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Problems to Profit
Riches in the Niches: Dr. Richard Farnam on Robotic Surgery, Overcoming Scarcity, and Why Doctors Burn Out
00:56:15
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- [00:00]
A
Foreign. Welcome back to Problems to Profit. Today we have a fun one. We have a longtime friend. I think I've known you since at least 2018. And man, my brother Richard here, he, he is, he's going to blow our minds. He's going to teach us some things about riches in the niches, about technology and business. And more than that, he's going to teach us where it counts. His business is literally the business of saving lives and saving my. Maybe one of my favorite things on the planet, vaginas. And you know it. It's more fun than that because, I mean, I've been waiting to do this introduction since he agreed to come on the podcast. He has a social media brand. He's like getting famous on YouTube and, and, and on YouTube, like they went with the brand. Dr. Rich.
- [00:55]
B
That's right.
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A
And he is a gynecological robotics surgeon. Right? And I mean, we all know doctors are rich, but like a gynecological robotic surgeon, like this is like literally the most productive type of surgeon, tech driven surgeon on the planet. He's a vagina surgeon and his nickname is Dick. I have been so eager to make this introduction, guys. Dr. Dick. I mean, Dr. Rich, I mean Richard. I mean brother. Welcome to the podcast Problems to profit. I'm. Dude, I'm so excited to have you. I already know the value you're going to deliver. I know what you're going to spill. I know how much it's going to help. But before we get in to riches in the niches, before we get in to this doctor Rich badass who. I mean, guys, I know this guy. Like, I've seen his life. I've been to his amazing house, I've met his family, I've met his children. He's the real deal in every sense of the word. But we've also shared long hot tub conversations, joking around and drinking way too much scotch and crying together and getting vulnerable. And I know you weren't always the bad mother you are now. There was a different time. And I like to always give everybody the ability not just to hear the ending of the story because it's always great to see. Oh, yeah, look at that handsome, sexy mother. He's rich, he's tall, he's white, he's gorgeous. Like all this, right? No, no, no. You started in a different place, man. I want to know, how did we get you from zero to Dr. Rich? How'd you become the man you are today?
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B
Well, how long you got? This is for you, bro.
- [02:29]
A
All the time in the world.
- [02:31]
B
All right, keep it rolling. Well, that is quite an intro. I'm not sure I can live up to that, but thanks for having me on, Preston. We've been friends, we've been colleagues, we've been business partners, we've been vulnerable, we've traveled around the world, and I think most of all, you know, we've helped support each other, not just in the business standpoint, but family standpoint, emotional standpoint, psychological standpoint, spiritual standpoint. And those are, you know, pillars. Because business success is nothing. Nothing if you can't be proud of what you do. I mean, what is successful, Right. Success is your children introducing you as someone that they're proud of. I, you know, I, as you mentioned and as you did as well, came from nothing. You know, we grew up in rural Wisconsin and, you know, came from a broken home. My parents were divorced when I was 12. You know, cold, long winters. You know, I remember one. One winter, we could afford one chicken for a week, and we had to have the chicken, and then we had to have the skin, and then we had to have the broth for three days. That's a challenging upbringing. And that process instilled in me the hunger to want more, be more, do more, and really created a scarcity mindset for me that, you know, I had nothing. I had to get something. And as I continued to grow, that something was going to happen to all of that, and it was going to get taken away. And it's. It's been a long journey. And as much success as I've had, I've easily had as many failures, and I've learned more from that than any single success I've had. But really, I remember the first time.
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A
You told me that, man, I appreciated it so much. And I'm talking, like, the scarcity mindset because, like, I remember the first time we talked, and we were both, like, platinum partners and in the Robins organization, and you reached out to me, and you're like, hey, man, I hear you're like the other El Paso Plat. And, you know, like, you kind of like, who are you? And, oh, yeah, I'm, you know, Rick Farnum. And I looked you up, and I was like, oh, and I have, like, this scarcity mindset. Like, I'm just a real estate guy. Like that. That guy's like, that guy saves lives every day. Like, am I even good enough to hang out with this guy? And then, you know, it's probably three or four years later, we're sitting in a hot tub, and you're like, man, like I'm always in scarcity. I'm worried about scarcity. And I, I remember wanting to like choke you and be like, you are mother. But, but I mean it was good because it was like, okay, well you know, I'm the same. Like I, maybe that's a place we can. How many people have that? How many people get this level of success? But we're still dealing with the same we had 40 years ago.
- [05:39]
B
Yeah, it's tough. It is a tough cycle to break out of. And I'm blessed to have an amazing life partner. My wife Nanda, she has always lived her life in abundance. That there's infinite everything and you just have to get it. And those are conflicting mindsets and it's caused more than one argument. But there's a beauty in that. There's a beauty in, you know what my thought process is. Nothing's ever enough. We gotta do this and then once we gotta do that, we gotta pay off this and then we gotta do this and when does it ever end? And it never ends. And the key and what I inconsistently do, but that's one of my New Year's resolutions, is to start the day with a gratitude abundance meditation. Like how amazing and lucky are we to have the luxury of sitting here doing a podcast on a Friday afternoon? We don't have to know what it's like to have hunger pains and just enjoying all of the beauty that we have. We're living in a time where it's so easy to become successful if you're willing to roll up your sleeves and work and work hard and get the result and be the top 1% at what you do and give it everything.
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A
What do you think? I mean there's a lot of people that are born into poverty and scarcity and, and they don't chase. Yeah, they're not. Maybe they get defeated. What was it? And, and, and maybe I'm asking this wrong, but I don't think I am. What was it that pissed you off enough that drove you to chase? Like, cuz you didn't go like the easy route. Like you didn't just. I'm going to go to medical school and become a doctor, right? I'm going to go to medical school, I'm going to specialize. I'm going, going to become like a robotics tech entrepreneur, doctor, speaker, teacher. Like, like, like you're you kind of like you did the unicorn. What was it that was unique about your situation? Or maybe not unique, but a decision you made that got you into just that? That I. I need to get going. What drove you.
- [08:06]
B
Early on? I mean, and this is. We've gone through any number of exercises in the Robins organization and other things to kind of work through childhood trauma and things like that. But, you know, my parents getting divorced, my dad leaving, and, you know, we had nothing. And I don't like having nothing. This is a terrible feeling. And, you know, we just had each other. And then growing up, having a family of my own, wanting to infinitely provide for that family, not just with material things and 529 accounts and Roth IRAs, but to be there for them, to be every. And, you know, I don't blame. I have nothing ill feelings towards my father. He did the best he could, and he's in his own right, a world expert at what he does. But there's a price. There's a price for pursuing perfection and excellence. And there also has to be a way. And this is one of the early things I learned in my Robbins journey is, you know, being the top best surgeon does not excuse you from being the top best husband and the top best father. Those things also have to be pursued. And where do you get the time to do all that? And my wife just gave a lecture. She was an invited speaker at a child's diabetes organization in Denver yesterday, and she talked about saying no. That was her thing is you have to figure out what your number one priority is and pursue that, delegate what you don't have to do, and don't be afraid to say no.
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A
She's so good at that. And I got to witness it recently, even at your birthday party with another person that wanted to go, and she was like, I said, no, we are full. And it was just that, matter of fact. And I was like, nanda, I love you.
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B
That's it.
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A
You are hilarious. I don't know if I'm as good at saying no as Nanda. I don't know if anyone is. She's a pro. We could have ended the podcast on the mic drop you just gave, even though we just started it. And I don't want to end it, but, like, we could have ended it on that. Doesn't excuse you for not being a good husband. Doesn't excuse you for not being a good father. And I mean, I. I feel like that you can't fake like, I. I've actually met your kids. I love your oldest because your oldest is. And I don't know exactly how old he is, but he's a teenager. Yeah.
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B
Colton's 15 now, and he will run.
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A
Up and hug you.
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B
Yeah.
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A
And I. Every time I've seen that, I'm like, I want that. I don't want to miss that. That is so, like. I mean, you're. You're a cool dude in your own right. But I like, I like meeting people and like seeing them behind the scenes, because you'll get a lot of people that are the flash in the pan, awesome on stage, but you get behind the scenes and they're fake as. Yeah, you're one of those rare ones. That is not. And what you said is profound and there's meaning. And I go to your Facebook and I see travel and I see experience with your children, and I see this lifestyle that's. It's not the influencer hype.
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B
Bull. Yeah, it's real. It's real. It's real true.
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A
And it's with your kids, maybe let's start there because I know that's a driver for you, and I know you're really good at it. How do you balance?
- [11:46]
B
So, you know, we have hundreds, if not more mentors, right? And you don't have to be some. I mean, you're a mentor to me. There's a lot of people that are mentors to me, and it could be in anything, and it may never be somebody that you've even met. Jesse Eitzler does this thing where he's got this. It's called the big ass calendar, right. And so at the beginning of every year, he schedules. He calendarizes that time with his family. Because if you don't do that and you don't make something immovable, date night, movie night, escapology night, you know, it's going to get pushed aside if you don't make that a priority in your life. And so I think, you know, forcing that onto your calendar and making sure you do those things is a good first step now, you know, things happen, life happens, things show up and things get moved around. But if they do, you got to reschedule some of those things. And I'm not. Not perfect at it, far from it. But I mean that. That's one of the tools that I've used. I try to listen more than I talk. I try to be a good role model. So when I'm about to do something and I'm like, nah, might not be the best thing I want my kid to see, you know? So those things go through my mind and yeah, just try to be there for them.
- [13:04]
A
I love that. I want to dive in a little bit, man. I had a totally different idea of where this should go, because I do want to hit riches in the niches, and I do want to talk about your mastery, because I do think mastery of any one thing. I mean, like, I. I wouldn't even consider myself a master of automation, because last time I did, I had a crazy lawsuit situation, and all of a sudden everything wasn't automated. And, you know, the chips got scattered and I had to go in and get directly involved and fix that. And now all of a sudden, I'm very automated again. So. So maybe I'm back too close to mastery, but I don't think you ever achieve it. But. But the closest you can get to mastery, you've done, and I think that has gotten you to your success. But diving in a little bit to mentors, because I like that you mentioned that, and I like that you said hundreds, because it demos the humility and willingness to learn. And you're one of those. Like, I would see you when we were in the seminars together, and we were both at this weird stage where I think we'd made some money, we'd gotten successful, and we'd looked around and we thought this was everything, and we'd chased it and we'd made it here, and we paid 100 grand to be in the room, and we were like, God, well, I thought money was everything. And. And I'm lonely and sad and miserable, and. And we found connection and community and all these other things. And I would see your page of notes, bro.
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B
Oh, yeah.
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A
And your notes.
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B
Meticulous note.
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A
And then you. You could do it on a tablet and you'd have photos with it. I mean, I was. Your ability to learn is something that I was not going to go in that direction. But as soon as you said mentors, I was like, okay, we're pivoting because. Because it's good. Dive into the ability to learn, because that. That might be your greatest skill. We can go into niches in a minute and dive in later, because that's where we were going to go. But dive into your ability to learn and maybe your love of learning. And where did you learn it? How did you get that?
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B
I think it's the continual process of improvement. And talking about mentors, Nick Saban talks about there's four type of people. Excellent, great, good, and average. Right? And you can be average. And that's what you're going to get out of life. You're going to get average results. And then when you move up to the upper echelons, I forget the terms, but maybe let's Call it excellent and outstanding, right? That difference is this much. And it's all in the details and to the amateur eye, there's no difference. There's no difference between someone who is excellent and someone who's outstanding. But the person at the very top, that 0.1 percenter, they're the ones that get all of the benefits, right? And you know, in life, in profit and outcomes and everything, and it's understanding that there's no perfection. We're always constantly in pursuit of getting better. And I mean, that's the way I approach life. I mean, certainly I want to have the best possible outcome ever for every single patient I've ever laid my hands on to try to heal. And you know, no matter how good we are, you know, we're. Everybody's going to have complications. There's this surgeon colleague of mine at Sloan Kettering and he's like, you know, Rick, there's two types of surgeons ain't got complications. He's from Brooklyn. Two types of surgeons ain't got complications. Surgeons that don't operate and liars. So things are going to happen and you've got to learn from those things and continually get better. Once you think that you've mastered something and you're the best at it, you're probably not even excellent. You're probably just average if you're not continually pursuing. And I apply that to life, to everything. And I've made it a point in my life to befriend and learn from people outside of the medical world. You know, talk about the niches. You know, there's only so much. There's no education you get in medical school about how to be an entrepreneur. In fact, it's almost like the opposite. Go work for somebody. And you know, there's nothing wrong with that, but it behooves all of us. And you know, on the podcast that I was recently on specifically for doctors, you know, look, there are things that you can do outside of medicine to ensure the well being for yourself and if you do it right, generationally for your family. But no one ever got wealthy. Being a doctor. You can be rich, but rich means you have a good income. Wealthy means you've got money and you don't even need to work. You work because you love it. You love what you do. You love going to work and being able to heal people.
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A
You are rich and you are wealthy. And I don't think that that has a uniqueness to the medical field. I think that's true for maybe with very rare exceptions, very Rare. Every type of entrepreneur out there. Like I think if you don't have some type of reinvestment.
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B
Yeah.
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A
And, and I mean even diversification program.
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B
Key diversification, you're gonna have a great job. Yeah.
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A
And you'll never be able to stop.
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B
Right.
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A
So. But in into learning, like what does learning do for you? Because you love it.
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B
Yeah.
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A
Like you ask better questions. You know, when it's not a me interviewing you format.
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B
Yeah.
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A
You're one of the better question askers that I know. Like, like I, I enjoy conversations with everybody. But you uniquely do ask better questions and there's more thought put into them and, and they're more of a challenge. And then you give these like, you give this look like. And I don't, I don't, I don't want to age you, but I call it like a grandfather wisdom look. Like, like you're waiting to sniff bull or truth.
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B
Yeah.
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A
And, and, and, and that, that, that's why I say you're such a good learner. What, what is it about like this, this curious? Where does the curiosity come from? With the directness to be willing to chase it. Where, where does that come from? Because if everybody had it.
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B
Yeah.
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A
We'd have no problems in the world.
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B
I mean, I don't think it's different from the running from scarcity but wanting to live in a world of abundance. You know, I always just want to. How are you gonna live your best life if you're not continuously trying to make yourself better? Not continuously trying to be the best person you can be. And you've gone to lectures where, you know, you see the first guy, they're in the audience, they, there's some recognized authority on stage and they throw their hand up right. Every single time because they want to have the self glorification that they're being recognized in front of, like maybe stealing some of that from the stage and they ask something and it's just some bloviating nonsense. Right. But just to have said something. So if I'm going to ask a question, it's something that I really, I'm continuously taking notes, looking for gaps, you know, where does this not make sense? Right. And not because I'm trying to trip up, you know, the person that we're learning from. Because I truly want to know if you did this and made this conclusion based on that. But maybe you didn't have the evidence to support doing that. Where is this coming from? Right. And it is to your point, the BS detector. Right. So maybe they are, maybe they are just Making that up. And I want to know before I implement something I've learned in my life, I want to know is this BS or is this something that's truly reproducible, that makes sense.
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A
Let's dive into the riches and the niches. Because, I mean, I don't know a better person to talk niche with. But in all seriousness, and we could go through a myriad of factors. I don't need to adulate you on your wealth or your success or your net worth. I, like anybody who's taken the Hippocratic oath, doesn't really compare it that way. I mean, you with your ability to learn, although you've done phenomenally well, we've joked about it, you could have made 10 times more money not going the route you went. So I don't want to talk to you about how your niche has produced more wealth, although I know it has. Okay, but that's none of your business, guys. What I do think would be cool to make their business, all the listeners, is by percentage, how many more lives you save that'll directly correlate to success. Yeah, but can you explain a little bit of what you do and why it's more unique and frame it in the way that you've niched out? And then after that, let's dive into the lives you saved, bro. Because that's like for anyone that gives that Hippocratic oath, that's the real thing. That's the real deal.
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B
That's why we're here.
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A
I build houses. I want to wear a cape to work every day. You actually get to.
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B
Well, that's very kind. I do want to circle back real quick. You said we were in this room of ultra high success people at one of these Robbins events, and we look across and we're like, yeah, we're so successful, but we're lonely. Right. And before we. I think it's just. And we've alluded to it, but before we talk about this idea of financial success and security and stuff like that, you know, I think it is important to identify what's the purpose behind all of this, is to have a meaningful life with your family. Like, we are going to directly influence the people that we see in our lives every single day. And we're going to be gone one day and, you know, we're going to be mourned for a couple months and then everybody's going to move on. And the words that we've said, the things that we've done, have the best direct chance of making the world a better place. My Children will have the best chance of that. Everything else now we're doing, reaching out to other people. I have a social media brand, as you mentioned, we're on a podcast and I fly around the world lecturing, trying to teach other people how to do surgery the best way, the right way. And so we can spread the sunshine, we can share what we know. But when I'm on my deathbed, I'm not gonna say, man, I wish I did one more hysterectomy. Right, that's. So I'm going to say I hope that the things that I've said and done will enrich the lives of my children and allow them in their own way to change the world. And with that being said, I think it's a noble pursuit to want to do the best you can for your patients. Heal, save lives. And there's nothing wrong with doing that. And also taking care of your own self and your family financially. Sometimes there's this perceived conflict of interest that you can't wanna help people and also wanna do good for yourself. Which I mean, is clearly nonsense, right? We have this privilege of living in this great country and being in a system where we can have both of those things. We can help people, we can do well by ourselves. But I'll tell you, burnout among physicians was an all time high. Like 70% of all working physicians complained of burning out. And not 70%, but four times the normal rate in society, suicide attempts.
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A
Wow.
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B
So 400% more people that are doctors wanted to kill themselves than regular people. And you know, this was obviously, I.
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A
Don'T think most people realize the level of stress in your industry dealing with.
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B
All the sickness and death of COVID and kind of, you know, this is our job, this is what we signed up for. We have to be in here on the front lines, exposed to these types of things and, you know, still help, still heal. And you know, what did we get? We got, you know, an extra large pizza, right? That's your thanks, right? You know, we got another Medicare cut this year. That's your thanks for sitting in there and saving lives. And look, we do well, we sacrifice a lot, right? So my friend who decided to be an engineer, my friend who decided to be an architect, my friend who decided to even go to law school, my friend who decided to be a home.
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A
Builder, he's not a friend anymore. We're not friends with those ones anymore.
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B
Not anymore.
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A
They go to law school, forget about it.
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B
Less friendly, Right, but. And maybe the law school is not the best example, but I'm probably. Well, I'm just talking about the length of the education, the amount of time you have to put in. Like, doctors basically make no income. They make negative income for a decade after college. And yes, doctors do well once they get out. But it takes a decade to get out from under the debt you put yourself into. So you're 50 before you starting to generate an income. Yeah, I mean, it's crazy. So. And I know nobody's going to feel sorry for doctors. Oh, you know, you're complaining, you're not making enough money. And everybody has their own point now. I think this audience is entrepreneurs. They're doing well, they're successful.
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A
But a lot of doctors are entrepreneurs, too. But the win you get is not as much the money, I mean. And doctors do well. But I mean, let's be real. And I'd love you to answer this honestly because I think you guys are probably in comparable income brackets and people don't realize this.
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B
Yeah.
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A
My plumber.
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B
Oh, yeah.
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A
For my home company.
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B
That's right.
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A
Who does plumbing a lot like a heart surgeon does. Okay. They both do plumbing. Might make more than the heart surgeon if he's got 10 or 15 trucks.
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B
That's right.
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A
And you know, he's got 15 trucks and 30 guys working them.
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B
Yeah.
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A
The heart surgeon is poor compared to the plumber.
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B
That's right.
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A
The risk of the heart surgeon is 10x the risk of the plumber. Like how many people are going to die when their toilets back up? Might be a experience. But you ain't going to die.
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B
Not going to die.
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A
You know, the schooling is 1x.
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B
Yeah.
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A
Or the schooling for a doctor is 10x the amount of the schooling for the plumber.
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B
Yeah, I know what you meant.
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A
So you doctors don't measure, at least I think the good ones. And I think you're the case, too. And while you've done incredibly well financially, too, I think it's more your investments that have done well than even the medicine.
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B
That's right.
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A
But you measure. You told me this one time, you said, I measure my returns in life saved. Can we dive into that, like on your niche?
- [28:13]
B
Absolutely.
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A
Tell us about a little bit about what you do. What do you do for a living? What do you do to make money? What's your business?
- [28:20]
B
Yeah. So it's an interesting niche. So within the specialty of obstetrics and gynecology, everybody's kind of, kind of familiar with obgyn. There are subspecialties. So what I do is called urogynecology, which is kind of like Urology for women, and even more specialized than that is robotic surgery. So everybody's familiar the concept with having to have a surgery, maybe a C section, having a big open incision, and then you deliver a baby, or maybe a heart surgery with a cracked chest to go in and fix the heart. So there's a field of within surgery called minimally invasive surgery. So we do the same surgeries through small incisions as opposed to a big open incision, which your recovery is 400% faster, and complications and even death are a third of what they would be from an open incision. So it's a big deal. Doing surgery is minimally invasive, and robotics gives you a better chance to do them minimally invasive compared to just what we call straight stick or just, you know, holding a camera and a little, you know, instrument in your hand. Robotics is computerized surgery. You know, it minimizes errors and, you know, it improves outcomes. So I got in early, you know, when everybody was like, that's a fad. What are you doing, you cowboy? This is crazy. In 2008 time frame. And we brought that to the borderland, and believe it or not, El Paso is like in the top 10 in the entire country cities as far as doing robotic surgery.
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A
Really?
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B
Yeah. So we brought it early. I taught everybody. Everybody does it. And, you know, patients are getting better care in that context by having more patients getting minimally invasive surgery.
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A
You know, there's a lot of doctors out there, and I've got a few friends that are doctors. Everyone doesn't know my other friend's name. Everyone knows your name. Everyone in the medical professional space here knows your name. I think there's too many doctors for everybody to know each other, so you must have done something right. So with all these ways that you've kind of niched in and used not just a niche, but also technology to drive your niche, which I think is a particularly important topic in today's society with AI and robotics and things like that, which, I mean, you're kind of on the cutting edge of in medicine. For the robotics piece. Right. Without going into incomes, would it be fair to say that somebody who is niched can generate several times, at least, the income of somebody that has not niched in the medical profession?
- [31:14]
B
Yeah. You know, in medicine, it's a little strange if you're the best lawyer in town. Going back to lawyers, you just charge $1,000 an hour. Right. You can do whatever you want. In medicine, as a physician, you have to sign up with the insurance company to be an authorized provider and then they own you. So you can only accept what they decide to pay you for any given surgery. And the single only lever you can pull is efficiency. So in my experience, robotics vastly improves efficiency and I can do two to three times more surgeries, not just surgeries, quality surgeries with superior outcomes than the next person. And so, so if the average doctor.
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A
Is saving 20 lives a month, you are saving 40 to 60 lives a month with the same manpower.
- [32:07]
B
Yeah. Ultimately, the only way to break out of the insurance headlock. Right. Is to go outside of insurance and do things for cash, which many of the, there's probably a handful, there's probably a dozen in the country that have decided, look, the care I give is so vastly superior than the, you know, the average care that people receive. I'm just going to ask them to understand that outcome, benefit and pay. And so I'm going to charge maybe three or four times what the insurance company wants to pay me because I'm out of network now, so I can do whatever I want. The insurance company may only pay a quarter of what I'm asking and so the patient makes up the difference. But this is your life, you know, like, you know, we'll pay $1,000 to get a better seat on our, on our international flight, you know, you're not gonna pay $1,000 to save your life, you know.
- [33:03]
A
Oh yeah.
- [33:04]
B
So that's kind of like, I think the way that the insurance companies have forced the system into having a small cohort of basically direct to consumer interactions for their healthcare. Now, on the primary care standpoint, many, many doctors have been doing this for years. Because if you're just talking about an office visit, you're talking about hundreds of dollars. When you're talking about surgery, you're talking about thousands of dollars. So it's a little bit harder to do it, but it's not impossible. Many doctors have done it. Now, again, I'm gonna serve as many people as I can, save as many lives as I can for as long as I'm physically able to do that. But at some point, you know, I don't get to delegate in my, I guess my job. I don't get to delegate here. You guys do this and all supervisor. I have to be the one that's doing the surgeries. Right. And that's what people expect and ultimately that's what people pay for.
- [34:00]
A
So from a niche standpoint within your career field, if you're still going to accept the insurance and work with the masses, your only way to exceptional is volume. With quality.
- [34:17]
B
That's right. So the quality is. Like you said, everybody knows Dr. Farnham, everybody knows Dr. Rich is having those outcomes that spreads by word of mouth. And of course, there are so many avenues available now for promoting your business online and. But nobody. You can put up whatever you want online. If your outcomes don't match what it says there, they'll find you. You're going to fail. So, you know, you can say, look, we're going to do these robotic surgeries. And at the end of the day, you know, I've had a long run at this. Right. I've been. I've been doing this for 18 years here, and I'm super confident at what I do, which I should be. But at the end of the day, I do the best I can. And the primary driver is always to make sure that this person I'm seeing in front of me, this patient, who to me is always an extension of a family, it's a family member. I'm going to give them the best possible outcome that I can.
- [35:25]
A
So we've covered learning, we've covered wealth generation or not wealth generation, income generation. So I guess riches generation.
- [35:33]
B
That's right.
- [35:34]
A
By niching out, yeah, we touched investing and what that can do with outcomes.
- [35:40]
B
Right.
- [35:42]
A
That's another area that you're uniquely very good at.
- [35:45]
B
Well, I have had to learn it.
- [35:47]
A
We've done. I mean, I've done a bunch of different things that I'm very heavily invested in the real estate world. But something interesting you do, and maybe it's part of your learner personality. And we've done some different deals together, and we've been in different things together. And when I've gone into a few different things, I mean, including a travel agency I built years ago, you're like, is there an investment opportunity in that? I think that was the first question you asked. What do you look for? Because I think that'd be a good thing for all investors to kind of pivot some of this, talk to and see what are you looking for in an investment and how do you underwrite it? Because everybody's lost on a deal here and there, but you've won much more than you've lost.
- [36:33]
B
Yeah.
- [36:35]
A
I hope you kept all that bitcoin we talked about.
- [36:36]
B
That's right. Yeah. I've taken some hits, but yeah, most of. And that's the learning experience, and I think that's the underwriting. The vetting is key. And so what I've. It's not a hard and fast rule, but I need three Points of confirmation. So someone pitches a deal to you, hey, look at this, we're gonna bring in. Doctors are targets, right? Doctors, they have a good income, they're relatively rich. And so scammers will come in and say, hey, let me. And I'm not, you know, so there are people that will have an investment deal and they don't want to take the risk with their own capital. So they'll go to doctors to get that capital. And if it falls through, they lose nothing. If it grows, then they, so it's a win win for that. And so in that circumstance, it's probably someone that's trying to get a good return, but if they don't, they've minimized their downside. And then there are scammers that are just basically trying to be out there to kind of take your money. And so how do you mitigate against that? And, and how do you gain that financial intelligence? And it's just a journey, man, and it's just constantly.
- [37:51]
A
Can you give us a few pointers, things you look for? And I'll throw in some too to compound what I'm looking for. And we'll add a little extra value, some bonus value for you guys on things that you can look for to seed a good investment.
- [38:05]
B
So I think it's. Every great company has a board of advisors. Every great company has a, has visionaries leading the ship in the right direction. They're not doing any day to day stuff, they're just there to make sure you're not going to fall off a cliff, right? And so I think you need your own board of advisors, right? So I have a group of individuals that, you know, some of them, we, you know, trade consulting, some of them are on a fee basis, some of them are just friends that are willing to help. But when I get a deal, I need at least three of my mentors that are uniquely qualified in their own right, in their own space to be able to corroborate the value of the deal and also to help me see what I don't see, right? So this made, look, okay, look at this great investment. 20% return, you know, and 50% down, 50% later. And you know, what, what could be wrong, you know, and so I need other people to kind of help me. Okay, so the person that's offering this, what are they getting out of it? Right? And so, and there's always that, I mean, that's just business. One of the things you have to get used to coming from the medical world where if I've got A patient in kidney failure, and I consult you, the nephrologist. I don't have to question whether, you know, you've got that patient's best interest in mind. That's the oath, man. We just know we're all gonna do the best to work together to get the outcome right. In business, it's the opposite. Right. Everybody's for them, trying to get the best deal for themselves. Get that 1%. And, you know, so is it 1% or is it 10%? Right. Is it a fair deal or is it not a fair deal? For the value that they're adding, is it worth the percentage that they're taking? And so for me, you know, and I've gone bust on deals where I had mentors that had vetted, you know, the deal.
- [40:00]
A
No deals, 100%.
- [40:01]
B
That's right. There's risk involved in everything. And.
- [40:05]
A
But I. I like that if I'm hearing what you're saying, and I like to kind of boil it down to a tagline. It's. It's like, know what's in it for everybody in the deal? Yeah, like that's.
- [40:18]
B
That's perfect summation.
- [40:20]
A
If we're looking at a. You know, we've done some multifamily syndications.
- [40:24]
B
That's right.
- [40:24]
A
That we've been in with other friends that put them together. And we both kind of looked at it, and we know that they're getting a piece of the upside, a piece of the gp. But we were. We were fine with that based on what the returns look like for us to get into it.
- [40:40]
B
That's right.
- [40:40]
A
And we knew we were getting some tax benefits, and we knew we'd eventually get some cash out and we might get some cash flow, and yada, yada, I throw another one at you, and maybe we'll volleyball it.
- [40:50]
B
Yeah.
- [40:51]
A
I like to see how much skin they have in the game.
- [40:53]
B
That's right.
- [40:53]
A
That's one of my favorites.
- [40:54]
B
That's right.
- [40:55]
A
How much cash are you putting in? Like, if you're coming to me for, hey, you be the investor in my deal. I'm putting nothing. I'm already out walk. I'm already out walk.
- [41:05]
B
Yeah, no, that's key. You have to know that the person whom is seeking your investment has skin in that deal. And if not that they have no faith in the deal in order to risk their own capital. That's something. That is a huge red flag.
- [41:25]
A
And I'm fine with the skin being cash or risk.
- [41:31]
B
Okay. Yeah.
- [41:32]
A
Like.
- [41:32]
B
Or sweat equity.
- [41:33]
A
You know, I mean, I would say sweat Equity, not so much. Yes, to an extent. But they have to sign a note for their percentage of the cash, which would be against their assets or income or credit or something, so that there's, you know, I don't mind, on a smaller deal, a couple hundred grand or less. If somebody's coming in and they're like the sweat equity, and I'm like, okay, you want me to put up like 300 grand on this flip home? You want 50%? Do a note.
- [42:03]
B
Yeah.
- [42:04]
A
I'll charge you 6% interest on a preferred rate of return for your half. So you're gonna pay me interest on 150? I'll put up the full 300. You're personally signing this?
- [42:14]
B
Yeah.
- [42:15]
A
If you it up, I get a judgment, and if I renew it, that's there forever. So any transaction you do, I can collect. So I basically own you for your whole life?
- [42:23]
B
Yeah.
- [42:24]
A
That's kind of my minimum standard. If it's higher than that, I need your actual skin in the game.
- [42:29]
B
Yeah. And that's, you know, so this is why I look for mentors with this expertise, you know, protect your downside. Right. And so if it's not in the form of capital, like you're saying, and it's not adequate, you know, what can you do to kind of protect that? I think real estate, the business that you live and breathe every day, there's just so many advantages there. It's not the only investment. And we talked about diversification as well. You need uncorrelated assets. As I learned in this Robins world, 50%, every investment class that you love will lose 50% of its value sometime in your life. So we learned that about real estate in 2008, at least in most deals. We learned that painful lesson about the market and the Great Recession. We learned it again during COVID And so you have to have investment classes that have low to no correlation. And you, I guess, technically need 12 uncorrelated assets in your portfolio. And understand too, that correlation changes over time. Right. Stocks and bonds used to be relatively uncorrelated. In the last four or five years, they're one to one.
- [43:44]
A
You know that that's interesting, and I'd love to get your feedback on this, because I almost have a different view, Even though I have the same view now. My view used to be don't invest in anything outside of your own expertise. Focus, focus, focus. Double down, triple. Become like this massive entity in its own right until you're too big to fail. And immediately, when you get to that point, then diversify as quickly as you can, take chips off the table. Because I feel like the Warren Buffetts of the world started that way. Like they, they went into one thing, they did it huge, then they diversified and they found one other thing. Yeah, but you look at the Warren Buffetts and you look at the Ray Dalios and they have different stories and they have different time. But would you, would you agree with kind of the dynamic that there's a paradox in that, like, if you're, if you're a startup, you don't need to worry about investment?
- [44:37]
B
Yeah, absolutely. And you know, the plants that you water grow. So if you put all your energy and attention to one thing, you're gonna be way more successful. You know, if you're going to do something, don't half ass it. Right. Do it all the way or don't do it.
- [44:56]
A
You're saying to full ass it, full.
- [44:58]
B
Ass, you don't want to half. At the end of the day, if you have given that pursuit everything that you've got, all your sweat, all your blood, your tears, and you fail, well, then you learned. You learned that's not for me. And I'm going to go on to the next thing. If you do it and you succeed, which if you're top 1% in anything, you probably will, then there are going to be returns on that. If you go in and you don't give it your full effort, then you have that pain of never knowing if you would have been successful or not. But this isn't necessarily about investment. This is just your life. Right. These are pursuits that you want to have. And I've had to scale back because I have done any number of different things, you know, over these years. On the investing side, on, you know, we have different businesses. I have my doctor business, I have my surgical education, social media brand, real estate business, surgical device invention. And when you're doing 10 different things all the time, you're not giving enough attention and focus to the one thing that is probably going to give you the most return. And you can do them serially. Right. But it's hard to be great at everything all at once. That's all I'm saying.
- [46:18]
A
I 100% agree with that. I mean, in the paradox that it is like you do only one thing, that's very high risk, but you can't do more than one thing unless you master that thing. And so it's kind of a fun dichotomy there.
- [46:39]
B
Yeah.
- [46:40]
A
So, Rick, I really appreciate this, man. Like, you're coming in, you're Teaching the niche. Where can people. I mean, I. I'm loving this you, by the way, too. Like, this is the new 2025 you.
- [46:53]
B
That's right.
- [46:54]
A
Like, I feel like you're very sen. Zen hippie. When I was watching your. Your TikToks and stuff before you came in, they were, like, flamboyant and funny and crazy, and I like that you, too, but I'm liking this you, bro. Like, and. And you give good content. You have a crazy amount of wisdom. I know our listeners are gonna want more of you. Like, where can they find you, bro? Like, where. Where can people get a little more of dick the vagina Dr. Dr. Rich, or.
- [47:23]
B
So our YouTube channel is just Dr. Rich. We've got pretty good movement on that. We're at about 65,000 subscribers. We're, you know, obviously, our goal is to get to 100,000 here pretty soon. Our TikTok is real. The real Dr. Rich. Our Instagram is therealdr rich. I have been, as we talked before, we started getting more and more requests to do podcasts, and so we'll have all that content on our channel as well. And as much as I love surgery and surgery education, what I'm finding is, at least in talking about niches, at least in the medical world, there's such a lack of. Of experience while training. And there is experience, but a lot of times it's bad experience investing outside of medicine and a real need in that area for education and potentially for me, another vertical for business education.
- [48:28]
A
You know, before we end, something just popped into my head, and I don't normally do this, but I want to. I want to pick your brain, because I think this is one last question I'd like you to answer and maybe close with for our entrepreneurs. I mean, I'm focusing this year on my health. And the word wealth comes from the word health. And I think when we're building this business, we sacrifice a lot to go chase the dollar. And sometimes you sacrifice. You sacrifice your health. Can you give entrepreneurs out there a few hacks on what to do to find the right doctor, find the right health coach? Look at what do they need to know about where to look and what to dig for and what metrics to follow to ensure and make sure that they're not just building this for somebody else down the line, but maybe they can enjoy some of it themselves down the road too?
- [49:22]
B
Man, that just opened up a whole thing in my mind. And, you know, maybe not for your audience, but maybe for your audience. You know, we tend to Think of things, you know, we see in the news as far away or statistics as not relevant. And speaking of working really hard and sacrificing your health, in El Paso, within the last 18 months, we've had a physician in their 50s die of a massive heart attack, another from a stroke, and another one in their 40s from suicide. This is not some faraway thing. These are patients that no longer have their doctor. These are motherless children in El Paso. And you've got to take care of yourself. And I don't think your mental health and your physical health are separable. These are things that you have to do. And I have gotten. I got into this world, this concept, this idea of mindfulness and meditation. I thought it was nonsense. And then John Hopkins published a study that says it lowers your. I think it was your diastolic by five beats a minute. I'll have to check, but it lowers your heart rate. In a randomized controlled trial, it lowers your heart rate. So five minutes a day, it could be anything. It could be guided. It could just be pure mindfulness. It could be walking meditation. It could be anything. Gratitude, I think, is a big one. We're so upset my pen doesn't work today and we forget all the amazing gifts we have around us all the time. So I think it starts with that. It starts with being in the right headspace every day. As far as your physical health, you will look at a million different experts and they all have a different opinion. And the other ones are all wrong, right? You can only eat the carnivore diets, the only diet, the vegan diets. So the whole world of nutritional science is not really based on any type of quality evidence. And none of the studies, it's so hard to compare. Generally, people accept that, like a Mediterranean diet, kind of pescatarian, some red meat is fine, is good. Try to do a lot of. It's like six servings of fruits and vegetables a day, this type of idea. And again, I'm not basing that on hard science, because there is no hard science. But I think everybody can generally concede that that's probably a good idea. Exercise is key. You know, it's like. It takes energy, exercise, but it actually gives you more energy once you've exercised. I have to do it in the morning. I can't do a full day's work and come back and exercise. So for me, I gotta get up and do it. Probably should do 30 minutes five times a week. If you're trying to get a, you know, a Chris Hemsworth body trying to get shredded. That's a different, you know, expert. I can't tell you how to do that, but just for your own health. And longevity supplements, again, this is kind of along the line of supplement science. There's not a ton of data. Most people aren't truly deficient in a lot of things. I will say vitamin D is 1. 70% of people are deficient in vitamin D. Okay, get your vitamin D checked, okay? If it's lower than 30, you absolutely need to start supplementing. And that's the bare minimum. It probably should be higher than that. So virtually everybody should be on. On vitamin D, just based on the statistics. There are different multivitamins you can take, and then there's literally hundreds of other supplements that may or may not be helpful. Some evidence supports, some doesn't. Again, there's no hard evidence that says everybody should be doing this or that. A lot of it's individualized, to be honest. So if you say, hey, what are the 16 things that you have to take? It depends on what's going on in your body. I will say this. The US for all of its flaws. So everybody's like, us, healthcare sucks. And that's true, except when you compare it to any other healthcare system in the world, right? You want to wait nine months for a gallbladder, go to Canada. It's got its flaws. It's got horrific flaws that hurt people, hurt the providers. But we all have to kind of get together to work better. But it is sick care. That's the reality. You go to see your doctor. No one gets paid to make you healthy, right? No one gets paid to do these things to make your life and discuss that and make that better. They get paid to see you when you're sick. Those are what all the diagnosis codes are. And so a lot of doctors get fed up with that and they go into this direct primary care. So I'm gonna see you for what I think is going to improve your lifestyle now before you get sick, okay? And there are doctors, and we all want the best, but there's a lot of external factors that force you into seeing patients when they're sick. There are specialists that are called functional medicine specialists, and that's basically all they do. They see you before you get sick and they optimize. Now, I will say, I'll be the first to say that a lot of the things they do is not evidence based. Okay? But if we sit around and we wait for the results of a randomized control trial to tell you that this is definitively the best thing that'll be 20 years from now. Okay. No, thank you. So there are things that we don't know for sure, but we think might help and we know that are probably not harmful. And there's many things that I do that I can't stand on my podcast and say, everybody needs to be doing these things because I don't have the evidence to support it, but I do myself. But for those viewers that are like, well, how do I get my heavy metals tested? How do I, you know, find out what elements I'm deficient in? Functional medicine specialist.
- [55:42]
A
Well, I think we just unlocked a treasure trove of what we are going to dig in with you on our next episode, because be glad to do it.
- [55:50]
B
We.
- [55:52]
A
We will have some fun. And I mean, your health truly is your wealth. I. I think even that for a lot of people, just hearing that is going to be like, if your name was Mike, I might have to drop you. That. That was. That was gold. So, brother, thank you so much for coming on the show. Thank you so much for adding value to our community.
- [56:10]
B
And, well, I'm honored to be here.
- [56:12]
A
As you all know, have an amazing day on purpose.