be in great community. Now for a million reasons, family reasons, spouse reasons, all kinds of reasons. They all congregate. So the more urban area, and it's not too different with staff. So you've got a situation where it's very hard for the community hospitals to do what they used to do for a lot of reasons. And so do I see more of a contraction? Probably. Yeah, 100% and then it's not that the country has to pay to do all things in every single place, but he has to make sure those people in our communities have access to great care in total. And it's harder. But that's why, you know what you talked about early pressing the top of your license, remote care, virtual care, and ultimately finding ways to create pathways where there's a great local facility that does X, Y, and Z. Well people have the ability to get to a more regional community hospital or center for more challenging or critical care.
Speaker 1:Oh absolutely. I mean there's downward economic pressure on healthcare. We're all, we all know that. And ultimately to get, you know, new surgeons, new services that are rural area that you got to pay a premium. I mean if you could live in Scottsdale, Arizona versus small town Arizona where the biggest store is Walmart and make more money down there, why would you come here? It's it, it's a difficult thing to, to manage for these small facilities cause they've only got so much resource.
Speaker 3:Yeah. I mean people are all over the place where they want to live. It's just that if there's a small swath population, health care system doesn't have the resources to put all the, recreate all the doctors and everything else in that community.
Speaker 1:What's your next big thing? What's the next big thing for Becker's?
Speaker 3:Yeah, no, for Becker's healthcare, our core mission is to strengthen the ears. We're in the hospital health system community, the surgery center community, the health it area, and then the spine community. And we're a big believer in you put 89% of your efforts into what you're doing currently, what's going well, doubling down on that. And then we spend 10 15% of our time exploring other areas and trying to look at those. And those are more sort of like what you call creative dabbling into either new product lines within those four vertical areas that we're in or a new vertical area. But really 89% of our mission is really focusing on making sure we've got six meetings a year. We've been in this for 27 years. Our businesses never have a meeting, a week meeting. It's really 20 sector a year. We don't really want any more than that. We want to make sure the things that we do, we actually do great. And so it really starts with the[inaudible] efforts in doubling down on what we're doing.
Speaker 1:Awesome. I think that's going to serve more people ultimately. And so what last words of wisdom would you want to leave? For our listeners out there, the anesthesia listeners and the others that are gonna listen to this podcast, what can you, what would you tell them about our industry? Healthcare in general.
Speaker 3:Yeah. No, there's so much. It's such a broad question. What we, what we tell people the great game in life is to have a plan and stay in Gates. And so find your plan, stay engaged. And then again, we always talk about nothing happened without, without great people and great teams. I mean I look at what you do usually that gives a job as a CNA and then you make it a job trying to stay in touch with your community and stay engaged in what's going on and know what's happening. And that's half the battle, right? There is no your core stay engaged and obviously do things with pretty people. And so it's just a pleasure being on your podcast and visiting with you. Thank you.
Speaker 1:Oh, I appreciate it, Scott. You've been great. It was fun to talk to you. I mean, we've had some communication in the past and I've read a lot of your stuff, but, uh, just the opportunity to have a discussion back and forth has been amazing. I'm sure people are gonna really appreciate it and thank you for taking time out. I know you're really busy to do this with us and uh, excellent. Thank you so much. Thank you very much.
Speaker 2:That's all for this episode of anesthesia deconstructed. For more information based on today's discussion, be sure to visit us@anesthesia-deconstructed.com you'll also gain access to our blogs, editorials, and more resources to keep you updated on the science, politics, and realities of today's medical industry. That's anesthesia-deconstructed.com.
