Looking for a New Cayman Physician, Moneyball, and Dinosaurs

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Youtube is always interesting as it constantly feeds you more of what you want to see. It’s sort of taken over Netflix and Amazon for me because of that feature. This morning it served me one of my favorite scenes from Moneyball which happened to coincide with helping our Cayman affiliate find a full-time physician. So let’s dig into how finding a new Cayman doctor exposes the orthopedic and pain management dinosaurs and what that has to do with Moneyball.

My Favorite Moneyball Scene

If you’ve never seen the movie Moneyball, it’s well worth a watch. At first blush, it’s a baseball movie, but it’s really about the slings and arrows of innovation. A team manager from a relatively poor team (Brad Pitt) meets a quirky spreadsheet math guy (Jonah Hill) who convinces him that he needs to be paying for runs, hits, and bases and not wasting money on the next hot prospect. Hence they both go against the baseball establishment to find cheap players who will get runs, hits, and bases. This rag-tag team eventually does what they predicted, it wins lots of games at a fraction of the cost of the rich teams burning cash on superstars.

In the scene above, a tech billionaire who owns the Boston Red Sox who made his money by disrupting established industries talks to Brad Pitts (the manager of the Oakland A’s) about why he called him to run his team. So what does that 34-second clip have to do with looking for a Cayman full-time doctor?  Let me dive into that topic.

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Dinosaurs, Moneyball, and Cayman

Our Cayman affiliate wants to hire a full-time doctor who can stay down there and treat patients, building a practice on the island and also helping out the doctors who bring their patients there. The Cayman affiliate site is permitted to offer culture-expanded mesenchymal stem cells, which is a product that has yet to be approved in the US, but one our clinic has been offering since 2005. At first, we did this in the US, but by 2010 it was clear (after we got a bit bloody-see clip above) that the US FDA considered your culture-expanded cells a drug, so we licensed that tech to a Cayman clinic where it was permitted under the practice of medicine. We also partnered with a US company to get that tech USFDA approved. Since then, our Regenexx network doctors have been able to take their patients to this Cayman site when they need more stem cells than same-day procedures can muster.

I agreed to help our Cayman affiliate find the right provider for that site and it’s this physician search that brings me to the dinosaur concept. You see, in a world where interventional orthobiologics (IO) replaces 2/3rds of today’s elective orthopedic surgery (something that we demonstrate to our corporate clients every day here in the US) and most of interventional pain management, the skillsets that orthopedic surgeons and many interventional pain physicians prize become outdated and less valuable. Let’s dig in there a bit.

Our corporate program has grown because we can replace existing expensive and complication-laden orthopedic surgery procedures with interventional orthobiologics at a lower cost and with fewer complications. This is something that most orthopedic surgeons don’t yet realize is coming down the pike. You see, they still view orthobiologics as a way to increase cash revenues to offset declining insurance reimbursements. What they don’t yet realize is that by Regenexx signing up hundreds of companies to use IO to reduce orthopedic surgery rates, their skillsets are becoming less valuable, and conversely, the IO skillset is becoming more valuable. With every new 100 companies (now about 700+) we sign up to cover IO procedures, this calculus becomes more obvious.

Take for example candidates for this Cayman position. I have had many orthopedic surgeons reach out about this position. I have turned them all down (save for one with interventional and IO skills) because none of them has the skill set of being knowledgeable about how IO is used and experience driving needles using ultrasound in joints and fluoroscopy in the spine. In a world where 2/3rds of their surgeries are replaced by IO, the more valuable skill set to Cayman is someone who is an experienced IO provider. Knowing how to perform arthroscopic knee surgery or spine surgery is not valuable for this position and as IO replaces more elective surgeries, becomes less valuable overall.

How do interventional pain management doctors fare? Better, but still not perfect. They do have spine fluoroscopy skills that can be retrained, but they usually don’t know peripheral joint ultrasound well. In addition, they often have no experience in how orthobiologics are deployed to replace all of the procedures they now perform. Meaning they still require significant retraining. Why? In a future world where orthobiologics are covered by insurance, RFA, stimulators, and SI fusion screws become dinosaur technologies.

A New Cayman Doctor

The good news for our Cayman affiliate is that I have found several qualified candidates. Some have more orthobiologic knowledge and those providers have a clear edge over those that don’t. However, all providers reading this should understand that when I’m screening providers for this job, what I’m really doing is aligning the skillsets for what US providers 10 years from now will need to have. Hence, if you’re a surgeon or IPM physician, IMHO you should be paying attention. Knowing how to crack a knee with an arthroscope or how to burn nerves in the spine or the knee (RFA) are skillsets that are less valuable in that world.

The upshot? At the end of the day, orthopedic care is changing. Our success in reducing costs for employers by substituting IO procedures for surgeries shows that providers in 2032 will need a different skill set than those in 2022. So if I were a provider now without IO experience, it’s time to get re-educated and retrained.

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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