Using Podcasts to Crowdsource Medical Expertise – Dr. Aaron Fritts, Co-Founder of BackTable

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. We focus a lot on new healthcare technology on Raise the Line, with most of the focus being on offerings in the booming digital health space. But that's not the only source of new products doctors have to keep up with. There's also a steady stream of new devices coming out that providers need to learn about and integrate into their practice.

The need for doctors to exchange information and tips on new devices and procedures is what prompted interventional radiologist, Dr. Aaron Fritts, to launch a learning platform called Backtable.com in 2016, which has since expanded to include articles, and podcasts and now serves ENTs, vascular surgeons, interventional cardiologists, urologists, and other specialties. Dr. Fritts now joins us to tell us all about it. Thanks for joining us today, and spending some time with us.

Dr. Aaron Fritts: Thanks, Rishi, I appreciate it. I love what you guys are doing at Osmosis, and congrats on the recent partnership with Elsevier.

Dr. Rishi Desai: Thank you so much. I want to start by just pointing out that, of course, BackTable is in large part due to your effort, but you also have some partners as well. Maybe that would help us segue into the backstory on BackTable and how it came into being.

Dr. Aaron Fritts: Yeah, for sure, the key partner being my lovely wife, who has been supportive this whole time, but also runs our ENT section. But–just to take a step back, I'm an interventional radiologist. We use a lot of disposable devices. When I came out of training, I joined a big group here in Dallas. I was traveling, I was at a different hospital every week, and every different hospital had different devices on the shelf. Even though I was familiar with a lot of the devices, because of fellowship and training, there was a lot of new stuff out there that I'd never even used before.

I found myself on the phone all the time calling colleagues from training, calling prior attendings, even partners in the group: "Hey, how do I use this?" Or like, "Are there any tricks or tips that you have for this so that I can perform a procedure safely?" And I thought that should be a resource for docs, because what I found was, there's a lot of guys out there like me, and there's a lot of new devices coming out all the time. It'd be a great way to help people keep stay up to date with the new devices out there.

We started that, just for our specialty for IR. It was actually initially an app. This app was a way for docs to… it was like Amazon reviews. You'd write a review about a device—what you liked about it, any tricks to it, give it a star rating—and we had pretty good engagement, but it plateaued after a few months, after I got all my friends to write reviews. Then my one of my other co-founders, Anish Pareek—who is not a physician, but he's our business side—he was like, "Aaron, we need to do some content marketing, like some blog writing, or maybe a podcasts." 

I didn't like the idea of it because I didn't like the idea of me with a radio voice or trying to do this, as most docs feel probably. I'm not a big writer, so I said, "I don't know about it." Then he pitched the idea of making it more informal, like click and clack on car talk. And when he when he said that, I said, "Okay, well, there's something there, that would be fun." And as my other co-founder Chris Beck said, it can be more like edu-tainment and less lecture style. That's the origin of BackTable, and the podcast is what it became known for. The app actually died out because it's so expensive to maintain. We actually had more fun doing the podcast. That's how it transformed into okay, let's just be an educational resource via podcasting.

Dr. Rishi Desai: Just so I understand the pain point, when you would go in to do a procedure, was it that you didn't have the technical know-how, like literally like how to do something with a new device? Or was it like not knowing when to use a new device, the diagnostic side of it?

Dr. Aaron Fritts: It was more the differences. Different biopsy needles, for example, have different ways that they function. Some come with coaxial needles. Some don't. Some have different levels of sharpness. They engage the sample in different ways. If you run into an issue with one biopsy needle versus another. I want to get that information out to my colleagues, so that they don't waste time on that one that gave me issues. They go straight to the better one.

Dr. Rishi Desai: That makes a lot of sense. Then I think about your podcast, if you're doing the click and clack style, right? And someone's listening, how translatable is that information? For example, if I'm in Mississippi and I've got a procedure, I've got a patient in front of me. I’m just trying to think through like, how relatable is your experience in, let's say, California or wherever you may be, to my experience in Mississippi? How does that translate when the patients are different, the situation is different, etc.

Dr. Aaron Fritts: To stick with the biopsy example, the first episode was me and Chris. I knew Chris liked one kind of bone biopsy needle, and I liked another. We just got on and went toe-to-toe as to like, what were the pros and cons of our each of our needles? His was: "Mine is cost-effective, because it's cheaper, and it gets the job done right." Mine was like, "no, actually, yours is a piece of crap. mine's more expensive, but it's sharper, and it gets a better sample and here's my experience." It was that kind of going back and forth. Does that answer your question?

Dr. Rishi Desai: Oh, totally. That's awesome. That makes a lot of sense. It feels viscerally authentic and real in that sense. I totally get that. My next question is: how do people get the trust that like, hey, is he just getting sponsored by the biopsy needle guy? You know what I mean?

Dr. Aaron Fritts: Good point. Yeah. Early days, we were not sponsored by anybody. We were going for authenticity. We still go for authenticity and even to this day, with our sponsors, we let them know, hey, we're not here to make infomercials for y'all. We may have a KOL or key opinion leader that is familiar with their device so that they can present the expertise and the know-how about the device. But the goal is not to talk about their device the whole show. It's to talk about how this device fits into their day-to-day practice. And again, why do they endorse it? Why did they use it?

That's the whole goal of BackDoor, because I feel like we do need industry at the table. That's how we innovate. This whole murky relationship with industry—it's troublesome, because when you're in training, you get taught to stay away from those guys. They're bad news, but that's not true. Like, that's how innovation happens. It’s when docs and industry team up, and they discover pain points, and they find solutions for those pain points. I feel like the podcast is a good way to talk through this stuff and have industry at the table in a responsible way.

Dr. Rishi Desai: That brings up another question. You say in training that there's this ethos of like, separation of church and state, or however you want to describe it. But your point is well taken. How are you supposed to improve if you can't have key stakeholders around the table? Do you think that the training setting ought to change a little bit, or change their stance on the industry?

Dr. Aaron Fritts: I do, and I think it is changing over time. I see a lot more people open to it. We're in this sort of innovation age, right? I do see more people in the academic setting, being more open to working with industry, leading those sales guys in the door, just from conversations we've had with people.

But when I was in fellowship, I only met one sales rep the whole year. He was the only guy that was allowed in the door. It was frowned upon to engage with those guys. I think that, yeah, some of them are very schtick-y, and they're not helpful. But a lot of them really are, and they're really knowledgeable, and you actually learn from them.

When I got on practice, I was by myself in all these hospitals, and I had to learn from the sales guy, because he was the primary resource. That's also why I wanted to supplement that with information from my colleagues, crowdsourcing information around devices so that my sole source of information wasn't just from the sales team.

Dr. Rishi Desai: Totally. It sounds like such an evolution from where things had started—where you're calling up, it sounds like a handful of friends and maybe relatives—and where things are now. I'm curious how the podcast itself evolved? Like what things are you doing today that maybe on day one you weren't doing? What has shifted and changed over time?

Dr. Aaron Fritts: Yeah that’s fun to think back, right? Because we've kept the original audio on the first episode the same. I cringe when I listen to it because you guys know from having a podcast, audio is important. There's a lot of podcasts out there and you got to evolve as a podcast if you want to maintain listenership and grow listenership. Originally, we were calling in on our little earbuds, and some of us were calling on our phones, and the audio was horrible. Then we realized, "Okay, if I can't listen to this, editing it, then how do I expect other people to listen to this?" Then what I started doing was, I got a microphone. We only had like two other hosts at that time, and I bought microphones for them. That really improved our host audio.

Then once we started getting sponsorships, I said, hey, let's reinvest this money into our audio quality. I started finding these little USB microphones for like 35-40 bucks on Amazon, and sending them via prime to them. Then they had a better guest experience as well, because they got a microphone, which we just give it to them. They get to keep it. We don't make them send it back or anything like that. That was like a major milestone for us in terms of improving our audio quality. The second big one was hiring an audio engineer, because before I was doing it all in GarageBand, and stuff like that. And then Descript came along, which is amazing software. And an audio engineer who actually knows what they're doing was another big milestone for us.

Dr. Rishi Desai: What sort of feedback have you gotten from listeners? And what advice or information are they giving you that has changed your decisions about programming, who to have on, things like that?

Dr. Aaron Fritts: I think the first thing that's great is that we actually get feedback from our listenership. I recently went to Podcast Movement, and there's a lot of talk about how to get feedback from your audience. Like how do you even know they're interested or listening? And that's challenging, right? Especially from physicians. Physicians are busy. Before I was reaching out to guests we had on the show, or people I know who are like super fans, and trying to get feedback from them.

But what's great now is like, it just comes. It comes via email, it comes via website, it comes via Twitter. It's like, hey, guys, I really liked this episode that you did on building this service line. Have you ever thought about doing one on a kyphoplasty service line, and in a similar manner? It's like, the feedback comes along with a suggestion on further content. It just becomes a flywheel of content where we don't even have to brainstorm anymore: Our audience is telling us what they want to hear.

Dr. Rishi Desai: Now, this is something that I'm particularly curious about, because the more I talk to you, the more I realized this is what sounds like very much a full-time gig, right? Yet, you're also claiming to be a doctor. How do you balance it? It seems to me that a big part of why you're so successful is that you're an authentic physician. You've gone through it. You do it day to day. Balancing the two seems like an enormous juggling act, and I’d just like to understand your work week. What does that even look like?

Dr. Aaron Fritts: With Covid the silver lining was … Burnout's a buzzword right now, but I was burnt out right before Covid. I was a solo interventional radiologist in an OBL, an outpatient-based lab, by myself. Then I also had BackTable. Then I was also doing diagnostic radiology on the side, teleradiology. It was just too much.

Then Covid hit. It took one of those things away, because the OBL shut down. It freed up some time for me. I was really just doing teleradiology from home for several months. It gave me the time to focus on BackTable. We saw tremendous growth during that period because conferences were shut down, right? People were looking for information, and all of a sudden, our listenership starts driving up because people were like, oh, wow, there's this podcast out there that talks about this stuff and I don't necessarily need to go to a conference because I can hear these guys. It's the same conversations we have at the hotel bar at the end of the day, at a conference. Lot of docs were also sitting around with nothing to do. They made for great guests. They had some time on their hands.

That was the silver lining of Covid. It forced me to take a step back, and then I realized, okay, I'm not going to go back to full-time medicine. I love BackTable. I love what we're doing. Within those first months of Covid, we realized, okay, we have an opportunity to start new shows.

My wife, who's an ENT, wanted to start an ENT show. We started that, and then shortly after that, we started one for urology, and then I was like, well, I have to do BackTable full time because all the other founders have other full-time jobs and I was the only one who was willing to go part-time. And I thank them for that for giving me that opportunity because I love it and it's been a great adventure. What I do now is: I do locums for my old group. I cover them once or twice a month in the hospital. That way I stay one foot in and keep my skill set up. Also, it helps me come up with ideas for the show.

Dr. Rishi Desai: How do you choose new specialties to go into? I mean, I can understand ENT, that's an obvious one. What about urology and other ones? Like, how did you choose that versus something else?

Dr. Aaron Fritts: Urology was great because there's a lot of overlap between IR and urology.  We collaborate on a lot of cases that have to do with the urinary tract system.  I had... He's pretty much a co-founder, Jose Silva. He was with us early on when we first started BackTable because he actually created... The same thing that we created for IR devices we actually created for urology. We actually had docs writing reviews for urologic devices.

Then the app fell off. Then I reconnected with Jose, and I said, "Hey, man, we're doing really well with the podcast. Would you like to be a host for a urology podcast?" He was like, "Yeah, let's do it." Then another good friend of mine, who was a urologist here at UT Southwestern, really liked what we were doing and wanted to participate. We got him hooked. Everybody, once they get that podcast, that microphone in front of them, they really enjoy it.

Aditya Bagrodia and Jose Silva are our urology hosts. One thing that we realized was the urologic topics that we covered on the IR side were really popular, and not just by ours, but with urology. We were like, well this makes sense, right? There was enough overlap. They're almost like spin-offs from the flagship show. Same thing with the innovation show that we have. It was a spin-off, because Brian Hartley, we had a whole innovation series for a whole year, where once a month, he brought on a physician founder. Those were really popular episodes. We're like, let's just create a med-tech innovation show around it, where that's all we do. We just bring it on physician founders.

Dr. Rishi Desai: Are there new spin-offs in the works? New ones that you're ideating around?

Dr. Aaron Fritts: Yeah. The next one I really want to do is spine because we've had several interventional spine guys come on, as well as orthopedic surgeons, neurosurgeons, all performing similar procedures on the spine. This one won't be specialty-specific, but it'll be more body-part specific. What I like about that is it's like our vascular show. It's multidisciplinary. You can have different docs coming on, collaborating, and talking about how they problem-solve. That’s the foundation of BackTable, which is collaborative and multidisciplinary.

Dr. Rishi Desai: That's awesome. It feels like you guys do it in a way that feels very real, versus a lot of times I think there's this emphasis on interprofessional care and professional communication, etc. But it's not done in a very authentic or, frankly, engaging way. But this sounds like it is.

Dr. Aaron Fritts: We try. I mean, it's almost like matchmaking, because it's always great when the host and the guests know each other already because there's already a rapport there. But sometimes the guest is stiff, and it takes... we always joke: You'll have somebody come on and there'll be super stiff for like the first 20 minutes. Then the last 10 minutes, they finally loosen up, and that's the best content. And you're like, ah, gosh, how do we get him to loosen up early on? But it's just the nature of the game, and pre-calls are hard because everybody's busy.

Dr. Rishi Desai: Maybe along with the mic, you send a bottle of Cognac or something. Take this 20 minutes before you start. It's funny, because that brings up the point of communication skills. A lot of times people think, if you're a great practitioner, good at doing the thing you do, you'll also be able to teach it well. Those two are not always related. I'm just curious, like, where did you pick up your communication skills? You're obviously very good at what you do. Did you read books? Did you have mentors, like how did you get to where you are?

Dr. Aaron Fritts: It's funny you say that man, because of course my mom and my wife say that I'm a horrible communicator.

Dr. Rishi Desai: It's not true, Aaron. It's not true! [laughs]

Dr. Aaron Fritts: In med school, I used to... It's changed how I learned, righ? The podcasting thing, communication skills, have come just with reps. Just doing it over and over again, having lots of conversations with people. I know, you and Shiv are very prolific networkers and have a lot of conversations with people. It just comes with time.

I had an awkward conversation with somebody yesterday and I reflected on it. I said, okay, why was it awkward? Is there something that I could have done to make it less awkward, or was it just that person? Was there something that I didn't communicate clearly? You’ve got to reflect and improve with every conversation. We try to do that with our podcasts as well. I definitely think podcasting—the art of conversation, how you form that skill set—it helps you in real life as well. What's been your experience with that with podcasting?

Dr. Rishi Desai: Like you said, I think the breadth of folks that I get to talk to because of this experience—it's a lot of fun. Earlier you said: if I'm not enjoying listening—you were talking about the technical aspect of it—but if you're not enjoying listening to an audio, how can you expect your listenters to listen or enjoy it? If I'm not having fun talking to a guest, how can I expect listeners to have fun? 

To me, that's an that's the name of the game. Like, at any point, someone can easily just switch, click away, etc.  So if I'm not having fun in talking to someone, then they're not having fun listening. I'm always thinking, how can I make this experience more fun for me? It's kind of a` selfish way of thinking about it. But it makes it a good experience. And that's what I aim for.

Dr. Aaron Fritts: That's all we want to do is have fun, especially if we're taking time to do this. And there's so much value in informing... I was talking to Shiv about this. There's this bonding experience that happens when you have somebody on the show. You get through to them, you have like there's this energy, and that energy makes its way to the listener. That's why they tune in again. I think it's important, to just relax. The more formal you make a podcast, I think the less likely somebody is going to listen to it, in my opinion.

Dr. Rishi Desai: Yeah, I totally agree. In fact, that's our teaching philosophy, too. Osmosis’s entire ethos is around making learning less formal, less stuffy. And I guess that might segue into my question for you. Because we are a teaching company, we love to fill knowledge gaps. Is there something that you could teach our audience? It could be something technical or something kind of, in the way of maybe mentorship or anything at all that feels important to you.

Dr. Aaron Fritts: Well, one ask I have is to please educate your med students about interventional radiology, because it's the coolest specialty, but it's unfortunately not well understood or explained by people, including IRs. We have a hard time. I go out to dinner with my parents, and we run into one of their friends and you try and explain what it is you do to them. The only thing they take away is radiology. They think, he's a radiologist.

They don't understand that what we do is amazing. It's imaging-guided-therapies. I started just saying, "imaging-guided therapies." I picked that up from Atul Gupta from Philips, because I think that's the best way to explain what it is we do. Yes, we're trained in radiology, but we use that skill set to then perform minimally invasive procedures. Now it's an independent residency program. It's super competitive, it's up there with like, derm and neurosurgery.

We want to make sure that our med students know what it is, we want to make sure that referring docs know what it is. When I was in the outpatient world, I was going out there and talking to family practice docs that had no idea what IR did, because probably nobody that they know went into it when they were in medical school. They've just never had exposure to it because it's a relatively new field.

And the general public doesn't know, right? They don't know that there's other minimally invasive options for fibroids, right? You don't have to have a hysterectomy. You can have a uterine fibroid embolization, where it's basically taking a little catheter, putting it into the vessel that feeds into that big fibroid, injecting some little embolization beads that shrink it down, and all via a tiny little nick in your groin, or in your wrist, which is even better. Amazing technologies like that, that we get to participate in, is why it's such a cool field. That's my take-home for any med students or anybody listening that is not aware of what IR is or does.

Dr. Rishi Desai: You hit the nail on the head for me. I love examples and you just gave me one. Do people, when you explained it that way and say look, “you could A.) get your whole uterus removed.” Big deal, meaning, it really is a big deal. Or B.), “you can you have a nick in your groin, a little tube placed inside of the blood vessel, it goes and finds where it needs to go using radiology to guide it, and then we get rid of it.” Do people get it, or do people say, well, what the heck is a fibroid? What example do you like to use for folks, usually?

Dr. Aaron Fritts: The issue is that women, unless they have fibroids, they tend to not really know what they are. But most women do because their mom had them or their grandma or somebody, and they know that they cause excessive bleeding and cramping and pain. For women, I can explain that.

When it comes to other people, like men, who may not know what fibroids are, I talk about cancer, right? Like liver cancer—it's a similar concept. If someone has a liver tumor, we can go in with a tiny little tube in their groin or in their wrist and get to the vessel that feeds that tumor because the tumors like to recruit blood vessels. You can inject chemotherapy directly into the tumor instead of systemically, and shrink that tumor down. And usually, people are like “wow, I didn't know that existed.” Instead of having surgery or systemic chemo. That's the other example that I tend to give.

Dr. Rishi Desai: That's awesome. I love it. I'm glad you use that as the example because I think a lot of people are gonna have that brain-wow moment, if they don't know what IR is. That is why I think it's so special. Listen, we have a lot of students and a lot of early-career health professionals in our audience. They look at you, they look at your life, doing what you love. You're still in clinical practice. You are making an important difference in how people communicate. What advice do you have for folks like that, that may say, hey, I want a career like that?

Dr. Aaron Fritts: I was just so hyper-focused on medicine, getting good grades, and getting into whatever residency. I would say, take business classes, I'm so jealous of Shiv, who took time and got his MBA. I wish I had the foresight or had that opportunity at that time, because I think it's important, even if you're not like a physician entrepreneur, just to help understand the business of medicine.

That's where physicians are at a severe disadvantage. We come out of medical school, and even residency training. We have zero clue as to what the business of medicine is all about. That's why our salaries have not gone up. We're not fighting for ourselves. We need to have a better understanding of the economics of health care so that we can stick up for ourselves—not to scare anybody, but I think that you will come out an overall better physician and have more advantages and less challenges in your career if you get that education while you're in that learning mode. Because once you get out in practice, it's hard. You start a family, your bandwidth is limited. It's hard for me to go carve out time to go do an MBA or sit down and read business books. I do, but I wish I had that foundation before.

Dr. Rishi Desai: I think that's fantastic advice and I couldn't agree more. Thank you for sharing that. Well, listen, thank you for joining our show today. That was fantastic. It was a lot of fun. Thanks, Aaron.

Dr. Aaron Fritts: Thanks, man. I really appreciate it. I love what you guys are doing. Anybody in the audience, if you want to reach out, my email is [email protected] and please check us out at backtable.com if you want to learn more about the podcast.

Dr. Rishi Desai: And just to underscore that, that's Aaron, A-A-R-O-N, right?

Dr. Aaron Fritts: That's right, A-A-ron.

Dr. Rishi Desai: Awesome. I got that reference. Well, listen, I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.