Rafael Akobundu on Scaling Hospice & Men’s Health Clinics While Balancing Family and Freedom

Zane Myers (00:01)
Welcome to the another edition of the holistic entrepreneur and I have special guests Rafael Acabando and I had to ask him how to pronounce it before we started because I was going to screw that up, but we're alright. I bet it does so. ⁓ So ⁓ Rafael, you run you start you started out as a registered nurse. I kind of like to get a little bit background before I just launch right into.

Raphael Akobundu (00:14)
Okay, you're getting screwed up all the time. It's all good.

Zane Myers (00:30)
to somebody because I think it's interesting, know, somebody's history as they, you know, became got to where they are. And you're actually from another country originally. When did you immigrate to the United States?

Raphael Akobundu (00:45)
Yeah, I Good question. I moved to the United States when I was 12. This is 2001, February. I came over with my parents and my three sisters at the time. I have four sisters now, but one was born in the States. But yeah, I moved in 2001.

Zane Myers (01:00)
Yeah, so I can tell it's you talk like a native because you know, don't notice an accent. Yeah, probably when you're hanging around your family and everything, probably can slip back into the accent pretty easy.

Raphael Akobundu (01:07)
I know, most of it is gone. ⁓

Yeah, yeah, a little bit of, I mean, we're British colonies. I always spoke English, but most of the accent is gone for sure.

Zane Myers (01:22)
Yeah. So, ⁓ so you immigrated it when you were 12 and then, ⁓ you, you professionally, you started out as a, as a nurse. And were you there in San Diego when you.

Raphael Akobundu (01:31)
Yes.

No, I was in the East Coast. So I graduated college in New York and then I went to nursing school in Cleveland, Ohio. And then I moved out to out West Arizona. So my first nursing job ever was in Phoenix, Arizona.

Zane Myers (01:49)
And then how'd you end up in San Diego?

Raphael Akobundu (01:52)
I would just visit San Diego while I was in Phoenix and I fell in love with it. So I ended up moving to San Diego in 2015 and met my wife at work who's also a nurse. So it's kind of home from that, home base for good, you know, just because she's sort of marrying into a nice place. Yeah.

Zane Myers (02:07)
Yeah.

It's a great town, especially you don't miss Phoenix come July.

Raphael Akobundu (02:17)
Yeah, that heat that he can get to you. mean, it's dry heat, so it's not like unbearable. But yeah, it can get pretty toasty there. Yeah.

Zane Myers (02:25)
Yeah, can get pretty toasty.

you were a nurse for quite a while and then you, how long were you a nurse? So you started this hospice and that was your first business and we're going to get into your second business too because I think that's interesting. So you started that business with your wife. How did that all start?

Raphael Akobundu (02:35)
Yes.

Yeah, so this is back in 2022. I have a good friend of mine who owns a hospice company as well. And he thought it would be something that would be a good fit for me in terms of owning one just because of my background being in clinical and being personal and things of that nature. So yeah, in 2022, we decided to take a leap of faith and decided to start one. So it's been a fun ride so far.

Zane Myers (03:12)
And so, but then you've more recently started this other venture and you've got your t-shirt. really appreciate you promoting your business. That's fantastic.

Raphael Akobundu (03:16)
Yeah.

Of course. Yes,

of course. No problem. Correct.

Zane Myers (03:26)
Huddled men's health. So when

did that start? You actually have two locations. When did that start?

Raphael Akobundu (03:32)
Yeah, we have two locations, one in Seattle and one here in Temeco, California. This started in 2023. However, prior to starting the hospice, I was already in the testosterone space prior to that. So when I left my previous company and I started my own in October of 2023. that has been less than two years of that.

Zane Myers (03:54)
So you had experience ⁓ with men's health previous to, so it wasn't completely, you didn't go into it, ⁓ let me go start some men's health, you were already working in that area.

Raphael Akobundu (04:05)
Yeah, I've been treating guys for low testosterone since 2017. So it's been quite some time now. Yeah. Yeah.

Zane Myers (04:13)
Okay.

But when you start an office and you've got the rent and you've got employees and you've got all these other things going on, that can be pretty stressful. How did you get your first customers?

Raphael Akobundu (04:33)
Yeah, that's great question. So a lot of it is usually just kind of in the beginning, it's just like a lot of hustling, right? So you have those early adopters who are usually like friends and family. ⁓ Those people usually get through the door first and then you always encourage them to tell their friends and tell their friends. So usually our first few clients are usually friends and family. And then we get, you know, patients through them and then we also do some, you know, digital marketing that helps as well. But initial patients are usually friends and families.

Zane Myers (04:40)
Mm-hmm.

Yeah.

So I did like, I looked at both of your sites, the Blue Monarch, the Hospice, and then I went and looked at Huddle and I thought they're both really well put together. I don't know who does your marketing, but they do, it seems like, your webmaster, whatever, they do a good job. And I noticed that they kind of localized on Blue Monarch according to areas of town. Probably people who aren't SEO geeks don't know.

what I'm talking about. So you have probably become a little bit of an SEO person by having these two companies.

Raphael Akobundu (05:32)
Yeah.

Yeah,

yeah, I mean, that's a little like far fetched. I know the basics, right? I just, you know, we just obviously pay an agency to do that for us. So I don't know like the ins and outs about it, but obviously having a digital presence is very important, you know, when you run a service business like we do. So ⁓ we do have the SEO team that kind of helps us with.

Zane Myers (06:02)
So tell me about you're getting going, get all, you get your friends and family to start coming in and ⁓ how long did it take you to, I'm going to ask ⁓ business questions too, because I think that's a, I think, you know, when you're doing a healthcare kind of thing, some people forget that, ⁓ that when you're running a business, you're, you know, you're delivering healthcare, but you're also running a business. And so you have to wear these two different hats.

Raphael Akobundu (06:14)
Sure.

Yes.

Yes.

Zane Myers (06:31)
One

is to take care of your patients. And then the other is take care of your pocketbook. Make sure that you're profitable and things are working. So when you were in San Diego, how long did it take you guys to get to a place where you were in the black?

Raphael Akobundu (06:48)
It's about my hospice companies that are rising. yeah. We'll start with the hospice. Yeah. I mean, I think the biggest thing about hospice is a very like, ⁓ operationally is very intense because it's 24 seven. we're providing services to terminally ill patients. So it's a very delicate situation. ⁓ so customer services has to be absolutely amazing, right? From, from our perspective. ⁓ but, initially I would say the first

Zane Myers (06:51)
Well, either one. I guess from the...

Right.

Raphael Akobundu (07:15)
We opened up in March, 2022. would say the first eight months, I essentially did everything as much stuff I can do. I was the nurse, I was the marketer, I was the nurse's aide, I was the administrator. So everything, you know, just like a typical founder story, right? So every hat you could possibly think of, I wore in the beginning, just to be as lean as possible in terms of expenses. So once you get to the company where, and it was fun, but at same time, it was hard, but it's fun because it's your own stuff, right? So you never felt like.

was this thing that was like, um, like overburden or anything like that. But anyways, um, got it to the point where I could hire someone. So the point when I got to a point where I could afford to hire someone, I did that. Uh, even though it was a little bit of a struggle just because I'm a fairly like new entrepreneur. So given a way that trust is very hard in the beginning, right? Like giving someone like a job title and say, I trust you do this and this and that. Uh, so eventually that's the only way I learned that's how you grow. You just have to delegate things. So I got to a point where I was able to.

Zane Myers (07:58)
Mm-hmm.

Raphael Akobundu (08:12)
luckily afford to hire these people and that's kind of how I got there. But the first eight months I did a lot of stuff myself.

Zane Myers (08:18)
So where are you now with that business versus where you started?

Raphael Akobundu (08:24)
Um, well, terms of, I'll just give you like in terms of no employees. So when I first started, had, you know, maybe a handful of employees, uh, four or five, maybe now I have 31. So yeah, it's kind of how we've grown. So it's good. Yeah. And it allows me to work on the business, not in the business. Right. So that's, know, usually what every founder would like to do, but I was in the business for a long time. I'm still kind of in the business, but not as, you know, as much as it was in beginning.

Zane Myers (08:28)
Yeah.

Wow, that's great.

So do you have some key people that are ⁓ running that for you? Because 31 employees, they can't all report to you. You'd be pulling it.

Raphael Akobundu (09:00)
Yeah, yeah, I'm lucky some

key staff members that do like essentially run the show. You know, for me, it's kind of like, I just get out the way. Like, I mean, I oversee things by kind of get out the way because most of them have been in the industry a lot longer than I have. Guy's been in the for years. So they know a lot more what they're doing than I do in terms of operational standpoint. But, you know, there's other things that I have to kind of oversee. But I'm lucky enough to have awesome staff members that kind of run the show, you know, without me having to physically be there.

Zane Myers (09:13)
Mm-hmm.

So in your spare time, which I imagine that wasn't... So how in the H-E double hockey sticks did you think, okay, well, I got this thing going now pretty good. I'm down to working like 60 hours a week. I think I start another business. Is that accurate?

Raphael Akobundu (09:48)
Yeah, I know

that's a good question. mean, the thing is, think a little bit of background is I was already in that business before I started the hospice, but I left that company and then started my own. So this is actually a lot easier than the hospice because the hospice, had no clue how to run one, like absolutely zero clue. Kind of just like went in head first and just figured out as I went. The testosterone clinics, I already been part of a clinic before for a couple of years. So that was a little bit easier and it's not as intense in terms of operation as hospice.

Zane Myers (10:16)
Mm-hmm.

Raphael Akobundu (10:17)
⁓ It's a cash paid business, so it's a lot. You can kind of like navigate things and structure things how you want it. So that was a lot more easier than a hospice to set it up because I've already done it before in the past.

Zane Myers (10:30)
So as far as getting staff for the hospital, you have to have medical doctors on board. You have to have all these people. those are, did you bring them in as partners or did you bring them in as ⁓ employees or how did you structure that?

Raphael Akobundu (10:48)
Yeah, that's a good question. It's very hard to like hire really good staff, especially in the hospital space. So in the beginning, it was a lot of a lot of nos. A lot of people told me no, it's because we're brand new. one knew who I was. So just a lot of networking, networking and eventually, like I said, I did a lot of stuff myself. So I would say, you know, had a reputation, but people started hearing about me and kind of like the work we were doing out there in the industry. So they were more open to coming on board. So, yeah, they just came on as employees and most of them have been great ever since.

Zane Myers (10:52)
Mm-hmm.

Raphael Akobundu (11:17)
kind of, you that's been the case.

Zane Myers (11:20)
No, I mean when you set up your men's health, ⁓ have to have, did you bring on the physicians there as partners or are they part of the business or ⁓ are they separate from?

Raphael Akobundu (11:23)
⁓ okay.

I see in terms of are they part of my hospice? that your question?

Zane Myers (11:37)
No, no, part of your men's, so you have the men's health business, which is separate, which you're the CEO of that business, right? And so you had to hire some pretty expensive people ⁓ to, you know, physicians. And so I'm just curious, and you can tell me, no Zane, I don't want to talk about that if you feel like it. Did Jade bring on those people as partners or did you just buck up and say, I got to pay this and this is the way it is?

Raphael Akobundu (11:43)
Yes, correct.

Sure, sure, sure.

no, I just paid him as Burma's employees. Yeah. So I just kind of just hired them and they've been wonderful. Our medical director, he's a spine surgeon. So he's really cool. He's in the Seattle area. Our medical director in Washington. But yeah, I just hired him. I found him through a friend. my other staff members just from posting on your typical job sites, Indeed and Zip Recruiter and things of that nature. Yeah.

Zane Myers (12:28)
Okay, fantastic. So

how do you, from a regulatory standpoint, I'm asking all kinds of technical questions. So I ask things that I'm curious about. And hopefully then the audience will also be curious about these things. From a regulatory standpoint, is there any sorts of challenges with that?

Raphael Akobundu (12:33)
Yo, what's up man?

Sure.

Sure.

In terms of, it's a regulatory in terms of the testosterone clinic. Yeah, I mean, it's a controlled substance, testosterone is controlled substance. So if you have a controlled substance involved, then you have to make sure like, ⁓ you know, everything is in place. So we do have to have a medical director on staff per Washington law, state of Washington. ⁓ If you have, you know, if you have a nurse practitioner, I'm a nurse practitioner, but you can, if you have physician assistants working for you, you have to have a medical director. So we have a medical director. ⁓ And then we also have, ⁓

Zane Myers (12:54)
Yeah, yeah,

Raphael Akobundu (13:20)
obviously, people like in the office, know, medical assistant and admin staff in the office. You have to have, we have a lab in-house, you know, people say, so that's, that goes through state testing. So we get surveyed. So our surveyor comes out from the state and then they're pretty much all day. could be a few hours. It could be all day. And they go through all our files just to make sure we've done competency tests and all the staff and all our

Zane Myers (13:31)
Mm-hmm.

Raphael Akobundu (13:48)
you know, books are up to date. So there is a lot of, you know, things that go into place there. And then we also have a software where we have to log testosterone that's dispensed in the clinic. Cause at our clinic, we have the options of patients coming into the clinic for their administration of injections. So you have to keep a log of that because the DEA wants to see every single ounce of testosterone dispensed in that clinic is associated with a patient. if you don't have that.

you can be heavily fine and no one wants the DEA show up at the door. So it's highly regulated in that regard because it's a controlled substance.

Zane Myers (14:22)
So what made you decide on Seattle other than I do know that there's some big players in men's health that are in Seattle already. was it just because that the population was really aware of that? Is that what attracted you to Seattle?

Raphael Akobundu (14:32)
Yeah.

Um, that's a good question. Zane and my, um, one of my partners lives in Seattle. So that's kind of what attracts me. So I'll visit him and he always talks about Bellevue. I had never been to Bellevue. Obviously you probably been to Bellevue being open to city. Bellevue right now. Oh yeah, exactly. So there you go. Um, so, you know, the demographics plays a huge role, right? So we're a cash pay, uh, cash pay clinic. So you want to be somewhere where people can afford your services. Uh, so we thought about, like, you know, but you know, in terms of.

Zane Myers (14:53)
I'm in Bellevue right now.

Right.

Raphael Akobundu (15:09)
The big players, there's competition in everything. If there's not competition, that means there's not a market for per se, right? So we felt comfortable putting it there just because they thought it would be a great area and it's been really good to us. So yeah, that's kind of why we did.

Zane Myers (15:11)
Mm-hmm.

So how long before you started the Men's Health in San Diego and then you opened the second office in Seattle, how long between those two?

Raphael Akobundu (15:36)
No, so my other office is not in San Diego, it's in Temecula, California, which is north east of San Diego. Yeah, exactly. Bellevue opened up in October 2023 and then opened up Temecula in June of 2024. that is eight months. Yeah, yeah, it was second. So about eight months. Yeah, so wasn't too long.

Zane Myers (15:40)
Temecula, okay, I know exactly where Temecula is. Yeah, it's like Phoenix only in California.

OK, so the other way around.

So you had an opportunity because you had this relationship with somebody there. You knew about the business and then you had somebody that you could trust that you could work with and that allows you to open at a distance away from where you are.

Raphael Akobundu (16:18)
Yeah,

I live in San Diego, so it's awesome to have them kind of oversee things there, why I'm not there. So it's been good. It's been good.

Zane Myers (16:26)
So if you do this over again, what was the biggest mistake you made? I mean, I'm sure there's a list, just the whole thing. What would you do differently?

Raphael Akobundu (16:32)
In business in general or just in...

⁓ that's a, that's a good question. think, ⁓ I think what I would do differently, I mean, I'm getting better at it. It's just not to trust people so easily. Cause in business you get burned a lot, ⁓ let's do vendors or partners or whatever the case might be. So, ⁓ you have to have a good way of vetting people out, whether if it's a vendor or whatever, if it's like an SEO, I you talked about that, ⁓ or if it's, ⁓ someone that's just going to do something that's significant for your business. So.

Zane Myers (16:51)
Mm-hmm.

Raphael Akobundu (17:07)
You you have to make calls. Okay, who have you worked with in the past? You know, call those people, see how that experience was. Cause it's been, I mean, it's been numerous vendors where you just, you know, just lost money because you didn't get the value they thought you would get out of it. So I would say my biggest thing would be, cause you know, in the beginning, every cent matters and you know, it not giving you any value back really sucks. So the biggest thing is just vetting people out and just making sure that you've done everything possible that you can.

Zane Myers (17:23)
Yes.

Raphael Akobundu (17:33)
to make sure that's a good arrangement for you because if it doesn't work out, then at least you know you tried. My issue was I was not doing that bedding as good as I should have been doing it. Yeah.

Zane Myers (17:43)
So now you feel like you're older and wiser on those things?

Raphael Akobundu (17:47)
Yeah, and

I'm older and wiser and I'm, you know, I always give people a benefit of doubt, but now when it comes to business, I'm always skeptical at first and then turn to believer eventually. So, so yeah.

Zane Myers (17:58)
So you get the pitch and you say, gosh, that sounds so fantastic. But then you get the deal comes down, it just doesn't work out the way that you were thinking.

Raphael Akobundu (18:03)
Yes. Yes.

No,

and another thing is I always said yes to so many things. So now I say no to most things, which you have to, because if you say yes to everything, you're just wasting your time really. So you have to know what you want to put your time to it. So saying no actually is a very, very good skill to have when it's in business. So many things come in all different angles and if you start saying yes to everything, you're just going to...

Zane Myers (18:15)
huh.

Raphael Akobundu (18:35)
drive yourself nuts. So I say no a lot. Now in a nice way, obviously, not in a mean way or anything like that, but it's important to have a boundary of things like that. Yeah.

Zane Myers (18:46)
Yep, that is

really one of the, in my opinion, a skill that ⁓ needs to be developed saying no. I think that's something you need for your whole life, because I can also get sucked into.

Raphael Akobundu (18:59)
It's very hard, very difficult because I'm a very easy going at just myself. So when it comes to when people pitch me something, I understand how to be how it is to be on the other side because I've done the pitching and some of my other business beginnings and people gave me, I was lucky when people gave me an opportunity. So I feel like for all these people and I want to say yes to everything, but then a lot of times it ends up burning me. So now I have to like figure out how to say no, which I have been doing a lot more and it's worked out.

Zane Myers (19:25)
So what's the best thing that you're doing now that's helping you grow the most?

Raphael Akobundu (19:33)
Delegation. Delegation is the best thing you ever do. In the beginning, I always wanted to do everything myself. I've only been a business, know, entrepreneur, sole entrepreneur for three years. So it's a lot of stuff that I'm learning. In beginning, Zayn, I always wanted to do everything myself. I didn't want to delegate anything because I knew if I did it myself, I knew what kind of work I put into it. I knew if it was right or wrong, right? So then when I didn't want to delegate, I was kind of not burning out, but I was just creating all these stresses of myself.

Zane Myers (19:34)
hahahaha

Raphael Akobundu (20:02)
So once I started delegating, you I just started growing and it was just, you know, things still happen, right? Something still doesn't get done right. But at the of the day, it's still much better than you trying to do everything yourself.

Zane Myers (20:14)
So when you delegate, you kind of almost have to accept that things are going to get screwed up. So it's like, I can do it all myself and I know it'll get done right, but you can't do it all yourself.

Raphael Akobundu (20:24)
Yeah, you can't,

you can't. mean, you you're always gonna have problems. So you just gotta like trust people to do what they say they're gonna do. And if they don't do it, then you just gotta deal with the consequences. That's all.

Zane Myers (20:36)
So what's your plans? now you have, ⁓ so Monarch, that, ⁓ your wife is involved in that, is that right too?

Raphael Akobundu (20:45)
She's currently not. mean, the whole idea was for her to be involved, but right when I started that business, we had our first kid, like literally like a month prior. And then we just had our second kid recently. So my wife is just mostly just with the kids. So it's really hard for her to be involved. And it's probably easier for her to not to be involved because, she probably, probably stress her out and stress me out. So yeah, it's a cool arrangement we have right now.

Zane Myers (20:47)
Okay.

Okay.

Yeah.

Okay. So, so you kind of split your time between those two things, ⁓ Monarch and the Men's Health.

Raphael Akobundu (21:16)
Yeah, I do. I spent my time between the two, but a lot of my time I focus now is just being home with the wife and kids and just taking that family time is super important to me. But yeah, when I do work, I split my time between both.

Zane Myers (21:30)
So, well, how much do you work? You sound like you're spending a lot of time at home, so.

Raphael Akobundu (21:34)
Yeah,

I when I'm home I'm working, I'm just around them, right? So it's like, so I mean, I work every day. I can't quantify in terms of hours, it varies, but it's not like, you know, like a 80 hour work week or 60 hour work week or anything like that. It's not like that. I have a lot of flexibility, but I try to go to the offices a couple of times a week. have our meetings, hospitals have meetings once a week, at least with the staff.

Zane Myers (21:38)
Okay, yeah.

Yeah.

Raphael Akobundu (22:00)
I try to make it in there at least twice a week. I, you know, and I work better when I'm not at home. So, you know, when I'm home trying to work, it's just a lot of, you know, just distractions. I try to be as home as much as I can just because, you know, I don't know if you have kids and I have two young daughters, one is three and one is two months old. So time flies from what I've seen of her, obviously. So just try to, you know, spend as much time as I can with them, you know, when they're little.

But that's not always the case, but most days I'm able to do that.

Zane Myers (22:30)
That's good for you. mean, that's, yeah, I do have kids. I have four kids and I have seven grandchildren too. I wish they were all around. mean, but yeah, because they say like the first 18 years, you're with your kids all the time. And after 18, you're going to spend 90 % of the time you spend with your children.

Raphael Akobundu (22:35)
Nice. wow, congratulations. You look great.

Zane Myers (22:59)
by the time they're 18 and then 10 % for the rest of their life.

Raphael Akobundu (23:02)
I saw that. I saw that quote and that's very true. That is absolutely true because, you know, I'm 36 years old and my parents live on the East Coast. I've probably seen them once a year. Ever since I was 18, I probably saw them once a year because I was, you know, I played college sports, so was always gone for that. So, yeah, that resonated with me and it's just, you know, that's very true. It's very true.

Zane Myers (23:12)
Mm-hmm.

Yeah,

it resonated with me too and I can't do anything about it. I don't like it.

Raphael Akobundu (23:27)
Yeah,

I know you can. You gotta live your own life, but like those first 18 years, you just gotta make the most out of

Zane Myers (23:30)
Yeah. Yeah,

and they're precious. So if you were to go back and do the whole thing over again, what would you do differently?

Raphael Akobundu (23:42)
In terms of business, starting a business or just, ⁓ do differently. ⁓ you know, I think I don't want this to sound cliche. I don't think I would do anything differently because I, cause what I for me is, I'm not risk averse. So I like to like take action when I see an opportunity. So if I were to do something different, I think it would make me pause and not want to take action. If that makes sense.

Zane Myers (23:45)
Yeah, certain the business.

Mm-hmm.

Okay,

Raphael Akobundu (24:10)
Yeah.

Zane Myers (24:10)
sure.

Raphael Akobundu (24:11)
So for me, yeah, I mean, there's things you can say, I could save money here and save money, but it would just lead to me over thinking. And then when I overthink things and then I'll have doubts and I wouldn't do it. Right. So if I was to do anything different, the only thing I think about is just vetting people out just to make sure people are who they say they are. They can kind of provide the services they can provide. But in terms of like starting a business, I don't think I'll do anything different because I've been the opportunity I've had. I've always just kind of just say, oh, this is great. I'm just going to do it. And once I say I'm going to do it, I just do it. So yeah.

Zane Myers (24:38)
So is your wife also a risk-taking personality or is she a safe person?

Raphael Akobundu (24:43)
that's, that's a great question. ⁓ I would say I'm more, ⁓ I'm more riskier now, but she was riskier in the beginning because, know, for me, I grew up in Nigeria. was never, ⁓ exposed to business. You know, we live literally like day to day kind of thing. ⁓ she grew up here in San Diego, ⁓ family was kind of in business. So she was more exposed to it.

So she kind of like understood a little bit better than I did. But now I take more risks than she does just because I guess I'm an operator per se. So I've had a little bit more experience. at first when we first met, she was more of a risk than I was.

Zane Myers (25:23)
So ⁓ does Blue Monarch, do you actually have physical locations or do you go out to people's homes to?

Raphael Akobundu (25:31)
Yeah, it's a, so most hospitals are community based. So community based and you go out to where patients live. So that's what we are. We have an admin office in San Diego where we have our meetings and we have staff there usually throughout the day, but we usually go to wherever the patient.

Zane Myers (25:34)
Mm-hmm.

Mm-hmm.

And so does it, I'd like to say I'm just satisfied with my own curiosity. So when you do hospice, I mean, if I'm in hospice, I'd rather be in my home than in some ⁓ building. But ⁓ when you do hospice, how often do you have to have somebody there 24 seven versus somebody who is, you know, just comes and goes and comes and goes.

Raphael Akobundu (25:50)
Yeah.

Yeah, that's a great question, Zane. It varies. It varies on, it depends on the condition of the patient. So if you're, you know, people that are in hospitals, they're deemed terminally ill. So if you're stable, you're comfortable. A lot of people think once you're in hospital, you're going to die the next day. That's not usually the case. So we have patients in hospital for a year, two days, two months. So if you're comfortable, it's based on kind of like what your needs are, right? So if someone who's a transition and meaning they're going to pass away soon, usually we see them typically.

every day and sometimes we're there all day. But if it's someone who's pretty stable, they're slowly declining, then that varies, right? So it could be four visits a week, three visits a week. So it all depends, but usually when we're there all day, it's just usually meaning they're pass away soon. So the patient needs that comfort and also so does the family.

Zane Myers (26:59)
So it's got to be difficult to make that profitable because you're controlled somewhat by Medicaid, right? So you can only, get a certain amount of reimbursement per day and then you have to deliver a certain standard of care, ⁓ you know, within that. so there's, it's just imagine there's a certain challenge with getting the employees, keeping the employees, ⁓ you know, getting them logistically all where they need to go and.

paying the employees the right amount so that he can keep them and keep them happy and deliver within, you know, here's your budget. Is that challenging?

Raphael Akobundu (27:38)
That's, that's always challenging, especially when you're getting paid by the government. So we're mostly reimbursed by Medicare. Medicare does increase our, yeah, they do increase our reimbursement rates slightly every year. So as an operator is always a constant challenge. know, cash flow is king, right? For every business. You have to make sure that things are looking good. So yeah, people are more expensive. Equipment is more expensive. Supplies are more expensive. So that's kind of like.

Zane Myers (27:46)
Medicare yeah.

Raphael Akobundu (28:05)
where the entrepreneur or spirit comes into place, just navigating those issues. think a lot of people deal with that. So for us, the only thing that makes us different is we're paid by the government. So we can't say, oh, we're going to raise our prices. We can't do that. Right? So it's always tough to navigate those, but we've been good at it so far. And like I said, Medicare does give us an increase every year, even though it's just a little bit, it still kind of helps. It's a really great service for the patient and the family.

Zane Myers (28:16)
Mm-hmm. Yeah.

Raphael Akobundu (28:33)
it's never just going to go away. So they do try their best to make sure they're keeping up with inflation and things of that nature.

Zane Myers (28:41)
So that kind of business is much more intensive than the men's health. are you planning on growing ⁓ either one of those businesses from where they are right now?

Raphael Akobundu (28:54)
Yeah, I would. I think so. ⁓ My biggest thing is it's always something that I grapple with. I think most entrepreneurs grapple with that is like, when is enough enough, right? So it's like, do you want to have more location, make more money and things of that nature? So there are certain things that I absolutely love, and that's ⁓ free time. So I always tell people, I started a business so I could have free time, right? ⁓ So now that I have a wife and kids,

Scaling is a very tricky thing. ⁓ I think the hospice, it's only gonna be in San Diego, it be anywhere else. The testosterone clinic will likely open up one in San Diego or Seattle, one more, and then figure out how things go from there. ⁓ Because ⁓ that's enough on my plate, three locations of that and then the hospice, and kind of see how things go. Things are going well right now, so it's no need for me to kind of expedite anything, but I'm just trying to just take my time and...

not rush anything, but the testosterone curve will probably expand that at some point.

Zane Myers (30:00)
So if you did that, then you'd want to plan that out. So make sure everything is copacetic and just exactly so at the one place. then pull your hair out and start something, another office somewhere else. But so you're talking about maybe expanding to a different place within Seattle, because it's a pretty big town.

Raphael Akobundu (30:21)
well Seattle or San Diego. So the one we have now is in Temecula. So it all depends. ⁓ I'm not quite sure, you know, we're in Bellevue right now. We thought about Kirkland, but Kirkland is just down the street from Bellevue. That makes, that makes any sense. ⁓ so we just, you know, weighing options by the same, you know, like I said, I have a two month old at home. So, you know, we're just, just sticking a day at a time just to kind of see how things go. But yeah, we'll like to open up another, ⁓ men's health location.

Zane Myers (30:32)
Yeah, it is.

So how often do you get up there to ⁓ Bellevue?

Raphael Akobundu (30:50)
I was just there maybe, I say three weeks ago. I'll probably be there. I try to get up there at least once a quarter. Sometimes it's hard to do that. I like to go up there more often, but at least once a quarter I get up there.

Zane Myers (31:04)
So how do you run your Temecula? So you have some really trusted partner there in Bellevue. How do you, do you have somebody similar in Temecula? Or is that you?

Raphael Akobundu (31:13)
⁓

It's mostly me because it's about 45 minute drive, the staff there. Lucky we have great staff there. So they essentially just run things. They have any questions that you should just call and text me or something like that. But it's me as the operator, main operator there. Yeah.

Zane Myers (31:17)
Mm-hmm.

Yep. Yep.

That's great. think we've almost, we're only 30 minutes in. Usually these goes for an hour.

Raphael Akobundu (31:35)
⁓ it's all good, it's all good.

Zane Myers (31:39)
But I don't know whether I, so Ted, actually tell me a little bit about ⁓ maybe some patient success stories. Those are always kind of interesting to hear. Somebody came in and they're in a certain situation and then they ended up going, ⁓ something else happened in the end and really changed their life.

Raphael Akobundu (32:02)
Yeah, I mean, you know, with testosterone, I mean, so many success stories with that. So I've been treating men since 2017 for low testosterone. Oftentimes then we have middle aged men come in, you know, late thirties, early forties. Sounds like that's kind of where things kind of start to fall apart for most men. So, you know, your most common issues are fatigue, mean, loss of motivation, just not able to sleep well, you know, no, you know,

sex life, things of that nature, right? So just getting older. So oftentimes they come in and if everything checks out, you know, medical wise, and they do have low testosterone diagnosed with that, then we do prescribe them testosterone. My biggest thing, however, that I like we do differently is I really hold in on lifestyle habits. That's like that's super, super important to me. ⁓ I don't know if I told you, I played college football, ⁓ upstate New York. So fitness and exercise and eating well, all those things that.

a huge part of my life. So I always try to tell patients that, and that's how I train my staff to treat the patients is if, you know, we can treat you with testosterone. However, if you don't have all these other things in place, you're not going to feel that much better. So oftentimes, this is their first time hearing that, or maybe really listening to that. So when these patients make these changes, it's literally a game changer. Like I've treated thousands of men that they've gone from like one kind of person to a completely different person for the better.

just from doing the things we told them, obviously prescribed them testosterone. So that's been a massive success. And then another part of that is too, we, men are very terrible, we'll go into the doctor, right? So if you actually average men, last time I went to the doctor, they can say, oh, like 10 years ago, right? So we do PSA screening. So prostate cancer is the most prevalent, it's the most prevalent cancer in men. So we'll do a PSA screening with all our patients. So we've had probably five to seven patients where we've

Um, detected, detected they've had an elevated PSA, which unfortunately turned out to be cancer, but good. was caught early. So if they didn't come to us to find out, um, they had this, they will never caught it early enough. But, uh, those always, um, always a good field story. I've actually had a patient text me last week. Just, um, you he came up with testosterone, but we couldn't prescribe it to him because his PSA was elevated and he did a workout and he ended up having cancer. But it was so early, uh, but he still did his own thing and they treated it and now he's fine. So.

It's always awesome to hear those kind of stories.

Zane Myers (34:27)
So if you have somebody with an elevated PSA, they obviously can't take testosterone because testosterone, mean, if they have cancer, then testosterone will help the cancer more than the patient. So once they are treated for that, they can't really go back on testosterone again.

Raphael Akobundu (34:43)
I think.

It depends. So usually we need just a write off from their doctor, if it's oncologist or urologist. So we just need a sign up from them to say it's okay for them to be on testosterone. Because if we don't get that sign up, then we don't put them on testosterone. Just like a patient had, like let's say patient had a stroke or a heart attack recently, we usually have their cardiologist or neurologist give us a sign up saying, hey, it's okay for this patient to be on testosterone replacement therapy. So oftentimes, you know, if they've had

prostate cancer in the past and they're like 10 years in remission, then that's usually okay. But if there's like a recent thing, they usually have their doctors send us a letter to say it's okay for them to be on testosterone. Because we're not cancer doctors, so we want to make sure that we have every party involved with that decision.

Zane Myers (35:31)
Mm-hmm.

All right.

So typically, the patients that you're seeing are men who are in their 30s, 40s, 50s that are overweight or just lethargic, and then they come in and ⁓ get on. How do you decide what dose to put somebody on?

Raphael Akobundu (36:01)
Yeah, so we have a protocol that we follow. We usually pull people on a very modest dose, the same dose, and we kind of work our way up from there. So we see how you do on that dose. And if you need an increase in dosage, we usually do that. If you need a decrease, we do that. But oftentimes, patients need an increase with such a modest dose. However, more more younger guys suffer from low testosterone. So you see patients in their 20s even. So those patients, can usually

tolerate a higher dose just because they're usually more active or they're just so low based on their age, they could use a higher dose. So it varies per patient, but we typically start most of our patients on the same dose and then we work out.

Zane Myers (36:44)
What do do when...

Oh, I had a fleeting thought and it just escaped from me. I'm the head of Joe Biden here for a minute. I forgot where I was going with that. So I've exhausted most of my questions. I really appreciate you coming on the podcast. And I think you'd be a great subject. I'm going to get my video guide.

Raphael Akobundu (36:51)
⁓ it's okay. It's alright.

worse.

Zane Myers (37:14)
little bit of a haze up there above you but I think he'll be no no he'll be able to tune that out I'm sure of it and so this will get up so what I'll do is hang on let me put on this and stop so thank you very much for being on the on the podcast and hang with me for just a second I put this stuff on here

Raphael Akobundu (37:17)
So sorry.

Sure, sure,