00:00:00 Dr. Keith Matheny, an ENT specialist with a focus on rhinology and the leader of Colin County ENT in Frisco, Texas, shares insights into his busy practice and entrepreneurial ventures. During the holiday season, they experience a significant increase in patients, seeing up to 15-18% more in December compared to January. This is due to people reaching their annual deductibles and delaying treatments until the end of the year. The lull in business occurs in February for specialties like ENT, and there's a slight uptick in March due to spring break. The practice is traditionally quieter in September when national meetings are held, but picks up again in October, November, and December. Dr. Matheny's practice has evolved over the years, with a shift towards treating more adults, particularly those requiring revision surgery. He has been with Colin County ENT since finishing his training in 2003 and was drawn to otorhinolaryngology (ENT) due to his interest in athletics before medical school.

00:05:00 Dr. Keith Matheny shares his personal story of how his experiences playing football and observing surgeries led him to choose Ear, Nose, and Throat (ENT) as his medical specialty. Growing up, he sustained multiple orthopedic injuries and became close to his team's orthopedic surgeon. Initially, he thought he would focus on shoulder and elbow injuries, but during medical school, he discovered a deep interest in the intricacy of head and neck anatomy. ENT specialists treat a wide range of patients, from premature babies to the elderly, and deal with various conditions that significantly impact quality of life, such as head and neck cancer and obstructive sleep apnea. Dr. Matheny is proud of his decision to pursue ENT, as it offers a variety of cases, focuses on improving patients' lives, and involves working with pleasant and interesting people. Additionally, he discusses his work with the Dallas Cowboys organization, which extends beyond the 53-man roster and practice squad.

00:10:00 The conversation turns to the topic of football and the potential health risks associated with the sport. Dr. Matheny shares his personal connection to the Dallas Cowboys organization and how he has worked with them for years, meeting many people within the team. He also mentions his cousin's experience as an athletic trainer for the Iowa State football team and the Cowboys. The discussion then shifts to the concerns surrounding concussions and chronic traumatic encephalopathy (CTE) in football. Dr. Matheny expresses his enjoyment of the sport but acknowledges the dangers, particularly the long-term effects of small traumas to the brain. He reflects on the pressure for boys in Texas to play football and shares his thoughts on whether he would have let his son play if he had one. The conversation also touches on the advancements in helmet technology and the debate surrounding its effectiveness in protecting players from brain injuries.

00:15:00 In this section of the "ENT Insights & Medical Entrepreneurship with Dr. Keith Matheny" podcast, Dr. Matheny discusses the challenges of brain injuries and the importance of financial preparation for physicians. He also highlights the differences between private practice in ENT and other specialties, explaining how the advancement of technology has led to minimally invasive procedures in offices, resulting in lower costs for patients and insurance companies. However, ENT specialists now have to bear the expense of purchasing high-cost disposable supplies and capital equipment necessary to perform these procedures, amounting to roughly $300,000 to $400,000 per doctor annually. The Physicians Financial Summit in Chicago in 2024 aims to provide attendees with a comprehensive playbook to ensure a prosperous retirement, simplifying the complexities of financial planning.

00:20:00 Dr. Matheny discusses the high cost of practicing ENT medicine. He mentions how expensive equipment, such as CT scanners, have become standard in the field, leading to significant expenses beyond payroll and medical malpractice insurance. He compares the cost of practicing ENT to that of oral surgery and notes that the transition to performing procedures in an office setting, rather than in a hospital, has made it much more expensive to practice. Dr. Matheny shares that he did not foresee this trend while in medical school or residency and expresses that the business side of private practice is not adequately taught in medical education.

00:25:00 The guest discusses the financial and business challenges that physicians face upon graduation. He explains that doctors often have unrealistic expectations about their income and spending, leading to financial instability despite earning significant salaries. The lack of business education during medical training compounds the issue, as doctors are suddenly managing multi-million dollar practices without the necessary skills. The guest suggests integrating business education into medical training at various levels to help physicians make informed decisions and run their practices effectively. He shares his own experience of wishing he had learned business skills earlier in his career.

00:30:00 Dr. Keith Matheny explains the importance of business education for medical professionals, particularly for residents. He laments the lack of such education in medical programs and the consequences it has on struggling medical practices. Matheny shares his experience with inefficient practices and the role of office managers, many of whom may have a high school education or less, in running these businesses. He emphasizes the need for physicians to have a good understanding of business operations to maintain their independence and autonomy in patient care. Matheny also touches on the self-inflicted challenges some practices face and the impact of external factors such as legislation and regulations on private practices. He expresses frustration with politicians passing legislation that doesn't improve patient care but wastes their time.

00:35:00 Dr. Keith Matheny shares his experiences with insurance companies and their use of AI to deny medical procedures. He describes a patient who had multiple sinus infections and needed a follow-up CT scan for surgical planning, but was denied by the insurance company. Dr. Matheny had to write a lengthy letter to argue for the patient's care and even faced denials from non-physicians. He also mentions that United Healthcare is notorious for denying procedures that don't require prior authorization, leading to unnecessary delays and denials. Dr. Matheny expresses frustration with the discrepancy in bonuses between insurance company leaders and physicians, and calls out the denial of care as a way to avoid payment. He also touches on the DEA becoming a problem due to increased scrutiny following a popular documentary.

00:40:00 Dr. Keith Matheny discusses the challenges he faces as a physician due to the opioid crisis and the resulting regulations. He explains how he spends significant time managing prescriptions and dealing with pharmacists, taking away from patient care. The pharmacy lobby in Texas is particularly powerful, leading to refusals to fill narcotics for pediatric patients. Additionally, changes in abortion laws have caused further issues. These administrative tasks take up to four hours a day and are a major reason why many physicians are leaving the profession earlier than planned. The joy of patient care is being overshadowed by these non-patient facing activities.

00:45:00 In this section of the podcast episode "ENT Insights & Medical Entrepreneurship with Dr. Keith Matheny," Dr. Matheny discusses the business side of ENT practice and the genesis of US ENT Partners. He explains that as ENT has become increasingly expensive to practice, he saw an opportunity to create cost efficiency in the industry. When he joined his practice, it was located in a dying hospital and was losing physicians due to infighting and poor customer service. The practice had several ancillary retail opportunities, such as hearing aid sales and allergy shots, but they were not profitable. Dr. Matheny attributes this to a lack of understanding on how to implement mid-level provider services, which was a new concept at the time. He then went on to create US ENT Partners, a company that has since grown to include 2600 physicians and 45 entities, focusing on creating more cost-efficient inventory in the ENT space. The company has been successful due to the significant retail opportunities in ENT and the economically impactful diseases it addresses, such as sinus and allergies, obstructive sleep apnea, and head to toe morbidity and mortality.

00:50:00 Dr. Keith Matheny discusses the evolution of his ENT practice and the formation of US Cent Partners, a group purchasing organization (GPO) for ENT practices. For the first few years of his practice, Dr. Matheny made improvements and transformed the business, making it busier due to improved infrastructure. As a result, other ENT practices in the Dallas-Fort Worth area sought his help, leading to the creation of a consulting company. During this transition, Dr. Matheny recognized the need for cost savings, inventory management, and other efficiencies, which led to the idea of forming an ENT-specific GPO. US Cent Partners now has thousands of members and helps practices save double-digits across the clinic, allowing them to reinvest in their businesses and hire more staff. The organization has expanded to include ancillary specialties like allergists, sleep physicians, and plastic surgeons. The relationship between US Cent Partners and suppliers is mutually beneficial, as the GPO provides new business opportunities and the suppliers offer discounts. The analogy of US Cent Partners being like Costco for ENT practices highlights the efficient business model that benefits both parties.

00:55:00 In this section, the guest discusses the business model of Costco and how they maintain strong relationships with their suppliers. Dr. Matheny believes that US ENT, a company he is involved with, is following a similar approach by offering additional services to their existing customer base, which has led to a profitable and growing business. He also mentions that other companies in the ENT space share the same customer base, allowing them to bring new technologies and ideas to their customers. The conversation then shifts to discussing Dr. Matheny's other businesses, with plans for a follow-up discussion on the podcast.