RX_Michael Hill: Audio automatically transcribed by Sonix

RX_Michael Hill: 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:
Hey everybody and welcome to Entrepreneur Rx, I am, today I'm really delighted to have with me a friend of mine and a co-conspirator in many projects, Dr. Michael Hill. Michael, welcome!

Michael Hill:
John, how you doing? Great to see you this morning.

John Shufeldt:
So you've had a, an interesting background, to say the least.

Michael Hill:
No, I'd say that I'm not particularly smart, but I am a dog with a bone and I'm here by accident. And that's kind of my thing that I think would be on my tombstone, I'm here by accident.

John Shufeldt:
You know, it's funny because I would describe myself that I've fallen through failure, so I totally get that. You know, Michael, I have to say, you're one of the grandfathers of emergency medicine, and I know that sounds like it's a pejorative regarding your age, but you are one of the, I mean, you're one of the early dogs and I'm early and you're earlier.

Michael Hill:
Not by much.

John Shufeldt:
Okay, thanks for that. All right so, so let's start at the beginning, why medical school? Why emergency medicine? How did you get into this gig?

Michael Hill:
Yeah, boy, how much is this? This is like the six-hour video, right? This is Mic series one, and then we'll go from there. Yeah, so the first is I went to my mom, I think when I was like in eighth grade and I told my mom, hey mom, I think I want to be an airline pilot because we knew someone that was, family who's husband, the wife, the husband was an airline pilot has seen like that seemed like fun in terms of flying stuff, so I told her that and she said, oh! I remember she was cooking and she said, Michael, can't you do better than that? Why don't you do something like help people like be a doctor? And I said, okay, that was kind of the initial start, that was the starting point in eighth grade. But then I think the other thing that I think a lot of people in my age group was the show Emergency, which was like the best show ever, people almost dead and then the doctors helped save them, that seemed like a very cool thing. So anyway, when I went to UC Irvine as an undergraduate and when I applied to medical school, this is, I went to medical school, and so they ask the question, why do want go to medical school? And I said, to change healthcare, and they said, how are you going to do that? And I said, I have no idea. And that was, that was the truth, I just knew that like, that would be like a cool thing to do is to change the healthcare system, and so I went to UC Irvine for med school and internship in internal medicine, and then I did my residency at UCLA. Now, at that time, this was in 82, you know, I think there's only probably about 20 programs across the country, but UCLA was recognized as a pretty good one. And I remember Jerry Hoffman, one of my faculty when he was doing the interviewing, he had said, well, we're only hiring future leaders of emergency medicine, and I said confidently with a lot of bluster, well, I'm going to be one of those guys or gals, I guess, I'm going to be one of those guys. So anyway, I luckily I got in there and there's no question UCLA changed my life because, and I think that's one of the things I looked at in terms of my life in general, is I described to someone before is I kind of look at life's like you're an inner tube in Texas during the summer, going down the river with a six-pack of beer attached to the inner tube, and you just kind of there's like bends, bends that in the river and, and then there's, and there's splits in the river and you don't really know which way the river's going to go, but you just kind of follow it. So UCLA was one of my bends in the river because my senior year they asked me to be co-chief resident with another great emergency physician, Steve Thumb, who's a research scientist and has done an amazing job in hyperbaric medicine and a lot of other areas. But it's part of the responsibility, as co-chief resident, is that you had to do the ... Conference each week, which for all of us knows basically where you review all your screw-ups that occur on a weekly basis. And so I had half of them, and the other co-chief resident, another really well-known guy, Doctor Raymond Johnson, president of Ace Up in the future, and I were the two and so I took the responsibility of writing down basically the learned lessons and the learned lessons were basically with hyperkalemia, here's the three things you should do. And with this, because we really didn't have much in terms of textbooks, I think we had Schwartz, Schwartz's textbook from University of ..... Sorry?

John Shufeldt:
Jim Tonelli might have been out?

Michael Hill:
The Tonelli was out too, yeah, but it was, you know, we had, we had the Journal of Emergency Medicine, which was pretty basic. And so anyway, so I started writing those things down, and so at the end of the year we kind of had some things and we had like a list of here's how to approach different things. And so from there, we, the Air Force had put me through medical school and so I owed them for, oh, sorry, in addition to that, Larry Berraf, one of our faculty, pediatric faculty, was helping edit the first Pels book. And so he asked me, do I want to, did I want to? They said, we've got a bunch of people that have written this, but we need someone to kind of edit it because there's a whole bunch of different ways we need to kind of standardize approach, and so I said, okay, I can do that, and so I did that as well. And kind of again, this is the whole idea of creating algorithms. So then I was lucky that I had joined the Air Force because the day before I went in, in that year, there was three of us that were residency trained, Bill Darcy, who, another emergency physician leader and myself. And the night before I started, 60 Minutes did an exposé on Medical Officer of the Day in the military, it was actually on Air Force medical officer of the day. And for those of you don't know what those were, but basically the idea was that everybody that's a physician should spend a night in the ER each month so that they can maintain their, quote-unquote, military experience and readiness, which meant that all of the atypical cases of anything got missed by the psychiatrist, by the pathologist, by the pediatrician, the chief medical officer in the hospital, would all spend a day there, and so it was a really impressive exposé on emergency medicine, medical officers for the day. So on Monday, when I joined the medical director I'm with is the surgeon general representative for emergency medicine, and gets a request from the surgeon generals, we need standards for emergency departments. And so, and they said, you guys got some residency training guys, I think we might have been the first wave of residency trainers, in the first couple of years of residency trained emergency physicians in the military. And I was at Keesler in Biloxi, Mississippi, which was a wonderful experience. Anyways so they said, well, give it to one of the new guys. And so they said, Mike, we want you to write the standards for emergency medicine. And I go, okay, great, what's the, I'm, first, I'm thinking, okay, we did that at UCLA, we got these, kind of these M&Ms, that's like a B-basic start for this. When do you need it by? And they said Friday, I'm thinking like, that's kind of fast, but okay, but I basically just took the stuff I did for UCLA, gave it to them. And it's like, I have no idea what's going to happen with this. And then afterwards, the next Monday, it comes out from the surgeon general, here's the standards for emergency medicine, please implement. And they send it to 142 Air Force emergency departments across the world.

John Shufeldt:
You're one year out of residency, and, and you're writing the standards for EM for the military, that's a classic.

Michael Hill:
No, it's not one year and it's like immediately after residency, over the residency into this, and so ...

John Shufeldt:
... Second.

Michael Hill:
So now I think it is kind of like a static thing. I have sent this out and I'm done. Well, what do you think happens when you send out a bunch of policies, procedures, and protocols to 142 emergency departments that are basically staffed by someone that's completed an internship?

John Shufeldt:
Well, thank God it was a, thank God I was before email or you would have been deluged.

Michael Hill:
Well, so but they gave my phone number. So the first day I get like 60 calls from people saying like, what is this? How do we put this together? And again, big experience in this, I don't know, like you should do this or this. And so it wasn't too long before someone from Eglin Air Force Base called me and said, look, you guys are just about an hour away, could you come just look in my ER and tell me, like, how I do this? Because I don't know. And I'm thinking, hey, I'm one of the future leaders from Emergency Medicine, I can do this. And so I go over there and it's like, well, you should have like a triage area and you should do that, it was very primitive, basic stuff, the bar was set very low for us.

John Shufeldt:
That's very at.

Michael Hill:
The end of my four years in the Air Force, I had gone to like 12 different Air Force emergency departments and looked at them and kind of made some basic recommendations, on my off time, which is a key thing, I think, in terms of my entrepreneurship is that none of this was easy. I asked my, my, the chief officer of the SG if I could go do this, and he said, you can do anything you want to as long as you work your 15 12-hour shifts each month. So on my off time, I went into these different areas and I was doing this just like, you know, this is kind of interesting, they're all kind of working in the same way. And I started looking at this like, this is like an ecosystem, this is kind of cool. And like there's lab and radiology dependencies, and so it was like, well, we should probably measure some stuff. And so it was like, okay, well we could do, you know, this was a primitive setting up of quality, length of stay, like the standby disposition, cycle times, mortality, left without being scenery, so that was unheard of that we would even be measuring that because from their perspective, no one, no, no emergencies were coming into the air anyway, and all these patients shouldn't be there. So anyway, so that was, so I did that. And then I was lucky enough at the end of my Air Force time to join a group called Emergency Physicians Medical Group, based in San Francisco, a wonderful leader of emergency medicine ... Wang was that, astute businessman and also his heart was in the right place in terms of what to do. When I said I had set up the Air Force quality standards for emergency medicine, he said, that could be valuable to us. And so, because his vision was that we could gain new business if we use quality as our lever for acquisitions, but actually meant it. So I first sent out the quality standards, this time I think we had seven ERs or eight ERs in ... 88, and I thought, well, okay, I'm done. And then it was like, no one wants to do this, so it's like change from Air Force to real-world and working with these guys, and so we basically put in a quality director at each facility and created a compensation for them. I think initially when we started with $500 a month, so this was kind of like-minded people that wanted to participate and we used it as a growth for our new folks that were wanted to get into administration in our organization.

John Shufeldt:
So that in 1986.

Michael Hill:
88.

John Shufeldt:
That was 88. All right, so let's test your long-term memory. What was the nurse's name in, in the ER?

Michael Hill:
I don't know.

John Shufeldt:
Dixie.

Michael Hill:
Okay, I fail. Totally fail.

John Shufeldt:
Okay, Grandfather, I'm just kidding you. So it's funny because, you know, there are so many EM physicians our age that, like, go back to emergency, go yeah, that's what I want to do, that's pretty cool stuff. And so it was funny for whatever reason, her name stuck in, her name stuck in my mind. All right, so for years, so you did, you did a three-year EM residency or was it one plus two?

Michael Hill:
So it was a two year, two year, yeah.

John Shufeldt:
No one plus two, and then four years in the military do all equality, go to 12 different EDs, plus Biloxi, and now you're up in San Francisco doing basically leading the quality effort for seven. Is that, was that EMG at the time?

Michael Hill:
EPMG, yeah.

John Shufeldt:
EPMG, very cool. Okay, keep going.

Michael Hill:
So in that, we grew from 7 contracts to 52 contracts by 1995, Art's vision of using, quality, worked and all. But it wasn't just quality, there was Josh Rubin who was wonderful on the financial and business side, and we had great medical directors and Art was responsible for selecting good physician leaders in that. And then the other part was I wanted to participate in the political arena, and so I joined .... I was part of ..., but I participated in the leadership in ...., and that was a wonderful organization with another bunch of group, of great leaders and we were able to meet, part, and the importance of that was we're able to meet the residents, the new residents coming out. And it was, our focus was let's find the best and the brightest of the residents because they'll help us continue to make the organization great. So we had, he put together a fellowship, which now is very common, but at that time was innovative, but we had some great people. Paul Cahill, a future leader in emergency medicine, president of .... Burnet Lev, was another one that came in from UC San Diego. We have some great people, so the organization was starting to click. Now, part of this, though, is that there was an equity program that people had ownership in the organization, and one of the things you recognize is the law of unintended consequences, which is if you create equity, then it pushes towards the .... At some time will occur because everyone wants to receive their equity. And so that happened in 1997 when we sold to Catholic Healthcare West. The big thing that happened to me in terms of my changes and I would go do pitches with, with Art and with Josh and I would do the quality section. But I got, I was also a regional director in Southern California because I've come from Southern California, they were in Northern California. So I started all the new contracts down in Southern California. We had an organized methodology to do that, but this one place, this little ER in San Clemente, the nurse director was very nice, she and I got along well and she left and I got a call from her like a year later saying, hey, I'm at this university emergency department, and I think they could really use you and you guys should, they're going to put an RFP and you guys should bid on it. And as a Californian, a Southern Californian, our, their definition of our world is northern United States is San Francisco, eastern United States is Las Vegas, western United States is Hawaii and Southern United States is Cabo. I mean, that's, so when she called me, it was like, that's Virginia, right? And I said, I'm pretty sure that's that's east of Las Vegas. So we're, yeah, we wouldn't be interested in that. And then she said, I said, but how big is the ER? And she said, 135,000 annual visits.

John Shufeldt:
Wow!

Michael Hill:
And I said, where is this thing? And she goes, Medical College of Virginia. I said, we're interested. So we go and we do our normal pitch and we compete against a guy, Steve Dressler, great guy, and they said at the end of our, our pitches, they said, well, we like your quality program, but we're an academic program, and so we really can't do you know, you guys be a staffing agency for us, but we like your knowledge space. And I said, so you need a consultant, and they said, yeah. Now, the only reason I said that was, my brother was a partner in this firm, Andersen Consulting, and so I said, well, yeah, we can do consulting. And so they said, great, put together a contract, and so I contacted my brother and say, how do you put together, like how do you figure out how much to build an hour for services? And he laughed it and you said, you're, you're such an idiot, you go to medical school and now you want to be a consultant. And I'm like, hey, I can do all these emergency medicine procedures, so this consulting can't be too hard. Anyway, at the end of two years there we got an opportunity to create a department, this was the, a traditional old style ER where you had five different academic departments owning individual parts of the emergency department. And this was also the time where the faculty was sent all the charts at the end of the, at the end of the week, all types of compliance issues. So, but we recruited in 20 emergency residency-trained emergency physicians, and it was the only residency program at that time in Virginia. There was a, there wasn't a way to get residency-trained emergency physicians locally. So MCV served as that, we did all of their facility coding, their professional coding and at the end of the two years we left. And so I thought as part of that, I went to my boss and said, do you think this is a one-trick pony or you think there's actually a market here? So in his scientific business perspective, insightfully said, I don't know, send out some advertisements that we fix ERs and see what happens, and that was the creation of the consulting arm Empath, which initially was emergency medicine pathways.

John Shufeldt:
When did you end up in Saint Joe's.

Michael Hill:
... We got, we, EPMG acquired the contract of Saint Joe's.

John Shufeldt:
Right.

Michael Hill:
And so I did, when we first started let's sell our services internally and St Joseph's was the first place that we did that. So we were there for a year doing redesign of the ED, but because boarding was such an issue, we had to do inpatient and because inpatient capacity problems are linked to inpatient length of stay, we now came into inpatient length of stay reduction, which was another interesting knowledge base.

John Shufeldt:
And so what you were saying, what year was that in Saint Joe, when you were at Saint Joe's?

Michael Hill:
That was 96, I think, to 98.

John Shufeldt:
Okay. All right. That was there, I was there at 2000, and then we did another ED redesign about 2000, I don't know, late 2000, I mean, it's probably 2007 or so.

Michael Hill:
Yeah, yeah, I know Michael Christopher, who I think is your medical director and I worked very closely on that project. Wonderfuly.

John Shufeldt:
Yeah, he was, he was the EPMG medical director then, and then they lost a contract and it was a mess for a while and we ended up taking it over in 2000. So when did you go out on your own? When did you leave Empath?

Michael Hill:
Well, what was interesting is that when CHW, after they bought us, and all the emergency departments that were not staffed by EPMG identified to their CEOs that this was a huge mistake. I think it took two years for them to say we want to sell it back to EPMG. And by the way, this little consulting arm we're not really interested in. Oh, but during that time, when I got by CHW, they said, we have this thing called ambulatory payment classifications that's going on, and since we have a consulting arm, why don't you do that? It's like, hey, we know how to do consulting, no problem. Now, go to the, what is this APC thing? So we created a curriculum, we figured out how to do charge masters, and so we did that for a year. And then in the meantime, we continue to advertise in the marketplace. And then we started getting, we got a couple of different organizations, we were lucky Huntington Hospital in Pasadena, Sacred Heart Medical Center in Spokane, Cape Fear Valley in North Carolina, and then the Success Valley Hospital in northern New Jersey. And so these were long term engagements, we were there for one to 2 to 3 years helping these organizations get better, designing these processes and focusing, trying to, for me, like I said, I'm not very smart, but I just, if I keep on doing this, I will figure out a methodology to kind of, because we want to do is to create a very quick way to change the hospital, that was really, our goal was to build this curriculum. And for example, the Valley guys who we worked with for four years, and I just talked to the COO I think last week, and he said, you know, 11 years later, we're still doing your stuff.

John Shufeldt:
That's cool.

Michael Hill:
It's pretty cool. The Medical College of Virginia, they had their residency program, I think, four years after we left, and that was like an annuity for me because we had emergency medicine residents instead of being pumped out ever since then. And one of my best friends, I didn't know this, we stopped communicating for about ten years, but one of his daughters actually went to MCV and their emergency medicine residency, it was like I was part of that when we started.

John Shufeldt:
In that .....?

Michael Hill:
That was the difference, I think in terms of emergency medicine versus consulting is the sphere of influence can be much larger than what it is that you can do in terms of your 2000 patients per year times 30 years, that's that's your scope.

John Shufeldt:
Right.

Michael Hill:
So I realized that this is actually kind of like medical school thing. I was like, hey, so this is how I'm changing healthcare.

John Shufeldt:
When did you stop practicing day-to-day emergency medicine? What year?

Michael Hill:
95, 95.

John Shufeldt:
No kidding, you went full time consultant, it was at a, was that a difficult switch for you? Because there's a lot of people listening to this who are wrestling with that right now, like, I want to do this new business, I want to do consulting, I want to be Michael Hill, however.

Michael Hill:
Nobody wants to be me, let's be clear on that. But look, what I would say in terms of this is each of these, when I was trying to go through in terms of detail of this, each of these was not a conscious decision of I'm going to jump off a cliff, I'm going to go do some high-risk thing, I have a vision of a new technology or anything else. Just all of these things just were simply step after step and opportunity after opportunity. And all the opportunities presented themselves not as a, oh, here's a gold ticket, just grab it. All of them were, go do some hard work, go try to figure it out and just keep on working at it. And that's what I said. I'm just a dog with the bone is, .... of these were like it was amazing, but interestingly in terms of these career so we continue, now, in terms of this consulting and then in the next ten years we grow Empath to a pretty successful consulting organization that size, we had about 50 folks and I was feeling that we weren't growing fast enough. I didn't feel like I could take this to the next level. So we looked for an exit strategy and so we found it with a publicly traded company called Navigant and one of the larger consulting organizations. And I learned what big consulting looked like, and I was excited by that because I figured, hey, if I could make change at this level, if I'm in a large organization, I can make an even bigger change. And that's a good example of a hypothesis disproven, in terms of that experience, because what we found was that their interests were different than mine. I remember one of my performance evaluations was, it was written down, is Dr. Hill innovates too much, and I was like, okay, I know this is not going to be the right place for me. But it was a wonderful learning experience, I got to run clinical care variation initiatives, things that I would not have done otherwise. I have to work with really large healthcare systems, with Henry Ford, with Baptist South Florida, Texas Health Resources, Mainline in Philadelphia, really new organization. It was always fun because we're always learning like new things to do. And at the end of that, I then went, at the end of my five years, when you sell your company, they make you stay for five years and you agree to sit for five years, they're creating the economic value for it. And then I joined Envision Physician Services, as senior vice president for the Western US, because it was something that was in my neck of the woods and I had a good leader in emergency physician named Paul Silke. And in that next year, I was looking at the contracts that I had and they, none of them looked good like my old EPMG contracts, bone of them had, we had a pipeline and good physicians and it wasn't, this was like we're at Maslow's hierarchy of needs, like water and roof, like staffing for the next shift or for the next week or for the next month. And this was not pulling the best and the brightest, this was people, I mean, there's good physicians in there, don't get me wrong, but it was, we had a lot wider variability in the quality of the providers. But anyway, they got bought by BlackRock and part of that was getting rid of the administrative, administration in terms of increasing your, your EBIT. And so I said, well, based on that, I'm going to go back to consulting, and so there was three organizations where they actually liked me and thought I created value, so I started doing the consulting again. And then and so we worked in Santa Rosa and California and Eureka, and then we got a call from a person I think we both know, who I had worked with in, with Envision who said, can you do clinic and a clinic system? And I'm like, I first said, no. And he goes, oh, and I thought that was a really stupid answer, if you can do amateur classifications, you can certainly do clinics because we had done clinics, but I wasn't a deep technical expert, and so yeah, we can do clinics. And so that's when we worked with Indian Health Services up in Eureka, and that's where I started figuring out how the clinic system works. So from there it's, after that is when I met you and I think you and I both said, we think there's an opportunity around rural healthcare because out of all these different constituencies and, and consulting in the major large for the large consulting organizations, their goal is find $15 to $25 million dollar projects, trying to reduce by 2 or $300 billion dollars overhead in a large healthcare system that's $10 billion dollars. But I'm looking at these rural healthcare systems and they don't have anybody. They got the CEO who's out, not available for the meeting because he's out in the parking lot with a snowplow removing the snow so that people can come in to work that day.

John Shufeldt:
Yeah, isn't that the truth?

Michael Hill:
So I just look at is that, that rural looks really like a big opportunity to create value. And so that's the stuff that I'm working on now.

John Shufeldt:
So it sounds like you've been, you know, kind of on the leading that you've been opera..., you've definitely been opportunistic, but you've been on this leading edge of like where healthcare, you know, you actually answered Jerry Hoffman's question in a sense you've done this your whole life now, you've always been on this leading edge of the next iteration of healthcare, whether it's ambulatory surgery, whether it's ambulatory fees, whether it's clinic now, rural know, Indian health service, then rural, it's kind of always where the need is. You seem to just end up there like, uh, like a smoke jumper.

Michael Hill:
I would say that if I was going to write a book of life advice to an emergency physician, it would be this jump. Jump at the opportunities that are in front of you, because I think none of these opportunities were like, hey, we'd like to pay you a million and a half dollars to go do this, create something new, this was all done on the side, this was all done in addition to the regular work. And I got some really good advice from Steve Resnick, an emergency physician, entrepreneur and leader in our specialty in the early years. And because I said to him, hey Steve, I'm really busy right now, I'm doing this national risk management course, we're teaching doctors how, you know, key things of how not to get sued, and that was a new thing when we started doing it and doing politics as president of .... at that time, and I was doing stuff at .... in the steering committee and I'm practicing full-time and I'm doing this consulting on the side and I don't know, like, which of these things should I choose? And his advice was keep all the doors open as long as you can possibly tolerate it.

John Shufeldt:
Yup.

Michael Hill:
Until you can't do it anymore and then give something up. Because once you give it up, you won't be able to get back into it because I had no idea where this was going to go. I mean, there's like six different directions and it's like policy or politics or I have no idea where it's going to go, but just keep on doing them all, and then life became clearer.

John Shufeldt:
You know, I think that's. I mean, that's great advice I have certainly, although I never heard it, I certainly followed that advice. And I think the downside is and, you know, I know you're pretty well, you know, there's a cost and the cost is everything you're not doing because we're head down fixing the world, saving the world in emergency medicine. You know, or doing, ore being Jerry Hoffman. But the flip side is, you know, the personal life and hobbies and all those sort of things, and so I see these, I see a lot of emergency medicine physicians, at least, you know, more in my era and a little bit beyond was, hey, I went to an emergency medicine because I do not want to make medicine my life like I want to, you know, I want to work my 12, my, my 12, 12 hour shifts are in your case, 15 in the, 15 in the Air Force. But I think there's these two ilks. There's the ilk like us, which is, you know, hey, I've got 15 days off a month, what can I do? I'm going to go back for more education, I'm going to do consulting, whatever. And then there's the other half that says, I want to play golf, you know, I want to go surfing, which is great. I just wasn't one of those people, and clearly you're not.

Michael Hill:
I would say two things is balance is a very poorly developed skill set in my, in my armamentarium. But, but I also say that I've always been looking at all this stuff is it's rarely been work.

John Shufeldt:
Yeah.

Michael Hill:
It's always been fun. I mean, like, I'll tell you, like this morning, for example, as we had made a decision on how to approach rural healthcare and how we were going to approach, like, how do we solve this problem, there's a lot of people that are already in this, so what value are we going to create? And so we had an idea of like, we should go down this pathway, and I spoke with literally over an eight-week period, 100 CEOs. And at the end of that, it was like, actually, that's not it at all, that's not going to work at all. But what we did learn was, well, here's the thing that we are thinking about. So today is I'm rewriting our Web page, I'm rewriting out our marketing collateral in terms of trying to craft a message that's understood that we can create significant value for rural healthcare. And to me, that's that's really fun. That's like so cool to be able to do that, so my wife will tell you I'm terrible on balance, my kids are probably ...., but I can tell you is it's really fun.

John Shufeldt:
And you haven't worked a day in your life.

Michael Hill:
I've worked a couple of days in my life, trust me, the Air Force was much like that, but for the most part has been it's always been a learning experience. You know, I don't know if any of your listeners have ever flew helicopters, but my senior year at UCLA I was with the .... President is, they had at that point the attending were the ones that flew the helicopters, the most competent people, well that year they decided to coach chief residents, could also fly helicopters. And I remember, like I come into Westwood and it'd be 10:00 at night and there'd be a call to like Lake Arrowhead, and we'd take off in a helicopter out of our Westwood, Beverly Hills, would be flying through the sky, looking over Southern California. I was saying there is no way they can be paid me for this, this is so much fun!

John Shufeldt:
Totally.

Michael Hill:
And you pick up a relatively stable person and bring them back. But that's what I look at is like life should be about that.

John Shufeldt:
Yeah. Yeah. You know, in most days when I'm in the emergency department, I'm like, you know, I would do this for free because it's a blast. But there are some days, as you alluded to, that like they couldn't pay me enough to do this. But you're right, flying to and from places, picking up patients or just going back and forth to work at night, yeah, it doesn't get much better than that. So what advice do you have other than jump? I love that advice. It's, you know, you're not, you're not, don't jump for the money, jump for the experience. What else?

Michael Hill:
I just, what I look at for a lot of emergency physicians, I just speak to emergency physicians, although I work with a lot of hospitals, too. They've got there, they've got a little bit different set of perspective in terms of what their burnouts do, too. But the challenge I think we have as physicians is that we are actually compensated fairly well, to be able to take risks is risky. And so that's why I look at it from, from my life is I don't presume I ever did anything very risky, I just simply went along the path and kept on exploring and pushing different areas. And I think that for emergency physicians, administration is going to pay less than clinical, just the nature of the beast, unless you're David Feinberg the he was always, I was, he was a psychiatrist and I was an emergency medicine resident. He was always way smarter than me then UCLA chair and now I think Google guy or something.

John Shufeldt:
Yeah.

Michael Hill:
But anyway, so the point was, is I just kept on trying to have fun, do things that were interesting. And I think that's what people ought to be looking at, is if you want to find a passion, do it on the side, test the market to see if there's an economic value to what it is that you're doing. And I was very lucky because in EPMG, I mean, I had an incubator where I had some degree of protection. I mean, I was doing the work, but I was also learning a whole bunch, and so that was really nice. But I think that get rich, quick part, and there are people that can do that, I'm not that guy. So I just, I just find, find something that's really seems fun to you and, and go see if you can make a business out of that on the side, but know that it's not going to be quick and it's not going to be easy and there'll be some degree of risk, you want to minimize that, and still be able to provide for your family.

John Shufeldt:
Yeah, that's, that's, I think you summed it up. Well, Michael, this has been great, where can people learn more about you. How can they contact you?

Michael Hill:
Funny you should ask. So our company's name is Rural Health Solutions, you can find me at LinkedIn. So we have an interesting thing like in the next five years, we got an idea that we can actually create a whole bunch of value to a lot of rural critical access hospitals. And so like I'm looking at the next five years is we're going to test that hypothesis, and just like many of my hypotheses, it could be wrong or it might work. And so I don't know, but whatever it is, it's going to be a fun journey.

John Shufeldt:
Yeah. And if it is wrong, you'll iterate along the way and come up with the right answer. I mean, that's, that's kind of been your 30 plus year history, so thanks for chatting.

Michael Hill:
Hey, thank you, pleasure talking to you, John.

John Shufeldt:
Pleasure! Guys, another episode of Entrepreneur Rx, we'll have everything in the show notes. Michael, thank you again and I'm sure we'll be talking soon.

Michael Hill:
Thanks, thank you, John.

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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