From Physician Burnout to Building a Scalable Medicare Practice - Dr. Carlos Rafael Elizondo

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This is the Beyond the Story podcast, a show that goes way beyond the story. And now, Sebastian Rusk Carlos, welcome to the show. Thank you, thank you for having me Sebastian. business coaching group, such a phenomenal community of human beings and business owners, obviously led up by Dan as well too. So great to connect with you. I love leveraging my platform of podcasting to meet new folks that No, likewise. Yeah, I think the elite group is is transformational. My wife and I just got back from the couples retreat there in Tulum. And so that was just that was super cool, super transformational Amazing. Yeah, they it has a lot to do with life, has a lot to do with business, that community, which is which is always great on both sides of the spectrum. So on, uh, on this show, I love, I love telling people's stories and for context purposes for our listeners, I always like to go back to the beginning of the story. Now, the beginning is different for everyone. So I'll let you decide where that beginning point is, but bring us back and help us better understand exactly where your story started and where it began and what brought you to present day Well, you know, first of all, my parents had a lot to do with it. My father was a, an internal medicine doctor. Him and my mother start started a company back in 1982 in a small town called Alice, Texas, about 20,000 people population. And, and that's kind of where it started. And just, we grew up in medicine and. you know, having private practice is something that's challenging. Just like any business that you own, any entrepreneurship is challenging. You know, private practice in this day and age is becoming more and more rare. And so, you know, my parents started that back in 1982. When I was 16, my brother passed away. And so that kind of created a huge transformation in our whole family's life. And I went to college, you know, at 18, like everybody else does, and was there in San Antonio. Didn't do too well because, you know, just with the recent, you know, within a year loss of my brother, it was, it was difficult doing a lot of things, doing a lot of things that teenagers do there in San Antonio, living away from my parents and didn't do too well in my first year of college. So I went back to, to Alice, Texas to work with my parents and, That's when I just saw my dad's passion. You know, I honestly always thought that I didn't have that brain to become a doctor. And I just saw my dad and my mother. My mom wasn't a doctor. My father was, but my mom was, you know, she ran the office. So I just got to see them do some magical things every single day. And that's when I realized, you know what, I'm going to go back and do everything that I didn't do that first year of college. Retake some classes. And so I went to the community college there in Alice. And I actually first tried to go to Kingsville, which is where I graduated. I ended up graduating.

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I tried to go there, but my GPA was too low just to even get into that university. So I did some community college hours, retook a lot of classes, and then I was able to get into Kingsville. And it was a pleasant surprise because when I got into Kingsville, my advisor there really, I attribute a lot to him, you know, a lot of times it just takes one person who believes in you more than you believe in yourself. And so I, the advisor that I had, his name was J.R. and J.R. Valadez, and he's the dentist right now. So he was there as an advisor at Kingsville and advisor, meaning, you know, somebody you go to and tell them, hey, what your plans are, what you want to do. And so he helped, he helped me kind of guide that path. It was, you know, I wanted to do something in pre-med. And so you take biology courses. And he was he was my zoology lab teacher. Right. That's a one hour course. And but that was a huge transformation for me, because when I went there, he just spoke so highly of my family because he was also from that small town of Alice. And I felt like I couldn't let him down. And so I ended up getting my first aid. in college in his, in the zoology lab. And after that first day, I just didn't look back. I didn't, I didn't make a B after that throughout my whole career. And then I ended up graduating magna cum laude there in Kingsville. Wow.

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And so it was, it was, and I talked to Jr to this day and I just say, Hey man, thank you so much. You lit a fire that I did not know I had within me. And, and so Jr really lit that fire. And it's still a journey because I applied twice to medical school here in the United States and I didn't get in. You know, my MCAT wasn't the strongest score. You know, my verbal score was a four, which is a very low score at that time. Well, I did speed reading classes. I did there was a couple of medical school familiarization programs that I did in Galveston. And I just worked, you know, I just worked very, very hard. And I ended up doubling that score. So I went from a four to an eight, which was huge. It was just such a huge accomplishment for me. And I still didn't get into medical school, but I wasn't going to give up there. One of my good buddies, who's also a doctor right now, Dr.

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James Cantu, he's from Portland, Gregory, Portland here in Texas. He said, Hey, I'm going to medical school here in Guadalajara in Mexico. Why don't you come down here? There's a lot of, there's a lot of people that come to medical school and I, down in Mexico and I didn't even know about that. And so I started doing some research and. At that time, my wife and I, we already had about my young, my, my oldest son was about three or four at that time.

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We had just, I had graduated there in Kingsville, just had another baby. So I had my oldest son, Carlos, and my second son, Diego, and we decided to move to Mexico. Diego wasn't even a year old yet. So we all moved to a different country. And it was the best thing, it was the best thing for my marriage because we were able to kind of just disconnect from everything and start in a whole new place and meet new people. You know, I have some really good friends to this day that we met there that really helped us in that process. Because when you're in a new country, it's, it's challenging.

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The new land, the different language. And my wife and I, my wife was more bilingual than I was at the time. And I, I, I said I was bilingual, but when you move into Mexico and you're, you, you used to be in bilingual in Texas, what we call Tex-Mex.

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You know, it's a different, it's a different animal. It's a different ballgame, you know, and the simple things that you don't even realize paying your bills becomes very difficult because you have to, you have to call the company, talk to them in Spanish and it's the proper Spanish, right? Which we weren't used to. And so it was challenging at that time, but we, but we were able to overcome that. And it took about five and a half years. In Mexico, you have to do an extra year. It's a year of internship that you have to do there. And some of the students actually go to New York to do their internship. For me, my children were already immersed in the culture. It was going to be significantly more expensive for us to move to New York. So I stayed there and did a whole year in this tiny hospital.

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which was very, very helpful. I mean, all these things kind of shape how you are. And so I actually did a couple of months at the UT Health Science Center there in San Antonio rotation so that way I could actually get my letters of recommendation. And I was a little bit stubborn at that time because I did not utilize, and as we talked about before we started this podcast, the importance of networking. And my father, I could have got, I could have gotten letters of recommendations from his friends that had, that saw me grow up. And instead I chose the hard route, which, you know, in hindsight, I really wish I, I, you know, everything happens for reasons, but I really wish I would have also reached out to his friends so that way I could have, you know, multiple letters of recommendation. And so I did a couple of months there in San Antonio and Dr. Bauer there, he was the medical director of the trauma center. He really took a liking to me and we became, you know, he was a great teacher and he would utilize me as a translator for Spanish speaking patients. And he was the one that wrote my letter of recommendation. And I was able to get into residency there in Corpus Christi, which is right there where my hometown, Alice's, 40 minutes from Corpus, so we moved the family to Corpus Christi, did three years of residency at Christus Spahn Memorial. Memorial Hospital is not there anymore, but that was a huge training ground for some really top-notch doctors because, you know, I always tell people that the more patients you see, the better, right? Experience. You got to do those reps like Martel talks about. You got to get the reps in. But if you can get the reps in with very complex patients, which is what Memorial was, it makes it even better. Because the more patients you see and the more complex patients you see, the more you become comfortable taking care of any patient. As a resident there, we were responsible for we basically ran the show there. We did have our attending doctors, which we would reach out to. They were, they were always available there. But at the end of the day, the residents really ran that hospital. And that's where you really learn so much when you're taking care of the ICU for a whole two weeks and you have to utilize your team, you have to utilize the resources. You know, I had never taken a care of a patient on a ventilator and so What do I do? I go to the people who deal with ventilators every day. And that's gonna be your respiratory therapist. I would talk to them, tell them what I wanted to do with the patients. I would talk to the RNs that were working in the ICU that had been working there for 10 plus years, knew more than I did. And we would just maximize all those resources. And I was very proud of those two weeks in the ICU rotation. Every time I did it, we had to do it as a second year and a third year. And so just really grew strong as a physician. And as we, as I finished residency, my father's practice, my father was getting, he was getting ill and it was getting more difficult for him to practice. And so my wife and I joined his team and we were, we were able to, to take what he had, what he had built, what him and my mother had built. from one location there in Alice, Texas to now we have four locations. We have one in Alice, two in Corpus Christi and one in Victoria. We just opened the one in Victoria about two months ago. And so. It's it's been it's been a journey, you know, I'll say five years into it. I really burnt myself out, you know, back in about 20 right after covid. So covid hit 2020. It was it was difficult because from one day to the next, it was so uncertain. And we had, thank God we were doing virtual medicine, about 20% virtual medicine. And once COVID hit, we went to a hundred percent virtual medicine overnight. And so that, that was super challenging. And at that point, we were very proud of ourselves because we didn't have to lay off any people. And we just, immediately you go into a different mode where You know, almost like a survival mode. What do we got to do so that we can keep the revenue coming? It is a business. We understand that there's that huge dichotomy with patient care and owning a business. And so we needed to pay the bills, right? So what we did was we immediately started calling patients and started doing all the, what they call wellness visits. And thank goodness at that time, we weren't the greatest at doing the wellness visits every year. So we had a lot of wellness visits to do. And so that's how we survived that, that mode. And then during that time, and then in 2021, That's when I almost sold the practice because I was just, you know, like Dan Martell talks about, I hit that pain line. And when you hit that pain line, like he talks about yourself, sabotaging your, you, you start to shrink or you start to say, well, maybe if I don't do so much, then, uh, then it'll be better for us. And so too much alcohol. just, you know, people and a lot of doctors start going to, to that substance abuse. And so just a lot of things going on. And what, what really took me out of that burnout was, and it's, it's so cool that I'm here right now having this podcast with you was nature. Nature got me out of it. I went, and then the irony is a patient invited me to an elk hunting trip. And we got into nature And we didn't even get an elk, but that's when I coming from Texas, that's when I realized that hunting is not about. killing. It's about the experience. It's about getting in nature, getting reconnected. Sure.

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And and I read that's, you know, coming from Texas, that's hard to say, you know. And so that's when I realized that hunting is about the hunt. It's about the experience. And it was my son and now one of my best friends and my another best friend from childhood of us four went up to the mountains, drank water from a stream, you know, cook food out there where we hunt like 10 hours a day with, you know, with a big heavy backpack. And I was still contemplating selling at that time. Well, after the Elkhunt, that's when I realized that, man, my battery was just so depleted and it had recharged, like overflowing recharge. And had a meeting with that company that wanted to buy us out. And we told, and I told them that I just couldn't do it because our visions weren't really aligning. And that's when my wife and I went back to the drawing table and said, Hey, this is going to be tough, but we can't sell. We have to continue doing what we're doing because we're passionate about bringing health care to the people that need it the most. And that's the underserved. And at this point, what we started to realize the underserved are going to be your 65 and older patients. And I'm not going to just. You know, pigeonhole it to the 65 and older health And there's not enough doctors. And so we, we really believe that the future of medicine lies in nurse practitioners and PAs teaming up with doctors to, to help provide as much high quality care to as many people as possible. Do you guys have a physical location or do you do people come in and see? So we have four physical locations, um, one in, in Alice, Texas, which is a rural community. which is kind of our passion, is rural medicine. Getting healthcare out to the ranches, to the farmers, to the cowboys. That's what we love doing. And so we have one in Alice, two in Corpus, and one in Victoria. The goal is to have another one in a rural location here in the next couple of months, which is, it's called Kingsville. I don't know if you've heard of the King Ranch, but that's where the King Ranch is in Kingsville. And so that's the goal to, to continue to expand. But right now we're really, that's why I joined the Martel group, right?

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Because just to help buy back my time so that way we can do more, build these protocols systems, you know, standard operating procedures. So that way. Across all the locations, we're doing things Sure. Yeah, that makes total sense. Well, it looks like you're doing work that clearly matters here. I love that you're getting out to rural areas and bringing medicine out to those areas where they really needed the underserved, as you would say on here.

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It sounds like you've had quite the journey, but I'm glad you and your wife decided to follow your passion and your heart on what you want to do. You're clearly doing work that matters. Really enjoyed learning more about you. I look forward to staying in touch with you as well. I want to encourage you to keep up For me, it's about intention. I think the first step is awareness. All change starts from within. When I started focusing on myself, everything around me started changing. And so I just wanna encourage people to take a step back and to focus on themselves. And when you do that, magical things happen.

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Great final thoughts. Dr. Carlos, thanks again for your time, my brother. I'm glad we're connected now. Look forward to staying connected as well. Yes, sir. Thank you so much. You got it. Until next time, friends. Thanks so much for tuning into this episode of the Beyond the Story podcast. We sure do appreciate it. If you haven't done so already, make sure you're subscribed to the show. This way you'll get updates as new episodes become available. If you feel so inclined, please leave us a review. We sure do appreciate it. Signing off from the podcast, launchlab.com studios.