The world is changing, medicine is changing and the way medicine is being practiced is changing fast. The remote medical office is a thing now, and medical practices are starting to adopt this trend in droves.
Tune in as your host Samuel Adeyinka sits down for a conversation with Dr. Steven Kupferman about a company that helps clinicians transform their offices into virtual offices with highly qualified staff that can work remotely. Every time he shares this breakthrough service for clinicians, he attains happy clients.
In this first installment of this two-part series, Dr. Kupferman shares his take on the importance of medical sales reps to private practice physicians.
Tune in right now and learn!
In this episode, we have with us, Dr. Steven Kupferman. With his practice, you can actually be in the office but his team is remote. He has done this through a company that he created himself. Again, it’s revolutionizing the way medicine is practiced, and it’s a game-changer for private practice physicians and other physicians alike. I am not going to spoil it by giving anymore. I’m going to save it for the interview. As always, we do our best to bring you guests that have different types of innovation from different perspectives and ways of doing things in the med sale space. I do hope you enjoy part one of this interview with Dr. Steven Kupferman.–
Dr. Kupferman, how are we doing?
Good. How are you?
Fantastic. No complaints. Why don’t you tell everyone who you are and what you do?
My name is Steven Kupferman. I practice full-time in Los Angeles in Century City, right in the center. Right before the pandemic, along with a gastroenterologist partner of mine, we started a company, which is a company that provides more or less back-office staffing for medical and dental practices that basically provides staffing to do all of the functions that can be done remotely.
This is something that you came up with during COVID.
I came up with it before COVID. We had started it before the pandemic, and then it took off during the pandemic. Most people didn’t understand what remote work was and what technology can provide for companies to allow people to work from home. Once the pandemic hit, everybody realized that so much of the day-to-day operations of a business, particularly medical and dental offices, could be done remotely. Starting with insurance-related items to pretty much anything that doesn’t require patient contact. As offices realize both the need to find people and the ability to do it remotely, our company took off.
Let’s talk about that a little bit. Your company was able to take off because, as you said, being able to work from home can change things for a practitioner. Tell us specifically what it looked like before a client of yours or you even had a service this utilized it, and how much it’s changed how you practice now.
It hurts to think back on those dark days. I run a practice of now six surgeons. There were 3 for a few years, then 4 or 5, and now 6. At one point, we had about ten people who were working in our LA office full-time, processing paperwork related to insurance companies. We had almost 30 employees, and I was managing pretty much all the day-to-day operations while practicing full-time.
It became incredibly overwhelming. There was so much going on with the people and their lives, taking care of them and their families, and the drama, so I started to look at other options besides all the risk associated with people working in your office, the real estate that I needed to provide space for these people to work.
I said, “There’s got to be another way to do this.” In talking to some friends, I stumbled across the ability to find people who were medically trained, mostly nurses and healthcare professionals who were doing this from the Philippines. They were remoting into practices, into businesses, into billing companies, and doing all the work contacting insurance companies. I said, “I got to try this myself.” A few years later, particularly in my practice alone, I realized that there’s so much that could be done remotely in terms of running the day-to-day operations of a medical enterprise.
Even now, there are a lot of medical practices that have not adopted this type of work. Talk to us a little bit about why not. What you are saying makes so much sense coming from a medical rep’s perspective. If you walk into an office and see how hectic it can be, especially in this area in Southern California, it can get pretty crazy. Why isn’t every office in every type of practice saying, “We need to operate this way.”
It’s an out-of-the-box thing. There’s no doubt. No one learned about this in medical school. Nobody in medical school visited an office, and their business was being run remotely. You have to be an out-of-the-box doctor, thinker, and innovative. You have to want to do this. That’s the first hurdle. The second hurdle is that some people don’t necessarily trust somebody that’s not necessarily in their office, so there’s a little bit of a level of trust. Doctors are generally very trusting, of course, because that’s the nature of what we do.
We need to trust what people are telling us on a day-to-day basis. Those are the initial impediments to practice taking this on. In general, it has been pretty easy to find and talk to doctors about it. The moment we start talking to them about it, they realize, “I don’t need eight people sitting in my thousand dollars square foot office in Los Angeles or Long Beach, or whatever it is.”
Once they realized the tremendous benefits, both financial and practical, they realize how great it is. Everything doubled down with the Great Resignation as practices realized that you can’t find people any longer to do these jobs that they were doing before. They start to realize, “This is an incredible opportunity for me.” LA got hit pretty hard with the Great Resignation because medical offices and a rep were mostly staffed by high school graduates who were working at the front desk.
They finished high school and needed to make money pretty quickly, so they got a job working in a medical office. You don’t need advanced training to be the front desk person, the biller or the insurance person in a medical office. You needed a good high school education, maybe a few hour courses or something like that, and you could even run a medical office.
Those people are now getting jobs with Google and companies that are desperate to find people. They are paying way more than a doctor’s office could ever afford. I started realizing this. I was having trouble finding people even before the pandemic, certainly, during the pandemic. Even now, it’s almost impossible to find people.
By law, it’s supposed to be a minimum of $25 an hour for that person who was making $12 only a few years ago. The opportunity is there for my company. Our doctor’s office is going to survive. The rates in typical Medicare offices have not gone up. It’s gone down, so how could they survive without something like my company?
Besides the financial piece, what other benefits have you seen by implementing a system like your company?
The financial benefits are very obvious, and they are blatant but the swiftness within which you can hire somebody, the ability to call now and say, “I need two people to work for me.” We can get to them within a week. Working in your practice, you can’t do that. It’s not possible here in California to do that. There are not enough people to take those jobs. That’s one of the greatest benefits. As you are growing your practice and building, you can literally pick up the phone, and we will give you resumes within a few days of people who are ready to work.
That’s probably the second real main benefit. The real third main benefit is that we are living in an employee-friendly society, particularly in California and Los Angeles. Doctors have tremendous risks to their employees. They are also paying a tremendous amount of money for space to seat them. You mitigate a lot of the employment risk by having people work remotely. They are not subject to California taxes and laws. It’s another tremendous benefit for my company.
Let’s go back to that example you gave earlier with the thousand-square-foot office trying to fit eight people in there while the surgeon is doing his procedures and trying to make everything work. Let’s take that picture now that your company has been implemented. Now, what does the office look like?
We didn’t give up space. We actually got more space for the employees that are in our office. We have break rooms, conference rooms, and a lot more space for our staff to spread out and enjoy their day-to-day work. That’s become a real key for employers to provide their employees with better workspace. We have been able to use a lot of that space to give them a great workplace because we need to retain the people that we need to be in the office, touching and helping patients. Those people are so crucial to our ability to practice as doctors. We need to make those spaces for them incredible so that they stay and don’t go elsewhere. That’s definitely changed.The people we have in the office are so crucial to our ability to practice as doctors. So, we need to make their workspaces incredible so they stay and don’t go elsewhere. Click To Tweet
It’s gone from a number of 8 people to 2 or 3 people. You’ve given these people more space, so some people had to go. How many people make up the practice now?
We have two people who are involved in all of the billing and insurance matters in the office. All the others have left. Almost all of them have left on their own because they found other positions. There are only two left there. They are incredible people. We love them. They do a great job if we need them, and then there are a lot of computers sitting around, computers that remote employees are using and logging into remotely to do their day-to-day work.
By the way, just so everybody is very clear, can you please give us your specialty again because there are a lot of people in our audience that are not familiar? For professionals that want to become reps and reps that are in different spaces or different industries altogether, what is your specialty, and what happens within that specialty?
We don’t have a lot of drug reps that come by our practice mostly because the drug companies never understood oral and maxillofacial surgery. There still are drugs that reps can come and talk to us about but they are not on the dental radar because we are technically a specialty of dentistry. What we do on a day-to-day basis is some medical and some dental. We do basic things like the removal of wisdom teeth and dental implants and treating little kids that are in orthodontics that have certainly impacted teeth.
We are expanding towards the medical side of our specialty, in particular, our practice. We do jaw surgery. We do all of the trauma to the face, whichever facial bones are fractured. Orthopedic surgeons don’t work on facial bones, so we handle all the trauma to the face. We do TMJ surgery and corrective jaw surgery for people who are born with jaw deformities and jaw infections that involve the teeth, jaws, face, and anything related to that.
That’s what we do on a day-to-day basis. Most of the sales reps that we work with on a day-to-day basis are either people who are in the dental sales business or the medical implant business, which we work with quite extensively. Medical implants are meaning plates, and screws that are associated with trauma and fractures as well as joints, and then certain drugs. There are a few drugs here and there that we use on a day-to-day basis, that we have reps that sell them.
That was spot on. Everyone is crystal clear on what happens now with your space. Tell me how you value the reps. Let’s talk about them all because you are right. I’m sure you see pain reps that are pharmaceutical. You see device reps that are selling you these implants and screws, and then dental reps that are selling you more nuanced devices that allow you to do the things you do. Tell us the value of these reps for you. How do you see their value to your practice?
One point of clarification. We don’t have two people working in the office. We have way more than two people. We have in about 20 or so but we have 2 people who are related to billing and insurance collections. There are plenty of people in the office.
Let me be clear right with you. Eight times, however, many need to make up the 30 or 40 that might have been there, which has now been reduced to 20 per department, either way, there’s more space. I’m assuming there’s more time for reps to come in and communicate whatever they are bringing to the office. Before we even tackle that, I want to know how you value that service in the first place.
I feel like our reps are invaluable. There’s so much that they bring to us, and we can’t work without them. There are many things that we do on a day-to-day basis in our practice that involve reps that we literally couldn’t do without them. They are truly invaluable to what we do daily. There’s almost no selling going on. There’s not much of that going on at all because of the way that we practice. They are invaluable. I will give you some specifics that come to mind. We work in the hospital and do a lot of trauma and broken bones, mostly lower jaw fractures but also cheekbones, upper jaw fractures, and eye sockets.
There are multiple companies that have the implants that are required to put those bones together. There’s almost no scrub tech in the hospitals that are familiar with these trays because there are a lot less facial fractures than there are on upper extremity and lower extremity fractures. They come to our cases very often, and they are able to make sure that the documentation for the individual implants that were used is proper.
They make sure that the trays are sterile and ready to go so that we don’t have to sit and wait another four hours to resterilize a tray. They make sure there’s a backup, the drills are working, and everything in the tray is stocked there are enough parts for each tray, and every single component is in there after each case gets restocked. They are invaluable to us. We also do a lot of jaw surgeries that also require plates and screws, and those also need to be available and ready on a day-to-day basis with backups. We depend on our saws and drills. All that needs to be functioning properly. That’s one aspect of our practice that requires medical device reps to be on their game at all times.
We do a lot of dental implants. We have dental implant reps that are crucial to make sure that everything is stocked so that if somebody comes in, they fell, and knocks out a tooth, we have the implants available there for them to come in, get their tooth out, and an implant placed. The relationships we have are great, and they support our ability for us to do what we need to do on a day-to-day basis. As I’m talking about this, so many doctors work for large hospital systems now.
We are responsible for making sure that our reps have everything that we need for us. Whereas if you are working for a large hospital system, the hospital system is responsible for all of that. If you show up as a doctor working for a hospital, getting paid a regular salary, and the products are not there, you get the day off. We don’t have the ability to take the day off. We are not salaried. They are crucial to what we do every day.
Your system in your company makes it even easier to spend that time with the reps and allows them to be the resource that you find so invaluable.
We have people in my particular practice that deal with the reps on a day-to-day basis. Most of the time for accounting purposes. For example, we will have them do our inventory and check to make sure that the order was received and everything was charged properly with the proper discounts. All that comes along with that. There are other things.
Sometimes, we have to request certain products because these are things that we need to use, and there are things that either the device rep is familiar with, is not familiar with or has brought to our attention that we want to try to get and obtain. Sometimes, there are FDA things that we need to go through with the device reps, so my people will work on that. They are working with them pretty regularly. It’s funny because then they come to the office, they were like, “Is so-and-so there? Can I see so-and-so?” They are like, “So-and-so isn’t here but they are here.”
It’s because they are remote. That’s fantastic. For those people reading, tell us a little bit about what you expect from a rep, and I want you to be as specific as you can. Maybe the top three things you expect from reps to come to your office and the top three things you don’t want to see when reps come to your office.
Obviously, we want integrity at all times from reps. I can sniff out when somebody is not doing the right thing. Integrity is crucial to reps. It’s unfortunate that the bad ones have made it bad for the good ones who are there to make sure that patients get what’s available for them that’s the best medicine can deliver. That’s unfortunate in any field.
Number one is integrity and that they are pushing a product, selling a product or representing a product that they know their product well. That’s probably number two. As a rep, you need to know your product. You can’t go in and wing it. You can’t rely on company training. That’s so important. It bothers me when a rep comes in, and they don’t know their product. Sometimes, that happens because they started. It takes time to learn your product.
Along with that, I will either use this as number 3 if I don’t think of number 3 but you have to be prepared. Preparation for medical devices is so important. You have to be ready for every possible scenario, particularly if you are coming into an operating room. You have to have every backup possible or every single contingency plan for whatever is needed. That comes with experience. You hope that the person that preceded you gave you a lot of information. Preparation, integrity, having contingency plans, and making sure everything is ready for you are crucial.
There’s this perception that the rep is the lowest on the totem pole because the rep has to make everybody happy, from the scrub tech all the way to you. At the same time, there’s a responsibility that the rep has a lot of influence in the room because they have to be the ultimate resource to you as the procedure is going along. Some will even say that whether the rep is wrong or right, the surgeon is always right. I want to know what your take is on that. First of all, do you find that to be true? If not, explain it more to us.
The perception is wrong. Sometimes, my partner and I will say in the room during the procedure, “The only person making money here now is the rep.” It used to be the case that the reps may have been perceived as the lowest on the totem pole but financially, it’s probably not the case any longer, so I will correct you on that.Reps may have been perceived as the lowest on the totem pole, but certainly financially it's probably not the case any longer. Click To Tweet
The rep has a lot of tremendous amount of responsibility and will be left holding the bag if they haven’t done what you asked me about earlier. It’s right. If you need an L-shaped plate that’s 2 millimeters and needs X number of screws and you don’t have that plate, then you are going to get reamed as the rep in the room no matter what.
That does boil down to the rep. Everything will roll to the rep because the rep ultimately was being dependent upon and compensated for having everything that’s there. That’s probably even more true now with doctors working for large medical groups because the doctors and the large medical groups are expecting it all to be there.
Whereas private practice people generally know that that’s not always the case, and if something doesn’t go right, they are the ones who are going to be left holding the bag too. More and more, it is becoming the reps’ responsibility because hospitals are contracting with reps and the doctors are less involved. This is a downside to taking doctors out of the equation a little bit because doctors depend on their reps.
They need to have everything there, and if it’s not there, then they need to have another tray that’s sitting on the side with everything in it as backup, and it requires a lot of time. You need to be there when the case is happening and to make sure that all the implants and everything are ready before the case has started. That could be the middle of the night. Instruments are being processed all day and all night. As a rep, you need to be there for that.
That was Dr. Steven Kupferman with part one. What I enjoyed about that interview was that he talked about the responsibility of the rep and how that role is so important to what he’s doing with these procedures. Even how he and his fellow providers look at reps and their roles. The lowest on the totem pole, he smashes that in the face and says, “Absolutely not. The reps are actually valued member that has a lot of responsibility and, of course, is compensated well for it.”
It’s great to hear that perspective from the provider’s side. If you are reading this episode and you are thinking to yourself, “I would love to work with someone like Dr. Steven Kupferman. I want to be in a space like maxillofacial surgery and be those reps that are contributing to those types of cases and selling devices for those types of cases.”
If this is you and you tune in to the show, you probably know what I’m going to say. Stop wondering, guessing or thinking about it. Take action. Take a big step towards what you want. Visit EvolveYourSuccess.com. Go to our page and hit Attain A Medical Sales Role, and then read what’s in the program. Read it for yourself. Before you even schedule a call, scroll down, read it, and understand what it is that we do that’s going to get you into a role to work with people like Dr. Steven Kupferman.Submit the information, send it in, and have a call with one of us here at Evolve Your Success. As always, we are doing our best to bring you innovative, uniquely prospective holding and pioneers of the medical sales industry. We are bringing them to you so that you can either get a resource, a program that can get you where you want to be, where you want to be within your performance if you are already a medical sales rep or the information to close some of the gaps in your learning that you have always been wondering about. Thank you for reading, and make sure you tune in next time for part two.
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