Hey, everyone. Welcome to ProteanPulse, a healthcare podcast from ProteanMed.
I’m Rajee Hari, president and CEO of ProteanMed, a healthcare staffing and recruiting solution provider based out of the Woodlands, Texas. I have a charming dynamic, high energy, successful veteran in the locum tenens industry. Mr Matt Young, he is the co-founder and partner of All-Star Healthcare Solutions. It’s located in Deerfield Beach, Florida. He had plans of pursuing a career in law and I don’t know what happened and how his life turned around and he came into the locum tenens industry. And we would like to pick his brain and learn more about him and his knowledge and his viewpoint for the industry. And we are excited to welcome you, Matt. Welcome to the podcast.
Thank you so much. It’s always a pleasure to see you and thanks for having me on.
Absolutely, Matt. Matt, you can say that you have seen, been there and you’ve seen that pretty much for everything in the locum industry. So from hiring and training, you’ve done operations, you’ve done sales, marketing, IT department. And of course, now you’re in the leadership position, right? So, can you share us a little bit about your background and how your career has shaped you thus far?
Sure. And I don’t know who the charming person is. You have must be the person coming on after me. But I thank you for those kind words, first and foremost. So I’ve spent almost two decades now in, in the locum tenens, staffing industry. I kind of got my start by accident a little bit.
I, as you mentioned in the introduction, I was a pre-law political science major in criminology in a small university in Western Massachusetts. I had met a couple of great mentors and we all have these kind of forks in our lives where we meet people and they make tremendous impacts. I had a couple of professors that I don’t, they kind of saw something in me, I guess I didn’t see in myself. And I’m very grateful for that to this day. Got involved and became a little bit of a late developing student slash nerd.
I suppose you could say my brother is a very talented attorney and now works for the GAO in DC. I thought that was the route I wanted to take, but I did want to take it in the northeast. So I had ended up moving to Florida uh right after my undergraduate uh degrees and I had a really close friend, my now business partner, Keith Shadow. He is the chairman of our board at the All-Star Health Care Solutions. He was only one of two people I knew in the entire entire state of Florida when I moved. And I was looking through my options for grad school.
I had been accepted into the police academy, believe it or not. I would have made an awful police officer that God bless our men and women. I don’t know how well I would have done. What was funny about it was, I had about a year to wait before I would enter the academy. And, again, a gentleman who I respect and love dearly said, hey, why don’t you, try this niche? I’m doing this work and I’m like a sports agent for doctors. They’re these talented people that are traveling all over the country and saving lives. I’m making a little bit of money doing it. I think you’d be good at it. And I said, well, job with benefits, dealing with high intelligent people, I got a year to kill anyway. Ok, great. The more I kind of got into the industry, the better I became at it.
I made a lot of close relationships and I was about to kind of entering that world of law, law enforcement and then graduate school. The more I really wanted to stay within this industry and that’s kind of how I got involved. And, and then the, the next big thing that happened to me was, a physician himself out of California that I had recruited for an anesthesiology position, was building a locum tenens firm on his own, and starting it from scratch.
I think I was 26. I didn’t know a thing about building a company, didn’t know a thing about Denver, Colorado, but I really had a really great relationship with them and I decided to to help a company come from the ground up. That was my first experience of building an organization which was very proud of my time there, spent about five a little over five years and they were kind of building up operations in Texas. I felt like Florida’s always been my home that led me to going back with my original close friend from the Massachusetts days.
I co-founded the locums organization with Craig and Keith Shadow, who are now sitting on our board of directors. They had a very successful firm place business and my expertise per se really came in the operations of the locums end of things. So, we’ve continued to operate that profitable term end of the spectrum. But again, the expertise I was able to lend and really create a great team around us rather was on the locum end. So that’s how I ended up with All Star.
And now I think that was what, 2011 or two, late 2010. So it’s been a wonderful ride and I met a lot of great people and worked with a lot of great physicians nationwide. So I hope that answered your question. But that’s kind of a condensed version of how I kind of ended up here.
This is mind boggling for me. So you decide to take a break one year break and you had a choice between law and law enforcement and then you enter into the locums field and then you in the direction of the locums and then you start your own. I mean, you help out as an entrepreneur pretty much with acquisition and then you start out with All Star and you have taken it to a new level. I should say I have just been reading up a lot about All Star. I’m pretty new to the field as well and it’s quite inspiring to hear your story for sure. So, with this 19 years or 20 years plus experience in the locum space, what are the key points of the lessons that you have learned about the industry that has shaped you and your life and your approach to providing these staffing solutions. What do you think has been the growth in the industry? And how has your growth been affected by it?
Yeah. And, and I could talk for two hours about that one question. It’s a great question.
What I always tell people because the first time you meet somebody and you say, well, I’m in staffing and then you say what kind of staff and they say what kind of staff and you say locum tenens and they’re like local tennis. What’s that? So you have to explain what it is. I know we’ll get to the NALTO and the lobbying that we do a little bit later on. But it’s amazing, you know, there’s now over 50,000 physicians alone, never mind MP SPAs and CR that provide this temporary care all over the country. And I know, this as well as I do, but most of this care is not being given in Beverly Hills or downtown Miami or, and again, and not that it’s on occasion it’s done in places like that. But we’re really talking about the rural and undeserved areas where some of these people across our great country are waiting three months to see a primary care physician or God forbid, they need specialty care or some type of you know, surgical procedure or again, an obgyn, I mean, how many counties in our country are without an active OBGYN servicing a population.
So whenever I talk about the industry, and obviously I’m very passionate about it, not only has it really given me the ability to earn a living and be surrounded by amazing people. But when I kind of put my head on the pillow at night, there’s something uniquely intrinsically satisfying of finding somebody a job. Number one, right? Not that they need me because they could find one without me. But the reality is if I can put them in positions to make the most impact and yes, earn a living at the same time and help, you know, grow my own organization as well, right? But it’s one of those rare situations where everybody wins.
What I mean by everybody is, you know, if a healthcare organization doesn’t have a physician in a particular place, they have to, God forbid, close down, or they have a lot of these, scenarios that are completely undesirable to put it lightly. But there’s a lot of complexities that come across with these placements and the bottom line is if we can place these folks in places that were needed, the organization, the company like AllStar.
So we certainly win, the provider wins, the position wins because they’re providing care, perhaps earning some extra money while they’re traveling the country. Keeping their skills sharp. Let’s say it’s someone coming out of retirement and they don’t want to work 40 – 45 weeks a year, but they’ll work 20. We want to keep that physician in the workforce. There’s no one wins if that physician ends up retiring early and then goes in fishes for the next 25-30 years. So there’s that, and then really the most important aspect of it is the patients and the communities win. Because right now, we all know when COVID taught us this, obviously going through the pandemic, but we have a nation of folks that really, really are in dire need of preventative care. Not to mention, you know, obviously when things arise of, things that are more urgent. So we want to be a part of that solution.
So when people ask where I get my passion from, and one of the reasons I got involved with NALTO as an example in donating time to do that is because I want to see the industry continue to flourish for all those reasons because it’s one of those few industries where everybody wins if that makes sense.
Yeah. So have you seen a change in the industry? Have you seen a trend that has happened over the past 20 years? And what are those changes?
Yeah. First and foremost, number one is really the internet, right? It is something that has changed all business and there’s a free flow of information that, that wasn’t there prior. And I think I’m gonna say it’s 95% good. Sometimes you get the 5% of the, you know, you’re gonna get 5% out of anything. But the reality is in the beginning you used to have to call some providers and they wouldn’t even know it existed and some client weren’t really kind of on the up and up.
There was this belief that physicians that chose to do this type of work were substandard. We now know for a fact. And there have been clinical studies that have proven this is that patient outcomes. Number one and number two cost. The patient outcomes are actually equal or better and the cost is equal and sometimes less.
Now, some people will say, well, you’re paying somebody a day. That’s more than if you had a permanent physician there. Sometimes sure, but the reality you have to build in a lot of other costs with an employee, right? Whereas a 1099 that’s choosing to be a 1099 that is working in multiple places. You know, they are accepting the contracts that they choose to and not accepting others. So it’s been proven over time. So if you would ask me the greatest difference, it’s that it’s the free flow of information and it’s also that the care maybe 25 years ago, it was substandard.
I haven’t read a study to prove that. But let’s even accept that as a possibility. Well, we’ve known that that whole theory has been debunked and there have been several, you know, case studies that have been proven, the, the two items I just said with the equal or lower cost and the equal or greater patient outcomes. And I also feel that the locum has become very popular, especially after the COVID situation.
What I see is many of them don’t want to take up a perm job. They’re OK with doing 1099. And I see a lot of doctors coming to me and saying, hey, if you have a locum opportunity, let me know because I’m ready to go 1099 moving forward. So I think that is a huge trend that I have seen post COVID. I’m not sure if you have seen that as well, but I think that’s, that’s an important point because early in my career, all I did was talk to physicians.
I got involved on the contract in terms of the hospital and the HCO side later on. And the conversations I used to have is, you know, Matt, you know what I wanna do, I get joy out of taking care of patients. That’s what I like, right? And instead, and, and again, you would know more about this than I would perhaps. But the, the reality is working within an HCO, what you end up having is I need you on this committee and then there’s maintaining your own this and then there’s, there’s all these other ancillary things that are, that are taking place where the beauty of locum tenens is. I can work as, as much or as little as I want, I can negotiate my own rate. I know the key things like MedMal (Medical malpractice) and travel and all my logistics are taken care of licensing, credentialing all the things that are in, right, which is part of what we do as agencies, right?
We want to alleviate that. We want to alleviate that friction and allow these physicians and providers to, to go to these areas of great need. And all they need to do is show up, take care of the patients and go home. That’s, and, and in my experience was uh the majority of the physicians, that’s what they really wanted to do. So that I agree with you wholeheartedly. I think that that’s a, that’s a big part in it and that’s a big part in the growth overall as the industry, both pre-covid and especially post COVID.
Absolutely. Correct me, if I’m wrong. Your expertise is building an organization grounds up, right? When you said you were 26 and you started this grounds up organization with a physician. What were the challenges that you faced and what are the learning points that you took home which you implemented in All-Star that has helped the organization become better and more robust compared to what you had the first time around.
Yeah. And, and I, I’m not making light of it, but I, I remember the first day that I worked uh with my colleagues out in Denver and the firm name was on X MD. I’m very proud of the work we did there. They’re now a part of health carousel. I remember it was a long day. It was like a 15 hour day and we were trying to figure out how to get that plane off the runway. And I remember calling my mom and I had never been to Denver. It was like the first time I’d ever been there. And I said, you know, I don’t know who’s more screwed. These people or me because I think I, I think they think I know more than I do and I thought they were further along than they are.
But as of all great companies, I mean, even, even Apple started in the garage, right? I mean, you, you get all of these stories of entrepreneurs that kinda not fake it until they make it. But kind of like through brute force, just say, ok, I have this level of expertise, but I think the the real key is embracing what, you know, you don’t know and that’s very Socratic I believe. But the reality is you went out there, I went out there with this talented group of people and said, ok, here’s what we know and here’s what we don’t know. But do we know enough to create a contract?
Find a physician, put a deal together, send them and get the proper malpractice and the proper logistics? Well, we can do that. Ok. Well, let’s do that 25 times. And then as we’re doing that, we, we’re gonna try the best we can to, you know, because the problems of a 0 to 5 employee organization pale in comparison to when it’s 100 people or 200 or 500.
Tell me about it. I’m in that 0 to 5, right? So I know the pain point.
You’re basically breaking rocks out there trying to make a brand, make a name for yourself. You don’t have a huge budget. So what you wanna do is in the best way, uh and, and I wish I wish there was a better answer for this, but you have to come through and do what you say you’re going to do. And when you do that enough times, both on the provider side and the client side. And I’m using client to describe HC OS obviously, that’s kind of what starts momentum and then being able to keep those retained earnings in in the company to help fuel the growth because you have two choices.
You can be a lifestyle organization or you can be a growth organization, you can’t be both. So if you want to drive a Ferrari after being in business for two years, your company’s never gonna grow. And luckily I was around people obviously at on, but especially at All-Star, we embraced that early on. And luckily for me, by the way, I wanna make sure to give him his due too.
Keith, my business partner had a long history in locum tenens as well and he was one of the top builders for years. So when we got that enterprise moving, that was like, you know, pouring gasoline on a fire and, you know, to be honest, and, and again, obviously I’m biased, but I would pick, you know, myself, Keith and, and Craig up against anybody building a company from the ground up.
I, I thought it was, was the, the perfect team for me. I couldn’t have done it on my own uh by any stretch and, and, and our executive team then grew from there, but that’s what I would say. So in the beginning, it’s just brute force, creating a brand, getting some momentum, getting profitable and then being willing to reinvest that into not only more places, but also knowing what you don’t.
So there are textbooks written on companies that outgrow themselves. They all wanna do this hockey stick, but they don’t realize in staffing in particular as soon as you hit that day, you know, increase, that’s the, the hockey stick. You better have the funding in place to be able to pay the doctors because I’ll tell you what, the first time you miss a couple of those payments. All that goodwill you built up with these providers.
They don’t want to work for an organization that delays their pay a day or two days or three days, they’re never coming back. So you have to be prepared to meet those challenges. Head on.
Interesting. So tell me a little about All-Star. Is it uh only focused on locum or does it do PM as well? And are you across the country? And how, what are your employee strength? How many people you’re billing? Can you tell me a little bit about All-Star.
Of course. So I think I mentioned a little bit earlier, All-Star was a perm firm prior to my arrival. They were very, very successful. They did do retain but they did contingency perm work. And then we obviously developed locum tenens in part due to my arrival, but obviously there was expertise there outside of my own and we now service all 50 states.
We’ve done, We now have internally I think the last number I saw was about 340 internal employees. That’s everybody from the people that call the providers to people that handle the logistics to the financial end to the travel end and what the average person doesn’t necessarily understand when they hear about the industry for the first time is the amount of complexity that’s into one single placement. And, you know, there are whether it’s, hey, I need somebody in North Dakota. Well, I don’t have a license in North Dakota. Well, we have a licensing team. Well, now they need to get credentialed, they get credentialed. Well, now I need to take, oh, I’m only gonna go there if I, my travels under X amount of hours. Well, we have a travel department and the amount of of people that have to kind of contribute to make one single placement happen. And the kind of that collapse operation takes the right leaders to make that happen.
So we are now, I know we’re in the, I think we’re in the top six or seven. I haven’t seen the updated numbers but, you know, started from zero and, and got to that level. I’m, I’m very proud of what, uh what the team’s been able to accomplish.
Excellent. That’s like about 10 years, 13 years into this company. Right. Yep. So I am, I was charmed when I came to Colorado for the NALTO Fly-in. Unfortunately, I couldn’t attend the San Antonio one, but tell me about NALTO, I mean, I was completely blown away by the organization. So tell me about NALTO.
Well, that’s very kind and I look forward to seeing you in Park City, Utah, in September.
But I’m hoping to come as well. So fingers crossed, I should be there.
Awesome. So I appreciate the kind words and, and basically my involvement with NALTO started, I’m gonna say about 15 years ago. So about when I was already in Colorado, I obviously knew what NALTO was, but I wasn’t really in a position to donate time nor did I have the expertise to lend at that point. So I started getting involved in the ethics committee as well as the legislative committee and the membership committee.
And number one, I want good solid relationships with even, even though they’re competing agencies, I always liked having good relationships. So if there was ever a dispute about a placement or something that needed to be worked out, I, I always had a face and a name and a number I could dial because sometimes I think what happens to, to firms that are kind of like outside NALTO is they draw a line in the sand and say, well, if you’re not, you know, you don’t go through us, you’re not going. And then remember what I talked about with the solution where everybody wins. Well, that’s the opposite. Everybody loses.
So, but one second for the listeners, uh NALTO stands for National Association of Locum Tenens Organizations, right? So, go ahead, Matt.
So I got involved and, and, and I wanted, again, solid relationships with my competitors. But, you know, our, our industry is so critical to, I mean, I think the last numbers that I, I mentioned the over 50,000 physicians alone, but you’re now talking about over a million patient interactions a year that are performed by locum tenens, physicians alone, not to mention MP PAC, RNA.
So this is this, this huge industry that has such tremendous societal impact. And I looked at it as a way to kind of give back. I said, if I can help move the industry along, help educate about it, help protect it, help, whatever. And I started with the committees, my involvement in committees and then I was asked to run for the board and I, I remember talking with some colleagues.
I said, I don’t know, I don’t know if you got me on there because if this hasn’t come across, I’m, I’m, I’m originally from Boston. So I say what I mean and do what I say. So I basically ran for the board and was elected and kind of, you know, contributed where it was needed. And then I was elected president of the organization or president elect four or five years ago and I’ve now served almost three years and passing the torch actually in Park City to very talented Jere Dana from Fusion. Another fantastic human being and, and they run a great organization out there.
But really what I wanted to do in particular when I joined the board and in particular, when I got into leadership is to make NALTO known on the national on stage because I, we had not done that prior and it just so happens that things like the Pro Act came, you know, up for debate in the House and Senate, when, when, you know, President Biden was elected, and whatever your opinions on labor are and you know, your opinions on whether Uber or Lyft driver should be employed or they should be 1099, your listeners.
And, you know, I, I know you’ve heard us talk about AB5 in California that came from the dynamic case which basically says everybody’s an employee until proven otherwise. Well, that’s may be all fine and good for Uber and Lyft and Instacart. And we could certainly argue them parts of that. But one thing we do know for sure is that the vast majority of providers in our space, these physicians and let’s lump in MP Spas and CNAs, they provide excellent work as well.
If they were forced to become W2s for agencies like ours, that number would drastically if not be cut in half even more than that. And so we sprung into action and we’ve teamed up with, and I’m probably skipping ahead here, but we’ve teamed up with a lobbying firm in DC.
We are back on Capitol Hill later this month. It was important for me. As time has gone on to protect the industry that has not only allowed me to earn a living but to make an impact. So what I wanna do is make sure that the story of locum tenants is being told on the national stage. There is no, you know, better, you know, goal or, or, or better pursuit of NALTO than that.
So if I could look back on the, the wonderful work this board has done and what I’m particularly proud of is we now have 30 out of the 50 members of our senate that we can call up and now they know what locums is. They know what it is, they know what we’re trying to do. They’re on board, but they’re kind of waiting for the right time to strike. I’ll expand on that in a minute, but we even had a uh a bill that, that we had helped, right, got introduced in the last Congress in the House of Representatives. And we’re looking to build on that on that bill and that progress in this Congress.
So we’ve made tremendous progress. There’s a long way to go. That’s really where we wanted to make an impact. If that makes sense. That’s interesting. So how I see that you were talking about the locum tenens moving from w2 to 1099 which is better for?
All right. Are the doctors in line with this as well? Are, have they committed to this? Do you have the doctor’s commitment for this bill?
Yes. So our part of our outreach in coalition building have been to speak to hospital associations on the hospital side and we have a number of them that are willing to support our bill, which is great.
On the physician provider side, we actually have a group of physicians that are coming with us to DC this time around.
Oh, wow. Ok.
So we will have representation from because we get that question a lot. It’s a good question is, well, why would the providers care? They do because they know if they’re with all due respect, I don’t have the qualifications to tell a physician to, to evaluate their performance and act like they’re an employee of our No II I don’t have the expertise. They know it. I know it. I’m comfortable with it. They have the expertise, they choose what contracts they accept in decline, they choose what their rate is, they negotiate that all the power is in their hands and that’s where it should be. And we want to make sure that, that, that status quo continues in the future.
Fantastic. This is exciting man just talking to you I’m just getting so much knowledge coming into me and I’m just hoping that I would just burst out with all this energy. Look at you. You’re the energizer bunny right there. And I did say charming and you know, now why you’re a charming man, I’m moving a little bit into the small business side, having talked about all star, your growth, your career and how NALTO has come into your life.
I want to talk a little bit about small business and your thought process in that. So take my company, for example, it’s, it’s pretty much a small organization and definitely I have a lot of challenges just breaking into the space because there are big wigs there. And I have definitely, I can say in spite of the COVID, I have made some progress as well. So what can we do to leverage the resources and the support provided by NALTO to make ourselves more successful and also stay competitive in the industry?
It’s a great question and I, I applaud, you know, obviously the progress that you’ve made and the good thing about the industry is and we get some visibility to this because NALTO receives probably 2 to 4 applications a month or every maybe 45 days that tells me that the industry is growing and you have new players going into it. A lot of them are physician owned, small business, women owned small, small business, veteran owned small business.
We welcome all of those players because we know the massive job that’s gonna need to be done as we, you know, approach the 100 and 10 to 100 and 40,000 physicians in particular. We’re gonna be short by 2035-2040. I wish that NALTO had the resources that it has. Now when I, I started my career in Denver, because if I was a startup organization, I would, if I did one today, I would apply to NALTO right away.
We have a onboarding as you well know process to say, hey, even though that you’re new, we want to take you in, we wanna share what we know because the last thing the staff in the local tenants industry needs is an outlier out there W-2 people or not doing, not getting the proper malpractice and, or stepping on land mines all over the place.
It’s, it’d be a bad look for the industry as a whole, right? So what we try to do as an example, let’s say that as a small organization, you don’t have a robust or even like a training and development um you know, section of your organization, right?
Well, NALTO provides that. So we have a seminar once a month, month that is for free for NALTO members that you can go on and get real training. Whether it’s leadership training or sales training or whatever the case may be from people that know the industry, these aren’t people that yesterday were selling washing machines, right?
They know locums, they know how to sell locums. And we get hundreds of people signed up every month. So here’s this organ, these organizations that are smaller that says, well, instead of spending $90,000 a year or 70-100 whatever the number is on a director of training and development, I already have that because I’m paying my dues to NALTO and I get these things automatically for free. The lobbying that I just mentioned kind of speaks for itself. Here’s this group out there, protecting my interests. You also have risk management. What are the land mines? I can avoid to step on when talking about malpractice for one of my providers. What are some of the things I should be doing from a credentialing or a licensing standpoint? These are huge deals and they are potential. Like I said earlier, landmines that for a new company getting into this, it’s, it’s literally for the, for the dues and the fees that are paid, you’ll make 50 100 times that what you would be paying, let’s say a consultant to tell you the same things.
And by the way you get to go to the conferences and, and forge these relationships, which is one of the reasons we’re talking now and enjoyed meeting you guys when you were out there and I want you to do well because you’re gonna give locums the the industry as a whole. You know, you, it’s gonna, you’re gonna reflect it in a positive light. That’s what I want.
Not only as president of NALTO, but even as a managing partner and a board member at all star, I want people doing locums the right way. I want the industry to continue to thrive someone out there going rogue and doing things in an unethical manner. Doesn’t help any, anybody, any one of us.
I agree. I agree. I mean that we also need someone to handhold us which is something that NALTO does. And that’s, that’s why I said I was blown away because everyone is welcoming and I could reach out to so many people and advises were given without hesitation. I was introduced to people, you know, it’s a tough industry for all. But, you know, at least I have people that I can connect to. But do you have any kind of a mentoring program within NALTO where you connect young entrepreneur with a veteran in the industry and kind of like, you know, the buddy system? Do you have anything like that in NALTO?
So it’s funny you bring that up because our membership committee is always looking to continue or to improve, not only the welcoming of the onboarding process, but what happens after that? So one of the things that we’ve done is we assign somebody uh from our membership committee or our board of directors depending on how many are needed for. Hey, this is a NALTO firm that’s coming to the conference for the first time or the first time this year or they haven’t come in a couple of years or because, you know, every situation is different. Sometimes the dates don’t match up correctly and et cetera, et cetera. So we continue to add that.
Now, is there a formal mentorship program? That’s an interesting idea. And I’d love to take that to the board and to the membership committee. But I think these things in the past have almost happened organically and that, that’s not to say we shouldn’t formalize it. But I do think to your point that the average new member and even existing member, I mean, I get questions all the time and I certainly don’t have all the answers either. But, you know, some of the largest companies in the country will, I’ll exchange emails with them is what do you think about what’s going on in Kentucky with their state legislation? And these, these are companies much larger than mine. And yet we’re all collaborating on these ideas.
So I guess the mentorship kind of never stops. It kind of keeps going. But what I would recommend to, to, to, to folks that are, have just joined for the first time is get involved with a committee that interests you and basically we all meet once a month and then you get to know these folks and that kind of just happens over time. But that being said, it’s an interesting idea. Outside of what I already mentioned about the, you know, kind of mentoring people and bringing them through their membership process and their first you know, conference, I think we could certainly expand on that. So that’s a good point.
Thank you. You talked about land mines just now when you were mentioning about new organizations, right? Can you give some examples of land mines that people have stepped on to which has actually brought them down and things that they can avoid a small organization like mine? What are the land mines that I should be looking out for? What should I avoid and how can I avoid those land mines?
Yeah, that’s a great question. There’s somebody gave a TED talk once I think on $100,000 mistakes. So that’s like our example of, of what we’re doing right now. Sometimes it can be more than 100,000. Some things that we go over and now to in, in, in pretty uh you know, granular detail is don’t sign bad contracts.
Sometimes it is better to walk away from a bad contract than sign things that give you this massive cloud of liability that will follow you for a number of years. Whether that’s indemnification language, certain types of insurance uh requirements that really are only belong in the W-2 staffing world. We’ve seen a lot of that and I think what the reason for that in particular is a lot of M SPV MS players that have been in the nursing world and other staffing verticals have started to come in. There’s nothing wrong with that. We welcome that.
You know, I think they kind of cookie cutter their agreement and made locums like nursing or local, like lead industrial or locums like it. And they’re completely different types of placements both in complexity. And in, in my opinion, kind of importance too. I mean, it professionals are needed. Their work is very much appreciated, but I think we would agree that, you know, if you’re taken in an ambulance to a facility, a doctor being there probably kind of a little bit more important, right?
You have contractual issues like I just mentioned, you, you certainly have the landmine of physicians sometimes will say I’ll carry my own malpractice. Bad idea. Never do it. Because now remember in your client contracts, you are warrantying that they are carrying it. And how do you know what if they pay their bill?
And I’m not saying they wouldn’t, but there’s no way you’re gonna follow up on that. What, what about tail coverage? Are you sure they’re gonna cover that? Because as you well know, statute of limitations for an obgyn case can be 17 years. So you’re telling me you’re gonna fall for them in the next 13 years to make sure they renewed their MedMal and paid their tail now. So that’s another example of this liability that again, just, just think about this, right.
Let’s say you an OBGYN goes to work for your firm. You trust that person that they’re gonna do their own men procure their own men and then all of a sudden they don’t. And then a lawsuit comes in, guess who’s named you are and you will be coming out of pocket for that because because again, you have no face sheet, you have no proof that you covered yourself. So that would be an another example. And then the last I’ll use is when a company in particular going from small to medium and medium to large, if you’re not prepared for that growth and the amount of funds you will need um to cover not only provider payroll but your internal payroll.
Look. The other thing is you, you asked about things that have changed in the last 20 years. It’s more expensive to book a day now than it’s ever been. You have a lot of different costs and regulatory concerns. You have V MS fees, you have all these things and the margins have tightened a little bit.
Again, we all deal with it but it, you know, you don’t want to cut corners and leave yourself this kind of open liability and this landmine you could step on. So make sure you have your funding in place for when your company does grow, you look at your projections and then say if and when we hit this bee hag or this goal, what does my company look like then? And what am I gonna need to have in place before that happens? Because you know, again, you can be a victim of your own success pretty easily.
I totally agree with you. Coming back to small industry again as entrepreneurs, right? What are the top three qualities that you think an entrepreneur should have to be successful in this space?
This may be a little cliche but persistence, right? So as I explained, you know, any entrepreneur has to be a salesperson, in my opinion. That doesn’t mean you’ll be cold calling hospitals and doctors for 20 years. But that said, can you get in front of a potential provider or a potential client and, and sell your services and sell it? Well, can you, can you negotiate? Well, meaning make the deal happen?
You know, I always kind of laugh and chuckle when one of our consultants books their first days and I’ll be the first to applaud that. My congratulations. Now, your work just begins because there’s so many kind of steps that have to be done for you to have a successful placement. So, you know, persistence, right? Again, you have to have empathy, right? So you have to all always picture yourself in someone else’s shoes So how can I massage this deal to make it make sense for, you know, again, let’s look in the mirror.
It’s gotta make sense for you if you’re a recruiter or a consultant or a client rep or what or a leader or whatever the case may be. But it has to make sense for the provider and it has to make sense for the facility. Otherwise someone’s gonna be unhappy and the person is never gonna be booked again. So can you again, can you be have empathy and, and be persistent?
And then you have to actually kind of, I don’t know if this is the best way to say this, but you have to be vulnerable, right? And what I mean by that is you have to build vulnerability based trust with your people to say, you know, I’m in here in the trenches with you. This is what I’ve been through to help build this business.
It’s kind of like, you know, come with me everybody again. There’s that old drawing, right? That’s, that says there’s a difference between a boss and the leader and the boss is the guy that’s kind of whipping the stage coach where the leader is the one outside the stage coach going. All right, let’s go. And there and he’s pulling it, there’s two different types of people. And I think the 1980s-1990s celebrated boss charging through the wall isn’t, isn’t something that’s accepted anymore.
And we could certainly argue the merits of the good and the bad of that, but no one’s gonna follow somebody that is just an order giver. Are you there? Have you built up that trust with your people? And the best thing to the best way to build that, in my opinion is to go up there and go, hey, I’ve screwed up too. This is where I’ve made my mistakes. And if I don’t know the answer, I will tell you, I don’t know the answer because I got news for you. If you go up there and pretend like, you know the answer, um, there’s enough people in any size audience to know that you’re full of it, they’ll figure it out.
Yeah. So they can see through the BS for sure. 100%.
So that’s, I, I get, then there’s probably more, but those are the three that popped in my mind right away.
Thank you. I think you nailed it. Those three seem to be the, the common trait, right? And that’s going to take the person forward or backward, depending on what they have. Has there been any aha moment in your life? Something that’s been like, wow, this is it, you know.
It’s funny because, I guess when you’re a part of startups in particular you’re, you’re so busy putting out fires and, and getting to the, the next goal I admit this too and I know this isn’t a therapy session. It’s gonna sound like it. But I don’t think I’ve spent enough time to smell the proverbial roses, so to speak. And, and to really, you know, it’s like the saying, you’ll sleep when you’re dead. I probably should sleep more too. But when we moved into a new office and you have these land, I must say land mines, is that what I meant?
You have these landmark things that happen in the development of an organization when you go from infancy to adolescence and then adolescence to adulthood and adulthood. And, you know, I remember when we moved from a small office that we leased and we purchased uh an office building. We got to be like 80 employees which to us, what can you believe? We’re 80 here we are probably almost 380. Now, I remember sitting there and, you know, we had blast, you know, and again, this was, it’s not, it’s certainly not like Wall Street. But for us, we used to buy all used office furniture and, and really put everything that we had back into the business. And yet here we were and we knew in order to be competitive and attract employees, we needed a nicer space. So we invested the money and we built this space and it was like, yeah, I think we’re, we’re getting there, but never ever did.
I say we’ve made it and I don’t think I ever will. And that, and, and that’s probably not a healthy thing, but that’s, I was about to say, is that good or bad? Yeah. I don’t know.
I’m, like I said, I’ve just been very lucky and very blessed to work with a great group of people, like, and even both on the All Star and obviously it’s the most important thing that I do.
But even my time with NALTO, I gotta be honest with you when I step down in September, that’s going to be strange.
Ah, I’m sure you’re gonna find 100 different things to do. knowing you. Next thing, you know, you may have something else in your plate and I’ll be like, wow. But do you stop ever? That’s what I’m gonna ask you. That’s kind of you to say. Yeah, I have a, a very interesting question put out there about mergers and acquisitions, right? So now that’s the, it’s very common in the industry. You see it increasingly happening in the industry. How do you see the activities of this M&A impacting the local tenens sector specifically?
Well, a lot of it’s already happened.
You know, there’s not many, call it 75-80 million and above you almost have this gap, you have a lot of zero to call it $30 million companies. And then you have a massive gap between like that middle ground and then you have the top dogs that have kind of done a lot of the acquiring that being said, during COVID, things slow down a little bit from an M&A perspective and rightfully so, according to the conversations that I’ve had to NALTO and All-Star, obviously, there is a heavy appetite for both private equity and, and strategic buyers to come in and and acquire profitable locum firms with good cultures and, and great P&L, et cetera.
So I don’t see that slowing down any time soon. This is the rolls Royce of staffing. And what I mean by that is physicians not only have such tremendous societal impact, but they also are revenue producing folks for hospitals. So every time I’m always very careful to say it like this, you cannot run a well functioning hospital without tremendous nurses and nursing through the pandemic rightfully. So got their due and they’re part of the heroes of health care. No question, but from a P&L standpoint providers positions in particular are the folks that kind of keep the doors open from a revenue producing standpoint. That’s why they command a premium and that’s why from a staffing standpoint, we command a premium because the supply and demand issue is just way off.
That’s, that’s only gonna get worse because not only is the supply of physicians, not where it needs to be, but you have aging baby boomers. You have a pretty, unfortunately, not the healthiest population or the healthiest population that you wish you did have was one of the reasons why the United States struggled with COVID more so than some other countries was because in comparison and we’re not as healthy, we have a bigger obesity issue here in this, in this country than in, than in other parts of the world.
What you have is a number of private equity folks and, and strategics, as I mentioned earlier, that will continue to look to acquire those firms. So I don’t see it slowing down any time soon. I think this industry with the current structure, current margins, current, everything has a runway for the next at least decade and a half, you know, or more. And what I mean by that is with the current structure, current margin, current kind of business landscape, which is also one of the reasons by the way that we’re very passionate about keeping these folks as 1099s because if all of a sudden they all became W-2s, the industry would change like that overnight.
And it’s, and, and of course, we would pivot, our firms would pivot but the costs would go up for the hospitals. There’d be less folks to choose from and who wins there? Nobody wins, nobody wins.
Do you think technology like AI or even, you know, all the new Softwares that are coming in. Do you think that’s going to impact the, the traditional way of recruiting in any, in this industry?
Yeah. I mean, I think it’s gonna impact, it’s just like anything else. Right. I think the first time, you know, you jump on, you know, ChatGPT and you talk about AI, your first inclination.
It’s kind of like the assembly, you know, ford assembly line the first time they had a robot build something, you know, it’s, it, it’s certainly a disruptor. And, but at the end of the day, I think that firms that learn to use it in the most effective way really will benefit from it. And those who choose to ignore it will face those consequences. But from a physician standpoint, for example, AI is designed to pick up patterns.
I’m not an expert in it, but I know enough to be dangerous. Physician care will always be physician care. I don’t think, I think we’re a long ways away from the robot walking down the hall, providing patient care. I, you know, that’s not what AI is but what I will say from, for example, radiology, right?
And when they’re looking at a scan, could AI be taught under the supervision of a radiologist how to detect patterns better and maybe early diagnose cancer or something like that. I know that that’s been discussed a lot. That seems to be a place that it could go relatively quickly. And there’s a massive shortage of radiologists. So maybe that’s a good thing. And then some of those folks could repurpose to other specialties just as an example. So I think it’s a reallocation more, more so than something that we should fear.
But in terms of the business as a whole, could a I help write emails to help us recruit people, I guess, I still think and I’m old fashioned. I will still say one of the greatest joys of me being in this industry is, is the lifelong friendships I’ve had with clients and providers. I mean, I, the people I recruited from original Cold Call, I’ve been to their weddings. I’ve had beers with them. I’ve been to conferences, I’ve gone into business with them. So it’s just one of those things where I don’t think anything will ever substitute the human interaction piece.
I think some of the busy work could be done by AI, but I don’t see it as AAA massive disruptor for what we do every day.
Interesting. So, is there anything that you want to use for a concluding speech or a presentation to the audience? Because I know you have a lot to say. I do. Yes, I know you do. You have this huge legislation with NALTO and also you have so much experience in the field.
So, so if you’re an NALTO member, you’re a physician or you’re a health care organization. You like it or not. You know, with the supply and demand issue, locum tenants will be a thing. I think over 90% of HC OS use locum tenants. As I mentioned, it’s over 50,000 physicians alone. Never, never mind. MP, PAs and CNAs. We need these folks to continue to be out there in particular, in rural and undeserved areas providing care. Ok. We want to protect that. How do I get involved? I’m so happy you asked.
So if you go to www.NALTO.org/action, you can literally, it takes 30 seconds, you plug in your information in your address and it will automatically send emails that say we care about these folks.
We know they’re providing care. Let’s keep the status quo, do whatever you want with the Uber Lyft drivers. We’re not making any, you know, judgments about that, but we want to make sure that God forbid if there’s an accident or someone in myself or someone in my family is in a rural area and needs care that someone from your firm, my firm, any one of the NALTO firms will be able to provide that care because without that, we’re talking the difference between life and death here.
So we wanna make sure to protect the industry, protect the ability for these providers to continue to provide this care nationwide. So, I welcome everybody to go to that website, reach out to me on linkedin, reach out to me via email. I’m on the website. I’m happy to take you through it.
We want, we need as many people to be involved as possible because one thing I have learned going through this process being on Capitol Hill is they all love the idea, but they don’t want to necessarily be first.
So what that means is we need to have three or four or five people from different parts of the country, Democrat and Republican come together and then this thing can, can, can really get moving. And the last thing I’ll say is there’s a lot of things that are partisan. I am proud to say that HRC 7881 was supported on a bipartisan basis by both Democrats and Republicans, which is a rarity in this polarizing time.
So if you could reach out to your representatives, it would be greatly appreciated. We’d love your support.
Thank you so much, Matt. That was great. Really appreciate your time. This one hour just flew by. I asked for 20 minutes. I’m so sorry. We spoke for an hour and it’s just, I can talk to you, as you said, for more than an hour as well. But I know you have another meeting to go to. So thanks for listening, everyone.
Thank you Matt for being on the show. I appreciate it. People, don’t forget to subscribe to ProteanPulse. We are on Spotify as well. You can search for ProteanPulse and remember to leave us your feedback. I will see you in the next episode.
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