Unbankable with Alex Shvarts

Welcome to Unbankable, the podcast for entrepreneurs who won't take no for an answer. I'm Alex Schwarz, and today we're talking about something that's revolutionizing healthcare. How physicians are breaking free from traditional medicine to build direct pay practices that actually serve patients. Because here's the reality. The health care system is broken. But smart doctors are creating alternatives that work better for everyone. Let's dive in. Today I'm joined by Dr. Dimmitri Gelmaker, a concierge medicine practice that's redefining healthcare in South Florida. Dr. Gelmaker is a boardcertified in internal medicine, obesity medicine with fellowship training in preventive medicine and nutrition. But here's what makes his story fascinating. He's built a direct pay medical practice that focuses on prevention, longevity, and personalized care rather than insuranceanced driven conveyor belt of traditional medicine. Through programs like transform 360 and his ninephase biohacking approach, Dr. Gillmaker has created what he calls medicine for the unbankable, serving patients who want premium health care without limitations of insured networks. He's here to share how physicians can build sustainable practices outside the traditional system and how patients can take control of their healthcare. Doctor, welcome. A pleasure to be here. May I call you Dimmitri? Of course. We're friends, right? And longtime friends. Longtime friends. And the first time we met, we went sailing on your yacht. Do you remember that? Actually, you forget. We met 20 years before that. Uh we played But you weren't a doctor back then, so I mean, you weren't important enough. So I uh we played poker in your in your basement. I Who won? Uh I think you gave up. I gave up. I don't quit. You you were winning so much you just gave up. Yeah. So you've been doing great. Like I'm watching your career and and your practice explode and it's exploding because you're um you're doing something different. And and that's what what I want wanted you to hear. I wanted to talk about it what that's like, how building that is. Um, and I think we're going to share a really good story for our audience here. You know, this podcast is is is designed to give information to help entrepreneurs, no matter what business they're in. Entrepreneurs who don't take no for an answer. And I know you you don't take no for an answer. You're going to find a way how to make things happen, how to get yes, and how to succeed. So my first question to you is what's the last no that you got? As a physician, you're trying to always find um common ground with people you're talking to because you have to convince them of doing something. So you get a very readily you get someone super resistant to what you want to do. But in medical school is about onethird of people will actually listen to what you have to say. So you get nos all the time. But you have to find what motivates people, what's uh what's going to get them to the next level and then work with them with that. So do patients tell you, you know, like you tell a patient, you got to do this, you got to do that, you got to think about it like think about it like this. You know, if I'm telling someone to quit smoking and they say no, you know, that's you can only go so far as try to convince somebody in the time that you have what's good for them, right? Yeah. Through what's good. So you work with what what you can and eventually you build a relationship of trust of love of friendship and they start listening to you. Uh but if they're resistant at first and you push against their no, you come up, you know, come up against a businessman. But putting medicine aside, you're also a businessman. You're an entrepreneur. You're building something, right? I mean, you not not everything is always a yes. You don't always get your way. So, you know, there's a there's an expression that doctors make terrible business people because we're too nice. We're trained to be nice. And um you have to work through that. Um there's no business training in medical school and dentists get far more training. You know, I went to the I went to New Jersey medical school and half of the school was dentists. There was a dental school there, too. And the dentist, you know, went through almost an entire year of business training before they finished the same amount of time, four years. And they were because you're ready to go out of practice. Some may some do residency, some do orthodontics, whatever. Um, but physicians, you go to residency and there's very little in the business of medicine and how to actually succeed in life. The American Society of Physicians and Surgeons, I think that's what they finally published a statement saying that we're talking about the word provider, you know, providers, providers, cuz the nurse nurse practitioners are becoming quote unquote doctors now. Oh, yeah. especially in Florida and opening up right and opening up their own shops and slinging Botox and they'll do all kinds of things peptides now and and they were like well doctors shouldn't be called providers I'm like guys take it easy with this who cares what you're called you know what you don't want to be called employee that's what you don't want to be called as a physician right because once you get into this rat race with uh administrators who are probably nurses because think about it, they finish school 22 and by the time you're done with your training and schooling, they already have 15 years of experience. They maybe have gone and gone and done an MBA and maybe I've gone and done a master's degree, a PhD or something else and are running the show and and writing your checks. It's an interesting point which leads me to this question. So you left traditional medicine to build GD care as a direct pay system, concierge medicine. What was the breaking point that made you say I'm done with insurancebased medicine? What happened for 2 years before I started a my practice? I worked for a company, a big company. I'm not going to say the name. Um but they were doing something called Medicare Advantage. Okay? So it's uh Obamacare. Okay. quote unquote VIP for the poor. It's great. You look at it, you know, it's like, wow, you know, people can get affordable health care. They can go get go see a doctor. They don't have any money at all. I became medical director of this fine institution and started looking at their books and said, I'm not not going to work here anymore. They get the cheap medicine. They get access to doctors that gets, you know, are only approved through through somebody that's not their doctor. they get uh sent to the cheaper hospitals. So the way Obamacare works in this whole Medicare Advantage scheme is that the physician and really the insurance company gets paid a lump sum of money and then out of that lump sum the patient gets care. So what do you incentivize as a business owner of somebody who runs a Medicare Advantage um facility is to spend as little as money as possible on each individual patient so you can keep the rest, right? So I looked at that and I'm like guys uh I'm out. Okay. And started my own practice and with the goal of providing people with exceptional healthcare um through spending a lot more time with them, treating every single person that walks through my office like family and uh you know really changing the the South Florida landscape and how medicine is being run here. Um it's it's been a journey. Let's talk about that specific model called uh concierge medicine. What does that actually mean for patients? How do you price services when insuranceances are not involved? Every doctor needs to decide what's their price point, right? Um how much are you willing to work for? If you're a physician looking to start your own practice, you have to decide what you're what you're comfortable with. And that can change over time. Um, and you have to give people a reason to pay you, right? You're most people will come to you initially like, "Hey, do you take my insurance?" And you have to figure out what you're offering them and if it's worth uh the amount the price point that you set it at, right? So, some, you know, the way I did it is like, look, how much how much money am I comfortable making in a year and divide by uh divide that by 2,000 hours, right? That's how most people work 40-hour work weeks and that's how much I'm going to be charged per hour. But what we're doing now is not really doing hourly. It's more of a membership or you know a program based. So you can sign up for a program like a weight loss program or concierge program or a peptide program or now we're launching a longevity program where it's going to have a hyperbarics, red light, IVs, peptides all stacked together. Uh what I don't like to do is nickel and dime people for a few shuckles. You stack everything together and you provide that and keep it simple. Uh you know this like a menu of services some people offer. I try to have like three. Keep it simple, right? And um and then work with each individual person as they come. Some people ask you for discounts. I try not to discounts. What I try to do is tell them, hey, you want to give you less services. That's fine. That there's a different price point for that. So, you have to be a salesman at some point, too. Yeah. I mean, listen, every CEO, right, has got to learn how to sell. There's a good book called uh to sell is human. Recommended. Um the best line out of that book is never try to upsell anyone. Upserve them. I like that. I like that. If you're trying to make more money in your business, you don't you don't try to push to have them buy something more from you. Says, "How about I give you 12 IVs in included in your service?" and they'll be so happy they'll pay you the the premium. Right. Right. So, I sell I always sell you're either uh selling a brand or you're on sale. Okay. And people never care about something where they're getting a deal or on sale. They treat it very differently. So, if you take luxury brands, right, for example, Hermes or Louis Vuitton, you're not getting that on sale, right? You're just not. And that's why people want it. That's it, right? As opposed to other brands. Oh, I'll wait till, you know, what's coming up right now? Memorial Day or Labor Day or Fourth of July. I'll be able to get that cheap. That's just a different um attitude and approach people have to this. Um, good. Good. Um, interesting stuff. So, you worked for someone else and then you had to launch your your own practice, right? That required money, capital. At Funkite, we've provided funding to a lot of medical practices, um, general practitioner, all all specialties, um, certainly a lot in the dentistry world. A lot of, you know, medical practices turn to us because they can't go to a bank and get money, right? So, we know the space very, very well. But some people, you know, um, they get money otherwise. So, what was your secret? How were you able to launch your practice and and and get it off the ground and be comfortable and if you can share that obviously. Yeah, I I'm cuz it would be interesting to other you know. So I was lucky enough that uh I had savings that I could tap into. Um and uh cuz I worked for 3 to four years I think four years as a local hospitalist which I traveled all around the country. They paid you a little bit extra but you're never home. I spent 185 days in a in a Marriott hotel and then after that um I worked for this other company and when I left they gave me severance. I quit and they gave me severance. So, you know, I knew something to shut you up cuz you had to sign that agreement. Right. Right. And uh I didn't sign anything. I just left. But they still gave me severance just as keep me keep me happy. But anyway, so I bootstrapped. I didn't raise any capital. I went founded, you know, a very nice office from a friend of mine and he gave me one room uh for a,000 bucks. Started my practice with $1,000 investment and my wife was a nurse and extremely uh good with paperwork, did all of my credentiing uh to make sure that we were ready to launch and we knew that. So, I had my uh I had my first child in November and took a three-month uh paternal leave, then got a three-month severance. So, I had a 6 months uh to think and plan and and build and actually started working while I was still getting uh my severance. So, I was still getting paid from the other job while I was building your own thing. Scared? It was not scary. It was just, you know, initially uh it's a lot of work, you know. Um, you believed you were going to pull this off, right? Yeah, I I knew I was going to succeed. We had a, you know, a few obviously, you know, rough patches that we were not sure, but we we started growing pretty rapidly. Uh, we I knew where to seek new patients from and we were well positioned where we were to acquire that and started doing aggressive marketing almost immediately. Uh, and that has scaled up uh, exponentially as with our success. So I never tried to uh shoot you know more than than I had. I always bootstrapped and iterated and really really uh was uh um you know ground floor um you know nickeling and dimming at first trying to make sure that nobody overcharging us and you know arguing over $40 from a marketing fee. So a lot of a lot of uh entrepreneurs no matter what field they're in um they don't have that knowledge like you have right you know you have the brain for this right you had the mental capacity on how to build a business manage cash flow um and keep track of everything but what do you say to someone who doesn't somebody who's working for another practice wants to go on his own wants to be the next Dr. and um you know, but they're they're scared, but but they don't like the system. They don't like what's working. You know, what do you say to them? Are there resources they can go and find to do all of this? Uh New York City Public Library. We're in Miami. Whatever. Get them Miami doesn't have as much access New York City uh public library or easier just, you know, get yourself a Kindle account and start reading. started leading, learning about leadership, learning about marketing, learning about business, learning about, you know, how to sell. Everybody's trying to sell something. The doctor is trying to convince someone to quit smoking. That's selling them on a better lifestyle, longevity, all of that. Right. Right. You know, we're all trying, you know, a father who's trying to tell a daughter, don't eat, you know, chocolates before dinner is trying to sell them on on this idea, right? You're you're you have to convince someone of some doing something. Paul was trying to do that. There's nothing wrong with being a salesman. Grifter is a different story obviously, but you know, if you're approaching it correctly, people would want to buy from you. This is, you know, differentiate successful people. Um, but in terms of where do you start, you start at start at the beginning. You know, go on chat and Google or, you know, look up uh what the top 10 leadership books I should read today or this year and start reading. Start going through it. It's a dollar, right? Like it's like the goodwill hunting, you know? You can pay for a Harvard degree and spend half a half a million dollars on that or what is it? A $150 and lay charges, right? The local library. Right. Right. You know, just buy buy some books on leadership and start start learning. You know, again, there in medicine, nobody teaches you this stuff unless you're with the right mentor and all of that. you know, I was lucky enough uh to be surrounded by successful family members and pointed me in the right direction. Um, but a lot of it I just had to just grab the books and just figure it out. I actually I got into MBA school, one of the top schools, and I went on a ski trip with a few friends of mine and they're all like kind of MBA business guys. Um, and I'm like, "Hey, I got into uh business school." And they're like, "So what?" I'm like, "Should I go?" I'm like, "How?" He's like, "How about this? Give me $40,000. will give my MBA it's a useless piece of paper you know you got to learn on the street you got to learn it by doing and uh to to learn learn the science of business you just read the books just you know where one thing doctors are good at is doing their research and learning right so just learn learn business it's just another skill like anything else you can be a surgeon you can you also learn how to manage accounting how to market and how to sell and how to be a a leader right okay very Good. Very good. There's hope. There's hope for those who don't. Yeah. It takes a little bit. It takes a little bit of charm as well and skill. Yeah. Charm, but there's hope for those that have a fear of the unknown. And um you got a little blueprint. That's very good stuff. So, listen, the biggest game in town right now is peptides, right? Sure. Everybody's talking about peptides. Everybody's taking peptides. It's the like the the latest latest thing, right? Um your take on it? Yeah, it's a craze, you know. It is a craze. There's about 19 peptides that were banned under 2024 Biden administration. Now, so RFK is is big into wellness and doing all kinds of things that are novel. Um, so coming this summer, a lot of those peptides are going to be taken off the category 2 list or the band list. Um, and are going to be made, you know, more readily available. Right now, people are getting them from the from the Gym Bros, you know, Jim Bro Science and getting all the information on Instagram and all that. Um, how do you know what's a good peptide, what's a bad type, bad peptide? How do you make this the same? Look, so it is novel. It's it's complicated. Um, you take peptides. Yeah, you've tried some. Yeah, you do look good. I got to tell you. I don't know what it is about you right now, man. You know, Dr. P or Dr. D, which one is it? You know what it is? It's uh vitamin C. Vitamin C. That's my secret. Um, so peptides some are FDA approved and should be used by people that need it. Um, some are much more gray and some are black. Um, you know, this one called epitholon, I like to call it the Putin peptide, uh, cuz he talks about that he's going to make him live forever, right? Maybe that's that'll be controversial. Um, so, uh, the biggest peptide in the world is insulin, right? It's been around forever. It's a hormone that your body makes. It's a peptide. tells your body and people have been taking it for treat diabetes for a long time now. The biggest one that's coming that's out is uh essentially the GLPS glucagon like peptide. So peptides are just signaling molecules. They just tell your body what to do and taking it exogenously from the outside will convince your body to do other things. So some peptides have been out for a long time and they're coming back. Uh couple that come to mind are curlin and tessimorin. Uh those are growth hormone boosters. Um a lot of studies have been done. So tesamemoralin is is pretty intense. It can cause insulin resistance although no published data has reported on that but that's all the gym bros. That's what they're doing. Um combine that with rea which is not even out yet. So you know you had ompic mangaro and now rea um it's essentially they took mangaro and they put in u glucagon into it. So in medical school we're all thinking why isn't everybody on glucagon and they started adding glucagon and people are injecting glucagon now. And in a hospital they'll give it to you. They'll give you glucagon if your sugars drop. Mhm. Right. To boost your sugars. So it mobilizes all your fat stores. Right. So people are getting shredded on it. Um, not out yet. Not FDA approved yet, but Jim bro Science, right? Again, so you have to be really careful about where you source it. So if it's not out, who's making it? So what I can tell you right now here and now there's four labs in the world that manufacture peptides. They all come from the same place, including the ones that Ela Lily makes, uses foraro. They're all in Shanghai. Don't tell me it's the the Wuhan lab. It's it's not far away. Wow. So, a lot of this stuff is being onshored, right? So, the Trump administration is not only trying to deband some of these peptides, uh, but they're also trying to onshore a lot of the pharmaceutical manufacturing. So Lily uh who manufactures by the way it's my daughter's name so I love that name but the the manufacturer of Mangaro right now you know the the biggest uh FDA approved diabetes and weight loss treatment the tersatite um so they under SEC reports they list that they source their API the active pharmaceutical ingredient from China. Now online people are every, you know, every entrepreneur is launching a peptide company. Now you're probably going to want to launch one after we finish this conversation. I won't. Right. Um because I don't know enough about it and I'm not here to to and that's that's a big problem is that I get approached on a daily basis of people that can you sponsor my peptide company and can you be the doctor for my I'm like you know who are you? You know like what what are you bringing to the table? There's an expression, you know, say no to the good to make room for the great. So success beget success. And I'm here, right? Like you saw my Instagram, so I'm here. I'm I'm I'm doing a video because you saw like all Dr. Phil and Dr. Oz weren't available today. So you were like choice number three. That's good. I'll take I'll take that after Dr. Phil. Um but Dr. Oz, too. It's good. You know, he went to Columbia as a he was a surgeon before he became successful. There's a concept, you know, what's the next level? How do you 10x? So, you know, uh I sit across from people and charge them a yearly membership fee, right? And a onetoone very in-depth, you know, concier service. Can you scale that? I don't know. You can only I I would say that you're I mean, I'm listening to you, right? reading your body language about the things you're talking about and um I don't know how you can scale it and I'm going to tell you why. So, you're a good salesman. You know your stuff. You speak very eloquently. You could um definitely um you give confidence probably to your patients. They feel they want to know my my my plan and my I didn't ask you for your plan yet, but if you want to keep interrupting me, go ahead. I'd love interrupting. You can go ahead. I'm excited about that. But I'm going to tell you, I don't think you can scale as big as you think you can scale because you need another seven Dr. D's in your office who are going to have that's the problem that I'm you know there's a uh it's called a rate limiting agent in science but uh it's a theory of constraints. You can hire doctors that might be great but they're not going to be you, right? And if they're going to be you, they're not going to last with you too long because they're going to go build a panel. I know uh personally one of the um most prominent, if not the best cosmetic uh dentist in the world, and he's got the most successful brand, but he can't I mean, he's trying to reproduce and he's got great team, but it's his personality, it's his approach, it's his everything. and he I don't think he is gonna be able to I mean it's hard. So how do you scale it? Um I don't know. I hope you do and maybe you'll figure it out because I figured it out. All right. Well then tell us how did you figure it out? Well well chat obviously know I met with uh you know I went to Shul. I figured it out in Shul. Uh and for atheist friends it's a house of worship for Jewish people. Sure. Yeah. Uh it's it's school. I went to school. Mhm. H I sat next and God gave God God sent you a message and and then you figured it out. I went it's it was a fundraiser for um for the sh and I sat next to an unassuming woman. She was early 30s. You got you got to love the synagogue because this woman ended up being she was the youngest venture capitalist in in Palo Alto a managing director rather. So how did they find this out? She donated $50,000. It was the first time first visit to the shul $50,000 donation just just out of nowhere and her name came up on the board. You know, they had this whole thing. So, she came to my office and taught me exactly how I should scale up because what Palo Alto is good for is figuring out how to 10x. Another good book. 10x is easier than 2x. We can work twice as hard. Good luck with that. You only have so many hours in a day. So you have to work less to make 10x. You delegate, delegate, delegate, delegate. So how do you delegate concierge medicine? You use systems. So you have uh right now we're in tier one. So we have going to have three tiers. Tier two is going to be essentially uh something we already launched called get a lababs. So, you'll be able to go online, you click at a click of a button, you uh get an order or you go to a lab where you know kit's going to come to your house or you know if you do pay an extra $100 some bottom they'll come join your labs for you and that'll be sent to a lab processed and you'll get a full functional medicine panel. They already have this like function health. This is nothing new. Right. Right. But I'm tapping into it as a physicianled and it's going to go through me because I have now I'm building a brand. Right. So I'm what am I building? I'm building trust. Why am I doing Instagram? It's to I I'm giving it away for free. I'm not trying to I'm not trying to I'm not trying to get Hold on. Hold on. I don't want to [ __ ] in your parade, man. I really don't. No. You can bring you can bring a lot of these ancillary ways. I mean, you know, this is con the concierge part. I don't care. We need to do blood work. You don't have to come to the office. They'll go to your house, right? Nobody wants to go to Quest Labs and wait 12 minutes to get a blood test. Right. I get I get an hour. No, 12 minutes. Quest is amazing. I'm in and out in 10 minutes when I need to do blood work. Depends which Quest you go to. There's four around here. I've never waited more than 10 minutes, but cuz you book an appointment and you go in and out, but that's not the point. Yeah. Yeah. the the the lab work and you know those things I I could see um automating it boom boom boom right but it's the attention that a patient needs I mean he's going to sign up with with Gillare to talk to Dr. because you're you're you're providing that peace of mind comfort right now. At some point, if you have way too many patients, you're not going to be able to do it. Yeah, we we have to cap we have to cap ourselves, right? So, how do you get to 10x then? Well, that's the thing. So, you you have to find how to reach the masses. How do you provide something that's a $20,000 price point and offer it for 500 bucks, right? and which is you take you take away that extra level that most people attention it's like the Tesla model you come out you come out with something concept and and look well it's the business of medicine right so it's it's essentially the concept where you are building something awesome that not everybody can afford but out of that you extract enough data and people get are getting out of their digital wallets essentially with their health data Um I'm paying to have money collected seriously a day. Five or six. Five or six. How much time do you spend with a patient? 30 minutes to an hour. Okay. So you're between 2 and 12 to 5 hours a day you're spending with patients. Yeah. Something like that. And the rest of the time practice looking how to grow and stuff like that. But you need those patients to sign up to be the concierge medicine. Forget about the the longevity stuff cuz that kind of you know the red light therapy that all Yeah. Yeah. That's what it's just a function of them th showing up and a nurse or somebody whoever is in the office does that. That's another way to scale. Yeah. Right. But you know and there's a lot of that. There's very very heavy competition in that. Yeah. Yeah. But um I'm just thinking how do you scale by giving the care of a doctor, right? I think that um and especially in Florida, I find a big problem. I mean, I actually still fly to New York. Well, my my whole medical team is in New York. That's right. Right. Because I know them. I trust them. They're a great team here. You know, you go to see a doctor, you see a nurse practitioner, you see an assistant. I mean, it it it's terrible in in Florida, right? Uh maybe more doctors from New York need to move here. So, you you can't get the attention that you can get in New York. I mean, it just at least for me, I haven't been a I know good doctors here that I I can turn to, but that's extreme cases. So, I think that people want to go to a doctor and get the attention. They want to talk to a doctor. They don't want to talk to a nurse. So, look, I hope you figure it out. And, you know, you're you're a really you're a really bright guy. Just concepts. You know, I think you're a bright guy and I think that, you know, um you're gonna figure out how to monetize what you're doing in a good way. you've done it already and that's great and you know but I think there's only one of you and you're right there's only 2,000 hours a year and um I think that if you're going to get into what you're talking about the longevity stuff and all these programs and ancillary things yes you can scale at 100x you're going to provide quality assurance people are going to be comfortable with you you're an eloquent speaker people are going to listen to you but if people are going to come to you because they want you to check them out. There's only so many hours a week you can do that, right? So, it's kind of scaling all of these products that like, you know, the transform 360, the nine, the biohacking, all of these other and they're great for a medical practice because they're going to help people in many ways, right? Red light therapy right now is huge, right? In many ways, people are doing it. Um, what about staff? Finding good staff, how do you deal with that? Yeah, good luck. I I've been lucky that uh I have very little turnover. We've been open three years. I've only had one person left and she retired. Uh longevity stuff didn't work for her. What's where's retirement? Going to live to 200. No, I'm just joking. Look, I think that you're you're you're hiring people that fit what you're doing. They have to fit what you're doing, right? You can't just You know, the most the hardest thing to find was a good practice manager, but I finally found one. Are you are you trying to hire other physicians to come work for you? No. No. Just I had I had several people interview uh few physicians, a couple of PAs, a few nurse practitioners. I turned them all away. Um why, if I may ask? They weren't me, right? Yeah. They weren't you, right? And so, uh going forward, you know, having nurses and maybe nurse practitioners and PAs might be in the cards. I don't want to dilute the brand by having them see NPs and PAs. Our brand is you're see a doctor, right? It's uh it's that level of care that I want to give people. Um so they'll never, you know, be handed off to a nurse practitioner. You're board certified internal in internal medicine as well as obesity medicine, right? How important is that combining the two of them today? Obesity medicine is huge. Yeah. Right. So I got lucky um that I came under toutelage uh from a gastroenterologist who was board certified in obesity medicine and he convinced me to go get boarded u and I already had a year's fellowship at Colombia and nutrition and preventive medicine. Um so it was kind of a sho I was a shoe in so I went to Harvard for um obesity and took the took the board passed um and that's just when the ozic race was just getting started. So I I got really lucky on that. We used the GLPS uh sparingly at first and we were trying to concentrate more on um nutrition, lifestyle because we don't we didn't want people just to take shots and get No, you have to have a lifestyle, right? You have to change drastically. You have to it's the only way to get lasting results. So, if you're talking about peptides, you can go on the full peptide stack and it's not going to make a much of a difference if you don't change the the fundament the fundamentals. You know, there's a the story of how do how do you how do you become Kobe Bryant? And he would show up at 3:00 in the morning and start doing fundamentals, footwork. Work on your footwork. Jumping jacks. Yeah. Start doing jumping jacks in the morning. It's not, you know, not doesn't take too much time. Do a minute of jumping jacks and then do your GPS piece and then do the peptides and then, you know, work on uh sure on fixing broke broken bones. But first, you got to learn how to how to walk before you can learn how to fly. Longevity medicine. That's nichi. It is nichi, but it's big today. Certainly people that can afford it. You know, everybody wants to live to be 100, right? Some of it works. I agree. I have a longevity doctor, right? Really great. Smart man. Tells me like it is, you know, but um nothing like an honest doctor. No, he's honest. That's weird. you need, you know, I think I I'm I'm I'm blessed because I ask enough irritating questions that an honest doctor wouldn't be able to deal with me. You know what I mean? Um and I think it's important for everyone to be able to ask their doctor questions. Why? Why are you giving this? Why am I taking this medicine? What people sometimes like a doctor says does this and doctors are look most of the doctors today just go by what the guidelines and research and science says. So if you have this you got to take this pill. If you have cholesterol you start with statins. You do this you do that. You do this. You do that. Right? Because that's it's the book right? For example blood pressure. You know, years ago, 140 over 85 wasn't considered high blood pressure. In fact, when people are older, they should have a little higher blood pressure. I don't know if you agree with that or not. Yeah, of course. Right. But no, science said it's got to be 120 over 80. So, they pump you with pills less than that. Right. Okay. Now, my cardiologist says, "Ah, you know what? Your blood pressure is too low." What? You've been feeding me this. You know, I have a great cardiologist, by the way, who I fight with all the time, right? But I do that like I ask why. And if they tell me something, I read, I research cuz it's important. But a lot of people, they just take uh what what they're told and they're afraid to ask, right? They're they're scared. So, um so this longevity thing, it's a good thing, right? It's giving people at the very least, it's giving people hope to live longer. And you know, I think a lot of our health comes from our mindset, right? How we feel about things like that, the perception, right? So if people are telling me, hey, you're doing great, your your blood works great, you're doing this, you're going to live longer and healthier, you start believing in it, at least the time that you are living, you're in better spirits, right? You know, it does work. It does work. Now, I don't want to live to 100 unless I'm a fully functioning human being and nobody's taking care of me, right? Do you know what I mean? I want to be productive in life. Yeah. Um, so they're called quality years. Quality years. Right. Right. So, um, I want to just say if you're getting value from this conversation, um, hit the subscribe button, leave some comments. Um, I hope you're enjoying this with, uh, Dr. Dimmitri here. um really remarkable stuff even where medicine is going and how business and medicine look medicine has always been about business right I think it's the biggest business in the world is medicine but now I'm I'm I'm loving how doctors are becoming are able to create a a great practice around it provide a great service provide get treatments great treatments not have to see 300 patients a week to survive cuz I don't think it's fair to the doctors either that they have to have a patient mill, you know, keep running through patients. It's not fair to anybody. It's not fair to anybody. And I think quality is not good. So, we do need more doctors so that they can see less patients and provide better quality. All right, let's talk about business reality. You're competing against free healthcare through insurance. How do you prove value to patients who are used to paying $20 co-pays? And what's your patient retention like? You know, I come from the Soviet Union. Um, and I have a niche because I speak Russian. It's hard to convince someone who is programmed to live under communism to open up their wallet and pay for anything, especially healthcare. I I had an experience recently with a family member that was sick and the hospital wouldn't give them an important medicine. So I being a physician's son, I went and grabbed the medicine from a friend of mine who had it as a sample, brought it to the hospital and administered in the middle of the night. I felt like I was in Soviet Russia. The push right now um is in the opposite direction, thank God, but it was very clearly going towards socialized medicine. Here's the problem. Okay, just I'll answer your question, but I just want to touch on this point really quick. And uh the concept here is that if you're incentivizing physicians to um not be doctors and be paper, you know, people. Um if you're telling them that we'll pay you only this set number of dollars for your time, they won't be incentivized to do a good job. How do you So, how do you incentivize them? You have to pay them more. Now, how do you do that? Um, you have to essentially find um what they're good at and plug him into the right system. I had a friend in medical school who became a dermatologist making a million dollars a year now. But before that, he was an investment banker and he almost didn't go to medical school cuz he's making so much investment banking. He just really loved medicine. The doctors have this calling to be doctors. But even if you go back to my mammdes and or hypocrates and all these people, they all talk about how doctors need to be compensated so they don't worry about money. If the if a doctor you know a lot of doctors become while they have a calling to be a doctor. I agree with you. Um at some point it seems and I've seen this so much the calling is become secondary to make being a businessman and making a lot of money. Some of them lose that calling. Yeah. You disagree with me? Um, no. I don't disagree that people get greedy. And no, they just like, "What am I doing this for? I mean, I got this license. I'm a doctor. Let me just make as much money as I can. Forget about, you know, the calling. It takes all kinds." Right. Right. Uh, try to not do that because, you know, there's something called Maslo's hierarchy and like what's your purpose in life to just gather as much money as possible? It's kind of boring after a certain number, right? I have a friend who's What is that number for me? Yeah, I like a percent to live world to live live off of percent. I need I need a certain amount of net worth where I'll feel comfortable not having to worry about money anymore. I don't know what that number is yet. And it's evolving, right? It's just growing every day. It's getting smaller. I need less and less. I'm more realistic. I'll tell you, I lived in um I took a year off and lived in Thailand and Oh, I remember that. Yeah. Yeah. Uh I made good during the 2008 crash. I bought bank stocks when they when they tanked, right? So I was I was I was good for a little while. I didn't have to work. So for a year I could I could you know screw around and you know I was volunteering. I was you know drive I drove a motorcycle through Asia like and I was thinking like that was nothing how much I have now, right? And I did that for a year. I could do that for next for the rest of my life, you know, and just never have to work again. So life but lifestyle inflation. I have a family, you know, all also all my work now is for them, right? Everything I do is give them a better life than you the im immigrant dream. I'm an immigrant and so like I want to provide them with a better life than I have. So everybody has to pick a number and that number can change over time and depending on what you want to do for the world. For me, my purpose is to help people. I find joy in it, right? Like I and I get the privilege of of doing that every single day and I get paid for it really well. It's great to to help people. I think you have to give back. And you don't have to be a doctor to do that by the way. No, you don't. Right. So you you know I told someone earlier today I said it's a lot easier to give than to ask. But if you want to earn somebody's trust, you you have to ask them for favors. You know that concept? If if you ask somebody for a favor, they'll like you better. I don't know about that concept. I think you you don't have to ask anybody to gain their trust. I think your actions will speak for themselves. And um um I don't I don't need to ask you for a favor to gain your trust. You you came here trusting me that we're going to have a good conversation and this is on you know this is being recorded and so I didn't ask you for a favor. Yeah. But I love you. That's why I'm here. I know. I love you too, Doc. I love you too. You're a character. All right. Couple of last items. So look, medicine's heavily regulated, right? you have to do things really by the book. Um, how do you innovate and offer cutting edge treatments and and you know and and you have to stay compliant. So, you know, this regulations now look, we're seeing some really good stuff coming out of this administration. What do you feel? Do you feel there's hope that, you know, the right medicines are going to get approved faster, the wrong medicines are going to get, you know, banned? Um, or is it becoming again too monetized? what do you think is happening like look we hear so much on the news um about you know big pharma this and that and lobby being like I don't know what to listen to right so do as a doctor do you see hope that medicine is going to be cheaper more affordable and better for the average person you know I I think with AI it's going to revolutionize everything really LLMs are being made specifically for doctors for lawyers for for niche right and they're being trained to communicate to physicians, right? All of the health data available. I mean, the one that almost every single doctor uses now is called Open Evidence. What they did, which was brilliant, which was uh they got um approval to use their health journals, New England Journal, British Medical Journal, the Lancet, top journals, and it only spits back answers based upon published research. So, evidence-based medicine to the max. Uh there was the CEO was talking about how it would take a cardiologist um who specializes in his field right just to learn the mo all the latest literature in cardiology it would take him 3 months let let alone maybe he wants to learn about urology maybe he wants to learn about something else that's going on but so just to learn in his own field it would take him three months to do that now with AI you can put in any question that a patient asks you using their AI and you come up with a a good plan going forward. So I think we're we're going into a time of abundance of information which not only I think we've been in a time of abundance of information but I think that you can access it. Yeah. But you're also able to now clearly find you know answers in the abundance of information. That's it. The process which you're amazing the process. Um you know critics say concierge medicine is just healthc care for the wealthy right. How do you respond to that? Um it's a good criticism. I don't I don't disagree necessarily uh that most of my patients they're high net worth individuals uh looking for optimize their performance. Um there it's a niche field. I used to you know do concierge for the poor um and it governmentr run restrictive they didn't get necessarily it's it's an incentive to go out there and work harder. Um, and I do proono. I It allows me to have patients that I don't charge a dime that come to see me and I spend these days. Doc, I called you one time. I needed a script. You told me you got to come in. You got to I got to see you. Yeah, I called you up. I needed some kind of like a Well, you're not a Holocaust survivor. Oh, I see. Okay. And your high note worth, so you got to pay. I see. I see. I'm a Dr. D survivor. I was on your sailboat, man. We almost tilted over. I remember that. No, no, no. Never. Um, all right. Last question because this is for entrepreneurs and so look for physicians who are burnt out on traditional medicine, want to build their own practice. What's your biggest piece of advice and what are the biggest challenges that they need to overcome? Take a hard look at yourself and what you want to do. Um, some people are not built to start their own practice. They're just not. They don't. They want to show up and and God bless them. The academ uh academicians, the people that are in university settings that get a salary and then they can spend extra all the time they want that are tenured for example or like they have professorships and they teach and they get paid pretty good for what they do. Um they're not necessarily high high producers cuz they do a lot of like research base and maybe they get grants and things like that. There's there's a niche for every single person. You find what your purpose is. Not everyone is meant to start their own practice. It's hard work. You'd almost talk them out of it. I I you know, it all depends on you know, you have to realize what you're getting yourself into. You know, if you want to be a founder, get prepared to work founder hours here. It's not it's not I always tell everybody I'm the CEO here from 700 p.m. till when I get in like 6:00 a.m. That's when I'm the CEO. between 6:00 a.m. and 7:00 p.m. when everybody's here, I'm an employee. I'm a slave. I work for all of them. Okay, that's not scalable. Speak for yourself. I have a great team. Okay, there you go. And um we're in a little bit of a different business than you are and things are scalable, but a good se you know this thing about you're not scalable. I'm not scalable. Nobody has that charm. Nobody has that charm. Yeah, that's true. But um it's it's not as it's not as easy to scale as people think it is. That's true. I mean scaling is um leverage. It's leverage. Oh, you got to do this to scale. You got to do that. You got to delegate. You got to do that. I mean, it's a lot easier said than done. Okay. But um you know I thank God every day for what we do have, what we've built here and the people around me and we're going to keep doing what we're doing. No, you got a beautiful office. But yeah, beautiful office doesn't mean success. Yeah, it's nice. How do you define success? Nice place to show up. uh being able to wake up every morning and being happy about what you're going to be doing that day and then coming home having a job well done and and 20 years from now. How would how would you like to define success 20 years from now? I think the same way. What would you like? Well, where do I want to be in 20 years? Yeah. How would you define success 20 years from now? I again I do this for my family. You know what? I said the same thing somebody asked me a few days ago. How would you define success? And I'd say I'm going to define success how I raised my daughters. What they've become, what they've achieved, and how well that's the biggest success to me, man. Work, business, money, it's irrelevant cuz you can have that. You don't have, you know, things happen. But what what I what I did for others and how they turned out to me is the biggest success. Dr. Dmitri Gillmacher, thank you for joining me today. you know, we always have this I don't want the audience to think that, you know, we we always have these kind of, you know, conversations and go at it a little and it's good. It makes it fun. It's deep. That's what it is. It's challenging and and I think that's great. And I like people that, you know, don't always, you know, just agree with me, push back with me, and, you know, we could do this for hours, I'm sure. Thank you so much for coming on. Good luck to you. I hope to see uh get care everywhere. Thank you so much, man.