Podcast #22: Dr. Joe Norris on Breaking Free from Medicine’s Hamster Wheel

Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry’s resources. Please note the views expressed are those of DocNation and not necessarily those of our guest or referenced health centers. Welcome back to DocNation.

Today we are talking with Doctor Joe Norris, an orthopedic surgeon with a passion for innovation. He spent years specializing in knee and shoulder surgery, led a major orthopedic practice, and even built and sold a cutting-edge sports performance facility. On top of that, he’s a founder of multiple healthcare companies focused on improving surgery, wellness, and education. We’ll dive into his journey, the business of medicine, and where he sees healthcare heading.

Let’s get started. Joe, tell us about what are you up to nowadays?

Dr. Joe Norris
Justin, you know, that’s a can of worms. First and foremost, I just want to say it’s a privilege and an honor to be on DocNation. As of a couple of days ago, I’m not just a podcast guest, but I’m also a member. Could not be prouder. And I’m really excited about everything you guys did.

I really appreciate you. I don’t know if you hear that from physicians enough. And I’m going to do everything I can to get the awareness out, for you guys. I think from where I’m at right now, and what I’ve kind of thought about leading up to this discussion, is kind of the two lives that I lead and have led, from the beginning of my practice, as a businessman or entrepreneur and a practitioner that cares so much about what I do.

In respect to surgery, in my profession and passion, where those kind of started separately and where they intersected has really guided my journey into how I practice, where I practice, and what I want to try to do to help the problems that we face. And my lens, as always, I can’t help it—from somebody who wants to solve a problem.

Stand it up, create value, and then understand what that value is. And so what I’m doing today, I am practicing in a lot of different ways. I’m a co-founder of a business. I’m a real estate investor and developer. You tell me where you want to go, and I’ll go that way. But there’s a lot of things that I do, and I wear a lot of hats, and that’s intentional.

I really enjoy a lot of different things, but my core is treating patients and doing surgery, and I still love to do it as much as possible.

Justin Nabity
Well, I think about your story and going back in time and compare that to what we’re seeing today, which is 75% of medical students are on antidepressants and stimulants, and you’ve got the suicide rate being double among physicians compared to the rest of the population. We’re not in a good… like, how is the community going to get healthier if the people who they’re looking to for help are struggling themselves?

I want to get your perspective. You’ve seen what it’s like to be on the employed side but also being self-employed. What do you see as having unraveled over the years because you’ve been in practice how long? How many years?

Dr. Joe Norris
Oh, boy. 2009 was the year—15 years.

Justin Nabity
Okay. 15 years. I mean, has it changed anything from when you started, or what would you say?

Dr. Joe Norris
Yeah, I guess I will start there. You know, when I came out, I was in a private practice, a decent-sized mid-sized group—ten surgeons amongst other practitioners. We did everything that orthopedic surgeons do. When they get together, they buy a magnet and have PT and have some ancillary services, business lines. We grew a practice and kind of treated it like my own little profit and loss P&L business, in addition to the whole group going out and really taking big swings.

We built a 60,000-square-foot medical office building as part of a wellness center and really did some things that helped scratch an itch for me as someone trying to be an innovator. As president of our private practice, by the time we got all the way there, I will tell you, I felt the burden—and it wasn’t because I was doing so many projects and different things with medicine.

It was because when you create the machine, you gotta feed it. So you get a PA, you get two PAs. Now they depend on you. Their families need you to pay them. And you gotta see more patients because you’re getting paid less. I really felt like I was on the hamster wheel.

Justin Nabity
How many years in? How many years into it were you?

Dr. Joe Norris
That was ten years in. A practice that people would have killed for—super busy, in the middle of the Midwest, in a honeypot of great commercial payers, insurance companies with their national headquarters. It was perfect, right? I was not feeling fulfilled. I would get up and be like, ugh, 55 patients in clinic today.

And it was kind of like taking loose-leaf paper, putting it in front of a fan, and then all day just picking up the papers. I did it. You know, I just finally decided, and my wife—my bellwether that helps me every step of the way—we just decided. We took everything we had.

All the wonderful things from the outside looking in were just perfect. And we picked up, pulled stakes, and moved. I went from president of a private practice to being employed in another state and having a completely different lifestyle. One, for the experiences of my kids and my family. But two, looking back at it, I think I looked at the next 15 years and thought, Man, I’m just not going to be the happy, fun-loving dad, friend, surgeon that I want to be and treat my patients the way I should.

So I changed it because I felt it. But it is scary and hard for physicians to do that. I totally admit that and understand it.

Dr. Anthony Giuffrida
That’s impressive, because I think a lot of physicians are very scared of change. And I think a lot of people use that against physicians. Would you say you were burnt out? Is that is that what, you know, an overarching term that has been used out there in medicine a lot? It you know, I think I feel it every now and then.

I think every physician feels it every now and then where you just you get up and you kind of do the same thing every day and it kind of you just walk in that same road.

Dr. Joe Norris
Yeah. You know, you I imagine you would probably say this, and agree, or disagree, you let me know. I don’t think that we identify it as burnout. We don’t we we don’t understand what that means. We just know that we used to get up and be challenged in one moment. This this this, reverse total shoulder today is going to be a blast.

And even the stuff that’s so exciting and so fun and meeting new people and helping them solve their problems and feel better. You don’t. And you, you lose the the enjoyment and then I felt that I was a little bit of a different person. You know, I’m never I’m never in a bad mood. And I felt like I was in some bad mood.

So in essence, I’m, I didn’t know it was burnout. But I would say, yeah, I think, I think a lot of it was burnout. And, and this is where it intersects with the other parts of my life, whether it be faith, but also business. And I got really frustrated with the business side, too. And and just because I had other businesses that I can completely understand and follow normal rules of business.

And so you solve a problem, you you create the solution, you create value, you get benefit. And and also it’s a fee for service. The and accounts receivable is steady and known and your costs don’t vary. It’s it was impossible to try to solve. And so I decided to kind of commoditize my skill set and practice business in things that were consistently following the right rules, I guess, from what I want, out of that interaction with how to create value and make more money.

But it also helped me go down the path, which I’m happy to talk a little bit about because I haven’t heard it on your previous podcast. Having an entrepreneurial mindset. One thing that I don’t want and don’t like is when physicians are playing a victim. Physicians are some of the smartest individuals in our country, and we need to we need to solve problems.

We we need to not complain and bitch and say, oh, woe is me. We need to say, how are we going to take control of this situation? And I and I had a I’ve gone down that path, of solving some of those problems. And I think, I think there’s a future for it.

Dr. Anthony Giuffrida
I think that’s a great point, Joe. I think a lot of physicians don’t think that the problems can be solved, unfortunately. And that’s part of the reason, you know, we have DocNation is we’re getting physicians together, like minded physicians like myself and you, that says, hey, let’s let’s, you know, bring the problems to the top and let’s try to solve them.

And I don’t think people realize, like, the hospital systems, they want to work with you. You know, even insurance companies, I think right now are see the writing on the wall that this this needs to change. It all needs to change. Health care in America needs to change. And everyone wants to work with us. We just physicians, like you said, do a lot of complaining without a lot of action. And that frustrates me a lot.

Dr. Joe Norris
Yeah, I have a, you know, so I went down the path, again, analyzing why is it frustrating for our compensation? And, because it’s just a, it’s a Pandora’s black box of not under and a physician who doesn’t even understand what an Excel spreadsheet which and I don’t disparage that. I think that physicians, if they’re not interested in it, they should do what they want to do. But because I was very interested in it and I gained a lot of knowledge, I started thinking about all the different costs and how to eliminate it. And and the first thing that I come to a conclusion is, what if someone came to me and said, hey, how much does it cost you to do a knee scope for me? I would have no idea. Right? So the first thing we got to do is understand our costs and then what margin we would have. And that’s where I believe we’re coming to a consumerism of medical care. And instead of saying, this is ridiculous, you know, you you, you push me down and make me work harder. And then I’m judged on metrics of am I nice?

Do I do they enjoy the interaction? And it’s not, hey, I’m a surgeon that has great outcomes and no infections. But because of that consumerism in my opinion. Again, let’s lean into it. If you’re a consumer and you’re paying cash because it’s all high deductible payments anyway for a lot of medical care, right? If we can create a business model where we know our costs and we can give you a, a, price sheet, if you look at, for instance, the surgery center of, of Oklahoma, I don’t know if you guys have looked at that as a case study before.

They’re an all cash ASC and they contract with employers. The employers have 80% less costs for outpatient surgeries. And that surgery center. Absolutely kills it. The surgeons love operating there, and the patients love going there. It’s it’s a there’s even networks that connect all these people who do understand the cost that they have and the, the revenue they need to create to keep their business afloat.

I worked with a guy named Doctor Jawad Arshad that created Wow health. And it’s just a it’s a network digitally of all of these providers. And you can go and be like, how much for an MRI? And if it’s cash, well, it’s $350. I paid more in a co-pay because that place charge the insurance company $1,500 with an agreement to pay 800.

I’m responsible for all 800. It you know, we got to take control. And I think consumers I hate to say that patients, they’re patients, but they know what they want. They know their costs. They know what what they would be willing to pay. Now we got to come to them and meet them halfway. I think that’s that’s part of a solution, potentially cutting, cutting out the middleman and all the bureaucracy and red tape.

Justin Nabity
Do you see your colleagues talking about consumerism within health care? Is that a term that pops up?

Dr. Joe Norris
I think, again, because of the circles that I travel in outside of medicine. I think that they talk about it, but not using the right, the same vocabulary. Okay, talk about shopping. And that’s a consumer, right?

Justin Nabity
Yeah. Okay.

Dr. Joe Norris
And then and then the patients talk about their, the, the, the feel. You know, I came to you, Doctor Norris, because I went to the behemoth orthopedic group, and I felt like a number and I was like cattle being herded. And you, you you took time and I got in and and so on and so forth. So, the short answer is, I think that they, without knowing it and talking about it, they do understand that that’s where it is. Patients are officially consumers of our care.

Dr. Anthony Giuffrida
But I think there’s a huge push towards concierge medicine, at least where I’m in, in South Florida. And that’s exactly what that is. Right, is you’re paying for access. You’re paying for more time, which, you know, equals better care. And unfortunately, I mean, when you started practicing, there was more time, which I think equals better care, you know, a big push.

You kind of said in one of your statements is, see more patients, see more patients, and there’s reasons for that. They need to, you know, the the cost of doing things are getting very expensive. And the reimbursements are not getting better. But there is a side effect of seeing more patients. Seeing more patients. We just don’t have the time. I don’t think physicians don’t want to spend the time with patients. They just can’t. And that concierge medicine has allowed that to happen. You know, and you’re seeing it first. It started in primary and now you’re seeing it even in orthopedics, which is interesting.

Dr. Joe Norris
Do you do you know any of that? Because I don’t personally know any of the concierge medicine doctors. Are they happier with that situation, too?

Dr. Anthony Giuffrida
Oh, 100%. And, you know, I always said it was very scary. It is very scary starting out. So a lot of the concierge medicine docs refer to me. And it’s interesting because I kind of have to tell a patient like, hey, I’m not concierge as I can’t get you in this afternoon. I’m sorry. But they understand that. But the concierge docs that I know very well said it was very scary to do it at first because they didn’t know if there would be a market. But once they get their patients in and they’re happier not just financially, but how they’re doing medicine, right, they feel like they’re being a physician again. So it’s interesting to see the concierge market picking up down here and how successful it is. And then I think patients enjoy, too. I feel bad for patients that have health insurance and are also paying for concierge doctor because you’re kind of paying, you know, twice for the same thing. But they really enjoy it. The patients like the access. It’s all about access now. And unfortunately I think that’s what’s going to become is you paying for access.

Justin Nabity
Doctor Norris let’s go back to what you said about knowing the what things cost. Let’s let’s can we talk about that from a across the board all specialty standpoint? If, if everybody who’s tuning in is going to say, okay, I’m going to take what Doctor Norris said, I’m going to go back to my clinic, back to the practice, where there’s private providers are employed. I’m going to go start to really get clear on this. What would be some action steps? Because I think you’re right. They’re completely clueless because it’s intentionally built to keep them in the dark. So if they want to have all this stuff, the data come into the light. What how would you advise them to do that?

Dr. Joe Norris
So I think that, the federal government actually started exposing this specifically just to orthopedic surgery. Now, they created a shared savings program for anyone in the country that helps, specifically one phase of care, which was post operative care. So, it unfortunately, we all know that that if you give rules, someone some entity may leverage that. So we they found that these for instance, after a totally or total hip or hip fracture, they were staying in these, skilled nursing facilities for exactly 19.5 days or whatever it was, because 20 was allowed and they said, hey, surgeons, if you help take control of this problem, we’ll give you half of everything that is saved because it’s not great care. Patients don’t need to be there for two weeks, three weeks. So they actually gave up and they we maxed out our benefit and huge revenue savings or cost savings I should say. But revenue to our to our practice every quarter. So then we started diving in. The people who the individuals or groups that understood that.

Justin Nabity
Yeah?

Dr. Joe Norris
And the couple that, are really innovative. One of my friends and colleagues is the CEO of a large group in the Chicago suburbs. He is the godfather of understanding risk, because that’s what we’re talking about, right? Going what they call at risk. So that is the doctor saying all of a sudden. And then another concept, at least in my world and it’s it’s a lot of different specialties is bundling right. So you bundle all the costs and this is done with third party payers and say all of a sudden now instead of to the patient, to the third party payer or to a employer that self-insured, okay, we’re going to bill, it’s going to be 80,000, $90,000 in bills for a total knee. How about this? You pay me $40,000 and I am the group. I do the PT, I do the surgery. We are the surgery center. I pay the anesthesia. I pay the implants. I we do it all well, 50% savings for them. And if you understand your risks and costs, it’s a hugely profitable thing for the groups that do it well. But you’re going at risk because if that patient has a complication and it turns into $90,000 a care that’s on you.

So I didn’t answer your question. And I’m trying to get around to it. I think understanding cost gets granular. But it’s very achievable. And you have to the best the best leverage that we can do is to own the entire vertical of care. So a vertically oriented care. So if you, for instance, in primary care, if you own the lab, I have control. If you’re a surgeon, if you have a surgery center, I have control. And you’ve talked about that a lot on a lot of your podcast. And it’s autonomy and it seems like big risk. And it is. But there’s a reason that you get enough orthopedic surgeons together or surgeons in general, and you buy a surgery center, you realize that, hey, there’s there’s a site of service. It’s got to happen.