Interview with Dr. Jonathan Baktari
Today's guest is a fascinating healthcare technology company CEO. Dr. Jonathan Baktari received his medical degree at Ohio State. He then completed his internal medicine residency at Northwestern University and Pulmonary/Critical Care Fellowship at UCLA.
He was at the peak of his medical career when he saw a new opportunity.
Applying everything he’d learned as a doctor, medical director, and educator, he launched two businesses—a vaccine clinic and a drug-testing enterprise—that are driven by technology and designed for fast, customer-centric service. And he’s continuing to write his second career chapter as a healthcare CEO.
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Launching a Healthcare Technology Company
Dr. Baktari’s company e7 Health was named the best technology company in the healthcare space in 2019. e7 Health is a systems company that has developed its own electronic cloud-based software to benefit patients and clients.
Don’t think the FIRST thing you’re going to do has got to be THE thing. – Dr. Jonathan Baktari
In addition to vaccines, antibody testing, and many other medical services essential to employers around the country, e7 is now providing at-home COVID-19 testing all over the U.S.
Developed a Thriving Business
By identifying a problem for employers and developing a team to address those problems, he was quickly able to develop a thriving business. And he provided great insights into how to succeed in growing a business similar to his.
It takes leadership and the ability to find and hire experts in specialized fields such as technology. It also involves dedication and persistence. As Jonathan told us, it is often the people you meet while building your FIRST thing who open the doors for the NEXT thing.
Summary
Jonathan has really made a splash in his field. He is leading a rapidly growing company. And he shared useful insights with us during this engaging conversation.
I especially liked his comment about working through so-called failures or setbacks when he said, “Don’t think the FIRST thing you’re going to do has got to be THE thing.” I love that.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- e7 Health
- Dr. Jonathan Baktari's Website
- Dr. Baktari's LinkedIn Page
- Dr. Baktari's YouTube Channel (for patients)
- How to Nurture a Career in Cutting-Edge Healthcare Technology – 156
- How to Introduce Transparency to the Healthcare Marketplace – 113
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Podcast Editing & Production Services are provided by Oscar Hamilton
Transcription PNC Episode 202
Why This Critical Care Specialist Launched a Healthcare Technology Company
John: Today's guest has come a long way from practicing pulmonary and critical care medicine, but he certainly built his businesses on his clinical background. So, I'm really happy to welcome you to the PNC podcast. Dr. Jonathan Baktari. Welcome.
Dr. Jonathan Baktari: Hi, John. Thank you so much for having me.
John: This is going to be fun. There's a lot we can learn from you I think. You've done a lot of things and I'm always interested in hearing how someone does a startup that's in healthcare, but not a clinical startup. So, we usually start by just asking you to give us a little bit of background about yourself, like your education briefly, and your beginning clinical practice when you got out of residency and fellowship.
Dr. Jonathan Baktari: Right. Well, thank you. So, I actually went to college at Case Western Reserve University, got a degree in biology and psychology. Then I went to Ohio State for medical school, which was amazing. And then subsequently, I went to Northwestern University in Chicago for my internship and residency in internal medicine. And then lastly, I wind up at UCLA for my pulmonary critical care fellowship. And then I finished that out and then I took sort of a quasi-clinical faculty position at University of Hawaii. And then subsequently got recruited to a big pulmonary critical care private group here in Las Vegas and did that for some number of years. And then worked my way into administrative and regular nontraditional medical entrepreneurship.
John: So you spend a lot of time from what I was looking at your bio in doing some UM, and then you became like a regional medical director for an insurance company. So, did you start UM at the hospital setting or in the insurance setting or third-party? How did that all work?
Dr. Jonathan Baktari: So it was actually pretty much both. My first job was being medical director for Anthem Blue Cross Blue Shield for the state of Nevada. That was an insurance company, obviously. Then I was medical director for the Culinary Health Fund, which is a health fund that's run by the culinary union. So they have their own health funds. So I was their medical director. And of course in between that, I was chief of medicine at one of the hospitals. And I was briefly head of an ICU, medical director of an ICU. So, there was a whole hodgepodge of traditional what doctors do when they're involved in administrative stuff. But yeah, then after that I became medical director for utilization management for hospital systems.
So I've worked for hospitals and I've worked for the insurance side, which is interesting. And I've worked on the clinical side and I also during all that time was at a clinical faculty at three different med schools over my career. So, I talk about having the vantage point of four pillars, like doing clinical, doing teaching, being on the insurance side and being on the hospital side. And I think a lot of inspiration I got was seeing it from everyone's point of view.
John: Now, if I remember correctly, I was working in the hospital as a CMO, there was a time when it seemed like hospitals were very interested in hiring people into their executive team that had experience on the insurance side. Because they were looking at ACOs and how are we going to manage these patients if we have to take risks? Was that part of that whole effort for you?
Dr. Jonathan Baktari: I mean the hospitals I'm sure were interested in because I have all this experience on the insurance side. The one thing I would say about doctors who venture off outside of traditional medicine, the one thing I found is one door always opens up another door. It's like nobody comes to you and grabs you out of your clinical practice and says, "Hey, would you like to be head of this insurance company or head of this hospital?" or whatever. It's always one door opening another. If you get offered a position on a committee in a hospital, take it, if you have interest in it, because that's not the point, that committee may not be the point, but that being on that committee will actually open up another door.
John: I mean, just what you learn on a committee like that. It's just different from clinical medicine. It's just a new scale, being on a committee, managing the committee. So, I'm thinking you would have been set up perfectly to continue in leadership and insurance companies or a health system, but then all of a sudden I see something totally entrepreneurial going on here. So, how did that come about from this whole background in which was really in corporate medicine in a sense, at that level.
Dr. Jonathan Baktari: That was almost as big of a leap as leaving clinical medicine and going into administrative medicine, then leaving administrative medicine, which is more corporate and literally being the entrepreneur and just literally following you. I think part of it is you get to see the pros and cons and how much impact you can have being clinical. And then you can see how much of an impact you can have being on the corporate side. And then you can see the kind of impact you can have in terms of doing things the way you want to do it, based on what you see maybe needs to be improved.
The downside of course is as you go from clinical to working for a corporation to starting your own thing, you kind of feel like you're jumping out of a plane with less and less of a parachute every time, because there is no backstop once you get to that point. I mean, it is what it is. And you could say a lot of pros and cons of clinical medicine, but the one great thing about it is you always have a paycheck and there's always income coming. And there's always this trade-off.
John: Most physicians are pretty risk averse. I mean, we're trained to be clinically and most of us shun the idea of starting something brand new from scratch. But tell me how you did that transition. Were you still working in one field and you decided to do the startup? And how did that whole thing transpire?
Dr. Jonathan Baktari: Yeah. With almost all of them, I always say if you're working 40 hours a week in clinical, you need to start working 80 hours a week in clinical administration. And once you got a foothold in, pull the clinical back. And I'm saying the same thing when you go to entrepreneurship, there's always a two to three year transition time because it allows you to really not panic and scramble, if the first thing you do doesn't turn out your way. But it does require you to initially work more so you can in theory work less, if that makes sense. So initially, you have to invest more time, and not just come back.
But yes, then eventually I cut my clinical back at half-time, after I felt like I had gotten a strong foothold into administrative. And even when I went from administrative to entrepreneurship, I cut the administrative back to half-time and focused on entrepreneurship until I was ready to do that full-time.
John: That sounds very logical, very intentional. That's very good. Not everyone can do that, but it sounds like you had a good plan. So what was the niche or the problem you are solving with that first entrepreneurial venture .I'd just be interested in your thought process on that.
Dr. Jonathan Baktari: Specifically, or why did I want to go into entrepreneurship? What was I trying to change globally or specifically when we started? Like specifically?
John: Like specifically, when you started the first venture, but then also tell us about the big picture.
Dr. Jonathan Baktari: The big picture, let's start with that is initially when you do administrative medicine and you do clinical medicine, like for example, when one of the things I found really frustrating when I was a clinician is a lot of times I saw hospital improvements.
Like when a hospital wants to make an improvement. For me, it was often very frustrating because all the improvements were done, to me, it seemed like a lot of improvements were done on the back of the doctors. Oh, you got to write your orders more legibly back when they were being written. You got to input more data here. You're not filling out that form. Which is fine, but often if you think about it back, now they have hospitals that are often hospital employees, but when the doctors are not hospital employees, a lot of the work is put on the back of the doctors because they're not paid.
And so we can just pile and often not in an efficient manner. In other words, it wasn't like leveraging technology. It was just, okay, doctors need to fill out this and do this and verify that. Which was good, but why not invest in technology to make the doctors do what they're supposed to do? And also the regular staff.
So, I think it was this lack of investment in technology. There was no real incentive to do it. And remember, electronic medical records took forever to take hold. There was a lot of inertia. Now of course everyone takes it for granted, but we could have had electronic medical records a decade sooner. But I think there was not enough "Why should we do it?" And so that was very frustrating to see that we weren't leveraging technology. And no one could say the medical establishment is really good at catching on to the latest wave of technology, right? We were the last ones in.
John: We were at least a decade behind.
Dr. Jonathan Baktari: Right. And then we're always doing it with a gun to our head. So I think it was that frustration with the lack of technology globally that I noticed at least on the clinical side. And then when I went to the administrative side, again the administrative side I found was very rewarding. I got a lot of skills, but it was really hard to make changes. It was like moving the Titanic. Almost every corporation will tell you to change or make progress. So when you factor those two things, you say, "Okay, we need to leverage technology and we can't be slow to make every change". If you put that together, what is the environment that addresses both those immediately? When it's your technology and your environment. And you're not making decisions with committee after committee, after committee.
The lure of that seems so obvious. And so, that's how I eventually got to where I got. Because we've become a software development company masquerading as a healthcare company. And we're able literally to make change. Like when COVID hit, oh, my gosh, our software development team got together. We are integrating with and launching nationwide all home and work saliva testing. We're going to integrate with a lab. We're going to create a patient portal. We're going to create a company portal. We had the team ready to go. And we were on the very few that rolled that out pretty early in the pandemic, nationwide COVID saliva testing, FDA authorized. We teamed up with a lab at Rutgers University. And again, if it was a corporation, I don't know how long that would have taken, but when there's a pandemic going on, you want to literally meet and say, "Okay, that's really great, we're working on this, but now we're going to rework it on this".
John: Right. Yeah, things don't happen that quickly in a big corporate structure at all. Everything has to be planned out. It has to be part of a strategic plan most of the time. So, I guess I'd like to know a little bit of the picture behind the curtain there. So, you're not a computer guy, right?
Dr. Jonathan Baktari: I'm not a computer guy, but I got to tell you I've always had the latest cell phone.
John: Okay. So, you weren't afraid of it.
Dr. Jonathan Baktari: I'm not a computer guy per se, but I'm at the forefront. I'm the champion of pushing technology in our organization because I see the value of what technology can do if done correctly, which in our organization, it's got two main focuses. Remove human error in delivering care and improve quality and two, reduce friction for the user experience for the patient and for the staff.
I don't know if you want to get into this, but let's just take electronic medical records. If you were going to build electronic medical records for anyone, and you want it to be successful, the one thing you would tell your software developers is, the most important thing about any electronic medical records is how well it does in getting reimbursed from third parties. Because it could provide all the great user experience, but if you don't get reimbursed for Medicare Medicaid, it won't really matter.
So you have to understand now that I've been in this electronic medical records world, the number one thing that software developers have to keep in mind when they're creating them is that we can't afford to go down 20% on our reimbursement when someone switches to our EHR EMR. So, once you know that you're beholden to this third party as the main driver of your software, a lot of other things take a back seat, and that's the physician and medical staff user experience. How much is really focused on preventing human error in delivering care, and how much could we focus on improving quality and care, leveraging technology.
If you can get the third party as your main focus and focus on those other things, we've created electronic medical records that don't exist anywhere in the world. Not because we're so smart, not because we're so good, not because we have the best developers. It's just that no part of our software deals with third-party reimbursement. So, that allows us to do magical things. We have 10,000 positive reviews on our website. I don't think any company in the world has 10,000. And all of it speaks to our technology and the user experience that that brings them.
John: So the healthcare is vast, it's huge, it's inpatient, it's outpatient, it's nursing homes, it's whatever. So you had to start somewhere. You didn't start with this technology that solved a problem for everybody. So, just give us a little taste of like, what was it you were trying to solve and how did you build this thing without going into too many steps? But how did you get the team together? Where'd you get the funding? That kind of stuff.
Dr. Jonathan Baktari: That was amazing. Well, if you want to know the tidbit, originally, it was a travel medicine clinic that does preventative care for travel medicine. And we quickly realized that we had all of these adult vaccines and a refrigerator that could be used for other things. For example, people have no idea that corporate America spends billions of dollars on vaccines, physicals and annual hearing tests, vision tests, to comply with government regulations and to keep their employees safe. It has nothing to do with primary care or urgent care. And same thing with schools, allied health schools, and other institutions, defense firms, construction companies. All of these have a plethora of preventative health care measures they need to do to comply with government regulations and other government bodies. And also to keep their employees safe.
And nobody was looking at that as a prime focus of the business. They were just doing it sort of as I call it as a "side hustle" to whatever else they were doing. And we said, "Well, why don't we take all those side hustles and put them as the main hustle?" If I can call it that. Because when you do something as a side hustle, the people who are getting the service know that you're doing this as a side thing, right?
So, when you walk into urgent care to get a pre-employment drug test or physical, I think you can figure out that this is not really what they do. Or if you go to an occupational med place to get a TB skin test for nursing school or whatever, you're going to figure out this is not their core business, but probably because you're sitting next to someone with a gash on their forehead. And you're just there to get a flu shot and a TB skin test. So you can start nursing school or you can get a job at a hospice or something.
So, it became very obvious that this whole area of adult vaccination for organizations, for schools, for employers and for retail clients was being ignored. What would happen if we took all of that and made it out of business? And had the exclusion of primary care, urgent care and OCC med.
And then if we added technology, for example, if you come into one of our clinics and you ask for anything, let's say you asked for a vaccine, but you have an allergy that excludes you from having that vaccine, in our system, if the staff tries to put it in, it won't let you, if you've already put that allergy. We even checked with the state database before you come in to see. You may not know you had it as a kid, we may know and not offer it to you. So, these are just small examples of what technology can do. That's on the quality side.
But on the reducing friction we are probably the only medical institution I know in the country that doesn't have a medical records department. And the reason we don't have a medical records department is there's nothing we can do for you that wouldn't be in your patient portal by the time you got to your car.
John: Nice. Now does this communicate with the purchasers as well? Like the companies that need this for their employees?
Dr. Jonathan Baktari: Yeah, so it's amazing because what we do is, we even have a company portal. So, as long as the patient signs off that the company can have access to that service for HIPAA reasons, yes, it will be uploaded and we can custom make the portal for that company's need. If the company says we have five locations and we'd like them compartmentalized based on location, based on departments, we'd like to search it based on the calendar year. We can customize that company portal to be a solution for the company. So, they're not in the data management business.
John: Very cool. All this we're talking about now is the current e7 Health. That is the organization that is doing this now. Are there any new things that you're starting to branch off into? It sounds like over time you have taken on additional roles in that space.
Dr. Jonathan Baktari: Well, yeah, e7 stands for seven books of business. So we do all seven, but they're all interrelated in the sense that a lot of our clients use more than one book of business. And what we're doing now is just any third party software that we were using, we're now integrating those third party software and creating it on our own so that we will be complete. We still use Slack and other third party software. So as every quarter rolls by, we have a list of one quality improvements and a list of third party software that we can integrate into our system.
John: Can you give us some idea, like either the scope of the business now in terms of the size or number of clients or something, and the change over time? It'd just be interesting to know because I know you're out west compared to me, I'm in the Chicago area. So, you're out west somewhere in Nevada, but tell us about that.
Dr. Jonathan Baktari: Yeah. We have two clinics in Southern Nevada and we focus on those. We've been around for 10 years, our revenues grow 20% or more year over year if you average it over those 10 years, and that shows no sign of stopping. From a revenue model. And you asked earlier how we do it? We bootstrapped it and we have no outside investors. We have no debt. We basically took a lot of our profits and just reinvested it in to get us this far. So that's been our model.
John: All right. That's a true entrepreneur, just growing and growing. And so much is based on technology. Do you have a sizable team in terms of the technology team at this point?
Dr. Jonathan Baktari: Yeah, we have I would say a group of software developers that, and the nice thing is we have resources to bring in additional people that are contracted, but yeah, we have a group of 5 or 10 core people, and then we have ability for specific projects to contract out more.
John: Well, this all sounds very exciting. This sounds like it is fun. It's probably a lot of headaches and a lot of work too, but it's fun. So, what kind of advice do you have for physicians out there who are kind of in a similar place where you were 10, 15 years ago? Medicine's fine. But they just have an interest. Maybe there's some problems out there that need to be solved. And so, what comments would you make to them?
Dr. Jonathan Baktari: I think the biggest struggle is psychological because no matter what complaints you have about clinical medicine, you're probably making a decent paycheck every month or whatever. And it's really psychological, especially if you have a family, a mortgage or to say, "Hey, I'm going to rock that boat because of this potential thing". And I think that's the biggest hurdle. No matter what you think. If we just went to the hospital doctor lounge and talked to your typical doctor, a high percentage of them would want to do something else if they could snap their fingers.
The question really is are you willing to rock the boat? And I think that's the biggest hurdle. Look, doctors are super smart. They're great, a very intelligent bunch. What keeps them from doing administrative medicine, starting a company, getting involved in other things, it's literally as I always tell my colleagues who were thinking about it, it's a pool that doesn't have a shallow end. You just have to jump into the deep end. And that's a financial thing. Also, I think we talked offline. You just spent 15, 20 years, however long to get to where you are. And then you got to say, you know what? That was really great. I'm glad I went to that residency. I'm glad I did that fellowship. And I'm glad I became a senior partner in the group, but let's check all that and move to something else. So that's almost next to impossible if you frame it like that, if you're really thinking like that. Who does that? Who fills up their shopping carts and has it all full and then says I'm not going to buy anything?
And so I think those are the two psychological barriers. I think how do you tell your family, "Hey, this really nice paycheck we're getting might be in jeopardy and how do you say to yourself, well what was that fellowship for? What was that residency for?" Even in my group, I'm a senior partner now, how do I walk away from that?
John: Well, as you're telling me that, and I'm thinking even about your situation, first of all, and here's what I would say to people. That it isn't a step back or a step off to move from let's say clinical to something else. In my mind, what you're doing is a step up, it's a step beyond. You've taken all the clinical and all that other experience you've had. And now you're even building something that's going to potentially have a much bigger impact. So, it's hard to look forward to that though, because it takes so long to get there, it seems.
Dr. Jonathan Baktari: It takes so long. And you're going to have to go through this transition period where you may be doing both. And so, you're like looking at potentially working more for a couple of years and potentially making less.
John: There's usually that dip that can occur at the beginning, but the rewards at the end, if it works, they're usually pretty good. And even if it doesn't work, you learn and you move on.
Dr. Jonathan Baktari: Not to get anecdotal, but I have a friend of mine who was a CMO for 20 years and that it was just one position and he was doing clinical, but both. And we were talking one day and he had some other opportunities and it's comfortable what he had. And initially I said, you got to jump in the deep end. And when he finally did give it up, initially, I think the first 6 to 12 months, like what have I done? And now he's so happy, when everything's settled.
John: It's not a trivial decision by any means, but yeah, the majority of the time works out because physicians are very resourceful and they can make it work if they are really committed to it and they enjoy it, especially. All right, we're going to run out of time here soon. So, e7 Health, it is kind of regional at this point, local? If I was in Chicago, I couldn't access e7 Health service?
Dr. Jonathan Baktari: No. We're just focusing on Southern Nevada right now. But our long-term plan is to come up with a strategy to grow nationally.
John: All right. Well, I still would recommend people look at e7health.com just to get an idea of what it looks like. It's good to look at a website and say, "Okay, what the heck has he got going?" But also at your website jonathanbaktarimd.com they can learn more about you there. We haven't talked about all your speaking engagements and you're kind of a local expert on COVID.
Dr. Jonathan Baktari: I know. We're doing a lot of teaching and we're doing a lot of COVID. We did a lot of stuff during the pandemic. A lot of that's on our website. E7 and our other projects are on the website, but yeah, it's a great way to keep up with us. And of course, if anybody wants to connect directly, LinkedIn is also an option. Go on my profile and we can connect.
John: Okay. We'll put links to everything in the show notes. Any last words of advice for a physician who's sitting on the fence right now and might be thinking about adding something to his or her plate?
Dr. Jonathan Baktari: Well, I guess the only other advice I would say is don't think like the first thing you're going to do has got to be duffing. The first thing you do will give you some insight and often people you meet during that first thing will potentially help open the door for the next thing. And it always works like that. And I know you have had administrative positions, you didn't go from, "Oh, I'm seeing patients" to a CMO. It's always one door opening another.
John: Absolutely. That is awesome advice. All right, Jonathan, thank you so much for being with us today. I've really enjoyed listening to what you've done and I'll be happy in the future to kind of see where things go.
Dr. Jonathan Baktari: Thank you so much, John.
John: All right. Bye-bye.
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Transcription PNC Episode 202
Why This Critical Care Specialist Launched a Healthcare Technology Company
John: Today's guest has come a long way from practicing pulmonary and critical care medicine, but he certainly built his businesses on his clinical background. So, I'm really happy to welcome you to the PNC podcast. Dr. Jonathan Baktari. Welcome.
Dr. Jonathan Baktari: Hi, John. Thank you so much for having me.
John: This is going to be fun. There's a lot we can learn from you I think. You've done a lot of things and I'm always interested in hearing how someone does a startup that's in healthcare, but not a clinical startup. So, we usually start by just asking you to give us a little bit of background about yourself, like your education briefly, and your beginning clinical practice when you got out of residency and fellowship.
Dr. Jonathan Baktari: Right. Well, thank you. So, I actually went to college at Case Western Reserve University, got a degree in biology and psychology. Then I went to Ohio State for medical school, which was amazing. And then subsequently, I went to Northwestern University in Chicago for my internship and residency in internal medicine. And then lastly, I wind up at UCLA for my pulmonary critical care fellowship. And then I finished that out and then I took sort of a quasi-clinical faculty position at University of Hawaii. And then subsequently got recruited to a big pulmonary critical care private group here in Las Vegas and did that for some number of years. And then worked my way into administrative and regular nontraditional medical entrepreneurship.
John: So you spend a lot of time from what I was looking at your bio in doing some UM, and then you became like a regional medical director for an insurance company. So, did you start UM at the hospital setting or in the insurance setting or third-party? How did that all work?
Dr. Jonathan Baktari: So it was actually pretty much both. My first job was being medical director for Anthem Blue Cross Blue Shield for the state of Nevada. That was an insurance company, obviously. Then I was medical director for the Culinary Health Fund, which is a health fund that's run by the culinary union. So they have their own health funds. So I was their medical director. And of course in between that, I was chief of medicine at one of the hospitals. And I was briefly head of an ICU, medical director of an ICU. So, there was a whole hodgepodge of traditional what doctors do when they're involved in administrative stuff. But yeah, then after that I became medical director for utilization management for hospital systems.
So I've worked for hospitals and I've worked for the insurance side, which is interesting. And I've worked on the clinical side and I also during all that time was at a clinical faculty at three different med schools over my career. So, I talk about having the vantage point of four pillars, like doing clinical, doing teaching, being on the insurance side and being on the hospital side. And I think a lot of inspiration I got was seeing it from everyone's point of view.
John: Now, if I remember correctly, I was working in the hospital as a CMO, there was a time when it seemed like hospitals were very interested in hiring people into their executive team that had experience on the insurance side. Because they were looking at ACOs and how are we going to manage these patients if we have to take risks? Was that part of that whole effort for you?
Dr. Jonathan Baktari: I mean the hospitals I'm sure were interested in because I have all this experience on the insurance side. The one thing I would say about doctors who venture off outside of traditional medicine, the one thing I found is one door always opens up another door. It's like nobody comes to you and grabs you out of your clinical practice and says, "Hey, would you like to be head of this insurance company or head of this hospital?" or whatever. It's always one door opening another. If you get offered a position on a committee in a hospital, take it, if you have interest in it, because that's not the point, that committee may not be the point, but that being on that committee will actually open up another door.
John: I mean, just what you learn on a committee like that. It's just different from clinical medicine. It's just a new scale, being on a committee, managing the committee. So, I'm thinking you would have been set up perfectly to continue in leadership and insurance companies or a health system, but then all of a sudden I see something totally entrepreneurial going on here. So, how did that come about from this whole background in which was really in corporate medicine in a sense, at that level.
Dr. Jonathan Baktari: That was almost as big of a leap as leaving clinical medicine and going into administrative medicine, then leaving administrative medicine, which is more corporate and literally being the entrepreneur and just literally following you. I think part of it is you get to see the pros and cons and how much impact you can have being clinical. And then you can see how much of an impact you can have being on the corporate side. And then you can see the kind of impact you can have in terms of doing things the way you want to do it, based on what you see maybe needs to be improved.
The downside of course is as you go from clinical to working for a corporation to starting your own thing, you kind of feel like you're jumping out of a plane with less and less of a parachute every time, because there is no backstop once you get to that point. I mean, it is what it is. And you could say a lot of pros and cons of clinical medicine, but the one great thing about it is you always have a paycheck and there's always income coming. And there's always this trade-off.
John: Most physicians are pretty risk averse. I mean, we're trained to be clinically and most of us shun the idea of starting something brand new from scratch. But tell me how you did that transition. Were you still working in one field and you decided to do the startup? And how did that whole thing transpire?
Dr. Jonathan Baktari: Yeah. With almost all of them, I always say if you're working 40 hours a week in clinical, you need to start working 80 hours a week in clinical administration. And once you got a foothold in, pull the clinical back. And I'm saying the same thing when you go to entrepreneurship, there's always a two to three year transition time because it allows you to really not panic and scramble, if the first thing you do doesn't turn out your way. But it does require you to initially work more so you can in theory work less, if that makes sense. So initially, you have to invest more time, and not just come back.
But yes, then eventually I cut my clinical back at half-time, after I felt like I had gotten a strong foothold into administrative. And even when I went from administrative to entrepreneurship, I cut the administrative back to half-time and focused on entrepreneurship until I was ready to do that full-time.
John: That sounds very logical, very intentional. That's very good. Not everyone can do that, but it sounds like you had a good plan. So what was the niche or the problem you are solving with that first entrepreneurial venture .I'd just be interested in your thought process on that.
Dr. Jonathan Baktari: Specifically, or why did I want to go into entrepreneurship? What was I trying to change globally or specifically when we started? Like specifically?
John: Like specifically, when you started the first venture, but then also tell us about the big picture.
Dr. Jonathan Baktari: The big picture, let's start with that is initially when you do administrative medicine and you do clinical medicine, like for example, when one of the things I found really frustrating when I was a clinician is a lot of times I saw hospital improvements.
Like when a hospital wants to make an improvement. For me, it was often very frustrating because all the improvements were done, to me, it seemed like a lot of improvements were done on the back of the doctors. Oh, you got to write your orders more legibly back when they were being written. You got to input more data here. You're not filling out that form. Which is fine, but often if you think about it back, now they have hospitals that are often hospital employees, but when the doctors are not hospital employees, a lot of the work is put on the back of the doctors because they're not paid.
And so we can just pile and often not in an efficient manner. In other words, it wasn't like leveraging technology. It was just, okay, doctors need to fill out this and do this and verify that. Which was good, but why not invest in technology to make the doctors do what they're supposed to do? And also the regular staff.
So, I think it was this lack of investment in technology. There was no real incentive to do it. And remember, electronic medical records took forever to take hold. There was a lot of inertia. Now of course everyone takes it for granted, but we could have had electronic medical records a decade sooner. But I think there was not enough "Why should we do it?" And so that was very frustrating to see that we weren't leveraging technology. And no one could say the medical establishment is really good at catching on to the latest wave of technology, right? We were the last ones in.
John: We were at least a decade behind.
Dr. Jonathan Baktari: Right. And then we're always doing it with a gun to our head. So I think it was that frustration with the lack of technology globally that I noticed at least on the clinical side. And then when I went to the administrative side, again the administrative side I found was very rewarding. I got a lot of skills, but it was really hard to make changes. It was like moving the Titanic. Almost every corporation will tell you to change or make progress. So when you factor those two things, you say, "Okay, we need to leverage technology and we can't be slow to make every change". If you put that together, what is the environment that addresses both those immediately? When it's your technology and your environment. And you're not making decisions with committee after committee, after committee.
The lure of that seems so obvious. And so, that's how I eventually got to where I got. Because we've become a software development company masquerading as a healthcare company. And we're able literally to make change. Like when COVID hit, oh, my gosh, our software development team got together. We are integrating with and launching nationwide all home and work saliva testing. We're going to integrate with a lab. We're going to create a patient portal. We're going to create a company portal. We had the team ready to go. And we were on the very few that rolled that out pretty early in the pandemic, nationwide COVID saliva testing, FDA authorized. We teamed up with a lab at Rutgers University. And again, if it was a corporation, I don't know how long that would have taken, but when there's a pandemic going on, you want to literally meet and say, "Okay, that's really great, we're working on this, but now we're going to rework it on this".
John: Right. Yeah, things don't happen that quickly in a big corporate structure at all. Everything has to be planned out. It has to be part of a strategic plan most of the time. So, I guess I'd like to know a little bit of the picture behind the curtain there. So, you're not a computer guy, right?
Dr. Jonathan Baktari: I'm not a computer guy, but I got to tell you I've always had the latest cell phone.
John: Okay. So, you weren't afraid of it.
Dr. Jonathan Baktari: I'm not a computer guy per se, but I'm at the forefront. I'm the champion of pushing technology in our organization because I see the value of what technology can do if done correctly, which in our organization, it's got two main focuses. Remove human error in delivering care and improve quality and two, reduce friction for the user experience for the patient and for the staff.
I don't know if you want to get into this, but let's just take electronic medical records. If you were going to build electronic medical records for anyone, and you want it to be successful, the one thing you would tell your software developers is, the most important thing about any electronic medical records is how well it does in getting reimbursed from third parties. Because it could provide all the great user experience, but if you don't get reimbursed for Medicare Medicaid, it won't really matter.
So you have to understand now that I've been in this electronic medical records world, the number one thing that software developers have to keep in mind when they're creating them is that we can't afford to go down 20% on our reimbursement when someone switches to our EHR EMR. So, once you know that you're beholden to this third party as the main driver of your software, a lot of other things take a back seat, and that's the physician and medical staff user experience. How much is really focused on preventing human error in delivering care, and how much could we focus on improving quality and care, leveraging technology.
If you can get the third party as your main focus and focus on those other things, we've created electronic medical records that don't exist anywhere in the world. Not because we're so smart, not because we're so good, not because we have the best developers. It's just that no part of our software deals with third-party reimbursement. So, that allows us to do magical things. We have 10,000 positive reviews on our website. I don't think any company in the world has 10,000. And all of it speaks to our technology and the user experience that that brings them.
John: So the healthcare is vast, it's huge, it's inpatient, it's outpatient, it's nursing homes, it's whatever. So you had to start somewhere. You didn't start with this technology that solved a problem for everybody. So, just give us a little taste of like, what was it you were trying to solve and how did you build this thing without going into too many steps? But how did you get the team together? Where'd you get the funding? That kind of stuff.
Dr. Jonathan Baktari: That was amazing. Well, if you want to know the tidbit, originally, it was a travel medicine clinic that does preventative care for travel medicine. And we quickly realized that we had all of these adult vaccines and a refrigerator that could be used for other things. For example, people have no idea that corporate America spends billions of dollars on vaccines, physicals and annual hearing tests, vision tests, to comply with government regulations and to keep their employees safe. It has nothing to do with primary care or urgent care. And same thing with schools, allied health schools, and other institutions, defense firms, construction companies. All of these have a plethora of preventative health care measures they need to do to comply with government regulations and other government bodies. And also to keep their employees safe.
And nobody was looking at that as a prime focus of the business. They were just doing it sort of as I call it as a "side hustle" to whatever else they were doing. And we said, "Well, why don't we take all those side hustles and put them as the main hustle?" If I can call it that. Because when you do something as a side hustle, the people who are getting the service know that you're doing this as a side thing, right?
So, when you walk into urgent care to get a pre-employment drug test or physical, I think you can figure out that this is not really what they do. Or if you go to an occupational med place to get a TB skin test for nursing school or whatever, you're going to figure out this is not their core business, but probably because you're sitting next to someone with a gash on their forehead. And you're just there to get a flu shot and a TB skin test. So you can start nursing school or you can get a job at a hospice or something.
So, it became very obvious that this whole area of adult vaccination for organizations, for schools, for employers and for retail clients was being ignored. What would happen if we took all of that and made it out of business? And had the exclusion of primary care, urgent care and OCC med.
And then if we added technology, for example, if you come into one of our clinics and you ask for anything, let's say you asked for a vaccine, but you have an allergy that excludes you from having that vaccine, in our system, if the staff tries to put it in, it won't let you, if you've already put that allergy. We even checked with the state database before you come in to see. You may not know you had it as a kid, we may know and not offer it to you. So, these are just small examples of what technology can do. That's on the quality side.
But on the reducing friction we are probably the only medical institution I know in the country that doesn't have a medical records department. And the reason we don't have a medical records department is there's nothing we can do for you that wouldn't be in your patient portal by the time you got to your car.
John: Nice. Now does this communicate with the purchasers as well? Like the companies that need this for their employees?
Dr. Jonathan Baktari: Yeah, so it's amazing because what we do is, we even have a company portal. So, as long as the patient signs off that the company can have access to that service for HIPAA reasons, yes, it will be uploaded and we can custom make the portal for that company's need. If the company says we have five locations and we'd like them compartmentalized based on location, based on departments, we'd like to search it based on the calendar year. We can customize that company portal to be a solution for the company. So, they're not in the data management business.
John: Very cool. All this we're talking about now is the current e7 Health. That is the organization that is doing this now. Are there any new things that you're starting to branch off into? It sounds like over time you have taken on additional roles in that space.
Dr. Jonathan Baktari: Well, yeah, e7 stands for seven books of business. So we do all seven, but they're all interrelated in the sense that a lot of our clients use more than one book of business. And what we're doing now is just any third party software that we were using, we're now integrating those third party software and creating it on our own so that we will be complete. We still use Slack and other third party software. So as every quarter rolls by, we have a list of one quality improvements and a list of third party software that we can integrate into our system.
John: Can you give us some idea, like either the scope of the business now in terms of the size or number of clients or something, and the change over time? It'd just be interesting to know because I know you're out west compared to me, I'm in the Chicago area. So, you're out west somewhere in Nevada, but tell us about that.
Dr. Jonathan Baktari: Yeah. We have two clinics in Southern Nevada and we focus on those. We've been around for 10 years, our revenues grow 20% or more year over year if you average it over those 10 years, and that shows no sign of stopping. From a revenue model. And you asked earlier how we do it? We bootstrapped it and we have no outside investors. We have no debt. We basically took a lot of our profits and just reinvested it in to get us this far. So that's been our model.
John: All right. That's a true entrepreneur, just growing and growing. And so much is based on technology. Do you have a sizable team in terms of the technology team at this point?
Dr. Jonathan Baktari: Yeah, we have I would say a group of software developers that, and the nice thing is we have resources to bring in additional people that are contracted, but yeah, we have a group of 5 or 10 core people, and then we have ability for specific projects to contract out more.
John: Well, this all sounds very exciting. This sounds like it is fun. It's probably a lot of headaches and a lot of work too, but it's fun. So, what kind of advice do you have for physicians out there who are kind of in a similar place where you were 10, 15 years ago? Medicine's fine. But they just have an interest. Maybe there's some problems out there that need to be solved. And so, what comments would you make to them?
Dr. Jonathan Baktari: I think the biggest struggle is psychological because no matter what complaints you have about clinical medicine, you're probably making a decent paycheck every month or whatever. And it's really psychological, especially if you have a family, a mortgage or to say, "Hey, I'm going to rock that boat because of this potential thing". And I think that's the biggest hurdle. No matter what you think. If we just went to the hospital doctor lounge and talked to your typical doctor, a high percentage of them would want to do something else if they could snap their fingers.
The question really is are you willing to rock the boat? And I think that's the biggest hurdle. Look, doctors are super smart. They're great, a very intelligent bunch. What keeps them from doing administrative medicine, starting a company, getting involved in other things, it's literally as I always tell my colleagues who were thinking about it, it's a pool that doesn't have a shallow end. You just have to jump into the deep end. And that's a financial thing. Also, I think we talked offline. You just spent 15, 20 years, however long to get to where you are. And then you got to say, you know what? That was really great. I'm glad I went to that residency. I'm glad I did that fellowship. And I'm glad I became a senior partner in the group, but let's check all that and move to something else. So that's almost next to impossible if you frame it like that, if you're really thinking like that. Who does that? Who fills up their shopping carts and has it all full and then says I'm not going to buy anything?
And so I think those are the two psychological barriers. I think how do you tell your family, "Hey, this really nice paycheck we're getting might be in jeopardy and how do you say to yourself, well what was that fellowship for? What was that residency for?" Even in my group, I'm a senior partner now, how do I walk away from that?
John: Well, as you're telling me that, and I'm thinking even about your situation, first of all, and here's what I would say to people. That it isn't a step back or a step off to move from let's say clinical to something else. In my mind, what you're doing is a step up, it's a step beyond. You've taken all the clinical and all that other experience you've had. And now you're even building something that's going to potentially have a much bigger impact. So, it's hard to look forward to that though, because it takes so long to get there, it seems.
Dr. Jonathan Baktari: It takes so long. And you're going to have to go through this transition period where you may be doing both. And so, you're like looking at potentially working more for a couple of years and potentially making less.
John: There's usually that dip that can occur at the beginning, but the rewards at the end, if it works, they're usually pretty good. And even if it doesn't work, you learn and you move on.
Dr. Jonathan Baktari: Not to get anecdotal, but I have a friend of mine who was a CMO for 20 years and that it was just one position and he was doing clinical, but both. And we were talking one day and he had some other opportunities and it's comfortable what he had. And initially I said, you got to jump in the deep end. And when he finally did give it up, initially, I think the first 6 to 12 months, like what have I done? And now he's so happy, when everything's settled.
John: It's not a trivial decision by any means, but yeah, the majority of the time works out because physicians are very resourceful and they can make it work if they are really committed to it and they enjoy it, especially. All right, we're going to run out of time here soon. So, e7 Health, it is kind of regional at this point, local? If I was in Chicago, I couldn't access e7 Health service?
Dr. Jonathan Baktari: No. We're just focusing on Southern Nevada right now. But our long-term plan is to come up with a strategy to grow nationally.
John: All right. Well, I still would recommend people look at e7health.com just to get an idea of what it looks like. It's good to look at a website and say, "Okay, what the heck has he got going?" But also at your website jonathanbaktarimd.com they can learn more about you there. We haven't talked about all your speaking engagements and you're kind of a local expert on COVID.
Dr. Jonathan Baktari: I know. We're doing a lot of teaching and we're doing a lot of COVID. We did a lot of stuff during the pandemic. A lot of that's on our website. E7 and our other projects are on the website, but yeah, it's a great way to keep up with us. And of course, if anybody wants to connect directly, LinkedIn is also an option. Go on my profile and we can connect.
John: Okay. We'll put links to everything in the show notes. Any last words of advice for a physician who's sitting on the fence right now and might be thinking about adding something to his or her plate?
Dr. Jonathan Baktari: Well, I guess the only other advice I would say is don't think like the first thing you're going to do has got to be duffing. The first thing you do will give you some insight and often people you meet during that first thing will potentially help open the door for the next thing. And it always works like that. And I know you have had administrative positions, you didn't go from, "Oh, I'm seeing patients" to a CMO. It's always one door opening another.
John: Absolutely. That is awesome advice. All right, Jonathan, thank you so much for being with us today. I've really enjoyed listening to what you've done and I'll be happy in the future to kind of see where things go.
Dr. Jonathan Baktari: Thank you so much, John.
John: All right. Bye-bye.
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