From Pharmacy to Diverse Business Ventures | Chi Patel, PharmD, MBA, Carolina Pharmacy

This transcript was generated automatically. Its accuracy may vary.

Mike Koelzer: Chi, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Chi Patel: my name is Dr. Chirag Patel. I just go by Chi, which is a little easier to say, but that's what my friends call me. I am an entrepreneur and business owner, pharmacist here in the Charlotte North Carolina area. Being a pharmacist and a pharmacy owner, we Quickly realized that, there's other opportunities out there for our community 

Today. We're going to talk about some of that 

Mike Koelzer: Now cheap. as an independent pharmacy owner, I say, I wish I would have gone out and done a few other things, maybe outside of pharmacy for better or for [00:14:00] worse, but she, as you and I've talked before, you're from Indian 

descent, right? 

Chi Patel: Correct, yep. 

Mike Koelzer: do you have a leg up on me already?

Chi Patel: would call a leg up, because I think a lot of us, at least, in the pharmacy space who come from a certain background, I won't just say it's Indian, there's a lot of different backgrounds, and it can be American too, we grew up with entrepreneurial spirit because our parents owned a business myself personally, my parents owned a motel, so I grew up there. Part of my childhood in a motel, so when I'm on dial up talking to my friends on AOL, someone comes into the front desk, I gotta sell them a room. So

I realized real quick

this is the value of our room. If they walk away from here just because I'm too busy that affects us. So from an early standpoint, even before I got into post secondary education, I was already in the entrepreneurial spirit.

Mike Koelzer: What is that about some of the immigrant families of being an entrepreneur, maybe owning a business, hotel, different things versus not, 

because I'm lucky if I [00:15:00] could, have a street sweeping 

Chi Patel: Yeah. 

Mike Koelzer: like that, much less opening something. Seems like, two times, four times the difficulty actually starting a business.

What is in the culture of actually it. Owning a business as 

Chi Patel: Yeah, I think there's many points, and I've thought about it before as well, A lot of us who are, first generation born here, like I said, I was born in Canada our parents are immigrants. So where they came from, they're either, not able to do what they can over there for financial reasons or because the opportunities are not there.

But also it's very competitive. If you're from one of these other countries, I use India as example, with a billion, I don't know what the population is now, but it's over a billion people.

Just imagine those small little towns and you're just, one of multi million people there.

So it's very difficult to make it. So coming over here, you already

have that drive that you've put everything into your ability to get over here and you're ready to do it for yourself. And when you work for someone

else, I think a lot of [00:16:00] people originally, maybe they start out that way to get their basis going, to have enough capital, to do their own business. They realize that, hey, our work ethic is stronger than your average nine to fiver or your average business.

And so when you have that, you kind of figure out like can I do this for myself and make the changes I want to see in my community? By doing it this way? Or do I just stick to it and do the safe way out, which is this way? I think in my community that I can speak for we have that drive, that risk assessment, and I don't think we really see the risk so much because we If you work hard enough you're going to achieve what you're trying to get out there for and at least if You fail it you failed on your own accord, right? So I

think that's the biggest part. There's also the fact that you know a lot in a lot of other these countries there's just so many different people who you're competing against like I mentioned and It's a little bit easier here. I always say that when I came to america I've sensed you know coming to charlotte, which is a smaller city You it's starting to blossom now, but there was like a few pharmacies.

There was like [00:17:00] one place to do this, one place to do that. And so there is room for opportunity in these different places if you find it and you find your niche that can kind of help your community.

Mike Koelzer: it's sort of a filtering out process to the people that are here may be left because they have I don't mean to paint a broad picture, but they might have bigger dreams, bigger goals, more energy to get over here then that.

flows forward into the entrepreneurial spirit.

Chi Patel: it does. And just being able to come over here and see, I can't even live it because I'm from Canada. So for me, my struggle was the cold weather, but it's a little bit different, but for our parents, our families are very close, so we know everything they went through. I mean, I've been to India multiple times. A lot of us

go back and we see, because we have our villages still there, and so we see how people who are our age are living, and what they don't have, and maybe what they could have, but,

 When we walk down the street here, you don't see kids walking down the street begging for money.

You see that in these countries. And you see it in, Mexico, you see it in Central America, you see it in South America. So it's not just [00:18:00] in Asia, but you see that and that really, hits home for a lot of people because it could be a lot worse.

So when you're willing to be able to put in and I would say this too, the same amount of work you'd put into some of these countries, you're getting nickeled and dimed and you're getting paid a lot less than you would be if

you came here. I'll give you an example. I was reading Phil Knight, the Nike founders.

And I found it interesting, because I've always thought why do they do sweatshops, and why don't they pay these people, they're a billion dollar company. And they point out a

very valid point there, is that they were overpaying these people in the sweatshops, and they realized that the government was like you're paying these people more than we're paying our doctors, and you need to cut that out. And so you, that really hits at

home, like these the salary in a lot of countries is very low. And when you come

here for the same thing, you're getting paid a lot more. It's. Definitely a reason to come here for the American dream as we say it. Our experiences and our perception really dictate how we live our life and how we view our future. And I think for a lot of

us, that's kind of identified for us early on in age. So that's where it comes from.

Mike Koelzer: All right. So now, Chi, here's [00:19:00] the problem I own an independent pharmacy 

Chi Patel: Yeah. 

Mike Koelzer: And I think I can speak on behalf of all of us owners that at some point we feel like we've gone from entrepreneur and owner into just being like the, PBMs, employee kind of, because they've taken away the freedom and they've taken away the profit and that kind of stuff we used to have a barbershop next door and I didn't want to be a barber, but you're kind of jealous of them, just having a 

cash business and not dealing with this or that, and nearly any pharmacist I've talked to has seemed to have had that dream of a little bit different thing to get back into that ownership role because it's very, oppressive cool though because you've done.

A lot of that. I know pharmacy is your 

bread and butter, or at least that's who you are, but the things that we were talking [00:20:00] about, you've gone out and have done 

Chi Patel: Yes. I don't look at myself like a pharmacy owner. I look at myself as an entrepreneur or a business owner first.

If you own a business, you probably understand how to run other businesses.

It's just about understanding the metrics and how things work in different sectors. So you can do

other things. That's the number one limitation. People think, oh, I'm a pharmacy owner. I have pharmacy. I can't do other stuff. And

That's a problem to begin with. You're limiting yourself. For us,

We've branched out into many different things. Many are medically related, which is a benefit to us, because we have a patient base. I always look at

it outside of the box. When I'm driving around, wherever I'm going to the beach, going to get groceries, getting, going to a sports game, every time I look around, I'm looking at things, whether I'm thinking it or not.

I'm seeing businesses and my mind is always going. Is this

something I could bring into what we're doing currently in one of my businesses? Is this, Oh, I went to Chick fil A and the service was great. These guys should be running the airport. How the

hell can we improve our efficiency in some manner, right?

I think the business [00:21:00] owner's mind never really stops. You're always going There's not like a

nine to five period that way and that I think that's what we benefit from and what we enjoy But I don't think we should be putting

ourselves in a box of just being able to do one

thing 

we do a lot of things that I'd say a lot of the other progressive pharmacy owners that I've met, at conventions do. Things like compounding, clinical work, rapid testing, telemedicine, wellness program.... 

 We've gotten into a lot of things that have helped our community, but are also financially, fruitful. So these are the things that we've kind of gotten into.

other things we have, kind of ventured into based off opportunity that's been in our communities has been, one, we, we've opened a med spa. Yeah. So a med spa is a foreign

space for a lot of us pharmacy owners, but a lot of it has to do with similar stuff that we're already recommending stuff for. Med spas are all cash based. If you really think about it, there's not really any insurance involved with it. And you're providing a service for people who are willing to pay for this service because it's a beautification process [00:22:00] really so we've kind of dabbled into that stuff with my sister who's a physician. And so it kind of opens things up for us. Yeah.

Mike Koelzer: Where does that come together? Med spa? Is some of it like massages and beauty 

Chi Patel: Yeah. 

Mike Koelzer: a 

combo term, 

Chi Patel: Yeah, so actually considered called a medical spa and aesthetics. So that's usually shortened to med spa. But med spa really

entails to all these processes and, procedures they do that are generally medical grade. A lot of med spas are run by a nurse and just overseen, but ours is run by a physician, which is more rare.

Where We do, hair removal, through lasers. 

Mike Koelzer: I gotcha. 

Chi Patel: that

sort of stuff. There's a whole bunch of different machines and procedures you can do.

Mike Koelzer: Kind of beauty stuff that needs medical 

care or intervention, sort of. 

Chi Patel: rather than put people on, these

medications that are really expensive or take a

long time to work. These are short, you know, Quick bursts and they work

and it's long term. You You have the short term things like

Botox and fillers [00:23:00] that everybody's getting right now anyways. But all these things really couple down to it. I mean, you see most med spas are doing weight loss now. Yeah. And that's something we're all doing in the pharmacy. I hope every pharmacy owner is doing that. 

Mike Koelzer: you mentioned you have a bodybuilder as a partner. Is 

that right?

Chi Patel: Yeah. He's one of our pharmacists actually. He's a pharmacist, a bodybuilder in one. and you know, I thought about it a while back. I was like well, you need to get me in shape. And so we started this

process like a year ago. And we said, how do we break this down? I've done so many things in the past that didn't work. Let's figure this out because if it works for me, I have a lot of other friends who don't have, um, Quite as good physique and they could probably benefit from this, rather than put all of our patients on weight loss medications Maybe we can find a long

lasting solution for these patients and not just throw them on, you know, Osempics.

There's so much that goes into our daily basis when we're talking to our patients. I think what We forget sometimes that they're making an active choice to come to our independent pharmacies. We are never the most convenient location to. Our [00:24:00] hours aren't always the best. We're

not open every day.

We're closed usually by 6 or 7 p. m. So there's an active choice they've made to support you. Now if they're gonna support you doing this, why would they not support you in doing something else? It's always been my thought process. And if we look at it that way, You're gonna learn real quick that I'd say 99 percent of your patients will support you if you have something else going on and they'll actually Tell other people about it and they're like they'll brag about it because this is my pharmacy owner and this is what they do

that's How I think we've all grown.

I mean, I don't know if everyone has different ways I didn't spend a lot of money Marketing is mostly just word of mouth and going one to two two to four four to eight And then grow that way, you get one family member, you generally get the whole family. So we have to look at it that way. But I always look at it this way

these patients have to eat somewhere. They have to go drink somewhere. They have to get

their weight loss somewhere. They have to get all these things. Where are they going? And why can't we be some of those things to these patients?

Mike Koelzer: great stuff you're doing there. What was the impetus then to reach out and do some of these other things [00:25:00] that are totally non medical and how did you decide which ones to do ? 

Chi Patel: You know, it goes back to saying we're entrepreneurs . So even if we were doing well, I think we would do this. But I think the fact that PBMs have really put us in a corner, For us to survive, we have to

find areas of revenue. And if we're not doing that, then, You're probably one of the people on the outside looking in. And we're all suffering, we're all struggling. We're still struggling just as much, if not more, But having these other revenue streams is really, really important. It's why they say you don't put all your eggs in one basket when you're investing, right?

And that's what you

essentially do when you're

doing a pharmacy. You're putting all your eggs into this one pharmacy. So you better make sure that you have different ways of generating a revenue, because we knew the PBMs have taken away our reimbursement. So what else can you do

to make some revenue to keep that going?

Mike Koelzer: So what are some of those Things then? what have you 

dabbled in? And why, why the directions 

you're into then? 

Chi Patel: so we have a few different things. We own Potbelly [00:26:00] Sandwich Shop, it's a Chicago based sandwich place. I'm sure a lot of people have had that.

We brought it to Charlotte

here with one of our friends who's in the food business, and Opportunity came up to invest with him.

So that was one of the things we did now. Great When you guys don't want to talk to drug reps, we love to talk to them because I they're selling me on their drugs I'm like you're just gonna get lunch from our place and i'll

listen to the rest of what you're saying and we get that

Mike Koelzer: So you got one of those, 

Chi Patel: we have three locations here in charlotte. 

Mike Koelzer: of those. No kidding. 

Chi Patel: We have a Medicare agency that we've started recently. We realized that, hey, we send our patients off to, a agent who comes in and helps patients, enroll,

but why can't we do this in house?

And I'm learning more more pharmacy owners are doing this themselves. We can become our own agents. It is some work to do, I won't say it's not difficult, or you can hire an agent work under, your separate LLC. And then they can see your patients, and they can enroll people, and there's, financial gain from that, but also, we know we're able to help them better.

We have an inside track because we're in this, the health space, so we know more of the stuff that these health agents out [00:27:00] there that have no background in medicine, or

pharmacy. So there's another opportunity for

us to do that, so that's something else Trying to think of what else.

I mean, we have a lot other things that we're, you know, in the works, but we try to find out other opportunities. We're not limiting ourselves to just one thing. It doesn't have to be health related,

but if the, investment makes sense for us, then why not? Everything trickles back to our bread and butter, as you call it, the pharmacy, but end of the day, I'm not

defined by the pharmacy. I'm defined by my whole book of business and so that's the way we look at it. We have to

look at ourselves as Business owners, whether you're owning a liquor store on the side, good for you. Because I'm sure that some of

your patients will be happy to go to your liquor store and do all that stuff.

So

we have to kind of look at it that way. That's what we've always thought in the long run.

Mike Koelzer: So Chi, you have a partner. Do you do anything else with him?

Chi Patel: Yeah we both kind of are independent. Most of the stuff we do together. But I have some stuff I do separate from him and he has some stuff he does on his own. , he owns, hotels. So that's a big thing on the other side it's completely foreign to medicine and stuff.

[00:28:00] That's more of a family business for him that you know He was like me raised in a motel but he

saw an opportunity for it and don't know what exact percentage I think 60 percent of hotels in America are owned by Patel So 

Mike Koelzer: kidding. 

Chi Patel: he is into and it's nice to be able to someone like that to be able to do it because if we're ever in a financial struggle You He has capital on that side or contacts on that side that might be willing to invest in something we're doing.

So it just grows your network going outward, right? If you're not just stuck to

one genre of business.

Mike Koelzer: Hey, you mentioned the hotels with Patels. That's a 

rhyme, by the way. 

You've got to work on that somehow. That's interesting because as we drive down the road and we see something we think owned by something from, let's say, the Indian heritage, we think we're going to see uh, uh, colorful, Indian 

design and stuff.

These are I imagine well known chains that are just owned by people that we never see and 

never think of. [00:29:00] 

Chi Patel: there's a lot. It's funny when you're scrolling through Instagram or some of these things, you see these little reels that talk about, hey, the first person who came from India bought a motel and then Literally, with his friends, instead of going to a bank, they basically borrowed from friends. And that's what everyone did.

Borrowed from friends for their next venture. And they got bigger and bigger. So the majority of, um, even hotel chains from, Hilton to W to, Marriott. All these are owned by, they're franchisees, but people I know as well. Definitely some opportunity in that, yeah.

Mike Koelzer: I guess I do think about who owns hotels. It's probably usually a group 

of people to 

take some of the risk out

Chi Patel: to be honest with you, it's usually a family. I mean, they're doing very well for themselves. Usually there will be a group, sometimes there's a group of two or three people and they form their own LLC and then they have a lot of hotels under it, management and all that sort of stuff.

Mike Koelzer: they might own more than, one. 

Chi Patel: Oh yeah, they all own more than one. There's people who own up to 70, 80, probably But there's different groups

of people that own a lot. I'm not in this space, so I don't know too much about it. I know as much as I'm telling you, but there's a group called Ahoa, Asian American Hotel Owners of [00:30:00] America. And they have a big thing every year, a big convention somewhere. And they always have like really big names show up, political or whatnot, because it's a big group, very powerful group with all the money

and businesses they own.

Mike Koelzer: That's something. As you say, you drive around town, what other businesses have you thought about in the past and maybe you thought quite a bit about in the past that you said, nah, what else have you thought about and said, 

maybe? 

Chi Patel: Yeah, that's a good question. I think when you were saying earlier, this brings us back to this, put this in perspective. Us pharmacy owners or pharmacists in general are the only business that I can think of. Where we have to take what, someone tells us for our products and service, You don't take an insurance or any type of thing to a restaurant, a bar, to anywhere else, any other business. These guys all have free reign to charge what they want, and if you want it, you pay for it. We don't have the ability. Now, we could do that and just be an all cash pharmacy, and there are some around the country that do that. Very envious of these

guys and how they're doing it. [00:31:00] But for much of us, many of us, if we lose one contract of the big three, we're essentially like screwed if

you look at it that way because it's a big book of business we got to turn

away. We're hopeful that the insurance thing is changing in our country, the paradigm of having to have insurance

is going and I see that. But hopefully most of us are around to see that where we're getting more Self pay people coming in and rather of that type, business when I'm driving around I see many things that I would like to I thought like I said liquor store before I've thought of a liquor store because It's the most basic concept you have rent you buy inventory You have maybe have one person running

it and then you're overselling everything you know how much a bottle of Tito's costs and how much you're buying it from let alone go to the next concept is if you go to a club or a Bar and not saying it's easy to run those because it's something completely foreign to us

But that bottle of Tito's is this big. They're charging a shot for this small amount for like 15 20 bucks 15 in a lot of

cities. and

people gladly pay for it. When we go out to drink, we don't care about that. We're here to have fun. [00:32:00] But when you come into a pharmacy to pay a

10 copay and stuff, you question it. So it's also goes

along with the industry we're in. And are we able to really like, grow from it? we're only growing if we're doing things outside of your traditional pharmacy by offering other ancillary services. If you're just filling prescriptions it's hard because you can't mark the drug up, so that's kind of what I see when I'm driving around.

I'm really looking for opportunities, that kind of can benefit us bring value to our patient, base, with other healthcare services.

Mike Koelzer: Some of that stuff really sucks. We've got a big health insurance in town and they give people O.T. C. cards and let's say they might have like, a hundred bucks a quarter or 50 bucks a year.

I don't know what it is, but these people can go any store they want to. Caveat that the store has to be chosen by the insurance company. And I thought, what a good time to let [00:33:00] almost the free market help. So let's say you're going to go buy some product a skin cream or something at some pharmacy.

And you know, that this pharmacy over here might be a little bit more expensive, but Probably not, but that's the image, but it might be more expensive. What a good time to let that person use the card and pay a little bit less at one place, but not get the service a little bit more at this place and then get the service and it's like, how would that affect the insurance company really?

Cause they've already spent the 50. But they force people even there to not come to the independent pharmacy. They only let them use this card at so many places. And I suppose there's a bunch of games being played. Like they 

get a kick back 

Chi Patel: Yeah, 

Mike Koelzer: this or that, but it's just sad how much the capitalism.

Is just sucked out of, I mean, it's there. That's why they're making these decisions. But on a micro level, it's just sad how capitalism seems to be sucked out of our [00:34:00] bones. Like I was talking earlier that you feel like you're just an employee for these 

places. 

Chi Patel: and I've been in the last two, three weeks really talking to a lot of people outside of the space who don't understand what we're going through. And that's, I think, the one thing that we really need to get out there. we all know what

we want to see change because it's not fair.

It's very anti American, very

steering patients in one place. No, level of competition. However, our patients don't know this. When they come to get a, let's say a co pay of a hundred dollar item, they think you're making a hundred dollars. There's no thought process to them. Wake. Hey, what does it cost them?

And

we really try to break it down. Now, we don't go into all that with our patients. We don't have time for all that. But when I'm speaking to different

people who are outside, who are interested in this, I've actually started to show them that new, I don't know if you saw the Mark Cuban, uh, visit he just had at the White House, because that was very powerful.

you had

the governor there, you had two pharmacy, independent pharmacists talking, and it's all well and great if we talk. But until you have someone with

power who Comes in and Mark Cuban comes in talks people listen and I

loved how he said it cuz he's very blunt And [00:35:00] I'm the same way Really said essentially

that they're just shitting on us and I think that hits home with a lot of

when I sent it to was Like dumbfounded they were they couldn't believe that we this is how we live our life.

This is how pharmacy is and what is the next step to change it? It's all good to have sorrow and empathy for us, but that doesn't pay our bills. We

need to see legislative changes That's the only thing that's going to help us on this side but 

until that happens, we know how the law system works here in our country, and it takes time. We really have to be able to dig deep and survive, and by doing these different

ancillary services, that's your way to really, one, build relationships in your community, and educate people on what's happening, which is, I'm all for that. Try to teach my students, everyone who comes in, and say, you need to know this before you graduate. Because if you

don't, that's a problem. And they're not teaching this in school. And that's one of the things during my rotation, I try to teach them about things that I never learned in my rotations. I didn't learn in school about not to rent, about a Roth IRA. These things that they should have learned. [00:36:00] So they get the basics of that, and they enjoy that. But there's a lot of things that I think, need to happen, you in legislation for us to be able to have a level playing field.

Mike Koelzer: Our listeners have heard this ad nauseum for me, but I think one of the things the new laws helps a bit that it starts to take away the smoke and mirrors. And so it might not change much, but at least instead of having to explain something to a politician that's going to take 12 minutes to explain, maybe you can explain it in six minutes because some of those DIR things are going to go away 

and things like that.

But sadly. One of the guys on our team who was all eager for some of the changes in Michigan to take place at the first of the year. And I told him, I 

said, don't hold your breath. 

I said, I've been 

here a few times. 

 It might, Help the vernacular of making it simpler, but he's been reporting all this stuff to this supposed coordinator in Michigan who's like collecting all this stuff [00:37:00] and we're sending him every day.

Now, how the PBMs are breaking these new Michigan laws.

She basically said. We didn't know it was this complicated and we don't really know what to do with it. We are not really sure how to handle this with everybody breaking the laws, I'm putting 

words into her 

mouth, I'm sure she didn't say it that way, but that's how I took it.

Like, Hey, these guys are so 

damn big and tricky that we can make all these laws and we still don't know where to start in corralling 

them.

Chi Patel: And that's true. 'cause in me speaking to our representative and senator, they asked me for framework, do you have any states that have this in framework? And so we shared that within the Kentucky does. And so they immediately got to those representatives and have that. So I think that helps them in their world

because they speak a different language to Just like pharmacists speak

our own language, they speak theirs. So to have that

framework, that might help them as well. I think Kentucky is really leading the charge in a lot of this for the for the country. There's other states, of course, but I don't know what his background is but I think they're really [00:38:00] helping us in this space.

So just be able to get each

state and it's important that every 

Independent pharmacist bothers, say the word bother, but whatever you want to call it, contacts, their representatives locally and at the state level and in Washington as much as they can because they have to listen. That's their obligation.

That's why they're, we're voted in. And I've had great responses from all the ones that I've spoken with. and, ultimately if they're all in that and they start speaking and saying all my representatives in all the states are asking for this, then it's likely to, we're likely to see change. We can't just see it coming from one area of the country. It has to happen all over a collective effort for us to really see this change. And like you said, it's not going to be overnight.

Mike Koelzer: That rumble helps of people talking this way. I remember back, I'm going to say it was 96, maybe late nineties. And this, customer came in the store and he had a computer company and I remember asking him, Chris, what is this web I hear? What are they talking about?

This worldwide web, [00:39:00] no idea. This is what years 

ago, basically. 

And he's like, well, it meshes this and all the people can then contact each other and this and that kind of stuff. I heard it from him and then I probably read it in something the next day and eventually 

you pick up 

on stuff and it's kind of like the old cliche where you don't realize.

How much certain cars are advertised until you're in the market for a car. Then it's every ad that pops up is a car. So, Oh, that's a car. That's a car. Or you learn new word. And you hear that word, you said, I've never heard that word before. And then the next week you just hear that word everywhere.

I think that's the same with the pharmacy conversation. The more we can. Talk in the more letters and things like that. And the naysayers are out there, me included saying what's that going to do? If anything, it can help raise that awareness ever so slightly, just like we have to learn about the web and the cars and new words.

You have to learn [00:40:00] this language also.

Chi Patel: I'm seeing that right now.

It's probably marketing as well, but gambling just became, sports gambling became legal in North Carolina a week ago

or two weeks ago. And now everywhere you go, that's all you see, but it's probably because your mind is

inclined to see it. So yeah, you bring up a really good point there. We have to have these discussions

to get there. 

Mike Koelzer: Have you ever seen the moonwalking bear? Have you ever seen that 

video? 

Chi Patel: it seems familiar. I can't place it on

Mike Koelzer: \it's a psychological thing where they've got like six people kind of standing in front of an elevator or something, and they're throwing a basketball around and You know, there's an average size elevator lobby throwing the basketball around.

The YouTube voice says, I want you to count how many times the basketball has been thrown around the room. And so you're watching the video intently and it's okay. One, two, three, four. And then it ends 20 seconds later. And he says, what's your answer? It's 21 times. right.

Now, [00:41:00] how many of you saw the. moonwalking bear in the video. And you're like, that's ridiculous. show it. sure enough, there's this furry guy dressed up as a bear doing the backwards moonwalk right between all these people. And so you have to back up the YouTube because you swear that wasn't there at the beginning of the video.

And sure enough, here's this moonwalking bear. So it's what you pay 

attention to. Of course. 

Chi Patel: Yeah.

I definitely agree. And in all of this, it's really coming down where we are in our place as pharmacy owners, pharmacists, and with PBMs. I don't see it getting very much worse. I mean, I'm not gonna would, but we kind of have to hope for better, but we can't just hope. There has to be action on every level, and that's kind of the way we look you're completely right.

We have to make some noise, and hopefully that noise causes small change. And eventually it causes substantial change for us and I think we're going to see more of it because it's no longer just us being affected, [00:42:00] I know all the doctors I talk to are complaining about things, more of them want to go into

concierge and we know once the AMA speaks up, you get a lot of things being done more than, more so than maybe our associations unfortunately, but that's just the way it is, right?

Mike Koelzer: I think the one good thing that when you first had insurances involved is for a while there It helped the average pharmacy owner because there's no way in hell that a pharmacy's revenue would be as high as it was If insurance wasn't paying for it, 

you know It might be a 

tenth of what it was when people are getting something on a copay years ago So that was good.

And then part of me says Hey, it's a free market and we're not getting paid because we're probably not bringing as much value, that's wrong because 

it's a broken system because you've got a huge player in the middle not bringing any value at all. So that can't be right. If someone's in the middle not bringing value, then that's not the free market. That's a, facade.

Chi Patel: I think initially PBMs were brought in, [00:43:00] to basically leverage better pricing for the community and From manufacturers,

but what's really happened is the opposite in the, in sense of the middleman, PBMs have realized I can control all these pieces from the manufacturer, patients to the pharmacies to everyone else, and now they do what I say.

If it's not on my formulary and I don't get a kickback, then I'm not putting it on the formulary. And manufacturers have had to raise the prices on things like EpiPen because for them to get the same profit now that they do these kickbacks. They have to raise the prices. It's the opposite of what was supposed to happen. I think they gave them too much power and didn't keep control on the government side, got at least three major PBMs run away with things, and I'm sure they meet and collaborate together. Kaluud is the word, right? yeah that's definitely part of it. And being from Canada originally, um, and then having, you know, a lot of family in London, England, I see in other countries and I have friends in other countries, they don't have these issues.

I mean, they have other issues, you know, socialized medicine, but they don't have PBMs. They don't have [00:44:00] someone dictating what you can prescribe, what you can get covered. And that's the reason when

you go to cities, if you ever go to Mexico, you can get whatever you want over the counter.

You don't even need a prescription. It's

just amazing to see the level of control we have here and it's not, for me at least, I don't think the control is there in terms of safety and efficacy. It's in terms of ultimate greed. Like, how can we keep the money in our pockets? 

Mike Koelzer: one thing I'm not is an economist. sure. 

know a thing, but I do look simple things, the three oligopolies of, the big three in it. I know that Lina Khan with the F.T.Cee is looking diligently at this stuff now, but doesn't seem right. It doesn't seem like you can lose a 30 year business that way.

I suppose though, when I look at other stuff, I mean, I'm a Chevy dealer or something, then I've got one business kind of supporting me. So I don't know a damn thing about it. It just seems that the monopolies don't seem to be good for the patients. 

Much less us, 

Chi Patel: we're not seeing costs of anything go down. [00:45:00] If anything, it's going up. Accessibility is even worse. Prior auths, all this other stuff that is being thrown around is just. It doesn't make sense. I mean, you think and you sit down and tell someone, Hey, the doctor writes for something so a patient can have it.

We dispense it so the patient can have it.

But neither me or the doctor have control over that medicine. It's some guy in a suit. Or a girl in a

suit dictating, 

it doesn't even know the patient, doesn't know the interaction, but they're saying if this drug is not making me money, I'm not allowing you to fill That's the basics of what it is. There's other stuff that's convoluted, but

really that's what it is. And that is very, I don't know if you want to call it un American, but it's not really what we're based on, right? And change should happen, but again, I know I'm not very much into politics, I'm not an economist, but I know Personally, change doesn't happen without having major power lobbyist groups and governors and all that stuff come in and say we need change for this reason.

And ultimately there has to be a

reason and usually money And now in this [00:46:00] factor the people being hurt the most almost, Medicare patients, we're even at the baby boomers and everything. I think we should start

seeing some change there, but I mean, it's something that we

hope to see a long time ago.

Mike Koelzer: gee when you and your Business partner think about your businesses you're in or talk about the hotel business or the potbelly and that kind of thing You must do some comparing Is there anything Better in pharmacy. I don't mean helping 

patients and so on, 

 Let me throw this in there.

I mentioned that because of insurances, like if insurance is paid for hotel rooms and potbelly subs for a while there. They might be paying, 50 bucks a sub and only charging hungry sandwich eaters a dollar and you can see how that revenue would go up.

And that's maybe some of the history of pharmacy, even when the PBMs were in there paying defined fairly, but what we would say fairly So I know you don't have that in those businesses, but is [00:47:00] there anything better in pharmacy or is this just like a big joke when you think about the businesses, how it's so mixed 

up? 

Chi Patel: I will say, if we're talking to, just about financials, then absolutely not. There's not one benefit to being a pharmacy. You'd think, In owning six pharmacies, and I'm not even sure exactly what our total sales are, we'd be profitable. In other businesses, you're buying, Let's say 20 million worth of drugs a year. You think you're

not going to make at least a

million? so look at it that way. Absolutely not. Because every aspect of our financials, is dictated by the PBMs. Also, who can come to us is a big thing too, right? Not everyone can come because they steer certain people in certain tiers to mail order their own pharmacies, and then pay themselves differently for the same medication, same patient. Which is already should be an antitrust so on the, on the financial side, absolutely not. Personally, I think, yes. I mean, we're all [00:48:00] healthcare providers. We went into it to help people. Me, I like my flexibility of what I do. I like the fact that, I'm not always working in the stores.

I'm here in my office. But I'm also able to do creative things cause we can create different niches within our own market. So that allows me to do this. I wouldn't be able to do this if I was a restaurant owner or something else. So we have in healthcare, we have the opportunity to do very many things and tie it together with your business.

So that's the advantage, but to be able to see it financially is a different story.

Mike Koelzer: know, it's interesting you say that because

 well, in the chains, in a franchise, you're not going to have a lot of freedom to 

do different stuff, 

I imagine. That's the one thing in pharmacy. There's a certain, you say, even though you're not making money, there's a certain pleasure of thinking these things through. And what I have a podcast.

Talking about, subs or hotel rooms. I'm sure they're out there. I'm sure there's a lot of podcasts on a [00:49:00] hotel management and on restaurants and things like that. I just don't picture it myself. So there's maybe some love for the challenge or the disgusting nature of this.

It makes us get creative and think of how to do this and so on. But it sure ain't 

easy. 

Chi Patel: Yeah, it's definitely not easy. The risk tolerance has to be very high. I can only speak for ourselves. We're putting our life savings into our pharmacies, even as they're not doing well. And the 20 years of work we've done comes down to what's happening right now because of all this stuff.

We could probably close and say. We're calling it a day, but we don't want to do that. We enjoy what we do on a daily basis. We Want to take care of our staff. We want to be able to provide for our community because we've been doing for so long. don't know what I would do if we

sold our pharmacy. Forget the fact we have everything else.

This is what keeps us sane. This is what we

come in to work every day and it doesn't feel like work But

it that's those are some things we take for granted sometimes, but I think it's hard to see that right now with everything we're going

through on the PBM side. It's just getting worse.

and worse. So there's definitely, some [00:50:00] positives on the pharmacy ownership side. You but right now it's hard to see a lot of that because you're not able to

function properly. 

Mike Koelzer: Tell me a little bit about the half dozen pharmacies you have I know you alluded to it earlier, you know, of maybe that's not a great number right now. 

We only have one pharmacy and I've always said, the worst thing I could do is maybe have two pharmacies or three, because guess who would probably be the floater, I'd be the guy 

at all these at certain 

hours possibly if I had two pharmacies, four or five, six, seven.

I would definitely have to have backup for that because I can't be in

six places at once. Maybe I could do two stores at once or something like that. So I've never even entertained it seriously, and I'm just happy where I 

am right now, 

but what are some of those thoughts between multiple and 

or two? 

Chi Patel: I think, a lot of it starts with you have to have your foundation, which is, at the beginning, your first store, second store, whatever [00:51:00] it is, and they have to be running well. You have to have trustable staff there. But I see this in a lot of pharmacy owners where the pharmacy owners are still working behind the bench every day. And there's nothing wrong with that. Don't get me wrong there. But if you really want to

be an entrepreneur and grow your business, you're the face of your business. You have to be out there in the community engaging and doing events, doing lunches, speaker programs and just meeting people and networking.

And you can't do that if you're working your shifts every day in your pharmacy. Now it also goes the other way. We can't not be in our stores. So me and my partner work shifts in our stores as well. We're, like you said, the floaters when you need someone. Or just, we get in there just to see what's happening in our stores because if you're out of it for too long, you lose, connect with what's actually happening on the ground level, right?

So you

need to be able to justify

the changes you're making at the top to fit with what's happening at the bottom. So that's what works. With respect to Having multiple units, we started out with one and two and we went from two to four At the same time we bought one we were building [00:52:00] one And then the other two came about because they were in the same town that my partner grew up in here in south carolina So we stopped at six just because of the reimbursement wasn't as good And really at that point we're you know We wanted to like We didn't want to just plant all these flowers and just have them wilt If that's an analogy you want to see them blossom the right way and then grow so we

could have been at many other places

 units and the goal probably still is in the future to grow when things get re normalized if that's happening or what that really

entails, because we still see an opportunity in different parts of town that we're growing because Charlotte's a very growing town, but at the same

time it has to make financial sense.

And so the challenges we have with sicks are huge challenges that I think people with one don't see and they're beneficial to not see whereas, if you complain about someone calling out sick we'll imagine that with St. Paddy's Day was yesterday, and how many callouts do you think with that and so when it's multiple

stores, it's tough, because you only have, independents still only have so many employees, and you don't want to have [00:53:00] too many employees, because then you're paying them, and you don't have the money for it.

Your problems are basically multiplied. When you have multiple stores, so you don't look at the positives to having you better buying power and other things like that You can move employees and you could probably you know patient knows Oh, I have a location in charlotte in rock hill and in these other towns.

So great You're a bigger name,

but at the same time there's also challenges that come with having multiple units as well So definitely pros and cons,

you 

Mike Koelzer: I imagine at some point you get so big That, I don't know. Let's say you owned, 300 stores or something. would be out of your thought process. Even if, store 32 168 didn't have a pharmacist or something there that day. I mean, it wouldn't mean 

anything to you because what are you gonna do?

It's in New Mexico or something. the fact that you have, as in my. Thing one or two or three and your thing six even you [00:54:00] still feel that on post 

1. Patrick's Day 

Chi Patel: we're still a small business We're still a mom and pop shop, whatever , 6, 10, 20, I don't think that's going to change the way we operate ever. If we get to a

level to be at that 300, then you're probably going to have what we have in terms of our structure. we already have a director of operations. We're going to have people in different parts of the country . The people who have all that number is really venture capitalists. I know there's a few out there that fly a helicopter around

and do that. For them, it's

more of an investment, I think, just to have a bunch of them and sell them so the value of actually helping your community those are business people doing that. I don't know any healthcare providers who have that many pharmacies. Those are businessmen 

they're accountants, they're not even pharmacists who own those things, right?

So you get 

Mike Koelzer: By nature, don't care. And even if they did care, what are they going to do about it? It's just numbers there's no emotions or feelings behind it. There would be for an owner.

And like you say, over a certain amount, you wouldn't be that 

person. 

Chi Patel: No, yeah, that wouldn't be possible for us at [00:55:00] all. The way we've structured things and the way we, you know, when we have our meetings and we really talk to our executive team, and we go by things is that we love what we do, I see a lot of people who, post TGIF and all those things, and I'm like, there's no TGIF for us. Even if we're off, we're working Saturday, Sunday.

If We enjoy what we do. 

Mike Koelzer: There's an old saying that it's something like if you put a bunch of people in a circle and everybody threw their troubles into the middle, that after a while, would take their own troubles back. 

 Golly, Chi, nice talking to you. I'm going to put you into the true entrepreneur category, because I think Hollywood has made entrepreneurs as this person that stored up their life savings and sold their dog and did all this and put it all into this.

And, it better make it, or I'm going to be living on the streets. And I've never seen it that way. It's. It's looking at the desires of the community and throwing things here and testing it and doing this and [00:56:00] molding it and things like that I think you fit the definition precisely.

So thanks for joining us. Great talking to you. And I wish you continued success.

Chi Patel: Yeah, it was a pleasure. Thank you for having me. 

You've been listening to the Business of Pharmacy podcast with me, your host, Mike Kelser. Please subscribe for all future episodes.