00:00:00 Dr. Brian Gantwerker, a board-certified neurosurgeon specializing in brain tumors, degenerative diseases, and spinal cord injuries, shares his experiences moving from Chicago to Cleveland, Ohio, and then to Phoenix, Arizona. He reminisces about the Midwestern representation in Phoenix and the upcoming expansion of the Big 10 conference, which includes teams from the Pac-12 conference. Dr. Gantwerker, who is a fan of Illinois and Northwestern football, expresses his excitement about being able to follow college football games from the West Coast, even if it means waking up early or streaming the games on his phone.

00:05:00 In this section of the podcast episode, Dr. Brian Gantwerker shares his experiences of living on the West Coast and the East Coast, specifically regarding time zones and lifestyle differences. He recalls feeling disoriented when watching the Super Bowl during his brief stay in Arizona, as it was in the middle of the day and he was used to the East Coast's schedule. The doctor also mentions the impact of time zones on financial markets and how physicians, in particular, need to be up early to manage their accounts. Despite the advantages of the West Coast's weather and outdoor lifestyle, Dr. Gantwerker notes the high cost of living and competitive real estate market, making it a challenging adjustment for some.

00:10:00 Dr. Brian Gantwerker shares his personal experience of moving from Ohio to Los Angeles to start his neurosurgery practice. He discusses the challenges of living in a competitive metropolitan market like Los Angeles, where the cost of living is high and the job market is competitive. Dr. Gantwerker talks about how he and his wife made the decision to stay in Los Angeles despite the challenges, as they had family there and wanted to raise their children in a multigenerational environment. He emphasizes the importance of having a good foundation and being stubborn in order to live where one wants to and shares how starting his own practice with his wife was a priority for them.

00:15:00 Dr. Brian Gantwerker shares how he started a business around the same time as having a family. He recounts the challenging period when they faced office issues and had to train new employees while his wife was going into labor. This confluence of events led to a stressful and chaotic situation, but they were fortunate to have dedicated employees who have stayed with them for years. Dr. Gantwerker emphasizes the importance of treating employees with dignity and respect, especially during difficult times like the COVID-19 pandemic. He took a pay cut to keep everyone employed and learned the importance of identifying critical staff members and maintaining their morale. He concludes by emphasizing that focusing on employee happiness and cultivating a positive work atmosphere is more important than squeezing in extra work or patients for a little more money. This approach leads to better patient care and higher employee satisfaction.

00:20:00 Dr. Brian Gantwerker discusses the importance of retaining staff for a successful and welcoming medical practice. He emphasizes the value of institutional memory and the positive impact it has on patients. Dr. Gantwerker also shares his experience of working with his wife in their practice and the importance of maintaining a work-life balance. He highlights the need for mutual respect and trust, as well as the significance of separating work and home life. Despite disagreements and challenges, the couple learned to create a boundary between their professional and personal lives to ensure a healthy balance.

00:25:00 Dr. Brian Gantwerker explains the importance of work-life balance for doctors and the role of their spouses in their professional and personal lives. He emphasizes the need for doctors to understand that they are not designed to operate at a high performance level all the time, and encourages them to allow their spouses to have space and time for their work. Dr. Gantwerker shares his experience of working with his spouse and credits her with many of their business successes. He also highlights the importance of respecting each other's space and understanding each other's perspectives, especially when it comes to financial matters. The couple commits to open communication and due diligence when making financial decisions together. Dr. Gantwerker emphasizes the importance of not bringing work stress home and avoiding the potential causes of divorce, such as financial issues. He concludes by comparing the relationship between spouses to a dance, requiring a back-and-forth interaction and understanding of each other's risk tolerances.

00:30:00 Dr. Brian Gantwerker shares insights on work-life balance, using the analogy of dancing with a partner. He emphasizes the importance of respecting each other's perspectives and roles in decision-making, especially when it comes to finances and business. Dr. Gantwerker and his partner have different approaches – he is more of a dreamer, while she is more pragmatic – but they have learned to find balance and become their own advisers. They have faced challenges and have had to become flexible and adaptable to succeed together. The conversation also touches on the inefficiencies of working too hard without focusing on the balance between income and expenses. Overall, the key takeaway is the importance of finding a balance and being good at "dancing" in both personal and professional relationships.

00:35:00 In this section of the podcast, the guest discusses the importance of growing a private practice efficiently and sustainably, rather than rapidly. He warns against treating a business like a venture capital investment, as doing so could lead to financial instability and potential loss of control. The conversation then shifts to the impact of artificial intelligence (AI) on the medical industry. While AI offers opportunities for improving treatment decisions and streamlining processes, the guest expresses concerns about the lack of guard rails and potential misuse of AI. He emphasizes that AI should be used as a tool, not a primary touchpoint, and that human decision-making remains crucial in healthcare. The guest also raises concerns about the potential for human error in AI algorithms and the need for clear responsibility and accountability when using AI in patient care.

00:40:00 Dr. Brian Gantwerker expresses concerns about the integration of AI in the medical field and its potential impact on responsibility and accountability. He warns against the diffusion of responsibility and the potential for AI to make mistakes, emphasizing the importance of clear guidelines and accountability before implementing AI in healthcare. Dr. Gantwerker also discusses the potential use of AI in administrative tasks, but argues that human expertise is still necessary in care and treatment decisions. He also mentions his work outside of the podcast as the CFO of Grand Vision Capital Group, where they help high income earners turn their income into real wealth through strategic investments.

00:45:00 Dr. Brian Gantwerker discusses the potential impact of AI on healthcare and work-life balance. He raises concerns about the replacement of human doctors with AI, citing examples from radiology and the potential for misdiagnosis. Dr. Gantwerker argues that certain stakeholders, who are most likely to be replaced by AI, are the ones pushing against it. He emphasizes the importance of the human touch in medicine and the need for collaboration between humans and technology. The doctor also warns against offloading decision-making processes to bots or algorithms when it comes to someone's health and safety. He concludes by stating that the corporate side should be kept out of healthcare as much as possible and that the focus should remain on caring for patients in one-on-one settings.

00:50:00 The discussion turns to ethical business practices and the impact of private equity firms in the medical industry. Dr. Gantwerker uses the example of a failed private equity firm in the emergency physicians sector, which is currently under investigation by the Federal Trade Commission for suspected pump and dump schemes. He contrasts this with environmentally responsible investing, emphasizing the importance of free choice and building businesses responsibly. He also shares examples of companies like Patagonia and Costco, which prioritize employee care and long-term benefits. The conversation then shifts to minimally invasive neurosurgery techniques, focusing on the approach to patient care and examples such as microdiscectomy and endoscopic surgery. These techniques aim to get patients back to meaningful life as quickly as possible.

00:55:00 Dr. Brian Gantwerker explains the importance of balancing advanced technology with good judgment in medical procedures, specifically in spine surgery. He emphasizes the need to prioritize patient care and outcomes over the latest technology or techniques. Dr. Gantwerker shares his experiences with encountering questionable hardware and spacers in the spine, urging caution and careful consideration before use. He advocates for a minimally invasive approach when appropriate, but not as a default option, and encourages a case-by-case decision-making process. The conversation also touches on the role of regenerative medicine as an alternative to surgery in certain situations.

01:00:00 In this section of the podcast episode, Dr. Brian Gantwerker discusses the complexities of treating spine injuries, using the examples of athletes Peyton Manning and Tiger Woods. He explains that while the goal is always to cure and mitigate, there's a possibility that surgeries may not work as intended. Dr. Gantwerker emphasizes the importance of being prepared for alternative treatments and negotiations with patients. He also touches on the controversy surrounding non-surgical therapies like regenerative medicine and the need for more clinical trials to determine their effectiveness. Ultimately, the doctor's priority is to provide the best possible service for each patient, considering their unique situation.

01:05:00 Dr. Brian Gantwerker discusses the challenges of making difficult medical decisions for athletes and dealing with their desire to push through pain. He shares an example of treating a football player with severe back pain, where the best course of action was a disc replacement or fusion, but the athlete's size and the pressures of his profession made the decision complex. Dr. Gantwerker also mentions the importance of counseling patients and making sure they understand the potential consequences of ignoring medical advice. He also touches upon the issue of health insurance providers and third-party administrators denying coverage for necessary medical procedures, despite scientific evidence supporting their use.

01:10:00 In this section of the podcast episode, Dr. Brian Gantwerker discusses the challenges he faced with insurance carriers denying coverage for FDA-approved medical treatments by labeling them as experimental. He shares an instance where a specialist was retroactively reviewing cases to deny claims, which is against the law in California. The denial of these treatments creates a significant issue for patients and healthcare providers. The state agencies are overwhelmed and underfunded, making it difficult to hold insurance carriers accountable. Class action lawsuits are the next step, but plaintiffs often struggle to provide impassioned testimony and engage jurors. The industry has people who sell their services to payers and turn against healthcare providers, creating an "Achilles heel" effect. Another challenge is post-payment reviews, where payers determine they will pay for a treatment but review it again before payment, allowing them to get around prior authorization reform. The system is broken, but it is fixable, and payers settle out of court or relent to avoid losing in court. As physicians start their careers and face financial pressures, they may be tempted to prioritize income over ethical practices, leading to an unsustainable system.

01:15:00 Dr. Brian Gantwerker outlines strategies for maintaining a good quality of life while planning for retirement. He recommends investing in a decent house, especially one in a good school district, and being willing to do some work on it oneself to save money. He also advises against outsourcing everything and suggests physicians take responsibility for certain tasks to save money and learn new skills. Dr. Gantwerker also suggests avoiding private schools and refinancing loans periodically, and warns against taking out home equity lines of credit (HELOCs) to finance home improvements. He encourages listeners to delay gratification and invest in hard assets, such as a car with a good resale value, rather than depreciating items like a brand new iPhone. Overall, Dr. Gantwerker emphasizes the importance of being smart about personal finances and avoiding the trap of living like a resident for years after graduation.

01:20:00 Host Nate Crannell talks about the importance of seeking a second opinion for financial planning, just as doctors do for patient treatment. He offers free one-hour consultations every Wednesday to provide a second opinion on financial plans, reevaluating goals, risk tolerance, and tax mitigation strategies to ensure financial confidence and peace of mind. Listeners can schedule an appointment by emailing Nate or by filling out a form on the Doctors & Dollars website.