Founder's Story - The Secret to Scaling a Values-Driven Business (from a Surgeon Who Did It) | Ep 237 with Dr. Charles Ruotolo Founder of Total Orthopedics & Sports Medicine

Episode Date: July 1, 2025

Dr. Charles Ruotolo is more than a surgeon—he’s a systems thinker reshaping how we experience healthcare. In this episode, he shares how he built Total Orthopedics & Sports Medicine into one of the most respected orthopedic practices in the New York metro area, while leading innovation in urgent care access, AI integration, and patient-centered longevity services. Key Discussion Points: Why most injuries after 40 stem from one overlooked mistake The mindset, repetition, and humility behind surgical mastery Building Total Orthopedics & Sports Medicine like a five-star hotel The strategic rollout of Total Ortho Express urgent care locations How AI and virtual surgery are transforming the operating room and front desk Creating Total Wellness: a proactive center focused on aging and vitality Lessons on scaling a physician-first, patient-obsessed practice Takeaways: Repetition and outcome-tracking are what separate good surgeons from great ones A thriving practice puts physician well-being and patient experience at the center The best business moves in healthcare are often the most human ones Technology should empower—not replace—the doctor-patient relationship Closing Thoughts:Dr. Ruotolo isn’t just treating injuries—he’s building a new healthcare model from the ground up. One rooted in empathy, speed, innovation, and trust. In a world of waitlists and red tape, his work is a blueprint for how medicine can—and should—evolve. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

So Dr. Charles Routolo of Total Orthopedics and Sports Medicine, something that I've been noticing as I've gotten older now in my 40s, it's like every time I do something different, I lift something, I'm getting injured left and right. I don't know what is going on, but I feel that since I've hit over 40, it's like everything is changing. But Dr. Charles, what do you tell either patients or people, what do you recommend as we are starting to hit over 40s plus? Is there something we should be doing differently or something we should not be doing at all? Well, I think if you're having pain when you're exercising or pain in general, you should be consulting with your orthopedic doctor for muscle skeletal pain because sometimes there's just one exercise that makes all exercises hurt.

So whether it's doing military presses for your shoulder or doing, you know, deadlifts with your back, you know, sometimes there's one exercise that makes everything else miserable. And I think going over your exercise program with your orthopedic surgeon could help you kind of figure out what might be the thing that's causing the pain and what you could do to make everything else not hurt again. And the goal for all this is to continue to be exercising. So when you look at for your lifestyle or something that you feel is a healthy form of. exercise or an amount of exercise. What do you normally do on a daily basis? I think you should be exercising at least four to five times a week. Certainly you want to be doing some aerobic exercise. Also, muscle mass is an important thing, especially as you get older. As you get older, you lose muscle mass. So doing some type of weight lifting also is good for your muscles. It's also good for

your bones. It helps for osteoporosis. So you should be doing a combination of weight lifting as well as aerobic. Amazing. So when you, when you looked at why you even got into this industry, looking back, you know, going back a few years ago when you first started, what was that spark? First time I saw orthopedic surgery, it excited me. You know, your restoring function. A lot of it was hands-on, which is, which was very interesting to myself. And the other thing is, it's, you know, it's a specific problem people come in with. Like, I have this pain. I had this injury. And you work to fix that, which is much different. then the medical patient comes in and says, I feel old, I feel tired, and they're on 30 meds.

And my, my, you know, on that, it was hard for me to focus, you know, my, your head would start spinning when someone says, I'm 300 pounds and I'm tired, you know, like, what do you do differently? So, but, but in orthopedic surgery, I think the other interesting thing is, these are problems that everyone's having, you know, and even when I was in medical school, you know, and you're studying about the heart, you're studying about the lungs and the kidneys. All my friends, whenever they had a question, it was always about. orthopedic surgery. You know, it was like, I hurt my knee, I hurt my elbow, why is my wrist hurt? And it was funny. In medical school, you really don't learn too much about that. You really

learn it in your training. And I'd always say, well, gee, we don't really don't learn that yet. So that's what sparked my interest is, is just how common it is, how it affects everyone through all age ranges. When you look at the success of your practice, I know you do a multitude of things. You have different doctors that specialize in different things. What helped build the success of your practice? And I think this is great for other people that are aspiring doctors, or maybe they already have a practice, and they want to grow and build it. So I think as the president of total orthopedics,

I think the most important thing is I'm on the front line. I'm a very busy doctor in the practice. And I try and make my practice physician-friendly. And physicians, there's a myriad of reason why physicians get frustrated, whether it's about, you know, the way the EMR, artworks or about the insurance companies or how they have to get pre-approvals for all this stuff. So anything you can do to make the physician happier on that end helps. And then my other philosophy is when you hire physicians, if a physician loves his job 90% of the time, but 10% of

the time you make and go do something that they hate doing, they'll hate their job 100% of time. So, so, you know, I always explain that to people is like, like the only thing I care about is that they're successful, you know, on the business end of it. Um, you know, it's a business, so they have to make money, right, and that, and that they do a good job with patients. Outside of that, if, you know, someone doesn't like getting sent to this, you know, far out clinic because that, like, it drives them crazy, you know, I don't make them do it. You know, you find what they, what they want to do, make sure that they excel at what they're doing and go with that. You know, don't try and fit every, you know, square into a round hole. It just doesn't

work. So as, as most businesses, we go along, we always want to add in some sort of service, maybe a new product. How do you look at it when you're like, okay, we've mastered this service, then I want to add a new service because you have a multitude of services. And I think a lot of businesses, they maybe do it too soon or they're not effective with adding in the service because they might take away from, you know, a service that they were offering previously. Yeah. So I think trying to be ahead of the curve is very important with any business. You know, you you don't want to be late to the party. So, so, you know, we, we added an orthopedic urgent care years ago before most people

had an orthopedic urgent care because you want, you want easy access. When you, when you tear your ACL on a soccer game on Saturday, you don't want to make a phone call on Monday and hear the doc can see you a week later. You're like, nobody's waiting that long if you're limping around. You want to make sure you didn't break something, you know, make sure you don't have a fracture, make sure you didn't need surgery right away. So the orthopedic urges and kind of help with that model. And again, it's 2025.

Nobody wants to wait more than, nobody wants to wait an hour, right? Like you want to be able to log out of something and get an appointment and be seen that day. Right. So, so I think trying to stay ahead of what's going on is important. But when you set up any of these things, you know, you got to go through your business model. You got to kind of work out how you're going to do it. Who's going to do it? It's not easy sending up a new business.

and you've got to devote time and resources to that. Our current, our big project is total wellness. We're setting up a wellness center for our patients. And I think that's excellent because most patients coming into orthopedics just want to feel better. They want to feel younger. They're concerned about longevity and aging. And so I think that's a great compliment to what we're doing. But we've spent almost a year since.

this all up. Our opening date is on July 7. You know, a lot of time and energy, a lot of conferences I went to researching, like, what we can offer. So I think if you're going to, if you're going to do something new, don't go in half, half in. Like, you've got to go in 100%. You got to put the people around you to help you to be successful. You know, I think that's, that's the goal with anything that you're going to start, any type of project. We've talked to some other doctors and practice owners around this whole new thing with this concierge type medicine where I think a lot of people now are looking for something, you know, they don't want to go and, and you mentioned it before, you don't want to go and wait 15 hours at the emergency room or you can't get a doctor for a week,

two, three weeks later. How are you seeing health transform with this new more concierge, more custom type to the person health care that people are willing to pay more for? Yeah, so, I mean, everyone's time is important. And I'll explain this to my staff all the time. If you're booking patients three weeks out, right? If you just worked a lot harder for the first three weeks, then you could book, because you're going to see the same amount of patients.

If you just catch up on those three weeks, then you can see everyone the day up, right? It's just catching up on that lag. I think, like, you have to think about what you would want as a patient. As a patient, nobody wants to wait three weeks to hear, like, why I can't walk or or why I can't sleep because my shoulder's killing me. So I think as long as you kind of look at it that way, it kind of fixes all the problems. But certainly concierge medicine is the way to be successful. It's like a hotel.

Like if you run it like a five-star hotel, you will be filled. You'll have happy people. And if you run it like a two-star motel, you might get some business here and there, people coming, but it's only because they couldn't find somewhere else to go. I like that. Run it like a five-star hotel. So I think a lot of practices, they need to hear that. When you look at the advancements in technology now, you and I were talking earlier about

AI and I'm sure, you know, robotics. Like my dad just had robot surgery and the doctor was in a total different country, which blows my mind. But how do you see the advancements of technology transforming maybe not just the industry that you're in, but maybe even surgeries overall? There's a lot of great things that are happening under. AI and robotics. There's these virtual surgeries.

There's surgeries where you'll be doing a shoulder replacement and you're wearing a headset and you kind of see your pre-op templated plan like overlapping what you're doing. And so you can match up what you're doing with what you pre-oply templated. You know, you're not like, I kind of remember how I planned it. It should be this or that. So that right there is amazing. On top of that, there are some things. that they're doing now with virtual where where you're wearing a headset and an expert in the

field that might be, you know, that might be doing this for the last 40 years, you'll be talking to them and the two of you are conversing over it and seeing the same thing that you're operating on in front of you, right? So you're talking to the great expert in the field on whatever it is in the shoulder or knee that you're doing. And they might be interacting with you as you're doing it live, which is amazing. And then on the business end, just AI in general is just going to drive business to be more efficient. So we're putting in place now an AI system that'll answer the phone 24 hours a day, seven days a week, and make appointments.

Like that was like that's unheard of thing. If you thought just two years ago, that would be something you couldn't do. But imagine being able to call your orthopedic surgeon at midnight on a Sunday night and get an appointment for Monday, right, as compared to, you know, and as a business, Monday morning is always like the busiest time. Like, how do you staff for Monday morning, you know, phone calls, you know, and medicine, you know, between 8 and 10 on Monday, we get like 10 times as many phone calls as you get the rest of the week.

But imagine if you could field all those phone calls on Friday, Saturday, and Sunday and make all those appointments so the patients don't have to wait until Monday. This excites me. It's like, I remember Google had the Google assistant many years ago. said, we're going to come out with this. And I thought to myself, like, I don't know. How's that going to work? Are we, are we as humans going to be accustomed to talking to this AI agent over the phone?

But now that we've been, you know, chat CBT obviously got us all into, like, you know, talking to AI. I was just watching a video about a man. It was a CBS, New York actually interviewed this guy. He asked Chat Chbetee to marry him and it said yes. and now his wife is really upset because he's really in love with chat chibati so i think we as humans now are already open to the idea of talking to ai but that's really great when you look at what makes a successful surgeon because i imagine that has to be one of the most complex jobs anyone can have i mean i i i could i don't think i would ever qualify to be a surgeon but when you look at

what makes a successful surgeon what are a few of those traits that you've seen? One is dedication and repetition, right? Like, you get better and better the more you do something and the more you dedicate yourself to perfecting what you're doing. So, you know, constantly watching videos, listening to what other people are doing. You know, it's like being the coach of a football team. Like the idea and plays, other people come up with great plays to counter what you're doing. And so you have to be constantly kind of looking at what everyone's doing because someone

might have a great idea that you didn't think of yourself. So there's constantly changing in orthopedic surgery of how we do things. And so to stay up with that, that's important. Two is just dedicating yourself to repetition, doing things over and over again. You get better and better. Like a musician gets better and better, the more they play an instrument. And then the last thing is paying attention to your outcomes. And I think this is where some people fail. Like, If you don't examine your patients, if you don't communicate well with your patients, if you don't track your outcomes, you may not realize that something that you're doing really doesn't work that great.

You know, just because you read a paper that says everyone comes out, you know, 90% success rate, doesn't mean that that's true for your patient population. And so you want to be tracking your patients, really taking a close look at your patients, doing a full exam every time they come in to see where they're at and how they're doing. That's amazing. I mean, you know, hats off to you. and anyone else who does surgery because, you know, we, I can, I would think when we look back, you know, pre-surgery and how things are post, you know, the ability for us to, as a species,

human race to do surgery, you know, how much better are we today? How much better do we feel? Like you said, there's, there's so many reasons why I'm grateful. And I can't wait one day. If I need to go somewhere, I want to go to your practice. And really, it's very interesting. I've never, heard a doctor talk about, you know, the five-star experience, uh, being there 24-7. I can tell that you're really at the forefront of medicine and having the patient, you know, being, everything is really around the patient. So if people want to get in touch with you, they want to find out more information, how can they do so? Um, so, uh, you can go to total orthosportsmed.com. That's our website. You could certainly Google us, um, you know, total orthopedics and sports medicine. Um, it

If you're, and if you're injured and you're on Long Island, just come to Total Ortho Express. You know, we have four locations. You know, you can walk right in. Our Massachusetts people locations open up seven days a week. So, you know, we're willing to see you pretty much at any time. Well, Dr. Charles Ruto, thank you for joining us. And thank you for all you do to help. I'm sure thousands of people every year, get better, stay better, be healthy.

I would look back like in our life and say, you know, the doctors that made a difference, I would remember them more than like teachers. I don't even remember any teacher. But I can tell you like the doctor that I had, you know, when I injured my knee or the doctor that helped me in these certain situations. So, you know, shout out to all the doctors. And a good doctor is like a teacher because you should teach you about what your problem is and what you can do to make it better.

If you're not teaching, you know, you're not helping. The best teacher is now the, no, and I thank you for that. I hope a lot of other doctors also, you know, take on that same mindset. But thank you for joining us today on Founder's Story. Great. Thank you. Thank you, Daniel.