Michel Reijnen left his phone and camera behind before walking nearly 100 kilometers through Costa Rica’s Osa Peninsula. He crossed rivers, slept in a hammock, hit a 30-kilometer day and learned quickly that being a vascular surgeon carried no special weight in the mud. David Villanueva built the 10-Day Jungle Crucible after watching people enter the jungle stressed, finish a hard trip and go right back to the same life. The miles are only part of it. He makes people stop, write, talk and pay attention to what comes up under pressure. That part got me. We spend a lot of time becoming useful. We get very good at our titles. Then it gets hard to tell whether the work still belongs to us or we belong to the work. Our new Life of Flow episode with Michel and David is out now. Listen at the link in comments.

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500,000 dialysis patients in the US. 70 to 80 percent of them need a fistula intervention every year. And the people doing their needle access? Non-clinical techs with a 35 percent annual turnover rate, punching the same spot over and over because nobody trained them on anything better. Aaron Moore saw this up close. Navy veteran, vascular surgeon, private practice in Jacksonville. He kept fixing the same complications caused by the same bad access patterns and decided to stop just treating the problem. Varustra is the company he helped build. An iPad app that maps fistula access points with photos and color-coded heat maps so techs can actually see where they've been and make better decisions. FDA breakthrough device designation. This conversation covers the broken dialysis access model, what it looks like when a practicing surgeon steps into medtech, and why Aaron believes if you don't understand your business, someone else will run it for you. Watch the full episode through the link in our bio. #LifeOfFlow #VascularSurgery #MedTech #PhysicianEntrepreneur #DialysisAccess

Most physicians have no idea how much revenue they generate. Not a rough sense. No idea. I didn't for years. I knew my salary. I knew my RVUs. I never connected those numbers to what the system was actually collecting because of my work. When you finally do the math, it's not a pleasant surprise. It's a gut check. The gap between what you bring in and what you take home is not small, and nobody on the administrative side is going to walk you into that conversation voluntarily. That's by design. We are trained to keep our heads down and trust that someone else is handling the business side fairly. And for a long time, I did exactly that. Signed contracts without understanding the real value of what I was trading. RVUs are supposed to be the objective measure. But most of us learn what an RVU is worth to the system only after we've already locked in a number that undervalues it. The negotiation happens once. The consequences compound for years. Miguel and I got into all of this on the latest Life of Flow episode. How to actually calculate what you generate, why most contracts are structured to keep you from asking, and what changes when you finally have the numbers in front of you. This is the conversation I wish someone had with me before I signed my first contract.

"Last time you went through the ankle, it took 20 minutes, and you sent me home. And now you're telling me we can do that again or you can cut my leg off?" I've had patients look at me like I'm out of my mind when I present both options. And honestly, I get it. From the patient's perspective, the gap between what endovascular limb salvage actually feels like and what a major amputation means is so wide that offering both in the same sentence sounds absurd. This is something Miguel and I talked about on our Case Cast with Dr. Mariano Palena. We had a 72-year-old, Rutherford 6, gangrene on the first and fifth toes with plantar involvement, referred for a BKA after open surgical exploration found nothing usable. Mariano's team did a CO2 angiogram, recanalized the peroneal, entered the foot through the posterior branch into the lateral plantar and across the arch, and restored full perfusion. Five devices, roughly 20 minutes, outpatient-level procedure. The patient healed in three months and went back to work. A leg that was scheduled for amputation was saved with what amounted to a same-day intervention. Now imagine you're that patient. You've already been through something similar on your other foot. You healed. You walked out. And now a different doctor is telling you the only option is to lose the leg. That's what barbaric looks like from the other side of the table. Not because the surgeon offering amputation is wrong in every case, but because when a 20-minute procedure exists and nobody even attempts it before making that call, something in the system has failed. Patients already understand this. They live it. The question is whether the rest of us are willing to catch up. https://youtu.be/pRngJ0Pi_zE

Why aren't more doctors owning their facilities? It's time for a change! Doctors should be in control of patient care, not just following protocols. Why rush to procedures like stents when personalized care is possible? Let's talk about the importance of quality over quantity in healthcare. What do you think about this shift in the medical field? #Healthcare #PatientCare #MedicalProfessionals #LOF

Is the freestanding ED model dying? 🤔 In this clip, we dive into the shift from freestanding emergency departments to Micro Hospitals. Discover how the changing landscape of healthcare is impacting patient care and business models. Learn why micro hospitals are becoming the new norm and how they can provide better service and efficiency. What do you think about this shift? Let us know! #Healthcare #EmergencyMedicine #MicroHospitals #LOF #PhysicianIndependence

This founder drops the ultimate truth: "Lose Yourself" by Eminem perfectly encapsulates the life of a founder. 🔥 Every single lyric hits home when you're building something from nothing. The pressure, the doubt, the "one shot" mentality... it’s all there. From networking at conferences to pushing through the grind, this song became his go-to anthem. If you're a founder, entrepreneur, or anyone chasing big dreams — this one’s for you. Drop a 🔥 if Eminem’s lyrics have ever motivated you!Show moreUsed a skillUsed a skillHere's the upgraded version: Every founder has an anthem. His is Lose Yourself. 🎤 Eminem wrote about getting one shot at the moment that changes everything. Founders know that clock. The pressure is constant, the doubt shows up uninvited, and the whole ride runs on believing your window is open right now. He says the lyrics map onto startup life almost line for line, from conference hallways to late nights in the grind. When the doubt gets loud, he turns the volume up. If you're building something of your own, this one's for you. Drop a 🔥 if Lose Yourself has ever carried you through a hard week, and subscribe for more founder stories. #Shorts #Eminem #LoseYourself #FounderLife #Entrepreneur #StartupMotivation #LOF #medtech #medtechinnovation

Medical training prepares physicians to care for patients, but not to manage their careers. Contracts, credentialing, taxes, negotiation, retirement planning. These decisions shape a physician's future, yet most of us don't learn about them until after signing our first job. The business side of medicine isn't optional. Hear more from Dr. Shahla Moghbel and Dr. Santoshi Billakota in our latest episode. Watch it now on our channel.

How do you build wealth? - by earning more, or by learning where your money creates the most value? For doctors, that means moving beyond saving income and toward investing in skills, businesses, and opportunities they understand and can influence. Dr. Shahla Moghbel and Dr. Santoshi Billakota share how changing the way they thought about money became part of building more independent careers. Full episode available. Check out Life Of Flow's channel now.