RX_Mary OConnor: Audio automatically transcribed by Sonix

RX_Mary OConnor: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hello everybody, and welcome back to Entrepreneurs Rx, sponsored by Accelerate Ventures. I am really excited today to have Mary O'Connor on this. Mary O'connor is the co-founder and chief medical officer of the Vori Health, it's a physician-led, virtual musculoskeletal company on a mission to empower all humanity to lead a healthier life. Mary, welcome!

Mary O'Connor:
Thank you so much, John, delighted to be with you.

John Shufeldt:
Thank you, okay, as I mentioned a minute ago, you have a really cool background. So can you just tell people, it might, definitely want to hear about your rowing career, because I thought that was totally, totally badass because it's one sport I've never done and I sucked it all of them. But, but just go, go back through the whole college and medical school thing and let us know kind of how you started on this venture.

Mary O'Connor:
Oh, well, now I'm going to, I don't want to bore people, John, and I don't really like to promote myself, but I'll give you the highlights. I'm very focused in terms of themes in my life, it's transforming healthcare to provide better care to patients, that's like an overriding theme. And the second is the theme focused on health equity and addressing discrimination and injustice and unfair things. And my personal experience with that started when I was a freshman at Yale. I started rowing and that was back when Title Nine was really young. And there I am at Yale, coming from a strictly middle-class background. I mean, both of my parents worked all the years I was growing up to support six children. I went on massive student loans, you know, I'm just this like really middle-class kid that worked her butt off to get good grades, and I get into this great school and so I go there and I say, oh, growing, I want to try this, to discover that we had no locker room, no facilities at the boathouse. So basically we would go out to the boathouse, which was a 30-minute bus ride from campus, have our practice, and then we'd wait on the bus, cold and wet and shivering while the guys all got cleaned up and put their warm, dry clothes on and go back to campus for dinner. So people on our team, women were getting sick, we had some very high-performance athletes that had been on the national team and were training for the 1976 Olympics, and the short story is we went into the athletic director's office to protest the lack of facilities at the boathouse. Now, this was after other conversations about, come on, like we don't have any facilities, this isn't right. And we stripped and we had Title Nine written across our bare chests and backs, and our captain read a statement that started with these are the bodies that Yale is exploiting. So we had a stringer from the Yale Daily News with us, and that was written up then in the Yale Daily News, which was picked up by the New York Times because ..., all those New York pep Yalies want to know what's happening on the home front. And then it was picked up by the International Herald Tribune, and then, you know what happened. The university was very embarrassed, and all of a sudden we had an addition to the boathouse the following spring with facilities for the women. So that was my first personal experience at unfair treatment, basically. And there I am, this young kid at a place where, like how does that make sense? And I realized that if we didn't have our voices heard, what did that say about us? I mean, whether we were successful or not with the protests, which fortunately we were, there was an issue of us standing up and saying, this isn't right. So that really got me started on my journey with health equity, combined with my years of clinical experience taking care of women that really were not well cared for in the health system, typically by my male orthopedic surgery colleagues that I don't actually think consciously we're trying to not give them good care. But the reality was, is that there's a lot of disparities for women, individuals of color, and that these individuals, in particular, don't always feel that their voice is heard and they're not listened to. So those are the two big themes of my life. I spent the majority of my career at Mayo Clinic, lots of leadership roles there, love Mayo, retired from Mayo in 2015 when I was recruited to Yale to create a musculoskeletal center, and I did that for a while and recognize the massive challenges with trying to make transformative change in healthcare systems. Which led me to the opportunity to co-found Vori Health with a spine neurosurgeon because we really appreciated that the kind of changes that we need are going to be very difficult to bring about in the established system. They're not bad people that are running our healthcare system, but they're very trapped in a totally messed up financial model in which their entire margin is generated by surgeries, procedures, and advanced imaging, and we know those services are very over-utilized, and that hurts patients and costs us a lot of money, which the country can't afford and patients can't afford. You know, medical bankruptcy is really significant.

John Shufeldt:
Yeah, amazing. Okay, so Yale undergrad, you did your whole history. You're just like, there is your whole history of, like, one long sentence. So I got to back up a little bit because I wanna ask about rowing too. Did you row before you got to Yale or just walk into this looks cool, I want to do it.

Mary O'Connor:
So, John, I'm old enough that when I was in high school, there were no sports for girls in my high school. So I went to Yale and basically walked on and you can't do that now. Like, that doesn't happen now in college rowing, first because there's a lot of high school rowing. And so kids are recruited now to college teams. But at that time, basically, I walked on and you work hard, you apply yourself, you're focused, most of the time you can be successful. And I was very blessed that I had great role models, women that were very successful in the sport. And when you, when you're in that environment and you're working out side by side with women that were on the 1975 national team that won a silver medal at the World Championship, and you say, hey, you know, I can hang with them, I can do that. Then you start to see the ability for yourself to do that, which is another reason why diversity in orthopedics, because I'm a minority in my field and have been, I've been like a ceiling breaker for my, you know, a glass ceiling breaker my entire professional career. It's really important that young people can see individuals that look like them to know that they can do it. And that cuts across all professions for sports, for business, for whatever.

John Shufeldt:
Yeah, I couldn't agree more. So you walked on at Yale. Now, did you row in the, did you and I and row after Yale too, right? Did you go out.

Mary O'Connor:
I did, I was, I stroked our varsity eight when I was a senior, we were national champions. We were, we were a very good team throughout my collegiate career. Again, we had these two just kick-ass women that were elite rowers that, that helped us see our potential and realize our potential. And then I stroke the United States Women's Eight to a bronze medal at the World Championships. And then I was on the 1980 team, the Olympic team, and that, of course, was the team that didn't compete because of the boycott.

John Shufeldt:
Wow. That is, that alone is amazing, that's very cool. All right. So Yale undergrad, then medical school at Drexel.

Mary O'Connor:
At Drexel.

John Shufeldt:
All right. So when did you decide? So you and I are in the same era. I think you're a year ahead of me in college. So we're, we've, I was just saying we've treaded the same path, but I'm quite sure we have not tread the same path because what you said a few minutes ago about women orthopedic surgeons could not be more true. I was our class president and I knew everybody in our class, there was not one woman in our class went to orthopedic surgery, when did you decide to go into orthopedic surgery? Because that, that alone for folks who are younger, was literally unheard of in our era.

Mary O'Connor:
Well, you know, I've always been the kind of person that likes that gets a lot of satisfaction out of accomplishing things and doing things. And so I definitely have a more, in some ways, a more surgical mindset, like you make the plan, you execute on the plan, you win the race, you do a great surgery, the patient is so much better, that's the victory. And I was drawn to orthopedics, not so much from my athletic background, but because you can take care of all kinds of people, you know, women, men, younger people, older people, and that there's so much innovation in the field. And, and so it's a very dynamic field. I thought about OB-GYN and I liked OB-GYN, but then I said, well, how much is that really going to change? And I didn't feel that my creative side would be as engaged in OB-GYN as it could be in orthopedics. And then I was fortunate, you know, that I got into a great orthopedic program, I trained at Mayo and that was a pivotal event for me.

John Shufeldt:
Were there any other women residents in orthopedics at the time?

Mary O'Connor:
There was one other woman who was a couple of years ahead of me and then I had a classmate in my year. So we were still a very small percentage because it was a large program. We had 12 residents a year at the time.

John Shufeldt:
Wow.

Mary O'Connor:
So.

John Shufeldt:
And that must have been at Rochester, obviously.

Mary O'Connor:
That was Rochester.

John Shufeldt:
Very, yeah, okay. So, so after that, you stay, you're inculcated in the Mayo system, which I've never worked for the Mayo system, I worked a little with their medical school now. And God knows Mayo probably wouldn't let me in the Mayo system, but you're inculcated in that system and then you stayed on for a number of years, was it, did you do your 20?

Mary O'Connor:
I did, I did. So I was then asked to join the staff at Mayo, Florida. So I finished my residency and fellowship and then I went down to Mayo Florida and that's where I worked for, until 2015 for a long time. Love Mayo, love the vision, the values, had lots of leadership roles there, and then had the opportunity to go and try this other gig at Yale. So I went back to New Haven.

John Shufeldt:
And what was your fellowship in?

Mary O'Connor:
Orthopedic oncology. So my clinical practice was tumor surgery and I did a lot of joint replacements. So those are my two clinical areas.

John Shufeldt:
No kidding. I didn't know there was a surgical oncology in orthopedics, so that's very cool.

Mary O'Connor:
Sure, I will say that two landmark publications on Pelvic Salvage and Shoulder Lymph Salvage first-authored by yours truly. So.

John Shufeldt:
Very cool.

Mary O'Connor:
I was mentored, one of my primary mentor is in a legendary surgeon who just retired at Roch, in Mayo Rochester named Franklin Simm, and he is just internationally known. He was Dr. Limb Salvage and I was just very fortunate to have such strong mentors and sponsors there, and it wasn't just Dr. Simm. There's many other Rochester consultants in the Mayo lingo, the attending is the consultant that were very supportive of me. And as you know, like none of us get to where we are without others believing in us and helping us.

John Shufeldt:
Yeah, so true. All right, let's switch now because you've made, the thing I've, that I've always struggled with Mayo is if you're in Mayo, you're in Mayo, there is no going outside of Mayo to do anything. I've had a number of friends there over the years who I said, hey, wouldn't it be cool? Let's do this and say, well, I really can't because you know, I'm in the Mayo. And so it's hard to be, I would think, entrepreneurial in Mayo, but that switch seemed to flip in you. Was it when you went back to Yale or was it after the stint at Yale again?

Mary O'Connor:
Yeah, well, I had a lot of opportunity to innovate in my role as chair of orthopedic surgery at Mayo, Florida. And one of the things that I did was I realized that I use the term surgical yield of my partners was highly variable. And like some of my partners would see these huge numbers of patients to generate their surgical practice. Like one of my partners, his yield and I defined yield as here's how many new patients you saw last year compared to how many surgeries you did was 15%. And my, my number was 40%, I had a very mature referral practice because I took care of all the bone and soft tissue tumor stuff, so I had a lot of referrals that resulted in surgery, right? But I said, well, this just seems crazy, like we're doing all this non-surgical work and maybe there's a better path. So the short story is I went to the powers that be and proposed a pilot. I love pilots, right? You always want to propose a pilot because it's less threatening. And I basically said, look, we're doing all this non-surgical work and orthopedics, so we could either ask some other folks, departments that do musculoskeletal to see more patients and unload us so that we can, I can get my surgeons to the OR more or let me pilot bringing in non-operative MSK specialists into the department. So easier to give me the pilot than to go have others crank it up, right? So the short story is I hired one non-surgeon physician and I hired a second and we were able then to get surgeons into the OR one more day every other week. So basically a 20% increase in my surgeon capacity without hiring any more surgeons and increased our contribution margin from my department to Mayo Florida by 19%, and we actually published on that. So it was like, wow, okay, this makes sense. I've got these great non-surgeon docs working alongside the surgeons, right? And we would obviously see patients for them promptly if they needed help or support or if it was appropriate that the patient really see the surgeon, etc. They said this model makes sense. It got to the point where the Mayo, some of the Mayo internists would request an ortho consult only with one of those two non-surgeons. They're like, I don't want my patient to see one of Mary's surgeons. I want them to see one of these non-operative docs in her department, okay? They were that, they were good and it just makes sense. So I realized that changing this model of how we're going to deliver musculoskeletal care made sense from a patient perspective and from a value perspective, right? Get the surgeons doing more surgeon work and allow the non-surgical care to be delivered by people that absolutely know what they're doing, but they don't have to be surgeons. So when I went to Yale, that was basically the model to build out that and in fact make it even more robust, right? Which I've done at Vori Health in our virtual model. So the concept is that primary care docs, many of them aren't that comfortable with musculoskeletal because they're not, they didn't receive that much training in medical school and they're so busy managing all these other conditions for the patient that they just can't focus on it, so what do they do? They send the patient to the surgeon, and when the patient sees the orthopedic surgeon or spine surgeon, then what happens? They get imaging and then it's more likely that they're going to get an operation. And I don't say that to be critical of my surgeon colleagues, I say because that's how we're trained and we have a bias where we're going to present to a patient options that we can do. And we know, we know from data out there on patients being sent to spine centers of excellence that once a patient is referred there, that 50% of the time they're told, no, you shouldn't have surgery, you're not a surgical candidate or you haven't had adequate non-surgical care or you shouldn't have it at all. But those patients were all told by someone at home that they should have an operation. So, again, I'm not trying to come across as too critical, but what I'm trying to point out is that we see the world through the lens of our experience in our training and creating a team that, that first focuses the patient on expert non-surgical care. And then if they're not improving, some patients are still going to need surgery and that's good, right? Identify the ones that really need it, then medically optimize them before surgery, which is also something we do at Vori, based on a program I started when I was at Yale that I was able to use my creative energies there for that and then let's get them to a great surgeon. Will lower costs, will improve outcomes, it's all good. I mean, this is the kind of stuff that we need to do to make healthcare better.

John Shufeldt:
Yeah, you've definitely now that I, I had friends who have failed backs and you wonder if they even ever needed their initial surgery. And again, I'm not second-guessing, but I wasn't there. But now they're on their fourth surgery and they're in constant pain. And you go back to the root cause of it and you're like, you send them to a surgeon, you're probably going get operated on, and I work at a place that has its barrows and as you know, you can't spit without hitting a neurosurgeon. But I have to say to their credit, they're not trying to operate on people, they're actually seem like they're trying not to operate on people. But I do get the lens of if all you have is a hammer, all the world's a nail for a lot of folks.

Mary O'Connor:
Let's take that scenario for a moment, right? So those neurosurgeons, those spine neurosurgeons, if they're doing this non-surgical care, how are they working at the top of their skill set, right? That just doesn't make sense. And we should pay surgeons a lot of money because they're very skilled and they do stressful work and it's a hard job, okay? But then let's try and create the systems that really support them working more at the top of their skill set.

John Shufeldt:
Yeah, I know. That's, I mean, that's brilliant. Is that was that the rationale or the concept behind Vori health?

Mary O'Connor:
Yes.

John Shufeldt:
Walk me through that.

Mary O'Connor:
So basically, Ryan Grant, who's my co-founder, is a spine neurosurgeon and we overlapped at Yale. My first year there was his last year, then he went on to Geisinger and Ryan has created other companies and has a lot of business experience. So he called me up basically kind of the beginning of the pandemic and said, hey, how are you doing? I'm thinking about starting this new company, let's, what do you think? And I said, okay, let's talk. And I realized that while I had made progress at Yale, there was also a lot of challenges there with people continuing to believe in this model of non-surgical care first, again, because this is my opinion, right? Health systems need surgical volume, advanced imaging volume, and procedure volume to make their margin. And I have a lot of empathy for safety-net hospitals because they provide care to everyone that no one else will provide care to. And university physicians, you know, we saw, I was Yale faculty, we saw everyone, regardless of insurance status, which was not the case for all the rest of the surgeons and physicians in the community, so it's a big challenge and it's interesting. So I'll tell you the story that your listeners might find noteworthy. So our seed investor, our lead investor in our seed round, basically interviewing me to be a co-founder and the chief medical oqfficer and I shared with him the statement. And I, John, I don't even know why I really said it, but I said, you know, I feel, maybe it's my Catholicism coming through. I said, you know, I feel a little bit of guilt about what we're going to do at Vori Health because it's going to disadvantage my partners here at Yale, like the faculty that take care of all of the underserved. And I said, because we're going to, you know, we'll take work away from them. We'll take work away from everybody, basically. But, you know, and let them, I mean, the idea is let us do this non-surgical work and then give you the patients that need surgery. So his comment was, isn't that what you're working on at Yale? I said, yeah. He said, well, how'd they embrace that in the long run? And I said, that's a really good point. He said, Mary, systems are not going to change until they're forced to change and they won't be forced to change until there's a financial impact to them. And I said, that's exactly right. It's unfortunate, but it's true. Again, they're not bad people running the system, they're just trapped in this totally messed up financial model that we have as a healthcare system in this country today.

John Shufeldt:
Yeah, it's it's funny, I, I started urgent cares in early nineties and got criticized by my emergency medicine colleagues about taking food off their plate. And then I started virtual medicine in 2010 and got criticized by urgent care colleagues for taking food off their plate. So I've walked that path, but that's what change and innovation is. And hopefully it's for the ultimate greater good, which clearly is what you're doing. So how does Vori work? So I'm a patient. Is it an employer? Sign up? Is it you guys direct to consumer or is it business, a B2B?

Mary O'Connor:
All of the above. So patients can come to us direct, direct from consumer. They can go to our website and sign up for an appointment. We have contracts with large primary care groups, insurers, other payers, so there's various avenues to get in. But patients can just self refer if they want. And I like to describe us as the virtual first option and in our philosophy is that we really want to look at that person as a whole patient and understand all of the different levers that we can pull that are going to help them get better. So classic example is someone with back pain. So in the normal world, right, they'd go see this PCP, they get referred to the spine surgeon, maybe they get, they're going to certainly get an X-ray, maybe they get an MRI, then they get referred to physical therapy. All right, that's up, that's good. But what that patient also needs is weight reduction, an anti-inflammatory diet, better sleep, because we know that people, if they improve their sleep, it helps their back pain, right? They may need stress reduction. And so if we surround that patient with a care team that consists of that physician, nurse practitioner, physical therapist and health coach, and we pull in registered dietitian if needed, right? We create an integrated care plan for that patient that focuses on what matters to them as opposed to what's the matter with you, with goals and tasks that could include something as simple as ok, your task for the next two weeks, you're going to try and sleep 6 hours a night. Things like that, and then make the change small so that we're working on the behaviour change that's going to support improving their MSK condition, as well as all the other things. And it's so important because we traditionally have not pulled in those tools to bring them into the space of that individual patient to say, if we do all these things, you know what? Chances are really high you're going to improve and maybe you won't need surgery or maybe you will. But if you need surgery, you're going to be in better shape, and and we're going to optimize you. We have a whole pre-op optimization program. I started that work when I was at Yale, we had a couple nurses, we piloted it, it's all basic, it's all basic stuff, John, that PCPs can do but don't have time to do, and the surgeons don't have time to do it. And, you know, we look at anaemia and malnutrition because even obese people are often malnourished. 18% of people having surgery have some degree of malnutrition. That's like crazy, like crazy. Vitamin D levels, screen them for sleep apnea, you know, do pain catastrophizing evaluations because, you know, if they're a pain catastrophizer, their chances of having a great outcome after that surgery are markedly diminished. So why are we not identifying them pre-op and getting them support? It's not that they don't need the surgery or benefit from the surgery, but like let's address this up front. So I did that program at Yale, we published on it, we drove down length of stay, lower ED visits, post-op low readmissions, I mean, it just makes so much sense.

John Shufeldt:
That it's so funny how many people I see in the emergency department with back pain and they're obese and they're, they're slumped over and, you know, their core is like totally devoid of strength. And I'll have these discussions with them very gently, because I'm in the emergency department and I try to be very gentle with patients, and they look at me like, dude, I mean, I just call the surgeon, I just want to be fixed. And it's so funny how many people, I've got a relative who was a young, healthy kid with back pain, he got surgery at 21 years old and, and like there are so many options because the athletic and there's so many options you have without going on because, yeah, but I don't have time to do them, I just want to be fixed. You know, I had a disc bulge and a, and a little bit of a nerve root impingement, and maybe that's what I needed, I'm not a spine surgeon. It just seemed like that was a race to the operating room and seemed a little like no .... dose pack, no for strength, all the things you just described, zero.

Mary O'Connor:
So if that young man, right, if someone had sat down and said, here's the data, 7.6% of lumbar spine surgery patients return to the OR for a second operation within the first year, Holy Toledo! I mean, like that is nuts, that is absolutely craziness. 7.6% coming back to the OR for second operation within the first year. Like we have to do better, which is, so like, taking the, it takes more time to talk a patient out of surgery a lot of times, as you know, than it does to get them to say yes.

John Shufeldt:
... It's crazy.

Mary O'Connor:
Yeah, it is crazy. But that's where you have to give them the support that they can see that pursuing a non-operative path has a potential to work, okay? If you don't give them support and buy support I mean a health coach, nurse practitioner, somebody who's connected with them, who's chatting with them two or three times a week with text where they're doing their, their physical therapy virtually where, you know, we'll have our sensorless motion tracking technology out in the next couple of months. And I'm really excited about that because we're going to be able to know if the patients are doing their exercises at home.

John Shufeldt:
Right. Tell us about your book real quick.

Mary O'Connor:
Oh, my book! Oh, how kind of you to ask. So my book is called Taking Care of You, The Empowered Woman's Guide to Better Health. And I started this project basically at the beginning of the pandemic. There's a medical anthropologist I met at Yale, and I just really hit it off with her. And I said, you know, we should write a book, I've been, this is like been this idea I've had, mostly from my experience of women not knowing the right questions to ask when they go in to see their doctor or nurse practitioner, whoever it is. And so so we did it. We got Mayo Clinic Press as our publisher, and the book will come out in late September or early October. And we have 100 women contributors, so the chapters, there's about 50 clinical condition chapters and then some sections about kind of overall health and then a final section about kind of optimizing and wellness, things like that. So yeah, I've never done anything like that before, John, it's fun, it's exciting. And you know, the goal is for this to be a resource for women so that they can be better advocates for their own health. And when they go in to see someone, they're going to be able to ask better questions, right? That's the key. So hopefully it will be so, so it can be on everybody's holiday gift list, right? You can you, can go get the book and gift it to all the important women in your life, you can go find it on Amazon actually, and preordered if you're so inclined.

John Shufeldt:
I will be definitely so inclined and we'll put it in the show notes too. Are you going to do an audible version of it?

Mary O'Connor:
John, I don't, I haven't gotten that far yet. That's probably on the list, but my main goal is, I'm doing the final proofs this weekend and then that's it, it's done. After that it goes to the printer and it is, it'll be, it'll be printed.

John Shufeldt:
Congratulations. That's very cool.

Mary O'Connor:
I want to emphasize one other thing in the book. So we also, all the clinical chapters are focused in a structured way. You know, what's the condition, what causes it, how is it treated? Why does it impact women differently than men? It is amazing how much stuff is different for women than men. And, you know, we, we went out, it's, this book isn't just about like orthopedics, right? It covers the broad, broad spectrum of medical conditions, wxcept we didn't include, like pregnancy, because there's a lot of books out there for women on pregnancy and reproductive health. So I really hope that it will be a great resource for all women to empower them to better health.

John Shufeldt:
Well, yeah, will definitely include it in our show notes and I'll recommend it to people. This discussion's been fantastic. Where can people learn more about you? How can they get ahold of you?

Mary O'Connor:
Well, they could always email me. Mary.OConnor O C O N N O R at VoriHealth, V is in victory O R I health.com and I'm on LinkedIn, I'm pretty active on LinkedIn. If somebody has is also on LinkedIn and then pick up the book.

John Shufeldt:
Mary, it's been great to have you on. Thank you for this. Really appreciate it. I think people will be inspired, I know I am.

Mary O'Connor:
Oh, you're very kind, John. We were just, just doing what I can to try and make the world better and make healthcare better, and in particular, address health equity and just make things better.

John Shufeldt:
Well, it's currently working. Thank you and thank you all, it's another episode of Entrepreneur Rx. Have a great rest of the week. I'll be back soon.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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