Chapter 1
Pacoās Story: How I Became a MedikalPreneur
The circumstances of my birth foreshadowed my chosen career path with prescient irony. While my parents vacationed in Brussels, Belgium, my mother had accidentally left her birth control pills in a dresser drawer at the hotel in Amsterdam.
āNothing will happen if you just miss one pill,ā said my fatherāa physician who should have known better!
That was in June of 1965. Fast forward nine months, and Paco was born in Matamoros, Mexico. When my mother told me the story, I immediately understood what Kahlil Gibran meant when he said: āForgetfulness is a form of freedom.ā
My arrival as their third child was an especially joyful occasion because my parents had suffered three pregnancy losses since my brotherās birth six years earlier, and my sisterās arrival the year before him. The miscarriages were hard-hitting because, at the time, my father was the sole physician providing care and delivering babies in a rural town of Tamaulipas, Mexico where they lived.
His lifeās work was treating patients and bringing new life into the world. At home, however, he and my mother were repeatedly suffering devastating loss. Yet their love, having blossomed since their introduction while my father was in medical school in Mexico City, endured the tragedies until it was time to celebrate again.
After my birth, my parents moved to Matamoros, in the northeastern Mexican state of Tamaulipas, a mere 20 miles from where he was the only practicing physician. The town rests on the southern bank of the Rio Grande, just across the border from Brownsville, Texas. Though far from my fatherās hometown of Saltillo in northern Mexico, and my motherās origins in the state of Chiapas near the Guatemalan border, they planted their roots in this medium-sized town.
My father, JosĆ© Arredondo, MD, provided medical care in his clinic for the workers of the Mexican government by day, and ran a private practice in the evening hours. Meanwhile, my mother, Carmen SoberĆ³n-Arredondo, applied her accounting knowledge to running a local pharmacy.
In Mexico, itās traditional for a child to take on his motherās maiden name as well as his fatherās last name; therefore, I am Francisco Arredondo-SoberĆ³nābetter known as Paco by most. To clarify the origins of the nickname Paco, letās briefly digress. There are a handful of theories, but the one that stands out posits that the nickname originated with Saint Francis of Assisi, the father of the Franciscan order. His name in Latin, according to folk etymology, was Pater Communitatis, which means āfather of the community.ā Hence, Paco represents the first syllable of each word.
I witnessed my parentsā industriousness and entrepreneurial success while growing up, inspiring the same qualities in me and thus setting the stage to trailblaze a life and career that have far exceeded my greatest expectations. I inherited a natural curiosity about life from my father and a strong work ethic and passion from my mother.
āI donāt care what you do,ā my mother always said. āYou can be a janitor. I just want you to try to be the best janitor in the world! You may not get there, but I want you to try and make that effort to always compete against yourself.ā
I was drawn to archeology and politics. At 17, I participated in the marketing team for a local mayoral campaign. My candidate lost, but the knowledge I acquiredālistening to peopleās concerns and inspiring changeāwould later prove invaluable as a physician.
Meanwhile, I occasionally accompanied my father while he gave pediatric consultations in the government hospital, exposing me to the medical profession and broadening my thoughts about work, money, and creating oneās own path in life. When I was 10 years old, I was sitting in the exam room with him (clearly, HIPPA did not exist in Mexico in the ā70ās!) and noticed that far more patients were visiting my dad in comparison to the other doctors.
āHow do they pay you?ā I asked.
āThey give me a salary,ā he said.
āBut you see more than the other ones. So they pay everyone the same?ā
āYes,ā he answered.
āThatās unfair,ā I said. āYou should propose that the government could add up the salaries of all the doctors and divide them by the number of consultations, so we can determine the cost of one consult. Then they should pay each doctor per consultation, incentivizing them to be better doctors.ā
My father laughed and said, āThings donāt work that way, but I like the way you think.ā He explained how Mexicoās two-tiered system of medical care enabled him to leave after four hours in the hospital to work afternoons in a clinic that he operated with several other physicians.
Young and shortsighted, I concluded incorrectly that my father was incapable of becoming a successful businessperson. Itās true: he was typical of many doctors who have the heart of a grandmotherādriven to help and heal everyone without regard to the money-making aspect of medicine. His altruistic calling into medicine was indeed admirable. But his inability to separate his empathy-inspired professional services from the business of operating a medical practice reinforced the doctorsā reputation as unskillful businesspeople. This hinders profitability. Even in a nonprofit organization, if there is no money, there is no mission.
My observation of incongruent incentives for a physician and businessperson planted a seed in my young mind. Meanwhile, from an early age, my family exposed me to progressive thought and inspiring conversations; at age nine, I began reading the newspaper every day to deepen my understanding of the world.
āWhat you gain in depth, you lose in width,ā my father often said, meaning it was important to become a well-rounded person. This prompted me to: read a vast range of books and articles; learn languages; interact with a broad scope of people from different professions; play many sports; and learn new skills such as mountain-climbing, skydiving, cooking, and getting my bartender and mixology certification. These endeavors, I believe, helped me become a better physician and businessman.
However, this broadening of oneās experiential world contradicted conventional wisdom, especially for physicians, who tend to focus only on information that enhances their performance as doctors. Later, in medical school, my peers often chuckled and questioned me for reading books that were completely unrelated to medicine. Undaunted, I read poetry, novels, and essays by authors such as Julio Cortazar, Octavio Paz, Pablo Neruda, Leon Felipe, Mario Vargas Llosa, Gabriel Garcia Marquez, Walt Whitman, Jean Paul Sartre, Michel Foucault, and Isaiah Berlin. My reading spanned human history, leading me to the most esoteric professions like wine making and soccer management. Argentinian soccer coach CĆ©sar Luis Menotti, once called the Philosopher of Soccer, is in my pantheon of inspiring thinkers.
Music also opened my mind to new ideas. For example, my father purchased an LP collection of 100 classical records (for Millennials, LPs are vinyl music discs that play at 33 rpm on a record player) in Mexico City. The record covers featured each composerās biography and explained how each developed his music. French composer Maurice Ravel, for example, was influenced by operas, passacaglia, New Orleans Jazz, and many musicians.
One mind-blowing revelation occurred while reading Thomas Mertonās biography, The Seven Storey Mountain. He said that music is not simply a group of sounds, but a group of sounds and silences, and oftentimes the silences play a more powerful role in our listening and learning experience than the actual sounds. I thought: What you donāt say is often more important than what you say. I began to see things not only in what they could be, but also in what they could not be. This realization irrevocably changed me for the better.
An insatiable hunger for learning inspired me, during medical school, to join the athletic team, learn French and Italian, and continue expanding my intellectual pursuits in disparate subjects. These experiences inspired multidimensional thinking. One-dimensional thinking can result in being oblivious to the world of fascinating ideas and activities outside the scope of a typical physicianās life and work. On the contrary, exposure to many ideas and topics enriches your general knowledge base and actually enhances your work as a doctor. Broad exposure to many interests boosts success, asserts David Epstein in his popular 2019 book, Range: Why Generalists Triumph in a Specialized World.
Another powerful lesson from my parents was our homeās āopen doorā policy, which helped my father cultivate a stellar reputation as a doctor who truly cared about his patients. At seven in the morning, the door to our home in the middle of downtown Matamoros was open to those in need, and remained open until our family went to sleep. Even on Sundays, the holiest day of the week, patients ...