Dr Bill Cherniak, CEO of Rocket Doctor on Virtual Care, Innovation & Artificial Intelligence │ Cherry Live!

Join us for an out-of-this-world podcast episode, where we'll follow CEO Dr Bill Cherniak on the explosive growth of Rocket Doctor!

About the Event

Dr Jordan Vollrath interviews Dr Bill Cherniak on his journey as an entrepreneur, the explosive growth of Rocket Doctor, how virtual care is transforming healthcare and how AI should shape the future of health.

Objectives and Discussions
  • What is Rocket Doctor
  • Feedback from patients and doctors
  • Expansion into the USA
  • Future of Rocket Doctor
  • Key learning from starting a business
  • Highs and lows of starting a business
  • Artificial Intelligence and the future

Have questions? We want to hear them!

More Resources:

LinkedIn: https://cherryhealth.co/linkedin

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Twitter: @cherryhealthinc

Instagram: @cherry.health

Speaker Identification:

[Host]: Dr Jordan Vollrath

[Speaker]: Dr Bill Cherniak

Jordan: Hello and welcome to CHERRY Live. I'm Dr. Jordan Vollrath, and for those of you tuning in for the first time, CHERRY Live is brought to you by CHERRY Health, Canada's medical network where healthcare practitioners connect. If you haven't logged onto the site yet, we're the number one largest platform in Canada for physician jobs with opportunities from more than 1,600 healthcare employers. And if you're on the other side of the table, it's free to post jobs. CHERRY.health is the link, and you can sign up and find yourself a new physician or even some locum coverage 100% free. No cost with our suite of tools. And then Cherry Live, of course, is our podcast series where we connect with innovators, entrepreneurs, and professionals of all sorts who are working to move Canada's healthcare system forwards. Today, we're joined by Dr. Bill Czerniak, Emergency Physician, Co-Founder, and Board Chair of Bridge to Health Medical and Dental, and the Founder and CEO of Rocket Doctor. Welcome to the program, how you doing?

BillThanks, I'm good. I'm good. Thanks for having me.

JordanAwesome. So yeah, why don't we start off with a little bit of just like, what is your week to week look like? You know, what's a day in the life of Dr. Bill like? You're an entrepreneur, you are a practicing ER doctor. What do things actually look like?

Bill:Yeah, I mean, I suppose the fastest answer is no week looks like the last probably, particularly because Rocket Doctor is across Canada and in California and looking elsewhere in the United States as well. So there's a lot of travel for me. But I'd say, you know, majority of the time is just spent on Rocket Doctor and I think like most entrepreneurs these days, there's a lot of zoom calls. Soto back zooms, but then jumping to in-person events, trying to budget an ER shift here or there every couple weeks or so, and then on a plane flying to one of the places that we're working in, I guess. And then maybe once a year going to East Africa with a nonprofit. So I was in Uganda in July, so that keeps things interesting, I guess.

JordanVery cool. And is that the Bridge to Health organization? Tell me a little bit more about that. I'd love to chat more about Rocket Doctor as well. But I don't really know a whole lot about Bridge to Health. What's this other project you've got going?

BillRocket Doctor really came fBridge to Health. So happy to kind of chat a bit about that. But I started that around 10 years ago. So when I was in residency, started to basically work with a Ugandan nonprofit that was doing really cool work in rural communities, bringing HIV access. And I had gone and worked with them as a medical student.But they had a really cool model of fighting disease, ignorance, or education and poverty in this intersection of health and social determinants. So basically, we thought, well, maybe we can create something that helps great local organizations like them turbocharge their work. And so now, Bridget Health has evolved the last 10 years. And we partner with government, civil society, and academia to build comprehensive care in rural underserved communities. Work mostly in sub-Saharan East Africa, but actually now the Middle East and Latin Americahave a couple of Grand Challenges grants. And so through Bridge to Health, actually started to get involved in a high tech diagnostics and working in these rural communities, which kind of pushed me more into the rocket doctor side of things.

Jordan:So how did that actually work? Was that a like virtual care, telehealth type of platform as well? Or what did that actually look like initially?

Bill:I mean, I like, I think all founders go through this sort of journey about what is the actual thing I'm going to do. And so at the very beginning, it was literally this idea of could we have some sort of diagnostic equipment box that you could put into rural villages in East Africa, where someone could get access to a doctor on the side of a mountain, it could have some devices and the ability to connect with a doctor. And then it sort of morphed over time into thisidea of could we, you know, do just continue the nonprofit work in East Africa with how we're going, but then look at a sort of technological enterprise in North America. And particularly I was working on the ER and just like tons of patients coming to the hospital with non-acute issues, which is not dissimilar from today, I think, trying to think, you know, yeah, not a lot of change. Thinking, could we try to pair diagnostics that we've been using in the field in East Africa, but with virtual caredomestically to basically try to improve access and get people support to physicians and primary care outside the hospital and then come in when they did need acute care services. So that was kind of how the genesis of RD came to be.

JordanSo it was kind of like the software of being a virtual care platform packaged with some hardware and like a Starlink device stuck, stuffed in it for internet access almost.

Bill:Yeah, I went through a series of iterative events. At one point we were going to set up these like medical device stations, um, you know, and just sort of plug them in and then, and then actually when the pandemic hit in the spring of 2020, it really kicked up and went, Oh, wow. Okay. This really needs to happen immediately. And, you know, provinces, particularly from Toronto and Ontario released publicly funded virtual care codes and thought, wow, this is great. We can actually suddenly improve access to basically everyone using their public health insurance. So really dove in headfirst at that time.

Jordan:So, okay, let's chat about Rocket Doctor then. When did you guys like formally start work on Rocket Doctor as it is today?

Bill:Well, I started in the fall of 2019, submitted actually an application to Y Combinator back then. And it was interesting because we had an interview with one of the partners there and they were like, uh, this seems cool, but you know, why would someone do virtual care instead of a walk-in clinic? And it was like very sort of early stuff. And then, yeah, they were like that. It seems like a cool idea, but you know, Airbnb started out as a mattress on some guy's floor, so go start seeing patients and come back to us in the spring.And then spring happened and we were like, oh, wow. And we just basically launched really quickly. And yeah, I mean, the idea for us is very different from a sort of typical digital health telehealth company and the traditional way you would think about it, because our approach has always been not to employ doctors or contract with them, but rather to empower physicians more in a Shopify kind of approach to build and create our own independent virtual care practices.And then we build the software and systems for the marketplace, and we aggregate these hundreds of doctors into a system of care that can then get directed out to patients, largely in rural remote communities across Canada, but then to focus on Medicaid in the United States market, which for folks who may not be familiar, is insurance for pregnant women, children, and people at or below the poverty line.

JordanAnd so, okay, how does it actually work? Like let's say I'm a family physician in Toronto or wherever, I guess, it probably doesn't really make a whole lot of difference there. What's next? Like I sign up for the platform, do I need to source my own patients and like port my own panel over to the Rocket Doctor platform and that's where I see them. Does Rocket Doctor help actually like build up my virtual roster of these like rural patients and people out in the community or how does that actually happen?

Bill:Yeah. And we're in Alberta, BC, as well as Ontario in Canada. And so there's two choices. If you're, you know, typically the physicians on the platform have really varied clinical duties and we'll come in and say, okay, I, you know, can't fly to a rural Northern community, but I'll plug in a couple hours on a Sunday or Saturday, or maybe I'll do like five to 10 hours a week, you know, like equivalent of a shift on the platform. And then I'll do my in-person emerge work or, you know,other family medicine duty or specialists. We have a bunch of those on the platform as well from just about every discipline. But then if you're a family physician with let's say a panel yourself, you can work with us and we can basically help to optimize the care of your patients virtually by leveraging this care coordination system we've built to triage patients for virtual care, match them. We have a backend team of clinical supports to help manage things thatgoing around referrals and just things to prevent patients from slipping through the cracks. And then just the tech side. And part of the kind of push for us into the next year is around interoperability to make it easier for folks that have existing panels that leverage an EMR already to have it plug into our system also.

Jordan:And so currently then, is this like a tool that integrates with my EMR and I would use during my like nine to five Monday to Friday, or is this something that's more of like, I want to do an extra couple hours and it's really built for that, like kind of picking up an extra walk-in shift almost.

Bill:Yeah, it's, um, it's up to the doctor really. Um, we can partner with physician pr- I mean, there's so many EMR companies. Um, so like most, I think digital health companies, there's not integrations to every platform that, you know, is out there, but, um, if a doc is interested, we can partner and then get connected to the EHR vendor to try to look at building and integration and figuring out different ways that we can work togetherbecause there's lots of kind of ideas and this is kind of new that part is a little new for us as our tech has gotten better and we've really found our place in the world of what we want to do to kind of help physicians practice medicine. I'd say majority of docs on the platform today though are the idea that they're doing a variety of different clinical duties and we're a part of that essentially.

JordanWhat's the feedback been like so far, from doctors and from patients?

Bill:Patients like exceptional feedback. We've had hundreds of thousands of reviews and we survey every patient to ask them how the visit went. And the average after almost 300,000 patients now is 4.6 stars of internal data out of five. And so, yeah. And so if I'm ever down on myself or it's a really particularly tough day, I just go into our feedback from patients and read some of the quotes and it's just likeI never realized how hard it was for people to access healthcare until I started Rocket Doctor. You get it when you're in clinical practice, particularly the ER, and you see what patients have to go through. But reading some of this stuff from rural communities about like, I tried to get a doctor for a month, but every walk-in clinic was full and I don't have a family doctor. I was in really complex stuff. I have cancer and I couldn't see my oncologist. I didn't know what to do and I had a fever. It's like many things can be handled virtually if you appropriately filter and appropriately match two physicians based on their preferences. So to your question about docs, docs seem to love it as well. I mean, we ask physicians to tell us how they want to practice medicine and then enable us to basically decide, so how do you want to schedule your day? What kind of patient presentations are you confident seeing? And then we match the folks together.

Jordan: Very convenient for both sides. So I actually used to work quite a bit of virtual care with TELUS initially early on during the pandemic and very much the same type of feedback. Like it was kind of like being a rural physician just through the internet and patients had so much appreciation for it because they just couldn't have access to care otherwise. Like there was new diagnoses of cancer coming up and all sorts of things that just like, obviously don't age well with time. And so having that access to care further out in these underserved communities made a huge impact.

Bill:Yeah. And we've seen, I mean, we do a postal code analysis based on where patients are coming from every so often. And it's pretty consistent. Half the patients come from rural remote communities. And I never knew how many small towns and cities and villages there were across Canada. You may not be aware, but some places are called villages and the provinces, but like hundreds and hundreds of them from every province. So it's super interesting actually.

Jordan:Yeah, democratizing that access to just like seeing a health care provider.

BillYeah, well, I mean, we're all mostly based, I think, in big cities. From a physician perspective, you've got obviously docs that go out to rural communities to base themselves, which is great, but I think the majority of physicians are in larger academic centers or around big city cores. And so patients, half of them live in rural areas and they just find it really difficult to get access to us. So yeah.

Jordan:It's a huge systemic issue and has been for decades. And I don't know if you really see much of a actual physical solution to getting doctors to go and move out into these rural areas. Like I know during medical school, they'll try and recruit students from rural areas. And I don't know, looking at my cohorts, some of them went back to rural areas. Many of them stuck around in the city after just getting a taste of, you know, urban life in the metropolis. And soI honestly think the technology and actually just using virtual care platforms like this is going to be one of those things that actually bridges that gap.

BilYeah, I mean, I, so I done a bunch of work through the global health circles on, um, like recruitment and workforce retention and rural, usually in LMICs, low middle income countries, but this idea of building training centers, like the Northern Ontario school of medicine that brings people from the North to train in the North who are more likely to stay in those rural areas afterwards.And part of actually the thinking with Rocket Doctor from my perspective is if you, there's good actual literature that if you expose learners to rural medicine during training, they end up going to spend time in those communities after. And certainly we need folks to do, like I do rural EM locums in Alberta and Ontario, licensed in both provinces, headed to Cold Lake actually at the end of this month. B to see patients in rural areas, even virtually, then there's a potential opportunity to connect them to those facilities to maybe go back and do a locum at some point in person, because we have no ownership over doctors or patients, we're the tech platform enabling that connection. So that's kind of a neat attribute for us as well, how we kind of see things.

Jordan: Yeah, no, exactly. And same experience in terms of doing those training rotations out in rural areas. Shout out to Crows Nest Pass in Southwest Alberta. I did some training down there. And of course went and did some locums and quite a bit of work back there after I graduated. But, yeah, just in the long run and more stable in terms of my wife and she likes the city better. So we're still here, but just the access to recreation opportunities, having the mountains and the biking trails and everything out there. So I think the training path is definitely a really good one. But then obviously supplementing that with the tech. So Rocket Doctor, where did the name come from? What was the origin story there?

Bill: In the fall of 2019, I basically had a Google Doc and wrote a bunch of names. And it was around the time of the Falcon X rockets where they were doing their self landing. And I heard Chris Hadfield, Canadian astronaut give a talk on achieving the impossible. And he showed a video of it. I was like, Oh, that's so cool. And healthcare really needs technology inserted into it. So that was basically the idea was futuristic and tech. And I was really sure that somebody a lot smarter than me would come up with a better name. And then, uh, from like a marketing background and then the name just stuck and the sort of stuck with us.

Jordan:How long did it take to arrive at that conclusion? It sounds like it was a pretty quick process.

Bill:Yeah, it was probably like a day on a Google Doc and then that was the winner, I think.

JordanAwesome. Cool. Yeah. I love the name. I mean, for us at Cherry Health, you know, we initially wanted to name it Apple Health because there was the association of like doctors and apples. And then my business partner actually pointed out that Apple was already taken. I guess that's already a tech company. So we were like, well, what's the next best fruit? And then, uh, this whole conversation took like a minute tops and then that was the name and then it stuck.

Bill: Do you know, interestingly, we had to get actually approval from the Canadian Medical Association to use the term doctor in our name, which I thought was kind of neat for Corporations Canada.

JordanInteresting. I did not know that. Well, okay, so then backing it up, how did you actually get started? Like, how did the company actually form? You know, you had kind of the idea with the bridge to health and you had some tech, how did you actually get started building out a virtual care platform and all like the security and compliance regulations around that? Like, what did that look like?

Bill:Oh, like law and doctor or something. Well, I don't know anyways.

Jordan: Yeah, I highly doubt they sought the proper approval. Okay, interesting. I did not know that. Well, okay, so then backing it up, how did you actually get started? Like, how did the company actually form? You know, you had kind of the idea with the bridge to health and you had some tech, how did you actually get started building out a virtual care platform and all like the security and compliance regulations around that? Like, what did that look like?

Bill:Well, I mean, it went through this process for probably eight months or so during that period back in 2019 with some of my cousins that are in the technology sector and getting a lot of advice from people. One of my brothers, who's now my co-founder, has a background in business and law and so chatting with him and sort of brainstorming and just working with people to try to basically put things together and t frankly, I thought Rocket Doctor was gonna be more of like a garage startup. I was actually supposed to move out to the Bay Area and take a new job as a faculty at West, doing some EM and ultrasound work at UCSF in Stanford, and then garage startup. And then the pandemic hit, borders closed, and just basically said, oh God, we have to like do this thing yesterday. And we really quickly justfiled the incorporate, like we used Stripe Atlas and got our initial incorporation done. And then I was actually working full time in the emergency department then. So I'd like get home at midnight and crack a Red Bull. And interestingly, we started out as something a little different, which was we were a COVID hotline at the very start of the pandemic. So I got a bunch of my colleagues from Hopkins. I did a public health degree a few years ago. And so we had a system. T initial build where it was partnered with Bridge to Health actually. So it was a free service where patients could submit a question about the pandemic because there was no resources for anyone. And we had a team on the backend of two public health folks and a clinician that would review a response and draft something that would then be emailed back to the patient or posted on FAQ.o basically help them understand. So like there was stuff about I'm disabled and my family brings me my food, can they leave packages for me? Do I have to wipe the thing with Clorox before I use it?

Jordan:Okay, so this is just kind of like the ask an expert, you know, direct link to somebody who knows what they're talking about early COVID. How did, how did this whole thing get funded at that point?

Bill: It was just basically I love the game. Everybody was unpaid and nothing. And then I sort of put in a little bit and then we actually was working in the ER and one of my co-founders, the third co-founder Justin Lozier, he's an Emerge doc worked with it Markham. And then he's been out West a bit as well, but he basically texted me and was like, Hey, this is really cool. What you're doing with rocket doctor. I want to join. It's like, Oh, okay. And so Justin jumped in and became, I was like, Oh, don't worry. It'll be like 10 hours a week, be a part-time medical director role. And then like six months later, he was a full-time chief medical officer. So more pretty quickly. Um, yeah, just evolved very quickly from there.

Jordan:And then you mentioned getting involved with YC. What did that look like?

BillDidn't have, I mean, they said no in the end. We applied, they gave us an interview, but then we're like, eh, come back, you know, when you've got patience and traction. And so actually we went back to our early investors and advisors and said, you know, do you think we should reapply? And they were like, at this point, you should just probably go for it and keep growing the business.

Jordan: Yeah. And then how did you grow from there? You know, you had a couple of early people starting working on it. What happened next?

Bill: So we had to put the legal infrastructure in place to be able to actually provide healthcare. So we wanted to make sure everything was organized for that. We had to get the initial technical infrastructure set up and I'm not technical. So, um, had to rely very heavily on friends and family and advisors around that. And then we did, we raised a little bit, you know, from friends and family, and then we're able to hire our first employee and it was funny because like, I didn't even know what Google ads were at the time. And I thought I was just going to post something on Facebook and we would get patients. And so, you know, it's funny, like the first we made, we got really lucky with our first hire who had a background in digital marketing and SEO. And so he helped us set the initial site up. And it was funny because we were like, okay, we're ready. Like, let's turn on whatever we're going to turn. And we didn't even know what the guy was doing. And he, his name's Fizz. He's very smart and like set the system up. And all of a sudden, like, immediately we started getting patients and we were like, oh my God. And so I was driving, I think up North and like Justin was around like going into an ER shift and then I was like, uh, we got to call these people and Justin, you know, you go into a spare room and see the pain. So him and I were tagged patients and they were like, okay, turn it off, turn it off. Well, you know, and then, yeah. So it started at like half a dozen a day and then slowly scaled up as we built the system.

Jordan:And this was at the time when there was the billing code now for the virtual care. And then that's how it started fueling its own fire. Is that correct?

Bill:Correct, yeah. Yeah, before, I mean, that's a whole other discussion, but before December in Ontario, we were seeing about 800 patients a day across Canada. And a real flywheel in the, and here in the, actually now we've still got that in Alberta and BC, just tons of patients, and thankfully virtual care is fully funded on the public system in Western Canada, but Ontario has some work to do.

Jordan:Well, and so how big is the team now? How many patient cases do you serve in a day, a week, a month, or however you look at it?

Bill:Yeah, it's typically around like two to 300 patients a day that come through the system and growing across Canada. And now we're just getting ready to scale up the US side as well, so that's gonna start to grow probably actually this month.

Jordan:What's the cross-border kind of implications? Are there different regulations you have to meet? Do the physicians have to be down in the States? They probably can't be up in Canada for billing purposes and medical legal reasons.

BillWell, it's actually fascinating because, yes, it's very complicated and different between states, provinces, countries, all sorts of stuff. But in the U.S., you can actually, so at the very beginning of Rocket Doctor in the United States, I'm licensed in California, in Maryland. So I was the first doctor on the platform from here at my office in Toronto.here I had a medical malpractice policy and like set up where basically I could see patients from California. So I remember seeing somebody who was in the Inland empire and it was like. Um, 96 Fahrenheit. It was like 35 degrees, 38 degrees. And it's like cloudy here in October, just like this actually. And he was like, where are you? Yeah, I'm actually in Toronto, but, um, these days we met, we basically keep, um, physicians in the province or state and, uh,of course have to be licensed in the province or state to practice medicine and then there's a lot of complex regulatory stuff.

Jordan:And so how do you plan to break into that US market?

Bill: I mean, we already are there. So we've seen over 6,000 patients since we launched. And I've just sort of quietly been figuring out our whole system and getting all the actually legal and structural stuff in place to expand. So, um, that's basically done now, which is why we're going to be growing this fall and our particular sort of, um, population that we're going to work with is on Medicaid and so, um, 90 million Americans that are on Medicaid. But basically nobody has thought about for some reason, designing a tech company to work with that population. There are for allied health workers, which is great to see, like community health workers, other marginalized communities, but for doctors that support patients on Medicaid, it's sort of not really being done for some reason today. So that's really where we're focusing.

Jordan:Really? Okay, cool. That's a good niche to be operating in. And then how do you actually fund the expansion into the States? Is it all self-powered just by revenues from the Canadian side or has Rocket Doctor raised around to actually facilitate going South?

Bill:Yeah, well, we're in the midst of like, I think every digital health company in the world in the midst of Iran at the moment, but we're about halfway there so far. And so that's helping us to basically scale things up in that way. By the way, often, I often joke to Americans that it took a Canadian to see the problem with Medicaid and the U S healthcare system. It's like the closest thing to our single payer federal mandate devolved to the, you know, States. For them to build their own system. It's just like our provincial healthcare systems, just sort of funny.

Jordan:That makes sense that the tech is getting imported from the Great White North then. Very cool. And then, okay, so growth has been very rapid. You guys just started in 2019 and now here we are not even a couple of years later. What's the big picture vision, you know, 10, 25 years from now, what does Rocket Doctor look like?

Bill:Yeah, I mean, I'd love to see us working much more deeply with public entities, both in the US and Canada, certainly, you know, across more states and provinces, but helping to kind of fuel provincial systems or state systems to really connect doctors and patients more broadly. And thenmy obviously background in global public health work, I think there's big opportunity to sort of support governments in low and middle in the global south. And so, you know, are there opportunities there in the future as well and sort of things that we can look at. So a little vague in my answer, I guess, but hopefully that's helpful.

Jordan:No, well, I definitely agree with you. And I've seen the same type of thing from my perspective, right? There's just not enough kind of collaboration across entities within healthcare, especially when it comes to the technical side of things.

Bill: Yeah, well, I'm going to, so I'm giving a talk today for the fast track health competition with Communitech. And part of my ending thing is in our marketplace model, the idea is like, we'll never be the best in the world at everything digital health, there's a ton of really incredible tech and companies. So how do we enable our system to be able to partner with really great companies that are trying to improve healthcare to basically just give more tools and resources to clinicians and patients to basically overall improve the system. So that's what we're trying to sort of build as well, technically.

Jordan:Right on. That sounds kind of like Cherry's business model as well. You know, just plugging in adjacent things, right? Cause there's so much cool innovation, new stuff coming out, tech, you know, do new treatments and modalities, all kinds of stuff. And a lot of it doesn't really see the light of day. You know, there's just this problem within healthcare of distribution and actually getting things out there. And, uh, you know, most smaller companies, startups, uh, they just don't have the deepadvertising budgets as obviously some of the giants within the healthcare space. And so it's difficult to actually reach that market and get in front of healthcare practitioners and let them know that there's new stuff out there.

BillYeah, I look at this now a lot, like when I was in medical school. So I started in Gensurg residency. And I remember as a, yeah, I remember as a med. Yeah, I really, I liked surgery, but I couldn't justify it like the, my whole life to the hospital, cause I obviously want to do all this other stuff. And, um, I liked to merge med and I actually had two applications for CARMS and I chose Gensurg at the last second to send out.

Jordan: Yeah, how far did you go down that road before kind of realizing it was the wrong decision?

BillI did a year, I did like three months of thoracics and some abdominal transplants and colorectal surgery and all sorts of, and it was really neat. I really liked it actually, really cool stuff. But I just remember that when I was a med student on rotation, I was like, okay, I'm gonna be really nice to med students once I'm a resident. So, yeah, seriously. And so people would be like, can I go to the bathroom? I'm like, yeah, you don't have to ask for my approval to use the bathroom, you're a human. Just go use the bathroom if you need to.It's not weakness. If you're hungry and you want to go eat food, that's fine. Like people get hungry. And so I look at it. It's funny, like in the digital health world founder, because I think, because we have this marketplace, we get reached out to quite a bit by companies that want to collaborate and explore. And so I really try to sort of like take every new reach out seriously, because you just never know, like, especially being a founder approaching, I approach people all the time, we were just like, ah, whatever, I don't have time for this.Like you say, so much good healthcare innovation just dies in the dark. Like doesn't even get light a day, even though it could be a great idea. So anyways, try to sort of dig in.

Jordan: It's tough, it's tough. Okay, well, okay. So in terms of growing Rocket Doctor, like obviously that's a big transformative journey. Like how has that changed your perspective on the healthcare system, you know, compared to when you were green and bright eyed getting going on this versus now, like what's been the learnings along the way?

Bill:I think I sort of expected that, maybe I'm sort of a overly optimistic person typically. I kind of expected that if you had something that had demonstrated positive outcomes that was helping people, then it would be a no brainer that everybody would wanna leverage it to help their patient population or physicians. And what I found instead is that takes so long to do anything in healthcare. And like, I get it. It's complicated. People are busy. They have to be careful with regulatory stuff, but there's a lot of, you know, politics at play, there's a lot of sort of, um, relationship building, which is fine, like it's how the world works. And so I think that's been one of the key sort of things is changing my perspective of thinking like, we just like an emerged doc, we just need to move quickly and get this done versus we got to be careful. Long cycles, relationship building, going through pilots and that sort of thing.

JordanIt's interesting because there's kind of like the top down and then the bottom up approach to getting things out there, right? And the bottom up, as you said, everyone's busy, everyone's got their own problems and own things going on. And so they're also kind of just trained to be skeptical. Like where's the evidence? What's the, I really need some like strong research and data behind this. And so it's kind ofI don't know if I'd say rare, but definitely like less common for people in that healthcare space to be jumping in as like, all right, early adopter, let's get out there and pilot some new things.

Bill :Yeah, I have, I have seen, I totally agree. It's always nice when you see like a center has a, um, or a system or whatever has a center for innovation or something where the, like somebody has been empowered to do exactly that and like reach out and try to build those collaborations, like that's really neat. We try and work with folks, like we actually will be announcing soon. Like we just got, um, accepted into UCLA's TechWidi Accelerator program. So, um, that's it. Thanks. Yeah. So that's a neat opportunity to work with thatsystem and try to build a connection there and just trying to find ways to kind of build those partnerships, I guess.

Jordan:What's, has there been a key partnership that you can point to that's really helped unlock things for Rocket Doctor along the way?

Bill:Yeah, I think one really interesting one actually was by the CEO of Georgian Bay General Hospital to talk about your top down where last summer in 2022, he just shot me a note on LinkedIn and was like, hey, we get a huge volume of patients that come in the summer months. We're having issues with the emergency department. Like I wonder if you could help us in some way. And I was like, yeah, I think so. And so we helped set up a virtual emergency department for the hospital.And that was a great sort of case example and kind of eye-opener for me as well, about how we could partner with hospitals to set up these facilities where, you know, patient can, um, they're coming, they're waiting in line at triage, you're not sure they need the ER. Well, now they can scan a QR code that we've set up, talk to one of our care coordinators, understand as an emergency, maybe not get connected to a physician virtually and then get managed virtually if it's appropriate. Um, and then now we're thinking about, well, can we also be available after a visitwhere if a patient has no family doctor, could they be connected to virtual primary care to be a support for that post discharge planning? So yeah, that was a really, I think that was a really good one.

JordanYeah, that seems like a really good symbiotic kind of addition. Yeah, so there you go. It's not what you know, it's who you know. Versus in medicine, it's very much, do you know the diagnostic criteria, the pathology, and all the treatments and everything? Or I guess then it is a little bit of who you know in terms of can you refer out if you don't know.

BillYeah. And it's, I think the similarity in my mind is what, who's your like champion. So like in medicine often, uh, as you know, like if you're a complex patient, you might have a family member who sort of like champions your case and advocates for you. Um, and then I think similarly what I've seen, I guess, in the startup space is like, you need somebody like that who is sort of like believes in what you're doing to sort of champion you as well in that space. I don't know if there's a good similarity there or not.

Jordan:Uh, in looking back over the years, what, and in terms of rocket doctor, what was your best day? What was the highest of highs? And then alternatively, what was the worst day? Was there a time you almost lost it all?

Bill: Highest of highs was probably when we closed our first VC investor. Because I, it was a big mile and it was a particularly crazy period of time because I had broken my shoulder and I was like typing with my left arm for two months, then it was on a hundred pitches and trying to get people to really like believe in what we were doing. And then I finally like, after all this work got our first investor. And so that, that was like the highest. And I happened to be at a buddy's place on the gold coast in BC. And so, or sunshine coast. And so it was just this like great sort of experience. And then lowest of lows would have been probably November of last year. As I saw that like, Oh God, they're really going to go ahead with this and cut funding for the public system. That was kind of the low point for me.

Jordan:Yeah, no doubt. And then, yeah, it's interesting, like in the business world, how it like fluctuates so rapidly, like one decision leads to just like a complete change in the outlook. And then you're scrabbling to put together a new plan and adapt and come up with something new.

Bill: Yeah, I remember being at a event in San Francisco in December shortly thereafter and was talking to some other founders and everyone I talked to had completely changed their company in the previous like two months and I was like, why do you think it is that we've all done this? And they were like, well, cause the people that didn't don't have companies anymore. And that like, that's the whole like early stage startups. You just have to be prepared that like something is going to go wrong. And like, you're going to have to rapidly pivot in some way to survive. Like, I don't know, that's maybe, I don't know what you think, but that's sort of what I've sort of come to the conclusion of is like, you just can't prepare, but you, all you can prepare for is to know something is going to happen that you haven't prepared for.

JordanIt kind of like just interacting with others in the space makes you feel a little bit better when you're hearing about like everyone else's pivots and how they've had to like completely upend the original plan and go down a different road. feel a little bit more comfortable knowing that that's just the normal operating procedure. That's just how everyone's doing it. How did you deal with skepticism? Or was there much skepticism? It sounds like you guys very quickly started generating revenue and growing just organically. Like, what was the actual thought from family and friends initially, coworkers?

Bill: I mean, there's definitely a lot of skepticism. I remember, good friends of mine actually from medical school, in December of 2019, I was telling them about this idea and we were having dinner and some drinks and they were all like laughing about, oh, you're going to be on the line with a patient and they're going to be having difficulty breathing and then all this. And it's so dangerous. And they were all like making fun of the whole idea of virtual care at all. I was like, you guys just don't get it. Like that's not, you don't, and so anyways, there was a lot of definitely skepticism and that continues today where I think like appropriately in healthcare, people are very reluctant to adopt new technology because of the fear that like it could cause harm. But at the same time, people are so busy that they don't really like take the time to review the literature evidence because they don't have the time. You're like constantly on the edge of burnout. It's like, Oh God, I have to try to process this whole new thing now too. So it takes, it takes work still to communicate to people like that much of medicine can be actually done using tech in this way, if you build a system correctly, where you can pair it with in-person when needed and you can fuel labs and imaging and diagnostics and referrals and continuity care. So, uh, yeah, it doesn't, it doesn't end, but.

Jordan:There's like a healthy bit of skepticism, but then I kind of think things have gone too far in the healthcare space. Like, I don't know if you've heard these numbers, but I've seen these floating around where there's a 10 year technology gap.So, you know, medicine still thoroughly relies on pagers and facts machines. Like, yes, we have robots doing surgery, but then also that. And then the same thing just like on the actual information flow side of things. So it takes 17 years for credible research to trickle down into like being adopted by the specialists to then actually like making its way down into primary care and becoming more of the standard of care. And so that you can see how that like healthy bit of skepticismhas like really started actually hindering things in the healthcare space.

Bill: Yeah, I totally, that's, I didn't know those stats, but it's really, I wouldn't disagree. I think actually what's been, so I used to say at the very beginning of the company that it took a global pandemic to pull medicine kicking and screaming out of the dark ages and of the 21st century. Cause literally like you couldn't see your patients unless you leverage technology in some way. So I see people trying to go back now, but like Pandora's box is open. Patients are like, well, what am I doing here? You know, there's so many different. I think doctors and healthcare in general is now maybe hopefully more receptive to new technology because of this. So like the AI, you know, craze that we're seeing, like I'm pleasantly surprised how many healthcare entities are really seriously looking at it and really trying to find ways to incorporate it into their systems of care. I think, you know, I don't know, maybe I'm wrong, but like a few years ago before the pandemic, I don't think it would have been explored as much so quickly with this new tech.

Jordan:I think we have to at this point. Like COVID and the pandemic, the system was already strained and bursting at the seams. And then you add in the extra constraints and the budget pressures and just like everything from those increased care loads and reduced labor force tothey have no choice now. Like it was already starting to get kind of crumbly. And then just immediately with this big external strain, everyone's like, okay, we have to. And then of course, like chat GPT three came online and then everyone was that, you know, suddenly AI was a household name.

Bill:Yeah, I think there's a lot that we probably can't even predict yet. That's going to come out in the next couple of years. Like I'll bet there's new tech that's going to come along. Um, that will kind of like you asked five to 10 year plan. Um, I mean, God, we don't, I don't know. Like there could be super interesting developments until like, I've been seeing some companies lately where, for example, you can take your phone and you basically just put it up with yourselfie camera and it gives you a blood pressure, heart rate, blood glucose, you know, like depression index and like these are clinically validated tools going through. So I think, I think the whole healthcare industry is going to change dramatically in the next couple of years.

Jordan: Really cool. Yeah, no doubt. Are you guys incorporating AI at all?

Bill:Yeah, we're building a system ourselves actually. We actually recently we got a grant from Google where we're working on some stuff around AI and developing a smart matching engine for our system to basically help fuel care virtually. So that's one of the things. And then figuring out, you know, how do we incorporate these tools into the platform generally. So we've got a team working on that.

Jordan: How long is that going to take till we've replaced physicians with SkyNet?

BillYeah, I don't think Skynet will activate anytime soon in the healthcare space. Like I think we'll have, hopefully actually we'll have AI tools that will support us as doctors to practice better medicine. Um, I think there's too much complexity around legal regulatory stuff to take. A doctor out of the equation entirely. Like the question is, okay, let's say, let's say you did replace a physician with an AI tool. Islike Google now the Like responsible for medical legal liability, right? Does that mean the AI has to get licensed by the Alberta You know the CPSA in order to practice medicine. Like how do you how do you define that? So I think there's like way too many of these questions to answer in the next five You know, I think it'll take us like five to ten years to start figuring this stuff out

Jordan:Well, it's interesting, right? They're looking at like the parallels between Tesla and their self-driving mode, right? Like statistically, it causes less accidents than a human does when you look at like deaths over how many ever million kilometers. I think it's 15 million kilometers on the road for one human caused death. And then, you know, if the number is less based on Tesla's driving, you know, but every once in a while it runs over a bicycle for no real reason. Like, are they bad people ao, you know, in the healthcare space, right? So you start looking at it of, okay, well, if we can provide care, this pretty good to somebody in, you know, a very, very underserved community, like somewhere in Africa, where there just literally isn't a doctor, you know, should there be legal liabilities around that? And then where do you draw that line as it starts coming closer to home?

BillYeah, I mean, just to use the last example first, I think just as a quick plug that standards of care are I think the same everywhere and medical licensing and quality of services. The question, but I think if you take it more broadly, if anywhere in the world, including in Canada, you don't have access to care, is it better to give something that is being tested in order to give yoservices. And that's like, that's more of an ethical discussion, I guess, I don't know. I mean, yeah, it's, and then how do you slowly build out use cases? And the thing I like when you were talking about the Tesla example, I think Malcolm Gladwell, or there's these books about perception on statistics and stuff. And it's like when you're in an airplane, statistically, it's safer than driving a car, but it feels way more dangerous, kind of have control over the situation. So that's maybe part of it as well.

JordanI'm curious, I'm excited for it honestly. Like when we were in medical school, this was not that many years ago, but there was an app you could get and you'd like type in all the symptoms that a patient had and then it would spit out your differential diagnosis and like what it thought was the best match. And then fast forward to today, now we have these AI scribe tools, which basically just like, takes the old school transcription software where it just listens and writes everything down and now it formats it nicely into like a whole soap note.And so I'm just picturing like once the two of those merge together and you've got the input with the output, like you basically got a virtual physician at that point.

BillYeah. I mean, I think I, it's funny. Like I believe that they'll never be a world in which like you don't need some level of clinician, um, because, uh, maybe, maybe I'm old school. I don't know. Maybe my dinosaur maybe we'll get replaced someday, but, uh, like there's so much stuff that you need sort of a hands-on thing to do that's very difficult to program, I thinkever say never, like there'll probably be a way to replace this at some point. Um, I think that for our careers, at least it's going to be being supported by tech to make better decisions. That's my sense of things.

JordanI think it's going to shift, right? It's like just how you see the tech starting to replace some things. Then the physician skill set might be more physical, you know, like obviously as an ER doctor, you're not going to be replacing that with AI anytime soon. Same thing with a lot of the actual hands-on examination, technical skills, those types of things.

BillWhat I really like, so Eric Topol, he's at Scripps in California, but he's got a book, Deep Medicine, and his whole sort of take in that book is, this was written in like 2018, 2019, and the whole idea is that AI and technology can replace the menial work that physicians do every, like even when I'm working in the ER, I have to fill in all of these pieces of paperworkfor various things, if you want like home care, you want to referral to a specialist, or if you want to do a doctor's, like any, all these things that just take time that are not why I trained in medicine, you know, like I shouldn't have to do it. So I think that's where we're gonna start, where these tools are gonna just get rid of all that garbage, so that like all the scut work, so doctors can practice medicine. And then, you know, the like baggage of digital health, like having to type your notes, as you say, we're now a scribe can just do it for you.So you don't have to be like clacking away trying to type your whatever and it can just do it. And then you can talk to the patient. You can actually think about a management plan. You can properly be a clinician instead of wasting your time doing all of this like paperwork. So yeah, I think it'll be great. I hope.

Jordan:It'll be a key, key team member, I guess, just like anybody else. Like it's kind of funny, like you'll, you'll be on the physician Facebook sphere and you'll kind of see like two camps, right. In terms of like how the interdisciplinary system works together. You know, on the one hand, you see a lot of physicians upset that nurses or pharmacists or whoever it is encroaching on their territory. And then like directly below that post, you see them talking about how we're likedoing all this unnecessary work and like, we're just too much work to get done. And it's like, okay, everyone's scope is going to start increasing and you just have to like adjust your practice to fit with that. And I think the AI and actual like software tools is going to be basically another part of that team, right? And so the physician side of things, we're going to have to just like change our skillset and our focus and then let some of that other work that can be just done more efficiently by somebody else or by a computer program handled on its own.

Bill: Yeah, I think that'll be good. And interdisciplinary teams are great. Like different people with different training are better at different things. Just like in medicine where like I have my skill sets I'm really good at. The infectious disease doc has theirs, the cardiology has theirs, you know, it's family doc has theirs, similarly the pharmacist has theirs. It's just a mat for me, like the creep is to say, well, how do we replace?Someone with someone else that we see happening in some healthcare systems these days and some like this sort of mission creep. And so I think that's the key is like you define what are what are your expertise and training skill sets? How do we maximize those? And how do we take away things that you shouldn't be doing and give you stuff that you should be doing to like make you enjoy your job? Like that that's hopefully how we can move forward in the next couple years.

Jordan: Exactly, and just kind of like getting past that fear of the unknown, I guess.

Bill: Yeah. Or a misperception where it's like, well, I'm just going to replace a doctor with a different level of provider because doctors too expensive and too difficult to work with, so we're going to bring someone else on and it's like, well, that's not how the system was designed. We're supposed to work together on a team. So like, let's figure out how to do that more efficiently.

Jordan: In terms of systems level things, is there anything or any problems that, you know, just you and your position growing with a software company, growing with a tech company in the innovation space, what other sort of things have you seen or are on the horizon in terms of like systems level challenges needing to be tackled?

Bill:I think the biggest challenge right now, the two biggest challenges we're facing in Canada, at least, are access to primary care and access to emergency care. Like those are the two things that are going to bring our healthcare system down if we don't figure it out really soon. Like people, I worked a shift Sunday night and a third of my patients didn't have family doctors or couldn't see a family physician and that's the word. Like I've been working, it's weird, I've been working for 10 years now in the ER, but that's the worst I've ever seen it.I've never seen anything like it before. And it just seems to be getting worse and worse. So those are the big, and that's what we're trying to help address in some sense. But I think those are the two biggest challenges I see. I don't know if you disagree or agree.

Jordan:Well, yeah, as a family doctor in my totally biased perspective, yeah, I fully agree with that. It's, it's like here in Calgary, there's a wait list of hundreds of patients long signed up waiting to see a family doctor. And, you know, out of my med school friends, I know several of them have already moved to BC cause there was recently like the big pay raise announced for their billing schedule over thereToronto because they just want to be part of the center of the universe because it's fun. But I guess it's the same everywhere, like all across Canada, everywhere short of doctors. Like is there a solution for that? What would you do? You're president of the CMA or Health Canada. Like what direction would you even go with things?

BillWell, I think actually, I think the CMA is doing some really interesting stuff these days and has some really strong leadership. And so I think what they're advocating for in a national licensure is a great idea. Like I, I had to, the mountain of paperwork I had to do to get my CPSA after I've already got my CPSO and a California license. And it's like, come on, like we have to do all this junk to sort of press. So let  d to where they want to live and work and don't set up these arbitrary boundaries by province. Like you've trained in a Canadian medical school that's accredited, you've got a residency, like you should be allowed to work in the country. So that's one, I think that would help a lot. And then technology. So like systems like ours that unlock potential from physicians, like we have doctors that want to give timeare happy to do work, they just want to be remunerated appropriately for it. So like governments have to like find ways to fund public systems that save costs to then redistribute that in other places. So like a $37 virtual care visit in Ontario is a heck of a lot cheaper than a multi hundred dollar to a thousand dollar ER visit, you know, and it's going to help on provider burnout because now you're not like as an emerge doc trying to sit there figuring out what to do with the patient withmultiple chronic illnesses, where you're like, I don't know, I can't, I'm here to manage your emergency, not your chronic thing, like, I don't know what to do with you, basically, which is what happens too often now, basically.

JordanYeah, there's only so much budget to go around, right? You can't just go and hire and train twice as many physicians. You know, there's got to be sort of this technological revolution where healthcare actually catches up and a lot of this administrative efficiency, inefficiency in the labor force and just like moving physicians and our actual like healthcare delivery around either virtually or literally by changing those barriers, cause I, you know, healthcare in Canada is funded federally, butadministered provincially. So it's like we have these 13 different separate health care systems. And so breaking down some of those boundaries.

Bill:Yeah, totally. And like, I think I saw a paper last year that was looking at the number of doctors in the country and saying if we actually did allocate and distribute people fully, you know, equitably, everybody would have access. But the problem is people are bunched up in cities and people don't have care. And so, yeah, I think that's a huge way that we could try to streamline things if we did that. There you go.

Jordan:It's a good thing we have companies like Rocket Doctor on the uprise. Awesome. Okay, well, I don't know if you have any other like final thoughts, maybe we'll cut it there and let you get back to your day and prep for your talk this afternoon.

BillThanks. No, I appreciate it.

Jordan:Awesome. Okay. Dr. Czerniak from Rocket Doctor, thank you for joining us. Appreciate the conversation.

Bill:Thanks for having me again.

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