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The following programming is sponsored by Marc J. Bernstein. The views expressed do not necessarily reflect the views of this station, its management, or Beasly Media Group.

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Entrepreneur, founder, author and financial advisor, Marc Bernstein helps high-performing business owners turn their visions into reality. At March Forward, Marc and his partners and associates think out of the box to partner with their clients in regards to their visions for their lives, their businesses and their legacies. And through his innovative work with the Forward Focus Forums, Marc connects entrepreneurs to resources that help to fuel their success. Founders’ Forum is a radio show and podcast where entrepreneurs share their journeys, revealing the stories behind their successes, and the lessons they’ve learned. Join Marc and his guests for a mix of inspiration, valuable insights, and a bit of fun! Now, let’s dive in...

Why Pivoting Keeps Work Meaningful

Marc Bernstein 0:53

Good morning, America. How are you? Yeah, uh I say that and I try to say it enthusiastically, and we're going through some interesting times, but I really hope that you're having a good morning or evening or whatever, wherever you are, whatever time of the day it is. I hope it's a good one. Um, I'm here this morning, by the way. We're doing this on Zoom today, which we don't usually do. And my background, my guest will see this, and maybe TJ, our engineer, sees it, but I'm in the clouds today. I tried this from a picture that I took out of an airplane, and somebody the other day said he just was marveling. We had the greatest conversation because he said, Looks like you're floating on a cloud, and I like feeling that way. So I put that on. So if you've seen this on video, you might see me floating in the clouds. Anyway, my guest this morning is named Pat. And I we always start with a topic of the day. And the topic of the day today is um the importance of the pivot. Now we've talked about pivot before, especially in light of the pandemic and how everybody was using that word all the time. But Pat has a slightly different outlook on uh where you might pivot. And I'd love to talk about with you, Pat, for a minute before we formally introduce you. So good morning.

Patrick Roth MD, MHA, FAANS, FACS 2:11

Good morning, Marc. Thanks for having me here. So the pivot is something that I've kind of come to understand as I've gone through my career. You know, to a certain extent, my career was very, very traditional. I went to college, to medical school, to residency, and uh became a practicing physician. Um, and I was very much, you know, um following all the rules. But as I went through my practice, I got into this habit of um spending time not only reading about my profession, but reading about things that were tangential to my profession. And in doing so, that created ideas and bridges. And um when I began to plateau, I'm a surgeon, when I began to plateau as a surgeon, I started I asked myself two questions. You know, what am I good at and what do I enjoy? And something gave me the courage at that time to follow that I those ideas. And so I've and I've pivoted many times. I've become a teacher, I've become an administrator, I've become an author. Um and and my latest uh interest is in healthcare design. But I think it's not only is it uh does it enhance one's career, but this idea of pivoting also creates passion and uh enjoyment in the career. And um, you know, I've I'm I'm in practice now 32 years following my residency, and for the most part, I've come to work every morning excited to work. And I think what allowed me to do that was this idea of pivoting. And and now, of course, I'm at the end of my career and uh and I'm looking at the ultimate pivot, which is retirement, and trying to figure that out. And so uh we can talk about this later, but I'm currently writing a book. I I write to help me figure out things. So part of the pivoting problem, I have a peculiar habit. What I do is wake up in the morning on sat, particularly Saturday and Sundays, but whenever I don't have a full schedule with work, and I spend a couple of times in um reading, um introspection, and writing. And I try to answer questions that I have in my mind, and that's invaluable in terms of allowing me to pivot.

Marc Bernstein 4:26

I that to me is very amazing because look, I've worked with a lot of physicians over the years, a lot of people in the medical field, and I don't know that um, and they consider themselves like many professions very busy, and I don't know that people take that time. I think it's a rarity that people take the time to be introspective, to ask themselves questions, try to figure out the answers. So, and I'm very attracted to uh having those kind of conversations with people. So I I know this is gonna be a fascinating conversation. You've already unleashed some really important topics, and we won't get to them all today, but we're going to get to some of them. So, now let me introduce to you Dr. Patrick Roth, M D M H A, F-A-A-N-S, and F-A-C-S, founder of New Jersey Brain and Spine. That's his business. So, also chairman of neurosurgery at the Hackensack, New Jersey University Medical Center, and he's chair of new neurosurgery of Hackensack Meridian School of Medicine. And he's held, as he mentioned briefly, and when we talked about the importance of pivoting, he has done a lot of other things. And he's been a neurosurgeon now, as he mentioned, for more than 30 years. Uh, he founded a large sub-specialized practice which allowed partners to pursue narrow lanes of interest. That's a very interesting subject in and of itself. We'll talk about that a little bit. And he became interested in identifying the pain generator and back pain and applying technology to solve the problem in a simple and minimal access approach, which means to me minimally invasive, I would think. And uh it he also became interested in the relationship of mind-body and its impact on pain, which is of great interest to me. And along the way, he went back to school in his late 50s to get a degree in public health and became an administrator, and as you mentioned, also a teacher and a writer. And he's written three books, and he's finishing a fourth, um, which is um uh tentatively called Flourishing the Ultimate Capital, which I love the title and I love this subject. So, anyway, officially welcome, Pat. Thanks. Thanks for having me. Um took a long time just to do your introduction. Uh so there's a lot of things going on there. So a lot of moving parts to speak in the language of the surgeon, I guess. So um you um tell me about your beginnings, you know, how you how you became what made you decide to become a physician, your education, and maybe intertwine that um with how you what where your entrepreneurial instincts came from. Because you're not just a physician, you're an entrepreneur in a big way.

Patrick Roth MD, MHA, FAANS, FACS 7:11

Yeah, you know, I think I would have to say that why I became a physician and why I became an entrepreneur both date back to my father.

A Father’s Lesson In Entrepreneurial Medicine

Patrick Roth MD, MHA, FAANS, FACS 7:20

So when when I was growing up, my father, who was a neurologist, used to regale us at the dinner table with stories of interesting patients. And um he loved his job. He was in in private practice, so he had no boss. He was in completely complete control of his schedule and his and his entire practice. And he had a history of doing entrepreneurial things, which really influenced me. For example, in the 1970s, when CAT scan was invented, he had three partners at the time. And they were interested in potentially buying a CAT scan machine. And his part his partners did an analysis of you know how much did I have to run it and how much did I have to make. And uh it looked like it wouldn't be profitable. And my father's like, I don't care if it's profitable or not, this is the future of medicine. We're gonna buy a CAT scan machine. And of course, they made a ton of money off it, even though they had predicted they wouldn't.

Marc Bernstein 8:19

Right.

Patrick Roth MD, MHA, FAANS, FACS 8:20

And the same thing happened when MRI was invented. You know, and it was interesting, you know, nowadays hospitals buy these machines, but they bought the machines themselves. Right. In my father's job as a neurologist, he dealt with a lot of stroke patients. And he realized this is before they had a the field of rehab and medicine. He realized that why you know why shouldn't I be involved in their rehab? And so he bought he put together a gym for his own patients and did that. Again, he did it out of what he thought was something necessary and enhancing in medicine, but he ended up making a lot of money off of it.

Marc Bernstein 8:55

And so when I came came into practice and formed the group I'm in now, would you say, can I just ask you to do what you love and the money will follow?

Patrick Roth MD, MHA, FAANS, FACS 9:02

Is that part of the that's exactly right. That's exactly the philosophy. And so that's been our it's it's you do do what you love, but also get really good at it. Those are the two things. One of the things that really interests me, and I uh this is from the work of Cal Newport. I don't know if you're familiar with him as a as an author, but what people, you know, when people are trying to decide what to do in life, they're often given this terrible advice, which is to follow their passion. And what I've learned, and and this is this is some of the work of Cal Newport, is you don't follow your passion, you create your passion. And you you create your passion by getting good at something. And so you know, for young people, the decision is pretty easy. Just figure out what they're kind of good at and then spend a lot of time getting good at it. You don't have to worry about the passion, it will follow.

Building A Specialized Practice Model

Patrick Roth MD, MHA, FAANS, FACS 9:51

And so uh, you know, when we found when we founded New Jersey Brain and Spine uh in 1995, actually, the idea was there were two concepts that I had. One was that we were going to all be super specialized in our own interests, what you know, do what we were good at and what we loved. And the second thing was that we were going to share the money completely. So there'll be no incentive in the group to hang on to stuff that you're not that good at, just to make the money. And so that's really the secret sauce of success for our group. The other thing that I really got interested in was this idea that medicine is so broken. As a surgeon, you would think that you should put all your energy into doing operations. That's where the money is, right? But we put a lot of money, I'm sorry, I'm sorry, a lot of time into listening to people, developing empathy. Um, and so that's the other secret success because that's really what's missing in medicine. You know, education. We spend a lot of time education.

Marc Bernstein 10:51

You hear a lot about not good bedside manner amongst physicians, right? You hear a lot about that. Well, you know, that would go hand in hand, I would think.

Patrick Roth MD, MHA, FAANS, FACS 10:59

Absolutely. It what's so funny is I hear people say all the time, I don't care about my surgeon's personality, I just want to make sure he has good hands. No, that's totally wrong. You want them to be you want your surgeon to be a human and care, as well as you know what?

Marc Bernstein 11:13

And I I'm I'm right with you. I had hip hip replacement a few years ago. And I could have gone to one of the big factories, the guys that are rated as the best and all that. And I started going through their process, and I said it's not for me. And I picked someone that I could relate to that that we had good conversations. He knew I wanted to play golf afterwards. He was a golfer. We were able to talk about you know what what life after the surgery looked like. And I went with that and it worked out really well. So I understand that conclusion. Um and by the way, one of the things that I mentioned in your bio, which is that you encouraged your partners, everybody, to have very narrow interests, which is the opposite of what most people think they should do. They think they should be good at a lot of things. Let's talk about that a little bit because I thought that was a really interesting observation that you had early on.

Patrick Roth MD, MHA, FAANS, FACS 12:00

Yeah, I mean, there there's been two kind of revelations I've had as I've

Simpler Back Pain Solutions And Mind Body

Patrick Roth MD, MHA, FAANS, FACS 12:04

gone through medicine. That was one of them. And um what I discovered, for example, as I went through just some of my personal stories. I went through this, I was a general neurosurgeon. I did everything brain, spine. And um, but as time went on, I became more and more interested and and also thought that I was better at spine. And even within spine, I became more and more narrow in terms of I what my sort of shtick is that I looked for simple solutions to complicated problems. So people have pain. The the sort of the consensus in at least in neurosurgery is well, do something really big, cover all possible um etiologies of the pain. And by the way, you get paid a lot to do that. And what I got interested in doing is finding simpler solutions for people's pain. And also bring it so much of pain is interpretive. So working on the whole mind-body aspect of pain, because even if I stab you in the thigh with a knife, part of that brain, part of that pain is interpretive. That's not occurring in your thigh, it's occurring in your brain. And so you can always affect pain by working on the brain and the body at the same time. So the the other thing that was really interesting to me was when I wrote my first book, which was about conservative treatment of back pain, my friend said to me, You're out of your mind to write a book like this, you're cannibalizing your own career. And you know, it's gonna, and but what ended up happening was it only it made me a lot more popular. And and I and because surgeons have it all wrong, surgeons think patients want the best technical surgeon. No, that's not what patients want someone who's gonna consider all types of treatment, not just surgery.

Marc Bernstein 13:49

Right, right.

Patrick Roth MD, MHA, FAANS, FACS 13:50

And so and I that was an accident.

Marc Bernstein 13:51

Everybody I think today loves a surgeon who's who will tell them that they might not need surgery either, right?

Patrick Roth MD, MHA, FAANS, FACS 13:58

Well, it's it's fairly simple. All you do is if you can put your and I I call this attunement, which is it's like intellectual empathy. You put your brain into the perspective of the patient, and that's how you help the patient decide what he or she is going to do. And it it never it never fails, but it's so hard for most surgeons. They want to do what they want to do.

Marc Bernstein 14:18

It's unbelievable.

Break And Sponsor Message

Marc Bernstein 14:20

Um, by the way, time flies really fast on the show, and it's actually time for a commercial break. So we're gonna take a quick one, and I want to follow up with you on that right after the commercial. So um here we go.

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Marc Bernstein 15:52

We're back on Founders Forum with our guest today, Dr. Patrick Roth. Pat, uh, before the break, uh I did some really interesting things you said. First of all, create your passion. Don't follow your passion. Create your passion and be real good at it. Um, and then the narrow you more narrow you can become, the more favorable you become, which is kind of reverse thinking of what most people would think. And um, and you were just starting to talk about, you know, you found some really unique aspects of your practice that made you kind of unique. Do you want to expand on those concepts a little bit?

Influence Through Listening And Empathy

Patrick Roth MD, MHA, FAANS, FACS 16:31

Well, I guess, you know, as as a neurosurgeon, you are trained to be decisive, strong convictions. I I had this vivid memory during my training of being called up in front of the chair of the program and um asked a question, and I kind of gave a waffling answer. And he had a very funny voice. He spoke like this, and he said, Dr. Roth, you have the right to be wrong, but you do not have the right to be indecisive. And that actually influenced me for many years, and I realized what one of the things I liked about being a surgeon was being decisive. Patients love it because you're confident. But what I've learned as I've gone through my career is that the real power in medicine is in influence, and influence doesn't come from conviction and and influence comes from being able to listen, feeling empathetic, sharing with the patient, sharing decision making with the patient. And so our practice is very mod very much modeled along that. And at first you'd think, well, you don't make money doing that. You don't make money educating the patient, listening to the patient, etc. But the butt the bottom line is that you influence the patients and your practice continues to grow. So it's a little bit counterintuitive, I think.

Marc Bernstein 17:53

Well, the other thing is to me, I'm gonna translate that into another thing I've been thinking about over the last couple of years, which is conviction means basically you're stating that you're right, you know, that you're you're correct. And one of the things I've kind of discovered, I don't believe there is really any right and wrong on almost most subjects, you know. Certain things, facts are facts, right? Although in this world we're not even sure that facts are facts, but there is no real right or wrong. And what's more important is that you're connecting with and relating to the person that you're dealing with. So if you're a doctor, it's your patient, and that's what you're calling influence. And I think that's really admirable. And I think maybe the world is starting to tilt in your direction, but it sounds like you were well ahead of your time in your profession in terms of looking at it that way, right?

Patrick Roth MD, MHA, FAANS, FACS 18:41

Yeah, well, there's also a really interesting concept of embracing uncertainty. So, you know, again, people have this tremendous need to make up their minds, they can't stand being in areas of gray. But there's lots of evidence to suggest that say you have a very big decision you want to make, instead of making it, sleep on it. And what happens is your the right hemisphere of your brain mulls over it while you're sleeping. And sometimes the answer comes to you when you're taking a shower or something like that the next day. But people have shown, the psychologists have shown that you make better decisions if you let them let it stew in your brain for a while before you actually make it. And so you have to you learn to be comfortable in certainty. You know, one of the things that in medicine resides for the most part in the margins of science. It's not we have this evidence-based medicine that we're confronted with, but for the most part, no individual patient ever really falls into that solidly. So medicine is interpretive, and there's a real benefit to embracing uncertainty before you actually make a decision.

Marc Bernstein 19:47

So there's an art to medicine as well as a science. Absolutely. Yeah, I love that. Um so many other things I want to go through with

Flourishing And The Real Drivers Of Health

Marc Bernstein 19:57

you. So it's one of the things you mentioned to me is, and I you kind of mentioned it briefly here, but we had talked about it earlier, which is that you wondered why you come to work happy every day. You know, I I know so many physicians and lawyers, I'm a lawyer by background, that you know, people pe professionals that come to work and they're not happy, they don't like what they're doing. They can't wait to retire because they can't stay on what they're doing for whatever reasons. And you wondered why that that wasn't you. You wondered why you you came together, you were happy every day. And and I and in fact, that's I think the book, your next book that's coming out kind of hits on some of that. So why don't you talk about that a little bit?

Patrick Roth MD, MHA, FAANS, FACS 20:38

Yeah. So, you know, uh when when I walk around the hospital cafeteria, all I do is hear doctors whining about medicine. And I always ask myself, why is it that I don't whine? Why do I come to work enjoying it? And so as I was sort of researching that subject, I got really interested in the subject of positive psychology, which came out of the University of Pennsylvania. You know, psychology prior to that point had been concerned with taking people who had deviant psyches and trying to normalize them. But no one had ever taken normal psyches and tried to optimize them. And so this came out of the University of Pennsylvania. And um it was a and I realized as I read some of the tenets there that it was something that I was doing naturally. And so it helped me to, you know, and I and I do more of it. So, you know, one of the obvious things is to invest in people and relationships. Um, and you can do that as a surgeon, you know. We have there's a in the operating room or in the office, there's a little microcosm environment which you can invest in, and that pays tremendous dividends. I'm sure it's the same for you, the staff around you with this radio show, right? You've invested in that, I'm sure, and that creates happiness uh and positive feelings.

Marc Bernstein 21:55

Yep. Yep. So so the people around you, the uh um you use the word social determinants. Um and and they're you know and though and I know those things influence health and longevity as well obviously. Um as a as a physician do you want to comment on that aspect of it briefly?

Patrick Roth MD, MHA, FAANS, FACS 22:15

Yeah I mean I mean look people th think that going to the doctor is is the way they should deal with their health. But health care is really disease care. Healthcare and and if you look at health as an entity health care only accounts for about 15% of our health. The other 85% are the social determinants of health and you can build health the way you eat the way you exercise the way you sleep the way you handle stress um and really the way you organize your career are all ways of building your own health that reside outside of the healthcare system.

Marc Bernstein 22:52

I agree and I've gone through a lot of that re reconfiguring um because of my health the way I conduct my business in my life over the last 10 to 15 years. And it's um I feel way younger now than I did then to put it that way to quote Bob Dylan in a way. So I know you're a music fan so I'll bring that in too I I I was so much older then I'm younger than that now.

Retirement Vision And Redesigning Healthcare

Marc Bernstein 23:19

Do you um let's talk a little bit so you're you are typical retirement age and you'd mentioned before trying to figure out retirement but I know at the same time you have a 10 year vision. So if you and I are talking 10 years from now which I hope we'll be doing which would be on April 29th 2036 and what would have to happen over that 10 year period Pat for you to feel like that would have been a successful period in your life? What does that look like?

Patrick Roth MD, MHA, FAANS, FACS 23:49

Great question. I well I think the first thing that comes to mind is that I've gone through and you've I've seen this written but it's really a great concept I've kind of gone from the resume building part of life to the eulogy building part of life you know instead of interest instead of being interested in how you pad your resume start to build the things that people will say about you at your funeral. And so one of the things that is going to be essential to me is that I increase because being a surgeon being a nurse surgeon gave me limited time sometimes but I want to make sure that I really establish relationships with family, friends, etc. It's really important to me. The other thing is I'm you know obviously it's a use it or lose it um in terms of your of your brain but what one of the things that people don't understand that if if you could pick one thing to to preserve your brain as you age it would be some form of aerobic exercise. Everybody talks about learning language and you know playing doing crossword puzzles but probably the most proven stimulant for longevity in the brain is aerobic exercise. So I want that to be a very solid part of my future and then as I transition away from being a surgeon I think what I would love to get involved with in an entrepreneurial way because I think it's so broken is healthcare design. And you know one of the biggest flaws of medicine right now is that the treatment that patients get depends on whom they see first as opposed to what they have. It's a crazy idea. And so I believe medicine can be redesigned so that the patient's treatment is not affected by the personal interests of the provider. They just happen to see first. That sounds like a big project so many people benefit from medicine financially that it's very hard to change the system.

Marc Bernstein 25:45

Right, right. Listen I just even there's actually well without getting into it there was a candidate for Surgeon General who I listened to and a lot of people thought she was a kook but she actually made a whole lot of sense because she talked about you know how much influence the pharmaceutical industry and the fast food industry have on medical schools today. It's shocking when you hear where all the funding comes from and where all the information comes from there's this big to your point intricate financial network that's hard to break much like our political system right but so it's a massive job and I'm glad you're taking it on. Yeah I love that I love that.

Favorite Songs Book And Closing

Marc Bernstein 26:24

Real quick because I know we we talked a little bit about uh music before and one question I'm really anxious you have a broad uh based interest in music um what is your favorite song?

Patrick Roth MD, MHA, FAANS, FACS 26:36

Well I'm gonna give you an interesting I'm gonna give you two songs because as I mentioned to you earlier the you know I grew up in a in a traditional rock environment and then really moved to alternative rock and have spent the last 15 years so as a traditional rock um I'm and by the way part of it's the whole history behind it but the um God only knows by the Beach Boys off the Penn Sound that's many people's favorite song yeah it's just because w when the Beach Boys released that album it got the Beatles and the Stones attention it was it was such an incredible and it it's such a beautifully written album but that song to me is the favorite on the album. And then the other song I would say to you is um you've probably never heard of it but it's a group called the Porcupine Tree which is considered a progressive rock group and it's and um it's I the song I love is I Drive the Hearse which is incredibly melodic. It's a pink Floydish type of song melodic but just beautiful and it's probably one that your listeners have never heard including me and I listen to a lot of music so I'm I'm going to check that one out.

Marc Bernstein 27:47

One real quick favorite book and that's all we have time for after that.

Patrick Roth MD, MHA, FAANS, FACS 27:51

I would say one of my favorite books is Stumbling on the Happiness by Daniel Gilbert. He's a psychologist at Harvard and uh it's a brilliant book changed my life reading it excellent well I think that's all we have time for.

Marc Bernstein 28:05

So I want to thank you for being here. It's a really fascinating conversation we may need to do it again sometime. And thank you all for listening to you in part on Founders Founders’ Forum was brought to you in part, by March Forward, LLC.

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