The Root Cause - Business of Medicine Podcast

Erik has known this week's guest for more than a decade — they started a cardiology program at the same Riverside County hospital, reconnected at a Metagenics clinic in Orange County, and watched each other leave the system.
Dr. Sanjay Bhojraj is a board-certified interventional cardiologist and one of the few cardiologists in the country certified by the Institute for Functional Medicine, where he now teaches. He is the founder of Well12 and the Integrative Heart Institute, hosts The Curious Cardiologist podcast, and writes on heart health for CNBC.
He was pushed into medicine — an Indian kid in small-town Indiana whose parents were both family doctors, with job offers waiting before he'd chosen a specialty. He was pulled out of it by a Saturday on call with eight back-to-back heart attacks, two friends his age who had their own, and the realization that at fifty he was a few years from being the patient. "It's not work-life balance," he says. "It's life-work balance."
In this episode
  • Growing up in his parents' practice, where patients sometimes paid in tomatoes — and what that taught him about the doctor-patient relationship
  • The jagged line: why every career outside medicine expects pivots, and why medicine sets the next forty years on day one
  • Med school at $8,000 a year, and how that freedom shaped every decision after
  • The frog in the water: four more clicks on top of four hundred, e-prescribing security keys, and turning over your own exam rooms
  • "We know you're going to stay" — how a physician's commitment to patients gets used against them
  • The dog in the open crate: doctors who don't realize they can leave
  • Five percent of a physician's horsepower is more business acumen than most entrepreneurs have — the missing piece is tolerance for failure
  • ReoPro, a bailout drug, and the meeting where administrators asked for 30% less of it
  • Why every hospital CEO should have practiced for ten years, and why physicians should be paid to sit in the meetings they currently attend for free
  • Davin's own years as a CMIO and CMO, and the executives who said doctors "don't understand business"
  • Three or four soft landing zones: med-tech consulting, fractional CMO work, a failed med spa, and Well12
  • Well12 — 20 to 40 people a month, blood pressure normalizing within two weeks, a woman who thought she had Alzheimer's
  • The HEART framework: hormones, energy, autonomic nervous system, rest and repair, toxins and triggers — and the question that clears a million-dollar chest-pain workup: "Did you feel safe as a child?"
  • The book in progress, the grand rounds invitation back at his own fellowship, and being a bridge between conventional and integrative cardiology
  • Where medicine goes: personalization, proteomics, and "you are 7.3 years from type 2 diabetes — here is the one lever"
About Dr. Sanjay Bhojraj
Sanjay D. Bhojraj, MD, FACC, FMCP-M is a board-certified interventional cardiologist and IFM-certified functional medicine physician. After more than twenty years in conventional cardiology in Southern California, he founded Well12, a twelve-week cardiometabolic program, and the Integrative Heart Institute, a virtual practice built around his HEART framework. He is an educator for the Institute for Functional Medicine, faculty for A4M, host of The Curious Cardiologist podcast, and a CNBC contributor.
Links

Creators and Guests

Host
Dr. Davin Lundquist
Dr. Davin Lundquist is a board-certified family physician, innovator, and healthcare leader with over 25 years of experience integrating medicine, technology, and holistic wellness. A graduate of the Keck School of Medicine of USC, he has held senior leadership roles at CommonSpirit Health, Dignity Health, and Augmedix, where he advanced the use of technology to enhance patient care. Driven by a passion to move beyond symptom management, Dr. Lundquist founded the Quantum Advantage Method™, a science-based, holistic framework designed to help individuals restore vitality and reverse dysfunction. His approach blends functional medicine, advanced diagnostics, and principles of quantum science to empower patients to achieve optimal health and lasting transformation.
Host
Dr. Erik Lundquist
Dr. Erik Lundquist, MD, ABFM, ABoIM, IFMCP Dr. Erik Lundquist is the founder and medical director of the Temecula Center for Integrative Medicine, where he blends conventional, holistic, and functional approaches to help patients achieve lasting wellness. Board-certified in Family and Integrative Medicine, he specializes in endocrine disorders, chronic fatigue, migraine management, cardiometabolic health, and chronic pain. A graduate of St. Louis University School of Medicine, Dr. Lundquist completed his Family Medicine residency at Naval Hospital Camp Pendleton, where he served as chief resident. He spent eight years on active duty with the U.S. Navy, including service as a battalion surgeon in Iraq and at the Naval Hospital in Naples, Italy. Certified by the Institute for Functional Medicine, Dr. Lundquist is passionate about empowering patients to take charge of their health and teaching fellow clinicians integrative approaches to chronic disease. Outside of medicine, he enjoys the outdoors, singing, dancing, acting, and spending time with his wife and three children.
Guest
Dr. Sanjay Bhojra
Dr. Sanjay Bhojraj is a board-certified interventional cardiologist and one of the few cardiologists in the United States certified by the Institute for Functional Medicine, where he now teaches the Applying Functional Medicine in Clinical Practice course. The son of two small-town Indiana family physicians, he earned his MD at Indiana University School of Medicine after undergraduate study at Northwestern, trained in internal medicine at Northwestern and in cardiology in Detroit, and spent more than two decades in conventional cardiology in Southern California, much of it as the heart-attack doctor on call. When the system stopped letting him practice the way he believed patients deserved, he left. He founded Well12, a twelve-week cardiometabolic program built on nutrition, sleep, breathwork, and stress resilience, and the Integrative Heart Institute, a virtual practice whose HEART framework looks upstream of cholesterol and blood pressure to hormones, energy, autonomic function, rest and repair, and toxins and triggers. He hosts The Curious Cardiologist podcast, writes on heart health for CNBC, works with the American Board of Precision Medicine, and is writing a book on his integrative heart method.

What is The Root Cause - Business of Medicine Podcast?

The U.S. healthcare system is at a breaking point—soaring costs, worsening outcomes, and widespread physician burnout. The Root Cause – Business of Medicine podcast, hosted by brothers Dr. Erik Lundquist and Dr. Davin Lundquist, charts a different path: one where healing, fulfillment, and business thrive together.

Each episode shares powerful stories of medical professionals who stepped away from the traditional grind to embrace integrative, functional, and alternative approaches to care. Through candid conversations with practitioners who have redefined success, listeners gain insight into navigating their own transitions, reclaiming a sense of purpose, and reshaping the way they practice medicine.

Erik
Okay, well, we've got another episode of the Root Cause Business of Medicine podcast for you today, and our guest today is Sanjay Bhojraj. who is a cardiologist from Orange County, California, who grew up in a family of doctors, was groomed to be a doctor, and uh thought he would spend his entire life practicing medicine in a institution. He had the constitution of being a doctor. Davin, what were some key points that you learned from our discussion today?

Davin
Well, Sanjay's very entertaining and you know, the way he kinda described the system and the impact that it has on doctors and you know, just the experience is very relatable. You know, it kinda takes you back and you know, the the abuse, if you will, that that you get, you know, from early on and just you kind of get beat down. Um but uh I think the way that he framed it and then also seeing him kind of emerge into this new phase of his career was is really fun to see and and I think others will enjoy hearing all about it.

Erik
I I totally agree with you. I I loved how he shared his story of transformation from having awareness that he realized he wasn't in alignment with his true authentic authentic self and what he was really meant to do in terms of practicing medicine. And that once he realized what that was, that then he took steps necessary to get himself into a position, into an environment.

into a situation that would allow him to be able to practice medicine and really influence lives uh for the better. And I think that th his story is is is one of our best. And I I love to at the end he shares a little bit about uh his book, his new book, and and gives us some medical uh tips at the end, which I think you'll really enjoy.

So we look forward to having you uh uh listen to our podcast today. Welcome to the Root Cause Business of Medicine podcast, where we explore what's broken in healthcare and what we can do about it. I'm Dr. Erik Lundquist and I've been practicing functional medicine for the past 15 to 20 years.

I'm excited to co-host this podcast with my brother, Dr.

Davin
Davin Lundquist, who's just beginning his journey into functional medicine. We come from different points on the path, but we do share a common goal. We want to rethink how medicine is practiced and help others do the same.

Erik
The US healthcare system is in crisis, rising costs, declining outcomes, and physician burnout at an all-time high. But you know, we found a different way, another way, a better way.

Davin
On this podcast, we dive into real stories from medical professionals who've stepped away from the traditional model, kind of like me, and have found a new purpose in integrative, functional, and alternative approaches to care.

Erik
These are authentic conversations with practitioners and friends who've redefined success not just for themselves but for their patients and communities.

Davin
Whether you're a clinician feeling stuck, a student seeking direction, or just curious about what is possible, you're in the right place.

Erik
This is the Root Cause Business of Medicine Podcast. Welcome back to another episode of the Root Cause Business of Medicine podcast, where our special guest today is Sanjay Bhojraj, and I probably totally murdered your last name.

Sanjay
No, he actually crushed it Oh

Erik
McNight.

Sanjay
Lundquist. You guys probably have a hard you guys probably have people looking at your last name funny too sometimes, I guess, right?

Erik
Yeah, exactly. Exactly. But anyways, uh Sanjay, Sanjay and I go back uh more than a decade, um, and we um But uh Sanjay, you know, initially did his medical school in Indiana and then went to Northwestern to do his internal medicine residency and then went on to Detroit to do his cardiology fellowship.

Uh, and s ended up getting um kind of brought back out to California where his wife's family is from and uh was uh targeted to start a program uh in cardiology at the same hospital I was working at, Inland Valley, there in Riverside County. Um, ended up doing uh something different uh uh by way of Loma Linda and then ended up finally in Orange County where we reconnected again. Uh when I was uh working at setting up a clinic for metagenics, uh and we we kind of rekindled our our acquaintance and started to actually grow a friendship, which has been phenomenal.

But Sanjay then decided he'd had enough of conventional cardiology and jumped out. Um and in the process of trying to figure out what he was gonna do, he uh started working with some med tech startups And now he's kind of getting back into patient care. And so we're excited to kind of hear your journey, Sanjay, and And what you know, how that all evolved and what you were kind of thinking when you first got into medicine and and where you are now.

I mean, I'm sure you never thought you would be Exactly doing what you're doing now when you first started medicine.

Sanjay
Yeah. I don't even think five years ago I thought I'd be doing what I'm doing now. So it's you know, and and as you're pointing that out, the the kind of jagged line of success You know, I think that that's something that that we have to realize in the medical world happens in almost every career outside of medical school, right, or medical education is that very rarely do you see somebody at the top of the entrepreneurship game who started out and ended in the same race, right?

So so there's a lot of pivots that happen. But in medicine, it you know, I think most of the time it's a very linear process, right? From the first day I remember I got into medical school Um August before I went to Northwestern for undergrad as well as did my residencies at there.

So we're in the quarter system. So I got in to medical school in Indiana in August and classes actually started in September. So my entire senior year, I already knew that I was in med school, which was a nice relief.

But that day I got in, every Indian doctor in my little community that I grew up in the middle of nowhere, Indiana, called me and said, hey. We have a job for you. And I said, You don't even know what I'm gonna do yet.

And they go, it doesn't matter. We'll find a job for you, right? Like like that's how set the career path was.

And my parents probably had a girl for me to marry and kind of all those things and you know as as happens in our culture Um, and and so in the medical universe, a lot of times, you know, right from day one, the whole next 10, 15, 20, 40 years of your life are already set. And for a lot of people, that's great. Some of us though kind of yearn outside of the system, or I think what I end up telling people is I kind of got trapped in between the what medicine used to be during when my parents are both family practice doctors.

So what it used to be during that era and then kind of what it turned into after the transformations that happened in the eighties. nineties and early two thousands into a more managed care model. Um and so that safety, that security, that income, all of that stuff.

that that my parents enjoyed and of course they struggled as well, right? But but that you know the the lucrative nature of what medicine was and what it turned into kind of switched on us, right? And I think for a lot of people They were so economically invested.

I mean, medical school now costs so much. I mean, when you know, this is when I feel old f because I went to med school in the nineteen hundreds. Uh but my medical school tuition was eight thousand dollars a year, right?

In my for in state tuition at that point in time. Uh and I think that allowed me a little bit more, you know, flexibility to be able to explore different ventures is that, you know, I wasn't saddled by debt for my entire career that I needed to pay back these med school loans, undergrad loans. Like it it allowed a little bit more freedom.

But yeah Getting back to your original question, definitely not the career path I re thought I would have on my first day of med school. I thought I'd be practicing in Hobart, Indiana. in one of my, you know, Indian uncle's practices doing either urology, OB-GYN, cardiology, GI, general surgery.

I had all the job offers, but uh, but you know, it didn't pan out that way.

Erik
Yeah, you know, it was funny we had uh Erik Goldman uh as a guest on our podcast, who, you know, is a journalist in integrative and functional medicine. And he kind of walked us through that whole transition of you know managed where it went from free enterprise medicine in reality, right? Where it was just people would choose a doctor based upon reputation and they would go and Uh their insurance would pay a portion of it, but they'd pay out of pocket for it, you know, but they the costs were relatively low. And and then the whole managed care you know , operation kind of grabbed a hold initially from the west and then into the east coast and then just kind of took the whole thing by storm uh and really kind of dumped medicine on its head in terms of physicians having a say in what's happening, um, as well as patients really having a say in what's happening. That whole partnership between the relationship between a physician and their patient really went out the w out the window uh with that.

Sanjay
A hundred percent. And I think, you know, that a lot of times leads to burnout, right? So I grew up, as I mentioned, a small town in Indiana And so, and my parents practiced in the town that where we lived.

And what I loved about kind of watching them in practice kind of as as I grew up. in that in that environment was the longitudinal relationships that happened between doctor and patient, right? Like like my dad delivered the babies of babies he delivered as a family practice doctor, right?

I mean there's something so sacred and so special about that And it was really cool, like growing up. I mean, I basically grew up in my parents' practice. I was like a you know, back when they didn't have child labor laws, I was like doing you know, all this junk in the office for them that probably I should have gotten paid for.

But that's that's my own trauma. But but the point being was like growing up in that environment and seeing that that beauty of that doctor-patient relationship, how it grows over time and you know, little kids become adults and and you know, as as happens a lot of times in small towns, everybody just kind of stays. Um and it was a really cool thing, right?

And and and as you mentioned, m medicine was different back then and now You know, it's so insurance driven um that, you know, I'll have patients whose employer changes their insurance plan. I'm no longer or was no longer on there. preferred provider list and that entire, you know, years of relationship that we had is lost overnight because they can no longer see me.

uh as a doctor or they'd have to pay out of pocket, which is not a inexpensive option either, right? So that that sacred doctor patient relationship Over time just got eroded, not just by um insurance companies, but I think the other biggest affront, and we probably all came up during the paper records era, right, was EMR. And now instead of your doctor looking at you and connecting, they're like looking over here, typing on a screen.

You're like speaking into this year and they're typing it in the other not even connecting as a human, right? And I think that that so many of us, nobody writes their med school admission essay, you know, I want to go to med school because I want to type into a medical record system. Right.

We want to help people. We want to heal people And I feel that that, you know, as I continued to evolve uh in in my medical practice, the conventional system was taking me further and further away. from the way I wanted to practice medicine and ultimately it reached this go or no-go threshold point where I just made the decision to pivot uh into something completely different.

And, you know, that is that is that jagged line of success. You know, that well, of jagged line of career. I think success is left kind of up in the air as of yet.

But but, you know, it's it's really when you're living out of line with what drives you, it becomes very difficult to continue in that sort of environment. And some people are just economically kind of stuck. uh some people you know may not have the gumption or the confidence to get out but you know for those of those those of us who can kind of create soft landings and and and look at other ways to approach medicine.

I think it's a really great opportunity to reconnect with patients in the way that we wanted to in the most pure form. before you know managed care and and hospital-owned practices and all this stuff took over our lives.

Davin
You know, it's interesting as you were kind of talking, it made me uh realize how kind of subtle the the transformation was, you know, kind of like going through it. I think those of us that did like med school and residency in the in the you know late nineties and early two thousands Um, you know, we kind of watch this whole evolution happening, you know, almost like before our eyes.

Sanjay
Yeah.

Davin
And then, you know, and then we were sort of part of that like, you know, all along the way. And and to your point, like I remember in med school doing a rotation With a family doctor, I think Erik, you you and I both um had the same, you know, person in Utah that, you know, we knew that was kind of a family friend. Um, and it was like your parents, the way you described it, you know, where this guy, you know, was still doing minor surgeries and delivering babies.

And and and what struck me one day was It didn't feel like he was going to work. It felt like he was sitting around talking with his friends all day and by the way practicing some medicine. You know, in the middle.

Sanjay
It just you know, I think now that you say that, kind of I just got goosebumps remembering. I mean, there are times where my parents got paid in tomatoes because, you know, we lived in farm community and that's what people had, but You know, I think that that love, right, is is really what's what's lacking and that's, you know, I and and and as humans, I think the only infinite capacity we have is an infinite infinite capacity to love, right? And so that that when I had patience in my practice when I was working in corporate Um, you know, oftentimes they would tell me, Doc, like you're the only person, Dr. B, that I feel like I can talk to that listens.

And it's because I loved patients like they were my own family, you know, and and And that's that's awesome, right? To be able to do that. It's difficult to do when when you've got, you know, some administrator telling you that you're taking too long per patient and you can only have 15 minutes with an with a return and 30 minutes with a new patient But I tried to do that as much as I can or could, at least at the time.

And I think that kind of led to my burnout in that system was I was no longer able to practice in the way that I felt patients deserved. Uh right. And so um but but yeah, as as you say that, yeah, it was Like when in my in my first first job out, I I was able to for a while at least practice that way and spend time with patients before I got like super busy.

And that was like the belly poke. That was just a beautiful time where I got to connect with patients and really like feel like I was making an impact, talking about lifestyle, talking about diet, you know, above and beyond just blood pressure medicines or cholesterol medicines or coronary stents or whatever. And also being an interventional cardiologist, what I loved about that was not just being someone who talked the talk, but someone who c was actually going in and fixing.

And it just, you know, like when when you go in and you fix someone's heart, there's just such a sacred part of that, you know, and and like seeing them. Like I remember I'd see my patients even now like walking at like a Costco or you know Walmart or whatever. And they don't see me yet.

But I'm like, wow, that person is able like pick up that bag of, you know, dog food or whatever because I was in there and I fixed their heart, right? And it's a really cool feeling. And and, you know, to to not be able to explore that interpersonal relationship, I think, is just one of the most big unrecognized tragedies of what's happened to medicine in this lat fift last fifteen or twenty years is that, you know, you can no longer connect as a human, you almost just become an automaton.

And, you know, there's no wonder that we're gonna, you know, doctors are worried about getting replaced by like AI models and things because that's Essentially what we've turned into a bunch of nested if-then statements like if blood pressure is low, then do this, if thyroid is high, then do this. And we're losing, I think the most important part of our profession is connection. Right.

And that's that's really and you've seen the same studies that I have is when f when patients feel more connected to their physicians, regardless of the efficacy of medical therapy, they do better. Right. And and there's something so powerful about that human connection.

And we really need to get back to that.

Erik
Totally, totally agree. And you know, we had a a guest on our podcast uh recently, Teona, who's a physician recruiter. And um one of the things that that she asks uh the physicians that she recruits is, you know, do you remember what you wrote in your medical school essay?

And if you do, if you don't, go back and look at it. And if you do, are you practicing medicine with the same why that you put in your essay? to s you know, go get into medical school.

And so when you when you brought up, you know, oh, my you know, what my essay was, I was I I was curious to think, well, do do you remember what you wrote? And did you get to the point where you're like Actually th I'm not practicing medicine according to what I wrote in my initial essay.

Sanjay
Well, I mean I th there was always that drive and and despite the influence of the corporate medicine, I did You know, I would take a little contrarian approach from a physician recruiter about something like that because I think that's where doctors get stuck. Right, is that that we are such bleeding hearts and we we do want to help people and that oftentimes get ta gets taken advantage of by physician administrators or practice administrators and hospital administrators that will say things like was said to me when when I ultimately left my job is that, well, you know, no matter what we do to you, you we know you're gonna stay. Right, because they thought that I was so invested in my patients that I was just gonna accept all of this abuse.

I got out of the system and I decided to bet on myself because, you know For better or for worse, I kind of believe that I'm always going to be okay and land on my feet. But there are a lot of people who when we get socialized through med school Right? Just, you know, when was the last time you remember an attending being nice to you?

You know, like no, I mean it's just it's just constant abuse. And I think there's a lot more trauma in medical education than we realize. And you're you know, we are the most intelligent idiots on earth, right?

Like super book smart and super street stupid, uh street smart stupid in the sense that, you know, you just kind of have to get out and kind of looking back as at at my career, I kind of felt like, you know, when I've when I've got my dog and he's in his crate and I open the door of his crate and he doesn't realize that he can get out. Right. He doesn't realize that he's got access to that freedom.

He's just kind of like staying in his crate for un some unknown reason. Then I have to entice him with a treat or a toy or something. Then he's like, oh, I guess I could have come out the whole time, right?

So so, you know, I am a little you know, that's almost like a sorry Erik, you walked into like a landmine with that with a trigger for me because I feel like we are so socialized by hospital administrators and things that we are not worthy. We can't be successful if we step out of their box. you know, of of their control when in fact we can, we just need to educate ourselves.

You know, when when I sit and think of the, you know, one walking into a cardiac cath lab in the middle of a acute heart attack There's probably 120 pieces of data that I'm looking at that I'm synthesizing all at once to figure out what needs to happen for this patient, right? And when I look at business, for instance, We just have to learn those metrics, right? We just have to learn those 120 indicators and we're gonna be okay.

Like the sheer brain power that we have. To to get into medical school MCAT and organic chemistry and kind of all this stuff is is ridiculous, right? And so we just have to realize that, hey, you know what?

Let me just take like maybe five percent of that brain power, five percent of that horsepower that I have in that engine and put it to understanding some business. You know, and you're gonna be great. You're no, you're five percent of your brain, you know, working on that business is better than probably, you know, sixty percent of the entrepreneurs that are out there and non-medical.

The only difference is They just kind of hustle and they're able to accept failure, right? And pivot, right? That's that's the difference.

And that's been the hardest part for me is I'm kind of pivoting into more of an entrepreneurial lane uh is accepting the idea of failure because before failure meant somebody died and that doesn't feel good for anybody, right? Now failure just means Okay, I spent, you know, X amount of money with this person and it didn't work out. Let me pivot and find somebody else uh that can make it happen, right?

But but you know, failure is is a funny F word for us um, you know, in medicine because we are taught to avoid it because our stakes are so high. But in business, it's just, you know, it's just part and parcel of everything. If you look at like Jeff Bezos and, you know, the things that that Amazon has done that have gone well, that's great.

But for every one success that he's had with Amazon Prime now, you know, they had a s uh mobile phone. that didn't work. I don't even remember what it was called, or they tried to go into retail and the Amazon store in my neighborhood closed because it just wasn't working well, right?

Like Failure is just part and parcel of every other industry but ours. And we kinda have to increase that tolerance. But you know, we're the people who, you know, when I came home with a ninety-six uh percent on a spelling test.

My mom would, you know, this is again back in the eighties and nineties when this was allowed, would like hit me with her, you know, sandal or whatever, cause culture, that's what we do, because I didn't get a hundred, right? Like that's like we're left We're socialized to never leave anything on the table and failure is not an option, right? And so we just kind of have to retrain our brains to realize, hey, you know what, it's not Fail failure isn't failure, it just it's an opportunity to pivot and and learn, right?

And improve. And and so that's been, I think, one of the weird transitions for me in this lane.

Erik
Well, I'm I'm glad to deep

Sanjay
that

Erik
Yeah, absolutely.

Davin
Makes a lot of sense. Um, you know, well there there's two things that sort of come to mind. I mean, I think um And and I don't think this is even, you know, biologically correct, but there's that like parable of like the frog in the water and you like turn up the heat and they don't they don't jump out because it it gradually kind of heats up and th that's kind of what it feels like happened to doctors, right? Like they just kept changing, you know, the temperature, adding one more regulation, one more, you know, click in a computer, one more thing. And

Sanjay
Yeah.

Davin
You know, after a decade of that, pretty soon, you know, you're like, oh my gosh. And I think for people like you, I can relate to this. I'm I'm guessing this happened to you too, because you prioritize the relationship, then at the end of a long day. You're staring at your computer going, Oh my gosh, I have to do all my notes and all that clicking and all that, you know, because you didn't want to do it in front of the patient.

Sanjay
Emotionally spent. I mean, I would be sometimes like a hundred notes behind Like I remember and I would have to come in on Saturdays or you know um or on weekends or something to catch up. Like I would put like the trigger words and and kind of quick notes in there and the, you know, put the recommendations and put in the orders or whatever, but then I'd have to backfill the notes.

But You know, it's funny because that you mentioned that because I remember going into some process meeting in the hospital. So I used to so I thought my savior would be going into the hospital admin side, right? Did not work out that way, but I thought, oh, that'll be a good role for me.

And I remember um these consultants that came in that were describing this new process and you know every everyone who's worked in corporate medicine you know, they put more and more on the physician and and you know get rid of the help people. And so they're saying, oh, you know what, this is only, you know, maybe four steps more um than what you're doing right now. And I said, wrong.

Like this is four steps on top of the four hundred other steps, you know, clicks and screens that I have to go to and all that stuff. that have slowly crept into what I'm supposed to do. I mean really what I'm supposed to do is have like somebody in there bark out an order and magically everything is supposed to happen, right?

I'm supposed to have a genie in a bottle, right? Because Doctors, that's what we learned to do is to treat patients, not do mouse clicks and things. Um and and you know, these processes just get added, added, added, added.

Um, you know, I remember for me to prescribe to e-prescribe a medication, you know, they had these verification screens and this, and then I had like a security key that I had to pull out to put in a six-digit rotating number and kind of all these things and I was just like, enough. You know, like this is not what I'm supposed to be doing, right? And I love that metaphor of the frog, you know, in that slow, you know, increase boiling water.

That's exactly what happened. And, you know, you just have to realize, and I think this was really through my wife who was in the business world, you know, she looked at what I was going through on the medical side and she was like, man. That makes no sense.

Like why are you having to do all this stuff? Like they should there should be somebody doing that for the first time.

Davin
The highest paid person.

Sanjay
Yeah, like you should be like in the calf lab only doing procedural work You know, it'd like for for instance it would be like like what's happening in the outpatient side would be the equivalent of, you know, me seeing patients But then also like vacuuming and doing the windows and all that stuff, right? Like like there's people that do that so that I can perform at my highest level. But you know, slowly there's this creep in.

I mean, I I remember one practice that I was at where I had to turn the rooms over um so that the next person could be seen. And I was like, wow, this, you know, it was it was like it was just what we did because as doctors, we just do what needs to be done for our patients. But at the same time, like There's so many of these little attacks and affronts that we don't realize that we're accepting until we, you know, bend until we break and we're like, I have to leave.

And then, you know, patients are on alert, practice is an alert, all sorts of stuff happens. So yeah I I would say, you know, to doctors, stand up for yourselves. You know what I mean?

And realize that so much of what we're dealing with is nonsense that you don't have to deal with.

Erik
You know, it's interesting. So the I I love what you shared about um the whole perspective of positions kind of being taken advantage of because of our kind heartedness and our our desire to want to help our patients. And um I think you may have misunderstood me a little bit in that the physician recruiter is for a concierge practice, right?

Oh there So her her her the reason she's asking that question is because she's trying to awake that awareness in them and say, look You're in a situation where you're not practicing medicine according to really the desires of your heart. What you went into medicine for in the first place. So let's let let me try and connect you with a concierge style or direct primary care type practice where you can actually go back to trying to practice medicine the way that you originally had hoped to.

Sanjay
Well, and that's perfect, right? But that kind of speaks to the fact that we have now kind of created this market where there is a need for concierge docs. And DPC, right?

Like there's there is an outcry from patients that say, you know what, I want to step out of this conventional system and actually have a connection with my doctor. And it's so important to me I'm gonna pay a monthly fee or an annual fee or whatever for it, right? And and that's great that in that setting, I think You know, that that's exactly the right question.

You know, those are the people that you're trying to recruit, the people that are not so far, you know, institutionalized that they're mouse, you know, glorified mouse clickers, but people that actually want to connect with humans again and be there, but you know, it is like I I feel strongly about this is, you know, these these intentions of ours sometimes get weaponized against us as docs. Um and you know, and they're just saying, you know, I kind of sometimes imagine like one of those old like forties m uh movie villains, you know, with a curly cue mustache smoking a cigar in a room and they're like Ah see, let's see what we can get away with and you know, see if anybody quits and then we kind of just dial it back a little bit, right? And and so, you know, I don't think it's quite that sinister, but it is kind of that sinister, right?

In in that universe Um and you know, unfortunately, by the time you're 500K in to your medical education and you know, most of us have families when we graduate and you've got kids that want things like lessons and sports equipment and kind of all that stuff. You're just kind of stuck saying, okay, this is, you know, the life that I have to accept. And I've seen so many of my partners.

Um, you know, I was in a multi-specialty practice. We had cardiology, nephrology, kind of all the ologies in primary care. And so many of them were just like, yeah, I could I can't leave.

Like, you know, I want to get out, but I just can't because you know, this is like I've I've created this lifestyle, you know, and and um and um and so you know you need to be able to just be humble and I think that's One of the one of the s you know, one of the most important things I think that that I have in me is because I grew up in a small town, I have a small town mindset in the sense that I don't have to have the fanciest car, the flashiest clothes. I mean, at one point uh my clothes were either all uh uh uh obtained from the hospital, meaning I was wearing scrubs all the time, or like Costco. You know, like uh, you know, so I would like Armani was like the farthest thing from my mind and you know, like the gap was fancy, right?

So um, but um, you know, I think a lot of times we get stuck in this Well, I'm a doctor, it ought to be this way, and it ought to have the the big mansion and the fancy car and the this, that, and the other. And we kind of do that to ourselves a little bit, but you know, at the same time, you know we we have to, to your point, I I think it was Davin, you know, was mentioning, is we have to be true to ultimately ourselves and like our original kind of concepts of what's going on, and then be, you know Be courageous enough to pivot when needed into a model that might work a little bit more in alignment with what we think medicine should be or how you want to practice. And if you want to be a Count the number of clicks you do per day and and you know and kind of punch the clock, which a lot of people are happy.

Awesome, right? There's there's a way for that, right? That's the amazing part of medicine is that, you know, if you don't like being in front of people, you can be in a non Patient facing male specialty, right?

If you love being with people and you can be in a people place. If you like doing technical stuff, if you don't like I mean there's There's something for everybody. And now, you know, career-wise, there's options.

But, you know, if you are if you are living out of alignment with what the purpose that you feel is then there's a problem and you can fix it. And, you know, not that you asked, but I'll just jump into this, is, you know, why I got into med school was basically I'm an Indian boy that was good at science and math and my parents brainwashed me from when I was a kid. Either go to medical school or be disowned.

Like there's this there's this joke, I heard it from a Jewish doctor, but it worked for Indian people too that said, you know, the Indian fetus isn't viable until after graduation from medical school. Right. Like it's it's kind of funny.

So like so for me, like That's what it was. I got pushed into this. Luckily, I love what I do, right?

But but there's a very different vibe when you're being pushed into something. than when you're being pulled into something, right? And now as I look at my career and using functional medicine and integrative medicine, I'm more in line with what I want to do.

And I feel like no matter what, no matter how much resistance I try, I'm constantly being pulled. by this gravity that I can never explain and never avoid and new things like you know like meeting you in Davin or you know being on this podcast or working with you know one of the functional medicine gurus, Dr. Jeff Bland and his thing. Like these opportunities just kind of keep coming along the way as guideposts to say, hey Sanjay, you're on the right path, right?

Like like these things wouldn't happen if this wasn't what you're you're supposed to do in life. Um, and and that being pulled into this new career and these new opportunities and this new practice I'm creating has such a different feel than than before when I was being pushed. And it just completely, I think, comes from being realigned with my purpose, like getting all stripping all the nonsense out of the way and all the crap out of the way and saying, all right.

Ultimately at my core, right, what am I meant to do on this earth, right? And and and once I kind of designed my life around that Man, it has just been like a whirlwind. It has been an amazing shift.

And the idea of burnout from what I'm doing right now, I mean, I'm probably working As many, if not more, hours than I was before. And anybody who's been doing startups or entrepreneur stuff kind of understands what I'm talking about. But Burnout is like the farthest thing from my mind because I just feel so driven by purpose.

And, you know, call it God, call it a higher power, divinity, the universe, whatever you want to call it. just being pulled and guided along this way just it gets me more excited day over day to continue doing what I'm doing, not less. And that's what I wish for my kids.

That uh that's what I wish for everybody on this planet is finding something that you're being pulled into because it is such an amazing feeling. For those of you who surf, It's like when you caught that first wave ever and you were just moved by the ocean. Like I still remember the first like in Waikiki, I took a surf lesson and then, you know, if anyone surfed that break it's like an it's like it's a mile if it's a foot And I just remember that feeling of being moved by the earth and how sacred and special that was.

And that's exactly how I feel and what I'm doing today is I'm just being pulled every day has a new challenge. Is every day great? No. But is every day awesome?

Yeah, right? Because I'm standing on my feet, doing what I'm doing, and finally being pulled into my purpose. Aren't you sorry you didn't ask?

Davin
No, I mean that that that's that's one of the questions we get to for sure, right? Is kind of uh You know, the shift that happens when people feel like they get aligned with their more authentic self, right? And and uh

Sanjay
And and Davin, I think it's great. I think we have to accept that shift happens, right? And shift needs to happen, right?

I'm obviously playing on words But it's okay. Like pivots are okay. Like you you need to do that, right?

Like it just it's just how we survive. You don't, you know, you but but you have to be open to that you and you have to have faith. in yourself and confidence in the universe that everything is going to align as long as you're acting in purpose with your values, right?

I think nothing ever bad can happen to you.

Davin
Yeah, yeah. No, and I I think this concept I mean one of my favorite authors is David Hawkins, who I talk about a lot. Um, but he has a book called Power versus Force, right?

And it's the he he talks about the different levels of consciousness and that you know, in the lower sort of more negative state, you know, things happen from force, right? Like you you know, that's where the like the dictators of the world and you know, they they have to force things to to happen to get their way. And when you elevate your frequency and your consciousness and you align with that higher purpose, then the power that comes from that is a godlike, you know, uh power that drives you and and almost tractor beam-esque, right?

Kind of pulls you. Towards it.

Sanjay
And I I love that, you know, in the CAF lab when we're doing procedural work, you know, I'd always teach fellows in residents, you know, nothing needs to happen by force, right? Things should just glide. Right.

And and that's exactly kind of how I feel right now is things are just gliding. Um, and and you know, and that's uh you know, I I haven't read him the his book, but sounds like I need to get it because that's exactly what I've been experiencing. I just didn't have the words to put behind that.

Erik
Yeah, it's funny. You were mentioning, you know, that the mindset, right? I think we all get kind of trapped between the mindset or brainwashing that we get in our training to the fact that we've got to be part of a team, we've got to care patience you know, come first and we have to sacrifice everything in order to make sure we care for the patient and th the worst outcome possible is that a patient could die. Right?

Sanjay
Right.

Erik
Though that is part of the cycle of life, right? It's like we we you know, we we forget that we're we're actually participants on a patient's journey. And the the goal isn't to save them from death.

The goal is to help them have the highest quality of life and experience as much joy before they Experience death, right? And as as providers, as physicians, we have this sacred responsibility because we have such an intimate relationship with our patients that we can actually influence that their decision making in a way that would allow them to have awareness so that they can make changes to improve their overall quality. of life.

But to go to go back to what you were saying, I remember I got out of the Navy, I'm in one of my first family practice jobs, and I'm I'm kind of frustrated with all of the hoops I have to jump through. You know, with the you know, I'm like on call every fourth night, I'm delivering babies I've got to a you know, I've got to answer the pager, I've gotta gotta jump through all these hoops on my, you know, EMR now that I'm learning for the, you know, the seventh time or whatever. And and I was just kinda I was just kinda complaining.

I wanted more time with my patients. And our kind of physician owner of the practice that I was a part of turns to me and says, you know what, you're never going to be happy until you're a concierge doc. And the funny thing was is I took that as an offense.

Like what? You think I'm not gonna be good at doing what I'm, you know, like that I'm not gonna be able to fit this mold? Like it was so funny.

I took that as such an affront In reality, I think he actually probably meant it as a compliment, but I took it totally offensive.

Sanjay
Maybe he manifested it for you, right? Like maybe that's what it was, right? He was just like, hey, this is what you should be, right?

Like you're not gonna be able to accept the status quo. Just like, you know, in the entrepreneur world, you know, I think of uh Mr. Wonderful, you know, on Shark Tank, he tells this story about his first job as a uh teenager. He was at an ice cream shop working for somebody and they were paying him hourly and so Um the owner of the shop said, Hey, you know what?

What I need you to do is go and scrape all the gum off of the tables or off of the floor or something, you know, when people put their gum underneath the table And he said, no, you pay me to to scoop ice cream. And the owner says, no, I pay you to do what I tell you to do, right? And and so that's when Kevin O'Leary said, you know, that's when I realized I could never work for somebody else, right And and I think that we are so in in that medical education world, you know, we're so just, you know, what what is the next step?

It's always, you know, well you you once you're done with residency, you get a job, right? And then then you just stay at that job forever. That's what we think.

And so the idea of of leaving kind of outside and maybe going to a different job or a different practice becomes so foreign to people because you think, oh, I'm just gonna be there forever. Um, but yeah, I mean I I think it's hilarious that he told you that, and that's ultimately what you ended up being because that was probably your fate, right? That's what needed to happen.

So maybe he cracked open the universe for you. And put that in there and and just kind of make, you know, subconsciously let you realize, oh, you know what, maybe that's the kind of doc I really need to be. So send that guy a thank you card or that woman a thank you card, I guess.

Davin
Yeah. I want to circle back to something else that you noticed. I think maybe because you were also on the administrative side a little bit uh in in healthcare, not just in the startup, but actually while still kind of in an an employed organization.

So I had Same thing. I was a CMIO, then I was a CMO of a of a medical group. And I remember um sitting across these executives, you know, who weren't doctors.

Sanjay
who

Davin
were making decisions. And and I'm like, well, don't you think we should talk to the doctors about this and kind of see what they think? They're like, oh, they don't they don't understand business.

And and I had this thought and I said, you know These are the smartest problem solvers on the planet. If we give them the data, don't you think they would probably be able to solve the problem And so it's not that they don't know business, it's that we're not keeping them in the loop. And I'm I'm just curious, you know, as doctors, is this our own fault in a way, because we just haven't stepped up or Because clearly we could figure it out.

Sanjay
Yeah, no, I mean I like I said, I think the raw horsepower of anybody that's been through medical school and has put up with the abuse of med school and all like our Like yeah, I'll I'll tell you one story and I'll get back to Dav and what you're asking, but I have a friend whose brother-in-law did Navy SEAL training. Like he was a SEAL in the in the Army or in the Navy rather, and then went to medical school after And so we were like having a coffee and I just kind of I I wanted to ask this question. I wasn't sure if I should, but I did.

And I said, hey, what was harder? You know, BUDS training, which anybody who's followed like Jocko or David Goggins or you know, I mean BUDS is no joke, right? That's kind of the the proving school to get into the Navy SEAL training.

um or medical school. You know, what was more difficult for you? And he said, without a doubt, med school was harder.

You know, and and buds, I mean, you're like going underwater, they're dunking you. You're holding like all this kind of physical, mental torture. And I was like, holy Like what?

Like, what do you mean? There's no way. He goes, Well, at least when we did Bud 's training, you know that they were breaking you down to build you up again.

But when I did med school, I just never had that light at the end of the tunnel. And I think that was Like that kind of hit me kind of hard, right? Kind of deep.

Erik
Breaking you down.

Sanjay
Yeah, they're just th and and so it's just breaking down and you know, we the the person that's that's venerated in meds in you know the med school lore is the person that got their appendix out at eight AM and was back on rounds at 8 31 a. m. right with the IV poll and pressing their PCA, making life decisions on other people. So, you know, getting back to this business of admin and how they look at doctors and all that stuff, I mean, I think that's part of the problem No, I remember and I you know I somebody the you know one of the listeners can find the study, but they looked at systems that were run by physicians versus systems that were run by administrators, like non-physician admin people. And the practices run by physicians were You know, some twenty-one or something percent more efficient in terms of kind of running a leaner organization, understanding where you could make the changes and not without affecting patient care.

So there are leaner organizations with higher patient satisfaction. And you know, with administrators, it's kind of funny because they are really, you know, the fact that they have no clinical understanding of what's going on becomes very evident when you're a physician in the room in one of these meetings and they're talking about this spreadsheet and that spreadsheet. And I remember famously in one meeting I said, you know, you guys have these metrics on here, but You know, what are you gonna start measuring your doctors by grammas per hour?

Like how many grammas they're treating per hour? Like it makes no sense. Like you can't apply these metrics.

Like they were looking at a particular medication that we use in the cath lab. um that was expensive. It was called ReoPro.

I don't know if anybody cares, but, you know, and they said, you know, we need to be able to take our utilization of this medicine down by 30% next year. And I said, okay, we've done, you know, whatever, 400 cases. We used it six times.

It's a bailout medicine. And you want us to reduce it by 30%? So that means we are okay with two people dying that needed this medicine.

And like, no, we're not okay with that. We just want a decrease of the utilization of this medication. And I'm like I I don't even know how to explain this to you.

Like that's what's keeping these people alive. You know, and and so there's such a disconnect sometimes. And so I do think that physicians need to um, you know.

Maybe I should say it this way. I think anybody who's a hospital administrator should have been in practice for at least 10 years. I think that should be a necessary, necessary requirement.

You know, and it doesn't necessarily have to be like, you know, an internal medicine doctor can only do internal medicine things or whatever, but someone who's been there, who's seen clinical practice, I think that needs to change. That needs to be a requisite for physicians You know, I I also think that we have to in the same way that and I don't know Davin if if you got compensated for your time in those meetings, but I certainly didn't. Uh and so I was at those meetings an hour or two out of my clinical day, out of the goodness of my heart uh right to make the hospital more efficient whereas these other administrators are getting paid per meeting right so you know we need to make it more lucrative for physicians to become physician executives, and I think that's one of the easiest fixes, um, is get people who have actually you know, sutured uh a patient, you know, or kind of diagnosed a heart murmur to be able to run hospitals and this, you know, you can't just have an MBA anymore and look at this stuff. from metrics and and you know the number of uh you know whatever shoulder replacement surgeries divided by the number of gauze pads used equals some sort of weirdo metric.

that is related to the number of b babies born, you know, whatever. Like they they can connect anything to anything, right? But but I think we need to kind of have a basis in clinical medicine before you can bump become an administrator, right?

You can't just go to med school without taking organic chemistry and physics and all like physics has almost nothing to do with my day-to-day existence as a doctor, but it was a prerequisite, right, to show that you had the skills and the intellectual power firepower to be able to get through med school. So I think similarly with ad admin, like, you know, you need to have, you know, I think every hospital CEO should be Because I you know, you just look at things differently, I think in a more clear way. You know, it's like when you see, you know, like what happened with Apple, where the CEO of Pepsi came in and tried to run a computer company, right didn't work out that great.

Steve Jobs eventually came back, right? Um, so you know, I think that's that's one way to fix kind of these sorts of issues that occur with processes. in the hospital, getting back to your original questions, yeah, you know what, rather than have a bunch of these MBA type people have the MDs go in and say, okay, you know what, we don't need you know, three people for patient transport, we can get away with two people per for patient transport or whatever it might be.

And we see things both at that ten thousand foot level, but also at that very granular level. So zooming in and out of the problem. uh to to come up with a longer solution or a longer term fix.

Um because most of the time in the hospital, I mean, I will tell you at least in the hospital hospitals that I've been involved with, and this has been several hospital systems, is, you know, they they basically let things slide until there's a sentinel event, right? And then everybody gets all upset. Oh my gosh, like You know, we had, you know, more catheter related infections, or we know we had a patient fall out.

We need to redo the entire system and kind of come to this. They're very reactive. Whereas in the physician side, you know, when I'm rounding and I see, you know, someone's bed rail down, I just put it up because I'm like, hey, you know what?

Like, I don't want this guy to fall, right? Like it's it's a very different way of looking at these problems.

Davin
Yeah.

Erik
Well, you know, you're what you're suggesting though is just gonna add to a very significant problem that we're already seeing, and that is a shortfall of physicians. Right. So we we get more more physicians into the I mean if you think if I mean Do the math, right? If we if we had a physician CEO for every hospital throughout the country, now we've just depleted our physician force even further.

Sanjay
But how many how many hospitals truly are there in the country? Six thousand?

Davin
Yeah.

Erik
I'm guessing

Sanjay
I mean somebody well s Google it real quick. I don't know. Somebody can somebody can look it up or I'll do it on my phone real quick. Chat GPT, how many hospitals are there in the country?

Davin
Yeah.

Sanjay
Um but my point is we're already losing how we're already losing how many doctors um uh in the US

Erik
Oh my gosh.

Sanjay
So I kind of I went off the hunting. But I mean how many doctors are we losing to burnout

Erik
Yeah.

Sanjay
Anyway, right. And then, you know, and and how many now and what is this what is what's happening to those doctors? They're going into other things, right?

I would rather bring those doctors back in, have them run the hospital, kind of you know, put them through like, you know, job retraining services or something. You know, like they do with like prisoners. Give them the skills.

Erik
You bring up a great point. I was I was playing a little bit of a devil's advocate.

Sanjay
But we're we're seeing that, but they're going into other industries.

Erik
Yeah.

Sanjay
Right? Like they're they're not returning to patient care. And I think this is kind of like I I agreed, it's a front-loaded situation if we get rid of the doctors who are Or if we retrain the doctors who are leaving and bring them back in, then at some point we'll reach a new equilibrium, right?

But it'll be in a much more balanced system where you had people like me saying to these consultants You know, four more steps isn't just four more steps. That's four steps on top of the four hundred other steps that you made us do, right? And and I think that's that's kind of part of the healing.

It's almost like you know, like homeopathy, right? Being exposed to the the the negative influence is actually supposed to be um uh healing over time, right? Or vaccination, right?

You you give people the attenuated virus or the attenuated polio, you know, expose them to that so that over time they build immunity, right? So, you know, take these doctors that are leaving Say, all right, if you want to really improve patient care, and that's part of what I'm doing now, is that you can improve patient scale patient care at scale. Not by being in clinic, but by fixing the systems that are broken so that ultimately we fix what's happening in medicine, right?

Like that's that's truly how you fix this. Otherwise, we're, you know, we're gonna be we're already reaching, like to your point, Erik, this negative uh growth phase of physicians because we're having so many physicians of that, you know, of that baby boomer generation who are retiring. doctors that are in our age group, the mid-career docs kind of shifting out of medicine.

You've got a bunch of like new grads, you know, or kind of early physicians who are just gonna burn out even faster. And more and more what's happening in the system is that we're relying on healthcare, what we used to call extenders, but now are you know healthcare, what do they call them, HCPs, healthcare providers. like nurse practitioners and peace.

I'm not saying that's wrong. That's what the marketers. But but if you want to bring doctors back because There is something very sacred about med school and being an MD or DO that I think extenders don't or you know practitioners, providers, whatever whatever that moniker is.

don't don't have that skill set, right? Like then we fix the systems that are creating these weird stresses that are forcing people to leave. I mean it's like instead of pouring more water in the leaky tub, just fix the plug.

Right. Like

Davin
well so um you I mean you bring up a good solution. I think you and I maybe also shared this where we had the opportunity to maybe go that route, right? Like I was definitely on a path you know, in my health system and and to my health system's credit, they did pay doctors to be executives.

Uh I was one of those. But even in that scenario, you know, for me I got burned out on that side of things too, you know, trying to make the change that just didn't seem like it was going to happen. And I needed to I needed to go about it a different way, right?

And so I finally left and here I am. Um, and I think maybe getting back to your journey, you know, why did you choose to leave versus staying and trying to make the system better? Maybe this is a different way to influence it, maybe for you, or just a line there, like you were saying.

Sanjay
Yeah, I mean, I think for me, you know, it was again, it was about the connection. Um, and really it was just about like I realized that had I continued on the career path that I was on, so I was every fourth day on call for heart attacks, but on days when you're on heart attack call you also still had clinic the day of and post and you know, I was running myself thin and as I was approaching turning fifty, I was like, boy, I'm gonna be within two or three years of a heart attack myself at the level of stress that I have. And, you know, since that time I've had two friends who are interventional cardiologists that are my age that had heart attacks, you know, from the stress.

And I realized, you know , I I need to take care of myself and make sure I'm as healthy as I can be to make sure that I can be there for my patients, right? And A lot of people, you know, they they feel that that's selfish, I think, in medical school, because that's what we're taught. You know, you I mean how many times had you guys been in clinic when you were sick, you should have called off, but you're like, well, who's gonna see my patients if I'm not?

So you show up in a mask and you know you're like bombing orange juice in between patients and Red Bull to kind of caffeinate or whatever it might be And your patients are like, hey, Dr. Lundquist, are you okay? Right? Like, like how many times has that happened to you guys, right?

I mean, I know I certainly know. I like I remember being sleep

Erik
last night.

Sanjay
Me? No, no, no. I remember being in in STEMI's like with straight up the flu. Like I'm sitting here taking care of someone's heart attack.

And then after the case was done, I just fell asleep in the chair where I'm supposed to be writing orders, slumped over for like an hour and the cath lab staff didn't even want to wake me, you know, because they're like, oh, he need sleep, right? I mean, so so, you know, we are socialized to not take care of ourselves, but ultimately kind of that decision to leave was that I knew that I was gonna be dead potentially in a few years if I continued in that way. And unfortunately You see this all the time in hospital systems across the country where, you know, a mid-career doc just dice, right?

Like it's it's not it's not an unheard tale. We've all had hospitals that we're worked off where they're like, oh my God, did you hear about Dr. So-and-so? What happened over the weekend?

That that stuff happens, right? So for me, I I realized that, you know, the most important thing for me is my family, my wife, my kids, my daughter My daughters being there for them. If I'm not there for them, then nothing else matters.

And and so I said, okay, I need to design a life that's more in l line with what I value, right? And it's not work-life balance, it's life work balance, right? Life should come first and then you bring in work.

And so um, you know, one of the books that I read was Designing Your Life or something. It was two Stanford um like PhD people that that did this course at Stanford, I think, and and my wife got me that book I think she bought it for herself, but I saw it on the kitchen counter and I just kind of picked it up and I read it like the way I read the Da Vinci code, just cover to cover. I couldn't put it down.

Uh and so I was like, wow, you know what? Like I need to kind of rethink things here and and you know, how do I wanna be there for patients? What do I wanna be as a h as a doctor?

Do I wanna be someone who treats patients, meaning give them medicines to get numbers in a certain range? Or do I wanna really heal them? Right.

And and it was right around that time that I found functional medicine and integrative medicine and realized that was really the path that I was meant to be on, not just being like a statin pusher or an ace. uh you know, Andrew Tensin converting enzyme pusher, like like I really wanted to heal people, not just treat them. And there's just a confluence of things that happened in my life that allowed that to happen.

I mean, I would lie if I told you I just woke up one day and decided to to quit my job and move to an island. No, this was like calculated, you know, it probably took me about two or three years to come to the point that I needed to get at where I felt safe. I tell people I created three or four safe landing zones for me so that if like this venture didn't work, that would work.

You know, so I was a little bit in med tech and a little bit in this venture and a little bit in functional medicine and I I created these soft landing zones But, you know, there was there was a point where, you know, there's one weekend call on a Saturday where I had eight patients who have back to back to back to back-to-back heart attacks. And I didn't get a chance I didn't get a chance to go to the bathroom, right? Like I didn't get a chance to eat.

It was just, you know, it was just raining heart attacks. And I said, This is like this is this sign from God. Like that's, you know what, Sanjay, like You can do this and you will continue to be successful doing this, the right meaning treating these heart attacks, but at what cost to yourself You know, like the universe is always there giving you signs.

You just have to be smart enough to listen. Right. And I said, okay, you know what?

This is, I think, one of the signs that I need to listen to and say, all right, now it's time to kind of design my life in the way that It can work. And at that time I was institutionalized like Brooks from Shawshank. I didn't know how to pee without somebody telling me that I could pee.

And I didn't know how to, you know do all these things, but I'm like, but I need to figure it out. Uh and so over the course of the next two or three years, I was talking to people that had already taken the leap to go into practice on their own, people in the functional medicine integrative community like Erik, like you You know, and I like pitch your brain, like, hey, what do you think? And what are you doing?

And kind of learning. And, you know, some other um like Yousef Elyaman, who you may know from IFM, he's been a great friend and mentor to me. And he probably gets annoyed when he sees my name on the caller ID sometimes.

But I'm like, bro, like, what do you think? Like, what can I do this? Is this gonna happen?

And he's like, oh my God, yes. I how many times do I have to tell you you're gonna be okay, right? You just have to have that faith.

But You know, again, like the universe, God, whatever put me around people in my orbit that, you know, said it's gonna be okay. I just kinda had to believe them, but most importantly, believe in myself. But yeah, it's It's it's definitely a different ride than I thought I'd be on.

You know, it's like getting on a roller coaster and then it turns into a water ride all of a sudden you're like soaking wet. You're like, I was not expecting this. But at the same time, that that doesn't take the thrill away from what you're doing, right?

And I think particularly getting back to The fact that I'm being pulled into this by a gravity that I can't explain just makes it so that much more exciting and that much more fun.

Erik
Yeah, I think each one of us has had that. kind of transition where we just w you get to a breaking point and it's in I don't know if the breaking point's the right word. Maybe it's real life.

Sanjay
A stressful moment like a go or no go moment. Yeah whatever.

Erik
Yeah you just you just and you just realize you I can't do this anymore. Right. And it's just like you make the decision.

I'm moving forward. And and that decision is is I I felt was the hardest, right? It was just for me, once once I made that decision, then all of the the fear jumps in, right, that you're talking about.

You know, it's like, oh, am I going to be able to be successful? How am I going to make this work? You know, am I going to be able to match my income or m more more importantly , am I gonna r l be successful, right?

Am I just gonna, you know, end up having to come back to where I am because I failed

Sanjay
Right. But I mean and I I definitely think that I had a hospital admin tell me You're gonna be back in two years asking for your job back, and I'm not sure if it's gonna be available, right? Is like this threatening kind of thing I thought was hilarious. But then think about what would have happened in the Star Wars universe if Luke just stayed on Tatooine.

Erik
Right

Sanjay
There would have been a really boring one movie and nothing would have happened, right? Like so if you want to be the hero of your life's journey, you have to take that leap. It's just a necessary part of the process.

Erik
Yeah, for sure.

Davin
Yeah. No, and I think um you talk about like how people start showing up in your life and I I think um You know, I I'm a believer in like, you know, the law of attraction and frequencies and things. And so I think when you start when your frequency changes, then you start attracting people that are in that same frequency, right?

And and so um it's been fun. I I mean I've seen it in my own, you know you know, transition if you will, where, you know, people, you know, oh, I went to give a talk and next thing you know, they're investing in my pri you know, it's like It's just been amazing and and they keeps happening. I mean, I just had another person like out of the blue just like turn up and say, hey, I want to partner with you on this other thing digitally.

And And, you know, whether anything comes of it is sort of almost beside the point. It's just like it's just cool to be around people who are you know, kind of flowing with you. And it it gives you energy and and kind of keeps propelling you along the journey.

Erik
So tell tell us a little bit about what you what you've been doing then since you kind of left. Like what is what are some of these you know, partnerships or or ventures that you've been involved with?

Sanjay
Yeah. So when I left, um the first thing I did is I actually started a cardiometabolic optimization program called Well12. So it's a 12-week program that help people helps people use diet and lifestyle to optimize their health.

Some point I was getting like 20, 30, 40 people a month into that. And so that was kind of really cool because what I was seeing was exactly what I was hoping for was to be able to use diet and lifestyle to get people off of medicines. Like the number of people that were lightheaded and dizzy within the first two weeks because their blood pressure was like normalizing now and I had to work to get them off of blood pressure medicine was like astounding.

reversing you know insulin resistance, preventing people from getting diabetes, but also, you know, as you guys know in the functional health model, is that when you're addressing root cause so many other things get better. So people's like neuroinflammation got better. I had a woman that thought she had Alzheimer's but turns out has just neuroinflammation.

She was like wandering outside of her house and then she kind of got back to doing crossword puzzles just through eating the right foods and sleeping and all these things. So that was pretty awesome. And then kind of I told you how I created a multiple uh soft landings.

And so um another thing that I did was got heavily involved. I live in Orange County, California. So we have a lot of medical tech um startups.

And so I started getting involved with med tech consulting and doing fractional chief medical officer work uh for a couple of companies. Initially I was in a just say yes phase where I just said yes to everything uh learning as much as I could and now I'm still doing that, but much more choosy uh about like who I want to work with, the companies that I think are actually going to be successful. And, you know, there's no way to accelerate that learning and that knowledge other than experiencing it and kind of uh being there.

Uh I was involved in a failed uh med spa venture. I thought, oh, it's Orange County. You can open up a s coffee shop inside of a coffee shop and we'll be successful.

Uh and so I got involved in a med spa and that didn't work out. And I said, okay, I just kinda took the learning that I had, cut my losses, and move on. Um, you know, because that's part of the business world as well.

That's not a failure.

Erik
It was a

Sanjay
it was a a very expensive education, but still somehow cheaper than med school would have been, right? So uh so I kind of pinted it out of that, and but you know, with every opportunity I kind of learned more and more. Um and then I got you know, kind of more deeply involved in physician education than and doing, you know, being a cardiologist who does integrative medicine, there's probably maybe a handful of us, ten, twenty, fifteen, fifteen, twenty of us in the country.

Um and so I was fortunate enough to, as you mentioned, Davin to meet the right people and become faculty for Institute of Functional Medicine now, faculty for the American Academy of Anti-Aging Medicine, A4M, um, and like teaching other docs how to do I guess what it is that I do. Um and then, you know, it took a couple of years, but you know, we talked about the trauma of med school and the trauma of medical careers. And now I'm kind of In that point where I feel like in my self-healing journey, I'm able to like launch a new practice.

So uh coming this fall, which is fall of 2026, launching uh my practice, the integrative health and integrative heart institute, um where we look at cardiology not just from LDL and HBA1C and all these conventional markers, but You know, where are we mentally, emotionally, spiritually? What are some of the things that we can do to c regulate your nervous system? How can we optimize hormones?

Um, you know, all of these different things that definitely affect our cardiovascular health. that are somehow not addressed in the conventional system. And again, it just it feels so inlignment in alignment with my purpose, right?

I think that if I was the the guy talking, you know, the the 90th guy talking about menopause, that would not, you know, while it is functional medicine, it's not what it's not my DNA, right? My DNA is cardiac and cardiometabolic. And so I just I love what I get to do, you know, taking 90 minutes with a patient to kind of understand the entire kind of background of everything with them, coming in with a therapy therapeutic plan and a diagnostic plan that just makes a lot more sense and I'm able to use a lot of the more advanced tools that are available.

You know, I I I live outside of the insurance system. So I think in a way people think that's a bad thing. I think it's a great thing because I get to practice medicine.

the way medicine can be practiced, right? Like because how many times have have you guys, if you if you deal with insurance patients, tried to get a test done and you had to make a prior authorization call and you had to talk to somebody begging and pleading as to why you think what needs to be done really needs to be done and can't we do this less substandard test? You know, can't you do a a treadmill, put them on a treadmill before you do an ultrasound?

I'm like, that's not even answering the same question. Like You know, so so it kind of I think makes for a much greater efficiency of delivery of care, but also, you know, as opposed to the conventional system where we basically fix things once they're broken. Right.

We can catch people when they're just out of alignment, right? They're just a little bit out of balance. Fix them then so that they never have to get broken and and really, you know, improve that health span.

as opposed to just, you know, keeping them alive longer. We can, you know, I am able to keep them more functional. And I, you know, my one of my taglines is the best way to manage a heart attack is to manage to never get one in the first place.

Right. And so that's what I get to do now with with patients. And it's exciting.

It's fun. It's powerful uh and it's important work.

Erik
Yeah, that's awesome. That's really awesome. Well, um I also hear uh or I I I it's come to my knowledge that you may be writing a book

Sanjay
Yeah.

Erik
Do you want to tell us a little bit about what that's gonna be about?

Sanjay
Yeah. So um you know, when I think all of us in medicine, none of us think we're special, right? That gets kind of beaten out of us, but We are in a talent pool of very special people, so kind of our baseline gets off.

And so I'm part of this mastermind group and and I've always had it in my head to kind of write a book about the way this new way that I see uh uh medicine uh or at least cardiology uh in this new framework that I've created. And so this summer I'm actually like right now beginning that research and Hopefully we'll have a book out in the next six to eight months, but really I'm trying to get it done in the next few weeks. Uh and it focuses on this integrative heart method that I've created.

So heart is mnemonic, H-E-A-R-T. So H stands for hormone optimization. We don't realize that, you know, for instance, I mentioned menopause, estrogen replacement is not as important, uh, you know, is not as you know, as much about rem improving hot flashes as it is about improving cardiovascular health, right? I think it's almost as important as telling a woman a woman not to smoke.

Right. That's how important it is to tell her to get estrogen because estrogen helps the vasculature. It helps the liver and and you know the the LDL levels and all sorts of different things.

For guys, testosterone replacement, which has been b vilified for years in the same way that hormone replacement for women was misunderstood, like giving back testosterone after this traverse trial that was that came out about a year or so ago, kind of we see improvements in cardiometabolic health Muscle mass. So it's not just about virility and and hitting a baseball, you know, 500 feet or whatever, but it's actually about being able to live. So hormones necessarily optimize.

E is um energy. So optimizing your mitochondrial health, looking at oxidative stress, our membranes. When you take fish oil, where does that work?

Well, it's actually making your cell membranes healthier, particularly in your mitochondrial membranes, right? People don't realize that Uh also part of E is uh part of energy is microbiome and optimizing your microbiome. That is where you take the energy from food and turn it into energy that your body can use, right?

M more or less masuminos. Uh A is autonomic nervous system. So Stress, all of these things fry our autonomic nervous systems, and there's things that you can do, including breath work that can help relax you and you can't heal if you're not safe and if your body doesn't experience peace.

And so for most of us that peace, that serenity is something that is attacked. on a daily basis by the foods that we're eating, the stressors in our lives, the toxic people we have, our work environment, all these different things. And so you have to have that awareness to kind of help you reta regain that ability to heal.

Um and that kind of leads me into R, which is rest and repair. So getting adequate sleep, I think there's probably an epidemic. of undiagnosed sleep apnea that is affecting our cardiovascular health, uh eating foods and getting ourselves compounds that help allow us to repair.

And then the T is toxins, and that's to heavy metal toxins like arsenic and mercury and molybdenum and all these other things that live in that part of the periodic table that we don't like, that that low middle part, right? The rare earth elements. But then also toxic thoughts like like our own mentality, our own mindsets, you know, people who are toxic relationships, people that that bring that energy David, as you're talking about, that bring that energy down as opposed to boost you up.

And then toxic tox toxic events that have happened to us, traumas. Uh right, Aimie Apigian, who is a recent acquaintance, you know, wrote this whole great book, The Biology of Trauma, that it really opened my eyes to how much We hold in our chests from from these events that have happened to us. And a lot of times when I'm now interacting with patients in this new kind of framework, it's that last T that's the most important.

Like I can't tell you the number of adverse childhood events that I've stumbled upon that are really driving that chest pain. You know, they've had these million dollar workups from other doctors, including invasive angiograms and all that stuff. Nobody can sort it out.

And then I just ask a simple question, you know, did you feel safe as a child? And then we'll say no and this happened to me and that happened to me. Like, all right, well let's get you to a trauma therapist who can kind of help you work through that.

And then all of a sudden, after even just two or three weeks of sessions that chest pain is lifted because that shame, that guilt, whatever it was that they're carrying is is lifted. So it's you know, that this is probably the first book I feel like. Um it just kind of the overview and then each one of the individual metrics will become its own book down the road.

But You know, it's really changed the way I approach the cardiology. I think that just like Kevin O'Leary, I'm no longer employable in a conventional practice because this is the way that I see the world now. And the the number of people that I I like it it it always kind of makes me nervous when I inherit a patient that says I've seen Everybody on the West Coast.

I've seen like eight, ten, fifteen. I think the record I think is seventeen cardiologists someone had seen before they ended up coming to me Uh and that woman I had her up and running and fixed within three weeks just because I was thinking outside of the box, asking the right questions, using supplementation instead of medications. Um, and she came to me with this chronic uh, you know, Angela equivalent type discomfort and we put her on one supplement, turned it around for her, and she did great.

Um, you know, but uh but it really refocuses and re-energizes kind of my purpose about what it is that I'm supposed to do. Um and as a highlight, I just got invited to do a grand rounds for my cardiology fellowship um to go back to a bunch of yeah to go back and talk to a hundred uh or so internal medicine residents, cardiology fellows um about integrative cardiology and why it's key. Uh and I'm I I can already see my some of my mentors from before eye rolling um before.

Like, oh my God, Sanjay, that guy went out to California, he became a you know granola Democrat, whatever they're gonna call me. Uh, but um, but yeah, going in there and then showing them that, yeah, you know what, there's actually data behind the experience of awe and how that affects our cardiovascular health, right? Being in like nature, like these things are hugely important.

They may not be randomized clinical trials the way that we're accustomed to them, but at the same time those randomized clinical or those randomized controlled trials are designed to not fail before they've even, you know, enrolled the first patient, right? We know this, people who know the clinical trial background, but our conventional colleagues, you know, they they see the little bit world a little bit differently. So I can't wait to kind of be that bridge between that that conventional world and this new integrative slash functional world to really show them the power and the value of what it is that we have to offer.

Erik
Oh, that's awesome. Well, this has been a great conversation. You you've shared so many amazing things and uh it's been a joy and and I've really enjoyed our friendship and we'll continue to to see that move forward. But Davin, why don't you bring us home with our final question here?

Davin
Yeah, so we we'd like to ask everybody where you see medicine heading, you know, specifically integrated into functional medicine. You know, what's the future in the next five to ten years?

Sanjay
Yeah, I'm really excited about personalization of medicine, right? I mean, I think at this point, because of all these huge randomized controlled trials, and I think that there is definitely a role for that. But we're now treating for the averages, right?

So so you know, I I tell people it's like saying that the average height in the United States is five foot nine inches, so next time you go to buy jeans. the only length they'll have is for people five foot nine, right? Because that's what the statistics show.

You know, you guys at whatever six foot fourteen inches tall that you guys are and me at five five. Like we would have I'd have to get extensions Or or um uh or you know, we'd have to hem the jeans otherwise and we'd be kind of shoehorned into fitting into what was available, right? Doesn't make a lot of sense.

But I think now with the computing power that's available, I mean, you know, the computing power of my phone is like one million times more than what got, you know, those astronauts to the moon in Apollo 13, right? We all know this. But but being able to use these models to look at at genomics, proteomics, transcriptomics, all of these new kind of personalized models to be able to then aggregate those thousands, millions of data points and say, all right, Davin, I know that you and Erik are brothers, but you're so different.

in these ways, right? Because you live near a toxic waste dump and he lives near the rainforest and your exposures are so different and this is how it's affecting your your gene transcription. This is why this is gonna work for you and that's not gonna work for him and this, that, and the other.

I think that we're so close. Some of the work that I do is with a group called the American Board of Precision Medicine. Is that I'm seeing kind of behind the curtain as to what's happening now, but what's down the horizon, I get super excited about that.

You know, like we'll we'll do, you know, 500 markers or a thousand markers. And look at them longitudinally and be able to say, you know what, you are 7. 3 years away from being diagnosed with type 2 diabetes.

This is the one lever that we can pull today to avoid that from happening. You know, pull that lever, look again in three months time, see those proteins that whatever that gene expression was back off a little bit, so now we can prevent disease. Like that is is what's gonna happen.

And I think as we see AI, you know, really taking hold of medicine, and I know people are threatened by it, but I think that in the same way that people are threatened by moving pictures when movies came out and automobiles when you know horseless carriages when hor when t uh cars came out. Like we need to embrace this new technology, kind of understand it You know, it's not like you know Terminator, it's not gonna kill us all, right? But we or at least we don't think it will.

But um but we need to embrace it and kind of realize what a powerful tool this is with all the diagnostics that we have available. to really extend and improve humanity. And I think that, you know, it's just gonna be so cool to see what happens, you know, seven years from now.

You go to your clinic. And you know, you put a drop of blood like Theranos or whatever that that failed startup was, or that fictitious startup. But but I think we're getting ever closer to something like that.

And I think it's just it's gonna be awesome because now you're never gonna have a medication side effect because we know exactly how a medication is gonna affect you or rarely will you have a side effect because we know oh you have gene XYZ uh that c that also you know works against you and so let's try this instead of that. I I think it's just gonna be an awesome time.

Erik
Oh that's that's great. So Sanjay, if people wanna connect with you or reach out to you or find out what you're up to, what's the best way for them to connect with you?

Sanjay
Yeah, so on all the socials, my handle is at Dr. Sanjay M D, so D-O-C-T-O-R -S -A-N-J-A-Y-M-D. Um or if you're interested in becoming a patient or you have someone that you want to undergo my framework, you can go to my website, the integrativeheartinstitute. com, just the way it sounds, uh, and I will be happy to help out in any way that I can

Erik
Awesome. Well thanks, Sanjay. That was a great discussion today. We appreciate you being on the podcast.

Sanjay
It is always great to hang out with you, Erik and Davin. Same for you.