When Her Employer Went Bankrupt, This OB/GYN Built Her Own Practice

I don't have daughters who, at this point, depending on where they live in the country, would not have access to reproductive healthcare that would be appropriate for them.

I have a daughter who lives in Alabama who wouldn't be able to get in vitro fertilization because that's shut down because we just can't figure our shit out.

Other countries have, like Europe has actually developed guidelines and they've just figured it out, but… You didn't build your clinic to feel like an employee in your own business.

I'm Matthew Calogli and on Out of the System, hosted by Doctor Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable patient center practices and doing it their way.

Hi, I am sitting here with Dr. Liz Lisser, who is an OBGYN by training. and has gotten out of the insurance rat race, and we are in beautiful Reno. And we're going to have a great conversation today.

Are you going be able to handle this today? Liz is feeling a smidge under the weather. We won't go into why because I'm not going break the hippo. Right.

But so we'll go as long as we can go. OK. Absolutely. So I've look I have had people on this that had a guy that was dealing with the flu. And right. Yeah we had to have a trash bag next to him the entire time.

We've been trying for like months to get him on the show. He's like I'm still doing it. Yes, that's how I feel about it. Yeah. You deal with stubborn people, don't you?

Doctors. I deal doctors. Yes. So I'm saying. A lot of orthopedic surgeons, a lot pain management, and then the OBG's, you all are a different breed. That's true.

Were you delivering babies? Absolutely. How many babies do you think you delivered? Oh, thousands. I have no clue, really. But I do know when I delivered my last baby, it was just over 18 years.

And in the state of California, where all my deliveries were, that's the statute of limitations for deciding that I screwed it up. It's not sick. It is.

So you've been having to carry whatever, look, whatever it's called, Look Back Malpractice. The tail, but it has been fine. I have been very fortunate with my liability insurance carrier.

That's what we call it now. We don't remove the word malpractices, the liability insurances. so I got really lucky when I stopped OB. Uh, I did not have to do a huge, very expensive transition down.

They just did really just, I'm sure it wasn't a favor. I am sure that it was their calculations. But I was fortunate. So what, now you come from a family of doctors, right?

I sure do. Parents are both doctors? Parents were both doctor.s So you could be anything you wanted growing up as long as it's a doctor? Pretty much. You got a brother and sister, are they doctors.

I have one brother, and he went into theater. God bless. What happened? Did he get dropped in his head as a kid? No, he just didn't get the gene. I don't know.

But now he's a therapist. Well, that's kind of the natural way to go. By the way, for the people that don' t make it in the theater and acting, they wind up being in therapy, right?

That was his path. He's great therapist, so that was good. That's awesome. Yeah. So, but so… There's couple architects, couple of dentists. Well, architecture is not what it used to be, and dentists make more money than all of us.

Yes. Well this is Argentina, so different. Okay, were you born here in the States? I was born in The States at the Mayo Clinic. My parents both went from Buenos Aires to The Mayo clinic to train.

Ah, okay. Yeah, they were doing their residencies. my dad was a little ahead, he was couple years ahead of my mom. Oh sure, you're one of those birthright citizens.

No, no, I was born in the US. Yeah, when you're born, in US it's called birthright. Oh, that's true. I'm joking. What does that mean? What rights have I lost lately?

You haven't lost any rights. So what birth right means is that it was put in place with the 13th and 14th amendments. And what Lincoln wanted to do is he didn't want to have a loophole that the South could come back and slave owners could say.

Well, they can't be citizens, we have to expel them because they're not naturalized citizens. So what you put in place was that if you were born here, then you're a naturalize citizen.

It's one of those quirky things that came out of the whole Civil War that… I'm a big fan of The History of Unintended Consequences. You do something and now you think it's a really great thing, but you don't understand the consequences 20 and 30 years later.

So are we experiencing unintended consequences of the fact that our founding fathers all own slaves? I mean, you know, it's so great. OK, that's true.

Not all. Yeah, not all did. And many of them were progressive about it. Remember, Washington freed every single one of his slaves. Washington was the first to ever say they were only going to work six days and we're going feed him.

He gave really good medical care. Jefferson was very similar, except for he decided to sleep with his and have kids. So yeah, a lot. But so they weren't all, you know, a lot of them were pretty progressive in that thought process.

I'm a fan of, how do I wanna say this? Bet you didn't think I was gonna get that answer this morning, huh? I didn' think we were gonna talk about this.

Neither did I. But that's okay. Yeah, well we're here to talk. You know unintended consequences are very relevant to career path and choices that we make, becoming a doctor.

Actually I wanted to be a nurse practitioner. Okay. Because my entire love of it was the educational part. Okay, I was in college and I volunteered at the women's clinic.

It was called the Contraception Gynecology and Sexuality Services Clinic. That's a freaking mouthful. I know, CGSS at Cornell. Who the hell came up with that?

I have no idea. You went to Cornell? Yes, and this was ages ago. Wow. And I got there in 1982 and the clinic was already established. Wow. Yeah. So it was very beautiful.

Dr. Lynn went there. Doctor Dwight Lynn, who's in our program, graduated from Cornell. We have quite a few doctors that have been. It was great. That was undergrad.

Then back to Southern California for medical school. Did you know at an early age that you were going to be a doctor? No. A lot of my clients would be like, oh, I knew at 14 or I know 12 or was it just like Well, I loved the healthcare environment.

I was what I now realize, a weirdo, because I enjoyed going to the hospital with my parents. They didn't do, like, bring your kid to work days. That wasn't a thing yet.

Just make a tube down his throat. It must have been just a scheduling thing, like I needed to be there for a couple of hours after school or something.

And you know how most people don't like the smell of hospitals? I was fine with it. I like, the antiseptic, it was okay. Wow, that's really weird. It was weird, I didn't know it weird at the time.

Actually I had a client one time said he loved the smelling of formaldehyde, and I'm like what? Seriously? And I think his grandfather was a doctor and he brought him to do like an autopsy or something like that at the age of 11 and watch things like as soon as he cut open the body I was like in heaven right smell right that's just weird anyway I know but see that what I'm talking about me was the smell of golf courses go ahead right it's a nicer smell I will concede I smell a grass at sunset's pretty impressive I remember, this is a vivid memory in my mind as a kid, I don't know why I saw this, but somehow, maybe this was a school trip, because my elementary school was very close to where the hospital was located.

Small town, Morgantown, West Virginia. They moved from Minnesota to Murgantow. That's a whole, that's another story. My dad got a master's program at WVU in Morgantown.

But we were shown a slice of a lung of non-smoker and a slice of lung a smoker. I saw that exact same thing as a kid. and black. And I was like, wow. It was an early, early exposure to the fact that our choices impact our health.

That was really formative. I saw the exact same thing. Yeah, it would be before fourth grade because I Catholic grade school. Yeah, and I remember they brought it into whatever science class.

Yes, And I Remember seeing it. And just being like it was in a bag. So it must have been like some government program or something like that. We need to stop smoking.

Jimmy Carter was bell bent on making sure we didn't smoke anymore or Something. Who knows? That is so wild. You get done and you go into the traditional system, obviously.

When did you graduate from when you finish up residency? Okay, so let me back up to one moment in college when I'm doing all the pre-med, all of the science, and I wanted to be a nurse practitioner and my mom, the pediatrician, now retired of course, says, you know, just go be I remember it being that casual, and I remembered saying…

Just give up the next seven years of your life. Okay. Yeah. That was not discussed. She started medical school when she was 16. And in Argentina, you just go straight through for, at that time, it was only six years.

Yeah, so you come out, you're not giving up your 20s and your early 30s. Exactly. That's exactly right. Okay. So then University of California Irvine for medical school, and Los Angeles was my residency in East LA.

And so I finished my presidency in 94. 94, okay. Mm-hmm. Obviously, OBGYN still at that time, the interns got to only do 24-hour shifts. The second, third, and fourth years, we all did 36-hours shifts Do you look back at those times and think how effed up that was?

A little, but I also look back and think those thoughts that people have, like, the weakness of the youth, and how can they even learn how to manage labor when they're not even there for more than 24 hours?

I mean, you know, those types of thoughts. There is that. Like, I suffered, You have to suffer. Yes, that's exactly it. That's we felt the same way in the Catholic Church about the altar boys.

So yeah, you, look, they molested you so now they're gonna, They molest me so they gonna moleste you. Yeah, it's pretty much how that works. Oh my God, I was hoping that's not what you meant, but that what's you mean, so yeah.

No, that is what I meant. I mean just, Father Mulcahy's gonna- Right of passage. It's the right of the passage, yeah I worked for a guy- All right, at least there's a purpose to learning how to manage labor and you have to be there for more than 12 hours.

Yeah, well, sometimes labor takes a long time. Exactly. Let's step aside from the fact that you've got Vietnam Vet Syndrome and that's just what it is, okay?

It's mild, thank goodness, but yes. Do you really think that that is the best thing for training? No, absolutely not. Okay. No no no, it's hazing. It is hazy.

And hazeing sucks. Hazing is bad. Yeah. sleep deprivation of 24 hours, you're operating like a blood alcohol content of 0.08. That's what it shows. And here you are, delivering babies and making life-saving, changing decisions.

Yes. The idea was that there were people further along, for example, your senior resident or your attending who had gotten some sleep. Mm-hmm. killing people, but it was difficult.

So did you come out and start your own practice in OBG? Absolutely not. I took a J. O. B. You took the J-O-B? I take a job and it wasn't awesome. It was the end of the heyday.

This is now, what did I say, 94. And I go to work for Cigna, which is it still around as an insurance company? Yeah, they're still. Well, at that time they had hospital locations in Los Angeles.

Wow. Now they quickly discovered while in those first few years that I was there, they figured out that that model doesn't work because the office model is keep the patient out of the hospital, but the hospitals income is based on put the patients in the existential internal conflict, I would say by the time I was done working there, they already had closed one of the hospital locations, something like that.

Yeah, because they kept dropping reimbursement rates and they continue about reimbursements rates. The reason why they don't want you to stay in the Hospital is because it'll pay as much as it used to.

Right. the only time that they paid money for a big last time was during COVID. That's why they admitted so many people with COVID, because they got bonuses.

People don't realize this. Aw, seriously, it wasn't because the people actually needed to be in the hospital. No, they did it. So there were, and it's…

Oh, I try to naive about this… Yeah. And then the other thing is they coded a lot of people that they may have died, that may COVID. They may not have come in with COVID, and they died or in the hospital, but they got COVID while they were in hospital.

And they would code it as a COVID death, which did skew the numbers because they've got a bigger comp. for the hospital bed. They got they got bonus dollars and had huge profits.

Yeah. Like there's there is always with this is what people don't understand. There's always a reason why things are the way they are. Right. And it's.

Always. Ninety seven percent of the time. It's based on money. Money. always based. Sure. If you ever want to understand why, things. Are the. Way they.

are it based? On money? Sure, especially in the medical field. I know. Well, there I was delivering babies and that seemed like a lot of money, but the malpractice insurance was a lotta money.

The time and effort was lotta money the sleep deprivation and I'm talking about once I working. So my first job working for Cigna paid great, and the schedule was great.

I literally, we've split 24-hour shifts. See, to 12 and 12. Yeah. So this was great because I had met the person who I would marry and have my kids with, who's now my ex-husband.

But we had meet, we were together. I finished 94, and we got married in 96. It was very helpful in terms of starting life. Right. I mean, anybody looking at how the model was would see that it wasn't sustainable.

Right. And then one of my colleagues had a sign on his desk that said, I can't be fired. Slaves can only be sold. Wow. Okay. Now, wow. So ha ha humor, right?

Except then the entire company got sold Now at this point, not a lot changed for me. Just the name of the clinics. They're like, we're not taking the hospitals.

Who signed your, like, I was going to say, whoever signed it, that's what changed. Who sign the paychecks? That was it. Yes. Yeah. It was called Friendly Hills.

Friendley Hills, medical group, Southern California. Sounds like a funeral home, but it was our medical. Probably was. I don't know. Let's just kill them off and get them to the funeral.

We can own the entire channel. Motivated by money, right? Yeah, motivated by the money. Tell you what, let's give a couple of nursing doses. So then it's a couple of years later and I go on a vacation and then I come back and say to one of my colleagues before I got back, I say, so what happened while I was gone?

Do we get sold? She goes, yes. And I said, no, she was kidding. She said I'm not. Wow. It was sold again to med partners and finally it got sold one more time.

At this point I am looking for somewhere else to be that I hope will be more stable. What year is this? We are now 2000. I remember because I showed up for work.

I had already lined up another job that I was just still at the process of confirming everything, and I'm pregnant with my second child. So I am like seven months pregnant.

And I get to the office. Luckily, my in-laws were visiting, so they needed my car. They drive me to work and they drop me off. There's a crowd in front of the door.

What in the world is going on? So, I waddled to the front and the doors are locked because the company had declared bankruptcy and closed the door. What about the people that were inside?

Did they get out? What happened with the patients? I'll tell you who was inside was the staff, because first of all, I managed to somehow run, not fast, back to my in-laws that are driving my Mustang convertible, which was not a good turn radius.

So they're having trouble leaving the parking lot. It's not really a car to be able to have kids around. I know. We traded that car in. I know, it was great.

One of my very few regrets in life. But they hadn't left. So I reached them to say, wait, you can't leave. I don't know what's going on. You have to wait.

They waited. And I managed to identify myself. These people are there for blood work. It's really early. Mm-hmm. and I see some of My patients. so I'm allowed into the building and handed a box to get my things off of the desk.

It was crazy. I know. When you become a doctor, you do not expect to have no type of experience. No. You work at Merrill Lynch, yeah. The nurses are like, here, Dr.

Lister, there's some items. We don't know what will happen to it. They're not going to let us use them for the patients, like IUDs, which at that time cost like $600. And you were sure, right?

I literally ended up with just a couple of these types of items, obviously sterile, but I was able, like a friend of mine, I know she was done having her kids and I go, well, oh my God.

I didn't have that mentality of like sell it to her or just take this to your doctor. So that was insane. And then the other job started, but things just kept changing very quickly.

When did you have the realization that… corporate medicine, hospital medicine was not gonna be your bag. When did the light bulb start to, like, do you remember a moment?

Do you a patient that where you were like hey, wait a second, you're my 50th patient I've seen today who's dealing with menopause and I can't keep prescribing you Wellbutin or something like that?

It was, I'll tell you what it was like. So while all these changes, so first of all, impression number one was this is the best, having a job is best.

And then it all just kept changing, changing. So not long after this crazy story that I just told were colleagues that had from the very beginning, some of them had formed their own group.

And these were amazing people, smart as heck. and that I really respected. They were mentors to me. We were friends. It was just amazing. So they had formed this group where I now was going to be an independent contractor.

This is the first little switch. Yes, yes, from the employee. Who am I going get to write off all this stuff? That's more advanced. I'm still a doctor brain at that point.

Raised by two doctors. That didn't help from a money management standpoint. Like rich dad, poor dad. My parents were the academics. You don't talk about money.

They were 100% that mindset. Okay. So I'm working for them and we are the supervising doctors and mostly midwives are doing the deliveries. And it was sometime during that time, I now have two little kids.

I want us to move closer to where my mom lives. So we moved from LA to Orange County in Southern California. And at this point, have developed relationships with a couple of the midwives, and they were very encouraging, like, let's start a practice together.

so I had a little bit of hand-holding and And I just knew and I worked part-time. Oh, this is relevant from when my first son was born, so he's now five Mm-hmm.

I Worked part time So that changed things right, right? Right. So the transition to having my own practice still billing insurance is But switching to having my own practice was somewhat natural.

I had the support from encouragement like, I can do this. You can this? Yes. Now, it was very difficult from the very beginning. Right? I delivered enough babies in a month to pay the liability insurance premium.

Okay, plus I didn't have money skills. So it was really just like, oh, thank goodness this these checks came in from the insurance company and now I can pay these bills.

Yeah. By the way, really typical and for those of you that are listening or watching like I tell doctors, there should be zero shame that you have about your lack of understanding of money or business.

Like, I grew up in a household where neither one of my parents taught me anything. Just was told that, why don't you know how to do that? Really odd. But there shouldn't be no shame you didn't know these things.

I don't want anybody sitting there going, like I hope they hear your story and go, oh, I'm not alone. Right? Yeah, absolutely. Because it's actually designed, by the way, it is designed in the system specifically to treat you like that.

All the programming is doctors are not any good with money, but doctors suck at business. Like the programing is there and it has done specifically, to keep you on the plantation.

Because they don't want you to leave. Right. And so if you never learn about business and you know, learn, about money and never learned about these things, you'll never realize how badly you're getting screwed.

Same reason why they didn't educate slaves, because if they taught them to read and write, they could read the Constitution and the Declaration of Independence and read all men are created equal.

They are endowed by the creator with certain inalienable rights like life, liberty and pursuit of happiness. It doesn't anywhere in the declaration of independence say except for black people.

Right? Like that doesn't exist in anything, right? So you have to understand the people that run the medical industrial complex are no different than those Southern plantation owners.

They are designed specifically, all they care about is their profits, and all the care is keeping you in the dark so that you keep doing the work and making them wealthy.

There's also the piece that everyone always says, oh, they should teach business classes in medical school. And so I spent a few decades thinking that thought, but I don't think that now.

Really, what do you think they do? Okay, so the reason I think it's correct is because we're too scared to not be learning the medical part. Okay. That would be the classes that students would skip.

Okay. What about nutrition? Shouldn't they teach nutrition in medical school? Oh, yeah. I got one week of that, not a four years of medical. Okay, now we're talking about the nature of illness.

That's changing. Teaching nutrition also isn't going to help from a business standpoint. But here's what I do think. Here's the talk that I would like to give, that i plan on pursuing at some point.

Like call my medical school and say, hey, you know, I could come give a talk. I mean, i'm assuming they wouldn't say no, right, if I don't charge them money, especially.

You just gotta give them a check to speak. But anyway, at your school. The talk would be more like, think about what you want as a through line. Think far down from an independence standpoint.

that would resonate with students. I think about myself. So I started medical school, I was 21 when I especially with the conditioning I had already had with my parents who didn't know anything about business, it would not have connected.

I think I would have thought to myself, oh, that's not me, those aren't my skill sets, but if you talked with me about independence and long-term goals, and this is what it looks like, these are the pros and cons of being an employee physician.

Because there are big pros. Huge pros as long as you know them going in. And the bad things like the medical records and the charting, that's one of the biggest reasons for burnout.

in that environment, there are solutions for those problems. And doctors, at least, like if you're aware of that going in, you can look for an employee situation where there our scribes, right?

There's solutions, for these things. And then there's the downside, right? I would say I have an entrepreneurial spirit, but I still wouldn't call myself an entrepreneur, even though I actually am now, just by definition.

But that's not my motivation. My motivation is teaching and helping people feel better, period. So while it's difficult, and I've had to learn a lot, that I'm learning faster now in your program, but these are things I have been working on for 20 years from a money mindset kind of thing, it still, I am very clear how much freedom I So every time I complain to myself, every I feel sorry for myself.

Every time, I think, are you serious? I'm right now, this far into the process, still figuring out exactly how much money I make. I can look at a ledger.

But to say exactly where it's going. So I've been doing a lot of work on that, I'd say, in the last two years. Good for you. But like I said, every time I feel sorry for myself, which is not rare, because I get offers every day.

There's a shortage of doctors. I literally hear from recruiters. Especially in OBDs. Oh, and the demand for OBG's is like through the roof. Correct. And the money just keeps increasing.

We'll pay you this much and we'll move you here and will pay your bonus. I'm like, what am I doing with all this difficulty of running my own practice?

And then I remember what I am doing, which is I control my schedule. Which is pricing. You control your care. That's absolutely true. Because you don't control you care in the insurance space.

That is, when I first started, I really did. Yes, you did, and I know you. I might have gotten in the medical field in 2014, but I spent a lot of time going through the past, like in talking.

You used to be able to make the decisions. Yeah, yeah I did and everything was covered. Everything. My biggest problem was a patient who lost their insurance.

Then I couldn't help them. Isn't that funny? I know, it was like the opposite. Absolutely. People don't realize that, you can help them more. And spending the time with people, that's also priceless.

Going back to this, whether or not you should have business classes, I would agree with you. I wouldn't have Business 101 in medical school. So there's a school in High Point, North Carolina, it's called Highpoint University.

And my daughter, Megan, who's now 31, so this was whatever, 12, 13 years ago, very smart young lady, we went and looked at it. High point was known for being very different.

The reason why it was this old university that had no endowment And this guy who immigrated to the country, who was a very famous public speaker and writer, his name is Nito Cubain.

And so Nino basically saw that the school was failing and he said, I can be president. So he became president of the university. What he did was he basically took this ramshackle university with dilapidated buildings and turned it into a four year motivational, how to make your life better and make a positive impact university, right?

So instead of like, you know, classes on Chaucer, which I had to take at Ferris State. Why am I a freaking golf pro? Why I am reading Chauser? Right? You know whatever, early British language, whatever.

Whatever, right? Literature. And so like the first class that you have, your first semester, every Tuesday, you go to a class in the amphitheater, in an auditorium, with every freshman, and Nito takes you through 10 weeks of basically how to set goals and how have an amazing life.

Wow. Okay. That's amazing. They give you classes on how to manage money, how do we invest money. These are all the requirements. You have classes like how-to host a business dinner.

Right? They have a restaurant there and you Oh my goodness, you get to practice. You get the practice, like how do you buy a suit, how you do buy professional clothing, How do make sure, do shine shoes, all these things.

So I agree with you, if we had a class of business one on one medical school, Somebody would get the test online They'd figure out an AI bot and you know, they were all right their way through.

All right, exactly But what if we took an approach I like your approach of saying let's talk about what your real options are Let's talked about the good the bad and the ugly about each one of them Yes, because there are good bad an ugly like, you, know let, s be honest you and I could both be if I Following a calling is It can become profitable, but the road is longer.

Yes, okay Yeah, like I always tell everybody if I was doing what I do. Yeah in another niche Our business would be doing ten million dollars a year, right?

Mm-hmm because You can sell it differently like yes, yes. That's what doctors I have to sell the whole customer journey the way that we build the process yes Now the good news is is that creates a barrier of entry to other competitors because I know my competitors and I Know where they struggle, right?

Yes, but like you have to be much more patient in this place in This market versus like working with whatever is startups, Right Yes because the math is different the Math is vastly different.

Yes. And yes, the risk is for you all Yes And so I agree with you like instead of saying how to manage your checkbook. I think there should be some basic life skills Because when that happens Doctors become informed now the challenge with that is too many medical schools are underwritten by the system Chairs are paid for by pharmaceutical companies and health insurance companies.

I don't want to use the word bribes. There's influence. Right. We can just say influence, yeah, subsidies. Well, that's encouraging to me because UCI also has an integrative wellness institute that was started a long time ago by Susan Samueli.

Really? I didn't know that UC I had that. And that's University of California, Irvine, right? Correct. To those of you at home that want to know what UCI is.

Yes. And I know her. Because her husband invented broadband. Nice. Yeah, and so he's from UCL. He has the School of Engineering at UCLA is named after him.

Oh, well, yeah, he's a big deal. Yeah, and they're great. They're a great people. Obviously, she cares about integrative health and solutions. And she was talking about acupuncture and nutrition like 30 years ago.

So she's been on the forefront of that. I talked to a lot of OB-GYNs. I'll never forget this. I'm at Don Buford's Orthosono, and he has a speaker dinner.

He does it twice a year. And I, you know, I am one of the speakers and I happen to be in town for the, he's like, are you gonna be for this speaker-dinner?

I was like yeah, it could be a time for that. So we go and we're hanging out at the bar and, there was Christine and a bunch of, literally like 70% of faculty staff has been a client or a current client of mine, right?

So I talk to Roddy McGee and Steve Darrington and talking to one the doctors who's, He's in the hospital system making 750 a year and he's getting ready to leave scared out of his mind His wife is OBG.

Okay, and I'm talking to her and she's peppering me with questions, right? Like can he really do this and blah blah, blah You know, is this really a good move, you know?

Hmm. And I said well We have this conversation and She's kind of opening up and i'm going and you, know what? I said, and if you ever decide to leave, you have a built in mechanism to building multimillion dollar business because you're OBGYN and all of your patients have menopause.

And I could barely finish the sentence. And she said, absolutely not. I am not going to be prescribing HRT. You should see the number of patients that come into my office, and they're bleeding, they've got polyps, They've gone on the verge of getting cancer because of estrogen.

She just goes off. Wow. Now, in my youth I would have argued with her. In my wisdom I go, okay, so maybe that's not an option for you. But you're different.

Like most OBGYNs I talk to think that hormone replacement therapy for women is a death knell. That you have menopause is just something you are supposed to fucking suffer with.

Right. And live a third of your life in. When did the lightbulb go on for you? Because you clearly are past the menoppause stage. By the way, the name of her podcast is Hotness.

So that'll tell you pretty much everything you need to know about Liz, okay? Yes, that's true, right? She's a little reserved today because she's not feeling all that well, and I'm just letting you know, like…

Like, there's like a whole frickin' layer underneath the artichoke. Yeah, absolutely. Like the iceberg. I call it the Artichokes, you're just not prickly.

Okay, all right, that's absolutely true. So how did the lightbulb go on, Liz? Like all your other OBGYNs are like, this is evil, they're all gonna die.

Yes, I called that the dark, the long dark shadow of the Women's Health Initiative study that started putting out results in 2003, roughly. And I was very fortunate.

A few things lined up for me. I had already been going to talks at like, you know, the hospital lunch lectures, that type of thing. And, I have seen original data done in animal studies in the difference between progesterone and pro-gestin.

Okay. So, already had been exposed to that and that definitely was not right. I mean, this was like a lunch and learn. Explain to the listeners why that designation is important.

It's critically important, but explain it to us. So women's ovaries don't make Protestants, they make progesterone, which now we use the word bioidentical, and that's the key word.

And I will always remember when that word first came out. I think it was popularized by Suzanne Sommers. And doctors at the time were very… Oh gosh, absolutely.

Wiley, who's not a doctor, she's just someone who was trying to help women feel regulated. Right. I don't do that protocol for the simple reason that it's complicated.

It's very complicated, we did it for men in the ED clinics. Oh, that's so interesting. Yeah, it was really complicated and I'm all about simple solutions.

And I mean, I didn't need to be changing my dosing every other Right like I don't I follow the moon. I followed the Sun. The same fucking thing every day Then there's women, we're different.

Women you guys are like the moon, the tides, you got all this shit going on. We are in fact scary. You never know when you're up. Never know. Do change every day, it is frightening.

I get it. And we did this on your podcast, that's the simplest way to explain men versus women. Men are the sun. Were up the same time every, like a minute plus or minus 30 seconds.

Set at the time time everyday, were in the fucking spot everyday. Wanna know where we are now? We're right there. Oh, we're going to be rising at 12 in the afternoon.

That's when the moon's going come up and we are going be in our waxing phase. And it's like, men are like I don't understand. I can't figure this out.

Just want a pizza. You know, it is like it gets the most. Men are trying to make… We won't generalize or anything. It's just like men, they are always trying make you the sun.

They are the Moon. If there is a cycle, put it on your phone. Right. Figure it out, you'll be much happier. Yes. I heard that once also for women to put on the fridge calendar.

Yeah, but men would ignore it. No, I I know I no Christine cycle like I'm like you're gonna get your period in two days She's like no, not like yeah, you are like, she I'd know it better than she's not you right?

Like I've learned them. You're my third, You know, been married and divorced twice like let's figure this shit out man, right See it can be figured out.

I am an optimist. That's right. Most men are stubborn and most men give up at 55 I'm like, no, let's make this better. Oh, you know, that's a time to start.

Yeah. No, it's time start Okay, okay, so you're talking about synthetic progestin correct versus projesterone natural bioidentical that is correct. So the Women's Health Initiative study did three things wrong and I'd have to put more thought into why I knew that right at the time.

What I do remember is the press release coming out and me thinking to myself, wait a minute, where was the study? Well, that's because the studied hadn't been published yet.

So they put a press released out on the results without the studying being… Correct. That's exactly what they did. Okay. Why? What do you think? Okay, a lot of theories.

Oh, no, we're going to… If you give me a… It sure comes back to money. Give me… We're gonna… Okay, even though I have my master's in public health that I got at UCLA because I thought I wanted to get back to more of the teaching and then I ended up…

I now am what they call an MDMPH. So I don't even use the MPH because an MDPH is a specific animal. They run health departments, they run community health clinic systems, vaccination programs, all sorts of things that I would have to shoot myself if you made me do those things.

So, unfortunately, I went into the program because I wanted to do more teaching. So it was this focus in community health education, and it super fun.

I loved all the learning. It was amazing. But then at the end I'm like, uh-oh, on an MD-MPH. And so I made the choice and I don't even put the MPH on very many things.

Okay. All right, where were we? We were talking about the hormones and the long shadow of the WHI. So somehow I knew very quickly that this wasn't right.

You knew intuitively. I did. This is the story I tell. a house at that time. We're trying to sell the house we lived in. And our realtor comes walking in, it's right after this has all happened.

Like the press release was like literally a month earlier. She comes in walking and she's beet red. she is dripping with sweat and can barely make it over to my couch.

and She plops like she just drops into the couch and of course I looked at her and I knew what happened, I know at this point I'm in… Was I 40 yet? I don't know if I was quite 40 yet, but I knew she was like 50-ish.

And so I new. As I said, what happened? Oh, I got taken off my hormones. I'm like, yeah, okay. So I know right away that it just wasn't going to be the full story.

So, what we now know, super clear, no questions, wrong hormones, women studied, and wrong route of administration of the hormones. So the women, if you're going to do a placebo-controlled study, you can't have women having menopausal symptoms.

So these women were in their sixties and sometimes even older, but average age in the 60s. So, these are women who had been off of hormones for at least a decade, no longer having hot flashes.

I don't know how they were feeling, But they weren't having the obvious things that clear up very quickly when you give them hormones. That's number one.

We know more about that, right? Like inflammation sets in, the bones start to disintegrate, all sorts of bad things are happening in that 10, 15 years off the hormones, So those are the wrong women.

The wrong hormones included the estrogen, which was premarin, right? Which is from pregnant mare's urine. Right, just synthetic. So that's why I don't use the word natural.

I use bioidentical or not bioidenical. Because, I mean, pee from a horse, that is natural, okay? But it is not what women's ovaries make. Natural to a whore, it's not natural to me.

So, non-bi identical estrogen and a progestin, not pro-gesterone. So wrong women, wrong hormones, and wrong route of administration. We now know, it's very clear, in the cardiology literature, all kinds of literature that oral estrogen does what we call the first pass.

You swallow it. Everything that goes into our stomach, we absorb it, goes first to the liver. The absorption, just the way the blood flows to the liver first.

So oral estrogen stimulates the production in the livers of the clotting factors. Increases the risk of heart attack, stroke, blood clots. So lots of ways to avoid that.

So now we know that transdermal estrogen is going to really, you're not going have that first pass effect, right? So you are not increasing the risk over placebo, it's never zero.

And it is also not, I also spend a lot of time talking about absolute risk versus relative risk. Right? Absolute risk of crossing the street, at one point I looked this up, of getting hit by a car when you cross the streets is one out of, let's say, 5,000. What if you were having your phone and you're texting?

Right. It's going to be like one of about a thousand. Probably. But if cross street twice, you just doubled your risk. Okay. So that's relative risk, but the absolute risk is still small.

Even with your cell phone in your hand, it's still only two out a 1, 000. Right! Okay, but it's double. So that's another thing that the WHO press release did that increased breast cancer risk by 37%, something like that.

But when you looked at the numbers, that was four additional women out of 10,000 women. It was nine in the placebo group and 13 in hormone group. Check this out.

They're making a huge stink about four out 10 thousand having adverse effects. Now, I'm not disregarding those 410,000. Statistically, it's relatively irrelevant.

Yes. And yet, we will push medications that we know do not work. and I'm not gonna mention them, that have higher risk factors and will say that they are life-changing.

And the difference is, is that, they have immunity because you can't sue the pharmaceutical companies for harm. They have, remember, most people don't realize this, the Reagan administration, and this was argued by the lobbyists of the Pharmaceutical companies, And they said, well, creation of vaccines is inherently What was the phrase they use because it's actually in the law.

I'm not gonna I won't get it right, but it some It's inherently risky or it inherently Damaging right? Okay, and they basically got Congress to write that into the bill that because the creating of vaccines and medications is inherently Risky and can cause harm to humans.

We need absolute immunity. So Most people don't realize you can't sue Pfizer, Moderna. We can go and sue them for COVID vaccine harm or any of it, like any other harm.

They have absolute immunity, which is just amazing to me. I know. Now, remember, I just mentioned that I have a master's in public health. And so I believe in Public Health.

Yes, the public trust, at least in our country, is a is it probably at an all time low? Oh, absolutely. Yeah. So so that's there's a lot of unfortunate things that have gone into that.

Oh yeah. Like it's one of a thousand. Right. I agree. The trust in our government since COVID, and you have to think at the same time, COVID came when COVID hit and we're all locked down, the, was it Netflix, Sackler came out at same because we were all freaking, what are we going to do?

We're going make more food and get fat and then we are going watch more stuff on Netflix. And that was the other thing that hit. You had kind of like this, that had Michael Keaton in it, I think.

It was really well done, it was beautifully well. Dope sick. It's dope sick, amazing. I haven't watched it, I'm too impressionable, just wouldn't sleep for weeks.

Yeah I didn't. Like I know what happened. You made me really angry. Exactly. But my point is that you have all these things that converge at the same time.

And it's really unfortunate. Very. It also brought to light, I think. I guess I'm going to speak more from my viewpoint. It brought a light a lot of the troubling processes of how things are approved and how the sausage is made.

Yes. Right. Thank you, Upton Sinclair. Yeah. So any thoughts on that? Well, again, it's difficult because it is true that there is inherent risk. I have to retain some degree of belief in the goodwill of at least some of the people in process.

For example, my favorite example is in controlling the safety of medications. There's a lot of people who care in all the FDA structure. It's when you get to the very top that you're talking about political appointees.

and you're talking about their friends, right? They bring in their friend. So the very top is really problematic. But when you look, obviously nothing's perfect and people aren't perfect, but in the structure, you just have a lot of people who care about the safety of these medications.

And then you also have a lack of the ability to be nimble. Okay, so for example… The government is not quick. Not at all. And I, of course, as most people who know me, know that I don't like the current administration.

My voting is based almost the single only thing that I vote based on is reproductive rights for women, reproductive health for woman. So that makes it very simple for me.

But I understand other points of view. Other than that, this administration is bringing in changes that will benefit my patients. that are already benefiting women in menopause, women using estrogen, taking the black box warning off of seven different estrogen products.

So I'm talking about me and my patient base at this time. I don't have daughters who, at the point, depending on where they live in the country, would not have access to reproductive health care that would be appropriate for them.

In vitro fertilization because that's shut down because we just can't figure our shit out Because other countries have like Europe has actually developed guidelines, and they've just figured it out, but we keep staying stuck Okay, so this is one of those ones where I'm like digressing digress No, that I think look.

This is really important conversation I mean yeah, I will just say this federally what most people don't understand is Is why those states have the kind of rights that they have?

Because without it we never would have created the United States of America because New York's like fuck you We're gonna go out and create our own country.

We gonna be like Europe, right? Right, California, Texas. Sure. Yeah, I mean like you know, but I but but again, there's a yes America has a different set We have a We have a different route basis.

We sure do. Versus Puritan, like the freedom thing like, oh, yeah, Pennsylvania is going to be for, you know, this type of sect and Rhode Island's going for this kind of fact.

And that's how originally we started. Right. Georgia was a penal colony. You know. Most people don't realize these things. I'm like a big time American historian.

So like I study the shit. Yeah, I like to read Heather Cox Richardson's daily column. I'm not familiar with her. She is great. she's a history professor.

Okay. And she says, at one point she goes, someone said, are you an expert on absolutely everything related to US history? She goes well, can't say that I could really speak very articulately about the history of opera in the United States.

Everything else. Yes. Right. So every day she writes a column. Some days it's talking about what's happening currently. Other days, it is talking what has happened historically if it happens to be a particular holiday.

But oftentimes, she will bring it back. There have been similar times to now in our past. And that is reassuring to me. Yeah. When you say the conflict of interest to everything's always going to bring different results.

You just, unattended consequences, you said that a while ago, right? So I'm okay with that. But what I don't like, so for example, and this was, I was thinking of this when we were talking about that the government is not nimble, okay?

The current Secretary of Health, held by someone with actual medical background. So you weren't a fan of Sarah, who was in the Biden administration who is an attorney general in California.

I wasn't paying attention. Okay, I'm just saying I'll just tell you thank you for being honest. Yeah, absolutely. Because that's always people like, well, you know, Kennedy has no health experience.

And like neither did Sarah and he was during COVID. If that's how you pronounce his last name. It's a question, it's not an indictment. Right, right. So, but what's happened now is I forget which group of advisors, the number that sticks in my mind is 17 people on some type of advisory committee.

And he, The current RFK Jr. cleared out all of them. I would have been happy if he'd cleared if we want to have an actual conversation, but I don't think people actually do want the conversation.

Yeah, I think that people are uncomfortable having a conversation Absolutely, it is uncomfortable. That's fine. We have to learn to deal with that. I expect my leaders to be able to do deal that, to not be killed when you can't.

But that's my definition of growing up, is learning to tolerate discomfort. It's one of my definitions of maturing in a good way. Well, it's almost like we've gotten to a place, societally, not just politically.

Correct. We've gone to place societaly that there's more power in the ego of being right than in willingness to hear a different point of view. Right.

I blame algorithms. You know, I get asked a lot. People try to guess where I am politically, okay? And a lotta people I think assume because I'm 58 and white, and I do tell people that Jesus is my homeboy.

Jesus Is my Homeboy, but I don't like to call myself a Christian. because I think that's very narrowing and people already have a predisposed disposition to position about it.

But if you were to look at my feed, there's a lot of quantum physics and a lots of, you know, are we alone kind of thing. And people are always trying to guess where I stand on stuff.

I've learned a couple of things. One, if I take positions, I lose the opportunity for spirited discourse. And the second thing is, I'm here to serve all doctors, not just Republicans, and not only Democrats, into free 100,000. It can't be about my political views.

Do I have political view? Absolutely. I political on a lot of things. But my job is very simple. to use my voice to free 100,000 doctors out of insurance-based care worldwide.

Now, I have opinions about this administration. I had opinions, about every administration, okay. Which is great, those are your favorite conversations.

And if I start with the basic premise that there's no clean hands on either side of the aisle, it pretty much lowers the, like, if we just assume that I would tell you, let's just say 90% of politicians in Washington D. C.

are there to enrich themselves at the expense of the citizenry. I know. Then it changes the conversation, right? I have to keep some degree of optimism.

Well, I am optimistic. Look, here's my deal that I want. You can keep the insider trading. Just give us term limits. Okay, I'll get you can do you're blatantly insider trading like if I did this on my own I'd go to frickin jail for 20 years right right you Can keep the insider training right?

Right like the Nancy Pelosi stock tracker is like one of the greatest things that you could invest in right You get it through autopilot You can tie your investments to what she does and she gets like an annualized 43% return like how does that happen?

Okay Keep it. Just give me term limits. That's like the most agree. Let's let the Most Out There. I'll get there with my political views. All right. Which that is, you know, that's probably I don't know what that Is.

Maybe that libertarian belief system. So I know. Now, if there were people with honorable good motives, then term limits are a problem. Not necessarily, because you can be a congressperson.

You can a senator. I'm just saying in terms of learning how to do the job. In other words, I am not saying someone should be there for a lifetime. We don't want a life time appointment.

That we don' want. But maybe, yeah, I don't see. Yeah, maybe. I mean, it's not a. Again, see, always I'm a historian. And I always go back to how did things become that the way that they are?

OK, not to say that that's how they should be. But why did they become the Can see the value and the I can see The value in the argument and I Can See the holes in The argument right Absolutely like Can I see?

The Value in? the Argument With Regards to someone like a Fauci do I think that he served too long and he had too much Control Probably I Think Maybe he got a little full of Himself at the end And he made a lot of fucking Money Okay.

I mean, he made a shit ton of money inside of trading on that stuff. By the way, so did all of Congress. Exactly. Right. Like, I'm not, you know, it's not just to him.

To Supreme Court justices? I don't know. You know, like… I think that is so crazy. I mean, they're supposed to not be political. They're so political!

Oh, so they are political? I just cringe. But they should have oversight on who they can pay for their vacations, right? Like, there should be more oversight of that.

Yeah, simple things. Like if you're going to… But then they don't want to because then it would apply to them as well. Right, well of course. I do a lot of Kabbalah study and that's one of the major principles.

Oh, what's that? If you're going to, it's so great, my Kabballah teacher has little kids and he talks, like one his kids came to him and said, that is not fair, and my brother got more of an allowance or something like that.

And he goes, okay, so let's talk about fair. Your room is bigger. than your brother's room. So if you want everything to be fair, then you are going to have to take turns with your bother having your larger bedroom.

Is that okay with you? And the answer was absolutely not. I know what that answer is going be. That's how it goes. He brings it all the way down to the level of how automatically we judge other people and we have to be really careful because we are inviting from a, you know, he doesn't use the word karma, but I'm just saying that, from an energetic standpoint.

If I am criticizing someone, I better be prepared to pristine in whatever area I criticize them in. And if I criticizing how they deal with money, then I'd better make sure that I 100% which is hard to do.

So my best bet is just don't critique that person just continue doing my Best to learn and grow So yeah, but that's not the motivation in In Poland. Well, it's nothing motivation.

I want the power. Don't aren't the ones who should be there Ideally, its a it' a big ego strike stroke. Yeah. Oh, I mean, can you imagine? Yeah Ladies and gentlemen, the President of the United States.

I mean, can you imagine? No. Can you even imagine that power? Oh, it's the last job I'd want. Well, I would say it is the least job. No, for me, definitely.

Garbage men are great. They get to see the amazing things that people throw away. Absolutely. Yeah. No, I would not. Too much trouble. I have two children.

That's hard enough. You don't have to worry about me doing it because I got a lot of skeletons, right? But if I did… Oh, that's going to change because going forward, from now going Everybody's gonna get to a point where 100% of people running for office have been kids and teenagers and young adults in the age of cell phones.

So the skeleton thing's going to change. If I were to run, which, you know, the best person doesn't win, right? It's about the packs and all of that. Correct.

Which is how they all enrich themselves. But if I would have run I'd hold a press conference and go, Let me introduce you to all the women I slept with.

Here's their numbers. Let's tell you about the affairs I've had. I'm going to tell exactly how I was a horrible husband and all of the mistakes I made as a father.

This is my bankruptcy file. These are all pictures. There you go. You know, I lost her money in the investments when the real estate market crashed. Like, here it is.

OK, any questions? I contend to this day, if Bill Clinton was asked, did you have sex with Ms. Lewinsky, instead of him saying, I did not have sexual relations with that woman, Ms Lewinski.

If he would have said, yeah, fuck her. And I didn't on the couch, and Hillary and I have not been having a good time. Yeah, it did it. I think everybody would have gone, all right, like literally, maybe like, what's for dinner?

Like, What's the ball game tonight? I know. His problem was that. I would do that now for sure. At that time, I'm not so sure, but now I totally agree.

Seriously, you don't think that Bill could have gotten up there with as charismatic as he was and said, Oh, Hill, Hillary and I have been struggling. No, no.

And I heard him speak and it's really a tragedy that he will be remembered for that He's a great brother than he was an amazing present edible work on the word amazing or the work that he's done since then is Absolutely incredible.

He is a scumbag. But yeah, I mean like he has got some look he is got again. That's what I'm saying Right, but people who get into that's the whole point He isn't perfect totally and we expect our politicians to be perfect, right?

He has an imperfect man, and I take sports heroes to the perfect I'd take bill today when you take Bill in the White House today I would take them in The White house and a heartbeat I think he was the last one that was able to get deals done on both sides of the fence.

That's not to say this one or this wasn't a good president in the context of their time or what they had to deal with because I do think you have to look at content in context.

But I would take him today because he knew how to see like, well, part of what I want is better than not getting any of it. Right. And that's what we've lost.

Yes. Calcified is the word that is being used for the politics. That's a great word. It is calcifying. People's opinions and beliefs are calified. Correct.

And the margins of elections everywhere at every level are so tiny. I live in Nevada and I love it here because I'm in Reno. Reno is very purple. Vegas is purple, maybe even towards blue because of all the casino unions.

But the state overall is red. We have a Republican governor and two Democratic senators. That's the perfect model. I live in California and it's a monolithic.

You cannot even have conversations with people. But I will tell you that one of our two state senators, not senators to Washington, It took almost a week to certify her election a couple of years ago.

And she won by like, what, 40,000 votes or 10, 000 votes? Yes, it was definitely a small margin and it took that long to establish it. I don't know about most, but a lot of elections are just that narrow and that's just from people not receiving information on both sides.

And their algorithms feed them what they want to hear. So it confirms, it's confirmation bias at its worst. When I think of landslides, so this last election when Trump won re-election.

And people are like, it was a landslide. I'm like it, was not a land slide. It was, not, a, land, slide by any stretch of the imagination. Cause the last, I remember Reagan, when Reagan beat Jimmy Carter, that was the landslides.

Okay. Yeah. That was over before the polls closed in the West coast. People don't realize this. The polls, closed at seven, right? On the East coast, by eight o'clock on the east coast half of, the country still hadn't voted.

Like they were still running. Right. They were like Ronald Reagan is going to win in a landslide, which what that did is it changed all the elections and that's in one of the landslides.

They took over the House of Representatives for the first time in whatever 40 years. I remember this. It was a bloodbath because I grew up in an Irish Catholic democratic family in Chicago and my father and mother were apoplectic.

Oh my God, it's the end of world. We discussed politics at our dinner table like people talked about freaking math scores. That was a landslide. This was not a land slide.

No, I mean, what was it 300 and something? That? Was not. A landslides this was. Not a mandate What is it the house of the houses at 218 to 214 or something like that or 216 like the margin of error is two votes three votes it depends on like who dies or who gets in the hospital or Who's yeah, who's just hit on a intern right like yeah?

I? Mean like this is not people people over the overstate underness the time yeah this is the end of the world I'm like you and I've been through too many ends of world yes exactly do you sit there and laugh do just go like I think this fucking movie before It's more cringe.

I'm not to the point of laughing because I watch basically the Supreme Court. And so I know that this is going to extend. So I pay attention to court appointees.

You know what? I do too. And my boys are in their 20s. There's a very funny comedian. She's very hilarious. I believe she's Gen X like me and her kids are Gen Z like mine.

And her routine starts out where she says, you know, so my kids were Gen-Z. That's the end. There are no more letters and then she says things like you know and so they're dealing with the possibility of nuclear war and they are dealing this and that and drugs and this but do your homework.

Do your own work. Very funny. Can we just get the aliens to come back now? Like just come now. Like I keep seeing like Atlantis is going to rise or Lemurians are going take her and I'm like can they come down?

We could use them now! I am like 58. I kind of tired. They would be really fucking great. They could just solve all the power world and give us all enlightened love.

Like, what are they waiting for? Like are waiting one more fuck up? Tell me what it is. They probably just have better things to do, Matt. You know, I think they're waiting…

They're probably in better worlds. Do you think, they are so fucked up, we're not going to… No. I know we were supposed to be here 10 days ago, but I'm not coming.

New people are screwed. No, too far gone. Let's just keep screwing with them, right? Right, oh dear. Oh my God. Yeah. That is so funny. I mean, because like everybody keeps saying, no, this is the age that the aliens are going to come back and the new Earth is going be built.

And I'm like, I am ready, dude. Like I got a mortgage payment due. Can we have them come? I got to finish up another college payment. Because if none of this is going to matter, I'd like to know now.

Yeah. I know. But again, we've got these four-year or eight- year cycles. And yes, things will change. Some of what I consider to be damage will be undone.

Everybody thinks that. Yeah, because they come in and they just undo all the other orders and then they do it. Your people did damage and we're gonna undo it and I'm like, okay, you guys are doing damage, and hopefully we'll be able to undo.

The whole executive order thing is out of control. But there are still things that are not four to eight years. They are 30 years, yeah. And that's my kids trying to plan their retirement.

And what's that going to look like? Plus, longevity in my family. My mom's 88 and my dad's about to turn 90. Well, I mean, that is the bigger issue. Remember, they ran the model in social security of people living three years after retirement?

Right. Right, exactly. Like, are you going retire at 65? Because I'm sure as hell not. I don't know. Can't answer that right now. Today you're not feeling all that great.

You're like, fuck it, I'll retire. It's got appeal. Today it's gotta appeal, yeah. Yeah, well I'm not going to be able to retire because I've got a lot of work to do.

I feel that way too. But in terms of the husband, absolutely. Absolutely. Would you do this, keep doing this? Would build a bigger brand? I would. Here's what I'd do.

My patients, they're doing great. I spend less time with them. Bring in maybe a nurse practitioner. Do something for them to keep them feeling great, because they are…

Once you get into the maintenance mode. We call them cruise control, and they love it. They love the title, being in cruise. Yeah, I'm on cruise with my doctor.

Then for new patients, those are my absolute favorite, like the first year is the transformational year and it's just awesome and totally juices me up.

Plus, with all the advising that I've received and that i've sought out and been coachable. You've been very coach able by the way. thank you, and I've been coachable for a long time.

And again, pursuing money mindset types of things. So I have raised my prices to a point that I'm really happy with. I know there are people who charge more than I do and there people would charge less than you.

There are menopause coaches who charged more then I And they can't even prescribe. Okay. So I feel really good, right? So this is also like a bit of a message to doctors, because that's scary.

But another thing that has been happening lately that I haven't had a chance to fill you in on is that a lot of the patients I've been taking care of for a very long time, so they came in at really low pricing models as we're asking them to renew.

And they are not at the price that my new people are at. It's still really modest, but it's a lot more than what they started at, and I have them feeling great.

They're good. So they're choosing not to remove their yearly program. Fantastic. I love it. can have four of those folks say to me, thank you for all your help.

My doctor is willing to write these prescriptions. And I can say, fantastic, vaya con Dios. Okay. Four of them can bow out and I have one. one new person at my lowest tier.

And isn't that really what you want to do as a doctor is to graduate patients? And I call them graduates. Yes, that's what we call when somebody like people work at this for three or four years and we're actually creating a new group for the alumni for them to stay in.

It's gonna be like less expensive and it's a way and its gonna like the pantheon of all the greatest minds. I love that keep the resources keep We're gonna call the Pantheon, right?

And it's gonna be by invite only. But the whole point is, you never leave. Because we want to, I want, it is gonna to be a lot less expensive than what we charge now.

And its designs, its different things, like you don't like enough coaching and all of that, we'll lose some masterminds. but the point of it, is exactly that.

Stay connected. Right? Yes, which people can do. Yeah, and you graduated them on, so you've hand them off. You've saved their lives. Right? And their marriages a lot of the time.

Yeah, isn't that great? It's not the best. It is the BEST. Isn't it the Best? Do you wind up cheating their husbands? So the very few men that I have in my practice are mostly husbands or partners or referred or kicked in the pants and said, you know, You need to go see her.

But at this point, I've also done something and I think you talk about this, but I know I'm gotten coaching on this which is it's counterintuitive. I mean I can help everyone.

Right? I'm doing hormone balancing. Most people need that in some way, shape, or form. However, my marketing is now super narrow. To women. Let's say 40s and 50s.

I prefer later 40's to 50's. That's really the sweet spot. It's very specific. They've been dismissed by other doctors. Things are better now with the changes that the FDA…

removing the black box warning from… Do you think that's going to change the opinion of OBG's? So here's what it has already. Oh, really? Yes, but it's being treated like new information.

Now we know that hormones are safe and I'm like, oh my God. It's been around forever. So now my patients are having trouble getting their… stinking estrogen patches.

Yeah, that's a big deal right now. It's such a fucking headache. People call me all the time, it's like, what do we do about the estrogen patch? And I'm like make them yourself.

Like, not that you can't. There's very funny. I got no answer. Hilarious Instagram reels of like a woman in a back alley deal. Oh, yeah. What do you want?

What are you needing? I need my estrogen pouches. That's hilarious. yeah, It is really really funny, he's, like okay, and then he is like name some ridiculous price.

Yea, I've heard some pretty funny stories. Like, one of my doctors, like, she's really smart. And I think she, pre-pot a bunch of extra, extra batches.

Did she see that coming? She's really smart. She has been in this space for 20 years, 25 years. Oh, she's another one of the OGs. I'm trying to get her on the podcast and she is like, no, I got to hang out on my boat.

Like, She is just like no. But like. That sounds good to me. My guy helped me like get free. like I changed your business. It took her I took a monthly recurring revenue model from like $45,000 a month to like three hundred and fifty thousand dollars.

And like they saved your fucking baking during covid. Get on a podcast. I don't want that. I'm not coming on. Like, all right, I'll get you mentioned her name.

All right. She's but you can tell me later. And if I see her, and I could like, she's semi retired, her husband's worth like 200 million, like they got a yacht, yeah, go fishing.

It's like why should I spend my time? She was like I've not gonna bother. That's hilarious. But yeah. So she still her clinics are still active. That's hilarious.

I didn't pre-buy them. But I happen to have extras because I mostly do the hormone pellets for myself. Every four months, which is just so easy. There's times where you need the patches in between.

So I ended up with them, and every time I look at them I feel guilty. And I'm like, can I give a box of these away? Then it would have that it really wouldn't be fair like who now you're now.

You're playing it gets on the life I know right? Who's gonna get lit? It's exactly right even though there's extra not a woman and child so men you can't get in right like you know Yeah, and if you try man, I'm gonna shoot you you got a you gonna die in the boat the rest of the region Isn't that hilarious?

Yeah? So I call funny to not funny way. Yeah. So What has What's been one of your big changes in the last six months? And this is kind of self-serving.

So for those of you, Liz is one our clients, and we met on the BHRT training academy cruise. We sat at the same dinner table and a lot of nights was you me and Christine.

And you were pretty skeptical. Because you'd been like, I've been in coaching programs. I did not take that personally. You took it to the challenge. Yeah, exactly.

No, that was not a problem. And I knew you wouldn't take it personally, so I'll tell you exactly what was going on in my mind at the time is, anyone who cares about their business spends money on their businesses.

Yes. Easy prey. I'm constantly being approached. You are very easy prey All right. For example, I started right before Three months before I met you, I was at A4M, and I decided to go forward with a podcast.

I'd been wanting to do it for a long time, so I hired Dr. Tots to… Yeah, Brett was great. All good. And so we start working together, whatever, end of January, let's say, And they say okay, you have to record 12 episodes, then we'll discuss when to launch.

So I recorded the 12 Episodes. And then my project manager says, I'm so excited. You're my first person I working with to record all the episodes. And I go, but that's what you told me to do.

Brett's on that call too. He's like, yeah, most doctors don't do it. So I am very aware of how much doctors spend. Well, it's that way in every industry.

I've run coaching programs where 50% of the people never made their coaching calls. Okay, I totally believe you and also doctors with having, seeing that there's X amount in the bank and they say, okay, can hire this person, but then they don't do what the person that tells them to do.

So that was partly what was on my mind. Also I was struggling, as you know, with a salesperson that wasn't doing a good job. And so I'm just aware of constraints that were happening in my actual business.

And so that was really skepticism is, is not the word I would use. It was more like resignation, right? Which is probably worse. That is that resignation is the worst place.

When people, we get on the call and they're like, I'm just resigned. I've got five more years. And I just going to sacrifice my life to stay in the hospital.

Yeah. Right. Exactly. No vision. I'm like, really? No hope. It's the most depressing thing in the world. Yes, it really kind of is. So that was happening.

And then there was the rest of the conference and listening to other doctors speaking, and I still hadn't heard you give your presentation. But during the course of that, I was like you know what?

This is my business. There's an epiphany. And then I was very clear, this is not my skill set. Running a business, not me skill-set. And I do have to hire help.

Then I think the thing that you said to me in another conversation a little while after that was not a promise, but a goal to recoup the annual investment in the first 90 days.

And I thought, okay, that is possible. I knew that it was possible and so I said, let's just do this. So I jump in and it so happened that a mastermind was like right then, two weeks later.

It was literally two week later, remember? It's my kid's birthday, he was turning 28, and he doesn't care. It's not greater than $20,000, like, just send money, Mom.

Right, exactly. Yeah, which I do, so he's nice. But right, okay, a lot of these things are in my mind, oh, my kids, never mind. You can go to Phoenix, you can do that.

And I knew it would be great, and it was great. Thank you. It was actually greater that I expected, that was good. Um, and, uh, And I started making changes quickly, you know, working with Dean, my coach and just like, like he's my Coach, right?

Like, Like the team player gets sent out on the field. Coach says, do this. You do it. Right. Cause the coach can see the big picture. That's a hard thing.

I think for a lot of people to do, especially doctors. Like I've always taken the approach. The coach told me to run through the wall. So I'm gonna run to the.

Yeah. Yes. And, I have had practice with that and a lotta people have it and that's on top of the personality, Particularity is not the words that come to me.

I don't want to say defect. And I want us a Cueularities. Okay, we can say that yeah special special of doctors You have to have a degree of ego to make it through.

Absolutely. You just have two all type-a personalities all people that achieve great things are fucking pain in the ass Exactly. Exactly I can be a giant pain-in-the-ass.

Trust me Yes, okay, I don't know that about you, but I know but like I do trust you I mean, yeah, very particular like yeah. I I look and I'm I no home wired I No, home designed.

Yeah, right and like as a side note like it's the hotel I am staying in The hotels nice the staff is nice. The food service is like the the urgency of like, oh I Don't I can't come up with an analogy, you know and likely none.

Oh I just, I'm like, the guy wants, you know, when I order breakfast I go to the same thing. I want three eggs scrambled, and I wants in bacon water. You want this?

No, just want that. Want this, no. Just need this. Like, bring my bill. It's like… I'm like very, you know, I've done this. I am also Aries, so I' m with you on that.

Yeah, i'm a Scorpio. And I m a double Scorpion. Right. i've just learned to like not come across pissed off. You know? Right, exactly. Like, try not to come off as an asshole.

Well, that's something I always say. Unless, of course, your like, Gemini and then you're gonna get really pissed of at me, right? I don't know how Aquarius does or Pisces, but okay.

No, that's absolutely true. Yeah. So you just learned to listen to your coach. Like you're saying, doctors are very challenging. Yes. Taking the bold steps is my personal work.

And I was just willing and ready to do it. This is part of my message is midlife is the opportunity, right? Like in my 20s, I vividly recall how much I cared about what other people thought.

Yeah. Do you care anymore about people think? Barely. It's minimal. It's minimal, it's to the point where I anticipate if they don't like it. Like right now I just listen to my marketing person and there's things that I would like to do.

She's great by the way, I'm going to have her on the podcast. I mean New York. Oh good. Two weeks from now. Good, she's lovely. Can't wait to see her.

Amazing, She is running a political campaign right. Now she got stories. No I can't fucking wait. Ohh she has got some stories, oh she is very lovely, a beautiful soul.

And so there are things that have been happening, for example, that affect women's reproductive health care that I would really like to comment on. And at the moment, I'm just kind of keeping my counsel and she says, will it bring you more patients?

And the answer is no. So I am just holding my tongue for right now. But I really want to do more of that. So I have very specific, clear goals where I want get to with my practice and my business, how to bring in help, again, maybe a nurse practitioner.

And that was a big thing for you, like, because you had gone through a really difficult season of life. Yes. lost someone very dear and dear to you. Yes, my beloved husband.

It wasn't my place to say. I got remarried and it was eight years total. We were together for a year, got married, and seven years later he got sick and he died nine weeks later.

Nine weeks. And he was the soulmate. Yes, help me run the business and God bless him. And I know he's listening. He wasn't very detail oriented. I've done a lot of cleanup in the last year and a half.

Well, yeah, I mean, it looks to be the same thing with Christine and I, like, Yeah, been married and divorced twice and they were both wonderful women.

I mean, nothing compares to what she and I have, like, unfortunately. And that's not any disrespect to those two beautiful women that I was married to, right?

But yeah, I would be devastated, so you were coming out of that, you had to deal with all of the estate stuff and all that. Still dealing with that for a while.

Not as thick and fast as it did initially, but yeah. You kind of stepped away from the business and you let your employees run the show. And you kind of lost a little.

Yes. I don't want to say full, because that's not fair to them. That's how I… You took your foot off the gas. Yeah. It's a good way to put it. And I had two good people on my team, one managing the operations of the office and the other managing sales.

But then they each had things in their life. So that led to some changes. You've had to kind and grow in your leadership style, haven't you? Absolutely.

What would you say has been the biggest challenge? I tell you, the big challenge has being communicating in a way that I am strong, I'm decisive, and they still know I care.

Yeah. That's the hardest thing, isn't it? Yeah! And at our base level, we all want to be liked. Right. That's right. And we operate. I had this revelation the other day, it's gonna be a teaching.

So I'm gonna give you a little preview of it. Okay. and I realize, so I have a client in, and we were doing a day. She asks the question, I get this question all the time, how do you find really great employees?

My answer has always been like well, you know, You got to focus on your values and are they a culture fit and all that and I routinely you've been around me I get these downloads right you see it happen.

Yes, and usually know what happens when I go Well, let's figure this out and go to the whiteboard. I just draw it out. And then I got done I'm like, oh fuck.

That's good. Take a picture of it. Like this is how this works for me. So I am standing at the Whiteboard she goes, how do you how you find really great people and i'm opening my mouth getting ready to do the values in the culture talk and All that I You can't hire great people until you understand that you hire out of your woundedness.

Wow. Excellent. I gotta be careful how much I say, but basically, because of what happened to her in her life as growing up, her human design is one way.

She's supposed to have a lot of downtime, Hermit time, like me. But she has set it up because when she had this trauma, she to take over her family. And so she's used to that need and desire of proving her worth for everybody to need her, which requires them to have 24-7 access to her which is in conflict with her design which causes this bitterness, right?

And this afternoon we're gonna go over yours, like before your session. And, this causes us bitterness and I said the problem is you're hiring out of this wounded child over here and this need to constantly prove your worth.

So, therefore, you are hiring people that you're going to have to micromanage to prove you worth." That's so helpful. Isn't that amazing? That is so. I can tell you something in real time.

Go ahead. My salesperson, who I was very excited about, the new one that I hired, yesterday told me that she's very sorry, but she found full-time work.

which is great. We had a wonderful conversation. I said, I wish you the absolutely the best. She said I'm not going to leave you high and dry. I can cover until you find someone.

Okay, fantastic. But I'll tell you, the thought that I had, so now I am having a little epiphany in real time here, which, is a belief that it's difficult to find some one who will be only working part time.

Because I don't run a model that would be a full-time income for a salesperson. Or you just make the comps so amazing because you change the way that your pricing is structured or whatever.

Yes, exactly. But there's solutions. There's solution, right? It's not an either or. It is always both and one. Including the fact that it's been that way up to now also doesn't mean that that predicts the future.

Right. The future, everybody wants to say the past always predict the feature. I disagree. Right, absolutely. Because we can choose our own future. Exactly.

I have a really beautiful Kabbalah piece with this, which is that going forward we have free choice, we free will, but we must, and I personally think for our sanity, that's not what they say.

that the teachers say, but the way I interpret it is- That's the lizardendum. Correct. But the teaching is that everything that happened to you up to now was, you must think of it as it was God's will and God forced your hand.

And it's very freeing. Interesting. Because you can't recriminate yourself. Right. It's like, okay, that happen because that was my path at that moment.

Yeah. Okay. Now, what I do tomorrow, I can influence But everything that happened up to now, I can just choose to look at it that way. God, source, whatever.

It's not a religious. Kabbalah is not religious, it's really the spirituality that preceded all religions, or at least the Judeo-Christian and Muslim, all those religions.

If you asked Abraham or Moses if they were Jewish, they wouldn't know what you were talking about. So that's sort of a lot of study that I've been doing.

I'll say this, most people want to spend their lives relitigating and re-prosecuting the past. Right, exactly. Well, this one little tidbit can just free people from that.

That's a big way to free it. Yep. Cool. Liz, we are out of time. Okay. See, you made it! I know. Did you think you were going to make it at the beginning?

Yes! Okay, good. Yes. I knew you would. So if people wanna find out more about what you do, website, My website, I just have redone it. It's all in my voice.

I love it, and it has a contact button on every single page. Doesn't matter where you go. There's a free ebook that people can download, which is a guide to midlife.

So I loved that. A lot of heart went into that, but it's very easy to schedule a discovery call. And the domain is? It is drlizmd.com. Beautiful. Yeah.

Thanks. I'm glad we were able to finally do this. Yay. No, you're on mine. Absolutely. There we go. Thank you.