Minimizing Mistakes in Entrepreneurship

Welcome to the Talent Empowerment Podcast, where we share the stories of great humans so you can lift up your organizations, your teams, and your community. I am your host, Tom Finn, and on the show today we have a healthcare CEO, a vaccine, and a COVID-19 expert. a pulmonary and critical care physician. He's a sought-after speaker. And with all of that expertise, he does it in person in terms of education, on the stage, and in humble little podcasts like this one today. Doctor Bakhtari, thrilled to have you on the show. Welcome.

Oh, thank you, Tom. It's an honor. Thanks for having me.

Well, you've got a deep and rich history that I will share with the audience here. And if you haven't had the pleasure of being introduced to Jonathan Bakhtari, MD, he brings over 20 years of clinical, administrative, and entrepreneurial experience. He has been a triple-board certified physician with specialties in internal medicine and pulmonary, and critical care medicine Doctor Bakhtari previously served as the medical director of Valley Health Systems, Anthem Blue Cross Blue Shield, and the Culinary Health Fund. He also served as clinical faculty for several medical schools, including the University of Nevada and Toro.

Currently, Doctor Bakhtari is the CEO of E7 Health and US drug test centers, so let's start there. You made a change in your core physician work by becoming a thought leader and entrepreneur in medicine. Why do you do that?

That's a good question. You know the long answer: it happened gradually. You know it wasn't something that happened overnight. I think once I finished all my training and started joining a big group and practicing clinical medicine, opportunities to do administrative work and serve on committees arose, and you took advantage of them. I believe that once that occurred, one door kind of opened the next. Obviously, you know it caught my attention, and it's just like any other… You know, it's like training for medicine. You know you start training for administrative stuff, staff physicians are very good at training, right? We go through a residency internship fellowship, so it's sort of like doing a residency in administrative medicine. So, you begin with one. That door opens up another door, which opens up another door. And if you're ready to keep walking through all those doors, then you'll kind of get to where I am today.

And I would think most listeners don't think of "traditional." Medical personnel is unusual for an individual to pursue this path as an entrepreneur. How did you think through this? Or what were the steps you took?

Well, I Think about the answer to that question, I think we need to deal with the sort of impression that a lot of people have that doctors are bad business people, right? I mean, I hear all the time that doctors traditionally prescribe but I don't think that's true.

I think doctors are bad businesspeople when they do it as a side hustle. You know, if you're a practicing cardiothoracic surgeon working 90 hours a week, you're not going to be a very good real estate investor. You just know you're going to make a mistake. That's why I knew there was a saying about doctors investing badly and running businesses badly.

But I don't know if that's really true or if they're so committed to their real profession. Working 50, 60, 70, or 80 hours per week and then staying current by taking CME courses. So if doctors traditionally fail at a lot of this other stuff, what I recommend and what I tell my friends… If you are going to do other stuff, You have to clear your plate clinically and focus on it.

Doctors are really good at training, and that's what we did. We did it with the medical school internship and residency fellowship, you know. We're excellent at learning stuff when we're focused. So, what I would say is that you have to slowly—you know when I started, I first did it as a side hustle, but then I slowly cleared some clinical time, and now I'm about half clinical. And yeah, for three and a quarter clinical, you have to be willing to give up some of the clinical to focus on other stuff if that's what you want to do.

And isn't it true in any profession that if we're overworked in one area, we're not going to be very good in other areas of our lives? I don't think it's unique just to doctors.

Well, it is in one sense because doctors traditionally don't work 40 hours a week. So if you only work 40 hours a week, maybe some of these sides Hustles would work. But if you're working 60 or 70 and you're on call every weekend and you know you're working from 7 to 7, that's what makes it more difficult for doctors.

Because if I'm a CPA and I'm working from 9:00 a.m. to 5:00 p.m. I want to have an Amazon business in my garage. You might be able to pull that off. But I don't think you can do it if you have more than a job? You have a career.

So, let's take attorneys who work 60/70 hours or anyone else who will work 6070 hours and is knee-deep in the whole field. Yes, I believe in any field is all that absorbing going to minimize your chances of being successful on another project?

Well, I think it's important to understand it exactly.  Because finding balance is essential no matter what you do. as your core. A lot of people have a career and then find a side hustle. People are doing it today.

They're using their core competencies to pay the bills, and then they're looking for something outside of that for fulfillment.

As a clinician is there a step up to leadership? Is there something that you always recommend people go to for their own leadership development, regardless of whether they are physicians or not?

In terms of leadership development, I think it's a skill set that people think they can just have because, you know, they're smart. However, there are literally skill sets that you must learn. You know how to hire people, how to fire people, and how to mentor people. You know how to deal with the crisis in the organization. What do you do when? When your entire system fails, or when there is a, you know. There are major cracks in whatever you're doing.

And I think people who starts businesses don't value leadership abilities as a particular set of technical skills they need to acquire. They think it's soft skills. You know. I'm good with people, so I'm going to make a good CEO. No, that's not it. That's not the case, all right?

I mean, it's like flying a 747. If you put me in the cockpit at 30,000 feet and say, "Land a 747," I can't just say that … Well, I'm pretty smart. I'll figure it out. No, the planes will crash. I mean, no. No amount of an MBA, law degree, or medical degree will help you land that plane. You would need to acquire very specific skills to land on a 747, right?

This is also true of leadership. You can't just get it because you're a nice guy and you know a lot. You have to say, "Okay, these are skill sets I need to acquire, so I need to find mentors." I need to seek out those skill sets. So, I can be successful because—think about it. Most people become CEOs of startups just because it's their idea, but they're not qualified to be CEOs, or they just have some money to throw at it.

But then, that is fine, it's OK to do that but then go ahead if you're going. To run an organization with, I don't know, dozens and dozens of employees, go ahead and acquire those skills. because they'll maximize your chance for success.

So, from what I understand, leadership is a skill set that can be trained and educated just like any other skill set or core competency that we all learn throughout our lives in various disciplines and areas. But if you're going to try to land a 747, you better know how to fly a plane.

That's for sure.

So, as you consider it. Some of them are Things that are part of your core competencies, competencies, and leadership Are there a couple of things that stick? To you, those are the rules of the road.

Personally, in terms of managing people or managing an organization, can you drill down a little bit?

Yes, in terms of managing people and an organization. For example, some people say that servant leadership is the way they look at the world, and from a servant leadership perspective, they invert the triangle of leadership. I inverted the organizational chart. And I feel like it's my job to support people throughout an organization, and that's the way I look at the world. Do you have a core principle in the way you manage or lead teams?

Yes, I have a two-sided coin. Don't micromanage people; don't essentially hover over them and manage them that way; do the flip side of it. You need to invest in knowing what they do. In other words, if I'm going to train people to answer the phone and you're familiar with our company, I'll train you. You better know how to answer the phone, OK, or any skill set that I'm asking my staff to acquire. At some point, I should have acquired it. You know, it's sort of like being the head chef, but you've never cooked. No one will respect you in your organization if you can't do what you're asking your employees to do.

Now I get that certain things are very specialized. I'll be the accountant, and you'll be the manager. Not going to. You know you're not going to go get your CPA, but the flip side of it is that you have to have a really good understanding of what software you're using. What are the pros and cons? What are you getting so you can manage people who are using that? Even if you know CPA software, QuickBooks, or what have you, whatever the department is.

If you do not get if you are not able to either do it or fully understand what they're doing. It's very difficult for you to catch errors, lead, mentor, or give feedback. If you have no idea how that entire process works, and I believe many people believe, "Well, I'm the CEO, so I'll let them figure it out, “But if they figure it out and they're not doing your great job, You won't get the warning signals because you aren't familiar with that department.

Now, as you grow, Of course, you'll have layers of people who can do that for you, but certainly starting out, you need to know pretty much anyone you're asking to do something again at the beginning phase. It's obvious that you know the CEO of IBM does not know everything; you know some. Everyone at IBM is doing it, but that's when you're a Fortune 500 company. If you have 5-10 employees or 20-25 employees, you should know what everyone is doing and what they theoretically could do it yourself.

Well, well said, and I think most CEOs would say, "Hold on a second." Doctor Bakhtari, I don't want to live through every mistake. I don't want to get bogged down in the details; I just want to lead. How do I find the time to do everything you just said as well as lead the organization?

When you're 5 or 10, you're just like everyone else in a startup with 5 or 10 people. Everyone takes out their trash. You're not there. There is no real CEO seat. I mean, when we had three, four, or five people in our organization, I answered the phone. I mean, I took out the trash, and that's the point. There is no one to guide you there 5/10 people You're all leaders. I mean, you're all the same.

Do you know what happens when you reach 20/30? Yeah, OK, then you can leave, but when you're just starting out and you're just starting an organization, everyone is the HR guy. Everyone is the same. When you have 5-10 people, who are the director of compliance? I don't know who's the director of HR. Who's the director of benefits? I mean, I believe people started an organization with the intention of modeling it after a Fortune 500 company. No, no, no. I mean, you're only 5/10 people. Everyone is everything; everyone is in every department.

I recall hiring someone when we first started out. They’re like, "Uh, who do you know?" Who's the HR director like? We're all the HR directors, I mean. We're, we're all the compliance, and you know whatever you want. Find out if Back in the day, a fax machine broke, if you know what I mean. Who called for the repair? Guy, I don't know who found the broken fax machines. I mean, is that the case? I suppose it's more suited to our startup, but in the startup world, and even until you reach a certain size. Everyone does everything.

And I'm sure you know if I'd say this if my staff had one Knee, I respect in terms of how we began. I think you need to show them that you're willing to do anything and everything. There is in the early stages, and hopefully, they’ll look at that and say, "Oh, oh he's willing to do anything and everything. So that's the approach I should take.

That collaborative effort is so important in a start-up, I've found. I've had two. You've done a great job of growing businesses yourself, and I think you hit the nail on the head. I loved when you said that people start companies and try to organize them around the Fortune 500 model.

I feel like I did that originally. I did the same thing, yeah, and I thought, "Oh my gosh, I come from a big company." I've stepped away, and I'm building a Startup, this is going to be so cool. We're going to have heads of HR and a head of business development. We're going to get it. You know we're going to build; where's my CFO? And then you realize very quickly, you are. all of them.

You are all of them at the same time. This is your chance to learn about each department. And then eventually you pull away, pull away, pull away as you let your finances grow. But you'll always know how things work because you learned everything at the beginning.

Yeah, absolutely, and I wonder, from your perspective, what are the biggest wastes of time in that early stage when you think back? What did you do with your time? I swear, I wish somebody would have told me not to focus there.

I believe we should have leveraged technology more early on. It's a catch-22 because you know your finances are limited when you're starting out, but I don't think the amount of compensation you can make by leaning into technology earlier on wasn't as apparent to me. Of course, now we're a technology company, but starting out, we weren't as clear as day, I can say that we've spent nearly every dollar we've ever spent on technology. We’ve probably gotten $10 back. If I said to you, "Hey, every time you give me a dollar, I'll give you $10 back," You know you wouldn't put a budget on that. You wouldn't put a limit on how many dollars you were going to give me.

It's leaning into technology and policies and procedures and organization skills and organizational systems, even things like memorializing mistakes and writing incident reports, and you know you always think, "Oh, we're too small for the job," which actually is the biggest thing when you're super small and have to write policies and procedures. Because you don't want to hire a new employee and have them make the same three mistakes you just made. So, if you create a policy that says "never do this" or "always do that," and you put that in a policy even when you have three employees, I say get a policy manual. So, when you Hire your fourth and fifth employees., they're not the employee; they're not going to make the same mistake. The decisions the three of you made initially are important.

Because they memorialize what you've learned for the next generation of hires. That, I think, is the best use of a policy manual, right? You're effectively memorializing the fact that we used to make such jokes. Our policy manual We created almost every single policy over the years because of an incident that happened. Nobody sat there and said, "Oh, we have a company. Let's write policies.” No, no, no. All our policies were written after something happened. As a result, it's almost like it’s a diary of all the blunders made by your companies. If you write a policy book correctly,

and you're building it as you go. You're not building it with chapters and some sort of binding at the beginning. You're not building the itinerary; you're saying, "OK, we've got a blank page. Here we go. Let's figure this out.”

I remember 2009 well. When I went to Diana, our office manager, and said because someone made a mistake, here's a policy. I said put it in this three-ring binder, and that's going to be our policy, puts it in the binder. She said “ it is just one piece of paper," I say. Worry not, it will grow, and you will only need to add that first policy. Never, ever do this. This or I always do that, and then I realize it. So, every generation of talent that we brought on board could read this. Now we have it online, and it's like it's very elaborate, but we started out with three-ring binders, and that's good enough to start.

Yeah, that's a very good way to start, so let's double-click on this just a little bit because we haven't really talked about E7. I'd like to hear from you about how the organization you founded has been so successful in Nevada. Tell us a little bit about the organization and what prompted you to pursue this path.

Yeah, I think. You know, back in 2009, I was introduced to the concept by a dear friend of mine, and I think we initially started off as wanting to open up a clinic or company that focused on preventative health and wellness, mainly in terms of adult vaccinations, you know that everyone is aware of childhood vaccinations, but they are unaware that there are so many occupations and reasons, such as travel and various situations, in which adults require vaccines.

And in that sense, we were like a COVID company before COVID hit, right? Because no one considered adult vaccinations until COVID. But so we really went into every book of business that adult vaccinations were involved in, which involved, you know, corporate health. You know a lot of occupations, including medical and non-medical ones. You actually need Vaccines, laboratory testing, vision, hearing physicals, and a lot of different things and drugs. We got into the student health business because if you were applying to nurse school or pharmacy school, you would need a slew of vaccines, physicals, and drug tests, so we offer student health travel medicine, which the CDC recommends you get frequently if you're traveling to third-world countries. Get a whole host of travel vaccines.

So we just went into every book of business. Adult vaccinations were involved at the exclusion of primary care or urgent care, so we didn't see sick people at all, and we sort of became "the." You knew the “900-pound gorilla” when it came to adult vaccinations. This is probably the only company in the country. That does this, and other companies do a little bit of what we do, but they're also doing primary care, urgent care, and occupational medicine, so we wrote the technology and software for it because it didn't exist, and honestly, I wouldn't say it would exist. And I've said this before. We're almost like a technology company masquerading as a healthcare company.

And you had already said that the technology investment was really and I imagine you're getting $1.00 in and $10 back because you're streamlining the patient experience in some way. Share with us your technology and how that impacts the experience on the path.

Yeah, I mean, look, we have 10,000 positive reviews on our website and hundreds and hundreds of reviews on Google, and I think yes, it's a testimony to my great staff, but it's also a testimony to all the friction we've removed from the system.

So, basically, you know. on our own. We actually want to improve the software and technology because it didn't exist where you could literally pull up to our parking lot and book an appointment while you're in your car. Get an appointment literally 10 minutes away, then walk in without a clip. Or, if you don't have any paperwork, you can be seen in 5-10 minutes and out in 15/20 minutes, and everything we did to you is on your phone. So, when you go back to your car, you can pull it up on your patient portal.

So it's really reducing all the friction that patience has with my staff. Staff, you know there's no punching and everything auto-fills, and everything's pushed to the cloud, and it really is that way. I think we have sort of modeled it after Amazon, right? I mean, you want to go on Amazon; you're three clicks away from ordering, and then, boom. You know you're not worried about payment or whatever. It's all automated.

And we just thought you might know if there was a way to do it. If you want to replicate that in the healthcare environment, you know where to go, as I've said before, but if you want to know what you ordered on Amazon a year ago, you don't call up Amazon and say I need my records; this is there, so whatever we do for you is pushed to the cloud, and it's there forever.

I know a lot of healthcare companies are doing this, but to the point that we literally don't have a medical records department. If we've ever done anything for you, you have it. So, I think it is. And then, of course, reducing friction for my staff. So, they're working on iPads. There is no paper, and everything is done seamlessly.

Roughly, So what I'm hearing is that I don't have to put my date of birth on the first page, then put my date of birth on the third page, then tell you my name again on that page. the fourth page

Wait a minute; you're assuming we have no idea who you are. You’re talking about what I call the "clipboard experience," right?

That's yeah.  

There is, indeed. Why do you need a clipboard?

This is, you know, I always say it's funny because. A lot of healthcare clinics say, "Oh, we have electronic healthcare records." Really, though, why do you give me a clipboard when I walk in? I mean, both can't be true.

Yeah, well said, and I believe all of us who are healthcare consumers, and there are billions of us around the world, of us who are consumers. It’s nice to see such an experience, but we don't see it as consistently as we do with Amazon, Apple, or other services that are just very streamlined with technology. Is there a reason that we don't see it outside of E7 consistently?

Yeah, there is a reason. The main reason is that I mean, think about it.

I mean, healthcare is what percent of our GDP? You would think we would have the best technology. But the reason we don't is that there are three parties involved. You are aware of the consumer. The patient, the healthcare provider, and then the third-party payer.

So, if you went to a restaurant, do you know what they like? and you're having dinner. And there's a third. The party that's going to pay for the dinner. So, you're having this intimate conversation with your friend or date or whatever, and then the person paying for the dinner sits at the table. It's going to disrupt how organic that interaction is, too.

So, when it comes to healthcare, healthcare insurance, whether government insurance, Medicare, or Medicaid, you know they have their own agenda and motivations. And they're imposing that on me. Because the relationships between a doctor, a patient, or a healthcare provider and a patient are complex, it is difficult to write technology that will satisfy all three.

And so the number one person most healthcare technologies want to please the insurance company because that is their primary goal. For example, imagine you're a clinic and I came to you and said I have new software and new technology that will replace all of your billing, but it's an electronic health record, and it will actually streamline the patient experience. They'll streamline the healthcare worker experience, but your Medicare reimbursements will go down 5% because we don't cater to Medicare as much as the software you're currently using, no matter how much better it would be for your patients or your staff, you would never agree to that, because what is that?

What's the main thing you're concerned about if you're in the healthcare business? How do we maximize reimbursement? And so, if the focus software can't have more than one main focus, I mean, it can, but the main focus is maximizing reimbursement, which may come at the cost of adding friction between the doctor and patient.

Very well said, and for those who don't know, I used to work for large insurance companies. A couple of them were national carriers and ran teams and parts of the organization, and I'm familiar with the other side of that. Station around erecting a barrier around your own software in order to not only maximize revenue. But also put a fortress up against the other insurance carriers so that it's very difficult for a customer, and typically a customer in this sense is a business. Right, we buy healthcare in the majority through our businesses, for our employees and so insurance companies internally look at it and say well gosh, we don't want the other insurance company to get this client. We better insulate ourselves with our own technology that doesn't talk to another competitor so that it creates an imbalance in the market and you're unable or it's just very difficult to move your business from one carrier to the other.

Right, well, and I think that's why we eventually decided that we had to write our own software. We couldn't take anything off the rack. It was so clear, and what you just described is so clear to us. Yes, I mean that literally, can you picture yourself saying OK, fine? We're not going to buy anything off the rack. You know, if you want to buy a nice suit, you're just going to buy the cloth and sew it up and make your own suits or dresses or whatever.

So yeah, that's exactly where you hit the nail on the head. That became clear when we investigated and looked at these other systems. They had other focuses than reducing our patients' friction and maximizing quality, which is all we're about. We want no mistakes, minimize mistakes, improve patient quality, and improve the patient experience.  

And this complex situation is difficult for many organizations around the country, certainly here in the United States. And it sounds like the technology has been the catalyst for you to really execute in your local market and so forth.

I understand you are in the great state of Nevada. I learned how to say Nevada, by the way, and it's not Nevada. It's Nevada. It's bad, like bad. If you don't know, and if you say it differently, when you're in Nevada, they'll know you're not from Nevada, so get it right, people. When you're there, you've got to say it. the right way,

So as you think about your own. Expansion and the success of your business Are you going to step foot outside of state lines? Because you are currently within state lines. Is there something you want to do or do have a bigger footprint?

Yeah, so we're doing this in two ways, and obviously, we're trying to scale our technology even more so we can. Expand regionally, but we're about a month or two away from launching E7 nationally, so that is going to be a nationwide service, and we've partnered with other labs, and national labs across the country, so E7 nationals plus. launched it about a month or two ago, and then anyone in the country, if they need certain laboratory testing, certain things that we can offer through our network, they can go anywhere in the country—all 50 states—and access some of our services.

Oh, fantastic! So you're collaborating with on-the-ground organizations and a network format, and then you're eventually expanding your technology to support these facilities?

Yeah, we already are. And then, simultaneously, we're also probably 12 months away from looking at You know, maybe getting some capital to grow regionally outside of Nevada with brick-and-mortar E7 health. So, we're doing both.

Yeah, that gives you a real competitive advantage in the market as you start to expand outside of the great state that you call home, which is terrific to see because I think all of us as consumers of healthcare just want it to be a little easier and a little more efficient so that we can gain access to the things that we need at a reasonable, fair, and appropriate price.

Right, right?  

As you think about the next steps for you personally, is it just the business, or are you working on some other things as well? Sometimes people are writing books that they want to share or anything else that's on their minds for the next few years.

Well, no, I mean talking about I just launched a course that's going to go on Kajabi. If you're familiar with that platform, you know we have an internal course that I've developed on how to answer phone calls. It's a minor part of what we do, but I've done it for 10 years, and, you know, my staff just said, "Hey, why can't you record this as a course for us to meet internally? So, I did it, and then we hired a company to organize it and put it together, and then this company helped me do it. You know we could just put this on for anyone because the information is comparable to landing a 747. To answer the phone for a business, you must have certain skills. Whether you're making sales And you know, anecdotally, through our business, when people go through their training, their conversion rate from booking appointments goes up from as low as 30% to 80% If they follow these rules and courses so that it's called the "high converting call class," I think we're going to be live and on Kajabi in a week or two.

So that was fun to do, but it's also fun because we have the course internally now for my staff, so that was really fun to put together as that's the most recent thing that's coming up.

And is there something that you absolutely love about your job? Because every time I see you, you're glowing. You've got great energy. It feels like you're really sitting on top of the world here. What do you love about your job?

I believe that developing the kind of relationship I've had with my staff and the sense that we're all in this together is an important part of the culture we've created. I mean, we're in the same boat. I never feel alone. I kind of feel like we have this… even if I step away for a few weeks, go to a meeting, or whatever, we've gotten to the point where, you know, we generally don't miss a beat.

And when you've grown your company to the point where you have amazing employees who are also owners, as well as a lot of talent, and lots of dedicated people. So, at this point, this becomes the fun part of running the organization. You know all the hard work is a little bit behind you. There are still challenges, but the fun part is having these amazing people in your organization.

Yeah, and I'll tell you from my perspective, every great CEO talks about the culture and the people. And recognizes that people drive the business, and that how you treat those people, as well as how you organize culture, policies, and procedures, matters. As you stated, the actions you take to support them are the most important thing we can do as leaders. Because if you can do that, you build trust, and once you build trust, you can build a fabulous organization.  

Right now, I think you're well set; you have to take care of everyone in your organization. You must genuinely care about their happiness, which is critical in many ways because the CEO's primary responsibility is to improve the lives of the people in the organization. That’s really your number-one job.

It was beautifully articulated there, and I know that people are listening to this and thinking, "How do I get in touch with Doctor Bakhtari?" How do I get to know this guy a little bit? How do I find out more about E7's health and when it's coming to my community. Or maybe I want to go and figure out how to find his course. What's the best? A way for folks to get in touch with you and get to get to know you a little bit.

Yeah, bacterium, these are websites, so at Jonathanbaktarimd.com there are, you know, all my past podcasts, but even on other podcasts, I have my own podcast. You can also go to YouTube. Just put in Bakhtari MD. And you can subscribe to our podcast. You can find me on LinkedIn, so I stay with LinkedIn and bacteriamd.com. Those are pretty quick ways to get a hold of us, and I'm more than happy to interact with any questions or thoughts people have.

We've covered a lot today, and I want to thank you for your time and your energy. Thank you for the work that you do. You do it with steadfast accuracy, and it seems to be very consistent in the way you're approaching the market and sharing the knowledge that they have, so thank you for doing that. You are lifting all of us up in the market with the way that You approach the business.

Thanks for the kind words, but really, a lot of other people helped me. Thank you for the kind words. It means a lot.

Well said. Always back to people and culture, which is what we preach on this show as well.

And thank you, my friends, for joining the Talent Empowerment podcast. I hope this conversation has lifted you up so you can lift up your teams, your organizations, and your communities. Be people and culture-focused first, and we'll get back to bring people and cultures together. Thanks, everybody.