Interview with Dr. Harvey Castro
This week, I present my interview with Dr. Harvey Castro in which we discuss the attributes of the best healthcare leaders.
Harvey is an emergency room physician and leader. He thrives on motivating teams by providing the most technologically advanced healthcare services to communities throughout the state of Texas. He believes in building sincere trust with patients, doctors, staff, and community leaders. And Harvey does this by consistently displaying compassion, care, and understanding.
Harvey graduated from the University of Texas Medical School at Galveston. He then completed his Emergency Medicine Residency at St. Luke’s University Health Network in Bethlehem, Pennsylvania. He has been practicing Emergeny Medicine for about 16 years.
Our Sponsor
We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.
The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.
By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.
Healthcare Leaders Never Give Up and Never Stop Learning
Along the way, he completed his MBA and took on leadership and business roles. He started as a medical director. Then he devoted his energies as a smartphone medical app developer. However, he hit his stride as a freestanding emergency room founder and CEO. That business has now grown into a network of freestanding ERs and other healthcare facilities.
Harvey is the first in a series of guests who completed the UT Physician Executive MBA Program at the University of Tennessee.
Leveraging Medical Training and Entrepreneurial Skills
We covered a lot of ground. Harvey has effectively leveraged his emergency medicine training and entrepreneurial skills to build a remarkable business. And it has happened because of a desire to serve patients better. But it requires the ability to take more risk than the average physician does.
I sincerely think being an ER doctor… you tend to be a risk taker, and that kind of evolves into the business world.
He also believes that the best healthcare leaders never give up, but continuously strive for better quality, safety, and service to patients.
Summary
You can find Dr. Castro on LinkedIn. And if you want to check out his business, go to trustedmedicalcenters.com. You can contact Harvey through LinkedIn or using his email address at harveycastro4@gmail.com.
And don’t forget that Harvey is looking for franchisees to start freestanding emergency rooms in other states. And he has also developed an investment fund for those interested in investing in his growing network.
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Transcription - PNC Episode 196
The Best Healthcare Leaders Never Give Up and Never Stop Learning
John: I was recently talking with the executive director at the University of Tennessee physician executive MBA program Kate Atchley, and of course they're a big longtime supporter of the podcast. And I asked if she had any suggestions for guests since obviously the physicians involved in their program are trying new things, advancing their careers, and many of them are doing nonclinical things or combinations. So, she introduced me to today's guest who is an emergency medicine physician, businessman and entrepreneur from Texas. Welcome to the podcast, Dr. Harvey Castro.
Dr. Harvey Castro: Thank you so much.
John: Hey man, it's good to see you live. We're looking at video today, even though this is a podcast, but it's good to see you and finally get a chance to spend a few minutes here and what you've been up to.
Dr. Harvey Castro: Yeah, I'm excited to be on the show and I'm excited to finally get to see you in person.
John: This is how we usually start. Just tell us a little bit about your background as far as your education, past clinical practice, and then we'll get into some of the nonclinical activities.
Dr. Harvey Castro: Well, I'm going to go way back. Literally, I couldn't afford college. So, I had to join the army to help fund college. I went to Texas A&M. I received two degrees there, a bachelor's of science and bachelors of art and political science and biomedical science. Because back in the day, I had this big aspiration of becoming a lawyer, a doctor, and a businessman. And so, I marched on and got into medical school and went to UTMB in Galveston, Texas.
Then I went to emergency medicine in Pennsylvania and started practicing medicine as a board-certified emergency physician. Loved it. But I always had this almost like a tickling to do something else. During residency, I was selling books that I wrote in med school. And then in residency, I started my heart vitamin company that I sold.
And then when I graduated, I started this thing called iPhone app. It was a new thing out there and I started trading apps. And so, I started combining medicine and whatever else I wanted to do with it. And at that time, I was combining technology with medicine. And so that was my educational background.
And then having all those accolades and things that I was doing, I started thinking, "Well, heck what if somebody taught me the business side of things? What if I actually got a degree in business?" Because all the things that I know of business, it's kind of like the streets of business. Like the street accolades is what I was learning and doing, but I thought if I had formal education, maybe I would be a better provider/business person in healthcare.
John: All right. But I know for a fact, just looking at your background that you are doing a lot of management before you decided to get the MBA, for sure. So, what kind of roles were you doing? We use this term commonly "medical director". That can mean a lot of things, but I kind of got the sense that there you, yourself or others were putting you in positions of helping them manage things. So, give us a little bit more detail on some of those positions you held.
Dr. Harvey Castro: Yeah. Excellent question. Early on, thank God, I was identified as the future leader. So, at the time the organization I was working with said, "Hey, we'd like you to go to the ACEF academy of leaders and go through all the phases. Phase one, phase two, phase three. And that leadership, learning that training, learning how to even talk to people. They put me as the assistant medical director, and then later I became the actual medical director of a free-standing ER in Dallas.
And that position helped me so much because I have had the leadership training. And so, then I was able to start free-standing. And within the first month I turned it around and made it profitable. It was literally from zero patients to profitable. And those leadership skills, going out to the community, talking to doctors, telling them about our business, looking at the different things.
And then later, I became a consultant in Texas. I literally would drive around or fly around the state of Texas and different companies would hire me to come and help them start their free-standing. And then after a while I thought, "I've been doing this so long. Why not start my own brand?" So, my business partner and I, we were in the business of rehabbing ERs that were failing. And so, we did one, within three months we rehabbed it, we had it profitable. It went very well. We were returning money back to our investors that have helped to start it. And then I said, "Why don't we start a company?" And we just came up with Trusted ER. And literally this was about three years ago. And in over three years, we've expanded to eight locations.
John: That's pretty rapid growth right there.
Dr. Harvey Castro: Yeah. It's crazy to turn around and see. We have about 350 employees, doctors, non-doctors, front office, different branches of the business. And to your point, you're right. We did all of this and then last year I went to school to get my MBA.
John: Okay. So now let's go back a little bit again. I want to kind of get the idea when you were doing the consulting and teaching others like how to improve their ERs? How long ago was that?
Dr. Harvey Castro: That was probably about seven years ago and it probably stopped about three years ago in the sense that I was just working for myself and just helping my own brand.
John: Now, at what point, have you stopped practicing? Or do you do the occasional shifts? How does that work for you and what was that transition, if there was one?
Dr. Harvey Castro: Yeah. That's an excellent question. I can honestly say I was working too much. I was working as an ER doctor. I was working in three different cities plus consulting. And literally I felt like I wasn't resting. Literally, I remember getting off at seven in the morning and then driving two hours and then going to a board meeting because there was this company, I started calling Trusted ER.
And I remember thinking "I can do this". And finally, after a year of doing that, I said, "You know what? This is not life. I'm just burning it on both ends". Then I took the leap of faith of saying, "You know what? I'm saying no to emergency medicine as far as a paycheck. And I'm going to put all my eggs into this Trusted ER and this'll be my daily bread". And it's really tough. Especially as other doctors know that it took so hard to get here. And then to say, "You know what? I'm going to stop practicing medicine and do more on the business side".
And so, now as far as clinical, the only way I would come into cover shift is if the medical director can't and then the chief medical officer can't and the regional can't. And then at that point it's me. But then at that point they usually fill up shifts. I really don't get to practice unless I want to go in and work a few hours.
But I'm more involved in teaching medicine and teaching the concierge portion of how we do emergency medicine, looking at the business side, looking at locations. And interesting enough over the years, especially with COVID, NBCUniversal, all the major networks have been calling me to do medical segments. And so, through peer reviews and looking at different cases in my experience in emergency medicine, which is over 20 years, I'm able to go in and talk about X and Y subjects. And so, last year I actually did about a hundred interviews on TV.
John: Really? Okay. I was wondering about that like, "Oh, maybe one a month for a few months", but a hundred interviews. I mean, that's actually something where that could be a whole career itself in terms of just being seen as the expert and promoting yourself and doing those kinds of interviews on a regular basis. But I see that it feeds into what you're doing from an ER standpoint, of course, and a business standpoint to promote what you're doing in Texas. That's awesome.
Dr. Harvey Castro: And it's fun. I feel like I can get back and it's a different medicine. When COVID hit and everybody was freaking out and scared, I hit the TV station up and said, "Hey, can we do a hotline? A free hotline, just call this number and we'll answer all your COVID questions". And we did this in March and we were on NBC and Telemundo. And I didn't realize that their outreach was all the way out to El Paso. So, we were getting thousands of calls and I had it literally on a list of doctors in the room together just calling and returning calls and just going through all their COVID questions.
But this was the fun part of medicine. When everybody's freaking out, I was able to get on TV and say, "Hey, let's look at X, Y, and Z. Let's talk about this". And it was actually a fun way of practicing medicine. Way different, but it's medicine.
John: Yeah. I think as physicians, we have no inkling of what things could be like if we kind of just open up to the possibility of whether it's expanding your own practice or creating something that has multiple sites or even opening a small hospital. I think you mentioned it is now part of this network.
Dr. Harvey Castro: Yes, sir. We opened our first hospital in Mansfield, Texas. And that was great because now we have the license to do other things. And so, for example, when COVID hit, we were able to start doing mobile testing. So, we were going to the employers. We were the first in Dallas to go out to the employers and test everybody at their location.
And then we were lucky enough to get the first PCR tests and antibodies tests and everything that one was coming out in Dallas. And we were able to show that on TV and have people come to our locations and get these tests and having that outpatient clinical license to be able to do these things. It was perfect timing. So, we actually started our own testing center. But again, I love being able to combine medicine and business and then trying to do something different.
I think it's hard and it's hard almost for us doctors to respect non-doctors in the business world, because they tell us to practice medicine in a certain way and we're like, well, you never help us at the scope and you never talked to a patient, you've never been in those situations. But when another fellow doctor is like I've been there, we've done this, I get that issue. And as the business side, these are the reasons why we want to fix it. And these are the things. So, it's actually been a different medicine that I feel honored and blessed to be able to do every day now. It's just different. No red tape.
John: Yeah, right. When you make a decision, I guess it's going to be implemented pretty quick if you're the CEO. But I do think there is a big need for more physician leaders. There was a time when more than half the hospitals in the country were actually owned by physicians. That's way back in the old days in the 50s. But now I think it's less than 5% or 6% that are led by physicians. And I think we do a whole lot better in medicine and in healthcare as an industry, if we had more physicians in charge of more things.
So, I think physicians should not shy away from that. Especially if they're interested, if they have an aptitude for it, like you've done, then just keep moving forward and you can contribute so much more doing that. I mean, in terms of the numbers of people you're affecting, I would think.
Dr. Harvey Castro: Yeah, it's been fun. I would encourage everybody to do that. Whatever you're good at and whatever medicine you're practicing, take it to the next level.
John: Absolutely. Now you talked about getting a little bit maybe burnt out while you're doing all these things and you say, "Well, maybe I got to cut the practice back at some point, if I'm doing all these business things", but then you decided, "Well, I'm going to go ahead and get this MBA". So, I want to hear what it's like from a student. I don't know that I've actually spoken directly to a graduate of the UT PEMBA before. I mean, I've talked to people and it's a common question I get about advanced degrees.
So, tell me what that was like and how did you carve out the time to do it? Because it's a pretty intense program. Go ahead and just run with that. Tell us about it, what your experience was and how you were able to manage that.
Dr. Harvey Castro: Honestly, I felt like I was going back to med school in that here's all this information being taught to you. I'm going to date myself. I'm going to school and being there and seeing just all the technology and laptops and plugins. I was like, "Whoa, this is so much more fun going to school now than back in the day when I went to school".
And the information was actually fun because we were given PowerPoints, we were given summaries, the books we were told to read. It was even more fun for me because it's like, "Wow, here's medicine and here's business. This is what I've been doing." So, I felt like I was able to get so much more out of it because now I was like, "Okay, now that makes sense".
And it's funny, it's kind of like riding a bike. It's hard to describe how to ride a bike, but once you start doing it, you do it, but then you don't really know why. Going to school was like finding out the "why". Why was I making these decisions? Why was I negotiating in a certain way? Why was I doing things? And it was great to get the Booksmart.
So having these professors talking to me about accounting and one-on-one and entrepreneurship, it was great hearing. Marketing was awesome, listening to different marketing ideas and theories and why things are done in a certain way. And then it's like, "Wow, that's just reinforcing some of the things I'm doing". And now I can actually improve my practice or running my business by using these tools.
As far as the time demands, oh my gosh. It was hard, because running a practice, running eight businesses, having the employees, being the leader, I would literally make time. So, every time I'd come home, I'd say, "Okay, I got to read this book. I got to summarize. I got to think about this". Or working on projects was really hard. Because imagine getting three busy physicians all together on a Zoom saying, "Okay, we are working on this project", it was hard. And then going to class every Saturday and then having a life for the Saturdays. I remember saying, okay, I want to go on vacation, but technically I have classes on Saturdays. So, it's going to be tough.
With that said, I'm glad I did it. Back in the day when I was in the army, I thought I really wanted my MBA one day and my MD. So, that was part of my goal and I wanted to get that. I'm glad I got it because I felt like I had the street-smart, but not the book-smart. And having both just gave me an extra layer of knowledge. And I was able to talk to my classmates and say, "Hey, the reason the professor is pointing X, Y, and Z is because this is how you'll see it in the real world. These are the accolades. These are the things that you need to focus on".
So, I can't say enough about the experience. I thought it was great. I think one of the things about me, I feel like I'm a lifetime learner so I'm all about going back. And today after this podcast, we are having a talk at the University and I'm going to be on it, just listening as a participant to learn more from the University. So, it's fun.
John: Yeah. We're going to try and actually put some of the things that they're presenting there. Dr. Kate Atchley said that we could actually promote that on the podcast. So, I'm going to be putting notices for some of those business-related courses for physicians or just the seminars because they are CME accredited. So, it sounds like it's a really good opportunity for those that are outside to kind of let them get familiar with the program.
But I know this is kind of a leading question. I kind of know the answer, but some physicians are like, "Well, I should've gotten my MBA back when, because then I would know how to run my practice better or run this group better". But I get the feeling that the virtue of an executive MBA is you're coming in when you've already had enough exposure to something that you actually know what you're looking for, when you hear it, it makes sense. I mean, you were talking about marketing before you did the MBA for your organization. And so, I guess my question is, would you agree with that? That there is some advantage to that?
Dr. Harvey Castro: There's a lot of advantages to having the experience of having a business. With that said I wouldn't preclude it as a prereq to go into getting your MBA. I always feel like it's important to have an end in line. If you're getting an MBA just to get an MBA, if that's your goal, that's fine. But if you're getting an MBA because there's X, Y, and Z, that you're wanting to get out of it, then you're going to get that out of the MBA. If you decide I just want to go through it and just see the bigger picture, then you'll get the bigger picture.
But I went into this very razor focus, like, "Okay, these are the things that I need to work on. These are the things I needed to do better on. These are the things that I should be open-minded to". So, every time certain lectures came, I was just taking it all in or pre-reading or trying to get the most or reading the notes. Actually, yesterday I spent some time looking at some of the old notes from our marketing professor and just reading through them I'm like, "Man, this is really good stuff that I need to apply". And so, I think it's important to have an end in mind. Why do you want the MBA? What are you going to get out of it? And then you'll get even more out of it.
John: Yeah, I think you could do either. I get that question all the time. Should I do this MBA or MHA and some other degree? It's a personal decision, but there's nothing wrong with trying to dabble in it a little bit in terms of the business side and then if you feel like you really want to pull the trigger. The other thing is if you can get an employer who will pay for part of it, that can be helpful.
Dr. Harvey Castro: Yes. Yeah, for sure.
John: The other thing I was going to mention is I'm assuming you had a pretty decent team that could at least free you up a few hours when you need to be freed up. It sounds like you have a pretty extensive well-run organization. So, I'm sure that helped.
Dr. Harvey Castro: It does. It does help. I felt bad for some of my classmates that said, "Hey, I just got off a shift and I'm here. I'm in a small group". And I'm like, "Oh my God, bless your heart. I can't complain. I was in bed last night. I slept in my own bed". And interestingly enough, I would say at least 40% of the class was emergency room. And so, that just tells me, I think there is a lot of burnout out there. A lot of doctors are like, "Man, holidays, weekends, I can't do this". And I think early in life, it's fun. And then later you're like, "Whoa, I have kids, I have this and that. It's not as easy to work a midnight shift as it used to be". So, I think doctors are looking to do something else.
John: Well, I've had a lot of guests on here who are ER docs. There seems to be something about the ER docs. I mean even urgent care, right? That's what I do very part time now. Half of them are either owned by ER docs or family docs. I mean, you got to have that broadest exposure to clinically. And of course, the ER docs usually have the more aggressive urgent cares where they do an IVs and things and do more procedures. But even beyond that, I can't tell you how many ER docs have been in start-ups or investing in some new company. So, I know there's something about the excitement I think of ER work and maybe the business excitement.
Dr. Harvey Castro: Yeah. I agree. I sincerely think being an ER doctor and I love all the professions, but being here, I think you tend to be a risk taker and that kind of evolves into the business world. And then you're more likely to say, "You know what? I'm going to jump in and start my own urgent care, even though I don't know anything about urgent care", because you're that risk taker. And sometimes to be successful, sometimes you need to take risks, calculated risks. And I think you see that in ER doctors.
John: Okay. Now I got to segue us into another business topic related to what you're doing. From what you told me before we got started today, you are in the process of franchising, what you're doing and maybe even looking for investors. So, explain that to us in some detail because I think we've talked about franchises, like being a franchisee and just signing on with somebody. But if somebody has a practice, a group practice, ER practice, something like that and what you're doing, how could you possibly consider franchising? Explain that to us.
Dr. Harvey Castro: Yeah. Well, it all comes down to what we're talking about today - Business. We all are healthcare providers. We spent hours and hours of taking care of patients. We know how to take care of patients, but do we know how to buy a business? Do we know how to negotiate a business? Unfortunately, when people see MD/DO behind your name, they're like, "Oh, that's a premium. We're going to charge you a little extra here".
So, what we decided is why not create a product that we can franchise and create that business. And in that way, we are negotiating, we know what the prices are. We already have the vendors. We have the system in place. Every organization that we've started, every ER, is very meticulous how we do procedures. We have a handbook. We have HR, accounting. We spend a lot of time making sure that when we opened and we grew so fast, we had to create these folders and processes.
And so, we've got it down to a science. And now we have our own HR, accounting, billing company, our own physician company, our own staffing company. So, we thought, why not create a franchise so that if another doctor wants to do the same thing, but do it in their community, here we go. We can support you. Not to promote myself or our company, but it's really hard to start a business, especially if you're going to make a lot of mistakes. And those mistakes sometimes cost a lot of money.
So, to me, it makes sense. And I'm personally looking actually at other franchises out there to say, "How can I invest in franchise X and Y?" Because they've already fine-tuned this. They've already fixed all the issues. They already know what issues are coming and how to avoid them. So, I would gladly pay a company to say, "Hey, come in and help me". I'm looking at some food industry places. And I'm like, I don't know anything about food, but this franchise is known. And that's why I thought, why not do the same thing?
On the Dallas side, we have eight locations. And we're about to launch basically a fund that if someone outside of Dallas wants to invest in Trusted ER, they can buy a share of the ADRs. And we're selling that. We have two parts of our business. One is an investor side and one is a doctor side. We're consolidating basically all the doctors into one fund and then letting other people come in and buy into that fund that is representative of all the eight locations. So, we're doing that and we're doing the franchise separately. So, it's been fun. I think it's a good tool. And I think as a physician, I wish I had that tool early in my career to be able to say, "Hey, I want to invest in X and Y. And this is run by another doctor or a nurse or someone that knows the business".
John: We'll have to have you come back on in a couple of years and see how things are going. But I did want to say the following. As my listeners know, my wife owns a franchise for a home helpers' business and she's been doing it for 12 years now. And we're thinking of semi retiring to another state. And I asked her, I said, well, if we move somewhere, you could easily open your own in-home care business, you know how to do it. Would you bother with the franchise? And she said, I wouldn't do it unless I was part of a franchise. Because there's so much support and it's not just the protocols and the procedures and things they've worked out. It's the ongoing support. You've got people that you're in touch with on a regular basis, you can ask questions, they have quarterly meetings, they have annual meetings.
So, I think a franchise really simplifies the process of getting into that business. Yes, you have to pay a fee for it. It's not free, but, boy, I'm going to be really interested in seeing how this works out over the next few years.
Dr. Harvey Castro: Yeah. Thanks. And I'm excited. I'm really excited.
John: You're going to be a busy man for a while I think probably for the next couple of decades, the way things are going. But it does keep you young, huh?
Dr. Harvey Castro: It does, it does. I do want to shed some light. No matter what you're doing, I think it's important to just have fun. I love medicine. I love practicing. I loved the business side of it. So, I'm having fun. I love being on TV and just doing it. It's not for everybody. But once you find something that you love, I would just say, take off with it.
I have a big heart for single parents out there with kids, single kids out there that are just teenage kids, teenagers having kids. My mom had me at an early age. And so, I literally wrote a book called "Success Reinvention" to kind of help others out there. I'm in the process of writing my own course. I'm hoping in the next two months that course will be out to just help other parents that are out there trying to struggle, but trying to improve themselves.
And in November, we're doing a video tape with Amazon. Basically, I'll be on TV on Earth Day next year. For the pandemics, I'll be on an Amazon TV series called The Social Movement. So, I'm kind of excited.
But whatever it is, I'm sharing these things, not to brag at all. It's just to say, "Hey, you can use your MD, but do it with different things". Here I am, I wrote a book. I'm doing a course. I'm going to be on a TV series next year. It's just about wanting it and then whatever it is that you enjoy, just go with it.
John: Yeah. It's so much easier to create things these days. Imagine going back 30, 40 years before the internet. I mean you can create courses, you can get online, you can collaborate, podcasts weren't even a possibility. I guess it could be on the radio. But yeah, that's good. That's absolutely true.
Well, before we go. We're going to run out of time, a couple of things. To get a hold of you, probably a simple way might be through LinkedIn. Would that be appropriate?
Dr. Harvey Castro: Yes, sir. I'm on all the social networks, Facebook, Instagram, but LinkedIn, I check a lot. And so, if you don't mind, LinkedIn me, and if you don't have LinkedIn, then my email is harveycastro4@gmail.com. And I answer all my emails myself. So, feel free to contact me about anything.
John: That sounds good. And they can see what the company's up to at trustedmedicalcenters.com.
Dr. Harvey Castro: Trustedmedicalcenters.com. It has all our locations. It got some great blogs. We started our own podcast actually called Trusted Talks. It just talks about health care specific to Trusted ER, and we have our own marketing media. You'll see lots of videos that we do in house. It's actually pretty progressive.
John: All right, trustedmedicalcenters.com. And the podcast is sort of geared for patients?
Dr. Harvey Castro: Yeah, it's for patients. Exactly. Trusted Talks.
John: Okay. I'll get that down and I'll put that in the show notes as well and send that out. All right, I'm going to give you a chance to just give a little advice to a physician. A lot of the listeners are sort of like struggling. They're obviously listening to this podcast because we're talking to people that have done new things and they haven't all left medicine, but they've started something maybe with medicine or built on their background in medicine, but they're scared sometimes of fear of failure, all kinds of things. So, any last words of advice for people that are thinking about trying something new like that?
Dr. Harvey Castro: Yeah, so much to say. I think at the end of that, I want to make sure everyone knows that you need to just stop and smell the roses. Take time for yourself, take time for you because if you're running, running, running, you're not going to be able to build anything.
But if you have time for yourself, even if it's simple, like I know I sound like I'm crazy busy and I am, but at the end of the day, I make sure I do something for me. It may be calling my kids and maybe going for a walk. It's important for you to just take time.
Sometimes I literally turn off everything when I'm driving to work and I just enjoy the solitude and quietness. That's something that helps me get the energy. And then when I'm at work, I'm ready to go or whatever task I need to do, I have full of energy and get to do that.
Make sure you take time for yourself so that you can make it sure that you have the energy to do whatever it is that you're trying to do. And don't be scared. It's all about calculated risks. So just take time and research, whatever it is that you're trying to do and then do it.
One other quick advice is, look at life like a ladder. It doesn't matter about you getting there quickly. It's about you going up that run. And it can take you 10 years, 20 years. Here I am, I'm in my late 40s. I'm 47, I just got my MBA. And so, I always wanted to do that. I thought that back when I was 18 and I personally want to get my JD and I'm pretty sure I'm going to go get it when I'm 65. So, I'm still going to go up on that ladder.
John: All right, we're going to hold you to that now. You put that date out there. All right. Well, I really appreciate those comments and I think we've had a fun talk today and very motivational, inspirational. I appreciate that. We'll be in touch again in the future, I am sure, Harvey. So, thanks a lot for being here today.
Dr. Harvey Castro: I'm honored to be here. Thank you, sir.
John: You're welcome. Bye-bye.
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Transcription - PNC Episode 196
The Best Healthcare Leaders Never Give Up and Never Stop Learning
John: I was recently talking with the executive director at the University of Tennessee physician executive MBA program Kate Atchley, and of course they're a big longtime supporter of the podcast. And I asked if she had any suggestions for guests since obviously the physicians involved in their program are trying new things, advancing their careers, and many of them are doing nonclinical things or combinations. So, she introduced me to today's guest who is an emergency medicine physician, businessman and entrepreneur from Texas. Welcome to the podcast, Dr. Harvey Castro.
Dr. Harvey Castro: Thank you so much.
John: Hey man, it's good to see you live. We're looking at video today, even though this is a podcast, but it's good to see you and finally get a chance to spend a few minutes here and what you've been up to.
Dr. Harvey Castro: Yeah, I'm excited to be on the show and I'm excited to finally get to see you in person.
John: This is how we usually start. Just tell us a little bit about your background as far as your education, past clinical practice, and then we'll get into some of the nonclinical activities.
Dr. Harvey Castro: Well, I'm going to go way back. Literally, I couldn't afford college. So, I had to join the army to help fund college. I went to Texas A&M. I received two degrees there, a bachelor's of science and bachelors of art and political science and biomedical science. Because back in the day, I had this big aspiration of becoming a lawyer, a doctor, and a businessman. And so, I marched on and got into medical school and went to UTMB in Galveston, Texas.
Then I went to emergency medicine in Pennsylvania and started practicing medicine as a board-certified emergency physician. Loved it. But I always had this almost like a tickling to do something else. During residency, I was selling books that I wrote in med school. And then in residency, I started my heart vitamin company that I sold.
And then when I graduated, I started this thing called iPhone app. It was a new thing out there and I started trading apps. And so, I started combining medicine and whatever else I wanted to do with it. And at that time, I was combining technology with medicine. And so that was my educational background.
And then having all those accolades and things that I was doing, I started thinking, "Well, heck what if somebody taught me the business side of things? What if I actually got a degree in business?" Because all the things that I know of business, it's kind of like the streets of business. Like the street accolades is what I was learning and doing, but I thought if I had formal education, maybe I would be a better provider/business person in healthcare.
John: All right. But I know for a fact, just looking at your background that you are doing a lot of management before you decided to get the MBA, for sure. So, what kind of roles were you doing? We use this term commonly "medical director". That can mean a lot of things, but I kind of got the sense that there you, yourself or others were putting you in positions of helping them manage things. So, give us a little bit more detail on some of those positions you held.
Dr. Harvey Castro: Yeah. Excellent question. Early on, thank God, I was identified as the future leader. So, at the time the organization I was working with said, "Hey, we'd like you to go to the ACEF academy of leaders and go through all the phases. Phase one, phase two, phase three. And that leadership, learning that training, learning how to even talk to people. They put me as the assistant medical director, and then later I became the actual medical director of a free-standing ER in Dallas.
And that position helped me so much because I have had the leadership training. And so, then I was able to start free-standing. And within the first month I turned it around and made it profitable. It was literally from zero patients to profitable. And those leadership skills, going out to the community, talking to doctors, telling them about our business, looking at the different things.
And then later, I became a consultant in Texas. I literally would drive around or fly around the state of Texas and different companies would hire me to come and help them start their free-standing. And then after a while I thought, "I've been doing this so long. Why not start my own brand?" So, my business partner and I, we were in the business of rehabbing ERs that were failing. And so, we did one, within three months we rehabbed it, we had it profitable. It went very well. We were returning money back to our investors that have helped to start it. And then I said, "Why don't we start a company?" And we just came up with Trusted ER. And literally this was about three years ago. And in over three years, we've expanded to eight locations.
John: That's pretty rapid growth right there.
Dr. Harvey Castro: Yeah. It's crazy to turn around and see. We have about 350 employees, doctors, non-doctors, front office, different branches of the business. And to your point, you're right. We did all of this and then last year I went to school to get my MBA.
John: Okay. So now let's go back a little bit again. I want to kind of get the idea when you were doing the consulting and teaching others like how to improve their ERs? How long ago was that?
Dr. Harvey Castro: That was probably about seven years ago and it probably stopped about three years ago in the sense that I was just working for myself and just helping my own brand.
John: Now, at what point, have you stopped practicing? Or do you do the occasional shifts? How does that work for you and what was that transition, if there was one?
Dr. Harvey Castro: Yeah. That's an excellent question. I can honestly say I was working too much. I was working as an ER doctor. I was working in three different cities plus consulting. And literally I felt like I wasn't resting. Literally, I remember getting off at seven in the morning and then driving two hours and then going to a board meeting because there was this company, I started calling Trusted ER.
And I remember thinking "I can do this". And finally, after a year of doing that, I said, "You know what? This is not life. I'm just burning it on both ends". Then I took the leap of faith of saying, "You know what? I'm saying no to emergency medicine as far as a paycheck. And I'm going to put all my eggs into this Trusted ER and this'll be my daily bread". And it's really tough. Especially as other doctors know that it took so hard to get here. And then to say, "You know what? I'm going to stop practicing medicine and do more on the business side".
And so, now as far as clinical, the only way I would come into cover shift is if the medical director can't and then the chief medical officer can't and the regional can't. And then at that point it's me. But then at that point they usually fill up shifts. I really don't get to practice unless I want to go in and work a few hours.
But I'm more involved in teaching medicine and teaching the concierge portion of how we do emergency medicine, looking at the business side, looking at locations. And interesting enough over the years, especially with COVID, NBCUniversal, all the major networks have been calling me to do medical segments. And so, through peer reviews and looking at different cases in my experience in emergency medicine, which is over 20 years, I'm able to go in and talk about X and Y subjects. And so, last year I actually did about a hundred interviews on TV.
John: Really? Okay. I was wondering about that like, "Oh, maybe one a month for a few months", but a hundred interviews. I mean, that's actually something where that could be a whole career itself in terms of just being seen as the expert and promoting yourself and doing those kinds of interviews on a regular basis. But I see that it feeds into what you're doing from an ER standpoint, of course, and a business standpoint to promote what you're doing in Texas. That's awesome.
Dr. Harvey Castro: And it's fun. I feel like I can get back and it's a different medicine. When COVID hit and everybody was freaking out and scared, I hit the TV station up and said, "Hey, can we do a hotline? A free hotline, just call this number and we'll answer all your COVID questions". And we did this in March and we were on NBC and Telemundo. And I didn't realize that their outreach was all the way out to El Paso. So, we were getting thousands of calls and I had it literally on a list of doctors in the room together just calling and returning calls and just going through all their COVID questions.
But this was the fun part of medicine. When everybody's freaking out, I was able to get on TV and say, "Hey, let's look at X, Y, and Z. Let's talk about this". And it was actually a fun way of practicing medicine. Way different, but it's medicine.
John: Yeah. I think as physicians, we have no inkling of what things could be like if we kind of just open up to the possibility of whether it's expanding your own practice or creating something that has multiple sites or even opening a small hospital. I think you mentioned it is now part of this network.
Dr. Harvey Castro: Yes, sir. We opened our first hospital in Mansfield, Texas. And that was great because now we have the license to do other things. And so, for example, when COVID hit, we were able to start doing mobile testing. So, we were going to the employers. We were the first in Dallas to go out to the employers and test everybody at their location.
And then we were lucky enough to get the first PCR tests and antibodies tests and everything that one was coming out in Dallas. And we were able to show that on TV and have people come to our locations and get these tests and having that outpatient clinical license to be able to do these things. It was perfect timing. So, we actually started our own testing center. But again, I love being able to combine medicine and business and then trying to do something different.
I think it's hard and it's hard almost for us doctors to respect non-doctors in the business world, because they tell us to practice medicine in a certain way and we're like, well, you never help us at the scope and you never talked to a patient, you've never been in those situations. But when another fellow doctor is like I've been there, we've done this, I get that issue. And as the business side, these are the reasons why we want to fix it. And these are the things. So, it's actually been a different medicine that I feel honored and blessed to be able to do every day now. It's just different. No red tape.
John: Yeah, right. When you make a decision, I guess it's going to be implemented pretty quick if you're the CEO. But I do think there is a big need for more physician leaders. There was a time when more than half the hospitals in the country were actually owned by physicians. That's way back in the old days in the 50s. But now I think it's less than 5% or 6% that are led by physicians. And I think we do a whole lot better in medicine and in healthcare as an industry, if we had more physicians in charge of more things.
So, I think physicians should not shy away from that. Especially if they're interested, if they have an aptitude for it, like you've done, then just keep moving forward and you can contribute so much more doing that. I mean, in terms of the numbers of people you're affecting, I would think.
Dr. Harvey Castro: Yeah, it's been fun. I would encourage everybody to do that. Whatever you're good at and whatever medicine you're practicing, take it to the next level.
John: Absolutely. Now you talked about getting a little bit maybe burnt out while you're doing all these things and you say, "Well, maybe I got to cut the practice back at some point, if I'm doing all these business things", but then you decided, "Well, I'm going to go ahead and get this MBA". So, I want to hear what it's like from a student. I don't know that I've actually spoken directly to a graduate of the UT PEMBA before. I mean, I've talked to people and it's a common question I get about advanced degrees.
So, tell me what that was like and how did you carve out the time to do it? Because it's a pretty intense program. Go ahead and just run with that. Tell us about it, what your experience was and how you were able to manage that.
Dr. Harvey Castro: Honestly, I felt like I was going back to med school in that here's all this information being taught to you. I'm going to date myself. I'm going to school and being there and seeing just all the technology and laptops and plugins. I was like, "Whoa, this is so much more fun going to school now than back in the day when I went to school".
And the information was actually fun because we were given PowerPoints, we were given summaries, the books we were told to read. It was even more fun for me because it's like, "Wow, here's medicine and here's business. This is what I've been doing." So, I felt like I was able to get so much more out of it because now I was like, "Okay, now that makes sense".
And it's funny, it's kind of like riding a bike. It's hard to describe how to ride a bike, but once you start doing it, you do it, but then you don't really know why. Going to school was like finding out the "why". Why was I making these decisions? Why was I negotiating in a certain way? Why was I doing things? And it was great to get the Booksmart.
So having these professors talking to me about accounting and one-on-one and entrepreneurship, it was great hearing. Marketing was awesome, listening to different marketing ideas and theories and why things are done in a certain way. And then it's like, "Wow, that's just reinforcing some of the things I'm doing". And now I can actually improve my practice or running my business by using these tools.
As far as the time demands, oh my gosh. It was hard, because running a practice, running eight businesses, having the employees, being the leader, I would literally make time. So, every time I'd come home, I'd say, "Okay, I got to read this book. I got to summarize. I got to think about this". Or working on projects was really hard. Because imagine getting three busy physicians all together on a Zoom saying, "Okay, we are working on this project", it was hard. And then going to class every Saturday and then having a life for the Saturdays. I remember saying, okay, I want to go on vacation, but technically I have classes on Saturdays. So, it's going to be tough.
With that said, I'm glad I did it. Back in the day when I was in the army, I thought I really wanted my MBA one day and my MD. So, that was part of my goal and I wanted to get that. I'm glad I got it because I felt like I had the street-smart, but not the book-smart. And having both just gave me an extra layer of knowledge. And I was able to talk to my classmates and say, "Hey, the reason the professor is pointing X, Y, and Z is because this is how you'll see it in the real world. These are the accolades. These are the things that you need to focus on".
So, I can't say enough about the experience. I thought it was great. I think one of the things about me, I feel like I'm a lifetime learner so I'm all about going back. And today after this podcast, we are having a talk at the University and I'm going to be on it, just listening as a participant to learn more from the University. So, it's fun.
John: Yeah. We're going to try and actually put some of the things that they're presenting there. Dr. Kate Atchley said that we could actually promote that on the podcast. So, I'm going to be putting notices for some of those business-related courses for physicians or just the seminars because they are CME accredited. So, it sounds like it's a really good opportunity for those that are outside to kind of let them get familiar with the program.
But I know this is kind of a leading question. I kind of know the answer, but some physicians are like, "Well, I should've gotten my MBA back when, because then I would know how to run my practice better or run this group better". But I get the feeling that the virtue of an executive MBA is you're coming in when you've already had enough exposure to something that you actually know what you're looking for, when you hear it, it makes sense. I mean, you were talking about marketing before you did the MBA for your organization. And so, I guess my question is, would you agree with that? That there is some advantage to that?
Dr. Harvey Castro: There's a lot of advantages to having the experience of having a business. With that said I wouldn't preclude it as a prereq to go into getting your MBA. I always feel like it's important to have an end in line. If you're getting an MBA just to get an MBA, if that's your goal, that's fine. But if you're getting an MBA because there's X, Y, and Z, that you're wanting to get out of it, then you're going to get that out of the MBA. If you decide I just want to go through it and just see the bigger picture, then you'll get the bigger picture.
But I went into this very razor focus, like, "Okay, these are the things that I need to work on. These are the things I needed to do better on. These are the things that I should be open-minded to". So, every time certain lectures came, I was just taking it all in or pre-reading or trying to get the most or reading the notes. Actually, yesterday I spent some time looking at some of the old notes from our marketing professor and just reading through them I'm like, "Man, this is really good stuff that I need to apply". And so, I think it's important to have an end in mind. Why do you want the MBA? What are you going to get out of it? And then you'll get even more out of it.
John: Yeah, I think you could do either. I get that question all the time. Should I do this MBA or MHA and some other degree? It's a personal decision, but there's nothing wrong with trying to dabble in it a little bit in terms of the business side and then if you feel like you really want to pull the trigger. The other thing is if you can get an employer who will pay for part of it, that can be helpful.
Dr. Harvey Castro: Yes. Yeah, for sure.
John: The other thing I was going to mention is I'm assuming you had a pretty decent team that could at least free you up a few hours when you need to be freed up. It sounds like you have a pretty extensive well-run organization. So, I'm sure that helped.
Dr. Harvey Castro: It does. It does help. I felt bad for some of my classmates that said, "Hey, I just got off a shift and I'm here. I'm in a small group". And I'm like, "Oh my God, bless your heart. I can't complain. I was in bed last night. I slept in my own bed". And interestingly enough, I would say at least 40% of the class was emergency room. And so, that just tells me, I think there is a lot of burnout out there. A lot of doctors are like, "Man, holidays, weekends, I can't do this". And I think early in life, it's fun. And then later you're like, "Whoa, I have kids, I have this and that. It's not as easy to work a midnight shift as it used to be". So, I think doctors are looking to do something else.
John: Well, I've had a lot of guests on here who are ER docs. There seems to be something about the ER docs. I mean even urgent care, right? That's what I do very part time now. Half of them are either owned by ER docs or family docs. I mean, you got to have that broadest exposure to clinically. And of course, the ER docs usually have the more aggressive urgent cares where they do an IVs and things and do more procedures. But even beyond that, I can't tell you how many ER docs have been in start-ups or investing in some new company. So, I know there's something about the excitement I think of ER work and maybe the business excitement.
Dr. Harvey Castro: Yeah. I agree. I sincerely think being an ER doctor and I love all the professions, but being here, I think you tend to be a risk taker and that kind of evolves into the business world. And then you're more likely to say, "You know what? I'm going to jump in and start my own urgent care, even though I don't know anything about urgent care", because you're that risk taker. And sometimes to be successful, sometimes you need to take risks, calculated risks. And I think you see that in ER doctors.
John: Okay. Now I got to segue us into another business topic related to what you're doing. From what you told me before we got started today, you are in the process of franchising, what you're doing and maybe even looking for investors. So, explain that to us in some detail because I think we've talked about franchises, like being a franchisee and just signing on with somebody. But if somebody has a practice, a group practice, ER practice, something like that and what you're doing, how could you possibly consider franchising? Explain that to us.
Dr. Harvey Castro: Yeah. Well, it all comes down to what we're talking about today - Business. We all are healthcare providers. We spent hours and hours of taking care of patients. We know how to take care of patients, but do we know how to buy a business? Do we know how to negotiate a business? Unfortunately, when people see MD/DO behind your name, they're like, "Oh, that's a premium. We're going to charge you a little extra here".
So, what we decided is why not create a product that we can franchise and create that business. And in that way, we are negotiating, we know what the prices are. We already have the vendors. We have the system in place. Every organization that we've started, every ER, is very meticulous how we do procedures. We have a handbook. We have HR, accounting. We spend a lot of time making sure that when we opened and we grew so fast, we had to create these folders and processes.
And so, we've got it down to a science. And now we have our own HR, accounting, billing company, our own physician company, our own staffing company. So, we thought, why not create a franchise so that if another doctor wants to do the same thing, but do it in their community, here we go. We can support you. Not to promote myself or our company, but it's really hard to start a business, especially if you're going to make a lot of mistakes. And those mistakes sometimes cost a lot of money.
So, to me, it makes sense. And I'm personally looking actually at other franchises out there to say, "How can I invest in franchise X and Y?" Because they've already fine-tuned this. They've already fixed all the issues. They already know what issues are coming and how to avoid them. So, I would gladly pay a company to say, "Hey, come in and help me". I'm looking at some food industry places. And I'm like, I don't know anything about food, but this franchise is known. And that's why I thought, why not do the same thing?
On the Dallas side, we have eight locations. And we're about to launch basically a fund that if someone outside of Dallas wants to invest in Trusted ER, they can buy a share of the ADRs. And we're selling that. We have two parts of our business. One is an investor side and one is a doctor side. We're consolidating basically all the doctors into one fund and then letting other people come in and buy into that fund that is representative of all the eight locations. So, we're doing that and we're doing the franchise separately. So, it's been fun. I think it's a good tool. And I think as a physician, I wish I had that tool early in my career to be able to say, "Hey, I want to invest in X and Y. And this is run by another doctor or a nurse or someone that knows the business".
John: We'll have to have you come back on in a couple of years and see how things are going. But I did want to say the following. As my listeners know, my wife owns a franchise for a home helpers' business and she's been doing it for 12 years now. And we're thinking of semi retiring to another state. And I asked her, I said, well, if we move somewhere, you could easily open your own in-home care business, you know how to do it. Would you bother with the franchise? And she said, I wouldn't do it unless I was part of a franchise. Because there's so much support and it's not just the protocols and the procedures and things they've worked out. It's the ongoing support. You've got people that you're in touch with on a regular basis, you can ask questions, they have quarterly meetings, they have annual meetings.
So, I think a franchise really simplifies the process of getting into that business. Yes, you have to pay a fee for it. It's not free, but, boy, I'm going to be really interested in seeing how this works out over the next few years.
Dr. Harvey Castro: Yeah. Thanks. And I'm excited. I'm really excited.
John: You're going to be a busy man for a while I think probably for the next couple of decades, the way things are going. But it does keep you young, huh?
Dr. Harvey Castro: It does, it does. I do want to shed some light. No matter what you're doing, I think it's important to just have fun. I love medicine. I love practicing. I loved the business side of it. So, I'm having fun. I love being on TV and just doing it. It's not for everybody. But once you find something that you love, I would just say, take off with it.
I have a big heart for single parents out there with kids, single kids out there that are just teenage kids, teenagers having kids. My mom had me at an early age. And so, I literally wrote a book called "Success Reinvention" to kind of help others out there. I'm in the process of writing my own course. I'm hoping in the next two months that course will be out to just help other parents that are out there trying to struggle, but trying to improve themselves.
And in November, we're doing a video tape with Amazon. Basically, I'll be on TV on Earth Day next year. For the pandemics, I'll be on an Amazon TV series called The Social Movement. So, I'm kind of excited.
But whatever it is, I'm sharing these things, not to brag at all. It's just to say, "Hey, you can use your MD, but do it with different things". Here I am, I wrote a book. I'm doing a course. I'm going to be on a TV series next year. It's just about wanting it and then whatever it is that you enjoy, just go with it.
John: Yeah. It's so much easier to create things these days. Imagine going back 30, 40 years before the internet. I mean you can create courses, you can get online, you can collaborate, podcasts weren't even a possibility. I guess it could be on the radio. But yeah, that's good. That's absolutely true.
Well, before we go. We're going to run out of time, a couple of things. To get a hold of you, probably a simple way might be through LinkedIn. Would that be appropriate?
Dr. Harvey Castro: Yes, sir. I'm on all the social networks, Facebook, Instagram, but LinkedIn, I check a lot. And so, if you don't mind, LinkedIn me, and if you don't have LinkedIn, then my email is harveycastro4@gmail.com. And I answer all my emails myself. So, feel free to contact me about anything.
John: That sounds good. And they can see what the company's up to at trustedmedicalcenters.com.
Dr. Harvey Castro: Trustedmedicalcenters.com. It has all our locations. It got some great blogs. We started our own podcast actually called Trusted Talks. It just talks about health care specific to Trusted ER, and we have our own marketing media. You'll see lots of videos that we do in house. It's actually pretty progressive.
John: All right, trustedmedicalcenters.com. And the podcast is sort of geared for patients?
Dr. Harvey Castro: Yeah, it's for patients. Exactly. Trusted Talks.
John: Okay. I'll get that down and I'll put that in the show notes as well and send that out. All right, I'm going to give you a chance to just give a little advice to a physician. A lot of the listeners are sort of like struggling. They're obviously listening to this podcast because we're talking to people that have done new things and they haven't all left medicine, but they've started something maybe with medicine or built on their background in medicine, but they're scared sometimes of fear of failure, all kinds of things. So, any last words of advice for people that are thinking about trying something new like that?
Dr. Harvey Castro: Yeah, so much to say. I think at the end of that, I want to make sure everyone knows that you need to just stop and smell the roses. Take time for yourself, take time for you because if you're running, running, running, you're not going to be able to build anything.
But if you have time for yourself, even if it's simple, like I know I sound like I'm crazy busy and I am, but at the end of the day, I make sure I do something for me. It may be calling my kids and maybe going for a walk. It's important for you to just take time.
Sometimes I literally turn off everything when I'm driving to work and I just enjoy the solitude and quietness. That's something that helps me get the energy. And then when I'm at work, I'm ready to go or whatever task I need to do, I have full of energy and get to do that.
Make sure you take time for yourself so that you can make it sure that you have the energy to do whatever it is that you're trying to do. And don't be scared. It's all about calculated risks. So just take time and research, whatever it is that you're trying to do and then do it.
One other quick advice is, look at life like a ladder. It doesn't matter about you getting there quickly. It's about you going up that run. And it can take you 10 years, 20 years. Here I am, I'm in my late 40s. I'm 47, I just got my MBA. And so, I always wanted to do that. I thought that back when I was 18 and I personally want to get my JD and I'm pretty sure I'm going to go get it when I'm 65. So, I'm still going to go up on that ladder.
John: All right, we're going to hold you to that now. You put that date out there. All right. Well, I really appreciate those comments and I think we've had a fun talk today and very motivational, inspirational. I appreciate that. We'll be in touch again in the future, I am sure, Harvey. So, thanks a lot for being here today.
Dr. Harvey Castro: I'm honored to be here. Thank you, sir.
John: You're welcome. Bye-bye.
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