Casey Gaetano with Integrity Compounding Pharmacy

Intro: [00:00:07] Broadcasting live from the Business RadioX Studios in Sandy Springs, Georgia. It’s time for In and on Business brought to you by the Sandy Springs perimeter chamber. For more information, go to Sandy Springs Perimeter chamber.com. Now here’s your host.

Adam Forrand: [00:00:33] Hello everyone. This is In and On Business with the Sandy Springs Perimeter Chamber where we explore the tension between executing on and innovating in your business. I’m your host, Adam Forrand, and today I am joined by Casey Gaetano, who is the owner of Integrity Compounding Pharmacy here in Sandy Springs. Welcome, Casey.

Casey Gaetano: [00:00:52] Thanks for having me. Excited to do this.

Adam Forrand: [00:00:54] Glad you’re here. For our listeners and even for you, Casey. Just as a reminder, we talk about working in and on your business. We are talking about when working in your business. We’re referring to the work that enables the delivery of a fabulous service such as integrity compounding pharmacy or a remarkable product. So what you’re really known for what the market and the community knows you as and working on your business refers to the growth oriented activities you undertake to ensure the sustainability and the viability of your business in the future. So we’re going to dig into that. The difference between working in your business and working on your business. So let’s just get to it. Casey Great, Let’s do it. Your signature says owner. Why do you use the word owner in your signature and not something else?

Casey Gaetano: [00:01:44] So it really goes back and this entire conversation, I guess what we’re going to be talking about in verses on business gets back to I am the owner of a compounding pharmacy, but I am not a pharmacist. So there’s never been one day in the history of our business where I could say it’s either my way or the highway. I will be doing everything right. I will be checking this prescription and it will go out the door. And that’s just the way it is because I’m the, you know, the pharmacist in charge and that’s what it is. Yeah. So for me, it’s always been a tension of working in versus on because by law, quite literally, I cannot do all the parts of what working in our business would would mean. And so for, for me and we still I still talk about this in hiring all the time, I say the best part about our business is that I’m not a pharmacist. The worst part about our business is that I am not a pharmacist because it forces me to clearly delineate the things that I do versus what our team of pharmacists do. Right. And that’s been basically the structure around which this conversation we’ll be having today revolves around.

Adam Forrand: [00:02:48] Yeah, so using the word owner in your signature and only owner. Right? Sends the right signal.

Casey Gaetano: [00:02:54] Yeah. For me. Well a lot of you know everybody else most compounding pharmacies the owners are are pharmacists. And so a lot of times there will be pharm.d this right and what board certifications they have and then either they’re most of them are the pharmacist in charge. Some of them end up passing that off at some point. But that’s what it’s to talk about. But for me, it’s more on the business side of things where it does get to be working on the business.

Adam Forrand: [00:03:17] Yeah, and that’s what’s going to make this conversation great, right? Hopefully, yeah. So we’re going to focus on working in your business. So when working in your business, what strategies or tactics have served you well so that you get the best out of yourself and or your team?

Casey Gaetano: [00:03:33] So in terms of working in the business, I got into compounding pharmacy when I was very young, 22, 23, and my job at that time was basically to do all the stuff that nobody else wanted to do at the beginning, right? So it’s like. Some of it, I guess maybe in hindsight it seems obvious, but I’d never thought about things like how do you make sure that the trash people come pick up your trash once a week? Somebody has to call them details, details. These things happen, right? At&t insurance contracts, all these stuff. So I kind of started there in terms of, you know, as we’ve gone forward, I’ve held different done different things in terms of in the business versus on and and part of it is how you define those things. But I’m still very involved in a lot of purchasing, very involved in our financial side of the business and even down to down to bill pay. A lot of times very involved in putting, you know, all of our orders together and sales and product development and all of this kind of stuff is where I tend to be more on for me involved in the business.

Adam Forrand: [00:04:36] Gotcha. Okay. And so what’s many years later? Sure. Right. How old is integrity?

Casey Gaetano: [00:04:42] So in our current form, it’s basically been the way that it is now since 2015. Since about eight years.

Adam Forrand: [00:04:48] Yep. And so you’ve grown to a team of one You.

Casey Gaetano: [00:04:53] Yeah. Well, I was never a team of one because I couldn’t be the pharmacist. But that’s true. So we were when, when I took over at Integrity, we had a team of, I think 5 or 6. Okay. And then so now we have a team of about 36.

Speaker4: [00:05:06] Wow.

Casey Gaetano: [00:05:07] So it’s different.

Adam Forrand: [00:05:08] It is. It’s very different, right? Yeah. What is the difference between as you were contemplating working in the business. Right. And those early experiences and those finer details to where you are today? What has been the through line? What has been the common thread in terms of your experience as it relates to your focus on delivering the service? That integrity is known for sure.

Casey Gaetano: [00:05:34] So when you have six or 5 or 4 or 2 or 1 employees at a business, then basically when you’re the owner, you’re responsible for everything, right? And that never changes when you have 36 employees or you have a thousand employees or a million employees. It doesn’t matter if you’re the owner, you’re still at the end of the day responsible for everything. What changes is the fact that you can’t do everything anymore, right? Um, so there’s a delegation side of that. And to me, one of the biggest parts is intentionality, which is okay if I don’t think about this and I just try to respond to every email and phone call and employee that knocks on my door or whatever in the moment, it’s very overwhelming. So you have to try to think about in advance, what are the things that you feel like you truly provide value add doing versus things that other people could do just as well of a job if given the right training that you’re kind of doing. And to me, that’s like really the ultimate question. And there are certain things as the owner that you probably can never you never give off right to anybody else.

Casey Gaetano: [00:06:37] You never want to delegate. But as time goes on, because it’s just the volume of requests, each individual task tends to just take longer and longer and longer because there’s more, Right? And so you just are slowly working down this funnel to just eventually deciding what is the one most important thing that if this was taking 40 plus hours a week for me to do, I would just only do this one thing. Yeah, I think, you know, for us and for me, I always said that our we would know our business was super successful if I could just sit in a dark room all day and just think about what we should be doing, Right. Um, you know, that’s. I wish that was the case. It happens on the way to work and in the shower, and while I’m brushing my teeth. Yeah, exactly. And all these types of things. But dimly lit. Yeah. Not dark exactly. Um, but yeah, I think, yeah, to answer your question, it’s just kind of working that funnel of trying to figure out what’s important and that only you can do it versus what’s what can be given to other people. Yeah.

Adam Forrand: [00:07:35] And so are there new systems or new protocols, new processes that you’re relying upon now that you didn’t rely upon many years ago or even last year or the last two years? Yeah.

Casey Gaetano: [00:07:49] We’re constantly reinventing processes and all of that kind of stuff. I tell people in whenever I do interviews for hiring, I’m still very involved in the hiring process. I always say, If you don’t like change, then don’t say anything. Just get up and leave. Just walk out the door. Never come back. Never. Don’t, don’t look back. It’s all good. It you’re good. Like let’s not do we’re good. Yeah. So we’re constantly changing everything. But that’s because I think it’s very easy. It’s very easy to understand that what works when you have five employees doesn’t work when you have 50 and and definitely wouldn’t work when you have 1000 employees. People understand that. What I think people don’t understand is that what works at 1000 employees doesn’t work at 50. And what works at 50 also doesn’t work at five. It’s actually bi directional in terms of scale with different things. And so if you are a growing business, you can’t like you can’t somebody that runs Coca Cola or something can’t just be like, Oh, well, here are all of our processes for our 100,000 employees. Like just institute these with your team of 30. It doesn’t work. And so you’re constantly as you go trying to reinvent things up and down. As as as it kind of comes.

Adam Forrand: [00:08:58] And so in the face of new regulations, in the face of other regulatory constraints that you have, is that borne out of just the sector that you’re in and the service you provide? Or is that that change? Does that come from within? Is it internal or is it as much external?

Casey Gaetano: [00:09:21] This is a great question. So so definitely being part of pharmacy and what we do in compounding is one of the most highly regulated parts of probably the the entire the entire economy. And there are certain rules about doing things like quality management meetings and standard operating procedures that we have to have by law. Thank goodness. Right. Exactly. The general public should be very happy that these things are in place. Right. So we have to have some frameworks for those for that, for that type of stuff as a business. But we try to carry that over into other things because again, kind of back to some of the scale stuff when you’re, you know, 2 or 3 employees, a doctor calls in and says, Hey, could you make this for me? And a lot of times if it’s just maybe back in the day, that would be just me and a pharmacist. We sit there and we look at each other, we think about it and decide whether we want to pursue that or not and what that would mean. But now, you know, we have 4 or 5 salespeople out there doing it full time. We’ve got 10 to 15 people answering phones all day long. We’ve got a lot of people working in the lab. And so it’s not just one question that comes in per week that we have to decide whether we want to do it or not.

Casey Gaetano: [00:10:29] But there’s 30 questions that are coming in per week about whether we should do things. And then, you know, we’re trying to build out systems such that if one doctor, let’s say one gastroenterologist, called in and asked about a particular product in April 2023 and I did three hours worth of research and we decided whether to do it or not. Well, if another gastroenterologist calls in in April 2024, we’re trying to build out systems so that we don’t have to like we can remember what we said and what we did and how we did it right and all of that kind of stuff. And so we don’t have to keep answering some of these same questions over and over again because I know that I’ve sometimes I’ll be halfway through researching something. I’m like, I’ve done this already. Kind of like reading a book. You get three chapters in and you’re like, Wait a minute, I’ve read this book, right? So we’re trying to build out those types of systems. And a lot of that to me is taking all the information that’s in all of our pharmacists heads, my head and our sales people’s heads and putting that into some sort of. You know, procedure such that we can learn from each other. Right. And we can save that information over time. Wow.

Adam Forrand: [00:11:39] So to provide more context for the listeners, you would describe your environment as a high mix, sort of low volume environment, or do you work on a low mix, high volume in terms of the the pharmaceuticals that you compound for your clients?

Casey Gaetano: [00:11:56] So in the Okay. So in the grand scheme of things, we’re kind of a little of both. So a regular retail pharmacy like your Corner, CVS, Walgreens, Kroger, whatever, a busy store might process 500 prescriptions in a day or a really busy store might process 7 or 800 prescriptions in a day. Okay? And usually at most of those types of places, they’re going to have one pharmacist on. On duty. On duty. And then just depending on what their hours are, it might be split between two different people or one person working a like 3 or 4 twelves or four tens or whatever the case might be. Just kind of depends on their hours. But a busy store would say do 500 to maybe 800 retail prescriptions in a day. Okay.

Adam Forrand: [00:12:43] Non compounded.

Casey Gaetano: [00:12:44] Pharmaceuticals. Non compounded. That’s just where they’re off the shelf. They’re off the shelf. You know, there’s antibiotics and blood pressure medications and all of these things. So and 1 to 2 pharmacists might be able to cover that for a day, just depending on exactly how that’s set up. We have 13 pharmacists that work just in Atlanta, and we only do about 250 to 300 compounds. Gotcha. Okay. So each one of our basically every single compound is just a lot more work than a particular commercial product. And that’s on a couple of different for a couple of different reasons. One, we have to make it so there’s that whole making it component to it. And then two, based on the types of work that we do at your regular retail pharmacy, at CVS or whatever. Every patient that walks in the door, most of the time it’s a refill and they’re on the same blood pressure medications and the same things month over month, over month. Obviously, that’s going to be a little bit different. You get sick, you get an antibiotic steroid, whatever. But a lot of times, you know, you have your CVS and you’ve been going there for the last eight years because it’s the one that’s most convenient to the house and they give you good service and whatever. For us, it’s a lot of new patients. And not only is it new patients, it’s new patients that don’t know what a compounding pharmacy is. And depending on how that conversation went with their doctor or their nurse, they might not even know why they got prescribed a compound.

Casey Gaetano: [00:14:02] Gotcha. And so it’s a lot more work on the front end. We’re getting payment. Insurance doesn’t cover most of what we do. So a lot of times it’s cash pay. So it’s explaining that whole process to them and then it’s got to be made and then it’s got to be, in most cases, shipped to the patient. Sometimes they do pick up. But we we probably ship about 90% of what we make. Wow. So so then you’ve got that and then you’ve got what pharma does. So or hospitals a little bit different, but you’ve got what pharma does. Pharma runs these massive batches that are going to go towards thousands and thousands and if not tens of thousands of people in a single batch, right? That’s very traditional manufacturing, whereas when we’re doing it, a lot of times we’re making batches of one. So we do a lot of one on ones. Okay. So it’s very time and labor intensive to just make that single compound that’s going to make a specific difference for a for an individual identified patient. Right. So it’s a very like it’s a it’s kind of we’re in the middle of all these all these different things that are kind of going on. Some things we do batch for up to maybe a few hundred patients, but a lot of things, about almost half, probably over half of what we do is one of ones. Gotcha.

Adam Forrand: [00:15:09] And so your primary relationship is both with the physician and the customer, the ultimate patient, right? Who is ultimately the customer who receive this specialty.

Casey Gaetano: [00:15:20] Correct combination. So so we the slogan that I made up was Our patients are our patients and our doctors are our customers. So patients are very important to us. Absolutely. Ultimately, who’s paying the bills? Right. And that’s who’s getting the medication and that’s who we want to get better. If that’s the case, or maintain whatever they’re trying to maintain, depending on what it is. So they’re very important to us. We, you know, think very highly of that relationship between us and our patients. But our sales and marketing are geared toward the doctors of those patients, such that, you know, if you are a particular patient, you go into your doctor, you know, it might be that 98 out of 100 people need one thing. But when that doctor realizes that you are in the two out of 100, they think a compound and be integrity compounding pharmacy. So that’s what we work with a lot of times on our salespeople, is that it’s that two part sale. It’s like when to use a compound. And if you are going to write a doctor or write a compound doctor, please send it to integrity versus some, you know, what other choices that you would have. Yeah.

Adam Forrand: [00:16:18] So does that culturally speaking at integrity, does that phrase your patients are your patients and your doctors are your customer? Is that imbued in every part of of the work that you do?

Casey Gaetano: [00:16:30] I think it is. And I always and I always catch myself saying I never want to diminish the work that our customer service and patient services team do with our patients. But from a strategy standpoint, my job, yep, that’s who I’m thinking about is, is why doctors would write compounds or we don’t always work with doctors, sometimes with hospitals, sometimes it’s with other pharmacies that are outsourcing different things, whatever. Right. Okay. But that’s who I’m thinking about, is those people as being the people that are trying to prescribe something or to handle something that they don’t want to do themselves and therefore they want to use us for that service.

Adam Forrand: [00:17:07] Yeah, brilliant, Brilliant. You know, the question of differentiation across compounding pharmacies, right, is the question I was headed towards. But you answered the question in terms of that ethos. That is integrity compounding, Right? It is acknowledging the difference between. Those whom you serve and how you serve them differently and why you serve them differently.

Casey Gaetano: [00:17:27] I think that’s that’s right. Most compounding pharmacies grew out of independent retail pharmacies and then they started doing compounding. And so for those places, the customers are their patients. It’s one and the same, right? Because they what they’ve realized in a lot of those cases was that they had a captive audience of two, three, 5000 patients that are coming there to pick up their regular medications. And it’s like, okay, if we just start doing compounding for this sliver of patients and doctors that already know us. It’s just, you know, a value add service that we can make some money off of. And sometimes that grows and grows and grows and the next thing they know they can. It can be a standalone compounding pharmacy, but it never typically loses the roots of the patients and customers being the same people. And that’s what their marketing is geared toward, doing Facebook things. And, you know, social media is more important to to them than it would be to us and all that kind of stuff. But for us, you know, I really do think that a lot of our job is to make our doctors look good. Yeah, I want my whole goal is that the patients not necessarily go tell me that we did a good job with our compound, but that they go to their doctor and they go back to their doctor and say, Wow, that recommendation you made was great. The company took great care of me and it worked. And thank you, doc. That is more where we are geared toward than just that individual relationship between us and the patient.

Adam Forrand: [00:18:46] Awesome. So beyond that mantra, how do you get the best out of your people on a on a day to day basis?

Casey Gaetano: [00:18:53] Do we have like seven hours? We do not know. I think that’s that’s very difficult. Seven minutes.

Adam Forrand: [00:18:59] How about that? Right.

Casey Gaetano: [00:19:00] No, that’s that’s that’s it’s such a challenging question. I think it’s the question. Yeah. In terms of of building an organization is how do you get the best out of your people Because ultimately all of the the words and the things I mean, it’s still human beings that are that have to do all of those things. And so I think it really is the ultimate question to me, the answer to that to that question, because it is so hard, is to try and simplify it. And what that means to me is if the our company aligns on like one on one axis, right? The patient’s professional life is a second axis and their personal goals and ambitions in life is a third axis. Okay. If those three things intersect, what I’ve typically found is that most problems just kind of take care of themselves because everybody’s incentives are aligned like, right? If it makes sense for them professionally and personally to have this job and what they do and what they bring to the table is a good fit for what we are looking for in that particular role. Then typically any sort of personal issue or lack of motivation or it kind of just all falls away. Whereas when those three things aren’t lined up, all of a sudden they don’t like this one policy on that and they didn’t like, like it’s like things come out of the woodwork, right? And it’s all because there’s an inherent tension in that. It’s just not the right fit at the right time for that, for the for that particular person. Yeah. So I think about that a lot in terms of just trying to align those three things up and therefore basically solving the problem before it can become a problem. Right? Because everything just makes sense. Yeah.

Adam Forrand: [00:20:35] Yeah. That’s incredibly hard to assess though, in an interview process, Right, Very. Um, and maybe you can speak to it or your managers, your hiring managers speak to that in terms of that alignment and certainly that ethos by which you guys operate. But assessing that through a hiring process is incredibly difficult. So you’re probably putting the onus on the candidate themselves.

Casey Gaetano: [00:20:58] Yeah, look, you’re never going to get it right 100% the time. No, I think the number that I read most recently was like, if you can be successful in hiring 70% of the time, you’re absolutely knocking it out of the park. Yeah. And even 50%, you can be happy there. Yeah. So I think and I think we’ve gone through ups and downs with hiring. We’ve had times when it felt like every single hire we were making was just the right person, just the right time. And then there have been other times where it’s like, okay, we hired six people in the last three months and none of them are still here. It’s been only three months. So we’ve kind of gone through both of of of those of those things. And I think the biggest the times when we make the most mistakes or when we are desperate and that’s either because we have a job that we just have to fill or because something happens or whatever the case might be. And we I almost always look back at it and I’m like, Yeah, we made that decision because we were desperate. And so we try to stay ahead of it. That keeps us out of being desperate. But that brings us to this other thing that’s kind of important called the budget.

Casey Gaetano: [00:21:59] You know, small thing. It’d be great to have an extra person at every position, but that’s not how it works. And so you try and balance those things the best that you can. But yeah, it’s hard in the in the interview process. So we try to see we try to select for people that like change, that are motivated, that are curious, that are. That. Honestly, the question that to me matters the most in an interview process is why do you want this job? Like when people have trouble articulating that, that to me is probably the biggest red flag because we’re a niche company, right? We’re a compounding pharmacy, right? There’s not that many. And when people can’t articulate why they would want to work at a compounding pharmacy, to me that’s kind of a red flag for like, have you done any thought or are you putting like any thought into your personal goals and life and write any research at all into any of this stuff? So when people are able to well articulate in a way that to me makes sense of why they want this particular job, that’s such a green light to keep talking to that person.

Adam Forrand: [00:23:01] It goes to motivation right across those three axes. Sure. Yeah. And while they can never meet the same motivation you have as the owner and the leader and the founder, if they’re getting close right, then you’ve got you’ve got an indication that there’s something there for sure.

Casey Gaetano: [00:23:20] And we are in health care. So obviously I am the the the owner of the company. So, you know, there is a financial component to that on on all axes. But a lot of people got into health care because they want to help people. And that’s really important, too. Yes, it is. So we try to make our company a place where people can help people if that’s what they wanted to do. And the most common reason that pharmacists will move from like from big box retail to integrity, at least on the patient services and customer service side, is because based on the nature of the business where it’s CVS, they might have 30 seconds to spend with a patient. A lot of times we try to give them the space to spend 15 minutes with that patient and actually trying to get in there and help them and do do all that stuff. And I think they they do find that rewarding. I think also when a lot of the retail pharmacists feel like doctors don’t always respect them professionally as much as they would. Okay. But and I almost have to like untrain that out of them because when they come over to our side, on the compounding side, those same doctors are calling because they have real questions. They don’t they know that they want something, but they don’t know exactly how to write it. Yeah. And so they’re those pharmacists are like, wait, a doctor hasn’t really asked for my opinion about something in five years and all of a sudden they’re starting to ask me for my opinion all the time. I actually, I really got to double down and know this stuff because my opinion is valued here, because the doctors need help getting what they need. And that’s that’s kind of what we’re trying to to be able to, to be set up to do. Yeah, that’s.

Adam Forrand: [00:24:50] Fabulous. So I’m going to transition to the working on your business. Sure.

Casey Gaetano: [00:24:53] The whole thing we were supposed to talk about.

Adam Forrand: [00:24:54] Yeah. No, we got the in part we got a great dose of the in part. And there was some absolutely fabulous stuff in there on the on part. You and I were talking earlier before this broadcast, this recording that you know where you are with 35 or so employees. Right. And you think about the viability and the sustainability and perhaps the scalability of integrity compounding where are you in that working on the business part? So you mentioned some of the things that you’re trying to delegate that you do, delegate some of the things that you’re in the mix on in terms of the operations at Integrity. But when you think about hiring new people and the prospect of hiring new people or you think about systems development within your organization that may take certain tasks away from others and perhaps automate them, like what does the future look like? When you think about when I’m going to you’re going to switch that gear, change that gear into I’m working on my business now. What does that look like right now for you?

Casey Gaetano: [00:25:59] So a couple of different things. You know, at its roots, pharmacy is a scale business meaning and in health care, a lot of things are not great scale businesses because people are getting paid for their time. Right. When we’re on the pharmacy side of things, we’re not getting paid for our time. We’re getting paid for prescriptions going out the door, which it naturally lends itself towards being a scale business right in addition to that, with compounding very high fixed costs compared to most pharmacy operations, just because it is, you know, at the end of the day, it’s a very small batch manufacturing facility. And the the actual costs of the drugs that we’re using to compound are typically quite low as a percentage of what that product looks like. So from that reason, I always think about compounding as a very scalable business. On most axes. The hard part to scale is actually the institutional knowledge of how to do everything correctly and how to sell it and all that kind of stuff. Yeah. So when I think about working on the business from a sales and actual production standpoint, a lot of that is working on processes that will build institutional knowledge. Institutional knowledge across employees such that, you know, as you grow, you’ve got ten, 12, 15 pharmacists, you’re going to have different people there every day.

Casey Gaetano: [00:27:18] Can you still do everything you need to do when 2 or 3 employees are out? And then in terms of sales, you know, do all of those sales people know what they need to be saying in front of doctors and then that coordinating with the patient services folks so you never want it, where a salesperson goes into a doctor’s office and says, Hey, this is how to prescribe this. The doctor does it exactly that way. They get a call back from the pharmacist saying, You didn’t do this right at all. And then they turn around, look at the salesperson, like, what did you tell me? So everybody’s got to be on the same page with all that stuff. And so I do think about that from a process standpoint. You know, we do that. We tend to hire younger pharmacists, generally speaking. So there’s a lot of learning and training to be done there, right? But that’s where we do a lot of meetings and a lot of internal teaching and internal learning about how to do all this stuff and then try to put it together in a way that it’s actually written down and saved such that anybody can go back and find our notes on a lot of these things and kind of and kind of build on that with, with other types of processes.

Casey Gaetano: [00:28:21] I mean, it’s kind of the same thing on the other side of things, all the different parts of running a business, there’s invoicing, there’s payables, receivables, purchasing inventory, all of these types of things. And again, that’s just to me, I spend a lot of time trying to think about processes such that that somebody else could do what I have been doing or what somebody else, you know, somebody else has been doing. And then if that person were to left or to leave, okay. And we had to rehire for the next person, how long would it take them to figure out how to do the job? Because if it takes two years to figure out how to do purchasing, that’s not going to work because that’s not necessarily a job that you’re going to keep somebody for the rest of their life doing. And we need to have it done in a way such that somebody new would be able to come in and figure it out. Right? And so that’s what I spend a lot of my time doing is trying to build those processes.

Adam Forrand: [00:29:11] Yeah. And so does that documentation that that memorializing of institutional knowledge does that is that a really just a hard transcript of documentation of conversations? Are you recording audio conversations? Are you recording them in video? How are you capturing this huge amount of knowledge that you have?

Casey Gaetano: [00:29:32] So a lot of it is mostly written So, so as a pharmacy, we have to have written SOPs on a lot of things and that’s where a lot of things will start. But then a lot of times we will make basically reference documents with instructions, supplemental supplemental documents that kind of just walk you through doing it the right way almost. Yeah. And so for instance, with purchasing, I know that they just added a yesterday, they added a box that could be checked so that somebody with an iPad can just have the iPad and know where they are in the in the doing it. And but it sounds really simple that we just added a checkmark. Checkmark to the document. Right. But it’s allowing people to basically figure out across hundreds of different SKUs what we need to purchase on a weekly basis without constantly getting lost in the middle of what they’re doing. It was so simple. It’s like, why did we not do this five years ago? But it’s little things like that. And then, you know that document now it’s made whoever’s doing purchasing now might move on. Somebody else comes in. Well, that little, that little check mark is not going away. And so it’s going to help the next person too. Even though it’s weird. Like institutions, I think institutional knowledge is something that’s kind of fascinating to think about, but like nobody’s going to talk to that person about the times before the check. Mark The checkbox, right. Like they’re just always going to know that the check mark, what the check marks for and why it exists and how it keeps you from getting mixed up when you’re in the middle of things. And so those are the types of things that you you build on these processes. You just iterate over and over times thousands of different things. And that’s to me is how you, you know, ultimately build an organization.

Adam Forrand: [00:31:07] Yeah. So you’ve got regulatory requirements in terms of SOPs and documentation, and then you add on really what makes integrity unique and special from an operational standpoint. Do they live in the same place? Do they live on the same platform or do you have separate platforms? I’m curious like, what does this look like? Yeah, we keep.

Casey Gaetano: [00:31:23] We keep everything on Dropbox. Yes. Shout out for Dropbox, I guess. Sure. Shout shout out for Dropbox. So we really keep everything on Dropbox in different folders and different things and almost everything. I mean, there’s a. Couple things that I keep in private drop boxes and H.R. files and stuff like that. But for the most part, any document that has to do with anything for our company, somebody could look up on their first day of work and just be like, Huh, I guess that’s the invoice that we sent to this doctor six years ago. Yeah, And it’s that.

Adam Forrand: [00:31:53] Knowledge that is absolutely critical for your future success, particularly when you think about working on your business and scaling your business. Sure. That that stays with the organization and it’s not lost with the individual as they make a transition out.

Casey Gaetano: [00:32:07] So yeah, I think that’s right. So I guess in terms of the on the business stuff, I think. I could divide it almost into like, internal strategy and external strategy. Like what? Like internal strategy is all about processes and how we move the pieces around the chessboard and who should be doing what and how we should be doing certain things and all that stuff. And then the external strategy is all about how do we present ourselves? What’s our brand? Do we do we know our brand? The doctors know our brand, Do our own employees know what our brand is, right? You know, then and obviously sales is the next step down that and just trying to understand, okay, do we want to get involved in allergy compounding? Do we not want to get involved in allergy compounding? Do we want to do fertility? Do we not want to do fertility? And if we do those things, what does it mean for the rest of the way the business works? Yeah.

Adam Forrand: [00:32:58] Moving forward.

Casey Gaetano: [00:32:59] Allergy doctors typically like typical turnaround time on a lot of this stuff in the industry is 4 to 6. 4 to 6 weeks. Sometimes in our fertility and genetics program, they want, if they call it five, they want us to ship it at 525. So you know, how do you have an organization that can handle these big batch runs for allergy on this hand? Right. But then the second a reproductive endocrinologist calls in and wants a fertility med, everybody drops what they’re doing and makes sure it gets out the door that day. Those are two conflicting things. So how do you run like processes side by side so that you can do both things or can you do both things? Should you pass on one right? Or can you do both? What what similarities do they have? What differences do they have? That’s to me that that is the essence of working on the business.

Adam Forrand: [00:33:45] Which in many cases and you know this well too, across different sectors, different verticals, that ability to be nimble and agile and serve a customer’s need and prioritizing those customers appropriately is really where the greatest challenges, right? And shifting gears and doing a fire drill, if someone calls at 5:00 and no, it’s going to hit the hit the dock by 525. Right.

Casey Gaetano: [00:34:11] I get pushback all the time from our employees like Casey. You cannot promise people that we’re going to ship things at 6:00 if they do not send it to us until 550. And my response to that is always when we made the decision to be a compounding pharmacy for genetics patients and for IVF patients, we made the decision that we will try our absolute best to do it. If we’re not, there is no doing it. There’s no for me, there is no doing fertility and genetics without the the end of the day problems and the immediate things, either you’re in or you’re out. Right? We made the decision to be in. And that means if it means we’re in, it is if it is physically possible, we are going to try to do it. And we made that decision years ago. And so that’s what we have to stick. Why? And I think it’s one of those things that employees like. It’s one of the reasons I like new employees, things like that. They’re just like, Oh, okay. And then they keep going, Yeah, Your people that come over work another jobs for ten, 20 years, that takes a little bit longer until they get the buy in and understanding of, okay, that is the way we’re going to have to do this one particular thing. Even though I understand that it makes it less efficient and I understand that it’s a pressure at the end of the day. And if we don’t double, triple, quadruple, check it real quick, it theoretically could lead to mistakes. And we understand all that stuff, but we try to put the guide rails on to respond to it because we made the decision to do it five years ago. Right. And we’re all in on it.

Adam Forrand: [00:35:33] Yep. And you’re maintaining that commitment through and through.

Casey Gaetano: [00:35:36] Correct. Awesome.

Adam Forrand: [00:35:37] So, Casey, you lead a group for us here at the Sandy Springs perimeter chamber that I it’s got many names, but I’m going to just call it a mastermind group. Sure. Because I think that’s the most accessible.

Casey Gaetano: [00:35:49] I never use the same name twice. So.

Adam Forrand: [00:35:51] Good. We’ll go with Mastermind. So you’ve got a front row seat to a lot of other business leaders who are challenged with particular aspects of their running their business, scaling their business. And so you’ve received advice and counsel from those folks. You’ve also provided that as well. As it relates to working in and on your business, what advice would you give our listeners and how to best balance that?

Casey Gaetano: [00:36:20] I guess the advice that I would give is that it is a balance. It’s never going to be all one way or all the other way. Yeah, One of the things that I think is most important for understanding your business is at least the beginning. Sometimes it’s doing your own books. Like when I talk to business owners that outsource that function from day one and didn’t didn’t happen to come out of like accounting or some other job where they had to understand how to do that and they outsource it from day one. I’m like, how could you? I don’t understand personally how you can understand your own business without doing your own books, at least for a little while. That’s fair. And so again, what my counsel be, do your own books for the rest of your life, even when it’s taking 80 hours a week just to do the books by yourself. No, but I think there’s there’s parts of it that you have to just do yourself at the beginning, even though it’s inefficient. Right? It’s the whole point is that it’s inefficient. Because you’ve got to learn it. And so again, that’s why I talk about it as like a concept of a funnel, because at the beginning you have to do everything yourself, basically. Yeah. And then you can start either outsourcing it or you start hiring for it, right? But everything at the beginning is this giant funnel.

Casey Gaetano: [00:37:30] And so you’ve got to start slowly working that funnel down in terms of what you’re going to concentrate on and what you’re going to try and either delegate or outsource. But my I guess my one piece of advice was you can’t go too hard in either directions because you do have to truly understand being in your business. Right. And I, I and I like, you know, our pharmacists that, that have that no longer work necessarily in workflow all the time. I always tell them that they’ve got to be in workflow at least once in a blue moon so that they understand they can still remember what the pharmacists are in workflow are looking at. So when they’re building the processes to help the work people, to help the people that are in workflow, they remember what workflow feels like, right? And I feel the same way for myself. Granted, not on the pharmacist side. For me, no. But still, like occasionally answering a phone call or dealing with an angry patient and understanding why they’re upset is not the worst thing to have to get your hands dirty in. Um. In order to truly understand the strategy of what you should be doing, right? So again, it’s kind of that balance. If you if you go too far out, you start to lose touch a little bit with exactly what your company is.

Adam Forrand: [00:38:37] Well and what you should be doing changes.

Casey Gaetano: [00:38:40] Yeah, right. And it doesn’t have to be the most efficient thing all the time.

Adam Forrand: [00:38:43] It does not. Not if you’ve made that commitment. Right. You’ve made that commitment to your customers, to your patients, to a community, to an organization. And then on behalf of all your employees as well, right? I think that’s right. Yeah. That’s awesome. Casey, share a little bit about where potential customers and patients might be able to find you.

Casey Gaetano: [00:39:04] Sure. So we’re we’re over at off of Dunwoody Place. So we’re North Sandy Springs. Feel free to call the pharmacy drop by the pharmacy. We do try to get to doctors in terms of of getting but if you’re a patient that that is either on compounded medication or has questions about compounded medication, please feel free to call the pharmacy. Find us on Google. Our website is mixed with integrity.com. That’s probably the best way to start. Yeah, I think that’s. That’s that’s honestly, it’s old school. It’s calling people don’t people don’t call anymore. But in our in our businesses there’s like so many exceptions and nuances and this and that and the other thing that it’s very difficult to automate down to like different things. So we just prefer people to call us and just say what their problem is and we’ll try and respond the best we can. Yeah. What’s the number? (404) 815-1610.

Adam Forrand: [00:39:54] And I can say I’ve been to your pharmacy before. The place is buzzing with phone calls. So I know they call. They do. It is old school, right? It is mixed it with integrity. Dot com is great. But when you have the question and you want to talk through it.

Casey Gaetano: [00:40:09] That’s that’s that’s definitely the way to go.

Adam Forrand: [00:40:11] That’s the best way. Casey Gaetano, owner of Integrity Compounding Pharmacy. Appreciate you being here today. Appreciate your leadership in our community as well. And thanks for these wonderful insights on how you can and should be working in and on your business.

Casey Gaetano: [00:40:29] Thanks, Adam. This was fun.

Adam Forrand: [00:40:30] I enjoyed it. Thanks, Casey. Yep.

Speaker1: [00:40:39] Broadcasting live from the Business RadioX Studios in Sandy Springs, Georgia. It’s time for in and On Business. Brought to you by the Sandy Springs perimeter chamber. For more information, go to Sandy Springs Perimeter chamber.com. Now here’s your host.