Episode 83: Bridging Subspecialties To Tackle Maternal Mortality w. Dr. Cesar Padilla

Feb 1, 2021

This Episode

Interview w/ Dr. Cesar Padilla

You Will Learn

– Dr. Padilla explains where he thinks the main issues lie when considering how maternal morbidity seems to be going backwards compared to other countries.

– Dr. Padilla explains the benefits of being able to discuss with other physicians from different fields to help further the discussion and study of maternal morbidity, as well as other areas.

– How Dr. Padilla thinks that we can best inspire the millennial generation when it comes to the practice of medicine

Resources & Links

This week, I am joined by Dr. Cesar Padilla about his work bridging subspecialties between critical care and obstetrics, to be able to tackle the problem of maternal mortality in the United States. There are a lot of new and exciting ways to Dr. Padilla is tackling this with some of his colleagues. We also discuss some other key principles that have guided his formation as a professional.

Justin (00:03):
This week I’m talking to Dr. Simon Lee. Dr. Lee has really brought experience and an incredible aptitude to get out of his comfort zone. That’s caused him to grow in a lot of different ways. This is a trait that he traces back to his father who came to the U S as a professor with no entrepreneurial training, but eventually ran a couple of businesses in order to support his family. Dr. Lee and I talk about a lot of things in this interview from his career and his experience, and I really appreciated, especially his perspectives on money, on savings and on lifestyle for physicians.
Justin (00:53):
He also talks about his experience in being a medical advisor for venture capital firms, which was a really cool topic and opened up some really interesting opportunities for him as you’ll hear as always. Thanks for tuning in hello and welcome to this episode of anesthesia and pain management success. Episode 82. I’m very pleased to be joined today by Dr. Simon Lee. Dr. Lee is a board of anesthesiologists and assistant professor at Emory university school of medicine. He’s an entrepreneur, he’s a lifelong learner. He’s currently working on BA he’s done real estate. He’s done locums he’s he’s really just has so many rich life experiences, and he’s agreed to come on today to share some wisdom with our audience. So Dr. Lee, thank you very much for being here.
Dr. Simon Lee (01:36):
Hey, great to be here. I appreciate you having me, Justin.
Justin (01:40):
And so the place I want to start off is a bit of an unconventional place. I don’t frequently have guests that are classically trained opera singers. In fact, you might be the first, so I’m curious, you know, just tell us a little bit about what is that like.
Dr. Simon Lee (01:56):
So I, I don’t do it anymore. It’s a very difficult and competitive lifestyle. I stopped seeing about 10 years ago during the great recession, when a lot of opera houses actually contract, you know, either shut down or contracted their seasons. So I lost multiple contracts that year, and I thought, I decided just to step away, take a year off, see how I felt. And then I would jump back in after kind of catching my breath and recuperating a little bit. And, you know, after that first year of taking time off, I realized that my home life was a better my reflux was gone. My stress level was, was a lot less than an I did miss it a lot, but I felt like my lifestyle was just so improved. And, and, you know, with the goal of having a family, I just felt like it was the right time to step away. And I had gotten so many positive things from that experience that I didn’t want to be the too greedy or stay in it so long that I got jaded in the happy.
Justin (02:57):
And so I’m looking at your CV here, and I noticed that you finished residency in 2006. And so you would have been a, you would have been a practicing attending physician at this time. Is that, is that accurate?
Dr. Simon Lee (03:09):
That is. And I was fortunate that I you know, I was, I went into a really good job market where there was a lot of opportunities and actually started off doing locums the first year out of residency, because the flexibility of that, that schedule fit really well with the upcoming kind of opera engagements I had that year. Pretty quickly I found a home down in South Florida where my wife was in grad school, working for what was then known as Sheridan now is envision. And I got to tell you, they treated me really well. They were incredibly flexible with my schedule and they’ve made it work for me. And in turn, they got a really appreciative and enthusiastic anesthesiologist who still worked when I was in town. I still work about 80 to 90 hours a week.
Justin (03:53):
So before we jumped on the call, you alluded to some of the lessons that you’ve learned in your operatic career that maybe in some surprising ways, translated into helpful insights for being a physician. Could you share a couple of those?
Dr. Simon Lee (04:05):
Yeah, I mean, you know, I was thinking about this the other day, one of the biggest things and especially relevant today in this pandemic COVID world is living in the moment. And I think one of the things that was the most most exciting and, and probably the most rewarding things about being on a stage was when you’re performing live. There’s no redos, there’s no take backs. It’s just that moment. And you go on and they say, the show must go on. It’s absolutely true, no matter how, how much you mess up or how, how big of a flood you, you, you, you you show you still have to continue on, and it’s really forcing you to live in that moment. And it’s really hard to do this sometimes as a physician, just as a human being, when you’re looking at, you know, your practice, the way that it’s, you know, the direction it’s heading, the politics within the office, the reimbursement changes, the hospital policies, protocols that are being forced on you.
Dr. Simon Lee (05:03):
A lot of those stressors you start to think about and perseverate on, and you think in the future about what’s next, what’s next, what’s next. And we don’t kind of live in the moment and just appreciate, you know, we do this amazing job where we take care of people at one of their most vulnerable moments. I know it’s a cliche that you all say during your residency interviews, but it’s true. We do do something that’s actually valuable, not in terms of money, but just in terms of a life skill and if something that you can do for society. And so I’ve learned to appreciate those moments where I’m in the moment. And I think the most the most relevant comparison I can make from like being on stage and performing is being in a code or being in a really bad trauma where you can not think too far ahead. You have to think a little bit ahead, of course, but you can’t think too, too far ahead, otherwise you get lost and you’ll miss the opportunities in front of you. And you’re really living a moment. And I think that’s, what’s exciting about those moments in medicine, where you’re doing something you’re truly there and present, and then, you know, hopefully you get to see the results of your work. That’s something
Justin (06:09):
I’m finding particularly helpful right now as just for myself personally, living in the moment. You’re not experiencing vicariously all of the million disasters that might happen tomorrow, but just definitionally a million things. Can’t all go wrong. But if you spend all of today fretting about the million things tomorrow, you’re just going to live in an anxiety jail especially with, you know, the headlines and political trauma. And COVID all these things. This is, this is only it’s, it’s as important as it’s ever been. Do you have any performer, maybe any anecdotes of like stepping out onto the stage for your first big performance or any shows or you just killed it and for somebody who has never done that? I, I, you know, I was in my high school talent show back in 2006. That’s the extent of my time on stage. And I’m curious from somebody who’s, you know, performed at some of the highest levels. Like what, what is, what’s it like?
Dr. Simon Lee (07:00):
You know, one of the things I appreciate the most was just the ensemble part of it. And so it’s a lot of different people that have very different talents at different levels of skill come from very diverse backgrounds, but you’re all centered on this one goal of putting on the highest quality and best show you can. And so in those moments, you know, that you’re working as a team and you really have to because, you know, a good artist or a good performer and a good colleague understands that, you know, the better your colleagues do the better you’ll do. And so you’re really in an environment where you’re supporting each other, trying to make, or trying to elevate the people around you, because, you know, in turn, that’s going to elevate your performance or what you do. You know, that’s probably the most magical thing about working in an ensemble like that.
Dr. Simon Lee (07:46):
And that’s kind of the teamwork that sometimes we miss in medicine, especially in anesthesia where it’s fairly solitary you know, I’d say one of the highlights is, is, is every time I got on stage, it was a highlight. I gotta be honest with you. It was what I, you know, what every performer lives for is to be on stage. And then, then kind of be in that magical moments moment where, you know, you can kind of feel the energy off the audience and then you feel the energy from your colleagues and that builds on itself. And then all of a sudden it’s over and there’s just huge sigh of relief, but also exhilaration. And then you also wonder, like what happened the last three and a half hours?
Justin (08:23):
Oh yeah. I’m a, I’m a big fan of the arts. And I had this experience going to see what is my favorite musical lame is with a friend and on Broadway in New York. And there’s just something about the live performance and the, just the communication of humanity and beauty and tragedy, and being bound up in that with those people who were like pouring out, you know, their, their heart and their soul on the stage, and being able to participate with that as an audience member. It’s, it’s just incredible. So it’s, it’s really cool that you’ve been able to do that from the stage. And even from
Dr. Simon Lee (08:56):
The audience you feed off, you know, the people around you, if they’re really into and really enjoying it, but then you can feel that, and there’s this electricity in the air. And that’s one of the things I love about New York city was there’s a constant electricity in the year. That’s just a buzzing, buzzing energy of talent and, and, you know, and, and stress, but also of you know, if people really going out there and trying to make something happen, and it’s really just an amazing place to, to either witness or to live in the arts. Yeah.
Justin (09:29):
So it’s clear Dr. Lee, that you are a bit of a Renaissance man, the little bit of time that we’ve known each other and have diverse interests and take us through maybe a couple other of your endeavors outside of clinical medicine that are things that have your attention right now.
Dr. Simon Lee (09:43):
Yeah. And so my, my journey has kind of been all over the place. You’ve seen me and say I’m as generalist as a generalist can be, you know, I’ve, I’ve, I’ve been, you know, I’ve been advised so many times to really just find it a really small niche and just dive right into it. And I wanted to do that because that would make life easier in so many ways, but it’s just not really part of my personality. So I consider myself a lifelong learner. I’m finishing up my MBA at Emory in the spring. And that was because someone was gracious. My boss was gracious enough to give me that opportunity and support me. I’ve been kind of on this raft, that’s allowed the river to take me wherever it goes. I’ve had some control, but for the most part, I’ve just been more of a, of a participant.
Dr. Simon Lee (10:29):
Some of the things that we’ve talked about that I’ve done aside from I’d invested in real estate. So I still have a pretty active portfolio and constantly looking to expand that in different ways and evolve that part of my, my portfolio. I had a agency or a staffing agency. At one point I had a dental sedation business at one point. And I’ve also been an angel investor as well as an advisor to several startups. And so kind of constantly expanding my scope of work as well as just learning has been challenging because it takes a lot of time and energy, but at the same time, you start to see so many overlaps in different industries and different verticals, and they really can help someone like me to make those connections. And that’s where I feel my strengths have really started to emerge is making the connections between different industry and seeing how they can overlap and how they can create synergy between the, between each other. Yeah.
Justin (11:24):
Yeah. Awesome. And you know, with these diverse interests and aptitudes it’s interesting. Cause I think, you know, and I want to zoom in on a couple of these in a minute, but there’s an underlying sort of way that you see the world. And we were talking before this about you know, just a client situation that I had where a physician was a little bit financially pinched and overextended. And I know that personal finance and understanding, like having a solid financial foundation is something that’s important. You and I, you know, these all sort of play into that, having different interests that are all going to pay you at the same time and creates a lot of stability and a lot of resilience in times of craziness. So tell me a little bit about your own personal philosophies about money and finance and building wealth and how has your journey unfolded?
Dr. Simon Lee (12:11):
Sure. you know, I think a lot of it’s rooted in my upbringing, so my parents were immigrants and they show up in a small like corner, you know, gift shop in a, in a, what we call now, transitional area. And then they built it into an import business. And so I saw along the way, if you saw where we were at the end of their careers, versus where we started, you would have thought that there’s a successful business people, but they weren’t business people. They had zero background in it, except the, the goal was to survive and to create a life for their kids that would allow them to not have to do the things that they did to make money. So one of the most powerful lessons I took from my upbringing was that nothing’s guaranteed no matter who you are.
Dr. Simon Lee (12:55):
So my dad had a very high, high, high, highly regarded profession and creative. He was a professor and he came here and he was in the qualified for nothing. So he had, he had to be a welder at one point. Then he owned a small gift shop. Things that don’t necessarily require any education, but he was an incredibly educated person. So nothing’s guaranteed, no matter what degree you have or title you get. And those are just, those are, you know, those were fairly superficial. You know, I appreciate the MD and I know in the future, I’ll appreciate the MBA that I have, but that does not necessarily make me make me someone who has it doesn’t guarantee me anything in life. And so I have to earn, you know, and so when I think about the philosophy around money I see it the same way when coming out of residency, you get this huge jump in salary and it’s awesome.
Dr. Simon Lee (13:45):
Like all of a sudden you’re like, I’m rich, right? But you know, you can, you can easily not be rich. You know, you, we fit into the house that we buy. So you go from a one bedroom apartment to a five bedroom house. And within two years, all the closets are full and you need more space. So it’s easy to expand into the space or into the salary that you receive, but you have to be, you have to keep it in the back of your mind that things can change at any moment. If you know, again, 2020 is a year where things changed a lot for people, you know, the financial relationship they had with their group or with their hospital certainly was either challenged or dramatically altered. And that’s probably going to be more of a norm for, for folks in healthcare, in the future, because it is a quickly changing industry.
Dr. Simon Lee (14:34):
I always see it as, you know, live comfortably and live your life, but always realize that, you know, next year you’re not guaranteed the same salary and it’s typically gonna be lower than what you’re making. Now, if you always expect a higher salary and you live to that moment, then you’re going to be caught shorthanded at some point. And it always amazes me and not to be critical, but I have colleagues who make really good money. They make very nice six figure incomes and they’re month to month, they’re living month to month. And that, that does not seem like a really sustainable way to live because you’re never going to make enough money with that mindset to ever be able to take a step back and say, Hey, I’m not taking any more calls or I’m going to cut my, you know, my time to 50% or 75% where I’m going to make adjustments to make my life better. You know, we’re working for certain reasons, right? We have a career. We, you know, we have to make money, but if that’s what drives, every decision you make is the salary that you need to make to maintain a lifestyle. Then, then you become you become subservient to the, to the paycheck. And to me, that’s that doesn’t signal financial freedom.
Justin (15:47):
Couldn’t agree more. And I think, especially in this era of shrinking reimbursement, which we’ve talked about a lot on this show and 10% year over year cuts from CMS, as far as Medicare reimbursement to anesthesiology, as well as the, at the micro level any practice or any hospital or any department could experience some sort of shock that could have employment implications for any individual physician having that margin is it just gives you this mental it just, it makes your life less stressful. I try to say, how do we build our lives for the least stress possible? I do that for myself and for my clients. And it’s like, w we make enough, we have enough, we can build intentionally so that we don’t have to stress. If we do that, then as you noted, we’ll expand to sort of fill the box we build for ourselves. And if that box is too big, then we lose our job. And then three things happen all at once. Then you’re very, very stressed and everyone I can prevent from being that stressed. I definitely want to try to, have you had any like times of financial stress or, you know, was the, is this early impression that you got from your parents that’s early example, has that been just like a, a lifelong hardwired, always leaving big margin in your life in that way?
Dr. Simon Lee (17:01):
Yeah, I’ve, I’ve always been a little bit more fiscally conservative. There was a period in my life. So when I first finished residency one of the things I did is I lived like I was a resident for the next, essentially four years. So I, I paid about the same amount of rent wherever I went. I didn’t buy a nice car. I didn’t, you know, spend a lot on like watches or, you know, or things like that. I did spend more on vacations and I enjoyed that part, but I was making a lot more money obviously. But just not spending that much more. And so I saved up a lot of just cash and invested a little bit in the market, things like that. But what that allowed me to do was to then be pretty risky because I understood that I have a certain income flow, like could depend on most of the time doing locums is necessarily the most stable job.
Dr. Simon Lee (17:51):
And so you kind of learn to live with no paycheck for two weeks or for a month, if you have to. And that’s kind of what got me into real estate investing is in 2010, I saw all around me. I was living in South Florida. I saw all around me, kind of the devastation of the real estate market unfold. I saw an opportunity to start investing. And so I literally took every single penny I had and invest started investing into real estate. And I even borrowed money from people I knew and said, I’ll be able to pay you back in six months or 12 months, you know, friends and family. And I borrowed money. I just bought very aggressively, super high risk profile, understand that every single investment, I just chalked it up to $0 in five years. I said, they’re all going to fail, but these are worth it. And so fortunately the timing was good and the investments turned out to be, to be pretty successful. And that actually paid the way for future financial success. And gave me a lot of freedom.
Justin (18:49):
There’s an excellent principal. I want to point out here, which Warren buffet famously said be fearful when others are greedy and greedy when others are fearful. And you think about sort of the economic cycle back then in 2006, 2007 real estate was at the sky high. They had these things, they called Ninja loans, which has no income, no job application, which is you can just come in off the street and not have anything. And they would give you a hundred percent or 105% of a mortgage to buy a property whenever that’s happening. That means there’s a dislocation in the market and stuff’s about to hit the fan. That was what was happening in Oh six and Oh seven. So you perceived that you saw in 2008 when everyone’s freaking out to March 7th, 2009, which is the bottom of the equity market. You’re seeing this thing unfold where all of a sudden everyone is fearful. Is this the end of capitalism? Everyone’s selling, selling, selling at the same time. Nobody can sell because of that, this phenomenon of the crowded movie theater with one exit door and somebody else fire, like we can’t all get out. And so that was a great opportunity to do what you just described. So this is well before the MBA, clearly you have some business acumen even early on to receive these types of trends.
Dr. Simon Lee (20:04):
Well, I also understood, I think the most important thing is to understand your own risk profile at that time. You know, I had a girlfriend who, you know, she was in school, so she had grad school loans. So she could live off of that if she needed to. And I could, you know, mooch off of her, if I had no money, I had no kids. And I had paid off all my student loan debt very aggressively in the first two years post-training. And so I didn’t have a lot hanging over my head, worst case scenario. I lose everything and maybe I have to sleep in my car for a couple of months. But I can do that. And I, I get one locums gig for two weeks and I’m all set again. I can go back into an apartment, you know, restart over.
Dr. Simon Lee (20:41):
And so that was, that was the bottom for me. It was like, I can, I can always bounce back from a total at that point in my life now with two kids would, would never dream of being that aggressive, but that was the right time for me to do it. And I understood that I was willing to risk everything because I was okay living with the consequences of that. Now I’m not willing to risk as much because I’m not willing to live with the downside. And so that’s how I, I kind of balanced my risk appetite at different parts of my life. And I think it’s something that if you can get a really good understanding of yourself early on, then it will serve you very, very well.
Justin (21:19):
Couldn’t agree more. Let’s talk about the locums scene. Cause this is really interesting to me. We’ve had guests in the past who have either done locums as physicians or work for staffing companies. And I think this is really interesting. I’ve even, we’ve had most recently, Dr. Elop Shaw out in Southern California who has talked about contracting with hospitals, with the locums company and how it’s very difficult for independent locums companies to exist because hospitals will basically screw you over or say, Oh, sorry, we can’t pay you the, you know, the the subsidies are too high. We didn’t realize we did the math wrong. We’re gonna kick it to legal. And maybe we’ll pay you in six months if our lawyers give us the green light and as a business owner, obviously that doesn’t work. So tell me about your experience as a, as a locums physician yourself and then ultimately getting into the staffing business and, and how that’s unfolded.
Dr. Simon Lee (22:10):
Yeah. So, you know, I did the locums thing as a physician at and necessity and convenience, which I think is how most people enter that market. And I found that to be a really positive experience. I got to work in a few different environments, very, very small towns to, you know, mid-size cities and different States that I never would have probably ever spent significant time in. I met some, some really talented people, you know, it, you know, coming from, you know, a big name, residency program, I thought, you know, only the best people are in academics at big, you know, Ivy league institutions. And I, I remember working with a surgeon in, I can’t remember the name of the town in Indiana or someplace like that. It was a tiny town, but one of the best surgeons I’ve ever worked with and I thought he’d been to the state and I thought he was phenomenal.
Dr. Simon Lee (22:56):
And so wasn’t this very small town, but he had his reasons for being there. And so it taught me not to judge a book by its cover or, or to take too much credence in terms of a title, right. Or in terms of a label that we put on, on ourselves. It also taught me a lot about the business side of, of medicine, where there’s a lot of frankly, a lot of waste because of shortsightedness and staffing or in how you treat and develop the people around you. And so if you don’t invest in your employees there, they are going to leave because there is a market out there and they will find a place for themselves. And so that leaves you short handed. And that frankly makes you vulnerable to having to hire locums agencies, which are incredibly expensive. It’s also, I think, bad for morale because, you know, I’m all of a sudden coming, I have zero connections to this hospital and I’m getting paid one of the highest salaries there.
Dr. Simon Lee (23:50):
And so that’s a, that’s a realistic, you know, part of the business, but it also shows how many gaps there are within the system, you know? And that, that really gave me a lot of insight into what I could do when I started my own agency with a partner in New York. And it was a small regional staffing company and we serve the needs of several small local hospitals, kind of like a, in a just-in-time type staffing model. We made our rates really fair so that they were both good to the physician and good to the hospital. And we also had lower overhead costs. And so we’d have to pass those on to anybody and that seemed to be a good balance. And that was a really great experience.
Justin (24:29):
Did you have any, you talked about like investing in your people and respecting them and, and how that’s important for morale and leadership and team building. Did you have any experiences either on the positive or negative side of that, that sort of stuck with you and said, Oh, when I’m doing this, when I’m employing people, I want to make sure and treat them the right way.
Dr. Simon Lee (24:46):
Yeah. I, you know, I, there’s always been a lot of tough lessons throughout a lot of mistakes, obviously, and most of those mistakes don’t come from financial decisions. At least for me, they’ve come from my relationships. And so learning learning about people, you know, when you’re, you know, when you’re a med school and I went straight from high school to this, you know, six year program. And so I came out really immature, not very wise the world. And honestly, I didn’t have a good lens on a lot of different types of people because I was essentially siloed into a very narrow group of people that were pretty similar to me. It taught me that there’s a lot of different personalities out there. There’s a lot of things that you have to consider and, you know, we call it emotional intelligence now, but it’s really just like, how do you understand, or how do you read the people around you and try to get to the root of what drives them and what’s important to them.
Dr. Simon Lee (25:36):
And that’s one of the things I never asked before when I worked with people was like, you know, what’s most important to them because I kind of assumed it was what was most important to me. And we were all on the same page and I was dead wrong. And I’ve had to learn that the hard way multiple times. Even, you know, as recently as a few years ago, when I was the division chief for our ambulatory surgical division at Emory really hard lessons learned there. But again, that’s kind of what life is about is learning and kind of evolving and growing. And, and that just makes you a better person and probably, you know, gives you a much nicer lens to see the world through.
Justin (26:12):
Totally. Did you have a moment when you were you know, employed with a staffing company or locums agency, and you said, you know what, I can do this. Let’s try to H how did you get from, you know, that being that doctor to being somebody who’s trying to build that infrastructure?
Dr. Simon Lee (26:27):
Yeah, I mean, so one of the things that becomes very apparent and it’s, you know, staffing agencies are a sales job for the people who run them. So they sell me on themselves as such a great partner. That’s going to take care of me, beat my needs, put me in great situations. And they sell themselves to the hospitals. As someone who’s going to find a amazing doctor to come and take care of all their needs fit in seamlessly. And all it takes is a lot of money. And, and pretty quickly you find out that it is just it’s, you know, my experiences were that a lot of those relationships were incredibly superficial and didn’t satisfy either party. I knew what I could deliver, and I knew what the hospital expected of me. And so I could maintain that relationship in a, in a good way.
Dr. Simon Lee (27:11):
And I did that successfully, but on the locum side, I found that there was a lot of unhappiness on the hospital or the payer side with their relationship and what they got, as well, as, you know, on the client side, which I consider myself a client in that role, you know, the communication, you know, being paid on time. Some of those, you know, all HR issues were, were just very poor. And so that really compelled me to say, this can be done better. And I think there’s much smarter and brighter people out there doing that in meaningful ways using digital you know, using technology. And I think that will actually be the trend in the teacher cause it’s such a fragmented and an outdated marketplace. Yeah.
Justin (27:56):
I, I really like the locums option as a mechanism for sort of ancillary wealth building for anesthesiologists. And I think one thing that I always try to encourage people to do is when you’re looking at a contract, like make sure that you’ve got flexibility to do some other types of things. That you’re a perfect example, Dr. Lee, like everything you just listed off the staffing company, the real estate stuff, dental, anesthesia startup stuff in order to do these things, which are all they start small, but they grow to be a very meaningful part of your, your income. Eventually they they needed to be permitted by whoever you’re working for. And you’ve been at Emory now for seven years. And presumably a lot of this stuff has happened during that time. And you clearly have an engagement with them that allows you to, if you’re fulfilling your duties with them, you can do some other fun stuff too. So,
Dr. Simon Lee (28:43):
Yeah, I mean, it’s a lot of you know, I know that when I’m an, as an anesthesiologist, I get paid for coming in physically coming in and doing work, you know, pushing drugs and debating things like that. I don’t get paid to just exist. Right. Whereas the beauty of, of business and the beauty of these passive investments like real estate is I may not have thought about a certain property for six months, but I still collected a rent check on it. You know, there are moments of more intense engagement, but that’s way less per kind of dollar earned or per hour earned that than you would have in any, any medical field. And so, you know, I break down my time and my, and what I value in terms of business decisions based on that kind of hourly rate, what does this cost me every year in terms of time and effort and what is the payout? And if those numbers aligned pretty nicely and are superior to what I could do, you know, as an anesthesiologist, and then it’s a good investment in my book. And that kind of is why also do some of the you know you know, legal, legal work as well, the medical legal work. Yeah.
Justin (29:48):
Let’s talk about that for just a minute. And then we’ll transition to the startup side of things. Tell me a little bit about your current medical legal and even experiences that you’ve had. And if somebody is interested in kind of getting into that, especially as an anesthesiologist, how would you kind of counsel them and describe the lay of the land?
Dr. Simon Lee (30:03):
Yeah, I, I think being part of Emory certainly helped. I was just kind of found by someone who was scouring websites and I found that’s what they do is they scour typically academic departmental websites to see who specializes in what they need. And that’s kind of how I got my start. I asked a couple of colleagues who had done this before, that were similar to me and asked them what they charge and they told me their rates and they told me the range. And I just kind of picked something right in the middle because I felt like, you know, I was probably somewhere right now. It’s been a great experience. It’s given me a great, you know, a much deeper appreciation for some of the intricacies of the medical legal world, especially how, you know, you know, we, we look at our risk or risk person in our hospital as kind of a thorn in our side, but they really are protecting us from a lot of unseen forces at play.
Dr. Simon Lee (30:55):
And I do a pretty equal amount of plaintiff and defendant cases. I try to stay as neutral as possible. And so my, my one rule is don’t tell me what side you’re on before you talk about the case. I’ll tell you what I think, and then we can, we can figure out if I am going to help, if I’m going to be useful to you or I’m going to be actually you know, not so useful to and it’s been, it’s been a really, it’s been a good experience, not just for the money aspect of it, but in terms of also feeling like this is another way that the skillset that I had took a long time to develop can actually help people. So when I’m involved in the case, it has to be something I believe in. And I truly can say with pure conscience that I, I believe what I’m saying and that this is what I believe you know, should be heard by, by a jury. And that helps either the patient or the physician who may be, I feel has been put into a position that’s not, not right.
Justin (31:51):
If somebody is interested in doing this and maybe it doesn’t get selected by that person out there working for a lawyer, scouring websites. Is there a way that they can perhaps try to introduce themselves to someone?
Dr. Simon Lee (32:02):
Yeah, I think there are some, I haven’t engaged any, but I know there are some websites out there that match physicians with with law firms that have a specific need. And I think once you start to do the work, you’ll find out if you like it or not. And they’ll also find out if you’re the right type of person for it. So a lot of now all of my, my work comes from referrals from, from other attorneys who have worked with me in the past for, you know, actually ironically or have been in a deposition on the opposing side. And then, and then contacted me for, for, for work. So it’s, it’s, it’s about relationships and just treating, you know, just having, having a respect for the process. So being respectful of the law, being respectful of the patient involved, cause it’s now this is their livelihood. This is our life we’re talking about as well as just being respectful to both sides of the of the legal team.
Justin (32:57):
Makes sense. Let’s transition and talk a little bit about like the startup venture capital stuff that you’ve got going on. So maybe briefly describe what that looks like in your life right now. And then we can zoom in on a couple of different things.
Dr. Simon Lee (33:11):
Yeah. So I’ve, I’ve done some angel investing in the past. Most of them have been incredibly poor decisions. And so that was an expensive lessons to learn. But each of them taught me something very important as, as most, most of those kind of add onto the MBA, perhaps it was more expensive than the NBA, but so I’ve always been an entrepreneur as talked about. And this was just another way to invest in people that I saw were talented and had ideas that resonated with me, frankly. I’ve gotten more and more involved in different ways. So I’m an LP in a venture fund. I’m a clinical advisor to a VC that’s based in Denver that specializes in healthcare startups. I’m a medical advisor to a couple of startups. The one that I’ve been the most excited about is, is one based out of Washington DC called belief. And that is a Bluetooth enabled end-to-end platform that allows physicians to really closely monitor the usage of narcotics from their patients who are on chronic opioids, as well as gives the patients opportunity to show accountability for their usage of, of crime payments. And so it’s a kind of a win-win situation for both sides. And that’s been something that I’ve been been, I’ve been working with this team, I believe in, in what they’re doing. And I, I believe it has actually really high value for our patients.
Justin (34:37):
I really liked the police work specifically. I want to come back to that in a minute, but before we do, let’s talk about, you used a couple terms there. I want to make sure that everyone listening understands what we’re talking about. So you said I’m an LP and I’m a medical advisor to other startups. And talk about what does it mean to be a limited partner in some kind of venture? How is that structured legally? Who are the other partners? Why do you do something like that? And what are you expecting to get out of it as an investor?
Dr. Simon Lee (35:02):
So specifically for venture capital and LP, is it called a limited partner and they are essentially investors into the fund. So a venture capital firm will create a fund that has a certain thesis around what kind of companies they are going to invest in, how big of a check they want to write, you know, what geographic location or what kind of mix of founder or, or, or advisory board that they want to see on these teams that they invest in. And so they have this investment thesis that they sent her around. I, I essentially am part of that fund because I invest in it as long with other other folks and also some institutions. And then, you know, and then you, you depend on the general partner or the people leading this fund to invest in good startups that eventually will either be acquired or go public.
Dr. Simon Lee (35:51):
And then when that happens, then obviously you have, you own a certain percentage of that company. And so you get paid you know, or you get rewarded for your investment in that company at the earlier stages. That’s the one other investment vehicle. If you don’t want to be an individual angel investor and make a lot of the same mistakes that I do, then one way to buffer that is to hire essentially a professional team to manage your investments. And that’s what they do is I give them a check and then they go out and they do all the work about diligence and really finding the best startups that they can and investing in those in a, in a smart way that brings the maximum Richlands to the fund. And then the, this, the, the clinical advisor role. So that’s one, that’s a, that’s a role that’s that can be very different depending on the startup, but essentially for someone like me. So a physician by training they’re they’re depending on me to come and give them my insight or my advice on some of the scientific or medical aspects of their, either their device or their technology, or, you know, whatever idea that they’re working on and bring, bring my breadth of knowledge and experience to them. So that, that helps them to understand where their market strategy, where their strategy or where their, where their technology may be going in a direction that’s not going to fit into the overall market.
Justin (37:11):
So I can envision people listening and saying, wow, that stuff you’re doing with believe as a medical advisor or clinical advisor, that sounds pretty cool. Like, you’re the doctor, you’re the smart guy in the room. People ask you questions about how they should build their product. You kind of like dispense from your, you know, your, the knowledge that you’ve accrued through your experience and through your training. And then they, there’s some economic exchange, presumably. So if somebody is either seeking opportunities like this, or is offered an opportunity like this, and they’re trying to figure out how do I position the, sort of the compensation element based on what they’re bringing, how would you sort of give them some context to intelligence to not get taken advantage of
Dr. Simon Lee (37:47):
Perhaps? Yeah, it’s really hard because, you know, as an entrepreneur or a founder, your startup is your life and it’s a very personal thing. And so you, you believe it to be incredibly valuable, otherwise, why would you be doing it right? And so coming in as an advisor, you have to respect the position that the founder is in and knowing and understand that they do value their company probably higher than you do. Because as an outsider, you just don’t see it right as, as clearly as they do with the person who has the vision for it and so on. So it’s really tough to say, this is a set number for a seed company or an idea phase company, or for a series a company. And this is how much a medical advisor should get. It depends on, you know, who you are. If you’re a key opinion leader in your field, then you probably deserve a little bit more equity in the company.
Dr. Simon Lee (38:35):
Typically what you’ll get is some shares or some equity of a company. But you have to also understand, you know, what are they willing to pay for your advice? You know, and it’s not necessarily a matter of value and you shouldn’t take it personally. It’s just a matter of, they’re trying to make the best business decisions for their company because where it is right now, it’s not necessarily will be in five years. And there’s a lot of people that will come between it. And those are mostly metric capitalists or other people who are going to put money into the company. And they’re going to want a portion of the equity as well. And so there’s this very difficult balance of preservation of equity for a founder that they have to manage at all levels straight from the beginning. I think talking to as many people that are involved in this is probably the easiest way to understand, you know, where you should position yourself in the end. You want to work with founders and founders want to work with advisors that are going to bring value to each other, but also be fair. You don’t want to win. There’s no, you know, if you, if you get, if you get 25% of a company just for being an advisor, you maybe have one, but you’ve also handicapped this company that it probably won’t be successful.
Justin (39:44):
Yeah. So tell us more about police. So for any listeners, it’s P I L L E V E [inaudible] dot com. And you can, you can check out the work that they’re doing. How did you get introduced to this opportunity? What has your role as a clinical advisor been like, and how’s it going?
Dr. Simon Lee (39:57):
So, you know, this is where relationships kind of drive everything else. So I remember sitting in some financial modeling class on a weekend, I sat next to this undergrad cause we both had Mac books and just kind of struck up a conversation and kept in touch. He had his own startup and you know, I, I talked to him several times and then one day he emailed me with his, you know, and CC and his friend, who’s the CEO and co-founder his company Yosef and said, Hey, Simon has been really helpful. Thank you guys would get along, just connecting you. And then we, we met over zoom obviously. And just, and we had it and had had good, good conversation. We resonated, I met, had met with his co-founder golf them prior to that, and we had had a good conversation. So it kind of blossomed from there.
Dr. Simon Lee (40:47):
Their story is Josefina actually has a personal history of opioid addiction. He’s been very open about it. And that really drove him to understand, are there some better solutions for people like me and are there better ways to manage opioids and opiod prescriptions. And so he partnered with got them who they were friends in DC and got them. His background is in software and they created this advice. They’re on their second or third version now. And it’s been, I think it’s a really exciting technology. It’s something that I think can really bring value to, to the physician. Who’s prescribing the medication as well. So the patient who’s who’s, who’s taking a chronic opioid. Essentially every time you take a pain pill, you have to just log into your app with your thumb print. You say your pain score is, and then you say, give me a pill.
Dr. Simon Lee (41:35):
It gives you a pill and it just keeps track of the timestamps. It, so it knows exactly when you took it. It knows exactly what your pain score was. And you can add into their comments about, you know, your, your, the moment in time that you’re taking this pill. If you want to, for data processes, the P the physician actually gets a dashboard. They can see every single patient on this platform and say, how much are they taking terms of pain medication? Are they adhering to the prescribing patterns that I’ve, I’ve, you know, I’ve, I’ve recommended, or are they kind of falling off of that? They can more or less are they going to run out, you know, 15 days early? Or are they going to have like a lot of excess? And so I can adjust my prescribing patterns based on the data I’m receiving, as well as bill for my patient monitor.
Dr. Simon Lee (42:17):
One of the exciting things they found is that patients who are using this platform actually report on higher, on average higher pain scores, their pain is actually going up what their usage of opioids has actually gone down. And so there’s, there’s this aspect of maybe accountability or awareness about their pain that is actually kind of healing. And so they knowing that they, they are identifying and putting a label on their pain, helps them to manage it better from a mental health standpoint. And so this may give some insight into addiction, or what they’re hoping is to potentially create patterns or recognition so they can understand if someone at risk for addiction is someone starting to display usage behavior that signals that there might be, need to be an intervention or discussion.
Justin (43:09):
And so, as far as the product itself, it sounds like it’s a combination of there’s like some hardware, and then there’s also like a software, maybe an app for the phone, or how does that mean?
Dr. Simon Lee (43:18):
Exactly. Yeah. It’s exactly what you said. So it’s a, it’s a hardware device. It’s it’s it’s a traditional pain candidate, a pill canister that’s attached to this Bluetooth enabled device that the pharmacist actually sets up and it’s really easy to use. And then the patient just logs into the app on their smartphone and the, it dispenses a pill.
Justin (43:39):
And so if somebody sat there thinking, Holy cow, I would love transparency to my patients opioid consumption. And I, this dashboard sounds really cool. Like how do I, how do I sign up for something like that?
Dr. Simon Lee (43:51):
Yeah, I think you can just go right onto the website. Feel free to reach out to me if you want it to kind of hear my perspective on it. I’m happy to talk, talk more on it. There’s a lot of exciting trials going on. They’ve launched it in a private practice in Manhattan with a, with a really forward thinking and highly regarded pain position. And he’s been using in his clinic and they’re, they’re getting some exciting results. So there’s a lot more data that’s going to come out. And I think if you’re interested in either using it or piloting it or being part of a trial, and I think there’s a lot of there’s a lot of opportunity there.
Justin (44:28):
Awesome. So w will in the show notes, if you want to reach out to Dr. Lee we’ll post his contact information, or just go to the website, P I L L E V e.com, if you want a little more info this sounds like a really cool software hardware combo that is going to be addressing opioid addiction in a unique way. So that’s really, really exciting your work you’re doing there as we’re kind of wrapping up. I’m curious you know, is there any other, th this is a show about equipping physicians for nonclinical insights that they need to succeed in business career in life. You’re a guy who has done exceptionally not only clinically, but also in all these other nonclinical pursuits. What other sort of words of wisdom or perspective would you bring for somebody who, you know, they’ve got the med school thing down, they’ve got the residency, they got all the A’s, they passed all the clinical hurdles, but they’re just looking for some that additional bit of wisdom from somebody who’s really walked the walk very well.
Dr. Simon Lee (45:23):
I think probably the most important thing for me. And when I talk to some of the residents is really just understand what your relationship with money just know who, you know, and be really, I didn’t get to be really honest with yourself. Like, what does money actually mean to you? How important is it? And if it is important, then you have to think about, you know, your risk profile what your goals are. I think you, as a financial planner is if someone that you could, you should talk to, to really put on paper in a, in a more, you know, kind of non-emotional way what you’re looking to do, put numbers down and then figure out a pathway to get to those numbers. And if that means like, you know, going from academics to private practice, that’s one pathway with them means becoming a passive investor in other things, then that’s another pathway, but you know, one of the things I think that physicians forget is that we’re really, really good at medicine.
Dr. Simon Lee (46:18):
Like we know more about the human body and we know more about our specialty than anybody else in the world when it comes to a lot of other things, we are not that bright. And so some of the dumbest money and investments comes from physicians because they frankly don’t ask questions and it’s not because they don’t want to know it’s just because they don’t know what to ask, because that’s not what we do. And so, you know, if you talk to someone like, you know, like yourself, just in about, you know, even in your benefits package, this is something that we all get, you know, I mean, I’m still fairly clueless. And I have to ask my HR director all the time and every year I ask more and more questions because I just don’t know where to start. So just understand that you don’t know a lot about some of these things and you’ll have to do research, you’ll have to do work. You’ll have to make mistakes and you’ll have to, you know, depend on a network of people around you that can give you some better insights.
Justin (47:11):
Awesome. Couldn’t have said it better myself. Well, Dr. Simon Lee, thank you very much for joining us this week.
Justin (47:15):
On another episode of APM success. I appreciate you having me. Thank you so much. If you liked what you heard this week, head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you want it to leave a review in iTunes, that also really appreciate it. Thanks for using some of your valuable time to join me today on APM success.