Be Creative And Flexible And Love Your Career – A PNC Classic from 2019

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Transcription PNC Podcast Episode 387

Be Creative And Flexible to Love Your Career

- A PNC Classic from 2019

John: Dr. Helen Rhodes, welcome to the PNC podcast. I'm really glad to have you here today. I always like to give my audience a little, let's say, preview as to why we're talking today. We met through a mutual friend and from what I know, you reached a point in your clinical career where you were, just needed to make a change for reasons which I think you'll describe. I thought your story sounds quite interesting and hopefully very inspiring. Why don't you describe a little bit about your background?

Dr. Helen Rhodes: Well, I did all my training in Texas. I grew up in Texas and I finished OB-GYN residency back in the early 90s, so that would be last century, I guess, technically, and was actually recruited by an academic institution here in the Houston area to do GYN only. And it was an academic position without any obstetrics, so I was pretty fortunate and it was very unique to have that opportunity right out of training, but I quickly discovered that I really wasn't ready for academic medicine.

I wasn't even 30 years old yet and so, after a couple years, I left that institution and worked in the Houston community doing full scope obstetrics and gynecology, various practice opportunities, multi-specialty group practice. I worked part-time, I worked full-time, I worked at a managed care group, and then, interestingly enough, about 10 years after doing that, I really was having difficulty with the lifestyle of obstetrics, primarily, and actually went back to the institution that I left 10 years earlier into the same position of GYN only and stayed there for almost another 10 years, but I always wanted to have my own solo practice and after my youngest finished high school, I made this big leap and left academic medicine again and started a GYN only solo private practice in a bedroom community south of Houston.

It was pretty risky to do that because it's really hard to start a private practice, especially mid-career with really no patients to follow you, starting it from the ground up, and not doing obstetrics financially, it was very challenging, so I started looking for ways to supplement my practice income, looked at clinical and non-clinical options, and did medical file review.

I actually, for a little bit of time, sold supplements in my office, did some testifying for legal cases, and got into locum tenens opportunities. Initially, just outpatient locum tenens opportunities because without doing recent labor and delivery work, I couldn't get any jobs in L&D anywhere, and there's really no retraining for obstetricians once you've stepped away from it for a couple of years. There's no way to get back into it. The American Board of OB-GYN doesn't have a formal retraining program. You really have to get lucky.

John: Helen, let me jump in there for a second. You were trying to get locums without the OB, and did you have any success at that, or was it pretty much a wash?

Dr. Helen Rhodes: I did have some success. I was able to do outpatient gen-like physicals for an underserved area in town. They weren't a federally qualified health clinic, but they were state-funded health clinics, so I was able to do that on Saturdays and some Fridays when I was not seeing patients or in the operating room.

I did that for a while, and I just got an hourly rate and saw the patients that they had scheduled. They weren't my own patients. I also was able to get an outpatient job with Texas Children's Health Plan, which is affiliated with Baylor College of Medicine, and did OB and gen, so that was good.

That way, I was starting to at least see obstetrical patients in the outpatient setting and relearn prenatal care, high-risk prenatal care, but at that point, I wasn't able to do anything in labor and delivery. I did have some success.

John: How easy is it to find locums? Is there a clearing house? Is it word of mouth? Do you just go on Google? How do you even start to look for positions like that?

Dr. Helen Rhodes: You have to throw a lot of lines in the water. You get on a lot of the recruiting sites and submit your CV, answer a lot of emails, texts, phone calls. I had a lot of dead ends because of the lack of recent labor and delivery work.

John: Okay, so that was a challenge.

Dr. Helen Rhodes: Yeah, very challenging.

John: Now, as you were going through this too, you started your practice. Was the issue in terms of the gross revenues or what have you, was it the fact that it was a startup or did you look and say, even when I'm busy, this is not going to be something that is meeting the financial levels that I think I need?

Dr. Helen Rhodes: Yeah. I think there's a lot of reasons that the revenues weren't where I wanted them to be. I had come from this academic salary and that was my benchmark. It was a pretty high benchmark because once you're in solo practice, you don't have anyone paying your benefits or contributing to your retirement or paying your liability premiums, etc., etc. That all comes out of your revenue. You can either do a couple of things.

You can see more patients because we are reimbursed per patient in this fee-for-service world of OB-GYN. We're primary care, specialty care, stuck in between. I had already lived that life of seeing lots and lots of patients and not getting to spend time with patients.

When I started my practice, it was very important to me to spend time with my patients. I wasn't seeing the volume that I was seeing before and I didn't want to see the volume I was seeing before. The overhead is higher and because I wasn't increasing my volume and doing tons and tons of surgery, my revenues were less.

John: Okay. You're looking at locums. You're trying some different things out. Take us down the next few steps in this process.

Dr. Helen Rhodes: It's an interesting story. For some reason, I wanted to go back to school and learn business. I did a hybrid program where we spent four residential sessions over an 18-month period and then did online coursework, lectures, projects. I did that between 2015 and 2017 through a business school and connected with some really innovative healthcare leaders in my class and the class ahead of me from rural Kansas. Until I met them, really my search for locums work had been confined to the state of Texas because that's where I had my license. One of the individuals that I met through the business program said, hey, we would love to have you come to Kansas.

Kansas is not that far. It's a couple hours. I ended up getting my medical license in Kansas. Well, that opportunity with my business school colleague fell through for various reasons, but another Kansas opportunity came up through one of the locums recruiters that I had been working with. This time, even though I hadn't delivered a baby in 13 years, the little hospital in the middle of Kansas said yes, and off I went. I did my first delivery in 13 years.

John: Oh, boy. Yeah. What was that like?

Dr. Helen Rhodes: I was very nervous. Very nervous. Of course, it happened at three in the morning, and I didn't have much time to get to the hospital and think about things, but that was the beginning of thinking outside the box in terms of, wow, if I can go to Kansas, I can go to other places too. I eventually got my license in New Mexico, and there's lots and lots of work in underserved rural areas of New Mexico, so one of those opportunities has actually turned into a permanent position.

John: Okay.

Dr. Helen Rhodes: Yeah.

John: So there was a locums opportunity in New Mexico?

Dr. Helen Rhodes: Yes.

John: And was it another sort of a smaller type location or?

Dr. Helen Rhodes: Yeah. It's definitely rural. It's about an hour south of Albuquerque, and the hospital is a critical access hospital, so by definition, it has less than 25 beds, but they have a very unique model for taking care of their OB-GYN patients.

There's a certified nurse midwife who lives in the town and knows all the patients on our service, and then there are four board-certified OB-GYNs. I live in Texas. Two others live in other parts of New Mexico, and the fourth actually lives near Washington, D.C. Yeah. So between the four of us and the nurse midwife, we cover the service. So I go there for just under a week, once a month. This small hospital is actually affiliated with a larger healthcare system in New Mexico, one of the bigger systems, so is able to keep things running because they they're a small hospital within a big system, so they can achieve economies of scale, et cetera, et cetera, from the business perspective.

John: Okay. Now, are you still balancing that with the other clinical activities in your private practice at home?

Dr. Helen Rhodes: I am. Because I don't do OB in my private practice, it's pretty easy for me to leave. As long as I feel like I can get all my patients seen in a timely manner here and get the surgeries done, it's really not a problem to leave and go work in New Mexico once a month. And having an electronic health record that I can take with me, essentially, as long as I have internet access, I can communicate with my patients here, check their lab results, communicate with my staff. I have two employees. Things keep running even when I'm not here. So it's wonderful.

John: That makes me think of, and I don't know if this is even doable, but would it be possible to do some kind of telehealth, telemedicine? Are there certain types of things that you could do? I've never talked to an OB about that.

Dr. Helen Rhodes: Yeah. So I've actually been talking about this with my office manager and my nurse that there are certain types of patient appointments that I think would be very amenable to the telehealth platform. It just became legal in Texas.

We really haven't had a lot going on with telemedicine until very recently. Some of the bigger hospital systems are now doing it and I'm looking to see kind of how they're doing it and to see if I can incorporate that into my practice. But I see a lot of young girls that I start on contraception and then they go off to college.

And I really like to see them two to three months into that rather than waiting for them to come home during the summer, the holidays. And so telehealth would be great because in the evenings or while I'm in New Mexico, or when I'm not seeing patients here, I could have a quick tele-visit with them or telehealth visit with them and see how they're doing. Similarly, my post-op patients, they could take a photograph of their incision and I could look at it and do a telehealth visit. Those are the two types of visits that I'm looking into for telehealth.

John: It wasn't that long ago I talked to an orthopedist and he came to realization because he was off visiting someone else. He happened to have a patient in the town who was a hundred miles away from where he did surgery. And while he was there, he just went to visit the patient to look at his wound.mAnd then when he got back, he said, this would be perfect for telemedicine. That was three or four years ago. So now that's what he does because he has such a large drawing area. He's a pediatric orthopedic surgeon. So he does a lot of his follow-up visits with telemedicine. So that'll be interesting.

I'll have to follow up with you down the road and see how that pans out. But you're doing some other things, right? Aren't you into something that is a non-clinical or it's sort of clinically related, but not patient care? Tell us about that and how that fits in.

Dr. Helen Rhodes: When I was in business school, I really had two main goals. One was to learn more about the business side of medicine and possibly go into administration. And the other was to teach others what I learned or become a consultant regarding healthcare economics, et cetera.

I found out from a friend of mine who actually, she's an OB-GYN that went back to law school about the time I went to business school. And she had told me about the plasmapheresis industry, whereby they hire physicians to be the medical directors for each of the plasma centers. So when I initially heard about that job, which was a couple of years ago, I wasn't very interested. I didn't think it was a good fit. But then after I finished my business school education, I thought, wow, this is, now I understand more about operations management, working in teams. So this might be a good fit. I ended up doing that to help supplement my income. And I really enjoyed it because it's completely different from clinical medicine. You deal with a lot of federal regulations and guidelines for the industry.

And you're dealing with a population of individuals that are extremely impoverished for the most part, don't have access to healthcare. And really your job as medical director is to make sure that the donors are eligible for plasmapheresis, that they're healthy, and also to keep the medical operations team credentialed. There's very specific credentialing that's required by the FDA and industry regulations. And you're responsible for that. And you're also responsible for medical education of the medical operations team. So it's very interesting work. Since I've gotten so busy with the work in New Mexico and other places, I've had to cut back on the medical director work. And I'm now a backup director for a couple of the centers around here.

John: Do you have a sense for how much demand there is for that kind of a position in case someone might be thinking, well, this is interesting?

Dr. Helen Rhodes: There's a lot of demand. There's several companies throughout the United States. It's not just one company. And they pay an hourly rate. The training is paid. They pay for your mileage.

The commitment is four hours a week. I know one person in our group, I believe she was a pediatric emergency room physician. She's given that up. And now she handles five centers in the Houston area. She's a medical director for five centers. But essentially, she's working five, four-hour shifts a week and making good money. And she doesn't have any overhead. She just drives from center to center and takes care of her responsibilities and has a lot of time with her family.

John: Sounds very nice.

Dr. Helen Rhodes: Yeah.

John: For you, how does that compare, let's say, to the various clinical things you're doing? I mean, just from a payment standpoint without giving necessarily an hourly rate. But I mean, when you had the time, it was definitely worthwhile doing.

Dr. Helen Rhodes: Yes. Yes. I actually first took on that position because I had a small business loan for my practice. And I had this goal of paying it back in a certain amount of time. And that's why I originally took the position. Because all the money that I was earning from being medical director went directly to the loan repayment.

But then once I paid it off, it was a nice little extra check every month. But yes, I think the compensation for that work is very fair and very comparable to what you would earn in a clinical job.

John: Without any call?

Dr. Helen Rhodes: No call. And you only work four hours a day. I mean, there's nothing else. There's only so much you can do there. Now, I don't know anyone who's doing more than a four-hour shift. I don't think they allow it. But four hours is plenty. It's a very different kind of work.

John: You have to be very focused, very meticulous in doing that?

Dr. Helen Rhodes: You have to be focused. Yeah. You're basically reporting to the center manager and to the quality department. And it is a very tightly regulated industry. As it should be.

John: Yeah. It falls under the FDA, does it? Basically, the regulations?

Dr. Helen Rhodes: Basically, the plasma that's collected is actually sent over to various centers in Europe. Depends on which company you're working for. At one point, I was working for two different companies.

And one of them had a processing plant in Spain and the other company had a processing plant in Germany. And so in Europe, the plasma is made into pharmaceutical products, which are then sold back to the hospitals here in the United States. They also make a lot of vaccines, as well as fresh frozen plasma and all the clotting factors.

John: Okay. So, it's a pharmaceutical business, definitely. Now you've kind of reached, it sounds like at least for now, a point where you seem to have a balance. You've got some stability. The private practice is pretty stable. You're thinking maybe of adding telemedicine if it works out. And you have this pretty stable situation. It used to be locums, but now you're employed or it's more of a stable situation with the New Mexico practice. And you're working with three other physicians there. So how do you feel?

Dr. Helen Rhodes: I feel great. I feel great.

John: You're still glad you left that group?

Dr. Helen Rhodes: Which one?

John: Whichever group. The original, the one 10 years later. You don't look back and go...?

Dr. Helen Rhodes: No, no. I think I love the autonomy most of all, because I'm doing exactly what I want to do. There's things obviously I can't control. I can't control what I get paid by the insurance companies for the work that I do for my patients, but there's so much that I can control. And it's very rewarding when I go to New Mexico because I deal with some very underserved women who really have limited to no access to quality care. And it's great to be a part of that team. And I get to be in the mountains once a month. I live by the shore here, live by the beach. So I get the best of both worlds. I get to travel and I love it.

John: When you go and you're in New Mexico, I'm assuming that the organization, the hospital, the clinic, whatever, and the patients are happy to see you, right? They don't take you for granted, don't yell at you because you're five minutes late or anything like that?

Dr. Helen Rhodes: No. I feel very appreciated. I actually am developing my own kind of practice within a practice there. I have patients that wait for me to come and they're my patients. And then we all take care of the obstetrical patients, but the surgery patients, I'm starting to do some surgeries there. They're very excited about that.

They've worked with me in terms of which equipment I need. And there's a general surgeon actually that comes two weeks a month. He actually lives in Florida. He was doing what I'm doing now. He had his practice in Florida and he was working at this hospital in New Mexico. And then he decided to close his practice. Basically he works two weeks a month and has two weeks a month off. And he's very happy. But yeah, I feel appreciated. I have friends there. I have an apartment there. I have a social life there. And the climate is so much better than what I have here. There's no humidity there.

John: Well, okay. What kind of advice would you have for physicians who are kind of plugging away and maybe they're unhappy or they're frustrated or they're actually burnt out or whatever?

Dr. Helen Rhodes: Yeah. I think most importantly is you just have to think outside the box and look at many, many opportunities and cast many lines in the water and expect to get a lot of no's and don't get discouraged. Cannot underestimate the power of networking and mentorship.

That's so important. To connect with another professional that's doing what you think you'd like to do and brainstorm with them. I've been doing some mentoring of individuals who are burnt out. I've been helping a couple physicians transition. We can help each other. Don't give up your licenses. You hear a lot, people step away from it for a couple of years and then they go back. I think it's wise to keep your board certifications and keep your licenses active. And for an OB-GYN, I would say don't step away from OB for too long because it's really hard to get back into it.

John: Even if you were doing, let's say, OB maybe temporarily for a few months each year somehow, or backed up other people one week, a quarter. I mean, would those things you think would keep it up enough to satisfy the hospitals?

Dr. Helen Rhodes: Yes. I think doing what I'm doing, because I'm not only going to New Mexico, I'm still doing weekend locums at other places in Kansas and Texas. And there's such a need right now, especially in OB-GYN, especially in rural areas. They don't have enough doctors and there's lots of opportunity where you could do it one weekend a month. To keep your skills up. It's very feasible.

John: Now, I'll digress for one minute on the locums. Do you find that there's much flexibility in your ability to negotiate? I mean, I've heard horror stories of someone saying, well, they're only going to pay this much and turn around and found out they would pay like almost 50% more than that if you just asked or kind of held to your guns.

Dr. Helen Rhodes: Yes. We are terrible negotiators as physicians. It's very important to learn that you are really in the driver's seat. You are providing the service that they need and want. So, don't be afraid to negotiate for what you want.

John: Okay, good. Good. That's what I have heard, but I've never done locums, so I don't know how aggressive one can get. But if you have information, if you've done it at other places, at least it gives you some benchmark. But if you're going in for the first time, you probably have no idea.

Dr. Helen Rhodes: And it's best if you can negotiate directly with the hospital system, if possible, and not through a recruiter. That's pretty difficult to do because of liability. Usually the recruiting company is going to pay your liability, which for OB is kind of high. It is high. But if you can get the middleman out of it and directly negotiate with the hospital, you're going to get a much higher rate of pay.

John: Awesome. That's good to know. Well, this has been very inspiring and very interesting and helpful for everybody. And you talked about you mentoring a few people. So if somebody would like to reach out to you just for a question or something, shall we use the LinkedIn? I know you're on LinkedIn.

Dr. Helen Rhodes: LinkedIn is great. Or my email address is hrhoads62@att.net. And I'm happy to communicate with people who are interested in my story and how I can help them.

John: I think especially people in your specialty everyone kind of naturally wants to hear it from someone that has had a similar training and background. So it's good to if there's someone who's doing OB out there that might be struggling, then hey, why not reach out? Like you said, networking is awesome. Mentors are great.

Dr. Helen Rhodes: Absolutely.

John: All right, Helen. Well, I really appreciate the time that we spent together today. And we'll have to keep in touch. And you can let us know if you ever get that telemedicine going or anything new that comes in with your practice. But thanks again so much for being here with us today.

Dr. Helen Rhodes: Thank you very much.

John: Hey, you're welcome. Bye-bye.

Dr. Helen Rhodes: Bye.

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