In this episode of the Telehealth Heroes Podcast, we interview Dr. Joseph Krainin, the founder of Singular Sleep, an award winning sleep center that offers at-home sleep studies. We discuss his unique career path, his pains with the American healthcare system, and why doctors should learn business skills in school.
Episode transcript
Brandon:
On the podcast today, we have Dr. Joe Krainin. Who’s the founder and president of Singular Sleep and award-winning online sleep center. After graduating with honors from Amherst college, he attended Tufts university school of medicine in Boston, Massachusetts, where he earned his medical degree. Dr. Krainin completed a fellowship in sleep medicine at the Michael S Aldrich sleep disorder center at the university of Michigan in Ann Arbor is a double board certified in sleep medicine and neurology. And in 2013 was elected as a fellow of the American academy of sleep medicine, Dr. Krainin, and thank you for joining the podcast today. It’s my pleasure. Great. So tell us, tell us, why did you get into medicine?
Dr. Krainin:
Well, I think everyone has the answer they give during their interviews for medical school. And then there’s like the real reason, but I think my probably not too different than what I said, science was always going to be where I went. I just had that sort of brain. I want to find the truth. That’s what I’m interested in. As David Foster Wallace would say the capital T truth, the unadulterated truth, and, and I’m not afraid to go there. And so I knew it was going to be science in college. I tried a couple of different things. I did an internship in woods hole at the, at, at NOAA national oceanographic atmospheric association. I ended up counting these minuscule Cod larvae or eggs. I forget what it was exactly, but it was very tedious and I’m like, I can’t do this, the rest of something like this, if I’m going to do so, it was, then I was like, I gotta do something with people.
I mean, that’s just going to be way more interesting than some like tiny little animal or some animal that you have to make a lot of inferences about by observing it. Like people are the most interesting animals, right. So let’s cut right to the chase. So then the, the, the natural thing was medicine. You know, you’re putting the science and people together. So that’s, that’s where you go.
So for me, you know, that was back and there’s also an overriding respect for medicine in my family, particularly the paternal side of my family, because my dad’s father was a physician. He was a general practitioner in New York. And he was like one of two doctors in the whole area. And I mean, he was just like integral to the community. He would just give the kids the school physicals on up to taking care of the elderly people in the town. And there was just a lot of respect for that, that, that field growing up passed down from, from that whole side of the family.
So I think that, and he was also Joseph Krainin and too, so I was named after he died, died about a month before I was born. So I never met him, but he was sort of like a mythical figure in the family. He was also, he also played semi-professional well, he played professional baseball for the New York giants, but he never made it to the big leagues. He was like, I don’t know, maybe AA or something like that. But this rumor was, he put himself through medical school by playing by the money or playing baseball. So pretty cool guy. I wish I had a chance to meet him, but you know, that was definitely an influence too.
Brandon:
Yeah. Great. So you got into sleep medicine and neurology. Tell us a little bit about that path and where that got you to essentially your passion and medicines back.
Dr. Krainin:
My attention in medical school was to go to psychiatry because I really liked the, the idea of the intellectual component of psychiatry. Like it wasn’t so cut and dry contrast that to orthopedic surgeon surgery, where you’re, you’re basically a tradesman, you’re an extremely, well-trained highly paid carpenter basically. And you ended up doing the same stuff over and over again, probably like three or four things is going to as a surgeon or you in most, most doctors that do procedures do just a couple things over and over again. I liked the idea of using my brain, but when I got into it, I found that psychiatry really wasn’t for me, it was like number one, just too depressing.
So I kind of had a falling out with psychiatry and then falling in with neurology, which was kind of the flip side of that. So the mind brain duality, right? So psychiatry is the mind. Neurology is the brain doesn’t get cooler than, than that. Right. And was a little bit more dry. Like you, it was easier for me to kind of hang it up and, and call it a day. And it was by far the most interesting thing to study for me. I mean, the brain is the most complicated thing in the universe probably. Right.
And like, maybe we’ll never be able to understand it because of just the limitations of our brain, trying to understand the brain. But once I, I mastered neurology, I just devoted myself like, like a slave to study neurology during residency. So that’s four years. I had just engross with it, just obsessed with it. But once I, I felt like I figured it out. It’s like, what can you do with neurology? I felt like you can’t help that many people. At least I felt that way. There’s a lot of chronic disorders that, that you’re dealing with that you can maybe kind of slow down or slow down the rate of decay of the individual’s abilities. But there’s not a lot of big W’s with neurology. So there was sleep. And there was also a very colorful mentor that pushed me there, Dr. David Rosenfeld, who is the first guy to characterize a subset of parasomnias, which is like sleepwalking sort of behaviors where people act out sexual impulses in their sleep.
And he coined the term sleep sex, and it later someone else discovered it and named it sexsomnia. But so he did the first case series of this, and he’s just like really fascinating guy and really was in the right place at the right time for me and sort of like, oh, you gotta go into this field. It’s so cool. And you can really help people. So that’s a great thing. Like coming from a neurology background, there’s a treatment for every sleep disorder and they work in people, although on some level, I don’t know if you compare it to say hematologists, oncologists, you know, this they’re curing or treating cancer and like saving lives. You know, what am I doing on a day to day basis? I’m helping people sleep better. That may not seem as important, but really you can meaningfully improve the quality of people’s lives very quickly, which is as a physician quite satisfying, because what they don’t tell you before you go to med school is a lot of times you just keep seeing the same people circling around it.
Sometimes you feel like you’re rearranging the chairs on the deck of the Titanic. Right. And it’s like, even that orthopedic surgeon, there was a problem. He fixed it. And then a couple months later person comes back and it they’re in pain again. Okay. Well, oh shoot. Well, what do we do now? So this it’s, it’s a, it’s, it’s, it’s very satisfying for me because people like love you, you know, when you get them to sleep well and they’re feeling good and, and much more productive during the day, they’re happier and long-term, we can really affect some, some good health benefits. You know, if, if these disorders are not corrected, like say sleep apnea, it can lead to a lot of badness down the line.
Brandon:
So it sounds like you are attracted to making an impact on patient’s lives and, and in neurology, there’s a lot of diseases that you can help, but it’s not really making a huge impact. Whereas you see that sleep is something that you can really make that impact that you’re looking at
Dr. Krainin:
For me. Yes. I’m sure, you know, neurologists love to argue. That’s kind of our thing we want to be, we want to be right. I think it’s because there’s so little we can do for people that we get our satisfaction for being right, being Craigslist. Like, you know, the, the, the classic thing was someone comes in with this, you know, very complicated problem. And the neurologist, you know, is teaching the med students and uses some German eponyms to describe this rare phenomenon. And it’s sort of like, okay, cool. Now what do we do? It’s like, well, there’s nothing to do, you know, next patient. So, but yeah, for, for me, it, it, it is one of the areas that is, you know, under neurology in some ways that that is a very active field where you can really help you. The other thing is it’s quite new.
It’s basically a baby. I mean, C-PAP was only invented in the 1980s. And so that’s the mainstay treatment for sleep apnea. Right. And you know, all the, all the innovation in sleep sleep medicine is, is relatively recent. So because it’s young, there’s a lot of stuff we don’t know. And it’s fun to be a part of that and help try to figure it out as opposed to, you know, Parkinsonism Parkinson’s disease. That’s pretty well, you know, a lot of that stuff has been worked out pretty well, whereas is sleep. It’s kind of, in some ways the wild west, I mean, we still don’t really know why we sleep. I mean, anyone who tells you otherwise is, is lying, which is, I mean, the fundamental question of the field is, has not been answered yet.
Brandon:
So did you start right from your residency going into sleep a full time? Or what was that transition that, that ultimately got you to doing sleep and your practice?
Dr. Krainin:
Yeah, so just like pretty much, it seems every field of medicine is tending towards sending away from generalists and more to sub or sub sub specialists. And so it’s very common in neurology after you finish this grueling four years, that you then sign up for more pain and do extra training in some particular sub specialty. So there’s a lot of different fields you can go into from, from neurology and sleep sleep was the one I was most interested.
Brandon:
Gotcha. So tell me how you run your own practice now, is that something you set out to always do to own your own practice and, and or how did you really, no, it was,
Dr. Krainin:
I think I was pretty much put through the, the sausage making factory by the system is what I like to say. And it didn’t even occur to me that I could do that because, you know, the days of my grandfather, he, he did one year of, of, of training internship. And then he actually, he was drafted to world war two and he ended up doing a lot of plastic surgery on returning vets and his commanding officer also physician said, I think you should go to the Mayo clinic and do some extra training in this. And by that time he’d had two kids and he said, no. So he just hung a shingle and start his practice just him by himself. And it was a business and people paid cash. If you can believe it, they didn’t have insurance. Can you imagine a time where there’s no health care insurance?
Like how did life work? Well, it apparently worked pretty well. You know, he, he had a nice life and that he was working a lot, but I think he was happy and satisfied. And he’s like I said, a very important part of the community, but the system now basically tells you, you need to get a job. Someone needs to write you a paycheck. That’s kinda the way the mindset is shaped right now. And even more so increasingly now, it’s, you need to either work for a big multi-specialty group or an academic type setting. There’s just not really the push towards private practice. Private, private practice has been basically like cut off at the knees. And it really was, I think, heading in the wrong direction. I think private practices, especially solo, private practice or small group is, is really, really important for competition, but it was, it was going in, in a bad direction. But then with Obama’s administration, basically there were some changes where, you know, to give you an example, changes were made in Medicare, where they said, okay, take the example of cardiologists.
We’re going to, if you do the echocardiogram in the hospital, we’re going to pay $200. If you do it in your private office, we’re only going to pay you 50. So of course, what are they trying to incentivize here? And what they’re, what, what happened was what they wanted was killing private practice. And, and these groups got bought by these ACH. That was a big thing. Then remember that. And I don’t know really what’s happened with all that, but the government wanted this consolidation of hospitals with big private practice, big primary care groups. And then specialtist specialists in this ecosystem where everyone’s data could be tracked through online medical records and whatnot. So that really was sort of like the death now, as I see it for traditional private practice is really hard now to just go out and hang your shingle and start a business.
But there are some of us who just said, we’re going to try it, the crazy ones. And you know, and to do that, you have to, as Steve jobs would say the different, I think the reason that I’ve had, you know, I, I’m still here with you. You know, I started, I started Singular Sleep. We launched six years ago. And I think that the reason we’re still here, still here and we’re doing well, is that I wasn’t trying to replicate the traditional private practice of old, but something totally different and found, found space for that. And I think the physicians who want to do something different outside of the system now also have to find that niche and elbow their way in which isn’t me. I think an uncomfortable feeling for a lot of doctors who don’t think of themselves as business people, because they don’t think of medicine as a business.
Well, I’m here to tell you it absolutely is just because you don’t see the sausage being made money is moving all around in that is, that is a business. And so I would love doctors to think more like that doesn’t mean get an MBA, but think more about markets and think about things in terms of a business. And I think that it could only help our healthcare system competition to innovation, trying new things, not everything’s gonna work out that’s part of growth and moving in the right direction. It’s all, it’s all evolution. Right. You know, and that’s what businesses, you gotta try. You gotta have a mutation and have a different phenotype. And then, you know, maybe it wins out. Maybe it doesn’t, if it wins out, it gets more resources. And that, that spreads and that’s how things get better. Right. What we have here is kind of like some reverse evolution in some ways, always. Yeah,
Brandon:
Yeah. Devolving in a way. So how did you, I mean, you were trained as a traditional traditional doctor and you go through the ranks, what caused you to break out of that mentality? And to really, like, as you say, think different, what was the set point that made you think different? And then what was that? How did that make you feel? And then what did you do to do that or to make that change?
Dr. Krainin:
Well, I, I think if I was going to characterize my story, I would say I followed the pathway that the system wanted me to follow, which was finished fellowship. I joined a hospital based physician group and I did well, I quickly became in like a year, the medical director of this big sleep center, I think in the end we had like 18 beds or something like that, which is really big. And after a few years I was number one, really bored. And that’s something, if physicians are honest, they’re going to tell you the practice of medicine. If you don’t know, no what’s going on in the first couple of minutes with a patient, then like, there’s something wrong with you. Because like, if you do this long enough, you should know pretty quickly like that shouldn’t be, your brain should be straight. Yeah. To figure out what the diagnosis is.
If you do this for a few years, it, you tend to see the same stuff over and over. It’s like, opt-ins razor, right. W with your approach to this. So in this specialty sleep medicine, I’m not gonna lie. The, the diagnostics of sleep medicine are nowhere like neurology. I mean, vast majority of people who come in are coming in and they’re going to have sleep apnea. That’s just sort of like our cross to bear. And so you got, you know, it wasn’t feeling challenged. And I feel like I hit like a plateau in terms of my growth and development, but also wasn’t really a decision. Although I was nominally the medical director, Esther of the sleep center, all the real decisions were being made by a nurse who is even though like not officially sleep, but she was really running the whole neuroscience department. And she was my boss.
And I’m like, why did I go to medical school and do all this training to end up working for someone who doesn’t have that training? And she’s making all these decisions and like, you know, would come down to hiring people. And I, I, I think this person’s great. And she would ultimately, you know, even though it would be this, all these committees and meetings and nothing would, you know, how it is in academia and you’re, you know, all these different meetings and you have to have everyone on board, but then there’s like someone really who’s the puppet master in the back and like can kind of make the call. So, and that wasn’t me. And it was like, this is really frustrating. So at that time I was kind of, I was getting a little bit bored with the clinical practice of, of sleep medicine.
I start, I got the idea of branching out to become like a performance sleep specialist and help like elite athletes, better manage their sleep to get more out of their bodies. And that led to a bizarre series of, of events where I ended up becoming the medical director of the Orlando magic NBA basketball team. Right. So most people just heard that. They’re like, wow, that must have been so cool. And that’s what I was thinking too. Like, I, this, I thought this, okay, this is it. This is my ticket out of the system. This is going to lead me to get specific expertise and credentials in this area. And then, you know, hopefully I’ll be with magic for a long time or whatever, or another team, but then I can be like the guy for athletes and have my own consulting business or whatever, but it quickly turned into a nightmare. So as a physician, you’re used to working with people, generally speaking, who have a problem and want to get better in this situation. People, the players generally did not want to acknowledge that they had any problems and certainly didn’t want to do anything about them. So, I mean, we can go, that would be a whole nother podcast, but there’s a certain sort of psychology that’s going to get you to this elite level. And part of that psychology is just like this extreme.
You could say confidence, or you could say narcissism that there’s no like recognition of any sort of weaknesses in them. And when you’re trying to help someone get better, it was just like a big wall was up. Like, you could imagine you or me, Brandon, we’re sitting in an arena. There’s 20,000 people cheering. We’ve got to make this free throw to win the game. Like, I don’t even know if I could get the ball, like, like to even touch the net. Like, I’d be so nervous. Right. But these guys, their psychology such, they don’t think about that. It’s like nothing. They’re like, they think they want, they have to be invulnerable. But so it was, it was very difficult to deal with that. And then I was traveling with a team and you don’t go into sleep medicine unless you’re like really into your own sleep.
And I, I love sleep and I love getting good sleep in this, this schedule for the NBA is terrible. So we’d finished a game at nine. We get on the plane at 11, we fly across the country would get in and out three o’clock in the morning, local time and then have to get up for shoot around at nine. And it was just terrible. It was like really a bad lifestyle. So this, this dream I had kind of turned into a nightmare. And then, so it, it all kind of, basically, it was one of those situations where an organization says that they want change radical change, and then realizes that they don’t any change at all, which is extremely common, like to give sort of like lip service. And like you get going down this group, think thing. And then like, when something changes, they’re like, oh no, we didn’t want that at all.
So like it enough culminating in B at that, at that year, Derek rose had had this terrible ACL injury and which kind of just like torpedoes career. So I’m like, oh gosh, what can we do to prevent these injuries? And actually I found a pretty good protocol use in Europe and the pro soccer leagues over there. It’s a series of like plyometric exercises that they had found had really reduced the risk of a, of a major ACL injury, which, which is, is a bad injury, not the most common entry in basketball, but could, could be devastating as we saw. So I basically was, like I said to the orthopedic surgeon for the team, Hey, I want you to put this like program together for athletes and come up with a protocol. And it was going to be like, I don’t know, something like 10 minutes every other day, as part of the practice, not a big commitment on their time.
And we ended up, he was adamantly opposed to it. And we ended up getting in a huge fight and basically he pulled rank. And next thing I know I’ve gone, I’m fired. So, so here, here I go. I’ve like gone in the situation. I thought it was going to be this dream job and it’s turned into a nightmare. And I think for me, that was sort of like you hear with like alcoholics, you know, finding rock bottom in a way that was sort of career rock bottom for me. And I’ve never talked about this publicly actually, or your first person, I guess this. And so what happened was, yeah. At rock bottom, it makes you think, how did I get here? And so that was the question I’m like, I don’t know. Well, even like basketball, why did I take this job? It was sort of like, I thought that if I did this, this would be good and this would be beneficial, but it wasn’t, I wasn’t thinking about what was right for me, Joe Krainin, and what was like the best fit.
I didn’t know myself. And this was a huge wake-up call. And it made me confront a lot of things, including a bunch of, I think, underlying fears and anxieties, and one of those fears, and we’ve talked about this. One of the big fears for me was learning how to ride a motorcycle. And after, so after this didn’t work out anywhere near, as I thought it would, it made me reevaluate everything and I was much more open to stuff. I just felt more open. So it was like, you know what, I’m going to learn how to do this. And I was so scared. I remember getting on the motorcycle at the Harley Davidson store and turning it on. I thought I was going to immediately ride through the fence onto the highway and kill myself. It’s so, you know, and then it was another other fears of like, you know, commitment and getting married and having kids.
And then the, really the deepest fear of if I’m going to be honest with you, Brandon was starting my own business because you’re really putting yourself out there, totally exposed to the world. It’s all you, you can’t blame anyone else. It’s like, here I am. I’m going to go for it. If I fail, it’s all me, there’s no one else to blame. And so I, I, you know, got the guts to do it. And, and I knew so in, in thinking about and learning about myself, which I don’t think a lot of us are very much in touch. We just kind of do things. Even a lot of people go into medicine because their parents wanted them to, or their brother or their dad or whatever. And they don’t. And then they’re like 20 years later, they have like a major midlife crisis and they’re like burnout.
They don’t want to go to work. They’re hating life. They’re depressed. There’s very high rates of depression and job dissatisfaction. I think pretty high rates of suicide and physicians too. And I think a lot of it is that people just don’t know why they’re doing the things that they’re doing. But for me, I knew that for my personality type, that I needed to be on my own and start a business. And so that’s what I did. And I looked around at a couple of different, I had a couple of different ideas. One was a performance Institute. I learned a lot about high performance stuff. And for focusing on like high school athletes and, and, and working with them with some of the techniques I learned to give, give them an edge. Another idea was a, a brain health clinic to help people keep their brain as healthy as possible, prevent dementia and be like a sharp mentally as possible, also kind of performance based thing.
And then the other idea was this online sleep center, because, so what happened was after the, the crash with magic, I just kind of like, while I was gathering myself together, my all my family had had moved to Charleston, South Carolina. So I thought, okay, let me, let me get set up there, get a little money to pay, pay the rent and then make my move. So I took a job at M U S C, which is where we met. And I was doing a lot of tele neurology and it was okay, but there are limitations. Like there’s only so much that can be done remotely. Like it’s hard to tell a nurse who doesn’t know how to do a neurological exam, a very complicated eye pupil test, but it occurred to me, this would be an ideal format for sleep medicine because there’s no physical exam really that I need to do.
It’s all in the history in conjunction with the sleep study. So it was like the aha moment. And then after thinking about it, I’m like, I really think because I have the most specific expertise here in sleep medicine, that this is probably my best bet. So the idea was to radically disrupt the way sleep medicine is done. The traditional method in my mind was ripe for it. It was just stagnant. It, the typical model was you have some symptoms like you snore a lot. You feel tired, you don’t sleep well. You go to your doctor. Typically primary care has to tell them about it. They order a sleep study. You wait a few weeks to longer go into an in-lab sleep, study, all the stuff, myriad, sensors all over your body. It’s really hard to sleep. There’s a little camera with someone watching you and someone coming in periodically and adjusting the sensors that pulled this.
It’s really hard to get a good night’s sleep there. And then you go home, you wait a week or two, you get the results that your doctor says, oh yeah, you have sleep apnea. I’m going to send you into a sleep doctor. You go see the sleep doctor that takes another month to get in. If you’re lucky, the sleep doctor then orders a second in lab study, where they find the right C-PAP pressure. It takes a few weeks to get into that. And then you have to wait a couple of weeks to get your, your machine from the durable medical equipment company that your insurance company is contracted with. It can take like three months, no problem to get this issue, start to be treated. So it’s not this
Brandon:
Huge pain point for patients. And we’re like this, this is not working. That there’s an opportunity here to disrupt how the sleep medicine practices is done.
Dr. Krainin:
And no one thought of it. I mean, it was just, okay. Yeah, this is the way it is. That’s the way it’s always been.
Brandon:
Like, when you said, Hey, this is right for disruption. How did you go about figuring out how to disrupt it? And were there books that inspired you or were there other examples that inspired you? What, what, what, what got you thinking on this path of, okay, this needs to be disrupted, but this is how to do it. And this is where I’m going to go.
Dr. Krainin:
Well, there was the tele medicine concept of doing that, like interacting with patients remotely, and then the connecting the dots with actually this is working just okay for neurology, but it works really well for sleep medicine. Coupled with home sleep testing was on the rise. The technology has gotten better where to the point where we constantly send people these kits and have them do the testing and sent back to us and then were there other sources? I think the big connection was with, okay, the tele medicine that’s this, this would be appealing. People don’t want to go in and we could do the whole thing at home. We can do this whole process at home very quickly. My
Brandon:
First experience with telemedicine. Yeah.
Dr. Krainin:
There was at doing neurology, tele medicine for him.
Brandon:
Yeah. That’s what I mean. So at the, where you were at, that’s your first experience with telemedicine? So you, you were, you were there, you had the background in sleep medicine, and then you were introduced to this new technology telemedicine, and then another new technology has come up that holds the combination of those multiple forces are converging at the same time.
Dr. Krainin:
There’s a very influential book that I read called zero to one by Peter teal. And it basically, the synopsis was like, there are two types of businesses in two types of innovation. There’s one that tries to take something and make it better. And then there’s that. And there’s only so far, you can go with that. The payoff is limited. The payoff is much bigger if you can go from so, so those were the, like the one to N concepts. And then there’s the zero to one where there’s like nothing there and you could potentially have a monopoly and I’m like, okay, no one is doing this. I think I could actually do it. And I think I could do it myself in the payoff could be huge. Let’s go for it.
Brandon:
And so, so you went for it. So I’m sure there were aches and pains along the way, but as you’ve gone through gone for it and the unconscious, how has that, how has that done for you in terms of your career, career satisfaction? And are you satisfied with what you’re doing today?
Dr. Krainin:
Well, it’s the same. There’s a Zen saying it’s like something like before I found Zen mountains are mountains and rivers are rivers. And as I was discovering, Zen mountains were no longer mountains and rivers are no longer rivers. And then I, I learned Zen in mountains, became mountains again, and rivers became rivers again. So I think what it is, it’s, it doesn’t change who you are fundamentally, but it’s maybe it’s sorta like psychoanalysis. You have like a different understanding of yourself. For me, it’s been the most important thing I’ve ever done in terms of my development as a human being. I liken it to when people ask me about my experience, I think there’s an underlying anxiety or axed and people have like, can I take care of myself? Can I, can I survive in this world? And not only that, but if we have families, can I survive in this world and take care of my family?
Dr. Krainin:
And this experience to me was akin to leaving the village where I was working as like a blacksmith and having a, like a nice, you know, comfortable life going out into the woods with a knife and just like teaching myself that I could survive just with my own skills. And it, it, it really is that like a self-esteem booster, you know, it’s hard. And there’s like a lot of pitfalls and fails that are, that are tough along the way. But when you get something going and it’s working and you’re like, I did this myself. You know, like, well, I don’t know if you didn’t, who did, but yeah, I did it. I did it. That’s, that’s what my wife was integral for sure. She was a teacher and she helped me. She was like the practice manager, if you will, nothing knew nothing about medicine, nothing about sleep apnea, very, very smart women.
I did well marrying her and she, I couldn’t have done it without her. She stopped teaching and helped me do this. And I had this vision, which sometimes seemed like a delusion, but I, I thought it was more likely than not that it would succeed and be worth the effort. And that’s the sort of decision I would say that that’s the decision point that people have to ask themselves is, is you’re not going to ever know a hundred percent, if this thing you’re going to try is going to work. But do you think it’s, it’s more likely than not. And if it does work, is the payoff going to be big, big enough to justify the risk? That’s important to ask yourself. So I think it’s been for me as a human development thing, I feel like a very evolved person because I’ve been able to do this.
And I have a much deeper understanding of how the world works, how business works in the inner workings of, of medicine. I think most doctors are just in their silo, their doctor’s silo, and they just do their thing and show up at we’re kind of mentally punch in, mentally punch out and they get their paycheck and that’s it. But they don’t, there’s so much going on behind what, what created that office that they go to, but all the marketing that gets the patients to show up and all these different things were fascinating to learn about. And then actually from the sites, like, as I alluded to before, the clinical practice usually gets pretty Monday, if not outright boring after awhile. And if you liked science, it’s all there because I’m doing more science, I think, than I did in clinical practice. I’m constantly looking at, okay, let’s try this new thing with marketing.
What if I do this with my online ads or this affiliate marketing thing, or this, we tweak the website copy to this word, instead of that word let’s monitor and see what happens are people doing what we want them to do? You know, it’s, it’s very interesting. It’s like it’s constant experimentation and the benefit is more money in your pocket, you know, if you’re right. So, I mean, what’s better than that really.
Brandon:
So what did Singular Sleep evolve into?
Dr. Krainin:
Singular sleep today? It is an online sleep center that focuses on the remote diagnosis and treatment of sleep apnea. So the typical situation is someone will order a sleep study from us online, fill out a form and order it. We send it out to them with detailed instructions about how to do it. They do the test in their own bed, in their own home, which myself and a lot of sleep practitioners think that there’s more ecological validity to doing your sleep center in your own home and the sleep lab. There are some, some downsides to it, but I think in general, the pros outweigh the cons in terms of getting a better picture of what’s happening that night with the person they send the sleep study back, my staff uploads it. I can read it wherever I am and send out the report, the official report.
And then they have the ability to do an online consultation with me, or they can go to their doctor and go over it and have the doctor, their primary care, whoever managed it, most folks will meet with me online. We’ll go, I’ll explain to them in detail what the report means. And then we’ll talk about treatment options. And the gold standard is still C-PAP, but there are more and more innovative alternatives coming out each year, including something that came out not too long ago, that’s basically a tongue stimulator that teaches your hype, your, your tongue muscle to be stronger and, and prevents it from falling back and including your airway. So different, different strokes for different folks. So depending on what this study showed, you may be a candidate for that or something, you know, something else. And then we sell the equipment to that, that treats people.
And that’s really where the magic happens, because if they get the equipment from us, it allows us to remotely. Now with the innovation of the equipment, we can, we can monitor them remotely in dial the machine in for them over time to the optimal settings, that best treat their sleep apnea. And then we’re in it for the long-term. We try to get people to check just like a typical physician’s office. We, you know, it’s a long-term relationship. This is a chronic medical problem for most people think of it as type two diabetes or high blood pressure. That there’s a, there’s a treatment, very good treatment. And if you don’t use the treatment, a lot of bad things are gonna happen to you. Probably there’s really not a cure per se, other than losing a whole bunch of weight for some people and the same sort of situation you might have with type two diabetes or high blood pressure.
Maybe if you lose a whole bunch of weight, if you go away, but it’s rare that that happens. So we’re, we’re, we’re, we’re managing it long-term and we want to make sure that the sleep apnea is optimally treated to help prevent the medical sequella hypertension type two diabetes, atrial fibrillation, my cardio infarction’s congestive heart failure, stroke, et cetera, et cetera, et cetera. There is a misconception out there in the medical community that so long as you’re using a C-PAP you’re good. That’s all you need to do. It’s done. Here’s the problem. He would be like, the analogy I would use is you have high blood pressure. You put someone on 20 mil milligrams of lisinopril and you never check their blood pressure yet. They still could be hypertensive. You know, I need to adjust the dose might need to put them out something else you just using. The CPAP is not enough. You need to make sure that the C-PAP is fully treating the sleep apnea. It’s really important. That’s what we do. And that’s what we do really well.
Brandon:
At the beginning you mentioned that you got into medicine because you wanted to find that truth, the capital T do you feel that you’ve found that with what you’re doing now?
Dr. Krainin:
I feel like I’m on the right path. I feel like I am much more knowledgeable about the capital T truth of the universe than I was six years ago. I have a deeper understanding of human nature. What motivates people, what people are after their wants and desires, how the world works than I did when I was an employed physician. It’s it’s like going into the matrix is what it’s like.
Brandon:
How has your perspective of healthcare in general changed through this journey that you’ve been on?
Dr. Krainin:
Well, one thing it’s been really delightful, the vast majority of my patients, since they have to open their wallets and pay money, they really want to get better, which is delightful. It’s delightful to work with them. When, when I was in the employed model, I see a lot of people who are kind of being pushed through the system, like their doctor referred them, they’re on Medicaid. They have no disincentive not to go to the appointment, but they’re not really motivated. They want to get things, just keep getting pushed around through the system. Like some very small percentage of patients take up a disproportionate amount of healthcare resources. It’s like, you know, some of that’s bad luck, but a lot of it is just not doing what you’re supposed to be doing. Like put down those Twinkies and hohos and go walk. You know what I mean?
And so the patients that I have for the most part are super great to work with. Now, the patients who can be a little bit challenging are people that were forced to do the sleep studies for some regulation, like a department of transportation thing. Like they’re not motivated. And they don’t. That’s how, like a lot of my patients where before it was, so it’s been really nice to see that it’s been nice to see, like when all the incentives are aligned, how great the practice of medicine can be when people want to be there and they want to get better. Awesome. Amazing. But that’s not the way we’re doing it right now. So there’s a class like a classic Harvard business school case study, which in the punchline is like the problem with wanting a but rewarding B. Okay. And that’s what we’re doing too much of in medicine.
So there’s a really cool study that, so before Obamacare, there was Romney care, right. And I’m from Massachusetts. So something that I was exposed to, and basically, you know, very generous, free healthcare for people. And they weren’t the healthcare authorities, weren’t getting the outcomes that they were really hoping for and expecting. So they thought, okay, let’s do a study. Let’s charge people who are, who have MassHealth, which is the free health plan, eight token fee, a nominal fee for the services. And the theory is that they’ll have some skin in the game, which will motivate them to take their health more seriously. So what we’re going to do is like charge people 25 cents for a doctor’s visit. And the theory is that because they pay that psychologically, they’re invested in it now and, and they’ll, and they’ll, they won’t, you know, they’ll, they’ll want to be healthy and get healthy.
So what do you think they found? Well, now it’s no surprise to me as I have a deeper understanding of human nature, but they found that just that 25 cent token fee led to worse outcomes. People just stop coming altogether. They’re like, oh, I had free health healthcare. Now you’re going to make me pay a quarter. I’m not going. And so the diabetes got worse. The high blood pressure got worse, et cetera, et cetera, et cetera. So they did away with it. So, I mean, we’ve got to figure out a different way because if you look at the budget for the U S it, it, it basically justifies in a con a famous economist who said the U S government is basically a healthcare company with an army. So like the, the majority of our expenditures are on healthcare and it just keeps getting bigger and bigger and bigger.
And at some point we’re going to have to reconcile with the fact that resources are limited. We can’t just keep printing money and spending it like drunken sailors. There’s going to be a reckoning. Right. And so how do we find better ways to use our resources that get the outcomes that we want? And that, that, that’s the challenge. I think it’s going to be like to do that would be total re-evaluation restructuring of our healthcare system. But if you asked what you did, what I would say it was, you know, let’s look at other insurance models like, well, first of all, we don’t take insurance. So that hearkens back to my grandfather, we just said, we don’t want to deal with it. And it’s such a hassle it’s so problematic. We said, okay, we’re going to offer you care for good value, modest, reasonable costs, but we’re not dealing with insurance.
And it, it that’s, that was another pain point for me. And traditional practice, you end up becoming, you know, above the nurse, who is my boss, was like, what’s the insurance company who’s basically dictating whether they’d approve a sleep study or not whether they had approved this medication or not, whether they had approved this other test or not. And I’m like, why did I go to medical school to just follow their algorithms? Like that’s not right. And that’s a big source of dissatisfaction, I think, with a lot of physicians. So this way, when we’re not beholden to insurance, I can just order what I think is right. Prescribe. What I think is right now, insurance may not cover it. And the patient may not get it for financial reasons, but I get to do the right thing. And hopefully people will respond and, and, and do what they want. So, you know, if they need a special high octane type C-PAP machine for a man’s advanced breathing disorder, I say, here’s the prescription. This is what you need. Now. Their insurance may make them jump through 10 hoops to get it, but that’s really a problem with the system and I’m not playing into it if you know what I mean.
Brandon:
So, as, as we wrap up with this, this episode, I usually like to finish with three questions the past present and future. So if you were to go back and do things over again, what is one thing you’d do different?
Dr. Krainin:
I would’ve confronted my fierce earlier. I think it took me a long time, better, late than never. But I think that in college, I would have started angling towards a business. Like, how can I start a business right out of college. It probably would have failed, but there’s so much learning in that. You know, if you don’t try, you never, it’s like the Michael Jordan quote about like taking shots, like I’ve missed. Like, I don’t know what he said, like what percentage I thought it’s 20,000 shot, whatever it was, you know, but we think of him as one of the greatest shooters ever. Right. But like, you got it’s, it’s all in the way you frame it and, and, and, and what you learned from it. So I would’ve, I would’ve gravitated towards business earlier and tried something earlier. That’s what I would have done in the past.
I pro I, if the question was really, would you go into medicine? Probably not. But I think that for us, physicians, you know, look deep, look in the mirror and really look hard at yourself and ask you, you ask yourself, is this where I visited myself? Be, is this the life I want to lead? And if you’re not there, I advocate, don’t throw it all away and go to become a different going a different career or something like that, or quit, but pivot to where something that is suitable for you. So for me, I came back to medicine, but I pivoted attacked like you wouldn’t ceiling to get to a position that works for me. And in medicine is so big and diverse that there is really something for everyone. I do. I do believe that some, some job that is going to make you happy or some not necessarily job, but some, you know, job, maybe you make for yourself, that’s gonna make you happy.
Brandon:
So, so the second question is president. So what is, what’s the number one most important thing or key to being successful with telemedicine today and, and your, your practice is that, oh, you mean you
Dr. Krainin:
May decide doxy.me cross doxy.me is the key to our success. Doxy.me doxing me. So, no, we did. We, you know, we started using doxy.me and we’ve used it the whole time and it’s been great. And, you know, I’d love to interview you someday because you were very, you were very influential and helpful. You introduced me to some very important concepts, like the diffusion of innovation theory, like, okay, here we are, Joe, you and I are right here. Now we’re like maybe early adopters. And like, but we’re going to be pushing to this. And then it’s going to get better for us. And I think COVID really hastened that didn’t it for us. And then it really advanced that fusion of innovation process. I think for telemedicine. I don’t know if there’s anything specific about telemedicine per se. It all goes back to curiosity, I think is the key thing for being successful, anything, but applying that curiosity lens to tele medicine specifically, I think the key has been online, like for us online ads and, and online marketing that is essential.
So whether in a traditional practice or not, I think that’s something that could really help your success knowing how to get, get, roll up your hands, be a little bit, you know, not afraid of being a beginner again, and diving into an area that you’re not, you don’t have a white coat for that area that makes you feel like armor, like doing something where you feel off balance a bit like how to manage bidding on keywords and negative keyword, exclusion, and, you know, looking at percentage of ranking in the top page, all these metrics that we look at, you know, may not be relevant to every doctor, but knowing how to like, make your website look great and writing good copy that compels people to want to contact your office and how to track that and know if you’re on the right track and keep experimenting and innovating and evolving and moving in the right direction, I think is, is integral for, for success. As we continue to move more to an online eco system for the practice of medicine,
Brandon:
Which leads into the next question. So future, what does the future of health care look like?
Dr. Krainin:
Well, there’s the future of telemedicine and there’s the future of healthcare in the U S I think I’m very bullish on the future of telemedicine. I think we’ve only just scratched the surface with this. And can you imagine a day where we have, we’re not just people like me who don’t really need physical exams, but maybe like an orthopedic surgeon can have, you know, a patient go to some spoke clinic somewhere, and there’s some sort of automated robot that does like anterior drawer sign or something like that. And it, and, and gives you what you need now. You know, so telemedicine is not going to be appropriate for everything, but it’s gonna get bigger. That would be my prediction. It’s only, I think it’s still in its infancy. What we can do with it, as we get more technology, the use cases are going to expand healthcare in general.
Brandon:
Well, today we spoke with Dr. Joe Krainin from singular sleep. Joe, thank you so much for your time today.
Dr. Krainin:
My pleasure.
