Practicing Medicine on a Reservation and Pursuing Medical Innovation
John Dayton is an Emergency Medicine Physician who has practiced in settings as diverse as the University of Utah Hospital and the Navajo Nation Reservation. In this episode John shares what it’s like to practice medicine on a reservation, how he built his company, Medforums, which is a Yelp for medical education, what he has learned as an angel investor, preventing physician burnout, and pursuing dreams. John discusses how multiple passions keeps him invigorated, refreshed and motivated, and why he believes it is a good model for others to follow to lead to more productive careers.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome, taking chances, learning new things, and constantly looking to improve are a few traits you'll find in successful and interesting people. John Dayton is an emergency medicine physician. And john is one of those. He's worked in just about every setting from a university hospital to the Navajo Nation reservation. John founded and built a company, MedForums, founded a physician entrepreneur group, is a contributor to several publications, and is an angel investor. And he's about to start a fellowship at Stanford on medical innovation and design. Oh, and by the way, is also getting an MBA. So in this episode, we cover what it's like to practice medicine on a reservation, how he built MedForums, which is a Yelp for medical education, what it's like to be an angel investor and what he's learned there, preventing burnout, being a physician of preventing burnout, and finally pursuing dreams. I think that this is really an interesting conversation, in that it really shows that you can be many things, you don't only have to be one, follow your own path. That's what John's doing. Here's our conversation. John, thanks so much for joining us today. My pleasure. Thanks for having me on. John, to get things started. Can you just take us through your journey in choosing medicine and choosing emergency medicine?
John Dayton, MD 02:14
Sure, sure. I, I've always been interested in the sciences. And my hero growing up, it's always been my dad. He's a he's an obstetrician. I just recently retired. But I always looked up to his career and, and he would run into people in the community that were grateful for the care that he provided. And that was something that I was interested in. Ultimately, I did not choose ob, a lot of people go into medical school thinking, you know, I'm either going to be a surgeon, or we're not going to be in the LR. And that's how they make their decision tree. After growing up with a dad who had a pager on his hip. The whole time, my decision tree was who wears a pager and who doesn't. And so I was kind of, I was more attracted to a specialist that would allow me to have set hours and even though the hours can be odd, emergency medicine turned out to be the greatest fit for me. He had a little piece of everything in the ER. And I liked that. And it's very rapid, and I'm your stereotypical ADHD physician, and we all seem to gravitate towards emergency medicine.
Patrick Kothe 03:24
It's often said that emergency medicine is more of a young person's game. Have you found that? that to be the case?
John Dayton, MD 03:32
You know, what? Yeah, that's an interesting question. Because over the last couple years, it's become one of the more competitive presidencies. And there's newer programs. And so that is, where we are younger specialty, that the downside of that is some folks are concerned that there's a high degree of burnout, the schedule can be ultra, even though it's set, you know, set, you know, nights and weekends for for a long period of time. It's not always conducive to good family life. And so I think there's a little bit of burnout with that, particularly with COVID. Lately, you know, folks have been on the front line and while emergency medicine, physicians have been there to take care of everybody, we've been particularly hard hidden in areas where COVID was was really rampant. A lot of our colleagues have worked kind of extreme hours and there's been reports of mental health issues. On the flip side hospitals and communities the word hit. A lot of a lot of my colleagues have been furloughed or have their hours cut or their pay cut. And so it's it's been two extremes that have both really been tricky to manage. Hopefully, things are starting to just settle down and get the Delta vary and under control and move forward. And hopefully that will normalize things for us again, we've seen so many things like missed heart attacks or missed appendicitis, ruptured, appendicitis, things that you know We don't usually seek as folks come in, but that folks in the community have been reticent to come in for care, because they've been so nervous that they get COVID.
Patrick Kothe 05:09
So, john, we're gonna explore a lot of different things in this podcast, because you've done a lot of things, you got a lot of different interests. But I wanted to kind of ask you about that, you know, you said, You're your son of a physician, but you've got so many different interests, has that always been the case with you that you have a lot of different things going on? Or? Or is this something that's just come on recently?
John Dayton, MD 05:35
No, it's I think it's a little bit you know, we joke that you're DAX, I add, I have a little bit of entrepreneurial add, a lot of folks will say, oh, and I'll get get a pick one thing and really nail and I think there's a lot of wisdom in that. At the same time, I'd like to learn about things and be, you know, be active and in different areas. And so that's led to some great opportunities and an interesting experiences.
Patrick Kothe 05:56
So let's talk a little bit about the practice settings that that you've had, because you've been in a number of different practice settings anywhere from university facilities to urgent care centers, and where and where you are right now. So let's talk about your early career and, and kind of the practices press practice settings that you were in early on in your career,
John Dayton, MD 06:16
right out of residency, I worked in a community hospital in the Salt Lake metro area. And that was a great experience. I miss being around residents and Miss teaching. And so I, I transitioned to the University of Utah I was there for about a decade. Every place has great things about the University of Utah is a wonderful place to practice medicine. After working at the University of Utah for life, I started doing locums medicine. And so that that was great for me because it gave me control my schedule. And it also enabled me to spend my time that I wasn't doing medicine, to build companies or be involved with investing and things in a way that wouldn't cause trouble with academia or put me afoul of any university entrepreneur. setups. JOHN,
Patrick Kothe 07:09
what is locums medicine,
John Dayton, MD 07:12
their years all around the country that, well, they need to staff their er, for 24 hours with emergency physicians and more and more the pushes to make sure that their board of emergency doctors, but a lot of times, these are hospitals in areas that for whatever reason, have a hard time attracting someone to live there full time. So we'll get contracts where your travel will be arranged to go work in these areas. Do a bunch of shifts in a row and then you come home. So right now that's that's what I'm doing at Indian health services. I'm working with the hospitals and the Navajo and Hopi reservations.
Patrick Kothe 07:52
So being a physician for hire, so to speak, not having a real home base. What was that? What was that like?
John Dayton, MD 08:00
Yeah, so he is a little bit tricky, particularly with family life. Because I'll do five to seven shifts in a row. I work only at places where I can do 12 hour shifts, because the last thing I want to do is leave my home to do you know a string of eight hour shifts and then I have a lot of time that I'm out working so because a lot of places like this have night differentials, and I like working night shifts anyways, I'll travel one day, I'll work five or six night shifts in a row and then get all the rest and travel home the next morning. And on one hand I'm away from my family for for a big chunk of time. On the other hand, when I come home, I kind of joke that that's my binge parenting time. So any any soccer practice or, or taxing that needs to be done. That's what I do. But at the same time, that also gives me some time to work on projects or other things that I'm that I'm working on,
Patrick Kothe 08:54
I assume the patient mix may be a little bit different, what's the patient mix look like on nights.
John Dayton, MD 09:01
So at nighttime, there's always interesting things that have to do with legal issues, people that are late that may not be up to any good weight, we see a lot of injuries from car wrecks and drunk driving. We'll see folks coming in from assault. And for whatever reason, most of the psychiatric conditions presented night. And I'm not sure if anyone's ever researched why that is but we see a lot of interesting things like that. So that's one end of the spectrum on the other end, you tend to have the patients that are are more sick, because you really got to have some bad chest pain or, or belly pain. If it's keeping you up in the middle of the night. You're worried enough to leave your home and come into the ER so we can get an interesting mix of trauma and high acuity issues. And then for whatever reason we'll see handful of things that are just very minor and urgent cares closed and and we're open So we saw we see those things as well.
Patrick Kothe 10:02
As my dad told me years and years ago, Pat, nothing good happens after 12 o'clock.
John Dayton, MD 10:11
I think that's fair to say, I think the percentage of alcohol related injuries or decisions or things like that definitely come in more for nightshift workers than than day shift workers in the year.
Patrick Kothe 10:25
So you mentioned that now you're working on a reservation and not a lot of us have a lot of visibility on what practicing medicine is on the reservation. Can you explain to us a little bit about what it is, you know, what type of facility that you're that you're working in, and the type of patients that you're seeing?
John Dayton, MD 10:48
Absolutely. So I have, I've been working more along the east coast, and and Midwest with my locums work up until a few years ago, but with COVID, and an increased need on the Navajo reservation, and then, with me living just a state away in Utah, I transition my practice to that area. And that's that's been fascinating. The the Navajos are particularly hard hit with COVID, you, you tend to have some populations where they're most affected, where you have multiple generations living in the same house, where you have, you know, social people that get out for events, where you have communities where you have difficulties with diabetes, and some other comorbidities. And unfortunately, all those seem to align for the for the Navajo people. So it was particularly hard hit.
Patrick Kothe 11:42
Can you explain a little bit about the type of facility that you're working in
John Dayton, MD 11:47
the facility where I work, it's the way that it's set up by Indian health services as they try to have a central facility that that handles many things, and particularly focuses on things that are important for that community. So there's an emergency department, there's an OB unit, there's inpatient beds, and then there's a collection of outpatient offices that are all in the same facility. Since diabetes is such a health concern in the community. There's also podiatry in the building and optometry in the building. The one thing that's a little tricky is there are some specialties that we don't have. So anything that comes in related to a heart attack or a stroke, or, or an orthopedic issue, those are patients that we're stabilizing, and transferring usually to Phoenix or to Albuquerque facilities.
Patrick Kothe 12:38
JOHN largest the population that you're serving, how large is the reservation,
John Dayton, MD 12:44
the Navajo reservation covers most of Northern Arizona. And then there's components of it that run it to Utah, and to New Mexico as well, kind of along those four corners area, none of it in Colorado. But there's pieces in Utah, New Mexico, but the bulk is Northern Arizona. It's a couple hours north of Phoenix, and the Hopi reservation where I also work is kind of its own island within the Navajo reservation. And so the Navajos, are they the second largest Native American group in the US their number, the number about 200,000. And there's several Indian Health Service facilities on the Navajo reservation.
Patrick Kothe 13:27
So we're not talking about a situation where it's like a city where people are real close by people are coming from considerable distance to the facilities.
John Dayton, MD 13:38
Yeah, so earlier I was mentioning sometimes places have a hard time attracting folks to to different areas. You know, it's a thriving community for specifically for Navajo, then our population at the same time, it's several hours from you know, like how, a few hours north from Phoenix a few hours west of Albuquerque, there isn't a major airport or anything in that area. So I'll drive down from Salt Lake City. Now before I do some shifts and that's about if I drive into Hopi reservation, it's a little over eight hours if I drive out to the Navajo Woods a little over seven hours.
Patrick Kothe 14:16
As far as the patients that are coming in. What's the situation with insurance are they covered by insurance not covered by insurance.
John Dayton, MD 14:25
Indian Health Service covers health care for these patients. So they're their care is is paid for by IHS and if we need to transfer them or go to another facility IHS pays for that. There's a lot of like red tape and forums to make sure it's approved to make sure that it's a reasonable transport that it's something that can't be done there that they they have health care provided.
Patrick Kothe 14:50
JOHN How large is the emergency department and how many beds are we talking about at the facility?
John Dayton, MD 14:58
So the ER is nine or 10 beds, we kind of oversee the the urgent care where that's open. And because they see higher acuity stuff than your standard urgent care, lately, we just call it era and er B's when discussing urgent care, and there's five or six beds there. And as far as inpatient, we can admit for people to kind of stepped on level ICU at a time. And then there's more beds for just regular med surge and pediatrics
Patrick Kothe 15:31
found the coordination of patient care is all always a big deal. And with people kind of coming in and out of the situation, how to how do you maintain good care? And what does coordination of care look like?
John Dayton, MD 15:48
Yeah, the way the way that it's set up, some of our physicians are employees of Indian health services. Some of them live there on the reservation full time some maintain housing there, but live somewhere else. Because a lot of times it makes sense to work in a block of shifts. And then the folks that aren't on the reservation, they are contracted through a group called Pinnacle that focuses on staffing, Indian Health Service hospitals with board certified emergency doctors. So I contract through them to work at Indian health services.
Patrick Kothe 16:25
So what do you like about being on this team? And also, what are some of the challenges that you're running into?
John Dayton, MD 16:34
The I think the most rewarding part over the last two years is there was a major need. With COVID. They needed physicians there that were able to manage their ways that were able to address sick patients. They need folks that were creative. And so that's been that's been a real highlight for my career. It's tricky, even though this, this group of people on the reservation are largest they are and they and the reservation is so big. Not everybody has what we would call kind of standard housing one of the most common complaints from folks when we realized that, that they could have COVID, they'd say something along the lines of, you know, when I was coming back from my outhouse, I would just lose, lose my breath. And that became a real common symptom of folks that COVID, about a third of the population does not have running water, or electricity in their housing. So very interesting. There have been some great efforts. While this has been going on to get solar power to the houses, even though some of the houses don't have that. Most of the kids have been able to stay online with school through through solar and and their laptops. And there are great people in the community. Some of the former some natives that are athletes contribute a lot of money. There's a gentleman that takes pitcher for National Geographic, and he's sold a lot of his images to bring water to the reservation to bring solar power again, a Milo Fowler, that's fascinating gentlemen, that grew up on the reservation. And so there's been a lot of more of a spotlight than usual, on some of the issues that that have, unfortunately, been long standing because of some systemic systemically racial, racist policies.
Patrick Kothe 18:25
There's hesitancy within certain groups to take the vaccine. What are kind of the prevailing thoughts around, you know, being vaccinated within the community on the reservation?
John Dayton, MD 18:41
This is an area where they have been very organized. And they were some of the earliest to have the vaccines and their community drives to have it to the point that in the morning, you'd see cars lined up all the way up from the community to where the Indian Health Service hospital is, for folks who wanted to get their vaccine. They they set up a lot of curfews because of one of the reasons you know that COVID spreads is people gathering and so they did everything they could to prevent that. They've had amazing organization on the reservation, and particularly at the Indian Health Service hospitals. The one where I worked just received an award for COVID care during during the pandemic
Patrick Kothe 19:29
is a feeling at the vaccination rate is higher than national average or lower than average yet at the same.
John Dayton, MD 19:36
It would be much, I believe it's much higher. But the interesting thing is just like, you know, like we're seeing in California and some other areas, the folks that were not vaccinated are starting to get the Delta variant. And we've we've seen a handful of those cases recently, but for a couple of weeks out there were there were no new COVID cases, which was a phenomenal thing. The era because it was so hard hit Initially,
Patrick Kothe 20:02
I think it's just a fascinating thing that we don't have a lot of visibility into medicine under reservation, and you shed a lot of light on that. So thanks, john, I want to kind of shift our conversation now into the entrepreneurial side of john Dayton. And you're dealing with with innovation. So you are an entrepreneur, and you actually founded a company. And I'd like you to explain a little bit about what med forums is, and how you got the idea.
John Dayton, MD 20:37
Oh, happy to. So admin forums, our goal is to help out professionals find the best resource for where they are in their training for what their current focus is, and for their learning style. So for example, medical students are always looking for the best resource to do well on their medical licensing exams or usmle. s. residents have an annual test that kind of gauges their performance called the in service exam. And then as physicians, we have annual continuing medical education credits, and we need to obtain these for a combination of hospital credentialing, state licensing and specialty society requirements. One of the tricky things when you go in and try to find medical education is it's not necessarily driven by who provides the best education, it's who has the biggest budget. And so there's a lot of great resources that don't quite get the recognition they deserve. Particularly in this space, called fo med, it's a start out as a Twitter hashtag stands for free online access to medical education, or free open access to medical education. This is something that a lot of physicians, particularly academicians are doing on their, on their own time. They're building sites on their own dime with with things that they're interested in, in medicine, there's no CME associated with it, but it tends to be some of the highest quality content out there. And so we wanted to make sure these groups got highlighted. So the way our our website is set up, it's kind of like a Yelp for medical education. And initially, we populated it with a bunch of companies that, that that we were aware of, particularly in the emergency medicine space. And we had folks put the ratings of the reviews. And after we did that, we had kind of a transition where they claimed their page kind of like to do with Yelp. And then other folks realized that they wanted to be on our page as well. So everybody from folks making their own podcast to, like the New England Journal of Medicine came to us and they have a page on our site. And that way, the readers or their or their students can leave reviews, they can leave feedback. And then we have some social media components to kind of make it interesting. People can tag things that they're interested in, they can tell their friends about it, they can post pictures of from the conference. And so that's something that we've been slowly building over the last couple years.
Patrick Kothe 23:07
JOHN, I can imagine that some people are really concerned with the quality education and some people are concerned with checking a box. So I imagine that the ratings are really important to those people that that are really concerned with the with the quality education.
John Dayton, MD 23:28
And yeah, it's a very, very interesting component. And particularly, you know, we've seen a lot of changes with with CME, the last couple years, conferences, you know, been on hate a string COVID people aren't gathering. And so that's really had people drive to see, you know, what online content is the best, including with webinars, which kind of podcasts are the best? And so there's, there's a real interest in say, well, I've done this conference in the past, it's not available this year, what are we going to do this year? We, we are a resource for that.
Patrick Kothe 24:00
JOHN, how'd you get the idea?
John Dayton, MD 24:03
You know, what I went to a world boards course that, you know, it's probably a combination to me, combination of them, but I, I didn't feel very prepared to take my oral boards after I was there. And, and I realized, I'm gonna need to go to another course. And that's, that represents a big commitment and time, opportunity cost, you're away from your family, or you're away from your practice. But ultimately, if that I better do this second course, I found that I would have a much better system much better teaching. I really sketched I should have, you know, if I would have known this existed, I would have done this course initially. The fact that there's other folks that that feel the same way and rather than being able to talk to the handful of people that you work with, being able to kind of crowdsource our peers on a national scale, it'd be more effective for something like that. And so that's, that's where that idea was born.
Patrick Kothe 24:54
So it's a website med forums.com. Can you explain a little bit What the user experiences is about,
John Dayton, MD 25:03
if you log in, and whether you're a physician or nurse practitioner or physician assistant, whether you're a resident or a medical student, you can you can, there's a big search engine, where you can say where you are in your training, what your specialty is, if you're looking for a board preparation course, if you're looking for a blog, or a podcast, basically, whatever you're interested in, and your learning style, and then, you know, we have several 1000 education resources on the site. And so can act as a resource to help people find something, to do g realize their time, and to highlight the best, the best education companies.
Patrick Kothe 25:42
So john, I assume you don't know anything about coding or website development. So how did how did everything get started?
John Dayton, MD 25:51
So the this is, this is a really interesting part. And, and, you know, initially, I was super motivated, if at all, just you know, I could learn how to do this, you know, reasonably right guy, which is, I think we're physicians always fail as entrepreneurs is because we believe because we're good in one space, that translates to sell fail, it's obviously not always the case. So I tried to do some things initially, on my own that didn't work. I tried to contract contract with some overseas groups didn't have great results with that, ultimately ended up joining a accelerator. And this endoscopes more of a venture partner group, where we came to me, he said, you know, we have this idea, we'd like to do this, here's what we can do. And then this particular group, they're called Rev. Road, this is a Utah based group. He said, Oh, yeah, your your pain points been building the website, we can do that for you. And we have some folks to help with marketing illegal. As a small company, obviously, you don't need your own lawyer, you don't. You don't, you're not big enough to hire your own marketing team. And so the way that works is it's kind of a swap, you know, we say this is this is what we need, they said, we can provide this for ownership of, you know, as a set percentage of the company. And so we worked with them, they have a phenomenal network, they have a phenomenal group. And they've, they they've really helped us scale. And this was something that had not worked trying to do it on my own.
Patrick Kothe 27:16
So how long was it from the idea to forming a company to getting the first version of your website
John Dayton, MD 27:25
up? Sure. So initially, I kind of had the idea in my head around 2016 2017. I thought, you know, I think something like this would be a good idea. And I talked to colleagues and they'd say, Oh, I totally use that. But you know, a lot of times your colleagues, they're, they're good friends, and they want to be supportive. So that I need to do more due diligence. So at one of the scientific assemblies for the American College of Emergency physician, actually took a team there, we did a bunch of surveys, we talked to a couple 100 doctors to get an idea if this is something that people would use, if so would they leave ratings and reviews, because that's kind of the meat of the site. And we had very good feedback, it was interesting to a lot of the older physicians, they said, Oh, you know, this is how I do my CME every year, I'm not really interested in doing anything else, I've found something that works. A lot of the younger Doc's were wanting to find the best option. And they were more interested in what we talked about social media components and things that were capable of doing with an internet connection, which is where a lot of the CME is going, they were more interested in and we thought that's perfect, rather than, you know, catering something to a group of physicians that aren't going to be practicing, as long as you know, if we catch these guys, as med students and residents, and they're interested, it's something they can use through their career.
Patrick Kothe 28:43
What do you customers say about the service? I mean, what are they really like?
John Dayton, MD 28:47
We kind of have a two sided market. On one hand, we have education companies and education producers. Now what they like about it is that they're, they're able to provide third valid third party validation for the site. Rather than say, hey, our conferences are awesome, just ask us, they're able to say, you know, here's a third party site, and they'll post copies of our reviews on their website. And they're able to show that, that they had that their educators have had a great experience, and in a way that's not coming from them. So it's kind of social proof. From the physician side, a lot of times we're just not aware of the the best options out there. We sacrifice a lot of time opportunity cost to attend a conference or we're just spend time studying our boards. We want to make sure we're doing it with the best resource and we provide a way for them to recognize what more than their peers from residency or a couple of guys in their practice. A couple of you know, guys and gals recognized as one of the best tools.
Patrick Kothe 29:45
So it took me a couple of years to get up and going.
John Dayton, MD 29:48
Yeah, couple years everything up and going. And obviously as as a newer entrepreneur, I made a ton of mistakes and but those are those are things I'll feel Learn to be better about it. I actually inspired Matt, I actually will start a new fellowship in a couple weeks, that's focused specifically on innovation. And I'm doing an MBA with that. Because that's something that I'm interested in, not just the company I built on my own, but through some angel investing and helping bringing some products to market, realized I wanted some some more concrete training to make sure I
Patrick Kothe 30:23
that's something I can do. Well, let's dig a little bit into angel investing, because you go from starting your own thing. And and I'm sure I assume you pitched for some money there to them too, to being on the other other side of it and, and evaluating ideas. So how did you get involved in angel investing? And tell me a little bit about you know, what you like about that?
John Dayton, MD 30:49
Sounds great. So with, with with starting with forums, I realized there's a group of very interesting physicians that have some business interests as well. There's a national group called society, physician entrepreneurs, where a lot of these folks have been congregating. And there wasn't a chapter in Utah. I talked to the to the folks at national, they said, well, we'll set one up. So I have a friend of mine, another emergency doctor, we set one up in Salt Lake City, and we'd set up meetings and the it's a tricky thing, because you want to find the physicians that are building things, physicians that are interested in doing it. You want to build meetings around questions like I have an idea, where do I go next? How do I do this within an academic system versus should I do this at a private system. And so we'd have quarterly events where we'd find a local physician who had taken something to market or had a business experience, and they would be speakers. Interesting, I love there's a lot of groups that want to partner with physician innovators. So we would be able to have some local banks and other groups, sponsor events. And I think our most popular events were some pitch pitch nights where we have early companies. And the rule is they'd have to have either a pre med student, or resident or physician as part of their C suite, what we did is we worked with our local angel investing groups and venture capital groups in Salt Lake City, they'd come and be the judges. And this was something that worked out well for everybody, because these groups were trying to get in front of funding audiences. And then the folks with the VCs and Angel groups, they were looking for healthcare investments, because they're doing very well over the last decade. And so it was a kind of a nice way to get the right people together with a common interests.
Patrick Kothe 32:38
Can we all learn things as we have more experience and more time goes by? So from the early days of you making investment? I'm sure you've learned quite a bit over that period of time, what have been some of the big things that you've been able to, to learn about? And what makes a good angel investment?
John Dayton, MD 33:05
You know, it's a great question that kind of as a connection between these society, physician entrepreneur events, and working with the angels, one of the local groups in Salt Lake City angels, approached me and said, you know, we have a lot of healthcare investments that are coming our way. We like to have physicians as part of our group to evaluate it. And that was something that was a little nervous for me, because I said, you know, like, I can let you know, if it's a good idea in the medical space, but I don't have any idea how to tell you, is this something that can scale or help you structure a deal to make sure it's something that's going to be good for everyone? They said, Oh, don't worry about that. An interesting thing about angel investment groups is you have folks that are good at what they do in their space. So they said, you know, we have guys, their, their their big thing is taking a company from you know, a certain amount of million to you know, the next phase. We have folks that look at the deal. We have legal experts, there's actually a lawyer that runs our group. And so they said, We just need to know, is this going to work on the medical side? And so I just approached that, like medical research, I looked at that said, the big questions you want to ask are you know, why this group? Why this product and why now? Is it good timing? Do they have the right intellectual property? Is this something that's a big enough space? Let's say it's something that er doctors love? How are we gonna get this adopted in hospitals? And that's a big question. You know, we don't hold as much as a specialty we don't hold as much sway as, say, your orthopedics. You can say, I want this set of Stryker tools a lot of times, you know, we use what's in the pyxis. And sometimes we have a chance to give input and sometimes we don't. And so those are interesting things that you have to navigate as well. I think one of the things that made the biggest difference is I worked with two different physicians that were were mentors for me in this area. A gentleman by the name of Tim Wolfe. He was a physician who invented the nasal atomizing devices. A different way of delivering medicine without an IV, there are situations where IV access is tricky, or they have someone that's very traumatized from injuries, able to get medicine, through the nose and, and he and he built this company on the side from when he was practicing. And so he was one of our speakers. So we had a society physician entrepreneur event, he was able to give kind of guidelines, you know, these are some things to look at, maybe this is a way to explore. So between him and another intensivist named Dr. Brennan Rosen Han, who brought a safety scalpel to market and that was one of the first things I invested in, it was interesting to see, I really wanted to, I didn't have an advisory board scene or anything along those lines. But I was interested in saying, How are you addressing? You know, bringing your device to a hospital? What are your strategies? How do you get it as part of a group purchase order, which is how a lot of the device equipment is sold, ai in medicine. And so that's something that helped me learn a lot about that process.
Patrick Kothe 36:01
So you were building med forums, before you had the benefit of all his learning that you've had as an angel investor? So looking back at your experience with med forums, are there some things that you would have done differently?
John Dayton, MD 36:16
Yeah, that's huge. You know, on one hand, as far as things that, you know, did well, we validated the idea, we talked to a large group of physicians. On the other hand, you know, I'm open about this, I tried to do it myself, I tried to hire people, I, you know, took some money. And some time, before I found the right fit, we were able to build the site, by finding a viable way to do that. I've since done some kind of entrepreneur boot camps. And there, there's some phrases like, you know, fail fast, fail quickly, you want to bring a minimal viable product to market as quick as you can. So you can see number one, if there's any interest, or number two, if anyone's going to pay for it, I website, like we were doing was a little bit more ambitious, we had to have a lot of folks on it. So it was a matter of finding the right business venture partnership to do that. And that's something I didn't even know was a thing, you know, with medical education, you're talking about a group of kind of self selected themselves dedicated their lives to healing others doing medical education, a lot of times at the expense of other things they can be learning about or other other time they can spend in different areas. And so you have a group of people that are phenomenal individuals that really great at one space. And a lot of times, you know, there's that funny phrase, you don't know what you don't know. And that's, that's very true for, for physicians, as we try to branch out into entrepreneurship or do other things or investments, we realized that
Patrick Kothe 37:42
we had a lot to learn, getting the need and developing the product. And going through all of the validation that that's one piece of it. But a very important piece of this, though, is how are you going to make money on it. So I imagine that you had a lot of discussion on business model, because there's a lot of different ways that you can take a website, and a lot of different directions you could take, take it in terms of monetization. So what was that process like?
John Dayton, MD 38:10
So that's huge, you know, we go back to the two sided market, on one hand, we want as many physicians to get on the site leave reviews and ratings as we can, we felt like if we charge physicians to do that, that they would not be interested, we wouldn't be able to grow. At the same time, when you when you approach these companies, you know, outside of a handful of really big education players, sometimes they don't have the biggest marketing budget. So it's a matter of convincing them, hey, our our way of doing this as is is going to be helpful for your company. But you need initial pilots to show that. So we do a combination of affiliate sells, where if someone looks at something on our site, and then they go from our site, and they purchase it, we get a percentage of that. We also do just a traditional kind of pay per click pay per referral system. And that's that's tricky to set up when you haven't done anything like that. And you're proposing a new business model to you know, a group that's been successful doing things the way they do that. One of the companies in the space a group called Mockingbird, they really attacked, they really attacked the senate phenomenal way. Rather than looking at the educators of physicians, they said, you know, hospitals, it's in their wheelhouse to make sure their physicians are credentialed. It's also they also have a group that's does that full time they have a budget. And so they've actually reached out to hospital groups to pay for their services. They help make sure their physicians meet the right credentialing goals and, and that's that's a very, very process. You have different states that have different specific education requirements, particularly they related to their cortex, opioid abuse, and there's other things that are important to different states and so that is reflected in new legislation and they stay on top of that. So they've been phenomenal partners with us because we've been able to look at their their business model and get some ideas from them at the same time, we have a lot of contacts in the space. And so we've been able to make some introductions. And so that's, that's been a great. We don't have necessarily have a formal partnership, but we do a lot of work
Patrick Kothe 40:18
together. JOHN, you saw a need within the education side develop a company, you saw a need for physician, angel investors to get involved, you form a group there, and then you became an angel investor yourself, is that what's really sparked your need for knowledge within the innovation of medical devices?
John Dayton, MD 40:45
Yeah, exactly. As a result of setting up a physician, entrepreneur group, and working as an angel investor and doing research for them. Ultimately, I became someone that gets a lot of referrals. People say, if you're doing this, you should talk to john and, and I realized I have ability to give some good advice help people make sure they don't make the same mistakes I made, just to evaluate what they're doing. At the same time, I want to be better at that. So I've been looking at different options, as far as MBAs or different ways to pursue further education, that space to make sure that I that I do, you know, offer valuable service to those groups.
Patrick Kothe 41:27
So you got a great opportunity now with Stanford, tell me a little bit more about that.
John Dayton, MD 41:33
So Stanford has a brand new fellowship they have it's called innovation and medical design, they have a combination of doing work with in the in the EDL to eight shifts a month in the Ed. But I'm also part of their digital health team. And they, because I have an interest in funding and bringing products to market, they have best contact. And they're able to set me up with entrepreneur residency groups with big healthcare funding groups and some venture capital groups. And so for the next two years, I'm going to be doing doing that and getting my MBA same time.
Patrick Kothe 42:14
It's been a few years since you've been in school, what do you think about that? Yeah,
John Dayton, MD 42:18
it's kind of a running joke. And in my family, my wife said, you, you can't sit still. So if you're going to even think about going back to school, you need to, you know, take some business courses, or do some things that you feel like will be helpful and make sure that you can do it. And the University of Utah offered a great physician leadership course. And she joked with me when I got home, because it was great education, just like give digitally still analog and that the way that it's set up now and the way education is changing, because of COVID and other things. I'm actually doing my MBA online. And this works perfect. Because I'm able to watch the lectures, do my reading what works for me, I do my tests and everything online. And so that's been great. I'm going through the Carey School of Business at Hopkins. And the reason I'm doing that is they have a big focus on health care, entrepreneurship. So what I what I didn't want to do is take a lot of classes, you know, you think back to college, and you had to do a bunch of GDS. And they're just saying she got out of the way, a lot of business classes, they have their core courses, which are great for business education, but I wanted to be able to do a lot of things with big data, Ai, and then specific to healthcare, entrepreneurship, like medical device, and they offer those classes.
Patrick Kothe 43:35
So john, are you going to be in college at the same time as any of your kids?
John Dayton, MD 43:41
Going back to, I guess, at this point in 24th grade, but um, yeah, I have a I have a daughter that so high school assignments in junior high and two kids that are in grade school. They've been good enough sports to say, you know, Dad, you're, you're always gone doing locums. We'll actually live on the same house together. We've tricked my wife and I've tried to frame it. As you know, this is a great experience for two years. We live in an interesting area. And then we're going to move back to Salt Lake City. And so as long as that last part particularly was there, they're they're on board.
Patrick Kothe 44:12
So john, you got the next two years that are laid out. But what comes after that you're gonna two years from now you can move back to Salt Lake City. And what? What do you want to do? Yeah, I'm
John Dayton, MD 44:24
very interested in bringing medical devices to market. I'm interested in digital health and in artificial intelligence. The ultimate goal is to be a venture capitalist, being a principal or a lead for the healthcare sector. I plan to still practice emergency medicine because I feel like that gives me street cred and keeps me aware of opportunities. But at the same time, I'm going to have a consulting component or working with a VC group.
Patrick Kothe 44:57
With john, good luck in the in the next to yours, great school sounds like a great program, and really is going to match up with your interest not only in medicine, but in developing technologies and your quest for knowledge here is really going to pay off as you move into the next phase of your career.
John Dayton, MD 45:16
Yeah, that ultimately, my my goal is, you know, when physicians want to bring something to market, or they have an idea that I'm that I'm able to help them with that that's, that's really what I'm wanting to do is kind of be that kind of translational physician. And, and, and assist with that.
Patrick Kothe 45:35
That word translational is always been really interesting to me, because it's not only translational, between the benchtop, and the research and the application. But it's also making sure that the users buy into it, that it's not only good from a theoretical standpoint, but from a practical standpoint, we look at things like,
John Dayton, MD 45:59
you know, with all the positive goals for electronic health records, ultimately, what happened with is with very little physician input, we had a bunch of electronic health records that were really just cash registers, with associated places to take notes. And we were told to use this and it was set up in such a way that these companies were not encouraged to have any interoperability. And now we're looking at a situation where we kind of need to revamp how we're doing that. Along those lines, when we look at how digital health and patient's own data and patients access to data, and things that can be done with artificial intelligence, all of these are going to become a part of medicine. So I want to be a voice and how those decisions are made, I want to be at the table there, I want to be able to say, you know, this data that people are collecting from home, can be very helpful for us in the ER, but we need a way that we can visualize that we need to make sure the data is vetted, we need to make sure that that information communicates with our electronic health record. And so I I want to be a physician voice as those changes are made brought to market. And so that's also a big goal I have.
Patrick Kothe 47:08
JOHN, as we wrap this up, is there any message that you'd like to leave with the listeners,
John Dayton, MD 47:15
a lot of what I do is just based on, you know, interests, that leads to opportunities. There's a big fear in emergency medicine that if you don't have something that you focus on, or something that you do that you're more likely to burn out. And so with that in mind, I've looked at opportunities, where I can be involved with innovation, where I can be involved with investing, where I can be involved as an advisor, ultimately, I feel like it makes me a better emergency physician. It gives me my kind of my space, my niche in emergency medicine, where I'm, you know, the innovation guy. And a lot of these things have been very helpful with avoiding burnout, as physicians have, you know, physicians aren't really high on the list of people like, Oh, I really feel bad for you, but that there's major, major issues in medicine, with concerns for loss of autonomy, with burnout, we've seen a rash of suicides during COVID, that included people that were very gainfully employed and people that had changes to their employment, I feel like if you're able to practice and you're able to have some other area where you have skill or knowledge, it makes you interesting as a person, it makes you so you're less likely to have a position where you don't feel like you have any other options. And I what I would recommend is folks, particularly Madison who have an outside interest that that's something that they explore, find a way to add value to their profession through that and add some variety to to, to what they do professionally and in their life. I think that's a good burnout cure. And that's something that I've been focused on.
Patrick Kothe 49:01
I find people with a lot of passions to be really interesting. And I always enjoy conversations with them because I get to ask questions and learn a lot about what their experiences are, as well as what their what their outlook is and why they do different things. A few of my takeaways from today's conversation. First of all prioritization, I thought it was really interesting. John's got four kids. And China's finding a way to do a lot of different things, but he's prioritize things. Well, I thought it was really interesting when he said that he finds a way to make make it work by searching for job situations that he can fit in his life, not the other way around. So so often I think we we fit our life into our job and john has found a way to fit his job into his life. So Secondly, you know, john is a lifelong learner. And that is something as you, I think you all know, I'm really passionate about to, he's a lifelong learner, he went from, you know, becoming a college student to becoming a physician, the learning he had when he founded a company, the learning that he he had, by by becoming an entrepreneur and, and joining a reforming an entrepreneur group, then becoming an investor and learning what that's all about. And finally, oh, he's going back to become a student again. And once he's done with that, there's going to be some learning that he's going to have doesn't end up with his dream of being a venture capitalist. The third thing is, you know, the passion for many things. And I think it's really interesting. He kind of described it a little bit as add stuff, but that's really not yet its passion. He's got many passions for many things. And when I hear that I think about, he's blazing his own trail. That's what he's doing. He's not going doing something that's ordinary. So often we we go the ordinary route. And what that leads to is ordinary results. I love the word, extraordinary. It's extra ordinary. It's, it's not something that is ordinary, you're doing something that's unusual. And if you're doing that and doing something that extraordinary, that's unique. That's what's gonna lead to extraordinary results. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device, podcast and Apple podcast, Spotify, or wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast. As interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
