How Dr. Keith Matheny Turned His Practice's Biggest Headaches Into Businesses, While Still Seeing Patients

Key Podcast Moments

• Keith traces his entrepreneurial path to a practice he joined out of training that had no website, paper charts, and money-losing ancillary services
• Basil and Keith identify the gap at the heart of physician training: a decade or more of clinical education without a single semester of business, leaving most practices run by well-meaning clinicians who were never taught how
• Keith explains how the shift of procedures into the office around 2011 drove supply costs for the average ENT above $400,000 a year, creating the problem that eventually became US ENT
• Keith describes the private conversations with members, away from any executives, where physicians facing 21% payroll increases and flat reimbursement break down in tears
• Basil and Keith make the case that staying in the exam room isn't a sacrifice for physician entrepreneurs, but the source of the credibility and insight their businesses depend on

Physicians spend more than a decade learning to care for patients and almost no time learning how the business that delivers that care works. Most practices hand operations to experienced clinical staff who know coding and payers but were never trained in business either. For years, the margins could absorb that. With payroll, supply costs, and overhead rising while reimbursement stays flat, they can't anymore.

In this episode of How I Doctor, guest host Dr. Basil Kahwash, an allergist and independent practice advocate, sits down with Dr. Keith Matheny, an ENT in the Dallas area who has built an unusually wide career without leaving clinical medicine. Keith holds patents on bioabsorbable drug delivery implants, has co-founded two device companies and a remote monitoring company focused on sleep apnea, and serves as team otolaryngologist for the Dallas Cowboys. He credits the decision to go into community practice after training at Vanderbilt with giving him the freedom to pursue all of it, including owning his inventions outright rather than sharing them with an academic institution.

The real starting point, though, was his own practice. Before he was legally a partner, Keith took over business operations at a practice with paper charts, no website, an inefficient revenue cycle, and ancillary lines like hearing aids and allergy that were losing money. Over the next several years, those service lines became profit centers that fed the surgical practice, the group expanded into three new parts of the market, picked up new referral patterns, and got involved in surgery centers and hospital leadership. That turnaround grew into a consulting business, which became the foundation for US ENT, a national group purchasing organization.

Keith launched US ENT around 2017 by persuading suppliers to sign on before he had any members. The GPO is free for physicians; suppliers pay a small percentage of each transaction. Early recruiting was slow, as many physicians assumed he was a front for private equity. Growth came during COVID, when practices facing shutdowns were suddenly eager for cost savings and new revenue. Today US ENT has about 3,500 members, and Keith says staying clinical is what makes that work. He feels the same squeeze they do, and he believes his patients, and his colleagues' trust, are the best reasons not to step away.

Keith's path is a useful counterpoint to the assumption that physicians who build businesses eventually leave medicine. Here's what physicians can take from how he's done it.

Top 4 Takeaways

Keith's story is bigger than one physician who happens to be good at business. What Basil and Keith surface in this conversation are the structural forces squeezing independent practices from every direction, and what it actually takes for physicians to fight back without leaving the exam room.