The Secret to Scaling a Values-Driven Business (from a Surgeon Who Did It) | Ep 237 with Dr. Charles Ruotolo Founder of Total Orthopedics & Sports Medicine

0:04so dr charles rutolo of total orthopedics and sports medicine something that i've been noticing as i've gotten older now in my 40s it's like every time i do something different i lift you know what's been a little bit of total But Dr. Charles, what do you tell either patients or people? What do you recommend as we are starting to hit over 40s plus? Is there something we should be doing differently or something we should not be doing at all? Well, I think if you're having pain when you're exercising or pain in general, you should be consulting with your orthopedic doctor for, you know, for musculoskeletal pain.

0:52Because sometimes there's just one exercise that makes all exercises hurt. So whether it's doing military presses for your shoulder or doing deadlifts with your back, sometimes there's one exercise that makes everything else miserable. And I think going over your exercise program with your orthopedic surgeon could help you kind of figure out what might be the thing that's causing the pain and what you could do to make everything else not hurt again. And the goal for all this is to continue to be exercising. So when you look at for your lifestyle or something that you feel is a healthy form of exercise or an amount of exercise, what do you normally do on a daily basis?

1:31I think you should be exercising at least four to five times a week. Certainly, you want to be doing some aerobic exercise. Also, muscle mass is an important thing, especially as you get older. As you get older, you lose muscle mass. So doing some type of weightlifting also is good for your muscles. It's also good for your bones. It helps prevent osteoporosis. So you should be doing a combination of weightlifting as well as aerobic. Amazing. So when you looked at why you even got into this industry, looking back, going back a few years ago when you first started, what was that spark? First time I saw orthopedic surgery, it excited me.

2:10You're restoring function. A lot of it was hands-on, which was very interesting to myself. And the other thing is, it's a specific problem people come in with. Like, I have this pain, I had this injury, and you work to fix that, which is much different than the medical patient comes in and says, I feel old, I feel tired, and they're on 30 meds. And on that, it was hard for me to focus. Your head would start spinning when someone says, I'm 300 pounds and I'm tired. What do you do differently? But in orthopedic surgery, I think the other interesting thing is, these are problems that everyone's having.

2:47You know, and even when I was in medical school and you're studying about the heart, you're studying about the lungs and the kidneys. All my friends, whenever they had a question, it was always about orthopedic surgery. You know, it was like I hurt my knee, I hurt my elbow. Why does my wrist hurt? And it was funny in medical school, you really don't learn too much about that. You really learn it in your training. And I'd always say, well, gee, we don't really, really don't learn that yet. So that's what sparked my interest is just how common it is, how it affects everyone through all age ranges.

3:18When you look at the success of your practice, I know you do a multitude of things. You have different doctors that specialize in different things. What helped build the success of your practice? And I think this is great for other people that are aspiring doctors or maybe they already have a practice and they want to grow and build it. So I think as the president of Total Orthopedics, I think the most important thing is I'm on the front line. I'm a very busy doctor in the practice, and I try and make my practice physician-friendly. You know, and physicians, there's a myriad of reasons why physicians get frustrated, whether it's about, you know, the way the EMR works or about the insurance companies or how they have to get pre-approvals for all this stuff.

4:01So anything you can do to make the physician happier on that end helps. And then my other philosophy is when you hire physicians, if a physician loves his job 90 % of the time, but 10 % of the time you make them go do something that they hate doing, they'll hate their job 100 % of the time. So, you know, I always explain that to people is like, the only thing I care about is that they're successful, you know, on the business end of it. You know, it's a business, so they have to make money, right? And that they do a good job with patients. Outside of that, if someone doesn't like getting sent to this far out clinic because it drives them crazy, I don't make them do it.

4:42Find what they want to do, make sure that they excel at what they're doing and go with that. Don't try and fit every square into a round hole. It just doesn't work. As most businesses, we go along, we always want to add in some sort of service, maybe a new product. How do you look at it when you're like, OK, we've mastered this service, then I want to add a new service because you have a multitude of services. And I think a lot of businesses, they maybe do it too soon or they're not effective with adding in the service because they might take away from, you know, a service that they were offering previously.

5:17Yeah. So I think trying to be ahead of the curve is very important with any business. You know, you don't want to be late to the party. So, you know, we added an orthopedic urgent care years ago before most people had an orthopedic urgent care because you want easy access. When you tear your ACL on a soccer game on Saturday, you don't want to make a phone call on Monday and hear the doc can see you a week later. You're like, nobody's waiting that long. If you're limping around, you want to make sure you didn't break something, you know, make sure you don't have a fracture, make sure you didn't need surgery right away.

5:53So the orthopedic urgent care kind of helped with that model. And again, it's 2025. Nobody wants to wait more than, nobody wants to wait an hour, right? Like you want to be able to log on to something and get an appointment and be seen that day, right? So I think trying to stay ahead of what's going on is important. But when you set up any of these things, you know, you got to go through your business model. You got to kind of work out how you're going to do it, who's going to do it. It's not easy setting up a new business. And you got to devote time and resources to that. Our current big project is Total Wellness.

6:28We're setting up a wellness center for our patients. And I think that's excellent because most patients coming into orthopedics just want to feel better. They want to feel younger. They're concerned about longevity and aging. And so I think that's a great complement to what we're doing. but uh we've spent i've spent almost a year setting this all up our opening date is on july 7th um you know a lot of time and energy a lot of conferences i went to researching like what we can offer so i think if you're gonna if you're gonna do something new don't go in half half in like you gotta go in a hundred percent you gotta put the people around you to help you to be successful you know i think that's that's the goal with anything that you're gonna start any type of project.

7:14We've talked to some other doctors and practice owners around this whole new thing with this concierge type medicine, where I think a lot of people now are looking for something, you know, they don't want to go and, and you mentioned it before, you don't want to go and wait 15 hours at the emergency room, or you can't get a doctor for a week, two, three weeks later. How are you seeing health transform with this new, more concierge, more custom type to the person healthcare that people are willing to pay more for? Yeah. So, I mean, everyone's time is important. And I explain this to my staff all the time.

7:50If, if you're booking patients three weeks out, right. If you just worked a lot harder for the first three weeks, then you could book because you're going to see the same amount of patients. If you just catch up on those three weeks, then you could see everyone the day up, right. It's, it's, it's just catching up on, that lag. I think you have to think about what you would want as a patient. As a patient, nobody wants to wait three weeks to hear why I can't walk or why I can't sleep because my shoulder is killing me. So I think as long as you kind of look at it that way, it kind of fixes all the problems.

8:26But certainly concierge medicine is the way to be successful. It's like a hotel. If you run it like a five-star hotel, you will be filled. You'll have happy people. And if you You run it like a two-star motel. You might get some business here and there, people coming, but it's only because they couldn't find somewhere else to go. So I like that. Run it like a five-star hotel. I think a lot, a lot of practices, uh, they need to hear that. When you look at the advancements in technology now, you and I were talking earlier about AI and I'm sure, you know, robotics, like my dad just had robot surgery and the doctor was in a total different country, which blows my mind.

9:04But how do you see the advancements of technology transforming maybe not just the industry that you're in, but maybe even surgeries overall? There's a lot of great things that are happening under AI and robotics. There's there's these virtual surgeries there. There's surgeries where you'll be doing a shoulder replacement and you're wearing a headset and you kind of see your pre-op templated plan like overlapping what you're doing. and so you can match up what you're doing with what you pre-oply templated. You know, you're not like, I kind of remember how I planned it. It should be this or that.

9:40So that right there is amazing. On top of that, there are some things that they're doing now with virtual where you're wearing a headset and an expert in the field that might be, you know, that might be doing this the last 40 years. You'll be talking to them and the two of you are conversing over and seeing the same thing that you're operating on in front of you, right? So you're talking to the great expert in the field on whatever it is in the shoulder or knee that you're doing, and they might be interacting with you as you're doing it live, which is amazing. And then on the business end, just AI in general is just going to drive business to be more efficient.

10:24So we're putting in place now an AI system that'll answer the phone 24 hours a day, seven days a week, and make appointments. That's an unheard of thing. If you thought just two years ago, that would be something you couldn't do. But imagine being able to call your orthopedic surgeon at midnight on a Sunday night and get an appointment for Monday. And as a business, Monday morning is always the busiest time. How do you staff for Monday morning phone calls? In medicine, between 8 and 10 on Monday, we get like 10 times as many phone calls as you get the rest of the week. But imagine if you could field all those phone calls on Friday, Saturday, and Sunday and make all those appointments so the patients don't have to wait till Monday.

11:08This excites me. It's like I remember Google had the Google Assistant many years ago. They said, we're going to come out with this. And I thought to myself, like, I don't know. How is that going to work? Are we as humans going to be accustomed to talking to this AI agent over the phone? But now that we've been, you know, ChatGBT obviously got us all into like, you know, talking to AI. I was just watching a video about a man. It was a CBS New York actually interviewed this guy. He asked ChatGBT to marry him and it said yes. And now his wife is really upset because he's really in love with ChatGBT.

11:45So I think we as humans now are already open to the idea of talking to AI, but that's really great. When you look at what makes a successful surgeon, because I imagine that has to be one of the most complex jobs anyone can have. I mean, I could I don't think I would ever qualify to be a surgeon. But when you look at what makes a successful surgeon, what are a few of those traits that you've seen? One is dedication and repetition. right like you get better and better the more you do something um and the more you dedicate yourself to perfecting what you're doing so so um you know constantly watching videos listening to what other people are doing you know it's like being the coach of a football team like the idea and plays other people come up with great plays to counter what you're doing and so you have to be constantly kind of looking at what everyone's doing because someone might have a great idea that you didn't think of yourself.

12:44So, so there's constantly changing in orthopedic surgery, how we do things. Um, and so to stay up with that, that's important. Um, two is just dedicating yourself to, to repetition, doing things over and over again, you get better and better. Like a musician gets better and better, the more they, they play an instrument. And then the last thing is paying attention to your outcomes. And I think this is where some people fail. Like if you don't examine your patients, if you don't communicate well with your patients, if you don't track your outcomes, you may not realize that something that you're doing really doesn't work that great.

13:20You know, just because you read a paper that says everyone comes out, you know, 90 % success rate doesn't mean that that's true for your patient population. And so you want to be tracking your patients, really taking a close look at your patients, doing a full exam every time they come in to see where they're at and how they're doing. That's amazing. I mean, you know, hats off to you and anyone else who does surgery because uh you know we i can i would think when we look back you know pre-surgery and how things are post you know the ability for us to as a species human race to do surgery um you know how much better are we today how much better do we feel like you said there's there's so many reasons why i'm grateful and i can't wait one day if i need to go somewhere I want to go to your practice.

14:08And really, it's very interesting. I've never heard a doctor talk about the five-star experience, being there 24-7. I can tell that you're really at the forefront of medicine and having the patient, everything is really around the patient. So if people want to get in touch with you, they want to find out more information, how can they do so? So you can go to TotalOrthosportsMed.com. That's our website. you could certainly google us um you know total orthopedics and sports medicine um if you're and if you're injured and you're on long island just come to total ortho express you know we have four locations um you know you can walk right in our mass pego locations open up seven days a week so um you know we're willing to see you at pretty much at any time well dr charles rutolo thank you for joining us and thank you for all you do to help I'm sure thousands of people every year get better stay better be healthy I would I would look back like in our life and say you know the doctors that made a difference I would remember them more than like teachers I don't even remember any teacher but I can tell you like the doctor that I had you know when I injured my knee or the doctor that helped me in these certain situations so you know shout out to all the doctors and a good doctor is like a teacher because he should teach you about what your problem is and what you can do to make it better.

15:32If you're not teaching, you know, you're not helping. The best teacher is now that I know I and I thank you for that. And I hope a lot of other doctors also, you know, take on that same mindset. But thank you for joining us today on Founders Story. Great. Thank you. Thank you, Daniel.