RX Podcast_Erik Ilyayev: Audio automatically transcribed by Sonix

RX Podcast_Erik Ilyayev: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody and welcome to another edition of Entrepreneur Rx, where we help health care professionals own their future.

John Shufeldt:
Hello everybody and welcome back to Entrepreneur Rx. This week, I'm happy to welcome Dr. Ilyayev. He's a physician, 2X entrepreneur, successful ..., investor, educator, and mentor. Erik is the founder and former CEO of myhousevisit.com, which is an organization that provides medical home visits to the elderly and home-bound. He found the company right after he completed his residency in New York-Presbyterian Brooklyn Methodist Hospital. Erik, welcome to the podcast, and kind of right out of residency, you couldn't just take it like a year off and practice medicine?

Erik Ilyayev:
No, no. I had to jump right in and thank you so much for having me, John. I love your show, it helps so many entrepreneurs, especially physicians in the medical field, so thank you for that.

John Shufeldt:
Thank you. Okay, so, well, let's back up. Medical school, college, give us a little background.

Erik Ilyayev:
Yeah, I mean, I kind of go a little more way back as far as what got me interested into medicine. We came to the country in 1989 from Russia, don't speak the language. My grandmother gets very, very sick as we move on towards that was probably like 11, 12 years old. Ambulance comes, tries to speak English, no one speaks English. I'm the only young kid, right, in the family who knows how to speak English within my mom and dad's family, and I volunteered to go to the hospital. And I'm in the ER and as a 12-year-old kid, I'm looking at all these things and I see grandma and she's not doing well. And then my eyes caught the monitor as a 12-year-old and I saw like 70, 80, 70, and all of a sudden, for some reason, I see like 30, 32. And not a doctor, 12-year-old kid, I tell my dad, Dad, I just saw that, that was at 70 and now it's at 32, that was her heart rate. Dad was a physician back home in Russia, so he's like, yeah, that doesn't make sense. And he said in Russian, go call the doctor, I called the doctor, pointed over there, and said it's 32 now. Lo and behold, she had a third-degree heart block, she needed a pacemaker and, you know, she got a pacemaker. That was my first introduction into the world of medicine.

John Shufeldt:
That is crazy. What part of Russia did you guys move from?

Erik Ilyayev:
We came from Uzbekistan when it was part of the former Soviet Union.

John Shufeldt:
I was in Moscow in 95 and I toured an Americanized medical clinic and then also a Russian-based medical clinic based in the Russian wall, while we said hey, we got all the technology, got a CAT scanner which, you know, in the early nineties was kind of a big deal, but to read the films or run the CT scan, but we have the CT scanner, so it was really interesting.

Erik Ilyayev:
Definitely.

John Shufeldt:
Ok, so that was your first taste of medicine. And then?

Erik Ilyayev:
And then, yeah, I mean, then I went to Hofstra for undergrad and initially I thought it was going to be a dentist because my dad was an MD in Russia, but he was, he restudied here dentistry in New York University. And the way he was, that's what gave me the drive when I saw my dad studying anatomy and pathology books in English with a Russian dictionary and writing on the textbooks in Russian above the English word, that said to me like, wow, this guy has a drive, I need to emulate that drive. So I was going to be a dentist, I didn't know how to study the right way, didn't get into dental school because of my DATs. My friend was in medical school in the Dominican Republic. I said, hey, not a dentist, maybe a doctor too, you know, because I wanted to be a doctor because of my grandmother. But then, like my dad said just be a dentist and like fate kind of brought me back and said, no, no, this is what you're destined to do. And I went to med school in DR, in the Dominican Republic, then in the Cayman Islands, did my residency in New York Methodist Hospital and, you know, started house calls, day one.

John Shufeldt:
Wow, that is so, I love the Cayman Islands, so strong work on that one. That would be a great place to have medical school.

Erik Ilyayev:
Right across the street from the Ritz-Carlton.

John Shufeldt:
I know exactly where it is. I would run in Seven Mile Beach, I knew exactly where the Ritz, never stayed but knew where it was. That's very cool. Now, I would not have studied at all if I went to medical school in the Cayman Islands.

Erik Ilyayev:
It was hard. I got to tell you.

John Shufeldt:
That's pretty cool. Yeah, that's resilience as hell. Ok, so you did three years of internal medicine?

Erik Ilyayev:
Yes.

John Shufeldt:
And then what made you, what prompted you to start house calls? As I mentioned a little bit before, my experience with doing house calls was entertaining, odd, and low reimbursement, a difficult situation. And that was in Scottsdale. That was about the business.

Erik Ilyayev:
Yeah, I mean, again, it comes back to experiences and this is my other grandmother from my mom's side. So I'm coming out of residency and I get a call that grandma fell. She doesn't want to go to the hospital and I'm thinking, OK, cool, I go visit her. I'm like, man, I wish I had a portable x-ray somehow, I wonder if it exists. I go Google it and I see that yep, they do, portable x-rays. I'm like, OK grandma, don't worry, look, I'm doing an exam, I think you're OK. You may not need to go to the hospital, let me just run an x-ray. Did the x-ray, everything's fine, ordered physical therapy to be done at home for her. I'm like, wow, this is, not a lot of people do that anymore. This is a great niche to get into, and I started my house call practice. By myself initially, and then I started training mid-level providers like nurse practitioners and physician assistants. And towards the end, we had around 20 mid-level providers working within the organization.

John Shufeldt:
Was it all New York City?

Erik Ilyayev:
It was, yes. Queens. Brooklyn.

John Shufeldt:
That must I mean, it was hard enough to do in Scottsdale. I can't imagine how difficult was to do in New York with the traffic and just the congestion. I mean, seriously, how did you pull that off?

Erik Ilyayev:
Yeah, I mean, it was a lot of strategy. The team, it comes back to the team. The team was so mission-driven that it didn't matter to them if they're looking for parking for 30 minutes ... It was like oh, I'm wasting time not seeing a patient. But they knew the mission, you know, to take care of those folks who really needed us. And so logistically, some of us had drivers, but most of us just manned it up and looked for parking.

John Shufeldt:
Wow. And this was all Medicare and Medicaid patients.

Erik Ilyayev:
Yes, yes. And these are folks who really needed it. You would go to people's homes and they wouldn't have anyone who would take care of them. You would see medication bottles, like 30, 40 medication bottles, and the patient did not know what they were taking. And the first visit you got paid for about an hour of your time. But again, that wasn't the mission. The mission was how can I help this human being? And that's what we had, the culture of the company. You spent three hours literally throwing out medications, but then you don't just throw it out, right? You call the pharmacy and you said, hey, please don't send this medication anymore. Because if you throw it out and it's an auto autopilot in the pharmacy, they're going to get it every month. So it was very, it was a very meaningful experience, really was.

John Shufeldt:
So it wasn't really concierge-based or was it? It wasn't concierge-based?

Erik Ilyayev:
One hundred percent Medicare-Medicaid. Our model was to help folks who really needed us, so our grandmothers and grandfathers, as we call them.

John Shufeldt:
So this was ongoing care. This was not a one-off. I did the one-off urgent care sort of business. You were doing the ongoing internal medicine.

Erik Ilyayev:
Yes, we were doing pretty much hospital at home before it became popular, and shout out to Rich Rakowski from Medically Home who actually brought that concept to the forefront in Boston. But we were doing that like regularly, without any funding, just with Medicare and Medicaid, you know duals.

John Shufeldt:
That is badass. How many patient businesses would you guys do in a month?

Erik Ilyayev:
Well, we would do, we would have a rule where we would have seven to eight visits per provider a day. So we would never have 10, 13, 14 because the goal really was quality, not quantity. And you also, they don't want to overwhelm. Having a team that's loyal, that's loyal to the mission, to the vision, you have to see things from their perspective, too, right? Seeing 13, 14 patients a day will be very difficult. So we saw around seven patients a day. You can kind of scan that out to 20 providers.

John Shufeldt:
Yeah, wow. And then what EHR did you use?

Erik Ilyayev:
We will. When I started initially, I started on a budget, right? That doctor with a little bag going, so we started with Practice Fusion. And the reason was because it was free at that time. And so that's what I started with and I loved it. I mean, we used it till the end.

John Shufeldt:
And then how long did you have it before it was acquired?

Erik Ilyayev:
Yeah, so close to a decade. We were doing house calls. Start off alone, then grew the team, and then there was interest from really great company called Concierto Care and shout out to Julian Harris, who's the CEO, Doc Thompson, Dr. Alan Abrams, who's a pioneer in the geriatric field. And they were growing nationally, and we had a merger and acquisition, t5hat was a very interesting learning experience for me from a business side as well.

John Shufeldt:
So, so what is this? I've had a few of those. So what did you learn? What was your takeaway? So I talk about this often, I'd love to hear yours.

Erik Ilyayev:
Yeah. Well, my takeaways was A, you have to have something of quality that someone else would want, and it has to be quality because people can see. Number two, as a physician or entrepreneur numbers are important. So part of my path to the entrepreneurship was I started powering up, I started reading great books like Seven Habits of Highly Effective People by Stephen Covey, right? The Personal MBA, I don't have an MBA, but I read that book by Josh Kaufman, took notes on it, would wake up five o'clock in the morning, and I have notebooks with notes and formulas of profit margin and net profit margin and the return on investment and all that stuff, right? But my buying remote patient monitoring equipment, what's my return on investment as well? Does it offer quality? Does it affect my NPS score when I'm working with patients? So you power up and then you begin with the end in mind. Because if you know you're going to head towards a merger and acquisition, you have the product ready and it's real. And if someone digs in it, over again, this is legit.

John Shufeldt:
So I love your phrase powering up. But did you really know, you know, one day, July 2nd, after residency that you're going to do this and someday to be acquired? Because that would be incredibly prescient.

Erik Ilyayev:
No, no. I did not know. I told you it was a grandma story where I said, hey, this is a great, and I see that in life, actually, no matter how much we try to. Steve Jobs said that, that's like we sometimes turn back and we look back and we see all the dots like, wow, that's why all those dots were there.

John Shufeldt:
Connect the dots backward. I literally just have this conversation today. You know, I listened to that Stanford address often, but it's like the dots backward makes total sense. Absolutely. So were you doing hospice care also in this?

Erik Ilyayev:
Yeah. So what happened was as we were doing house calls, we saw that look, although we do like hospital at home, there are certain resources that we just don't have. And so initially you started referring to the visiting nurse services of New York as for hospice. And then started really seeing that we've developed an art to the goals of care conversation. We developed an art to structuring hospice to the patient's needs and not necessarily to what hospice is in that frame, right? And especially for we work mostly with the Middle Eastern, Bahari, and Jewish communities within New York, and there's a cultural importance there, too. And so I started falling in love with hospice and I became the regional medical director of hospice as well. After that, I fell in love with the organization so much because of their values, I transitioned to be a consultant within that organization, so I'll tell you why, we had a meeting today in the morning and Dr. Rochelle Bignam, who's the Chief Medical officer, we were talking with the whole team and she said, guys, our goal is not the census, our goal is how do we increase awareness and access to people who need it most for hospice services, and she meant it, you could feel that in the culture of the company. And last week we had a lady who was very sick and they asked me sometimes to have these difficult goals of care conversations. And we had the primary care doctor, the nephrologist, because it was a CKD patient, two of the family members and the hospice MD, even before this patient went onto hospice, we had an hour-long conversation. Now, think about it, the daughters didn't want the patient to go to the hospital, but at the same time, you have a daughter who knew mommy, and mom is laying in front of her in the bed and she's passing away and she doesn't know, how do you deal with that? Like, who do you call when you see that pattern of breathing? Who do you call when mom's eyes, who? And so we were able to walk through that, hold her hand, initiated hospice, she passed away yesterday. I got a call this morning, called the family, and the daughter was like, Doctor, thank you so much for what you guys did, my mom wasn't in a cold emergency room, my mom, I said, what about DNR, DNI? Like, we had that conversation. My mom was, they didn't have anything, she didn't want to have done to her. And you and I, John, being physicians, we've seen this so many times, right? And she passed away surrounded by her loved ones, and we had the resources, we had that nurse for crisis care to come and take care of her when we needed her most. And so it comes down to values, really. I really enjoy the work with the VNSNY and hospice.

John Shufeldt:
Yeah, that's an amazing story. And you know, as you pointed out, particularly with COVID, we've seen so many people die cold and alone and on Facetime, literally, trying to communicate with their loved ones, and it breaks my heart, I mean, it's tragic. Let me ask you a question, when you, before, when did you sell your company? When did you sell?

Erik Ilyayev:
Yeah. In March of 2021.

John Shufeldt:
So you lived through COVID hell in New York doing home calls. How was that? It had to be unbelievable.

Erik Ilyayev:
It was. It was very, very difficult. Our community got hit particularly hard, very hard. I'm big into social media, and so I was one of those doctors social media influencers within the community on Facebook. And I, more than, like, we have up to 5000 friends on Facebook, you can't have anymore, and I would see on my feed every day a funeral, every day, you know, people in mourning. So that was very challenging. At the same time, the opportunity was telemedicine because we were able to help people and navigate people and through telemedicine once the legislature allowed that. And we were very happy to do that. We were one of the few, like a lot of medical offices were just closed, because physicians didn't know what to do as well. People were all scared, we get it, but we had our team go to people's homes and it was, again it was rewarding.

John Shufeldt:
Wow. Yeah, I mean, that's, you know, the colleagues I had that traveled to New York to help, you know in Arizona got hit bad, but nothing like New York. I mean, you guys were literally ground zero again. That must have been, ... You were doing home business, for God's sakes.

Erik Ilyayev:
And it was a team. I'll tell you, it was really my team. They, you know, sometimes you have in medicine, you clock in, your clock out, look, my shift is over at five p.m., whoever is following up, follow up whoever's on call. My team didn't have that. Like my team, they're always on. On the vacation, they check labs to make sure their patients labs are not like, I'm very proud of them. I really am. You know, something like Gina, Maia, Alexei, Olga, like a whole team, Isaac, like really dedicated people, they're the right people in the right seat.

John Shufeldt:
At the right time.

Erik Ilyayev:
At the right time.

John Shufeldt:
Yeah, that's impressive. Well, the culture always stems from the top. You've got to build from the ground up, but it always stems from the top. And so they emulate the leader, which was you, so strong work on that because you are the influencer there. Ok, tell us about IKonnect.

Erik Ilyayev:
So IKonnect is a software company, when, you know, being an entrepreneur and the reason I love entrepreneurship is because I love music, and if you go on Facebook and you type in chains music video, like chains, you'll see a music video which I produced along with the content and the music for drug awareness and music is interesting because you don't just create one song, right? You create music so people can like it and enjoy it. Entrepreneurs too, you don't just create one company, you want to bring value and bring happiness through the company, many songs. And so I wanted to work with physicians, and I saw that chronic care management and remote patient monitoring were really coming into the forefront. And I said I love technology, why don't I start a tech company, a health care tech company? And it wasn't smooth sailing. There's a lot of learning, right? The developers you choose, the messaging, a lot of learning, but in the end, we have many physicians using our platform, delivering remote patient monitoring and CCM to patients, generating revenue for themselves, saving the system expenditures and quality for patients.

John Shufeldt:
Yeah, in real-time.

Erik Ilyayev:
Yeah, I mean, I had a, quick story, I love experiences because I think they really paint the right picture. Had a lady who is in her eighties, went to see her cardiologist, she was on remote patient monitoring with us, she went to see her cardiologist and then all of a sudden we noticed that her blood pressure is 80 over 50. Our baseline is like 110-120. Like, whoa, we got the alert because it's live, right? Our team called, lo and behold, she was started on a beta-blocker because she had a little bit of CHF on the echo and her blood pressure was 80 over 50. She was asymptomatic, but hey, you know, a little bit of orthostatic and she's over it, boom! And then you've got a hip fracture. We caught it in time, spoke to the cardiologist. This continued, success story, all with a simple remote patient monitoring device.

John Shufeldt:
That is a great story. I just had a patient the other day in the emergency room, her heart rate was 30, and then, yeah, it was ... rhythm and her pressure was fine and I'm on trial, she wasn't having chest pains, so I'll try Loazropine, did nothing and she stayed very stable, so long story-short is finally got a hold of her records, finally her daughter comes in and I realize she's put on a beta-blocker. I'm like, probably the beta-blocker. But had she had the home patient monitoring, she would have known this at home, you guys would have had all her medications, and it would have been, one, you guys could have stopped it and she needed to come in great. You know, I would have known the answer in her glucagon way before we did.

Erik Ilyayev:
Yeah, I'm so excited about what the future is holding, a number one for remote patient monitoring, number two, with clinical decision support systems that will assist physicians. Because look, you and I look at EHR, but we're not looking at every single spot. It's very hard, whereas you'll have an AI in the background scanning and suggesting to us saying, hey, doc, look, you may want to focus on this thing over here. Wow, and I think it was there,

John Shufeldt:
So I have a ... healthcare story for that, exactly what you said. You know, I still envision putting on a pair of underwear and a t-shirt, and all of a sudden, you know your biometrics, AI alerts you to issues, you know, I've worked on things where picking up urinary tract infections, I mean, just all sorts of things based upon these simple basically chip and the clothing sort of things. So very, very cool. You're way ahead of your time, that's awesome. Now, did know, is it something culturally with you about being an entrepreneur? Did you know when you were 12? I mean, are you from an entrepreneurial family? I mean, you're obviously from a family of badasses, frankly.

Erik Ilyayev:
Yeah. I mean, a lot of it comes from my dad. My dad, really. I was the only son, the only child. He spent a lot of time with me, and they were immigrants, again, experience. My mom was a cardiologist in Uzbekistan. Dad's an internist. They come to America, they had no money, and I remember as a child, seven, eight years old, my mom was on the floor cleaning a bathroom for a super-wealthy family, as a cardiologist from Uzbekistan in New York, cleaning bathrooms. Fast forward 15-20 years, dad becomes a dentist, builds a beautiful house from scratch himself, right? The American dream where it's a meritocracy, right? We're not entitled to anything, but if you come to this country and you work hard, hey, something good can happen. That's why I think I got my entrepreneurship from, is my parents and God bless them, I love them. Yeah, and I'm doing the same thing to my kid now, My son, my wife, six kids, five boys, one girl, and I'm doing the same thing.

John Shufeldt:
So were they considered, pardon my ignorance, were they considered privileged in Uzbekistan because of their profession? Were they in the upper echelon?

Erik Ilyayev:
No, no. You know, physicians in Russia would struggle. They would get paid very, very little, they wouldn't have enough to live, it was a very difficult environment in Russia. And so when they came here and they saw that, hey, if you work hard, you can achieve a lot, that's where I see that from, you know, and I want my kids to have the same drive.

John Shufeldt:
That's amazing. So what advice, does he do some mentoring, what advice do you tell him, because you do mentoring, you're the director or vice director of undergraduate medical education for Kingsbrook Jewish Medical Center, what advice do you give to these kids? Is it the work hard and achieve advice?

Erik Ilyayev:
Yeah, a couple of things. Number one is begin with the end in mind. You know, don't just sign up for something just because, oh, my mom said or someone said, like, make sure you enjoy it and make sure to calculate. If you want to be an ER doc, make sure to begin with the end in mind. Mentorship, hang out with people who are in that field, right? Get the grades, number one. Number two is from a patient care, one of my doctors told me, Dr. Shaqhi, he used to say to us all, don't be quacks as doctors. I don't want you guys to be quacks as doctors. And I say that to them too. And we'll kind of maybe we'll finish with this, but I'll say another experience, I say this to my students all the time. I was in my first-year residency, my kid, Yosef was just born, he just had his circumcision, three weeks later, my wife calls me, I'm in residency, Erik, he's crying, he's just nonstop crying, I don't know what to do. I run home, I say, OK, let's figure it out. Undress him all. I see. oh, wow, big inguinal hernia, right?. OK, a little kid has a hernia,l we have it in our family, so like, ok, cool, rushed into the E.R, it's late at night. The third-year surgical resident, I'm a first-year internal medicine guy, I mean, what do I know? I just started, I don't know anything, this guy's a third-year surgical resident, comes in and say, don't worry about it, man, it's reducible. I'm like, are you sure of that because I'm like, I'm looking, I mean, I'm just the first year, what do I know? But hey, doesn't look? No, no, don't worry about it. It wasn't reducible, he just didn't want to deal with it. He said, let the morning shift deal with it. Dr. Kessler, amazing surgeon, he came in the morning panicking, this is getting necrotic already. In the meantime, my kid started to get septic, right? Needed to have emergency surgery, and I learned from that, like, look, this is my son but at the flip side, I tell my medical students, this will be someone else's son, so how or this will be someone else's grandmother. So how can you reframe any time you take care of somebody, this is my mom. How would I act if this was actually my mom? Or how would I act if this? No, no, not if this was a patient, but this was actually my mom, wouldn't my medical guidance change? And although we don't want to admit it, a lot of times we will say different things. We will say, look, maybe you should do this if it's your mom or dad, you know what I mean? And so that's the message I impart on them. Some of the messages.

John Shufeldt:
That's a great message. So I love this quote by Sigmund Freud, one day in retrospect, the years of struggle will strike you as the most beautiful. That sounds like how you approach life.

Erik Ilyayev:
Yes. Yes, every challenge is an opportunity. It's an opportunity to grow, to learn from, and it's a blessing to be alive. We're very blessed, just got to work hard, every day.

John Shufeldt:
Right. When you see someone, you seem like someone with great wisdom, so give me some, impart some wisdom to me.

Erik Ilyayev:
I could get some wisdom from you, John. I mean, I'm looking at your background. JD, MBA, MD, I mean, I want to be like you when I grow up.

John Shufeldt:
Well, ditto. But I want your perspective on this because you have some really unique perspective, I can tell. What are you saying and how are you dealing with these physicians who are espousing all the anti-vax, anti-mask, all this BS? How are you dealing with them? Because I'm starting to get more than a little frustrated with the level of bullshit out there.

Erik Ilyayev:
It's tough. It's very tough. I mean, we have to follow the science and follow the data, just makes sense. You look at the numbers of folks who are hospitalized now, obviously, look, I think everyone should think about having the decision themselves for sure, like a human being needs to be able to decide for themselves. But when you talk about science and you see the, think about polio, we would have been like, Oh, don't give the... what would have happened? Like what would have happened? You know, think about antibiotics if you would have been like, no, just give ginger and garlic, don't give antibiotics, don't get Vanke when you have sepsis. You know, don't give an .... don't get on with that, garlic and pepper, it will help you and breathe it in every day, you'll be fine. Like we understand. So people should follow the signs, be careful giving recommendations to people not to get vaccinated because if they pass away because they listen to you, it will be on your soul. Because they may have been on the verge of saying, you know what? I should get it. And then Dr. Smith comes on TV and says, you shouldn't get it, and then they catch it, and then they die. Someone lost their mom and dad, a son, a daughter, a father.

John Shufeldt:
I literally had not quite hundreds, but a lot of people in the emergency department who are like, literally about to intubate them, maybe I have made the wrong choice. Yeah, you did make the wrong choice. We wouldn't be here, but for that choice, and it's what the hell?

Erik Ilyayev:
And it's sad. It's sad because you're there in the front line, seeing it in the ER and telling yourself, man, this could have been prevented, he could have been home having dinner with wifey today.

John Shufeldt:
Holy, and I had to, I mean, Arizona, we had it pretty easy. I mean, God knows we're not in New York, and it was still it's still suck. I don't want to end on a downer. Erik, how can people find out more about you? You're like, think of that more wisdom to impart.

Erik Ilyayev:
No, thanks so much. Linkedin is great. You know, they can type in Erik Ilyayev on Linkedin. Facebook, I share a lot of family, music, I have a song with my daughter, where I sing to her and talk about when she's going to get married, how it's going to be, it's a really cool song. So check me out on social media and it's a pleasure.

John Shufeldt:
How do they find that song you mentioned on Facebook?

Erik Ilyayev:
Yeah. So they go to Erik Ilyayev and then they'll go public so they can click on the videos and they'll see a song, and my cute little daughter is just sitting there, she's a little older now, and there's a song, you'd love it too, John. You should check it out, I'm sure you'll love it.

John Shufeldt:
I'm a frustrated musician, so I absolutely will check it out. So thank you very much. All right, this has been a real pleasure. I've learned a lot and I know our listeners well too, so thank you for being out, I really appreciate it, and great work.

Erik Ilyayev:
Thank you, John. I feel honored to being on your show, honestly and the good work that you're doing. Again, I looked at some of your backgrounds. So impressed with what you're doing for everyone. God bless you and your family. Thank you.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur RX. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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