Ronak 0:00 Today’s guests are Dr. Nishant Reddy and Dr. Greg Smith of NJ ENT. Dr. Reddy did his surgical residency at Rutgers University and Dr. Smith at Jefferson. Their other partner, Dr. Samir Undavia couldn’t make it today but he specializes in plastic surgery. NJ ENT was established to bring comprehensive ENT and Facial Plastic Surgery services to the New Jersey area. Their unique approach to care and commitment to excellence has made them one of the top ENT practices in the tri-state area. Dr. Reddy and Dr. Smith, welcome to the show, and let's jump right in. Just tell us a little bit about your background.Dr. Smith 0:34 Sure we actually both went to medical school in the same place, so I grew up in South Jersey, went to university around here as well, and then went to graduate school, medical school at Drexel University, College of Medicine, and that's kind of where I first met Dr. Reddy here. I was one year senior to him in medical school, and then went on to do a residency at Thomas Jefferson University. I stayed in the area afterwards, and we set up our own practice. After meeting each other again in practice for about seven or eight years, we decided to start our own practice, and we're currently in Marlton, New Jersey.Ronak 1:20 Awesome. And you. Dr Reddy?Dr. Reddy 1:21 So I did my residency training at Rutgers. That's where we kind of diverged from medical school, myself and Dr Smith and we met in our first job outside in private practice, and myself, Dr. Smith and Dr. Undavia eventually decided to start our own practice. We wanted to do things and what we believed was a better way and a different way that's more patient focused. And so we started NJ ENT and facial plastic surgery a little over a year ago, and it's been going great ever since.Ronak 1:54 So can you talk a little bit about the traditional way of doing things? And you said your practice is a little bit different. So what are some of those differences? Dr. Reddy 2:04 So, currently in our healthcare climate, most physicians are employed. They're employed by big hospital systems. They're employed by private equity groups. And you know this, these employed physicians are part of almost a cog in a big system, a big wheel that sometimes may not have the patient's best interest in mind. And so often times we get complaints of patients going through these large practices where they see maybe a different provider every time. They may not see a physician. They may see a different doctor every time, and they're essentially treated like a number, right? You go there and, you're just part of this giant system where you don't necessarily always get like that personalized kind of care that maybe we were used to decades ago in this country, where when things were more, when doctors were more, business owners and private practitioners and independent and so we're trying to go back along that, that more personalized care model.Dr. Smith 3:15 Yeah, trying to realign the incentives of healthcare. So as Dr Reddy was alluding to, yeah, a lot of these practices, in order to become more and more successful, you just need to see more and more patients, so the volume has to increase in order for you to become more successful or to gain a promotion. And so to do that, you just have to continue to make you see more and more and more patients, and really, like, the alignment of the patient and the physician is a little bit different than like, the patient wants more time with the physician, not less, and the physician wants to spend less time with the patient in order for them to be the most successful. So we're trying to find a way that we can kind of break that that alignment and kind of get the incentives back in line and so that we can see appropriately the right amount of patients, which we believe is, to be better for the patient, better for decision making, and allows us to provide more patient centered care.Ronak 4:19 I mean, from a patient's perspective. I mean, I was really excited when you guys joined, I've been going to EMTs for the past 20 years because of a previous medical issue. And typically, when you call a practice, the wait time is anywhere from six weeks to six months. And the fact that you guys did same day appointments and next day appointments, I mean, it's phenomenal. What are some of the kind of services that you provide? Because I know you do everything from, just diagnosing simple sinus infections to surgery.Dr. Reddy 4:51 Sure. So we provide comprehensive otolaryngology or Ear, Nose and Throat care. We provide everything from patients that complain with ear complaints like hearing loss or ear infections, nose and sinus issues. Sinus infections, trouble breathing through your nose, nasal congestion, those are some of the most common things that we see, we also see, very commonly, throat issues, things like throat infections, tonsil infections, voice problems, trouble swallowing and lumps and bumps in the head and neck area. And then our partner, Dr. Undavia, he focuses on facial plastic surgery, so nose jobs or rhinoplasties, facelifts, nonsurgical options like fillers, botox, things like that. 5:53 Dr. Smith Yeah, excellent. Well put.Ronak 5:57 Yeah, what are some of the advancements in technology you've seen in the last, you know, decade or so?6:04 Dr. Smith Sure. So, you know, things in general go in waves of kind of becoming more complex and less complex or minimally invasive. And so things are swinging towards more minimally invasive types of procedures for nasal obstruction procedures, you know, allergy treatments are more targeted over time, so things are swinging more towards trying to solve a symptom or a problem. Using more individual guided treatments. So, for example, nasal obstruction. In the past, you may see somebody and everybody just has the same type of deviated septum, or turbinates or enlarged or they have this area called the nasal valve, which is too narrow and you may get the same symptom, get the same treatment every single time. It's a deviated septal repair or turbinate reduction or a nasal valve procedure to widen the nasal valve. But now you know there are more individually guided treatments. There are minimally invasive procedures that can be done even in the office to help with these patients. And so you'll start to see radio frequency devices that are coming out, which are kind of remolding or reshaping some of the narrowed areas within the nose. Allergy treatments and allergy medications are starting to become more targeted at treating the allergy system from the top of the cascade of inflammation, as opposed to just treating the end results. So things are really progressing rapidly in the area of ENT and mainly focused on allergy breathing issues, even cancer research has changed things dramatically in head and neck and ENT as well. You know, in the past, a lot of head and neck cancers that were potentially HPV related or throat cancer, tonsil cancers, neck nodes. A lot of those required massive surgeries and big oncologic resections and reconstructions, and now a lot of times, we can spare those massive surgeries and extra chemotherapy and radiation treatments with these more biologically targeted chemotherapy medications that are aimed at fixing kind of some of the earlier mutations and things with the cells. So treatments have gotten much better. Patient outcomes are much better with everything we see patients with a lot less morbidity from the treatments, right? And that's what the whole goal is. Can I get somebody breathing better with less morbidity? Can I get their allergies and sinuses better with less morbidity, as opposed to, like, just doing the biggest thing possible? Right from the get go, we're starting to see a phasing in of treatments that really benefits the patient significantly, historically, sinus surgery, for example, used to be these really barbaric treatments. So if someone had a really bad sinus infection, you would do what was called, like a treffination, or like drilling in or chiseling into the sinuses through the skin. And then things went well at the time, what we thought was minimally invasive, which was doing a wide opening, but taking out the natural doors into those sinuses, if you will. But it's still a big surgery, with a lot of cutting and redoing a lot of the anatomy within the skull and sinus cavities. And now we're starting to see even more minimally invasive where we're dilating those sinuses open or putting different medications into the sinuses and irrigating the sinuses out or that, without having as much morbidity and downtime. And so Dr. Reddy, myself, and Dr. Undavia, we all specialize in kind of that whole gamut of procedures trying to stay with the least morbidity towards patients, with giving them the same result. Ronak 10:22 And Dr Reddy, you actually created a company, Fox. Can you tell us a little bit about that? Dr. Reddy 10:28 Oh sure. So, NG Ent, we're always trying to stay up to date with the latest technologies and the latest innovations in the ENT market. And as Dr. Smith alluded to, the ENT market has been slowly going more and more towards minimally invasive and in office procedures. And what we noticed is that while that space has been going into that direction, there's been a big deficit in the market when it comes to video endoscopy, there's a lot of limitations to what's on the market with video endoscopy, and so what we decided to do is create a prototype and a new way of doing video endoscopy that kind of addresses some of those limitations, including things like making it wireless and making the latency better and things like that. So we have, you know, some patents that are granted for that technology. But, you know, these are all sorts of advancements that we can make in the field to try to make in office sinus procedures better for the patient.Ronak 11:42 No, that's, that's very cool. So talking about like, prevention and wellness, you know, what are some things that patients can do to maintain good ear, nose and throat health?Dr. Smith 11:52 Yeah, when it comes to prevention, especially with the ear, nose and throat, like a little bit, goes a long way, especially if done early. And so for things like allergy, for example, if you start trying to stop that inflammation early, as opposed to waiting until the symptoms are severe, you can usually prevent severe episodes or occurrences by doing some things up front and so things like nasal rinses and irrigations for the sinuses and nasal cavity are extremely helpful at trying to avoid exposure or irritants that are laying in the nasal cavity, which is your filter for a prolonged period of time. So salt water rinses are a pretty simple thing to do that's very preventative and decreases inflammation kind of early on, things like nasal steroids. And there's a whole gamut of nasal steroids on the market now. And really the biggest advancement in those in the last decade or so is just the delivery systems into the sinuses or nasal cavity. So nasal steroids can be something that we can kind of target and figure out, you know, to try to decrease some of those inflammatory issues. When it comes to reflux issues. We talk about prevention there as well. So, a lot of times we get patients coming in with difficulty swallowing and painful swallowing and severe voice complaints and hoarseness. A lot of times, if you address some of the reflux problems, early, patients may not get to those severe hoarseness or dysphasia. And so we talk about dietary changes and things like alkaline diets or other reflux alternatives for non acidic reflux. And so a lot of times, these head and neck issues that most commonly get complained about, which are like allergy, reflux related things can if you do something small up front, can prevent a cascade of significant inflammation and issues down the road.Dr. Reddy 14:07 Another simple thing to do for prevention for most nose and sinus issues is adequate humidification, so especially in the winter time and the summer time when you have your HVAC units running in the house, it's really common to have dry air in the home. And so if you just get your humidity level up, that often times will make your mucociliary tract system, which is your cleansing mechanism, and your nose and sinuses just function better, and you're less likely to get nose and sinus issues.Ronak 14:42 Yeah, I think when I came in to see you guys with frequent sinus infections I was gettin one of the things you recommended was xhance and looking into it. It was just a novel way of getting that medication so I'm glad that I'm a patient of yours. First of all, just because I know you guys are on top of all the latest procedures and medicine as well, speaking of like, social media. So you actually have your own podcast? We Knows Noses. Dr Smith, you want to talk a little bit about that? Dr. Smith 15:15 Sure. So we started our podcast a little over a year and a half ago, and it really was to educate patients on some common things with ENT, even when a lot of people don't know what otolaryngology or ENT is or does, until they have an issue that somebody says, hey, you need to see an ENT. Even myself, when I was going into the field of otolaryngology, I have to say, I didn't know all that much about it, either, and this was most of the way through medical school before I really learned a lot about what ENT is and does. Is something that we don't learn a lot about, even in medicine and in training in medical school. So there's a lot of physicians out there that have a deficit in ENT knowledge. Certainly, patients and the general public have a pretty big deficit when it comes to ENT knowledge. You know, most of the population doesn't even know that. You're not really supposed to stick Q tips in the ears, for example. So even simple things like that. We try to educate the population on what are some common ENT issues. What things may you try like before coming in to see an ENT, what are some of the common things we see? What can you experience? So we could try to run the gamut of topics with ENT and facial plastic surgery as well, which is part of ENT as well. So the whole purpose of it was more for education. So I was very hesitant in starting the podcast, but thankfully, Dr. Reddy was not, and basically convinced me to go ahead and start this podcast, but it's been a great journey so far, and we have got a lot of positive feedback from patients coming in, finding us and telling us how much they love the podcast and how helpful it's been for them. So as soon as I got that first response from a patient saying that they loved it, and it was so helpful. That to me, surely surpassed any embarrassment that I got from putting myself on on a recording was at least I know that our information is getting out there and is helping somebody make a more educated decision or a better decision and informative decision. Ronak 17:41 Yeah. I mean, what I like about it is, I learned things that I would never look up, right? So there's always a new topic every time you publish an episode, and I'll listen to it in my car, and it'll be about things that I would never think of. So just having that kind of larger knowledge of what you guys do is fun for me, and you're actually a star on TikTok. So sometimes you put your recordings of the different things that you do. So how's that been and like, Why do you think people are so attracted to these type of videos? Dr. Reddy So yeah, TikTok was a bit surprising. Initially, I was posting on social media, a lot of videos that I would find interesting. So, you know, kind of elaborate surgeries and nuanced procedures. And it was getting some traction. But then I started posting the most ridiculous videos, you know, that were, short form, kind of gross videos sucking snot and cleaning boogers and cleaning mold or fungus from a person's nose or earwax. This is kind of like more of the day to day stuff that ENTs typically deal with, right? And surprisingly, people love it, and it's the same people that tend to like things like Pimple Popper videos, you know, gross, short clips that really catch your attention. And those clips, I've noticed has just gone viral over the past year. So I think that's what's kind of led to this whole TikTok phenomenon.Ronak 19:22 No, I mean, it's definitely some interesting videos. So thanks for posting those, especially the earwax and things coming out. So talking about surgery, and obviously you guys do a lot of surgical procedures, are you able to tell, like, some horror stories I know, Dr Reddy, you so you actually operated on me last year, and you said I woke up from anesthesia, just just swinging right. I had to kind of be held down. What other things have you like, experienced?Dr. Reddy 19:54 So, you know, luckily, knock on wood, complications from. Sino nasal procedures is exceedingly rare. The most common issues I actually see are from the anesthesia that's administered because of the surgeries. And one of the most common things that you alluded to is just waking up, sort of combative, right? So a lot of patients, you know, they're in a whole new environment. They're in the operating room, the hospital. They've maybe never had anesthesia before, and there, it's a whole new environment. And then when you're sedated and you're getting you're waking up from sedation, you often times can get confused, and it might be scary, and you might actually think that you're in danger, and so you might start swinging at people that are trying to actually help you like, so sometimes we have to get multiple people that kind of hold down the patient until they're slowly coming out of the anesthesia. So that's probably, like, one of the most common things that I see.Ronak 20:55 Yeah. What about you Dr. Smith?Dr. Smith 20:57 Yeah. I mean, I agree. I think most of the most complex problems to deal with are ones that we're not expecting. So we're trained to look for complications related to surgeries. We're not necessarily trained or, like, always thinking about those things which are related to anesthesia, or, you know, sedations, where patients may wake up confused, or may syncopize and and pass out, and it looks sometimes frightening as they're going through like a syncopal event, or when they're going through a delusional event when waking up from anesthesia. Yeah, typically, it's related to hallucinations or delusions, because you can't, there's no rational things that you can do to make it any better time, most of the time, and sometimes you can, you know, give a little more sedation to try to, like, ease that back end. But that is, probably the most frightening or complex thing that we deal with, with feeling the most like helpless.Ronak 22:06 What are some of the weirdest things you've like, seen or removed from someone's ears and noses? Dr. Reddy 22:15 So one example is, are insects. So insects coming out of people's ears. So sometimes people, they might fall asleep, and the next day they might hear a scratching sound in their ear, or it might feel some sharp pain in their ear, and then you look in their ear and there's something like a cockroach in there. And so those are always kind of a little skeevy to deal with. How about you Dr Smith?Dr. Smith 22:42 Yeah. Again, it's the unexpected, you expect to see, like when you're in someone's nose, like a like a growth, like a polyp or something, but like when you see a tooth or something that's inside the nasal cavity, I think all three of us have had a tooth in the nasal cavity before, and you're like, What is this thing in the bottom of the nose? And you're like, kind of poking it, and then you pull it out, and it's a tooth. So sometimes like that can be farm bodies, or another one of these things that kids often put goofy things in their nose and their ears. And sometimes they live in there for years and on the kind of unfound and so, yeah, sticking a forcep inside the nose or the ear and pulling out like a small piece of eraser or like a googly eye from a toy or something that can be pretty crazy. Yeah, nothing, all that gross. Ronak 23:42 But so, before we started recording, we're actually talking about a shortage of Ents all across the country. Can you guys just talk about a little bit about why that's happening and what you think would be a good kind of solution to solve that problem?Dr. Reddy 23:59 That's a tough question. Dr. Smith 24:04 Yeah, it's complex, because understanding, why is part of it, and sure, like, population growth and booming of we talk about, like, some of these, like, cities and places in the country. Dr. Reddy was talking earlier about, like, Dallas's explosion of population growth in Houston and some of these other cities that maybe used to be industrial and now are switching over to more tech heavy areas, and they're getting a lot of influx from other countries and becoming kind of more valuable to live in. And even like the Midwest and Western places like Colorado, but even some of the East Coast cities are starting to see a resurgence of population. So population growth is a big thing, and population growth seems to be exceeding what the growth in medical education and training for. Sub specialties like ENT and so another issue is just Ents in general, there's a lot of people that don't necessarily want to work, you know, 100 hours a week anymore. And so you get a lot of physicians that maybe have a dual income family and maybe don't want to work 100 hours. And so they may be working, you know, 60% or 70% time. So you may train the same, ENT, but they may only work three quarters of time, as opposed to, you know, years ago, if you went through all that training, most people were going to work 100% and try to get as much out of it as possible. So, you know, I think Ents are still extremely productive, but each ENT may, you know, in general, may become a little bit less productive as well. So there's a population growth conundrum, and then people realizing that quality of life is a pretty big interest as well, and don't necessarily want to burn out young, so they try to space it out, and are having bigger families and trying to spend more time at home, as opposed to just being away all the time. And then what it takes to try to get a new Ent. We talked about, a little bit Ronak. It's a lot of time. So we talked about, even if today, I wanted to start another ENT into the community, it's going to take at least four years of medical school, plus another five years of residency training, because specialties like ENT take five years, and some specialties, even with a fellowship like ENT, an extra fellowship may take another year or two on top of that, so you're talking at least nine to 11 years before you can get another ENT into the community. So once you realize that there's a deficit in EMTs, if you're behind, you're a decade behind, before you start increasing those numbers. So it's a big problem. You know, our academies are aware of these issues too, but sometimes it takes such a long time for them to recognize that there's a problem that before they recognize it's a problem, you're already behind. The medical field in general is a really hard thing to ramp up quickly. It's not like a commercial business or something that in a year or two you can get on the ground and running with appropriate funding and construction the medical practice, because it's such a complex field and requires such a heavy education burden, it really is a big problem to try to get more into the community fast.Ronak 27:42 Dr. Reddy, you were mentioning like mid levels could be like a possible sort of short term solution.Dr. Reddy 27:50 I think you know, appropriate use of advanced practice providers like nurse practitioners and physician assistants can really broaden an Ents reach and can help care for more and more patients in the community. The other I think that potential, like partial solution to the issue, is just more education for your primary care doctors, urgent cares, those frontline medical practices that are seeing patients, usually first for things like for patients with things like nose issues, sinus issues, ear problems. And you know, adequate education for those patients, for those doctors can widen the reach of ENT care.Ronak 28:45 So where do you guys see the field of ENT medicine heading in the future?Dr. Reddy 28:51 So I see a lot of parallels to what's happening in the cardiothoracic and cardiology world, you know, back in the day when you had a blockage in your heart, you were and medication wasn't enough, you would typically have open heart surgery. And now, when you're having a nose or a sinus blockage in ENT, well, typically, in the past, you would get sinus surgery. However, in the cardiac world, what happened is they started to develop more and more minimally invasive procedures that can avoid open heart surgery. They can be done minimally invasively with balloons and catheters through your blood vessels. And what they did is they modified that technology, and they adapted it for Ear, Nose and Throat use. And so what we're seeing in real time in the ENT world is that same shift that happened in the cardiac world, where more and more patients are avoiding the full surgery in the operating room, they're avoiding a trip to the hospital, they're avoiding general anesthesia, and they're coming to the office for a much more minimally invasive sinus procedure that's done with balloons and catheters. And these patients are oftentimes getting similar results in terms of their symptom relief, but they're avoiding the morbidity that's associated with the procedures. They're avoiding the general anesthesia and minimal downtime, so oftentimes people are going back to work the next day. So I think that's really the biggest change that we're starting to see in real time in our field.Dr. Smith 30:34 Yeah and if you think of the economics behind it. The general cost to the healthcare is way less and so most of us have trained where if there was a problem within the nasal cavity like Dr. Reddy was saying, you had to make the septum perfectly straight and shrink the turbinates so that there’s tons of room and open up the sinuses as wide as possible and patients would get better. But there was a lot more and morbidity, downtime, and costs associated with that. And so if you can decrease the costs associated with that, you don’t have the hospital overheads and anesthesia and all that. So the cost is significantly decreased. The patient becomes a productive member of society again, quicker, and so there’s not as big of a cost loss with that. And so, there’s a lot of economic benefits. We have slowly started realizing and certainly I know I have changed my practice significantly. And in the beginning I would’ve said, “Oh no, there’s a little bit of a septal deflection, I gotta make that absolutely perfect and get everything exactly straight.” And we now know that’s not necessarily always true, like sometimes, it really is just because I think that it’s a little crooked and patients don’t know that. Patients don’t come in and say, “I have a deviated septum.” Typically, they say I have nasal obstruction. And if you fix that nasal obstruction and they’re breathing substantially better and it’s improving their airway and maybe their sleep and all other things downstream, it doesn’t always have to be 100 percent perfect. So you can really tailor everybody’s treatments. And so, as Dr. Reddy was saying with where healthcare is going, I think that’s a big thing. Understanding costs to the system is part of it as well and I think a lot of physicians aren’t necessarily educated in the costs of the hospital system as well. And so you come out and you work for a hospital system, of course if you take that same patient to the hospital and you do a surgery, the hospital benefits and gets more money out of it. Which is great on the hospital’s side but not necessarily great for the whole healthcare system. It’s a complex problem because you need the hospitals to continue to get the funding because that’s what helps support both the economy but the population and their need for care. Especially charitable and indigent care, so it’s a very complex economic issue when it comes to depreciating costs and care.Ronak 33:23 I can imagine. But, I know you guys are busy and this was really a great episode. Thank you so much for coming on. Where can patients find you?Dr. Reddy 33:30 They can find us at our Marlton office, for more information you can go to our website NJENT.com . Our phone number is 609-710-NOSE/6673 and our podcast is We Knows Noses. You can find us on all major podcast studios.
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