Presentation by Dr. Nerissa Kreher – 349

In today's episode, we present an excerpt from Dr. Nerissa Kreher's masterclass on securing the best biopharma positions from the 2023 Nonclinical Career Summit.

Dr. Nerissa Kreher is a pediatric endocrinologist and the Chief Medical Officer at a biotech company.  She received her medical degree from East Carolina University. She then completed a pediatric residency and pediatric endocrinology fellowship at Indiana University School of Medicine.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.” If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat. Or check out her website at allthingswriting.com/resilience-coaching.

Unveiling New Horizons: Career Transitions in the Biopharma Industry

Dr. Kreher's journey inspires physicians to contemplate career transitions beyond traditional clinical practice. With over 17 years of experience in the biopharma industry, she offers invaluable insights into the diverse pathways available to medical professionals seeking new challenges and opportunities.

Through her narrative, Dr. Kreher illuminates how to leverage clinical expertise in roles ranging from clinical development to patient safety and medical affairs.

Decoding the Biopharma Realm: Contrasts and Considerations

Nerissa highlights the contrasting dynamics between clinical practice and the biopharma industry. She explores the differing hierarchies, teamwork dynamics, and work flexibility, offering her insights for physicians contemplating a career transition to the pharma industry.

These insights will help listeners prepare for their transition from a frustrated clinician to a fulfilling biopharma career.

Summary

Dr. Nerissa Kreher describes how to navigate from clinical medicine to the biopharma industry effectively. Gain insights into diverse career pathways beyond traditional clinical practice, from clinical development to patient safety and medical affairs. Explore new horizons with invaluable guidance from Dr. Kreher. 

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Nerissa Kreher's Website [IndustryMDCoach]
• Landing Your First Pharma Industry Job May Be Easier Than You Think – 311
• Research and Development in Nonclinical Pharma Careers
• Medical Science Liaison Is Still a Fantastic Pharma Job – 261
• Highlight These 5 Experiences to Land Your First Pharma Job – 242
• How Does a Physician Land a Pharma Clinical Development Job? – 214
• Use These Simple Tactics to Land a Fantastic First Pharma Job – 209
• How to Find a Job in Pharma That You Love – 184
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 349

The Best Biopharma Positions For Motivated Practicing Physicians

- Lecture by Dr. Nerissa Kreher

Dr. Nerissa Kreher: I'm really excited to be here, John and Tom, thank you so much for this amazing forum. I've enjoyed participating over the last couple of nights and looking forward to tomorrow night as well. Thanks for the opportunity. I'll be speaking today about career opportunities for physicians in the biopharma industry. And I'll get to a little bit of lingo in just a second.

A little bit of background on me. I have a business called The Pharma IndustryMDCoach, and I help physicians explore and ultimately find a fulfilling career in the biopharma industry and use a step-by-step guide of taking you through the process of a resume, LinkedIn, interviewing, negotiating.

But in addition, I'm a certified life coach. And so I also apply the principles of life coaching to help people dispel imposter phenomenon, lack of confidence, self-doubt. And I'll raise some of those things throughout our conversation tonight.

John asked us to start by giving a little bit of our background. I thought it would be fun to share my story because people often ask, "How did I end up transitioning?" And I have to tell you that it was a bit fortuitous actually, but I'm very grateful that it happened. And I'm 17 years now in the biotech industry.

Of course, medical school, residency, fellowship, I'm a pediatric endocrinologist by training. I got married during medical school, had kids during residency and fellowship. And my husband, he was a year behind me, med-peds, and had practiced, but then decided he wanted to go back and do a sports medicine fellowship. We found ourselves in the situation of this is a match for sports medicine, and I was looking for a real job. And so, we ended up looking in three different cities, obviously ones with large academic centers where I could have a pediatric endocrine job.

I was on a clinical research path. I got my master's in clinical research during my fellowship and really enjoyed seeing my clinical research patients, but I never really enjoyed being in clinic day in and day out. I really was on that clinical research track and that's where my passion was.

Through this, I thought I had a job waiting for me at Mass General Hospital in clinical research. When my husband matched in sports medicine there, I called the program director, division director, and the first words out of her mouth were, "Oh no." That obviously was a bit stressful. They offered me a job, ultimately a job seeing patients 80% of the time.

I'm very grateful that I at least knew that's really not what I wanted and didn't just take the job out of feeling helpless and hopeless. I interviewed around the East Coast as far as Rhode Island and Dartmouth, New Hampshire, still didn't find what I was looking for. And a sales representative from Serono asked if I would give her my resume so she could share it at her company. And some of you may know or not, Serono has a recombinant human growth hormone, which obviously is a pedendo I'm very familiar with.

That landed me my first role in the biotech industry as the medical director in medical affairs. And I truly loved it from day one. I think it really pulled from that forever learner phenotype that many physicians have. I was exposed to so many new things, but also I was an expert in pediatric endocrinology. And so I was able to teach people, but I was also learning from others at the same time.

I'm now 17 years in, I've worked at seven different companies, medical affairs, as well as clinical development. I'm in my third chief medical officer role. I've had the opportunity of doing two public offerings, taking private companies public, and I serve on the board of director of a public biotech company as well.

COVID hit us, I felt like very, very dire straits in the early parts of COVID. I couldn't go and do a shift in an ER. And so my way of helping was to try to start helping some of my colleagues that needed to transition. And that's where the IndustryMDCoach was born from. So, that's my story. You can probably tell I have a lot of energy about our industry and really enjoy helping people understand it. I look forward to any questions at the end of the talk.

I like to compare and contrast a little bit between clinical and the biotech and pharma industry. Before I do that, I will use biotech and pharma and biopharma very interchangeably. It used to be that biotech technically meant something that we made in cells. For example, recombinant human growth hormone is manufactured in live cells. And pharma meant things that are synthetically made.

It's a big mishmash now. So many, many companies are biopharma companies because they do both. Some people actually now sort of refer to pharma as bigger companies and biotech as smaller companies. I think biopharma encapsules our whole industry. But if I use one or the other, I probably really mean biopharma.

In the clinical setting, and I fully admit there are some generalities here, but the physician is pretty high on the totem pole from a decision-making standpoint. I recognize insurance, admin, things also have an impact on that decision-making, but they are relatively high on the totem pole.

In the biotech and pharma industry, the physician may not be the ultimate decision-maker. Even as the chief medical officer, meaning I'm like the top medical officer at the company, I'm very rarely making decisions in a vacuum. I have my CEO, I have my chief operating officer, my chief financial officer. And so, decisions are being made in cross-functional teams all the time. That's one big difference that I think a physician really has to think about as they consider, "Is biotech and pharma the right thing for me?"

Obviously, clinical individual patient care, biopharma, we're caring for groups of patients. Now I actually don't even have an active medical license anymore. So I'm not caring for them, meaning making medical decisions for them, but I'm doing things that impact their medical journey overall. And I work in the rare disease space and I'm also understanding that medical journey and learning from patients. I do have the opportunity to be at patient meetings, have patients come to our office and speak to us, but I'm not doing that day-to-day medical care.

I mentioned cross-functional teamwork. Clearly physicians are working cross-functionally every day, with nurses, with physical therapists, with occupational therapists, we can name lots of them, pharmacists. But they all are generally healthcare providers, or at least in that healthcare provider universe. Whereas the cross-functional teamwork we do in the biopharma industry is much more highly varied. And so, for example, a program team might have a person from manufacturing, a person from regulatory, a person from clinical, an operations person, a program lead who's in charge of timelines, deliverables, a finance person.

And so, we're really working with people who speak very different languages than us. And one of the things you have to learn when you come into the industry are some of these languages so that you can actually communicate effectively with one another. But again, as I said, that was one of the things that I found to be really fun because I wanted to learn new things.

In clinical, the day can be very highly structured. As many of you know, there may be a patient waiting for you tomorrow at 08:30 and you know that they're supposed to be in the room. For those of us in the biopharma industry, I don't have a patient waiting for me. I may very well have an 08:30 in the morning meeting, but if my child is sick and vomiting, that meeting is a very different pressure than the patient waiting in the room. And so, there is more flexibility overall in the biopharma industry.

Now, lots of caveats. You could have a manager that was a dictator-style manager and your flexibility is out the window. But just in generalities, not having sort of that scheduled patient waiting for you makes that very different.

We have key indicators of success. Obviously, we're trying to make bonuses. We're trying to hit our timelines and our goals. Our key indicators of success vary with the function and with seniority. And so typically, the company sets their goals and they filter down through the organization. Whereas in clinical, maybe if you're in academics, it's related to grants or publications, then obviously RVUs are a major measure as well.

Funding pressures might be high. That, of course, might apply more towards the academic group. But in biopharma, we don't have funding pressures. I don't need to get a grant to do the research. The company has a budget to support that.

Those are some compare and contrasts. One, not better than the other, but I like to share them with people so that if they're thinking about a transition, they can start to think about, "Would I like that? Would that be concerning to me? Does that sound really exciting to me?"

I mentioned learning a new language. So I'll move past that one. But I really do encourage people to think about what kinds of learners are they? Do they enjoy new challenges? Do they enjoy or maybe even, sometimes I feel like I get bored if I'm doing the same thing day in and day out. And so this ability to interact with different people helps with that issue of not getting bored.

Again, you're typically not going to be the decision maker. And so when I'm working with a physician that wants to transition, there's this balance of humility and confidence that you have to strike during the interview process. People have stereotypes about doctors. And I think many of us would laugh at the stereotype because we know that for most of us it's not true, but people do think that doctors are know-it-alls. And so when you're looking at being on a cross-functional team, people don't want to work with know-it-alls. So you're balancing that in the interview process, but you also have to balance being confident and showing that you can do this job.

I think it's a lot of fun. One of the perks in my mind, I love to travel and I've had the chance to literally see the world. I've been to Japan, to the country of Georgia, Australia, Europe. Now, some people would say I have no interest in travel, and that's fine too, because there are roles in the pharma industry that have very little travel for physicians too. But for me, this opportunity to really see the world has been great.

I have amazing colleagues. I'm still in touch with people from that first Serono job. I was just at a networking event tonight. And the six degrees of separation, it's way less than that. This industry, people move roles, move companies. And so, you really have an opportunity to meet some really cool people.

And it can be really stressful. We still have timelines. We still have expectations. There are weekends that I'm working because I'm at a conference. There are evenings that I'm working because maybe I'm running a clinical trial in Australia and the times are different. I had a boss one time who said, people think we sit around and drink coffee and eat bonbons. It's not drinking coffee and eating bonbons. But the stress is something in my mind, I have more control over when I do the work. I still have to do the work, but the "when" there's not sort of it waiting for me in a patient room.

So, what are the main roles for physicians in the pharma industry? I break it down into three. These are the three entry level roles. Now, once you get in, really the sky's the limit. Physicians can be CEOs. Physicians can lead business development functions. There are all kinds of opportunities, but those are rare until you get your foot in the door, unless you have some kind of other specialty training like if you were maybe went through a MBA program and came right out into pharma, there might be some other opportunities.

But tonight we'll focus on the three main ones, clinical development, patient safety or pharmacovigilance. And at some companies, they call this drug safety. A lot of names for the same thing. And medical affairs.

In clinical development, the main roles that you're thinking about as you're looking for jobs, clinical scientists and clinical development physician, which is the director level or senior director level. And it goes up from there. Most physicians that are entering are entering in the associate director or director level. That's where I'm pointing most people, and then you can rise from there.

Pharmacovigilance, drug safety, patient safety. Same thing. You're sort of director level in pharmacovigilance. And then medical affairs, again, same thing for the physicians, medical affairs director. And then there's also another thing that many of you have heard of called a medical science liaison. I'm not going to spend much time on that tonight because we have another person that's going to spend a whole lecture on MSLs and she's the right person to do it because she's been an MSL. I've never been an MSL. And so I'm really looking forward to her talk as well.

As we move through those, I'll talk about clinical development first. Clinical development involves all aspects of studying an investigational drug product in humans. So we refer to early phase trials as phase one and phase two and late phase trials as phase three and phase four.

So if you think way, way, way back sometime, probably in medical school, you might've learned about this in one of your courses, but phase one trials are the initial safety trials. These are the first time we're putting drugs into humans. It usually in larger drug populations is in healthy volunteers. In the rare disease world in oncology, it's often patients that we're doing these safety studies in.

Phase two is early proof of concept. So you're still looking at safety. We're always looking at safety, but you're starting to look at proof of concept efficacy. Phase three studies typically are the large phase three. They're randomized double-blind placebo controlled studies that we use for registration or approval of a drug with regulatory agencies.

And then phase four typically is post-marketing. After a drug is approved, companies still are running trials to either follow long-term efficacy or follow long-term safety. And we refer to those as phase four.

That gives you a sense of the sort of large bucket of what clinical development is, but that doesn't really answer your questions, I'm guessing. So, let's dive a little deeper. The clinical development physician at the, again, associate director, director level, when they're coming into pharma, they're going to be involved in clinical development strategy and planning.

We're thinking about not just what does one trial look like, but what does it take to develop the drug all the way from putting it into the first human to getting it approved, whether it's with FDA or EMA, which is the European FDA or the Japanese or the Chinese or whatever it might be, whatever regulatory agency. You're thinking about the whole program.

More detailed responsibilities might include protocol design, where we're focused as the physicians on what are the appropriate inclusion, exclusion criteria, endpoints, safety monitoring. Maybe there's been a safety signal in the tox studies, you need to pull that into the protocol so you can monitor it in humans.

Another big regulatory document called the investigator's brochure, the physician's going to have a lot to say about what's in that document. And then of course, as you generate data, you've got data analysis, presenting data at scientific conferences, highly engaged in regulatory conversations. Going and talking to FDA, going and talking to MHRA in the UK.

Engaging with thought leaders or key opinion leaders, KOLs, to get their input. So I'm a pediatric endocrinologist and I work in the area of neuromuscular disease right now. So I don't know everything about neuromuscular. I need to go and ask the people that do. And so those are my thought leaders or KOLs.

And then I'm interacting with people like clinical operations. Those are the people that actually execute the trials. Regulatory, patient safety, patient advocacy. Again, those cross-functional team members.

I mentioned some of the titles already. Some of the transferable skills would be clinical experience, clinical trial experience. But here it doesn't have to be that you were the PI on a phase three pharma-sponsored randomized double-blind placebo-controlled study. It can be that you participated in research and that can be retrospective as well. Data analysis, publications.

Without clinical research experience, I typically would say to people, clinical development will be the hardest place to enter. But if you have research experience, which many of you do, then there are opportunities to come in through clinical development.

Moving to pharmacovigilance, again, drug or patient safety. This involves all things safety data. Those physicians are really not thinking about the efficacy of the drug. They are focused on safety and they have to understand the whole safety package around the drug from when it was first put into cells and into animals all the way through.

They're focusing on understanding all the available data and trying to assign whether or not there's relatability to a side effect to the drug, but maybe it's related just to the disease that we're trying to treat. And that's where the clinical knowledge comes into the patient safety role.

They have significant interactions with clinical development, with regulatory. I think I had no idea coming into the industry how much safety data we have to send to agencies like the FDA every, not even just year, but there are reports that are required by law that go in and these safety physicians are highly involved in those.

Some of the titles, associate medical director, medical director. And transferable skills here, your clinical experience. You're the one that understands pharmacology. You're the one that understands the actual clinical disease and that understanding is what you bring to the table for a safety role.

Clinical trial experience is a plus, but not a necessity. And if you have any experience as a principal investigator, that's PI or sub investigator where you've had to report safety data, again, that's a plus as well, because you understand the reporting process, but that's something that you can learn in the job. It's really that clinical experience that comes as the transferable skill.

And then moving to medical affairs. I actually find medical affairs to be the more difficult of all three to explain to people, because if I talk to you about a clinical trial protocol, most people can get that safety, but medical affairs is a bit nebulous. The definition is the external scientific medical arm that takes clinical or medical information from the company to external stakeholders, such as those key opinion leaders and patient groups, even more importantly these days. They share that information and they bring information back into the company for us to integrate into our development.

Medical affairs is engaged in the scientific exchange of information with external stakeholders. Those stakeholders might be, as I've said, thought leaders, but healthcare providers generally. It doesn't have to be Professor Smith, who's the best neuromuscular doctor in the whole of the United States. Yes, Dr. Smith is probably important, but the doctors who are treating the neuromuscular patients day in and day out are also very important to me. And I'm using neuromuscular as an example, it could be endocrine, it could be cardiovascular. But getting that information, what do they need from drugs? What is an unmet need? What is not being met appropriately? And again, patients and patient family input as well.

They're sharing that scientific and clinical knowledge and they're gathering that scientific and clinical knowledge. They also are very engaged in teaching. Oftentimes, I'm asked to give a lecture to a group of laboratory colleagues who they understand what they're doing at the bench, but they might not understand the disease they're actually working on and helping them understand it and talking to them about what happens to the patient helps them really understand why they come to work every day. So there's a lot of teaching involved in med affairs.

And you're interacting with a lot of people, clinical, but here may be more commercial colleagues and also regulatory because we are a highly regulated industry and anything we take outside, we have to get approval to do so. Regulatory is an important part as well.

Similar titles, again, I'm going to leave medical science liaisons for tomorrow night, but associate medical director, medical director and transferable skills here, again, that clinical experience. And if you have experience with data analysis, with publications, that can be a really nice addition as well, but again, not absolutely necessary.

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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

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The post The Best Biopharma Positions For Motivated Practicing Physicians appeared first on NonClinical Physicians.

The Second Annual Summit is Here – 348

In today's episode, John provides an overview of this year's Summit designed to make your clinical practice great or move on to a better alternative.

With a lineup of expert speakers and a comprehensive agenda, the Summit aims to equip attendees with actionable strategies for improving job satisfaction and exploring nonclinical opportunities.

The second annual Nonclinical Career Summit runs this week. It’s not entirely nonclinical in its scope, however. We have several presentations about starting and running a cash-based private practice. It features twelve experts who share inspirational messages and valuable know-how live over three nights.

It's called Clinical Practice: Make It Great or Move On

And beyond building your cash-based practice, our speakers will show you how to create an asset that can be sold later. Other experts will discuss MedSpas, Infusion Lounges, and other cash-only businesses, using Real Estate to diversify your income and assets, and several nonclinical side gigs including Expert Witness and Medical-Legal Prelitigation Consulting, Medical Affairs Regulatory Consulting, and remote SSDI Application Reviewer.

To learn more check it out at nonclinicalcareersummit.com. Remember that there is NO cost to attend the live event. And if you can’t participate in the Summit, you can purchase the All Access Pass videos (only $39 until April 16, 2024, when the price increases to $79).

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Trends in Addressing Physician Burnout

Physicians have faced increasing stress and burnout in recent years due to corporate employment structures in the healthcare industry. There are several basic approaches to preventing these common consequences of clinical practice.

1. Aggressive Contract Negotiation: Physicians are placing a greater emphasis on negotiating employment contracts to safeguard against burnout inherent in corporate settings. While not discussed extensively in the summit, this strategy is crucial for those considering employment.
2. Identifying Root Causes of Dissatisfaction: Physicians are focusing on identifying and addressing the underlying causes of dissatisfaction, whether it's related to the nature of their vocation, organizational policies, or interpersonal dynamics. Analyzing these factors allows for targeted solutions to alleviate stress and improve job satisfaction.

Highlights of the NonClinical Career Summit

The Nonclinical Career Summit starting on April 16th features a lineup of expert speakers covering various aspects of nonclinical career options for physicians. Here's a sneak peek at what attendees can expect:

1. Speaker Sessions Overview: The Summit will host twelve live presentations, spanning topics from evaluating the need to leave clinical medicine to exploring diverse career paths outside traditional practice settings. Each session offers actionable insights and practical advice tailored to physicians and other clinicians seeking alternative career paths.
2. Logistics and Registration Details: The Summit will run over three consecutive evenings, starting on April 16th, with sessions starting at 7 p.m. Eastern Time. Live attendance is free, but registration is required to access the sessions. Attendees can opt for the All Access Pass for $39, providing access to session recordings and bonuses.

Summary

This week's podcast previews the 2nd Annual Nonclinical Summit featuring 12 expert speakers addressing ways to create a clinical practice outside of the corporate style of healthcare and nonclinical career options. Attendees are encouraged to register early to secure their spot and gain access to valuable resources aimed at supporting career transitions and enhancing job satisfaction.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit
• Information about the Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Episode 348 Transcript

Over the past few years, I've noticed that there is a backlash to the increasing stress and burnout in physicians resulting from employment by large corporations. It seems like the burnout's getting worse and it's related to being employed, losing their autonomy, and really working in that sort of healthcare industrial complex, seeing as many patients as you can in every hour. So in response to that, I think physicians have begun to implement various strategies to prevent or address the burnout, the stress, and the dissatisfaction that's coming.

So these are some of the four trends that I have seen. It's not everything, but I see these as something that's getting more and more common. So first is a bigger emphasis on aggressively negotiating employment contracts.

After all, if you understand that employment leads to dissatisfaction and burnout, and maybe if you've been through it once already, to some extent, you should be able to address the cause of that burnout by building safeguards into your contract. We won't be addressing that in this summit, but it is something I've noticed, and you can take a listen to my interview with Ethan Encana, who's an MBA slash JD, which was posted in February 13th of this year. So if you listen to that, we'll be talking a lot about trying to protect yourself from the things that cause your burnout in your contracts, if you decide to go with the employment route.

Now let's move on to the next one, which is more in keeping with what I want to talk about today. And that is a big thing that physicians are focusing on now, and people are teaching about is finding, identifying, and somehow preventing the root causes of your dissatisfaction and addressing it in new ways. So is it your vocation itself? Is it the practice of medicine? Or is it the organization you're working for and their policies and procedures? Maybe they don't staff properly.

Is it the boss that you report to that's causing your stress and anxiety? Sometimes a fierce conversation can solve the problem. Sometimes moving to a different clinic or hospital will work, but you need to spend the time really analyzing what's, what, what it is about the work that's making things worse. And is it something that you can resolve either in the current situation or at a future one? So that's something we don't talk a lot about on the podcast, although I have had one of our summit speakers, Dyke Drummond, on the podcast to talk about that, but that was several years ago.

Number three is the physicians are implementing new or updated practice models that put more control in the physician's hands. Things such as direct primary care, concierge medicine, and other forms of cash only medical businesses. And this can solve the problem in two ways.

Number one, a lot of times doing that requires you to be in your own practice. So you're starting your own business. So you're not working for someone.

Doesn't mean it's not busy. Doesn't mean it's not challenging, but now you have that autonomy and you're in control. And the other reason is that it's oftentimes the insurance companies, which are driving this whole approach to medicine, where you've got to see as many patients as possible, because they have certain schedules, payment schedules that are difficult to, you know, earn a living on.

And a lot of the drive to see a lot of patients is because of either Medicare and counting it worked RVUs or trying to see so many patients an hour. And that can be overcome by starting your own business and taking cash. And you figure it out in that setting.

Since you don't have to hire two or three people per physician to do the billing, you can cut costs in that way and you can generate income. So it's another thing that I see growing in the past two or three to five years, even. And then the other one is just finding a part-time job.

It's something you can do on the side because you can then either cut your clinical back to part-time also. And then you get to do two different types of jobs. One, a clinical, one, a non-clinical.

You can find, you know, you feel like you're seeing a little more variety of things. You have better hourly compensation sometimes with the non-clinical side, especially those we're going to be teaching at the summit. And again, if it involves starting something like either a practice that just doesn't bill insurance or a med spa or an infusion lounge or a weight loss clinic, you're still at the end of that able to sell it.

And that's a big asset that can really be a big chunk of your retirement and really builds to what I would call it through that process, some career diversity. The other thing that's nice about doing something like one of these side gigs or side jobs is that they can grow to be a little more part of your week as you retire from clinical, let's say, as you get older. The other is it's protecting you so that if your clinical job, which may depend on employment by a hospital or part of a group, that would be protected.

That gives you that leverage, that independence that you otherwise wouldn't have if someone decides to fire you. Okay. So that's why, because of those last three issues that I've been noticing, Tom and I both, that's why we're calling this year's summit clinical practice, make it great or move on.

So there are ways to improve your practice as it is, where it is, or ways to improve it by moving and doing other things. And there are ways to make it better by splitting it with another non-clinical career. And so that's what we're talking about at the summit this year.

And I think it's very apropos. And the tagline is recognize dysfunction, fix it and protect yourself or seek better opportunities. So you can see, as I go through what we're covering during the summit, it kind of brings all of those in and those kinds of terms will probably make better sense to you.

So let's get into the specifics of this year's summit. Last year, we were, just like last year's summit, we're holding it on three consecutive evenings, starting the day after this episode, day or two after this episode is released. I might be releasing it a little early to give people a chance to go through this before the summit actually starts.

And we're doing it that way in the evenings live to enable as many clinicians to attend the free event. So as many people can come for free, making it because we know that Tuesday, Wednesday, Thursday evenings are the best time. If we do it during the day or on a weekend, people usually cannot even come for one or two of the hours of presentations.

But by doing it in evenings and doing it live at night, people can carve out some time and maybe at least watch one or two or three of the sessions each night. Now it starts on April 16th at 7 p.m. Eastern time with four live presentations at the top of each hour. They'll end 50 minutes later, followed by a 10-minute break.

And each presentation includes a live Q&A during the last 10 or 15 minutes. It continues on Wednesday, April 17th and Thursday, April 18th, obviously each night starting again at 7 p.m. Eastern. We're holding it on a typical Zoom meeting platform that most of you are very familiar with.

Questions will be submitted using the chat. It could get a little bit confusing if you got a we're going to use the chat and either myself or Tom Davis will curate the questions. You know, sometimes we get two or three that are very much similar and we'll kind of bunch those together.

But that way we can spend 10 minutes at least getting, you know, answers to really the burning questions that come up during the presentation. I think I mentioned earlier, live attendance is absolutely free, but you have to register in advance to attend. That's the only way we can get you the link to attend.

So you just sign up on the link that I'll give you in a minute. And once you're registered, you can come and attend as many or as few sessions as you like. To save your spot, you're encouraged to register using the link that one of our speakers may have sent you.

You know, you might be watching this, but maybe you're already a student of Dr. Drummond's or Dr. Unachukwu or anybody that's helping us here, which I'll be going through in a minute. And you definitely can use their link and then they get credit. If it's easier or if you don't have any link from anybody else, then you should just go to nonclinicalcareersummit.com and you'll be given an option to sign up for the live free event.

And that's also the same link for purchasing the All Access Pass, because we understand that not everybody can attend all the live sessions. So we're making the recordings available for a very low price. That's just $39.

And given all the work that goes into putting this together, that's pretty darn reasonable. Now it does increase on the day that the summit starts. On Thursday morning, the price goes up to $79.

I'm sorry, not Thursday morning, on Tuesday morning, when the summit is starting later that day. But in the morning, it jumps to $79. That's on April 16th.

So if you want to get that really best price, you should sign up for the All Access Pass by Monday, April 15th. And again, it's $39. So you have to get that registration in by midnight on that date.

And again, it's also available at nonclinicalcareersummit.com or by using any speakers affiliate link if they're sending those out to you. All right, well, let's get into the details about the speakers and the lectures. Basically, like I said, we have four presentations per evening.

They're all live except one is being recorded ahead of time because the speaker is actually not available during the summit. But we didn't want to not include him in this thing. So let's just start with the first one.

And I'm going to say that these are not in the order in which they're being presented, but kind of in the order that they flow in my mind in terms of addressing the main thing we're trying to do for the summit. So for example, Dyke Drummond, Dr. Dyke Drummond, very well known. HappyMD is what he's known for.

He's got a podcast. He's been doing this a long time. He's coached thousands of physicians.

And he's going to be speaking on Tuesday night, the first night. And he's going to be answering this question. Do you really need to leave clinical medicine or is it just the job? And the official title, is it just a shit job or boss you want to escape? So really, it's not necessarily clinical medicine or clinical nursing or other clinical specialties that you're working in.

It's oftentimes other things that lead to the dissatisfaction and the burnout, the anxiety, things like that. So he's going to take that question head on. And how do you determine if this is really you should leave medicine or whether you should stick with it, but resolve the problem in a variety of ways.

And some of the ways he's going to talk about is just how you take control of what you're doing, listing the alternative practice models that might solve the problem. And if it is time to leave, let's put out that ideal job description process. So you can assess when you're going somewhere else, is it likely to be a better situation? So the next speaker I want to talk about is Mike Wu Ming, a very good friend of my podcast and myself, and he's written a book.

And he's going to build on what Dyke is telling us from the standpoint of what his experience has been with owning cash-based medical clinics. Okay, so it's still a practice. It's a medical clinic.

And he just describes sort of the mindset changes you have to go through to make this happen. He'll list the four or five financial levels of a physician, what that means, what it means to be a CEO, not only of your business, but of your life. He'll talk about ways to provide medical services outside the insurance industrial complex, if you want to call it that.

Let's see, he'll compare different types of cash-based medical clinics and where he sees future growth. All right, the third one, again, an expert on business in general, Dr. Una, Dr. Nneka Unachukwu. She goes by Dr. Una.

She has one or two podcasts. She's coaching a lot of physicians, and she's got many courses. And she's an expert and does a lot of speaking about creating a successful business.

In her case, I think is a good mix of people she's worked with who have created healthcare businesses, not necessarily a medical practice. Some have created different medical practices. And so she's going to talk about the business practices you must adopt to be successful, to get into a little bit about the importance of branding and marketing.

And again, she likes to focus, and I think she'll touch on this as well, how to build a practice or a business or both that has value and then eventually sell that business for cash out at the end, which again, I've mentioned earlier, is a great way to help segue into your retirement. And I've got just a hint of this because I'm currently in the process of helping my wife sell her own business, which she's been running for 15 years. And so we're going to just find out what it's worth at this point.

And it wasn't really something that we dwelled on up until the last couple of years. And I guess I'd mentioned now that if you do build a business of any sort, you should really always try to think of the eventual selling of that business because we all eventually go away. And even if it means turning it over to a partner in a medical practice, how does it happen? What's the value? Thinking about those things.

So those are the kinds of things that Dr. Una are going to be talking about. Then to kind of round that out and from another perspective, Joe McMenamin, who just was on my podcast, I think last week, but yeah, and he's going to be talking about corporate entities, meaning, you know, LLCs, corporations, things, how to create a legal situation for your business that makes it safe, protects you financially, keeps the tax concerns in mind. He's also going to touch a little bit on contract negotiations or starting a new business, other things to consider besides just the corporate structure.

And he'll be comparing those different legal entities that can help make your business successful. So the next is we're going to get even right into the nitty gritty of some of these cash-based businesses. See now a med spa, many physicians are familiar with, I wouldn't call that a medical practice.

And I don't think you need a license to run a med spa, although it helps if you're a medical director, if you're doing procedures that obviously are licensed and you have insurance for that. Now practice insurance, but she's going to talk about this. I believe she owned her med spa for 15 years.

She started it from the ground up. She grew it, she marketed it, she branded it and she sold it. And they happened not too long ago.

And she actually was able to segue into staying on as a part-time medical director. And so it really worked out well. She's very happy with how things went.

And again, I don't think she was thinking about the sale of it when she started it, you know, 10 or 15 years ago, but it worked out well for her. So she's going to share some of her experiences with that. Next two guests, our speakers are Jennifer Allen and Kimberly Lowe.

Now they're actually each doing an individual presentation because Jennifer is a physician and Kim is a nurse. They're going to discuss their particular experiences and reasons for going into starting an infusion lounge or an infusion center. And both of them will spend a little bit of time talking about what the heck is an infusion lounge.

And it turns out it can be a lot of different things. And let's see for Jennifer, she's going to be focusing too on the basic services they usually provide and how hers is different and who's sort of best qualified, or let's say has the best background and personality to do something like this. And a little bit about the first three steps, prepare to open your own infusion lounge if you decide to do that.

Now during Kim's session, and Jennifer's I think is on the first day, Kim's is on the third day. Again, she's going to tell you why she thinks it's a great investment and describe how the partnership model, you know, is working for them, for her in particular. She's going to hopefully mention some of the other businesses that nurses might be able to get into in healthcare that, you know, not everything is open to a nurse, you know, medical practice per se isn't.

But even in some places as an NP or an APN, you can do something like that. But she's going to talk about, you know, nurses and kind of side businesses that they might be doing that are similar to what she's doing. And she might end there with three mistakes that you should avoid when starting an infusion lounge.

Well, that brings us up to Paul Hercock. He's been on the podcast twice. He's from the UK.

And he created, well, he has a business that uses medical regulatory consultants or medical affairs, regulatory consultants to help meet the needs of the MDR regulations, medical device regulations in the UK and in the EU. Paul is a physician and he's been working in this field for a long time. And so he started hiring people to do this for him, for his business, which is called Mantra Systems, I believe, Mantra Systems.

And then because he was having difficulty finding people, he created a program to teach people how to become medical regulatory affairs consultants. So that's what he's talking about. And I think it's going to be very interesting.

You'll be working remotely for companies that are mostly in the UK and the EU, but you can work from the United States. In fact, we have a lot of people that contact me that are from the EU. You know, they maybe have traveled, they've immigrated to Europe and then they decided to come to the US and they may have a degree from somewhere in Europe, UK, France, you name it.

And there's no reason why they can't continue to do work back there remotely because things are just so easy to do in that way these days. And in fact, Paul told me that they often look to hire American physicians to do this because they have a lot more experience in dealing with the FDA. The MDR regulations are actually relatively new in Europe and the UK.

So that's going to be an interesting one. Very useful, very practical. Then Dr. Armin Feldman is going to come on.

He's been on the podcast a couple of times and he's going to tell us all about medical legal pre-litigation, pre-trial consulting. And I've discussed this before, but it's an awesome side hustle. Don't have to be licensed to do it, but you definitely have to have a medical background.

And he's going to explain exactly how that works, why there's a growing need for the service and how to get the necessary skills to do it. That brings us to Gretchen Green, who's pretty well known for teaching hundreds of physicians, how to become expert witness consultants. She's run her course nine or 10 times.

And so she's going to give us a quick overview of how to become an expert witness, how to build the business side of that, what to do, what not to do, what it entails. And so this is going to be really interesting and an overview for what she does. And then the last one is Tom Davis, known to many of you, I hope, as my past business partner in Newscript, which we've closed down back a few months ago.

But he's here helping with the summit. And he's been involved with companies that provide social security disability reviewers. And it's something that I didn't quite understand or wasn't well aware of.

I'm definitely aware of an independent medical examiner, but there are also other layers of the process of becoming, let's say, qualified for disability payments from social security. And it's a very niche area, but you can definitely get a remote position as a social security disability application reviewer. And it really piqued my interest.

I want to learn more about that. And so this is something that almost any physician can do. I believe they need to be licensed to start out, but I'm not sure you have to remain licensed.

And there are full-time jobs available as well as some part-time jobs, from what I hear. So I'm really interested in hearing Tom describe exactly what that entails and who's qualified and how we would apply for that. And then finally, did I say finally with Tom? There is one more, and it's kind of the icing on the cake.

And it's a little different, but we thought it would be nice to have Dr. Pranay Parikh talk about real estate and how it can make physicians' lives better. So we're not talking about becoming a full-time real estate investor or manager, but as I spoke about earlier, when you can build different sources of income, different sources of assets over time, then why not do that and add that to your portfolio of income streams? And so we thought, well, it's not a clinical type of thing. It's something many physicians are interested in.

So he is going to be talking about real estate. He spent, I don't know, the last five or 10 years in real estate. He actually has a real estate company that he's partnered with.

He's worked with others that you have heard of on the physician side of things. And there's so many different ways of investing in real estate. We thought, okay, Pranay, come on this summit and talk about how a side hustle in real estate can bring emotional and financial rewards, list the benefits and challenges of investing in real estate and describe, we're going to have him describe the three most popular approaches to investing in real estate.

That wraps it up. That covers the 12 lectures that we're bringing during the summit. I'm really looking forward to learning from all of our speakers.

They'll be sharing their wisdom. You'll be able to follow up with them later if you want to. Some of them are going to probably be promoting the summit with us.

Some of them are going to be providing their own bonuses. So if you are already following some of them or on their email list, watch out for their emails because they will be helping to promote it. So even if you're using the free version, if you register through them, you can get any bonus they might be providing as being part of this.

Our team is really excited to bring you this year's summit. We're doing our very best to bring you actionable advice that will help you to improve your current situation, establish your own practice or healthcare business, or create a lucrative side gig so that you can maintain your autonomy, improve your income and satisfaction and support your transition when you withdraw from clinical practice. So there's a lot of benefits to this year's summit.

Sign up for free right now or purchase your all access pass by going to nonclinicalcareersummit.com. The day that this is being released, the all action pass still only costs $39. And I think it'll be that way for another day or two. But if you're listening to this later, you'll have missed that $39.

So on Tuesday, April 16, the price will jump up to $79. Still a very reasonable price if you need to get the recordings. And then after that, when the summit's done, they'll actually jump up in price again.

But for right now, if you want to get in early, go to nonclinicalcareersummit.com. And to make things easier for you, instead of remembering that link, you can find the show notes and some other links by going to nonclinicalphysicians.com/make-your-clinical-practice-great.

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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

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The post Make Your Clinical Practice Great or Move On appeared first on NonClinical Physicians.

Interview with Dr. Joe McMenamin – 347

In today's episode, Dr. Joe McMenamin provides priceless advice for the new expert witness.

Dr. McMenamin, an attorney with an extraordinary blend of medical and legal expertise, shares his compelling journey from medical school to the courtroom. He describes the convergence of these two disciplines, offering insights into the integration of medical and legal expertise.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

In only 1 week from today, the second annual Nonclinical Career Summit will be starting. It’s not entirely nonclinical in its scope, however. We have several presentations about starting and running a private practice without fighting the insurance companies.

It's called Clinical Practice: Make It Great or Move On

And beyond building your cash-based practice, our speakers will show you how to create an asset that can be sold later. Other experts will discuss MedSpas, Infusion Lounges, and other cash-only businesses, using Real Estate to diversify your income and assets, and several nonclinical side gigs including Expert Witness and Medical-Legal Prelitigation Consulting, Medical Affairs Regulatory Consulting, and remote SSDI Application Reviewer.

To learn more check it out at nonclinicalcareersummit.com. Remember that there is NO cost to attend the live event. And if you can’t participate in the Summit, you can purchase the All Access Pass videos for only $39 (until April 16, 2024, when the price increases to $79).

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Exploring Expert Witness Work: A Physician's Perspective

Joe delves into the need for expert witnesses, emphasizing their role in educating lay jurors on complex matters. He discusses the distinction between fact and expert witnesses. He also outlines the demands on the expert witness, including the need for clarity and credibility in communication.

Considering Expert Witness Work: Opportunities and Considerations

Benefits and Opportunities

John and Joe explore the potential benefits of engaging in expert witness work for physicians. They discuss financial rewards, intellectual challenges, and educational opportunities associated with this role. Joe highlights the satisfaction of contributing to the legal system and assisting jurors in reaching informed decisions.

Challenges and Considerations

Despite its advantages, Joe cautions physicians considering expert witness work about its potential challenges. He discusses the time-consuming nature of reviewing medical records and the necessity of navigating cross-examinations. Joe also addresses the importance of maintaining credibility and the risks associated with advertising one's services as an expert witness.

Exploring the Intersection of Medicine and Law: Career Considerations

Joe shares advice for physicians contemplating a transition to law, addressing common frustrations within the medical field, and the allure of pursuing a legal career. He highlights the significant commitment required to attend law school and cautions against making impulsive decisions driven solely by dissatisfaction with medical practice. 

Summary

Joe McMenamin offers valuable insights into legal careers, particularly in expert testimony. He mentions his law firm, Christian and Barton, and encourages interested individuals to contact him for more information. Moreover, he extends an invitation to connect via email for discussions on career transition or legal inquiries.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Christian & Barton Law Firm
• Joe McMenamin's Bio and Email Address at Christian & Barton
• Christian & Barton Phone Number: 804-697-4100
• How to Be the Best Expert Witness Consultant – 262
• Top Reasons to Become an Expert Witness Now – 163
• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Priceless Advice for the New Expert Witness

John

I've always been interested in expert witness work as an attractive side gig. You know, it's interesting, it's intellectually stimulating, it pays well. And in fact, I've had a couple of physicians here on the podcast before, but I've never had an attorney who actually engages or hires or whatever you want to call it, expert witnesses for their cases.

So I'm really happy to have today's guest here. Welcome to the podcast, Joe McMenamin. Thank you, John.

I'm happy to be here. I appreciate the opportunity. I have to just say that it's hard for me not to call you Dr. Joe, because as Joe was going to explain, he does have both the MD and the JD, so he's going to get into why and how that happened. But again, his work has been, you know, as the attorney engaging the physicians to help him out on cases. So that's the perspective we really want to get today. So why don't you go ahead and tell us a little bit about your background and education, how you ended up where you are these days.

Joe

Sure, John. Yes, I went to med school. I'm not a young whippersnapper.

I went to med school between 74 and 78 at Penn, and then did internal medicine at Emory from 78 through 81. And towards the end of that residency, I applied to law school. It was a concept that I had been thinking about on and off since boyhood, and never really made up my mind for sure until pretty late in the game.

In fact, I was applying to nephrology fellowships at the same time that I was applying to law school. Decided on the latter and went to Penn once again, finishing in 85. It took me four years because halfway through the first year, I had to take a year off when we discovered we were pregnant and I had to put a few dollars together.

So I was a moonlight ER doc for a while. And then finishing law school in 85, I went to practice at a large international firm, was there for a good many years. And then about 10, well, in 2013, I did solo stint for about a year, which was, sorry, 10 years, which was quite a change.

And now I'm at a firm called Christian & Barton in downtown Richmond. Curiously enough, in the very same building where I began my career, but with a different firm. And health law is the main focus of what I do for what I assume are obvious reasons.

John

Very nice. Yeah, that must've been an interesting few years there. Have to jump back and forth, you know, in your education, work again clinically.

How did that year go?

Joe

Well, actually it was longer than a year. I mean, I began my ER moonlighting career as a resident, as a JAR and an SAR. Kept it up during law school, all the way through law school, which is entirely doable.

Law school's curriculum is a very different animal from medical school. The one year that was full-time was occasioned, as I say, by the impending birth of our firstborn and the need to put a few dollars together.

John

Since that time, when you took that first, I think full-time job as an attorney, you never then went back to clinical work part-time or moonlighting or anything?

Joe

No, no, I haven't touched a patient since, good Lord, 1985. And so as I tell lay people, if your back hurts or something, I am not the guy you want to talk to. I mean, Rusty doesn't even begin to cover me.

On the other hand, everything I do benefits from and utilizes in some fashion and to some degree, my education and training in medicine. And I've been fortunate to be able to develop a legal practice that capitalizes upon that stage in my education. And I'm grateful for it to this day.

Excellent.

John

Well, the first question I have relative to this, the reason you're here today to understand this work as an expert witness is really to get to your side of the story, your take on it as someone who's engaged physician. So why don't, let's see, why don't we just start by saying, telling us about, you know, why is there a need for expert witnesses? Why this should potentially be an interesting thing to do on the side for physicians, most of whom will still be practicing when they do this, although I understand not always.

And just kind of tell us about your perspective on those topics.

Joe

Well, the reason that expert witnesses exist and not just in medicine, but a great many other fields is that in US law, pardon me, which was stolen in large measure from the British, a lot of decisions are made by juries. And, you know, people wax eloquent about the wonders of the jury system. And indeed it does have a lot to recommend it.

But jurors are by definition lay people. They're chosen from the ranks of registered voters or from drivers or what have you. And it's not impossible theoretically that the next jury that comes along might have a Nobel Laureate in physics on it.

But the probability of that is pretty remote. And even if you did, that doesn't mean that this very bright, very capable person knows anything about how to work up an acute abdomen or what have you. So the idea is to bring in people who by virtue of their knowledge, skill, training and experience are able to enlighten the jury about the menace, about what is expected and whether in a given instance, the defendant, the person being sued did or did not comply with what we refer to as the standard of care.

And because we recognize that however intelligent, somebody with no medical training or background is not going to have any knowledge or at least probably has no knowledge or if he does, he has precious little about medical topics, we bring in physicians to serve as experts. Now, if the case involves, let's say toxicology, we might not want a physician, we might want a toxicologist or it involves a totally different field. I mean, there's all sorts of experts in all sorts of fields that limited only by your imagination but an accountant could be an expert witness potential or a geologist could be an expert witness depending upon what the nature of the claim is.

I focus of course, on healthcare matters. So naturally, the vast majority of the doctors, sorry, of the experts I've hired have been physicians.

John

Okay. Now, what is your understanding of why this might be interesting to do for a physician? I'm sure some of the people come in and do it maybe with some misconceptions but why would you think it'd be something that would be of benefit for a physician to pursue?

Joe

Well, I'll start by suggesting that it is not for everybody. You could be the best doctor on planet earth and perhaps not be a very effective witness. Reverse is also true.

You could be an extraordinarily talented witness but not necessarily a great doc. They're entirely different skill sets, at least as I see things. It may be useful to have a little background in evidence law to preface what my remarks on this.

There's a distinction in the law of evidence between fact witnesses and expert witnesses. A fact witness is just that, somebody who, for whatever reason, has knowledge of facts pertinent to the case. So I leave work this afternoon and I happen to see the Chevy hit the Ford in the intersection.

I don't know the driver of either one. I don't know what either one was doing. I frankly don't even want to be involved but I happened to be there at the time.

I saw what I saw. In the event a lawsuit ensues from that situation, then whichever side thinks my testimony would be useful to its version of the case, can require me if necessary, or can certainly ask me, and if need be, back it up by law, and require me to come to court to testify to whatever I saw. And this proponent, the side that has asked me to come, can ask me a series of questions designed to elicit from me whatever knowledge I have of this situation.

After that, the other side, the side representing whoever the defendant is, if I'm on the plaintiff's side of it, will cross-examine me, ask me a series of questions intended to suggest to the jury that maybe I'm not such a reliable witness. Maybe I didn't see things very clearly. Maybe it was a cloudy day and my vision was hazy because, I don't know, I'm not wearing my glasses.

Or maybe I'm not reliable. Or maybe I'm friendly with the driver of the other car. Whatever, all of that is perfectly kosher, perfectly legitimate.

And, you know, if I do well on cross-examination, the side that asked me to appear will be pleased, and if I don't, then the side that did the cross-examination will be pleased. But the point is that all I can testify to is what I saw or heard or what I know. I cannot offer an opinion.

I cannot say, I think the driver of the Chevy was at fault, even if I really do believe that, and even if, in fact, there's good basis to say that that's true. That's an opinion I cannot offer. Moreover, I don't get paid for my time.

It's expected of me as a citizen to show up when I need to and to testify. An expert witness is a different animal. An expert witness, first of all, is a volunteer.

Nobody can force you to be an expert. You have to willingly accept the opportunity if it is given to you. Second, you do get to charge for your time.

The law recognizes that every moment that you spend horsing around with some lawyer some place is a moment that you cannot be seeing patients or whatever it is you normally do, and as a result, you're losing money in this proposition unless you can bill for it, and so you can. And third is, yes, indeed, you can give opinions. That's the whole point, in fact.

The reason that whatever makes you an expert is that you have knowledge that most people don't, and therefore your views on a particular technical or scientific or medical or otherwise complicated subject are intended to be, and we hope are, useful to this jury of laypeople who have no prior exposure to these concepts, have very little understanding of them, and the biggest job that the expert has is to be a teacher, at least as I see things. You're there to teach the jury what the facts are. Now, even that's a bit of an oversimplification because although I think the distinctions I just drew between fact witnesses and expert witnesses are correct, there are also two types of experts.

There are so-called consulting experts, and then there are testifying experts. A consulting expert, as the name suggests, serves as a consultant to a lawyer, or maybe a group of lawyers, and is chosen presumably because of his knowledge, whatever his expertise may be in the judgment of those hiring him, is highly valuable, highly relevant to whatever is at issue. But that person does not appear in court, does not testify, and the side hiring him is under no obligation to identify him to the other side, nor to tell the other side, even that he exists, much less what his credentials are, or what his opinions might be, or what the basis for those opinions might be.

He's purely behind the scenes. The testifying expert, on the other hand, is the one that Hollywood will make a movie about, or at least feature an expert in a movie about a trial. This is the person who, yes, will indeed have educated the lawyer ahead of time, presumably, but will also be there in court, will take an oath to tell the truth, will then testify in response to questions posed to him by the sponsoring lawyer, and will respond in turn to the cross-examination questions offered by the sponsoring lawyer's opponent.

Now, both the plaintiff, that's the person bringing the suit, and the defendant, the person being sued, have the right to call an expert, or sometimes multiple experts, depending upon the nature of the case and its complexity. It's not unusual, for example, to have at least two experts on both sides. Why?

Well, because the malpractice theory proceeds on the basis of ordinary negligence law, which has four components, classically, duty, breach, causation, damages. Nothing novel here. I'd be disappointed in any first-year tort student who couldn't rattle that list off just as well as I can.

Duty. If you're my doctor, I'm your patient, you owe me a duty. It's pretty much that simple.

It's usually straightforward, not so much. If I'm an accident victim on the side of the road, and you are driving past, and you see me there, and you're able to help, and you decide to help, or you decide not to help, that's duty. Generally, that's not contested in these cases.

It's pretty clear that you do or you don't own a duty. Breach is, in contrast, highly contested. That's the heart and soul of the case.

Did you or did you not breach the standard of care at the relevant time caring for this particular patient? The plaintiff's expert's job on standard of care is to say the standard of care requires A, B, and C. Doctor so-and-so, the defendant failed to do, did do A and B, but he didn't do C.

That's a breach of the standard of care. The second expert that that plaintiff may call is a causation expert, because that's the third element of the story. Again, it's duty, breach, causation, damage.

It's causation is the so what question. I don't know. I'm a general internist, and you come into me with a history of a bad cough.

It seems to be getting worse. You're coughing up blood. You've lost a bunch of weight.

You've got some chest pain. Oh, and by the way, you've got a 100-pack year smoking history. And on examination, I discover that you have a hard mass in your left supraclavicular fossa.

And then on X-ray, there's a mass demonstrated in the left upper lobe, but somehow, I don't put two and two together, and I say, well, sorry, you've got the cough, nothing serious. Probably go away in a few weeks. I'll see you again next year for your annual physical.

But after that appointment, you leave my office, you cross the street, and you're run over by a bus, and boom, you're dead right on the spot. Is there a cause of action against me for medical malpractice for failing to diagnose what I hope was a reasonably clear case of lung cancer? The answer is no.

Why? I might have reached a standard of care in not being able to make that diagnosis, but I didn't kill you. My mistake didn't kill you.

The bus killed you. So maybe there's a claim against the bus company or the driver or both. Maybe there's a claim against the city for not putting a stop sign there.

I don't know. Use your imagination. But there's no claim against me as the doc because I had nothing to do with your death.

There are a class of experts who testify to causation, which is, from a medical point of view, often the most complicated and also the most interesting part of a malpractice case. Why did so-and-so develop condition X? Or why did he die at the age of whatever when he should have lived another 10 years or so it could be argued?

Now, one doctor could serve as both the standard of care expert and the causation expert, but it's not unusual to have one of each or, for that matter, more than one. And then just as the plaintiff gets to call experts to testify to these matters, the defendant can too, and the defendant will if he, as it descends, at least in my view, and you find somebody that you think is highly qualified, testify contradicting what the other side's experts said. Now, at the end of the day, who gets to decide the answer?

The jury. Now, philosophically, you may think that's smart or dumb. I'll leave that to you.

But we've been doing it this way. I'm using we in a grand collective sense, tracing it all the way back to England shortly after the Norman invasion in 1066, William the Conqueror and all that, for nearly 1,000 years. And that's how we decide these cases.

So for better or worse, the lay people sitting in the box are the ones who decide what the standard of care is and whether on a particular occasion, Dr. Smith did or did not comply with that standard. Now, I finally get around to your question was why would you want to do this? Well, you've already pointed out a couple of things, John.

First, you do make money doing this. You know, your time is valuable as a physician. And, you know, it's not at all unusual.

In fact, it would be unusual not to have an expert charge less than let's say $300 an hour. 400 is not unusual. 500 is not unusual.

600 is maybe pushing it a little bit, but not all that much. You know, the sky's the limit. There is a downside.

If your fee is so high as to put you out of reach, you may not get hired because you're simply too expensive. Or the lawyer is willing to bear the freight for whatever that fee happens to be and it warrants into many thousands, but the other side gets to find out what your fees are and can cross-examine you. And a skilled examiner will have no trouble suggesting that because you're $20,000 richer or having got involved with this lawsuit that you're a hired gun and therefore your credibility is out the window.

Now, the jury will not necessarily reject your testimony because of the 20,000 or 40,000 or whatever it is, but it might. So bear that in mind. But there is a source of revenue here and it's not trivial.

There are people who push this really hard. I had a, I mean, one of the most enjoyable aspects of malpractice defense work is cross-examining the other side's expert, at least when you've got some goods on. I mean, I had an expert who testified against me many years ago that I remember vividly.

He maintained a private airplane. The better to go from deposition to deposition to courthouse to courthouse all across the United States and made a handsome living doing this and simply didn't bother seeing patients. Well, it wasn't that hard to cross-examine this guy.

Maintaining airplanes is an expensive proposition. You have to earn a lot of money to be able to do that. And he did, he did it by testifying.

He would testify all over the country all the time and he didn't bother seeing patients because he was too busy testifying. Now here in Virginia, he would not qualify because there's a rule here that says that if you don't have an active clinical practice or at least have had one within two years of the relevant day, then you're no longer qualified. However learned you might've been 20 or five years ago, you're out of business.

Not every state has that rule. So more elaboration perhaps than was necessary, but income. The other thing is it will help you develop a better understanding of the legal system.

Doctors have extensive educations going for years and years and years as I don't need to tell this audience, but seldom do they get much exposure to or experience with the legal system. This is one way to learn about. As you pointed out, John, this is an intellectual challenge.

It is clearly an intellectual exercise here. When you're talking to a jury, remember these folks have no relevant education or training. The wisdom in the field is to suggest that you ought to assume that these folks have a seventh grade education.

Not to disparage anybody, not to put them down, but just because they really don't have much to go. So you've got to take concepts that you and other really smart people have spent a lifetime studying, understanding, agonizing over, and reduce it, translate it in a manner that lay people can understand. Got to keep it simple enough that John Q.

Public, listening carefully, can follow it. So teaching lay folks about complicated subjects is not necessarily an easy thing to do. It is definitely a challenge.

And then when you get cross-examined, if you weren't challenged before, unless the cross-examiner is really lousy, which is possible, then you're truly about to be challenged. I mean, that's the whole game. The game with cross-examination is to try to discredit this witness by whatever means you can come up with short of breaking the law.

And there are a lot of ways to do that. So you need to be on your toes if you're going to survive cross-examination. And if you don't survive it, your chances of being hired again are diminished a little bit.

On the other hand, if you come through it like a champ, the same guy that hired you last time is going to be interested next time if there is an opportunity. Or there isn't, but there's a network among lawyers on both sides of the V, as we call it, the plaintiff's bar and the defense bar. If I need an expert on some topic where I've never had to hire an expert before, I might call up one of my buddies on the defense side and say, hey, Charlie, I had a case coming up.

I need a pediatric neurosurgeon. Can you help me? Yeah, do you have any experience?

And he'll say, no, I'm sorry, I don't either. But he might say, but talk to Mary Smith down the street. I think she hired somebody like that.

And I call Mary up and Mary may be able to say, well, talk to Dr. X at Mecca University. Guy's terrific. And I do that.

Well, we talk to each other and we know about these things. You're also, and this might sound corny, you're also making a meaningful contribution to the justice system. Remember, the jurors, I'm convinced, truly do want to do the right thing.

They want to be fair, they want to be just, and they struggle to do this correctly. And if you're able to help them reach a logical, sound conclusion, not only will they be grateful, but you have genuinely contributed to our country, at least as I see things. And of course, if you testify on the defense side, and I never did and never will do plaintiff's work, you're helping your fellow docs.

Now, I don't know, John, have I, should I go over to the negatives or should I stop?

John

Good question. Well, I guess, yeah, why not? It's kind of addresses this issue.

If someone was thinking about pursuing this work, there's probably certain things you'd want them to know about it, what they should expect, the good, the bad, the ugly. So yeah, why don't you take that on now?

Joe

Well, I've already dwelled at some length on the cross-examination phenomenon. Cross-examination is tough, at least if your examiner is worth his pay. I mean, if he's any good, he'll do a good job.

And that means you've got to be very, very alert. It's time-consuming. If you're going to do a good job, you've got to review the medical records.

Many times in malpractice cases, the medical records are extensive. And the days when we relied upon paper, you know, you got two feet worth of documents to plow through. And granted, doctors read charts all day, every day, and they know how to do it.

But something that doctors, frankly, don't often do is they may not necessarily read the nurse's notes, or the PT's notes, or the OT's notes, or never mind the NA's notes in a nursing home case. You know who does? Plaintiff's lawyers.

So to be aware of what's in potentially damaging information in the nurse's note written at two in the morning, you probably need to read that. Even if in your actual work in clinical practice, you want to see what your consultant had to say in his note. You want to maybe see the progress notes from your colleagues who wrote a note in the chart yesterday.

And you're not necessarily going to pay so much attention to what the occupational therapist had to say. But in litigation, what the OT said might very well be important. So it takes a lot of time.

You're also going to spend a lot of time with lawyers. Some people would consider that cruel and unusual punishment. Depends on your point of view, but if you don't particularly like lawyers, and if you don't, you are not unique in the medical profession, factor in that you're going to spend a lot of time with people that you may not necessarily like.

Now, on the other hand, if I'm hiring you, one of the things that I will do my best to do is to make you happy, since I want you to cooperate with me, work hard with me, do a good job for my client. So I'm going to do my best to keep you happy, but I can't change the fact that I'm employed. Now, and of course, if you do plaintiff's work, you will run the risk of antagonizing your colleagues.

Now, flip side of that. Just as I can portray the guy with the private airplane as a prostitute, if you did nothing but defense work all day, every day, well, I'd be grateful, I would kiss your feet, but you wouldn't be vulnerable to cross by a plaintiff's lawyer who would point out that in the last 16 cases you've reviewed, all of them were for defense counsel. And you refused 17 opportunities to represent, not to represent, but to testify on behalf of plaintiffs, if that were true.

So factor that in as you're thinking about these things. So it can be enjoyable, but it also has its downsides. And one thing I would caution you about is you want to be careful about advertising.

Some docs are eager to do this kind of thing, make that very clear. When I was a baby lawyer a long time ago, I received a letter from a doc in the Central Virginia area addressed to me at my law firm and inviting me to hire him as an expert. No, I'm sorry, I got my story mixed up.

That's not quite correct. Instead, it didn't go to me directly, it went to a guy down the hall, one of my colleagues, one of my fellow lawyers in the firm, whose field was construction law, didn't do malpractice work at all. But he wandered down the hall, he said, Joe, take a look at this, I don't know if this guy's any good or if you're interested, can't help me, but maybe he can help you.

Well, I didn't hire him. And frankly, one reason was because I try to avoid hiring people who advertise. Why?

Because of the very thing that happened when the guy came to trial, by chance, a year or two later. At the right point, when my opportunity to question him came, I said, Dr. So-and-so, who is Ron Eimer? And he said, I have no idea.

I said, well, you write letters to Ron, don't you? I'm sorry, I'm not familiar with this person. I said, all right, well, let me show you Exhibit A.

And I show a copy, of course, to opposing counsel, and I show a copy to the court. Take a look at Exhibit A, if you would. Do you recognize your signature at the bottom of that letter?

Yes, I do. Is that your signature? Yes, it is.

Okay, and Ron Eimer is the person to whom this was addressed, is he not? Yes, and it says Ron Eimer Esquires. He's a lawyer, is he not?

Yeah, and beneath that, it says McGuire Woods and Battle, which was the name of the firm at the time. That's a law firm, is it not? Yes, it is.

So you were ready to Mr. Eimer to get the opportunity to testify, weren't you? And of course, you're getting well-paid for your time this afternoon, are you not? So your advertising really paid off pretty well, didn't Mr. Plaintiff's lawyer?

You know, I can be an SOB when I need to be. So think about that. Doesn't mean you never advertise, or you shouldn't.

Maybe you have to, but be careful because you're creating potential cross-examination equipment and believe me, I won't hesitate to use it if I think it's going to help my client prevail in the case. Also, be careful if you testify too much, as I indicated earlier, you undercut your credibility. Even if there isn't any rule that says you're out if you don't have an active clinical practice, as there is in Virginia, if I can portray you as somebody who testifies for a living, doesn't really take care of patients, then I have severely harmed your credibility because the jury wants to hear, almost always.

They want to hear from docs who actually care for folks who are sick or who are injured, not from people who don't do that for a living. It's too easy for opposing counsel to paint you as incredible, not worthy of belief. Also be careful of organizations that group experts together.

There are companies in the business, there are companies that will advertise to lawyers and say, look, we've got a whole stable of experts in every subject from A to Z, and they really do. They've got from anthropology to zoology or whatever. You need an expert in whatever field, we can help you out.

And they can't. And I won't mind admitting that at times I have relied upon organizations such as that, but be careful because if you get in bed with those guys, you'll have a contract with them. The contract will likely be discoverable.

Contract may very well have language in it that people like me will be able to use to hit you over the head on cost of examination. Think about proof sources. They're important.

You know, it's not an obvious thing. And I had to try a few cases before I began to understand really how important these paper trails may be. So, you know, think about these negatives as well as the positives.

I'm not trying to talk you out of doing this in the least. I've had some, I'm deeply grateful, and I mean that with the most profound sincerity to experts who helped me out and helped me get a doctor's chestnuts out of the fire in a way that was convincing to the court, convincing to the jury more important. And I'm indebted to those folks and I would help them any way I could.

And on the other hand, if you testify against me, I'm going to try and crush you if I possibly can. You may crush me, but that's the name of the game.

John

I do have two or three other little questions before I let you go. One is, you know, people always ask, okay, well, how much am I going to have to do with that massive chart review? How much am I going to have to do for prep and writing report?

And then, oh, do I have to, you know, go to a deposition, prepare for deposition? And what about how often will I end up in court? What's your experience been with that?

Joe

The amount of reading and preparation is largely a function of the complexity of the case and the scope of the medical record. If the chart is comparatively skinny and the facts are simple, well, frankly, there's a pretty good chance of mine I go to court, but if it does, then your prep will be comparatively painless. Now, you will have to spend time with the lawyer that hired you.

That's important. He needs to understand how you're going to answer a particular question, and you need to understand the rules of the road, and the lawyer's job is to acquaint you with them. The lawyer is not there to tell you to answer a certain question a certain way, but the lawyer can try to anticipate what some of the questions will be and can discuss with you various ways to handle them. In the end, it's your opinion, not the lawyer's.

You're the expert, not the lawyer, so you have to answer it as you see fit, but the lawyer can point out that, I don't know, if I look at my wall over there, there are probably six or eight adjectives I could use to describe its color, none of which would be incorrect or untrue, but one might provide in the mind of the listener a different image, maybe a better image, than choice number six, perhaps, and there's nothing wrong with discussing those possibilities.

As far as depositions, that's a matter of state law. All of this stuff is governed by, nearly all of it, is governed by state law. Some states do not make provision for depositions, and it's a matter of choice.

It's a matter of grace and agreement between the lawyers, but you can't force a deposition of the opposing expert in some states. In other states, you can. It's a matter of right.

You get to do it. You can count on the deposition taking probably a good two, three hours and another one or two before that for prep time. Remember, that's all billable.

You get to bill for all of it. I take the position that the prep time, you bill to the lawyer that hired you. The deposition time, you bill to the other lawyer because he's the one who determines how long that deposition goes.

Now, some depositions are endless. I mean, I've had them go for two days, but that's rare. That's unusual.

I've had them be 35 minutes. That's equally rare and unusual, but a couple of three hours, maybe four, that's not unusual. That's fairly typical.

Trial work, you may be on the stand for a relatively short period of time. Often, that's not the case. We'll get to that in a second.

What you may not realize, though, is you have to be available on call. The lawyer does not control the pace of the trial, at least not completely. The judge has the most control over that.

The judge is going to be sensitive to when the jury needs to get up and get a bite to eat or to go to the john or whatever it might be. Things happen. You've got a game plan before the trial.

You have six witnesses. You want to call them in this order. You think you're going to need an hour for this one, 30 minutes for that one, two hours for that one, and so on.

You make all those plans, but while the planning is a good idea, very often you can't stick with that plan. You think that you're going to call your expert at roughly two o'clock on the second day of trial. Well, you can tell him that and he can plan around it, but it might not be until the third day of trial, or it might be 10 o'clock that morning, or it might be some other time.

For a practicing clinician running an office or a hospital practice too, for that matter, that's really difficult to deal with. Yet, the lawyer needs you to have that kind of flexibility because he just doesn't have control over the point in time at which you're going to be needed. When he needs you, he needs you.

No joke. If you're somehow unable to put an expert on, chances are you lose that case. It's very, very difficult to prevail without your expert.

When you sign up, recognize that you're making a commitment and it may be very inconvenient to you. If that's not acceptable, I fully understand and respect that, but don't sign up. Now, discuss it, of course, with a hiring lawyer.

There are circumstances when the degree of control is a little better than I've suggested, and maybe it won't be so difficult. But do realize that trials are unpredictable animals, and things happen at a rate, at a pace that you may not be able to predict.

John

The other sort of short question I have is what's the demand like now, and is it related more to specialty and expertise, or is there an ongoing demand, or is the demand already kind of flooded with expert witness? What's that about?

Joe

Well, this is the United States, and it's 2024. We live in the litigation capital of the known universe, and our enthusiasm for litigation, we as Americans, does not seem to have abated at all during the course of my career. If anything, it may have increased.

And the national pastime is not baseball. The national pastime is litigation. Now, of the physicians out there, and what are they?

A million doctors, maybe, in the whole United States? There's a certain number of them, a fairly high fraction. You want nothing to do with any of this.

They flat will turn you down. And that's their right. They have every right to refuse.

There's no duty to do this. And that means that your pool to choose from is narrow. Of those willing to testify, there are some that I wouldn't hire because it's too easy for them to be cross-examined.

Of those that I am willing to hire, it could be that my number one draft choice is going to be on vacation on the day of trial. And so I'm out of luck. I can't use that guy.

And so for a whole variety of reasons, the chances are good, I would think, that the demand will be there. And there is a market for these services. If it is of interest to you, and you don't want to advertise, you can quietly over lunch or a game of golf or whatever floats your boat, mention it to Dr. So-and-so. Or maybe mention it to, if you happen to know a guy working for, a person working for a malpractice insurance company, who after all will be the ones to pay your freight at the end of the day. Say, you know, I'm curious about this. Tell me about it.

And you don't put anything in writing because that's too easy to find. But a little conversation like that could pave the way to opportunities. So you want to be discreet about it.

And I wouldn't go beating the drum, but let the word get out in subtle and not too obvious manner. And you might get some opportunities. You might find that you really like it.

Then again, you might hate it. So go to school on whatever opportunities you do get and judge whether to keep up with this sort of thing based on your initial experiences.

John

I do have one more question. And this is a tangent that we kind of discussed a little bit during a prep meeting that we did a while back. And it was this idea that as a physician, I get really frustrated.

I'm tired of people telling me what to do. And, you know, the heck with it. I'm going to go to law school and somehow take this out on somebody else.

What's your advice? Or have you heard that comment before? I have heard that comment before.

Joe

I get phone, not every day by any means, but I get from time to time, I get a phone call from Dr. So-and-so from out of the blue, somebody I've never heard of, probably will never speak to again. But somehow, he got hold of my name. And he says, tell me about law school.

Tell me about being a lawyer and all that. And I've developed, I'd like to think, a fairly accurate set of antennae for telling whether the inquiry results from a sincere curiosity about how you combine these fields and whether it would be of interest versus the kind of physician you just described, John, who's thoroughly hacked off because some person somewhere who doesn't have anywhere near his credentials or his training or his knowledge or his experience or the pressure or the responsibility of caring for a patient has just told him, well, no, we're not going to provide prior authorization for whatever it is you want to do.

Well, I understand why you would be very angry about that. If I were subjected to that, I'd be furious. And I don't mind admitting that, however, is not, repeat not, a reason to go to law school.

Law school is a three-year investment. Nowadays, you're looking well at six figures. It's a time when, yes, you can work part-time as I did, but you're not going to be able to earn the fees that you could in full-time practice in medicine.

And, you know, it's not as hard as medical school, in my opinion, but it's not a walk in the park either. There's a lot of reading to do. Some of it is fairly difficult sledding.

Some of the professors you'll like, and frankly, if your experience is anything like mine, some of them you won't. And, of course, you'll be in there with a bunch of young leper snappers, quite possibly. Now, not so much as years ago, but still, you'll be older than most, probably.

Those factors may not necessarily be to your liking, or maybe they will be, but it is a major commitment. It's not just something you decide to do on the odd Thursday for no particular reason. So, if you're angry about the way medicine is being practiced, I understand that.

React to it in some way that makes sense, but don't, on that basis and that basis alone, go to law school. One of the reasons, one of many, that I went to law school, quite honestly, is that I saw a lawsuit wreck the life, and I'm not exaggerating here, I think that's not an exaggeration, wreck the life of a young doctor who was a year ahead of me in training, a fellow that I truly looked up to, a fellow I consciously tried to emulate, because I thought he's the ideal resident by the time this happened, he was a fellow.

I'd like to be just like Dick. And something happened, and he got sued, and he just wasn't the same person. And frankly, I don't think his patients got, at least for a length of time, got quite the same service that they did before.

And I thought, this is wrong. Somebody ought to do something about that. But this was after having thought about it for, I don't know, however long it is from seventh grade to senior residency, a long time, on and off, and weighing many variables and asking people about it, talking to people who are in the field, etc.

You don't do it on the spur of the moment. You don't do it because you're ticked off, however justified your anger may be. You do it because you want to be a lawyer and practice law.

Otherwise, don't bother.

John

I tell you, looking back though, it does sound very interesting. I'm way past that hill. But anyway, okay, so last thing, how do we get a hold of you?

Joe

The best bet, frankly, is to either call me or send me an email, and we'll set up a time to chat. The firm's name is Christian and Barton, B-A-R-T-O-N. And if you Google McMenamin, Christian and Barton, you won't have any trouble.

You might not have any trouble with Joseph P. McMenamin. There aren't that many of us, even in Ireland, and it's still an unusual name.

John

And I'm more than happy to talk to you. All right, well, with that, I want to thank you so much for spending this more than half an hour here today talking about this very interesting topic. So, Joe, with that, I guess it's time to say goodbye.

Joe

Well, thanks very much for the opportunity, John. I enjoyed it, and I hope it's of interest to your audience.

John

You know, one thing that we forgot to mention, so I will throw it here at the end, is that we're going to be seeing you at the Summit, which is going to be in place, is going to be going on within a week or two of the release of this. So, I think my listeners know, because I've mentioned it in other podcasts, but Joe's going to be speaking on a different area of his expertise, having to do with the structure of corporations and starting a small business, those kinds of things. And that'll be running the 16th through the 18th of April of this year in the second annual Summit.

And, boy, we really look forward to hearing from you there, Joe. That'll be fantastic. Thank you, John.

Looking forward to it myself. All right. Bye-bye.

Bye now.

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Interview with Dr. Jennifer Allen and Kimberly Lowe – 346

In today's episode, Dr. Jennifer Allen and Kimberly Lowe describe how they grew their Infusion Lounge business together.

Dr. Allen and Kim Lowe were both fed up with conventional approaches to patient care. And they found that they shared a vision for a more upbeat joyful atmosphere. They describe their innovative approach to healthcare delivery, combining facets of direct primary care (DPC) and integrative medicine. Together, they discuss the evolution of their Infusion Center, The Well, highlighting its diverse services, including IV infusions, hormone therapy, and aesthetic procedures.

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The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

In only 2 weeks from today, the second annual Nonclinical Career Summit will be starting. It’s not entirely nonclinical in its scope, however. We have several presentations about starting and running a private practice free of insurance companies.

It's called Clinical Practice: Make It Great or Move On

And beyond building your cash-based practice, our speakers will show you how to create an asset that can be sold later. Other experts will discuss MedSpas, Infusion Lounges, and other cash-only businesses, using Real Estate to diversify your income and assets, and several nonclinical side gigs including Expert Witness and Medical-Legal Prelitigation Consulting, Medical Affairs Regulatory Consulting, and remote SSDI Application Reviewer.

To learn more check it out at nonclinicalcareersummit.com. Remember that there is NO cost to attend the live event. And if you can’t attend all or part of the Summit, you can purchase the All Access Pass videos for only $39.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Dr. Jennifer Allen's Journey to Direct Primary Care

Dr. Jennifer Allen shares her unique career trajectory, from nurse to family physician and eventually transitioning to direct primary care (DPC). She recounts the challenges of traditional healthcare and the liberating experience of offering membership-based primary care outside the constraints of insurance.

In her candid discussion, Dr. Allen highlights the pivotal moments that led her to embrace DPC, emphasizing the benefits of alternative healthcare models for physicians and patients.

The Evolution of The Well: A Nurse-Physician Partnership

Kim and Jennifer discuss the inception and growth of The Well, an integrative health practice offering services like IV infusions, hormone therapy, and aesthetic procedures. They detail the journey from conception to expansion, reflecting on the challenges and rewards of their collaboration.

The duo shares insights into their holistic approach to healthcare delivery, emphasizing personalized care, patient education, and the impact of integrative medicine on their rural community.

Navigating Challenges in an Infusion Lounge

Our guests discuss the challenges they faced in establishing The Well, reflecting on legal considerations, business aspects, and the treatments available through integrative medicine. They share their strategies for fostering growth, emphasizing the importance of flexibility and focusing on patient-centered care.

Summary

Dr. Jennifer Allen and Kim Lowe shed light on their innovative approach to healthcare. For those intrigued by their integrative healthcare services, they direct readers to The Well's website. This platform showcases their range of offerings, including IV infusions, hormone therapy, and aesthetic procedures.

Additionally, for individuals seeking an example of a DPC practice, Dr. Allen points to New Freedom Family Medicine's website. Listeners are encouraged to reach out to 636-629-8444 for inquiries about The Well and 573-271-2927 for New Freedom Family Medicine.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• The Well Infusion Lounge Website
• Dr. Allen's Practice Website
• The Well Infusion Lounge Facebook Page
• How to Start and Grow a Profitable Cash Based Medical Practice – 293
• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Episode 346 Transcript

Why an Infusion Lounge May Be the Best New Thing

Interview with Dr. Jennifer Allen and Kim Lowe

JOHN: Today's guests have not been on the podcast before, but they are both speakers at the upcoming summit that I mentioned at the introduction of this episode today. And I thought it would be helpful to bring them on, introduce them to you and hear about what they're up to, give you a little groundwork for the summit. And especially I'm really happy to have them here because I've been fascinated by healthcare professionals who have found new ways to deliver care or deliver healthcare in new ways that does not involve insurance companies.

So there are different ways of doing that. We're going to learn a bit about that today. So with that, I would like to welcome Dr. Jennifer Allen and Ms. Kimberly Lowe. Welcome to the podcast.

DR. ALLEN: Hi, thanks for having us.

JOHN: This is going to be fun. I'm going to learn a lot because this is one area where I think I've had one guest that talked about DPC about two years ago and other associated sort of cash-based practices. So we're going to learn a lot today.

So the first thing I'll ask you both is to take turns and tell us about each of your backgrounds, your training, and maybe a little bit about your work history, and then we'll get into how you got together.

DR. ALLEN: Okay. Well, I'll go first. So I'm Jennifer Allen.

I'm a family physician board certified. I started as a nurse back in the early nineties. Life sort of intervened.

I was going to wash you with the idea of going to medical school, and I sort of had a midlife crisis at 20 and was like, no, I don't want to do that. So I left school for a year, did a few things. When I was ready to come back, I just, I graduated with my degree and I didn't know what I wanted to do.

So I did medical research. Then I was cooling my heels and was bored and still didn't want to go to medical school at that time. So I became a nurse and that was great.

I was a nurse for about nine years and then I became a nurse practitioner. I did that for nine years. And then an amazing thing happened that would be a topic, I guess, for another time.

I was given a gift to go to medical school. And so a patient of mine really wanted me to be a doctor. And she said, if I would go back, she would pay for it.

So, so I did. And, and then I did my residency at Mercy Family Medicine in St. Louis and went back into hospital-based practice after that. I hated it.

I just, I could, I love my patients, but I couldn't deal with the mess that that is. And so I had learned about direct primary care along the way, which is, membership-based practice. We don't bill any insurance.

Our patients join our practice as members and pay a monthly membership fee and get basically all the primary care I can give them. Kind of like Netflix, you know, you pay your bill, you rent movies and, you know, you don't have to pay at the time of service. So that experience got me out of the system.

There's a lot of healthcare knowledge that we are not exposed to when we are in the box of traditional Western healthcare that is controlled by the powers that be. And so in that knowledge gathering, I, I learned about other things like IV nutrition and hormone therapy and things like that. And then I met Kim and we had some similar ideas.

And so we joined a partnership and that's where the well came from.

KIM LOWE: So mine's not nearly as exciting. I was a nurse. I've been an RN now for, I guess, oh, going on 16 years.

I graduated first with my associate's degree in nursing, went straight into the workforce at the hospital. I started out in labor and delivery, newborn care, had worked at some big hospitals. I worked at smaller hospitals.

I decided to go back and get my bachelor's degree in nursing in 2015. I too, like I said, have the whole experience, the hospital experience. I love my job.

I love my patients, but the bureaucracy of it all is just a little too much. So I ended up going to work for an integrative medical physician down in St. Louis. And it was a fantastic time in my life because I learned so much.

And he also, he wasn't necessarily direct primary care but he had the same fashion of ideas of how we do things here. So we do the IVs and the hormones and also the direct primary care portion of it, where you come in for regular clinical visits. So I learned a lot there and just, you know, it's an hour commute back and forth.

And I got tired of that life. I did, during COVID, work for a very short amount of time just prior to COVID, I should say, starting. I worked for the insurance company as a case manager because I thought that would be a great way to work at home and to help raise my kids and things as they got older.

Not ideal. So the company was great. I mean, they cared for me as an employee, the benefits were great, but it was just very difficult with the position that I was put in, knowing the things that I knew with integrative care and there was a different world out there.

I started seeing Dr. Allen, I think it was actually in COVID, probably 2020, as a patient of hers. And I wanted to get out of the world of doing insurance and case management and all of that stuff. And I came to her with this idea and I said, hey, I have all this unused, untapped potential and skill.

How would you feel about opening up an infusion lounge? Let's do IVs. Let's do some things.

Let's, you know, get this kind of show on the road for this side, which has been great. I mean, we've gotten some major expansion, I think here, and we've just grown together kind of as business partners, like learning new things. I help her out in the clinic sometimes when she needs, she helps over here.

Like we just kind of scratch each other's back. So it works really well for us all, but that's my background. Not as exciting, but it's just a lot.

JOHN: No, it's good. I mean, it's, you know, we all have different stories. And so, so you were both, you know, working in different ways.

And so it sounds like, Kim, you kind of were the one that said, well, maybe we could do something together where we can expand and both benefit from that. So what was it, was it complicated creating this at the beginning, even from just a legal standpoint? I assume, you know, that your partners in this, in a business sense, as well as in, you know, just socially and so forth.

DR. ALLEN: Yeah. So we actually, I was looking into IV infusion. One of my nurses in our Herman location was talking about doing some IV infusions in our Herman office, and I knew it was a great idea, but I didn't have the, the free time, essentially, to be able to build that by myself.

And it wasn't, I mean, it was literally like a month later, Kim came to me and I was like, you know, we've been considering this. So, so she really was the physical energy that was able to come in and, you know, put the paperwork together and, you know, the literal physical plant, if you will, of it. We just formed an LLC 50-50 partnership and pretty easy, opened our doors.

KIM LOWE: So the moon, the sun, and the stars aligned like all at the right time for this to happen, because it just, it was meant to be, it just was a meant to be practice and things just worked out how they were supposed to.

JOHN: All right. Well, one of the questions, you know, I, I'm kind of, when we were talking and, and even in the summit, you know, I keep throwing this term around, you know, infusion lounge, infusion center. And I understand that you're, the well does a lot of different things and maybe even shouldn't be pigeonholed.

And I understand things like, you know, aesthetic services and med spa type services. I mean, a lot of these clinics have different mixes of what they do. So tell us like what you do, what the technical definition of an infusion lounge is and anything else you want to tell me about the actual business and how, how you take care of people.

KIM LOWE: So I think it's, it's kind of sprouted more from the initial idea was of course the IVs, right? And so as time went on, you know, you start getting to know more things, you see more things, you research more things. Integrative medicine is one of those things that's forever expanding and there's always new things out there that's better and more healthier.

And we actually after, I would say, probably a year of doing IVs and things like that, we were approached by a rep for hormone therapy replacement. And at first we weren't necessarily cool on the idea. I'm like, I don't know, this is somewhat new.

I had heard of it before. I'd never actually done the pellets myself, but at the integrated medical center where I worked, they did those. And I really kind of pushed.

I was like, I think we should, you know, maybe look at this, right? So we got some books, we got ideas. They offered to do pellets for us and give us the information and send us to all these locations to go to watch these things and talk to the actual patients that have gotten them placed before.

And the more we knew about it, the more research we ended up landing on, it probably took, I don't know, three or four months before we were really like, yeah, let's do this.

DR. ALLEN: And so go ahead. Sorry. That's okay.

I mean, again, I, in my separate journey as the DPC doctor, I was looking for new ways to help my patients be healthier. I'm not a box checker. I don't, I don't like a lot of big pharma kind of medications.

And so I was coming on this information on my own in my other practice with nutrition and hormone replacement therapy. And so I was already learning about it. And literally the rep came in the door one day and was like, Hey, what do you think about pellets?

And so the, you know, you either love pellets or you don't, there's a, we live in a very, um, delineated, you know, culture and hormones are not bad. And, but unfortunately the last generation of us as healthcare providers have been educated that they are bad because of bad science and bad research. And that, that stuff gets perpetuated.

And until you delve in on your own and start learning about these things, we just don't know, you know, we're, we have these preconceived notions. And so I was gaining this knowledge. And again, Marla walked through the door and I was like, you know, let me look at this because it's, it's just a different vehicle for the same kind of hormone replacement as patches, creams, and pills that everybody is okay with.

So once, once I realized that it was just a different vehicle and it's not scary and there is a lot of good science behind it. Um, I was like, yeah, let's try this.

KIM LOWE: And so I would say it's, it's probably a different topic for another day, but, and maybe even in the summit, we can talk about this, but hormones are one of those things that I think are absolutely life changing for people. I mean, it is, it literally been a life changing thing in our practice. And, you know, just to see people come in and actually tell you that they feel better.

We're able to get people off of medications that they've been on for years for anxiety and statins and all of these things that have all these eroding side effects to your body later on in life, all in place of a bio-identical hormone pellet. And so to me, it gives you some really warm and fuzzy feelings that we're actually doing good for people out there.

JOHN: Can you give me a one example, just a type of person, client, patient, if you call them in terms of with the implants that what would be like their, the problem that they have, you identify it, how do you identify it? And then, um, what was the impact of, you know, using the implants?

DR. ALLEN: Well, so for a lot of women who are going through menopause, I see it as a continuum. You'll have people who have symptoms early on with the, the loss of testosterone that, that starts actually in our early thirties, women have testosterone. That's the first thing.

Oh, really? Yes. Women have testosterone and it's a very important hormone for us.

And when, when you're coming into your forties, you start to, you start to get the brain fog, you start to get anxiety, you start to get depression and, you know, nobody has a, um, venlafaxine deficiency. Nobody has a Prozac deficiency, right? So, um, when you start looking at those things and how people are interacting in their interpersonal relationships, they're tired, they have no libido, sex doesn't feel good anymore, things like that.

That patient, if you could get somebody to open up, they come in and they just say, I don't feel well. And so you have to sort of peel off the layers and figure out what's going on. And then you approach the subject of hormone replacement.

And I've had women tell me, you gave me my life back and tears streaming down their face. So it's so rewarding to see that.

JOHN: All right. Well, the next question is just kind of a follow-up on sort of the business aspects and just the lifestyle. It's just, you've been doing this, I think three or four years.

And so just kind of, other than that story, which is a very positive one, like, just give me a, what your sense is you're feeling about how it's been going. And do you really think looking back now that it's definitely been something that you're glad you got into?

KIM LOWE: Yeah, absolutely. I mean, I think we laugh now because we were at another location last year, roughly about this time, and it was an 800 square foot clinic. It was tiny.

We were on top of each other. The amount of people that we were seeing was steadily climbing, you know, every day we were seeing more and more. And so we had expanded now to our new location, which is fantastic.

It's 3000 square feet. The regenerative medicine side, the well side is on one side. And then we have the primary clinic on the other side with a conjoined waiting room.

So our patients feel like they have access to both places. The amount of awareness I think has really skyrocketed. And to be honest, you know, the best way that we get patients is word of mouth.

People are really happy with our services. We're a small town, I would say we're rural still. We're not a big town.

We're, you know, we have, we don't have a Chick-fil-A if that tells you anything. So we're not that big. We would still have a rural population and our Hermann office is very rural.

But I would say our, our clientele is just continually going uphill because people are so happy with the services. They come out, they feel better. They don't feel like every time they walk in here, they're just wrote another prescription.

JOHN: Now you've expanded the services even beyond what you've mentioned so far, right? I mean, it seems like there's new things. They probably aren't maybe, you know, 30% of your activities, but what, what other things are you doing besides what we've already talked about?

DR. ALLEN: So we have some radio frequency devices. We do aesthetic procedures like wrinkle reduction, skin tightening, body contouring. We have a cryotherapy machine.

Stress incontinence. That's huge for women.

JOHN: So now if I think about like what would be checking my boxes, it'd be something that, you know, I enjoy doing making a decent income. My patients are happy and I don't, I might be busy, but I'm, you know, I'm happy to do the work because it's, it's part of a mission. So that's what I'm kind of hearing from you that it's kind of checking all those boxes.

DR. ALLEN: Yeah. From, from my point of view, because I have both responsibilities, I mean, I, I work more than the average person who's probably watching this podcast would like to work, but from on the well side of it, it's not something that I have to do on Saturdays and Sundays or at night. And, and that's really, you know, that's really nice.

Now on the direct primary care side, I work a lot, but some of that is me. I'm kind of a workaholic, but I am getting better at boundaries. And if you just teach people, you know, Hey, I am a human being and I deserve my Saturday and Sunday, then they're okay with that.

And if they're not, then they can find somebody else. So.

JOHN: Yeah. And that reminds me when we, when we're finished and when I post this, I'll put links to everything, you know, about the well as of course, but then I'll also put links about your practice, you know, just, you never know. It might be some physicians that maybe don't even live too far from you that might want to look at, you know, what you're doing and maybe call with a few questions or send some patients over.

But, uh, you know, I, I, I've found that even physicians who are busy, if they're doing things, they love, they actually don't have burnout. I mean, they might be tired, but they're not fried the way, you know, it was back in, you know, the corporate style of medicine that most of us physicians and nurses at least learned in our training and, and dealt with. So it sounds like you'd agree with that.

DR. ALLEN: Absolutely. Yeah. Everything about it is different.

KIM LOWE: Yeah.

DR. ALLEN: The documentation is different. The requirements, the environment's just different.

KIM LOWE: The interaction with patients. I mean, just the, the doctor nurse, everything about it is completely different than an intense setting where you feel like you're constantly under a pressure cooker to do more, excel more, be better, take more patients, like all of these things where you don't, you don't have time to actually sit and talk and get to know your patient and build a rapport with your patient. And in the end, that's how you start to peel back the layers is to, to have them feel comfortable enough to talk to you because they are feeling better.

Then you really start getting to the core of a lot of the problems. Right.

JOHN: And the model that you're using with a, you know, a partnership between a physician and nurse that seems to be working out well also. Right. Because a lot of the delivery requires, you know, someone in nursing, obviously that really knows what they're doing and, you know, the physician can deal with the things that require that license.

But it makes sense to me that that would, that partnership would work out.

DR. ALLEN: Yeah, we do things. I mean, a lot of what she does in the clinic is delegated by protocol. You know, so there's established steps, but you know, she's a bachelor's prepared nurse with a lot of experience, so she can use her clinical judgment and problem solve.

And she knows her limitations and she calls me if she needs recommendations or advice.

JOHN: Yeah. Excellent. Well, go ahead and give us the links, the URL or the phone numbers, anything you want to share with anyone who might want to contact you about The Well.

KIM LOWE: So the website is thewelliv.com. And then our phone number is 636-629-8444. And we're responsive to either call or text, so we welcome either.

JOHN: All right. And so some of my listeners might want to see, you know, an example of direct primary care. So what's the website for your practice?

DR. ALLEN: It's newfreedomfamilymed.com. And our phone number is 573-271-2927.

JOHN: Okay, great. Well, we're going to get into a lot more detail during the summit. In fact, I've split this couple up for the summit, Tom Davis and I, because we want to get the perspective, you know, individually from the nurse and the physician, you know, but I think there's just so much interest in doing things like this that are novel and not your run of the mill type of practice.

And, you know, a lot of us are saying we need more individual, you know, family physicians and internists and others who are going into practice outside of the big corporate style of medicine and healthcare. So this is a really good example. So I'm really happy you were able to join me today as guests.

DR. ALLEN: Thank you. Well, thanks for having us. We, I'm very passionate about it.

And I really think that direct primary care could save our healthcare system and keep practicing physicians practicing instead of retiring early, you know, because they can't do it anymore.

JOHN: I think I have to, I might put you on the spot right now and tell you that I'm going to definitely invite you to come back and just talk about that topic sometime as someone who's been living it. And so I just throw that out there. So listeners keep that in mind.

If you want to learn about that, we'll get Dr. Allen back here sometime to talk about her practice in more detail. All right. Any last words of advice for our listeners who might be frustrated, upset, burned out, any of the above, and they're just thinking about maybe just leaving medicine completely or nursing for that matter.

Any advice?

KIM LOWE: I mean, I was there once. I mean, I thought for sure. I'm like, I'm going to go be a veterinarian or something.

But I was there. All I can say is I, I prayed on it. I thought about it.

I, I found somebody who I knew I could trust. I mean, I think, I mean, kind of the same thing. You just see the burnout was high enough.

We just, we wanted something different. We wanted more.

DR. ALLEN: I think you keep it simple. You think of an idea of something, you know, that makes sense to you and then just put one foot in front of the other and see if you can make it happen. It's scary when you keep it in here, right?

Down, look around other people.

KIM LOWE: I mean, we are more, I have people all the time that ask me, how do you do this? And I'm like, well, it's, it's simple. It's really not that hard, but if you ever want help by all means, let me know.

I don't mind giving you a hand up on something information you need to get started, or you have the idea, you have the practice, but you're looking to expand on stuff. And we do that quite a bit. I think we have a couple of practitioners that come to us and Hey, we're trying to start IVs.

Can you help us like figure out where we need to go and what we need to do? So, I mean, I just one physician, one nurse helping each other, I think is fantastic. It works out really well.

Just be willing to help.

JOHN: Yeah. I think when you're in it, you can't even see the light, you know, that there's an option. And then once you actually break through that and you start doing it, it's amazing.

It's not like easy. It's kind of simple in a sense, there's just steps you have to do and it takes work, but I think you're a good example of that making it work. Okay.

Well, thank you so much. I, with that, I am going to say goodbye and thanks again for being here.

DR. ALLEN: John, thanks for having us.

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The post Why an Infusion Lounge May Be the Best New Thing appeared first on NonClinical Physicians.

Interview with Dr. Jonathan Vitale – 345

In today's episode, we present Dr. Jonathan Vitale's inspirational masterclass on securing your first utilization management job from the 2023 Nonclinical Career Summit.

Dr. Vitale shares his journey, emphasizing the appeal of UM's remote nature, stable hours, and reduced stress compared to traditional clinical practice.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, go to nonclinicalphysicians.com/sponsorships OR contact us at john@nonclinicalphysicians.com (include SPONSOR in the Subject Line).

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Dr. Jonathan Vitale's First Utilization Management Job

Dr. Vitale shares his journey from traditional family medicine to becoming a manager of utilization management physicians, highlighting the pivotal moments in this nonclinical career path. He discusses how his early exposure to utilization management, driven by family experiences with insurance rejections, sparked his curiosity and ultimately guided his transition from clinical practice to a leadership role in UM.

Through anecdotes and reflections on his career trajectory, Dr. Vitale provides a compelling narrative that inspires physicians to explore alternative paths.

Navigating Utilization Management: Roles, Compensation, and Application Process

Delving into utilization management (UM) careers, Jonathan provides a comprehensive overview of its definition, functions, and significance within healthcare organizations. He lists the primary goals of UM, emphasizing its role in ensuring the appropriateness, efficiency, and cost-effectiveness of healthcare services while minimizing potential harm to patients.

By delineating the three main categories of UM companies and elucidating the key responsibilities associated with each, Dr. Vitale equips aspiring UM professionals with a foundational understanding essential for navigating this dynamic field.

Jonathan's Advice on Overcoming Fear of Rejection

Apply, apply, apply. The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, ‘My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened.' And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance.

Summary

In his insightful discussion, Dr. Jonathan Vitale shared his journey from family medicine to managing UM physicians, highlighting the appeal of remote work, balanced hours, and reduced stress in UM roles. Dr. Vitale also offered practical advice on gaining UM experience, building CVs, and navigating the application process.

You can contact him through his email drjonathan@drjonathan.com, or check his website drjonathan.com. He also encouraged joining the supportive community of Remote Careers for Physicians on Facebook.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Jonathan Vitale's Website
• Remote Careers for Physicians on Facebook
• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 345

How to Secure Your First Utilization Management Job

- Presentation by Dr. Jonathan Vitale

Dr. Jonathan Vitale: I'm going to talk about myself a little bit and how I got to what I do today, and then I'm going to talk about what is UM or utilization management. I'll talk about the types of UM, the day-to-day of a UM doctor, then the compensation, which everybody is very interested in, the application process, how to get experience so that you can apply, how to build your CV, how to get appropriate coaching if you need that. And then I'm happy to answer any questions.

Again, I'm Dr. Jonathan Vitale. I am a board certified family physician. I had a pretty traditional journey to being a family physician, and today I'm a manager of utilization management physicians at one of the top health insurance companies in the country.

I'll tell you a little bit about my journey and how I got there. I had a pretty typical path to becoming a family doctor, except I picked up a master's in counseling before medical school. And after medical school I did residency in Chicago and family medicine, and then I moved to New York City where I live now for my first attending job at kind of a concierge clinic that I thought I would enjoy because I really did not like the traditional doctor's schedule, the traditional working nights and weekends, working a lot.

And after doing that for really just a few years, I decided that I needed to transition. I was very fortunate and one of the very fortunate people to have heard about UM very early on. I actually knew about it when I was in high school because my brother has type one diabetes, and my parents would always be getting rejections from the insurance companies. And I always wondered why, and I would ask my mother, and she would tell me that they had doctors working at insurance companies making decisions.

I'm one of the very lucky people who knew about UM, and was intrigued by it very early on, although that's probably only about 1% of UM docs who knew what it was before they became burnt out.

But another thing I wanted to say is welcome to everybody to this amazing community. The community of nonclinical, or as I call us non-traditional physicians. It is a very, very warm community. It's a very welcoming community, and it's a community of people who really want to help you transition into a job that you love.

What I've kind of came to the realization of early in my medical career was that doctors in general, from day one of saying you're a pre-med, day one of deciding your pre-med, you are overworked, you are underappreciated, you are underpaid. And that continues for the 10 or 15 years it takes you from day one of pre-med to becoming an attending. And I think that what happens is a lot of people just become very used to being treated that way. That's why so many doctors do so much extra work for free. Name another profession where you work extra hours and aren't paid for it, or you're doing your charts at night, not paid for it, or on weekends not paid for it or taking call nights and weekends, not paid for it.

And I never understood that, and it always bothered me immensely because I think physicians are amazing. We have so much to offer and we should be fairly compensated and respected for that. And that was one of the things that got me into wanting to transition. And also my background as a counselor is really what got me interested in and after I got there coaching other physicians on how they too can get there.

What I do today in addition to my utilization management job is I also coach physicians. Specifically I help people get remote careers, mostly in UM, but I do know about other fields as well. You can always reach me at drjonathan.com or email me at drjonathan@drjonathan.com, or please, as John mentioned, join our Facebook group of Remote Careers for Physicians, which is a wonderful community of physicians helping out physicians who are interested in remote careers.

I always joke that I was into remote careers before being in a remote career was cool. I started that remote careers Facebook group in 2018, and since the pandemic, it's exploded. Nowadays everybody wants a remote career, it seems like, and I think it's as best of a time as any to transition into this field. But I'm especially going to be talking about tonight utilization management.

So, what is utilization management? It's also called utilization review. But for tonight, we're going to call it UM or utilization management. The best definition I could find is it's a systematic approach used by healthcare organizations, insurance companies, and other stakeholders to evaluate and manage the appropriateness, efficiency and cost effectiveness of healthcare services.

The primary goal of UM is to ensure that patients receive the right care at the right time in the right setting, while minimizing unnecessary treatment costs and potential harm. Another way I think about it is we reduce fraud, waste, and abuse. Probably mostly waste. Probably 80% of what we deal with are waste, wasteful orders, or wasteful requests, et cetera, which we'll talk more about later.

There's really three main buckets of UM companies, and I always like to be very general about how I describe this. And then we'll move down into some specifics. There's private UM companies. These are those third party companies that I always talk about, which are good companies to try to get experience with. Those are superfluous. Many of them are listed in nairo.org, which we'll talk about later. Then there's healthcare systems or hospital systems, which also hire UM nurses and UM doctors.

And then probably the most common for full-time docs would be insurance companies. Insurance companies also hire their own UM nurses, their own UM doctors, their own UM physical therapists, pharmacists, et cetera. And these are the big names you've all heard of. This is your Aetnas, your Humanas, your Uniteds, your Anthems, your Kaisers. They all hire their own UM clinicians to work for them.

And what you do in UM is usually one of three things. There's prior authorizations. Everybody has heard about a prior auth. Everybody knows what a prior auth is. There's certainly a lot of attention in the news nowadays around prior auths and reducing the paperwork associated with prior authorizations. But there's a lot of UM that goes along with that.

A physician orders a test, a study, a medication, a home health service, which I'm involved with. And the prior auth physician determines whether or not that meets certain criteria, and most importantly, whether or not it is medically necessary. That's prior auth. And there's also concurrent reviews. This is very common in the hospital setting. When we're talking about bed days and how long a patient can stay in a hospital, how is this patient doing day to day? They're checking in to see if they can extend and give them more days or if they're suitable to go home or go to rehab or go to a different level of care. That's called concurrent reviews.

And then the final one is probably the smallest, and those are retrospective reviews. Those are done when the service has already been provided, already been rendered, and now they're reviewing it on the backend to see if it was medically necessary and if it fit the guidelines.

The reason why a lot of people go into UM is really primarily I would say what attracts people is the lifestyle, meaning it's typically remote. It's typically 40 hours a week when you're in a full-time gig. It's a typically salaried position. Typically, not always. Also, you have very low liability. Basically, you're not practicing medicine. You don't need malpractice insurance, you carry errors in emissions insurance. It's interesting work. It's a very comfortable pace and you're not patient facing. It's a much lower, lower stress job. And you have typically, generally speaking, nights and weekends off and holidays off.

In terms of compensation, and this is a very hot topic. I'm asked this all the time. There's really not good national average data. I will tell you what I see because I look at hundreds of positions for UM all the time. And I would say there's a very big range. I'm sorry I can't be more specific, but generally if you're a full-time UM physician and you're in one of the primary care areas, you're typically talking about the lower to mid $200,000 range as a W2 base salary. I've seen it all the way up to $300,000, maybe a little bit more for people like an oncologist or people with very, very high demand skills.

But keep in mind, in addition to that, first of all, that's 40 hours a week, but in addition to that base salary, we're also talking about merit increases, which typically happen every year on the order of usually around 2% to 3%, but it can be more than that. In addition to that, you're talking about quarterly or annual bonuses, and you're also talking about usually a stock gift if you work at a large insurance company as I do.

There's a lot of additional compensation that's also very attractive. So, always keep that in mind. I always like people to keep that in mind when they're saying, "Hey, but I make all so much more money than that." I say, "Yeah, but you probably work 80 hours a week and are a hundred times more stressed." So, keep that in mind.

Some other things I wanted to talk about is basically the process of what your typical day looks like when you're doing most UM. And I'm going to talk about full-time jobs, and then we'll talk about the gigs. The full-time jobs, which are kind of the cream of the crop of UM, which are those very, very highly desired 40 hour a week full-time jobs, which are very competitive, is you typically have a set number of cases that you're reviewing per day. You're not chained to your desk. It's not like it is in most clinical practices where every second of your time is scheduled and monitored and you need to be patient facing in order to bill. No, you typically have a set number of cases that you're attempting to get through. Sometimes there's peer-to-peers involved as well. And sometimes you have a few meetings and things like that when you're at the basic medical director level. Medical director is entry level for utilization management.

And then there are also opportunities to grow, kind of like Marie was talking about at MSL. There's some opportunities to grow into more of a team lead and manage a team. And then there's opportunities for being a manager and managing a larger team, which that's what I do. I manage a large team of UM physicians and I also hire them and interview them.

And then there is also the opportunity to branch out into other fields in health insurance companies, which other people are talking about in their lectures tonight. I won't get too much into that.

Something I do want to talk about is some of the other gigs in utilization management. There are small companies, usually these third party companies that exist and they do certain reviews. They may be doing reviews for a certain procedure, they may be doing reviews for a certain medication. And what they'll do is they'll have a panel of doctors of 1099 or independent contractor physicians who they will reach out to and say, "Hey, we have this request for this medication. Can you review it for us? And we'll pay you X number of dollars." It's usually very low, by the way. It's usually like $20, $30. And those companies exist and they are superfluous.

And a lot of physicians look at that and say, "I'm not doing that." And I say, "You don't understand. You have to do that. You do that to get experience. You don't do that to make money. You do it as a side gig while you're still in your other clinical job so that you can get some experience under your belt in doing UM so that you can put that on your CV." And that's why you do those roles for six to 12 months so that you can actually have some experience to talk about when you apply for those big full-time positions.

Now, how do you get these gigs? It's pretty simple. I talk about it all the time on Remote Careers. You just go to nairo.org, the National Association of Independent Review Organization. You click on members, again, you don't become a member, you click on members and you scroll all the way down and it lists the logos of 20 or 30 of these companies.

You go to every one of those individual company websites and you navigate the website and you click on apply to be on the physician panel, and you submit your CV to every one of them. And I guarantee you, at least two or three of them will contact you within the week and put you on their panel. And that means you are now getting UM experience. That's a great way to get you UM experience. Yes, it does take a lot of time to sign up for all of them. I never said it would be easy. And it's a great way to get your first step in the door.

I always say this. My specialty is helping doctors who have no other experience, no outside experience. Normal, average doctors. I guess no doctor is average. We're all awesome. But I would say regular doctors into the world of UM who have no prior or outside experience. No connections, nothing else. That's what I help people to do because that's how I got involved.

After you have that, the next thing that you need to do after you've done that for six or 12 months, that's when you're able to actually apply to these full-time UM gigs that most people want. Like every other non-traditional job, especially nowadays, it is very competitive. However, what I can say, and I think this is really, really important, that it's not that it's super, super competitive, which it is, but it's more so the fact that doctors are used to it being ridiculously easy to get a job. If you're a regular traditional outpatient family doctor, been working at your clinic for 10 years, and now you want to move to a different city next week, and you want a job there, all you have to do is send out an email with your CV to a couple people, and you'll probably get a hundred job offers the same week.

That's how it is for clinical doctors. We're very spoiled. But that is not how it is when you make the transition. And that's something that you really have to psychologically get behind and understand that for many people it's going to take a year, sometimes two years, to actually make that transition to get enough applications in to get rejected enough. As you always hear me on Facebook, for those who follow me, I always say to people, you haven't been rejected enough yet. That's your main problem. It takes a lot of rejection, a lot of getting ghosted before you get your position. But you will get there. Don't worry, you will get there. It's just a process.

The thing that you also want to do is you want to work on your CV, and there's lots of coaches to help you with this. I'm one of them, but there's certainly many other coaches who can help you with this, many of whom you're hearing about these past three nights. And you also want to work very hard on your interview skills, and coaches can help you with that. I can certainly help as can all the other coaches.

And what you want to do is you want to make it your job to every day apply and send in your CV to openings for utilization management. These are typically listed. I like to keep things simple. They're typically listed on Indeed, on LinkedIn and also on the private insurance company's websites.

What I encourage people to do who are interested in a life of UM is every single day, it only probably takes about an hour out of your day, you want to be visiting every one of those websites, and you want to be searching, you want to save this in search, you want to be searching for medical director utilization review, utilization management, utilization review, physician, physician reviewer, MD reviewer. All those synonymous terms that a lot of companies use. And then you want to be looking for those positions and you want to be submitting your CV.

Yes, absolutely. Networking is great. If you can do that, if you have any contacts, if you network through LinkedIn, if you network through one of these conferences through a SEEK conference for anything like that, that's wonderful. But what I can tell you is that in the UM world, things move very quickly and that works both in your favor and against your favor.

Let me be more specific about timing. I always talk about when I first got into UM about how I applied for a year and got rejected probably over a thousand times. At least hundreds and hundreds of times I was rejected or ghosted. And what I've learned now that I'm a hiring manager for UM is that timing is everything.

Let me be more specific on that. Many times these UM companies, especially the insurance companies, which are the largest employer of UM docs, are always trying to get more business. They're always trying to get more contracts. They're always trying to expand their geography. They're always trying to do UM for another network, for another geographic location. They have business folks who that's all they do is try to broaden their business.

And as you guys know, anybody who's worked in business, business is a tough field. Things move very fast and sometimes very unexpected. You can literally be at a job or I can literally be in a position and I can literally hear one day, "Hey, you know what? We finally got that contract we've been after for eight months or 12 months. Now we have a need for five other doctors on your team, as we call them FTEs, full-time equivalents, five FTEs on your team. And you need to get them up and trained and ready to go as soon as humanly possible because we're going to start getting UM cases from that network in three months. And we got to be ready to go."

This is the kind of thing that happens. So, what am I doing? We're posting it on our website. And the first good CV I get who is board certified, who's got some decent experience, I am scheduling them for an interview. But let me tell you what though. That same candidate, if they applied two weeks before, they probably would've gotten either ghosted or rejected. Again, I don't write the rules, ladies and gentlemen, I'm just telling you what they are.

The HR oasis for these big companies is don't assume that they're going to put your CV on hold. Don't assume that every job listed currently is available. That's another one. Don't assume that you're going to even hear back. That's why my best advice is it's a numbers game. When the new positions come up, is why you have to be checking every single day. You need to be applying for that new position, because that happens all the time in UM. And which is good news for people like us, because it means there are definitely jobs that open up and that need good folks.

But the flip side of that though is let's say that you have 20 years of UM experience, 20 years of clinical experience, and you're the most competent UM doc in the world, and you reach out to me and send me your CV today. I'd say "I can't do anything with this but thank you." Because we don't have any openings, I'd say just keep monitoring our website. That's how it works at a lot of the large health insurance companies. Yes, there's other things that happen at smaller companies where they may keep things on hold, but I'm just telling you how it works at the large health insurance companies. That's why I always say to people, and you see me say this on Facebook and everywhere else. Apply, apply, apply.

The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, "My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened." And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance. And these jobs, especially UM jobs, as Marie was talking about MSL jobs, they're very competitive. There's more docs than ever that are looking to make a transition. The other thing is doctors are looking to make a transition earlier and earlier in their careers.

My team, I would say on a whole, at this point, we have about 25 docs on my team. And we are all stages of our career. There's people who are in their early career, mid-career, late career. There's people who are post-retirement who just do this for fun. If that tells you anything about the job as well.

So, it is difficult to get a position, but it's definitely not impossible. It just takes persistence and there's so many people who are there to help you.

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The post How To Secure Your First Utilization Management Job appeared first on NonClinical Physicians.

Interview with Dr. Lara Salyer – 344

In today's episode, Dr. Lara Salyer explains how she integrates the best of traditional and functional medicine in her practice. In the process, she takes listeners on a journey of career reinvention and personal empowerment. 

Dr. Salyer shares valuable insights and practical advice for practitioners seeking fulfillment and career balance. From the transformative power of creativity to the importance of storytelling and self-expression, listeners are inspired to try something new.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

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We'll learn about creating a cash-based practice, MedSpa, Infusion Center, or other business, protecting yourself legally, and learning a lucrative side gig or investing in real estate.

Admission to the live event is free. If you prefer, you can purchase the recordings and bonuses for a small fee. Please join us on the evenings of April 16 through 18.

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Reimagining Healthcare and Integrating the Best Parts

In this engaging podcast episode, Dr. Lara Salyer reflects on her transition from burnout in family practice to discovering functional medicine. During our interview, she emphasized the importance of aligning one's career with personal passions and values. Dr. Salyer highlights the transformative power of creativity and innovation in revitalizing professional and personal fulfillment.

Empowering Practitioners and Cultivating Her Speaking Engagements

Lara describes her new role as a mentor, guiding practitioners through strategies for reclaiming joy and autonomy in their careers. She shares practical tips for crafting impactful speeches and navigating the speaking circuit, emphasizing the value of storytelling and authenticity. Additionally, she explores the significance of boundaries, self-expression, and embracing “messy” progress.

Dr. Lara Salyer's Advice on Career Fulfillment

Find your path to fulfillment with WARM: If I'm feeling stuck, overwhelmed, unhappy, I start with “W.” Whose voice is in my head right now making me feel bad?… then Aim low with tiny steps, Remember your ‘why', and “M” is “Messy moves the needle,” you don't have to be perfect.

Summary

Through engaging anecdotes and actionable tips, Dr. Salyer offers a roadmap for reclaiming passion and purpose. Whether you're navigating burnout or seeking to reignite your professional spark, Lara provides hope and guidance, reminding us that it's never too late to design a career that aligns with our deepest values and aspirations. To get in touch with Dr. Salyer you can find more information and contact her directly on her website drlarasalyer.com.

And if you wish to access any of her programs, you can use the Coupon Code “CATALYST” for a $50.00 discount off the usual price.

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• Dr. Lara Salyer's Website
• Freed.ai Medical Scribe App
• How to Reclaim the Best Parts of Your Career – 120
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 344

Integrating the Best of Traditional and Functional Medicine

- Interview with Dr. Lara Salyer

John: Sometimes when rebooting your practice, it's helpful to speak with someone who has a lot of imagination, and that describes today's guest to a T. She first appeared in the podcast in December of 2019, and she was about two years into reimagining herself, at least her approach to patient care. And she's continued to innovate since then, and she's now mentoring clinicians, more than she was at that time. I think that she's a great one to talk to today about remastering, recreating your life and your career. Dr. Lara Salyer, hello and welcome to the podcast.

Dr. Lara Salyer: It's a pleasure, John. I was so excited to receive your email invitation again, and mind blown that it's been four years. I feel like it was just yesterday. We were talking about innovation and transforming healthcare, and look, it continues. I'm happy to talk to your listeners about reimagining healthcare.

John: Yeah, I couldn't believe it either, because I just made a point a few months ago to say, well, I got to go back to my old guests and see what they're up to. And in my mind, your name just stands out. It isn't like something I had to dredge up. It's like, yeah, Laura, she's in the Midwest, she's been doing all these things in Wisconsin. Four years. That is crazy.

Dr. Lara Salyer: It's crazy. We're practically neighbors. But see, this is the beauty of what we've all been through in this global pandemic in the last four years, the world is made larger and smaller. I feel like it's really exploded our ability to connect across the seas and virtually. With the advent of telemedicine laws changing, there's so much cool things and innovations and AI that it's really inspired me. And yeah, I'd love to dive in and just talk about all the changes. Where should we start?

John: Well, let's see. We don't have to redo everything we did last time. I will have a link to the previous episode that has a lot of the information and how you found functional medicine and got involved in that, which I think has escalated exponentially. But anyway, start from there maybe and where we were then. And just touch on some of the things that are new about you and your practice and what you're doing with patients and other physicians.

Dr. Lara Salyer: Sure. Well, this is sort of the example of creating your own career that is a self-expressive vote of the future you'd like to see. And that's really what I embody and I try to use this as my compass as my mantra every day. Just in a one sentence nutshell, I was a burned out family practice doctor, realized I was burned out, not sure if I wanted to stay in medicine, but then fell in love with functional medicine on my last CME and decided that's what I wanted to do. I opened up my practice and we had our interview in 2019 and I talked about what that entailed being an entrepreneur in this space and learning those ropes.

Well, since 2019, I've really enjoyed embracing this creativity of educating patients with online courses and having online group visits every week that provides an ecosystem of support for my patients and really exploring this sandbox of tools that we have right at our disposal to make medicine fun again. And it's naturally been sort of an attracting beacon to other practitioners looking to innovate and to explore some of these options.

I've really amped up my mentoring, not just in the functional and integrative space. I help those practitioners grow and scale a membership practice in their own community using a lot of AI and tech. But I also mentor colleagues in burnout, those that want to tap back into creativity. I graduated from the flow research collective in their high flow leadership, so I can coach how to get that flow acquisition, which for those that don't know, flow is the only time your brain produces all five neurochemicals of happiness. The more you learn how to make your day flow channeled, the happier you are, the more easeful life feels.

And so, I'm enjoying this renaissance of my own personal career, helping practitioners learn how to become and embody their ideal self. And then that naturally just extends into my international speaking career. I had the honor of being invited to the center stage in London last year, last summer, on the largest European medical conference and was able to stand beside some greats that I was honored to have shoulder to shoulder. It just keeps expanding and it's just fun. And like I tell my teens when it stops being fun, now that's the time you need to think of making a shift. But I'm still having a blast.

John: That's a lot to talk about and to consider, but it sounds very positive. I don't know if we're going to get into the flow thing a lot, but maybe we will. But maybe just for our purposes, is that flow state, whether you're working or at home doing something, I'm assuming that's the same thing that in general we talk about when you're in that zone.

Dr. Lara Salyer: Yeah, in the zone. Yes. Just simple. Mihaly Csikszentmihalyi coined the term and it's anything from being in a sport or you're doing Tetris or you're balancing your books. It's just being in deep work.

John: Okay. Cool. I wanted to talk about the speaking a little bit because a lot of my listeners ask me about how to get into that. It seems to be kind of a black box. They don't know how to start. And just some tips on becoming a recognized speaker and getting some of the big types of engagements that you've talked about already today.

Dr. Lara Salyer: I've got lots of tips, John. I think I'm a shameless kind of person who is open to feedback all the time. So, be prepared to speak and make mistakes and fumble and keep getting up and trying again. But the key to establishing your own speaking career is finding your story. You have to have a story and everybody has a story. And once you find the story that is underlying this anchoring mission of why you feel compelled to speak, what are you speaking about? For me, it's speaking about healthcare burnout and the intersection of creativity and how we've lost that piece in healthcare.

And I really believe that physicians, if we could be allowed more autonomy to be self-expressive in the way we deliver medicine, we wouldn't have as much burnout. Of course, it's not that simple. If you look at my message, anybody could look at it and go, "Well, that's not the cure to burnout." No, I'm not saying it is. But it gives me the platform to tell my story, to offer things that I've learned that have helped people. I work with residencies and medical schools and I travel and do workshops. I'm able to craft this around my central story, which is I'm a physician who burned out and found a second career. Or third or fourth, however many you want to count. For anybody listening who's thinking, "How can I develop my speaking career?" start looking at your story. What's your story say? What are you passionate about? If anybody stopped you on the street and said, "You have 40 minutes to tell me something that you're passionate about without any slides, without any prep." That is what you need to talk about.

And so, right there, getting the topic and then second, crafting your PowerPoint, working with a mentor. I had my own public speaking coach, and I believe firmly in coaching. And that's part of the underlying result of my mission with working with so many residencies in medical schools and in my mission that I want to make coaching a part of medical school. That every medical student has a coach assigned. Everybody's got somebody there because we are not above needing that kind of executive help.

And so, when you work with a coach, like a public speaking coach, it can help save time and unlock some of the things that you didn't know you were doing and fidgeting. It makes such a difference. I would start there with knowing your story. What does that say about your mission and your vision in the world? And then working with a coach to help you craft that narrative and really make it professional.

John: I think that's awesome. Because when I think about things that successfully communicate, whether it's a book or a presentation, it always includes a story. Either the speaker's story, the writer's story, or somebody else's story, but it always ties back. That gives that great example of the point you're trying to make and it pulls people in, and they want to hear how the story ends. So, that's cool.

Dr. Lara Salyer: Yes. At least for me, I hated being in, and this is just my preference. Whenever I would be in a lecture or in some kind of presentation and listening to the speaker, it always felt empty to me when there wasn't some kind of transformative takeaway. And so, I like having all of my talks have something at the end that the listener gets, whether it's something that they can download or something that they can walk away with and remember you by. If you're looking to make a speaking career, develop that signature talk. Have some kind of takeaway. Like something downloadable. And if you don't have any of the fancy things like a CRM or an autoresponder, if those words don't resonate with you, you can simply just ask them to give you their email and you can send them something. You can be very old school about it. You don't have to be super polished and professional.

John: I think there are other people that think, "Okay, I'd love to have a speaking career." I don't think they're necessarily as committed because they're a little nervous to have a little stage fright. So, how do you get ready? That UK presentation, that was a big deal.

Dr. Lara Salyer: That was a huge deal. Oh my gosh.

John: How did you prep yourself for that?

Dr. Lara Salyer: Oh goodness. Well, it's that fine line of delusional almost OCD prepping and then trusting the universe that it'll be okay. I love the books. TED Talks, Chris Anderson, or Talk Like TED. Those are the two favorite books I have. I also like Rule the Room is another book, that's a resource. And I often listen to a podcast by Grant Baldwin called Speakers Lab. And believe it or not, that has taught me more than anything because he goes into the business of speaking of how to invite people or pitch to people and follow up and all those kinds of things.

I've learned a lot about the business, but when you're coming down to the wire and you're practicing, it's a combination of I would look at my slides because I was allowed to have some slides, but it was a TED style talk. I had 20 minutes to give my one message. And so, I would practice with the slides and then I would go on a walk and I would listen to myself because I recorded myself and I would listen and imagine the slides on my walk. And then I would try to see if I could anticipate the next sentence. I'd pause the recording and see if I could anticipate the next sentence, not so that it was rote memorization because a lot of public speaking coaches would say, "That's awful. You do not want to memorize your talk." You want it to feel like a conversation. And you want to allow for inflection and for moments of improv in a way.

What I would do is divide my talk into four segments of main points and I would try to anticipate, "Oh yeah, there's that next point. I'm going to talk about this." And that's all it was, was a summer of walks with my dog and just really memorizing the next point that was going to happen until I became comfortable that I felt like I could do it without any help.

John: No, that's awesome. Because you can tell, I watched a lot of TED talks in some of the smaller venues. You can tell the speaker is glancing at a monitor or screen or something to remind them of what they're doing. It doesn't really flow and it's okay, the message is good, but when you have a really good speaker, it flows and it's engaging and it goes by like in two minutes.

Dr. Lara Salyer: Yes. And don't be afraid to practice. Before that UK talk, I had other opportunities where people said, "Could you just give a 20 minute? - Oh yes, absolutely." And I remember in Toronto, I was asked to speak at a very large event for naturopathic doctors, and it was going to be broadcasted and I had no teleprompter, nothing, no slides. I thought, "This is even harder than UK. I am on it. Let's do this. This is going to be gritty test time." And I did it. And guess what? There were interruptions. Somebody walked in front of the feed when it was being recorded. There was a person that interrupted the door and I got put off. I didn't remember my next line, but guess what I did? It just took a moment. And that's the thing is when you face that kind of awkwardness and you realize you're not going to evaporate into ashes, it's okay. And you chuckle and you learn how to sidestep.

Everybody wants you to succeed. Nobody is sitting in the audience waiting for you to mess up and going, "There it is. I'm glad she's messing up." They want you to have a great time. So if you fake it till you make it in that moment and be like, "Okay, here we go", that's when you get to be that elevated speaker that people want to hear from because you're relatable.

John: That's great. That's awesome. I love that. And a lot of resources, I wrote those down and we'll put those in the show notes so people that are really interested can take advantage of those.

Okay. We're going to move into helping other clinicians, but I think before we get into that and how you're doing that, I think our listeners need to understand exactly what does your practice look like now? Functional medicine, not everybody even know what the functional medicine is and kind of tied to that. I think you still call what I would call clients patients but there's a distinction that some people make. And I think it's easier in functional medicine than let's say in doing something like yoga. You're not going to call them. If you can capture all of that in the opening of this next section here on how you help physicians.

Dr. Lara Salyer: Sure. Real quick, I do have a license to practice medicine in Wisconsin and Illinois. I have my attorney that comes in and teaches inside my mentorship for practitioners. I stay very, very close to the law. I don't want to call my patients clients. I'm still a physician, so I have a physician patient relationship. But my practice is very tiny. I call it very cozy. And I keep it that way because I have a lot of other hats I wear. Last year I was invited to be the director of practitioner activation for the School of Applied Functional Medicine. Basically I am the mentor for their school. And so, that is a job that I do part-time, but I also have my own mentorship, the Catalyst studio.

And these are practitioners that come in for 12 months and they're with me and they have a bunch of resources online. And we work one-on-one, and we also have weekly masterminding. We call it studio time. And the reason I've created this artistic metaphor is because I want physicians to create their masterpiece, their work-life masterpiece. I don't believe in work-life balance. I don't think that is something we can achieve. I believe it's a masterpiece. It's an integration of work and life. And so, they're with me for 12 months. And then in addition to that, I have one off session.

People that aren't even in functional medicine, they don't even care about integrative medicine. They might be a medical student, a resident, or just an attending who's like, "Hey, I need some inspiration on how can I pedal through some of these emotions, this burnout." I use solutions focused, positive psychology, a little bit of acceptance commitment techniques that help them tap back into flow. And I give ideas and resources and really get them back into what are they doing here. And helping them with decisions. It can be making a decision on the next step for their career or just how to play again as an adult. We forget that and kids are so good at that. I love being almost that little inspirational fairy that can help my colleagues get back into that childlike wonder.

John: Can you give me an example? And it could be even amalgam of many people, but what is the type of person that shows up at the beginning, either for the one-off mentoring or the 12 month? And then how does it look different at the end of that period? I'm just trying to get that so the listener can say, "Hey, that sounds like it's right up my alley."

Dr. Lara Salyer: Yes. That's great. I like to call this the average practitioner. They are frantic, they're rushed, they're stressed. They're feeling almost hopeless and wondering why they chose this career. But they feel stuck like "I have to be in this track." They don't see many options. They've probably not played or had their hobby dusted off the shelf for years. They probably look at you with blank eyes when you said, "When was the last time you did something fun?" They don't even know. They don't have free time. They really are a victim of their calendar. They're really reactive in their calendar planning instead of proactive. That's the typical practitioner.

And then at the end of my programs, I call them the catalysts. The catalysts, they are expansive, open-minded. They're innovative. They are very much in control of their calendar. They're very autonomous. They see those elements in their calendar and time and space and energy. They're boundaried. They're able to really keep and protect that energy and spend it on things that give them joy. They are more tapped into gratitude and creativity. And these catalysts are such a joy.

And so, I can take people through this journey. In fact, I have a 10 hour CME course that people can take online. Completely self-driven. And it helps them kind of walk through the standards that I've found have worked really well for my clients. I call those clients, my mentees, my catalyst. And it helps walk them through some of the basic foundations of finding your flow and finding your anchoring down into your "why" and how to use that throughout your day to bring joy back into focus.

John: On average, is that group of people employed at a large organization where a corporatization of medicine has kind of driven most of them crazy? Or are they in a practice and they're just overwhelmed? They may own it, but it's out of control because they're trying to handle everything.

Dr. Lara Salyer: That's great. For the functional integrative physicians and practitioners inside my 12 month mentorship, those people usually are solopreneurs. They might be employed, they might have a hybrid practice of insurance and cash pay. And these people are really looking how to strategically move that business. How to make it more streamlined and flow channeled. The one-off catalyst advantage, those are the people that sign up for just one or two or three sessions.

I have bundles of packages where they can meet with me one-on-one, and there's nothing to do with business. It's more about personal development. And those come from all walks of life. I have discounts for students and residents because I remember those days, you can't really afford much. And then it can be attendings, it can be nurse practitioners, people that are just curious about personally developing themselves. And they come from all walks of life as well. They could be independent, most of them employed.

My grand goal in my future, my five to 10 goal is I would love to be a chief wellness officer at a large organization because I've enjoyed working in this high level systemic change and seeing the results of what some of these modalities can do for practitioners is really life affirming for me. So, it's just been a wonderful journey.

John: Now as a secret in some of those to really focus on doing what you love and where the flow can occur potentially, and getting rid of the stuff that just drives you crazy. And does that require delegation? Does that require, or can it enable one to say, "Look, I'm a family physician, but I'm not going to do 100% of what a family physician could do. I'm going to focus on something that I like to do and I'm going to get rid of the rest."

Dr. Lara Salyer: Yes. Oh, I love this. It is getting comfortable disappointing other people. I think as physicians, especially family physicians, we are the bottom of the totem pole. We get everything dumped on us and we just get used to serving our patients, saying yes, doing it all. And it's time to push back. And it's okay to have boundaries. This is where I help people with those boundaries in saying, "Listen, if you are literally burning up and you are a miserable shell of a human, you're going to work, you're coming home from work and you are just not happy at all, something's got to change."

Now you can't change overnight the whole system. The system is slowly changing. But we are at a dawn of a new healthcare with AI helping. I love freed.ai. It's a wonderful program that is a charting program where all it does is listen to you and your patient and creates a beautiful SOAP note. I actually interviewed the founders. It's a resident and her husband who's a computer guy, they founded this company. It's phenomenal. And it's things like this that are going to help us fall back in love with medicine and do what we do best, which is being a healer. We are right now data entry clerks and we're not able to delegate because a lot of hospitals are saying, "No, you have to enter in those lab results. No, you have to do it all." And it's crumbling.

I really believe if we hang on, we are almost through the dark ages of medicine and we're about to enter the dawn of where AI can help us and it's suddenly going to be so much fun. It's like driving a Tesla. It's just, "Wow, everything's done for me." And so, hanging on, I think that's my role in this whole structure is helping our colleagues just to hang on and let's find a way through this that can help you stay human while we wait for AI to help. And it might mean take a day off every week and you go to your administrator saying, "I need to be different RVU. I need to back it down." Because we want to want to save you before you go out with the ship.

John: What was that link again to that AI tool?

Dr. Lara Salyer: Yeah, it's freed.ai. And what I love about them is they give you 10 free visits to try them out. You don't even have to put a credit card in. The proof is in there, amazing algorithms and AI. And then when you do, it's really affordable. You can get an industry, your whole institution can get a license, or you can get your own. If you use the code CATALYST, you get $50 off. I'll just give that out there so people can get a discount if they want it.

John: Excellent. I'll tell you and our listeners here why I am so interested in this is because my thing in the past has been "What other options can you do if you're a burned out physician?" But really, 15, 20 years ago, there wasn't a lot of focus on fixing within your own practice or something like your practice. Now I'm trying to get more people like you to say, let's go back to the beginning and take all the good things that you wanted to be when you went through med school and residency. And let's try and get rid of the other crap that doesn't help.

Dr. Lara Salyer: Yes.

John: That's just holding you down. And as we push this, I think we're going to see more of it. So, I appreciate what you're saying.

Dr. Lara Salyer: I'm glad that you've recognized that. I think there is an exodus of people. Their pendulum swung where people were leaving. Sadly, we lose a lot of people to suicide, a whole medical school class worth every year. And there's a lot of physicians that are just retiring early. But I think the pendulum is going to swing back the other way. Like you said, I want to save the career of medicine. I want to make the career of medicine something that still honors the joy and the creativity and the self-expression. Nobody wants to go see a robotic doctor. And so, I really think that we're almost there. We just got to hang on a bit and keep working at it.

John: The thing is not only are physicians frustrated and upset, the patients aren't happy. They're not happy with a five minute visit for something it takes 20 minutes normally and the doctor spends all their time documenting and sending notes in and blah, blah, blah. The whole thing has to change for patients as much as for physicians.

All right. Why don't you spend a couple minutes telling us about your website and what's on your website and how to get ahold of you and all that kind of stuff?

Dr. Lara Salyer: Oh, sure. Absolutely. We'll start to different things. If you're a patient in Wisconsin or Illinois, you can find me on my website, drlarasalyer.com. But I do keep a very, very long waiting list because I devote a lot of my time and passion to our colleagues. So, if you're a physician, a nurse practitioner, and you're curious about what creativity and flow can do to enhance your happiness and joy, again, go to my website, drlarasalyer.com and you'll be prompted through a series of buttons. It'll ask "What are you here for?" And it will direct you to the practitioner page.

And I would encourage you to take the Catalyst Archetype quiz. It's a free quiz. You'll be matched to one of the four archetypes. Are you a fervent flame, a resolute rock, a wise wind, a reflective river? And then it matches you to a two-page plan that will give you suggestions on adult play activities, things that you could do to enhance your hobbies and self-expression.

And also on that page, you'll find opportunities to do a sample session with me, a real one-on-one working session where we can just dive in and start getting you aligned with your best self. And all my stuff is there. If you need a speaker for your next conference, you need a keynote, again, I have a speaking page on my website. I love speaking. I'd love to connect with you. And there's an application form there as well.

John: Excellent. Well, listeners, I think you should take advantage of that, even if you have to skip the next few weeks of podcast listening. Spend that time checking out Lara's website and make a plan to change your life if you're not happy.

All right, Lara, we're going to run out of time here. So, just some more advice, some last minute advice before we go to our listeners who might be unhappy, out of balance, just frustrated and not enjoying their careers in particular. What advice do you have before we go?

Dr. Lara Salyer: I love little acronyms. I'm going to give you an acronym that I use when I'm feeling stuck, when I'm feeling unmotivated or overwhelmed. It's WARM and it goes like this. If I'm feeling stuck, overwhelmed, unhappy, I start with "W" and I ask, "Who's talking? Whose voice is in my head?" Is it the administrators saying, "You need to see more?" Whose voice is in my head right now making me feel bad? Is it my family of origin? Maybe it's an auntie or a grandma or something. Who's talking right now? Am I listening to my own voice or is it someone else?

The next is "A", which is aim low, not aim high. Aim low. Use Tiny Atomic Habits. James Clear is famous for that book. Atomic Habits. Do one tiny thing. Aim Low. What can you do in the next moment, even if it's just your next breath? Aim low. You're looking for tiny evidences of progress that you can find your way out of this mess.

Then "R" which is reason. What is your reason? What is your reason for medicine? Anchor yourself back into your "why." Why are you doing this? And there's many reasons. And it can shift, it could be stability. I wanted a predictable career. I wanted travel, whatever. But look at your reason because it may have shifted and maybe you're aiming towards the wrong North Star. But just look at that reason.

And lastly, "M" which is messy moves the needle. You don't have to be perfect, you don't have to have the answers all right now. You don't have to figure it out, but you can be messy and show up messy in this spot. When you're feeling overwhelmed, stressed, just remember WARM. Who's talking, aim low, find that reason, and then just be messy and give it another day. It's always going to be better.

John: Thanks for that. I'm going to write that down and see if I can apply it to something I'm doing today.

Dr. Lara Salyer: Perfect. It works every time for me.

John: It sounds like it does. I like the last one too. You're saying in there messy moves, avoid perfection. Don't let perfection drive you so much. Just do something in the right direction. I like that.

All right, Lara, this has been fantastic. We're going to have to get together again, probably in less than four years, if I'm still podcasting.

Dr. Lara Salyer: Another leap year.

John: Oh yeah. No, that's not good. All right. I want to really thank you for being here, and I'll put all those links in the show notes and share it. And with that, I'll say goodbye.

Dr. Lara Salyer: Thank you, John. Bye.

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The post Integrating the Best of Traditional and Functional Medicine appeared first on NonClinical Physicians.

Interview with Dr. Chelsea Turgeon – 343

In today's episode, Dr. Chelsea Turgeon describes her unique career as a coach and digital nomad. This episode is an excerpt from Chelsea's popular lecture from the 2023 Nonclinical Career Summit hosted by John Jurica and Tom Davis.

The narrative explores the internal conflicts, moments of self-discovery, and the decision to step off the conventional path. The blog provides a nuanced view of the highs and lows of the digital nomad experience, dispelling myths while offering practical advice.

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The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, go to nonclinicalphysicians.com/sponsorships OR contact us at john@nonclinicalphysicians.com (include SPONSOR in the Subject Line).

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Dr. Chelsea Turgeon's Journey

Dr. Turgeon recounts the challenges she faced during her medical education, exploring the mismatch between her interests and the demands of hospital-based rotations. As she grappled with the internal conflict of wanting more freedom, she took a leave of absence to focus on her next steps.

Her journey took an unexpected turn as she resigned from residency, eventually finding herself teaching English in South Korea.

Embracing the Digital Nomad Lifestyle

Chelsea shares her experiences with the digital nomad lifestyle, both the invigorating aspects and the challenges. She emphasizes the importance of intentional routines to maintain stability despite the transient nature of her lifestyle.

She shares her observations on nurturing relationships while traveling. And she provides insights into earning an income remotely, with examples of healthcare professionals thriving in unconventional roles from telehealth to health tech consultancy.

Navigating the Road to Financial Freedom and Fulfillment

Dr. Turgeon provides valuable insights into financial strategies for sustaining a digital nomad lifestyle. She discusses fellow healthcare professionals who have successfully transitioned into remote roles, such as speech-language pathologists conducting virtual patient sessions and veterinarians specializing in remote image analysis. Additionally, she explores alternative career paths demonstrating that lucrative remote opportunities exist outside the traditional medical sphere.

Summary

Dr. Turgeon recounts her transformative path, from teaching English in South Korea to embracing the life of a Digital Nomad, building her own successful business, and achieving a six-figure income across 20 different countries. Her presentation concludes with insights into how she and others discovered meaningful work, creating a life that is both fascinating and deeply fulfilling.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• Dr. Chelsea Turgeon's Website
• Pathway to Purpose Coaching Program
• Dr. Chelsea Turgeon's LinkedIn Profile
• How You Can Forge a Wonderful Life After Medicine – 246
• How to Go from Surviving to Thriving in a Remote Healthcare Job – 278
• Light Your Entrepreneurial Fire and Create Your Ideal Life
• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 343

The Extraordinary Life of the Physician Digital Nomad

- Presentation by Dr. Chelsea Turgeon

John: This is Dr. Chelsea Turgeon. Chelsea, is it true that you're coming to us from Bulgaria today?

Dr. Chelsea Turgeon: It is true.

John: Oh, my gosh. Well, the wonders of technology make this all possible, so I'm going to be really interested in hearing what you have to say. And so with that, I'll just turn it over to you for the next 30 minutes or so.

Dr. Chelsea Turgeon: Yeah, absolutely. Thank you so much for having me. I'm so happy to be here. I'm going to just go through and talk about my story and how it is that I got to be having this conversation with you guys from Sophia, Bulgaria, where I have been learning to ski for the past few weeks, which is something I'm totally new at. I literally had never put those on my feet before. And just a quick doctor reference that people will get. When I first put the skis on and started to ski, it literally felt like laparoscopic surgery with my feet. Because in laparoscopic surgery the instruments are these extensions of your hands that are really clumsy and it's hard to figure out how to navigate them. And you have to figure out if you move it this way, it goes up, and if you move it this way, it goes down. And it literally felt like having laparoscopic instruments on my feet until I learned how to navigate it better. That's just something I thought that I told some of my surgeon clients that and they were like, "Yeah, we totally appreciate that."

My story. I initially started out, I grew up in Alabama, born and raised there. I always have been interested in psychology. I was somebody who was quite a nerd growing up. I would have my parents drop me off at Barnes & Noble and I would say I was going to study. And I would study, but then I would go to the self-help aisle and just browse the aisles, looking at all of the books on happiness and how to deal with rejection and overcoming depression. And I was just so interested in that whole world. I was interested in how the mind work, how to become happier, how to live better. And that was an interest that I always took with me. In college I majored in psychology and I was trying to decide my career path going forward.

And I did what most people do when they're trying to figure out their career path, which is I pulled the audience. I pulled anyone and everyone around me, which is how a lot of us are taught to approach our careers, is looking outside of us for approval, for advice, for other people's ideas of what we should do with our own lives.

I would tell people, "Okay, I'm majoring in psychology. I think I'm either going to be pre-med and become a psychiatrist, or go to grad school and become a clinical psychologist." And every time I presented those options to people, I would get met with this insane amount of validation around the idea of going to med school, becoming a doctor. "Oh, you must be so smart. What a noble profession." I just slowly started to lean towards that as my career path.

I didn't totally know this at the time, but I was very much craving this external validation and basing a lot of my career decisions from this place of what is going to impress other people and what is going to make me feel important and significant. And so, I was making my career decisions from that place, which is so common. A lot of people do that. I wasn't really going into myself and asking, "What would I really love to be doing?" And I also think from a young age, we're taught to look at what do college admissions want to see on their application? What kind of test scores are you supposed to have? What sort of extra curriculars are you supposed to have? We're just used to basing everything we do on these external metrics that other people are putting on us and then we conform to those metrics.

And so, that's what I was doing and that's what I did for years. I went through medical school. I actually didn't mind my first two years. I do really like learning and studying and I liked that there was a lot more kind of location independence in med school actually. We didn't have to go to classes. We only had to go to 20% or maybe 50%. We had this small percentage where we actually had to be in class. We could actually do a lot of it on our own time, watch the recordings of classes.

I actually spent a lot of time in cafes and being on my own schedule. Like I could go to the gym in the mornings and I only had to be present for a few things. And I actually did really enjoy that flexibility. That was in first and second year. And so, I think having that sort of lifestyle was enough for me at that point to get through the hard parts of the rigorous curriculum, the long hours of studying and all of that.

But then I got to third and fourth year, and the way my med school was structured third and fourth year are very hospital based. You're on rotations, you have a set schedule. You're there for very long hours, 12 hours at a time in the hospital sometimes. They expect you to work weekends even as medical students.

And so, that was the first time I really started to feel this sense of rigidity and like I'm being boxed in. And I couldn't wait until I got off every day. Every day, as soon as my attending said I could go home, I would just feel this huge weight off my shoulders, this relief, just excessively happy to be leaving. And I was starting to question it at that point, "Do I want to be working in a job where all I'm doing is looking forward to the moment I can leave every day?" And there were things I liked about interacting with the patients, but I didn't really love the hospital setting as a whole. I had a hard time with the hours. I require so much sleep. I sleep eight hours a night at least. And then I take a nap during the day. And so, just having that sleep deprivation, I know it's challenging for so many people, but I was really struggling with not getting enough sleep, with just the rigidity of the schedule.

And I started to realize I'm not really that interested in all of the evidence-based medicine and all of the science and the studies and the research. Going and having to learn about the research and the evidence just felt like such a difficult thing to do. It was something I didn't want to learn about. What I was more interested in were things like motivational interviewing to help patients with smoking cessation. I was much more interested in the psychological aspect and the behavioral change. But again, these are things I noticed after the fact and not things that I was paying attention to as much at the time.

I kept going on, I carried on through, I went to residency. I decided to do OB-GYN residency and I made it through my first year. And after the first year, I was really having these big doubts around if medicine is the right career path for me. I was able to push off the nagging thought for a while. I had this thought, "Maybe medicine is not right for me." I was starting to have all these other ideas of what I wanted to do. I started to listen to podcasts about people who are traveling the world and making money online. And I was like, "Wait, this is a thing."

I learned about the world of coaching. My sister actually introduced me to the world of coaching. She got a life coach. And when I was making the transition from med school to residency, I was feeling a lot of anxiety, a lot of imposter syndrome, a lot of just fear, uncertainty. I felt like I was on this conveyor belt that was going and it was like there was no exit of the conveyor belt and I was just stuck on it. And I was leaning back and it was just moving forward. And I was going into this factory, or into this whatever, that's going to crush me. That's how I was feeling as I was going into residency. And I was like, "I think I need some help, but I don't know if it's therapy."

My sister referred me to her life coach and I started working with a coach myself and remember feeling so jealous of her. Because at one point she was emailing me from Rome and I was like, "Wait, you're in Rome and you're working and you're just traveling there for fun." And so, all these little moments of me sort of noticing, this is one thing I tell my clients all the time, is to pay attention to your jealousy. Because while we experience it as an uncomfortable emotion, it is actually a very powerful indication of what we want. It doesn't always mean we want the exact thing that we're jealous of, but within that we can dig in and say, "What does this mean about what I want?"

And for this, I was like, "I think this means that I want more freedom. I love the idea of being able to travel. It feels expansive." And so, all of this is happening as I'm starting residency. And I was like, well, I'm just going to try residency anyways. I'm going to give it a proper try. I'm going to see if the reason I didn't like being in the hospital in the first place was because as a med student, you don't really have many responsibilities. You're just kind of there shadowing and you don't really know where you fit in.

And I was like, "Maybe I just feel awkward and I feel like I don't know what to do. And so, maybe when it's my actual job and I have a role, I'll feel useful, I'll feel helpful." You just really give it a try and see if it's truly that I don't like medicine or if I just don't like this awkward role of med student. I did my first year of residency and it was pretty clear to me by the end that this was not something I wanted to do. However, I kept meeting with my program director to try to tell her, "I don't like this. I think I want to leave medicine." And they kept convincing me, "Just try this next rotation. Just try this next thing." And so, I did these two rotations in a row that just kind of broke me in a sense. Because if you're already on the fence about something, your heart's not fully in it at that point anymore. And then you go through this rigorous schedule and hours. I did OB nights rotation, which is I did seven emergency C-sections in one 24 hour shift at one point. You're just going and going and it's really rigorous. And then I did gyn onc. There's some really sick patients on gyn onc and it's pretty emotionally devastating. That was a really hard rotation to be on as well.

And by the end of that rotation, I was just fried. My program director, we met because she knew I was already on the fence and already struggling. We met and she suggested I take a five week leave of absence from the hospital. And so, I took five weeks off, was able to catch up on sleep finally, journal a lot, connect with my intuition. I went on a camper van road trip around Utah. And during that whole time, what really came to me is I just want to be out in the world. And it didn't make sense. There wasn't a super logical plan around this, but I just had this feeling, this connection from my intuition that was just telling me I just want to be out in the world. I want to be outside, I want to travel. And I didn't have a great idea of what that was going to look like, but I had a very clear sense of knowing that I didn't want to go back. And so, I made the decision that I was going to leave residency and I was going to give this traveling thing a try.

And also I just want to share I was not a traveler before this. I wasn't the friend who took the summers off and went to Europe. I had never really traveled. I went to Nicaragua once for a week on a medical service learning trip in undergrad, but I wasn't a big traveler. And so, it was very strange that I was having this draw to travel the world. And so, I decided to follow it and I turned in my resignation letter and decided to get a job teaching English in South Korea, which sounds a little bit weird, why would I do that?

The way that it kind of came to me was I wanted to travel. I already made that clear. I also wanted a source of income while traveling. I'm a resident, I wasn't stuck in the savings. I didn't really have a lot of leeway where I could just take a sabbatical or anything. I needed to be able to make money. I wanted to travel.

And so, I came upon the concept that you can get this online certification and start teaching English in abroad. And there's a very high need in Asian countries, but you can also do that in Spain and other European places, Latin America, anywhere. I got this online certification, I got a job teaching English in South Korea. I don't know why South Korea to be honest. I don't know if I just wanted to get as far away as possible, but that's just sort of what ended up happening. And I spent a year there teaching English.

And during the time I also went to basically Google Academy or Podcast Academy. I listened to every single podcast I could about building an online business, learning about marketing and strategy, SEO, websites, blogging, all of that. And I initially thought I was going to be a travel blogger. I made my first website and I called it the turquoisetraveler.com and I was like "I'm going to become a travel blogger. I'm going to build a six figure business travel blogging, and that's just what I'm going to do and it's going to take some time to build up the income. So, in the meantime I'm going to teach English." It just felt like, "This is it, this is the plan."

But I realized pretty quickly that I didn't really like writing about travel. I love writing itself, I love traveling. I don't like them sort of being intertwined. I really liked writing about my journey and personal growth and spirituality and so then the idea of life coaching sort of came back into my life. I just had this email that popped into my inbox that was like, "Do this free 30 day life coaching bootcamp and then see if you want to become a coach." And so, I signed up for that. I ended up doing a yearlong life coaching certification program.

I decided to shift from travel blogging more into life coaching and started doing that as my business. After a year of teaching English, I made $2,000 the first year in my business. I was teaching full-time, had the full-time job and I was charging people $60 a session, super casual.

But it was a start. I was getting started. And so, I made $2,000 that first year and then decided I wanted to be fully location independent. And so, I started teaching English online, and was able to make $24 an hour doing that, which was not terrible. I was living in Vietnam at the time. I decided to go to Vietnam. This is when the pandemic happened. I ended up getting stuck in Vietnam during the pandemic and was teaching English online and also starting my coaching business. And so, from there, transitioning from doing these online side gigs and coaching part-time to making coaching my full-time source of income.

And as I've been doing that, I just celebrated my four year travel bursary as I've been traveling the world. I've lived and worked in 24 different countries on five different continents. And I have now successfully built a six figure coaching business where that is my full-time thing and I'm able to really support myself and not just in the backpacker way, where I'm really struggling and staying in hostels, which is where I was initially. And I love that phase of my journey. It was so special to me and I'm really glad I had that time. And now I'm able to really focus more on growing a full business and supporting people in a bigger way, and I get to do all of that while traveling the world.

Let's talk about what does that actually look like? Because that's a big question that I get asked from people is, what does it look like to be a digital nomad? It does seem really glamorous and there are so many good parts of it there. Overall, it's a lifestyle that I love and I wouldn't trade it. However, I think it is important to talk about some of the realities of it because it's easy to look on Instagram at somebody living this lifestyle and think it's all just sunset photos and hikes and all these glamorous things. But there can be difficult parts of travel.

And I don't say any of this to complain. I say this because I know that can be annoying. Like, "Oh, what a sad life that you have. You have to deal with traveling and all of these things." I totally understand that it's such a privileged lifestyle and I'm so grateful for it.

And I think it's important to just be super honest and clear about what it actually entails because it can take a toll on your mental health if you're not being super careful about, because it can be disorienting. You're flying all over the world, you're changing locations all of the time. Really having to be intentional about the routines that you do to ground yourself is so important because there's times where I was in five different countries in two weeks and trying to run a business at the same time. And that is really hard.

And so, being a digital nomad, it's different. You're not traveling. You're not a backpacker, you're not on vacation. Having to figure out how you balance your work and then your self-care, the things you need to do to just maintain your sanity. And then also the fun stuff, the sight-seeing and the tours, there's all of that too. There can be a lot of pressure and I think it just really comes internally, but when I'm in a location, I'll feel pressure of, "Oh, I need to go to this museum and see this site and do this thing and check all these things off." But sometimes I just want to lay in bed and watch Netflix because when you're traveling long term, as I have been, I've been traveling for four years now, you're not always going to want to see things in the same way. You're not going to want to do the same things.

Now as I'm planning my travels, I don't really look at a list of top 10 things to do in this destination because you just get a little bit burnt out and jaded from going to the newest waterfalls and seeing all the churches and the mosques. I know all of this can sound very privileged to say these things but what I'm trying to get at is it's important to really, again, not fall into this external pressure of, "I'm in this location, this is what I should be doing." But really just checking in with yourself and seeing, "What do I want to be doing here? What is going to be nurturing for me?" And giving yourself time to just live your normal life and be a person and know that it doesn't always have to be adventure and travel all the time.

Actually, just to share a little bit more about that for me personally, next week I'm actually sort of moving to Albania. And I say "moving" loosely because I have a suitcase. It's not really moving anything except for myself. But I'm really looking forward to doing several months and potentially even getting a yearlong lease in Albania and having some heads downtime, having a bit of a home base and having more stability because there is that aspect of all the transient, all the variety that it is important to just check in with yourself as you're doing this and set up a routine that works for you.

Some people, we call them slowmads, they travel slower. They go for three months, six months in a location. But I have not been slowmading at all. I've been fast, fast, fast. I've been doing one month in each country and just going around. It's been great and it's what I needed. But yeah, part of that is really just planning out and checking in with what works for you.

Those would be I would say the main cons that I can think of. You're designing your whole life. And so, there's no 09:00 to 05:00 structure. There's nothing set up externally. You really have to do what you think is going to be best for you. The pros are endless. It's such a satisfying, fulfilling lifestyle.

I'm open to being wrong about this. Maybe one day I'll change my mind. As of right now, as I look at my future, I don't think I'll ever be somebody who permanently lives in one location. I imagine myself having multiple home bases around the world because it's a very expansive lifestyle. To me it feels like I'm living to the fullest in the biggest way. I'm seeing the world, I'm doing things that people only dream of doing. I don't even have a bucket list because the moment I want to do something, I can just go do it. The list doesn't build up, I just get to go do the things that I want to do. And so, there is so much freedom, there is so much expansion.

I've just met so many people and you grow and you change and there's so many experiences I've had that wouldn't have been possible if I was still in a hospital tied to a mortgage and having to commute to work every day and just sort of living in this structured routine. It's really shaken me up in a lot of ways. I've grown, I've learned a lot of things about myself. I've changed a lot of patterns.

Some people can digital nomad within the US and that's great too. But for me, being outside of the US has really introduced me to other ways of living and shown me a lot of the conditioning that can happen in the US and allowed me to just step outside of the box and really start to formulate my own ideas about things, which I don't know if that level of independent thinking would've been as possible if I was surrounded by people who were all thinking the exact same way, which can happen in the states more often. My mind is expanding, my heart is expanding in a big way. It's just a very expansive lifestyle.

I would say another con that is just coming to me as well is relationships. Community, romantic relationships, friendships, all of those things are very possible as a digital nomad. There's lots of hubs around the world of big digital nomad communities. And there's a lot of transient nature within all of those. And so, when it comes to cultivating community and meaningful relationships, there has to be a high level of intentionality around that. For a while I was just a free wheel and solo traveler and then I realized, "I need friends. This is something I really need." The cool thing about being a digital nomad though is many people that you meet and who are living a similar lifestyle, they also really need friends. So, they're really open.

In the US I think we can get into some of these really established patterns of no new friends because we have my group, it's kind of a closed situation. As you travel, I meet a lot of people and they're all very open to connecting and you're able to make these deeper connections because everybody that you meet has a leaving home story too. So, that's another cool thing. Every time you meet someone and they're not from around here and they're just traveling the world, it's like, "What got you out here?" That's always really cool because you can go deep pretty quickly. Because people don't just leave everything they know and start traveling the world for no reason. There's usually a deep motivator or some sort of wake up moment they had. That's really powerful to connect with people like that and meeting people from all over the world too. I can recognize the subtleties of different South African city accents because I've just met so many people from so many places. And so, that's a cool thing too.

I think one thing a lot of people want to know is, "How do you make money? How do you support yourself while doing this?" I think a lot of people, especially within medicine, they worry like "I don't have any skill sets that are transferrable to this. I don't know how I can make money remotely doing healthcare." I just want to talk through some of the other healthcare professionals I've met out here, because there's other ones out here and that's so fun.

What I want to share is there's ways to make money potentially using already the skills that you have as a healthcare professional or you can do what I did and come up with a totally different way to make money. I'll just talk through some of the main roles and jobs that I see people doing so that you guys can have some ideas of where to start.

As I've been traveling, I've met a speech language pathologist who was actually an independent contractor and she was seeing her patients virtually. She was doing patient work, was seeing patients virtually and billing. She said she's in a gray area and isn't sure if it's 100% kosher, but she has been doing this as an independent contractor working with patients in the California area. And she took it on the road and is doing it virtually.

I've met a veterinarian. She does consultations, she looks at radiology images and she reads the images and that's her full-time job. You walk by her computer and she's just looking at images of animal insides all day. And so, she's doing that. She's able to take that skill working for a company that just reads the images and is makes her living that way.

I've met several nurses and I don't remember exactly what they were doing, but some sort of patient care role that they were able to do remotely as well. And then I have a friend right now who I've actually been traveling with and she's not medical, but she works at a health tech company called Cerebral. And within that, she's said they have a whole clinical team full of people who are clinicians who consult on the operations and consult on different aspects and they're all remote as well. And so, there's lots of opportunities within health tech, doing either clinical things like telehealth or even just working on the consultant side.

So, that's some of the medical areas that I've seen. Obviously there's another route like I did. I just created my own business. There's a lot you can do in the online space, and especially like physicians, other clinicians, having something like a coaching business or a consulting business and just having any sort of face-to-face interactions with people, I just want to see more physicians making their own businesses and being able to help people on their own terms because they're just such bright, incredible people. And having that ability to just help people in the way you want to, is really powerful. I think it's a really natural transition for physicians to become coaches if that's something they're interested in. And there's a lot of resources to that. Obviously, for me, it was a longer trajectory. I wasn't able to support myself with that right away, but totally worth it.

Other potential income sources that you could quickly learn and master. There's ways to do things like coding bootcamps, which you can do. I just want to go into things that are good ways to make good money that don't require you going all the way back to school. You could do a six month coding bootcamp if you're somebody who's into computers and or into coding in that way. And you can get a six figure job pretty much right out of that six month coding bootcamp. And the bootcamps are a couple thousand dollars. But if that is something that you're interested in doing, it's a really reasonable way to get yourself into a remote position.

Another thing that's similar to that is UX/UI, which is user experience, user interface. It's a little bit like website design, but you're consulting, you don't have to know the coding behind it, but you create what apps look like. When you look at an app and you see what it looks like, the appearance, all the images and the way that it's all laid out, that's UX/UI. That's another thing where you can do a short bootcamp and get a six-figure job pretty quickly after that. I have another friend who's doing that. Those are just some ideas.

I think as we're in medicine, we get this tunnel vision and we think that in order to have these high salaries, we're going to have to go all the way back to school again. If we wanted to change and to do something totally different, we think we'd have to go all the way back to school and it'd be this rigorous process. But I wanted to share with you some of the people I've met who are doing things that they didn't actually go to school for and they're able to find a way to make good income as they're traveling as well.

And that's just the start. I think there's a whole Facebook group for remote careers for physicians. Especially with after the pandemic and the way telehealth has blown up now, there's so many ways to support yourself financially through the internet. It's actually really incredible.

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The post The Extraordinary Life of the Physician Digital Nomad appeared first on NonClinical Physicians.

Interview with Dr. Angela Mulrooney – 342

In today's episode, Dr. Angela Mulrooney explains how to create your ideal life and shares her inspirational career journey. 

Dr. Mulrooney's unique journey began as a gymnast turned dancer and choreographer while studying dentistry. She built a thriving practice following graduation. However, she developed an illness that made it impossible to practice. So she transitioned into coaching dentists, leveraging her experience to build a successful coaching company.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Clinical Practice: Make It Great or Move On

Recognize dysfunction, fix it, and protect yourself, or seek better opportunities

In only about one month from now, the second annual Nonclinical Summit will be starting. It’s not entirely nonclinical, however. Sure, we’ll be presenting topics related to fully nonclinical work, such as freelance Medical Legal Prelitigation Consulting, Expert Witness Consulting, and Medical Affairs Regulatory Consulting. But we’ll also have experts talking about whether it’s medicine you need to leave or your job or current boss. And we will discuss several types of clinical businesses that make you the boss, opt out of insurance participation, and build an asset that you can sell later.

If you’d like to learn more, check out the 2024 Nonclinical Career Summit, with a complete list of speakers, topics, and objectives for each presentation.

And just like last year, you can attend the live sessions for FREE, so block your calendar on April 16, 17, and 18 from 7 to 11 PM Eastern/4 to 8 PM Pacific.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is much happier now as a professional writer and a coach. Debra says, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

From Dilapidated Practice to Referral-Based Success

Angela pursued her dental career dream by working primarily with children. She took over a rundown practice, revitalizing it over six months by implementing physical and aesthetic changes. And she converted from insurance-based to non-assignment services.

By investing in her skills, including IV sedation, full-mouth rehab, and implants, she transformed the practice into a referral-based success, targeting patients afraid of the dentist.

LinkedIn Mastery and Unleashing Influence

Recognizing the power of LinkedIn in reaching professionals, Dr. Mulrooney strategically utilized the platform to build her coaching businesses, rejecting conventional choices like Facebook and Instagram. Unleashing Influence, her coaching company, emerged from her experience coaching dentists.

Leveraging LinkedIn's Sales Navigator, she refined her approach to connecting with the right professionals. She guided them through a transformational process in her events, ultimately leading them to join her coaching programs. This approach has proven highly effective, resulting in significant success for her clients.

Dr. Angela Mulrooney's Advice to Create Your Ideal Life

If you have been plateauing for a while, you've got to decide if you want to stay plateauing or if you want to get out of your way.

Summary

Dr. Angela Mulrooney's career evolution serves as an inspiration for frustrated clinicians. To connect with her, reach out through her LinkedIn profile, where she actively engages. Additionally, search for her on popular social media platforms or visit her website Unleashing Influence for more information.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Unleashing Influence Program
• Dr. Angela Mulrooney's LinkedIn Page
• How to Start and Grow a Profitable Cash Based Medical Practice – 293
• Do You Want to Live Life and Practice Medicine on Your Own Terms? – 237
• How to Be a Successful Physician Entrepreneur – 123
• Top Five Start-Up Secrets for the Physician Entrepreneur – 087
• Entrepreneur and Business Owner – Interview with Dr. Mike Woo-Ming – 019
• 2024 Nonclinical Summit – 12 lectures & Attend for FREE
• Dr. Debra Blaine's Coaching Services

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 342

Light Your Entrepreneurial Fire and Create Your Ideal Life

- Interview with Dr. Angela Mulrooney

John: For those entrepreneurs listening and watching today, I have a real treat for you. Our guest was working as a dentist and somehow her entrepreneurial side kicked in and she created a very successful referral-based dental clinic, and then later a professional dance company, and then a coaching company for dentists. And then this is morphed into what she's doing now, which we'll get into in today's interview. I'm very pleased to welcome Dr. Angela Mulrooney to the podcast. Hello, Angela. How are you?

Dr. Angela Mulrooney: Hi. Thanks for having me. I appreciate it.

John: And I appreciate you being here. Another healthcare professional who has veered off in a direction which I think my listeners would love to hear about. Like we usually do here, why don't you just start by telling us about your background, how you went from being a dentist to doing what you're doing today. You don't have to go into too much detail, but just an overview of what you've been up to the last decade or so.

Dr. Angela Mulrooney: Sure. I originally was a dentist and I wanted to be a dentist since I was two. It was really a dream come true. And every day that I got going into practice it felt like I was just playing. Power tools and blood. Pretty cool. I did that for the first four and a half years. I worked as an associate, primarily working with children because I was so ridiculously shy. I couldn't look adults in the eye. I focused on kids because I could just tell them stories. And then I happened to run into one of my old bosses who was working in a locum for a 78-year-old dentist. And he was like "I really don't like doing this dentistry. Do you want to take a couple of days off my hands?" So I said, "Sure." That was on a Friday. By Sunday night he called me, he is like, "Ang, can you just take the whole thing? I really don't want to be practicing dentistry." I was like, "Okay."

I had no idea what I was getting into and walked into this practice. It was the most rundown, broken down practice I'd ever seen. The carpet was black because it had never been cleaned. Pretty gross. But every day I walked in there I just stopped and it turned into me going from always saying "I was never going to own a practice" because I was still a professional dancer at that point to me thinking, "Wow, there's potential in everything here. I think I can turn this place around."

I ended up going and seeing the 78-year-old dentist. He unfortunately was dying of bladder cancer and asked him if he was okay with me putting a bid on the practice. And it was funny because before he had always said there was no way he was going to sell it to a woman. He was very old school. And he had heard enough good things from the patients who had come to visit him like they were family. He was like, "Yeah, I would actually love for you to take over the practice." So I did.

And six months into owning it, I really scraped everything that was in there. Rebuilt the whole practice physically and aesthetically and also went from taking insurance to not taking insurance. I went from an assignment practice to a non-assignment practice and went and started investing in my skills to be able to serve.

What I saw was potential in the practice was these people who were terrified of the dentist because the old dude was pretty rough. I went and got my IV sedation. I did my full mouth rehab, implants, all these things. And that's how I created a referral based practice because most people do not want to work with patients who are afraid of the dentist because it takes a lot of time.

I had really a blue ocean market and started just sending out letters and referral pads. And every month on the week that the referral pads went out, we got a whole rush of referral of patients who either needed IV sedation or who were terrified of dentists.

So, that was awesome. I got the practice to the point that I wanted it to be at. And then I got injured out. I ended up with focal dystonia, which had been kicking in slowly over time. And then finally during the middle of a surgery, my hand completely stopped working. I couldn't pick up my drill. So, it was the last day I practiced dentistry, which was a really scary day. And so, that put me on a completely different path to start doing other things with my life.

John: All right. Did you say you were a professional dancer in there?

Dr. Angela Mulrooney: Yes.

John: Explain a little bit about that. We got to know.

Dr. Angela Mulrooney: Yeah. Actually, I was originally a gymnast as a kid and then when I went to university, the biggest social club was the University of Saskatchewan Ballroom Dancing Club. I was like, "Okay, well, that's where everyone else is so I'll go there." And the first year after I was in the club, they started asking me to teach. And I'm like, "No, no, I'm trying to get into dental school. Don't distract me." And then I got into dental school and I'm like "Please distract me, let me have a position." I started teaching and then I turned pro the day that I graduated dental school. And so, I had those two parallel careers. I would go into the studio at 05:00 or 06:00 in the morning, go and train until my shift started. And then when my shift was done, I would go back to the studio and teach. I had two careers going at the same time pretty much until I got injured.

John: Did that interfere then with the dance as well or did you end up teaching that later or at the same time? How did that fit in?

Dr. Angela Mulrooney: With the dystonia, it affected styling because it was actually this very famous picture of me with my hands are supposed to be like this. So, it affected styling and sometimes control of my arm, but we just built choreography around it and got it. We just made it work.

John: Okay. Then what did you do after that? You got very entrepreneurial after all this happened from what I know. So, go on from there.

Dr. Angela Mulrooney: After I got injured, everyone was telling me that you built this brand, you're known in the market, you're known to patients, you're known to the dentist to keep going with it. You can run this as a CEO and not practice clinical dentistry. I was like, "Okay, I guess I can do that." The unfortunate part was I had invested so much in my skills, I had to bring in four different associates part-time to try and cover off the skills that my patients were used to receiving. That was a bit of a headache. And after two and a half years, I'd been through the global financial crisis when I first bought the practice. And then I was in Calgary, which is an oil-based city. And the 2015 oil crash, the economy was dropping super fast. And I just was like "You know what? Every time I go into the practice my heart hurt because these people don't care as much about patients as I did." It didn't feel that way.

And so, I decided it was time to just pass the torch to someone else and start moving on with my life. I decided to sell the practice, I fire sold it, and passed it on to someone else. And honestly, the day that the deal went through, official ownership transferred, it was like this weight was lifted off me and I felt released to go and do new things. So, it was interesting how much that weighed on me trying to keep this thing alive that just wasn't a fit anymore.

John: Okay. Now I know ultimately you began at some point teaching other people how to become entrepreneurs and pursue their dreams. But take us through the way that developed or the steps to getting to that.

Dr. Angela Mulrooney: Yeah. After I sold the practice, I took a year away from dentistry because everyone knew who I was and what had happened. And everyone that I met in the dental world was pity. And I didn't deal very well with pity. I was having enough problems just keeping it together. So, I stepped away, spent a year just building my professional dance company.

And in that time what happened was the pieces of "why" things had happened started to make sense. I was like, okay, I've been through some really strange things from the owner dying halfway through me buying the practice to getting sued by my team to worst case scenario of being injured out of my career. So, I decided to take all the lessons of what I've done and create my coaching company for dentists. And really what my goal was, it was to help them to build a brand but also find their passion in dentistry. Because a lot of dentists really don't like dentistry and they're doing things on a daily basis that they don't like. My goal was to help them to get passionate.

That went on for about two and a half years. And how I built that company was actually getting on LinkedIn, posting content, starting conversations. And in a year of putting effort into LinkedIn, I went from 200 to 12,000 industry followers.

John: Wow.

Dr. Angela Mulrooney: And so, then people started to go, "How did you do that? And can you do that for me?" I started to take a few different colleagues' accounts and I said, "I don't promise anything. I don't know if what I did was a complete unicorn or if I can replicate this, but I will try." I started working on their accounts that I was actually able to replicate the results. So that's where unleashing influence, the original iteration of it was a social media agency for professionals.

And so, that came out of me building my business coaching company for dentists. And that became an official company on January 17th, 2020. March 17th, 2020, Canada got shut down and so exactly two months the day I had some big decisions to make because I had a couple of team members. I had three different companies. I had my dance company, the business coaching company, and the social media agency. And I told the people in the social media agency to buckle in, keep yourself healthy, get lots of sleep because we are going to take this to the moon. And by 10 months into the pandemic we had gone from two and a half full times to 14 full-time team members. So, it just took off.

The dental coaching company got shut down because dentistry got shut down. Dance company got shut down because we weren't allowed to be near each other. I definitely picked the right pony at that point. And then by the end of the year I was like, "I don't want to be in lockdown in snowbank anymore in Calgary." I made the decision that I was exiting Canada to go hang out in a tropical place for at least 12 months. I want to avoid snowflakes for 12 months. So, I bought a one-way flight to Nicaragua and arrived there on January 21st, 2021.

John: Wow. That's a lot. Now I could ask you a thousand questions, but I want to go back because your experience with dentists applies I think to physicians as well. And so, I'm just curious when that thing was working and you were going to even expand it, what were the things that dentists could do with their practices that were unique to each of them? In other words, it's like with physicians. We're cookie cutter. We are family medicine, we all do the same thing, we get bored, that gets tedious and so forth. But I can imagine there are things you can specialize in certain things or you can focus on certain things. So, just give me a glimpse of some of the things that you helped dentists do before we get into the rest of it.

Dr. Angela Mulrooney: For sure. Well, what happens is we're trained in university to be generalists and you're not going to be good at everything. And so, if there's things on your schedule that make you go, "Ugh, do I have to do this today?" Or if there's a patient that you see that you feel that way about, why are you doing that to yourself?

John: Oh boy, I've had those feelings. Yeah.

Dr. Angela Mulrooney: Yeah. Life is way too short. So, if you can be comfortable saying, "Okay, I no longer do root canals. Maybe I don't do surgery anymore, maybe I don't do kids." And focus in on the skills that you're actually talented at and passionate about. Yes, you're going to have to send some people out or you're going to have to bring an associate in to cover that stuff. But what's going to happen is you're going to get better, you're going to get more niched into your genius in that skill and you're going to be so much happier doing it and patients are going to feel that.

So, if you are not a good jack of all trades, which let's be honest, nobody is. If we can start getting away from that jack of all trades, they have to give us a jack of all trades education in university because they have to expose us to everything, but it doesn't mean we have to do everything forever. If you can hone it down to the things that you actually like doing and focus around that, you can build a practice, you can make money doing anything, let's be honest. But you have a professional degree, you have a designation that is recognized by the public. If you say you're a doctor, you say you're a dentist, people have the gist of what you're doing. It's pretty easy to market it and just focus on exactly what you like to do and then either fill in the gaps with an associate, as I said, or refer those patients out. But you can design a practice around anything that you want. There's no legalities about saying no to root canals, saying no to surgery, saying no to whatever you don't want to be doing.

John-: Yeah. I can imagine in the US where you'll say a family physician, you're on some kind of Medicare panel, you can't necessarily refuse. But if you say, "Look, okay, I'm just not going to do that anymore. I'm going to do this part of my practice. And if you don't like it, go somewhere else." That's fine. I've not really heard anyone really emphasize that aspect, but it sounds very effective. I appreciate that.

Okay, now jump forward. Basically you had started this agency, it was a social media type company. What does that really look like? I'm trying to imagine who were on that team, and maybe just explain a little more detail as to what that business looked like and was comprised of. It sounds interesting.

Dr. Angela Mulrooney: Sure. There was 14 full-time creatives. I had everything from copywriters to graphic designers to people who were doing video editing for me. I had one manager in place. But yeah, pretty much it was almost 14 full-time creatives. And so, there was pods working on different clients. There was lots of little moving pieces in it. And I'll be honest, there's a reason I sold the agency. It's a lot to manage because there's so many moving pieces and you have to be relying on people to keep up. And I found I had to build a lot of redundancy in because at that time there was so much turmoil in the employment market as well. So, someone would get offered another job and they'd be like, "Okay, I'm moving over there." So then you're quickly replacing. We always had two of everything and a backup plan for that, which was really stressful, especially when there was a shift. So, I was losing a lot of sleep over my agency, which is why I ended up selling it.

John: Now, who are the clients? What type of people or companies were they?

Dr. Angela Mulrooney: Most of my clients were actually coaches, consultants, and speakers. Because what happened when we had the shutdown, all the events were gone. Their way of being able to go and hang out and have coffee with people or speak from the stage and get clients, all those in-person marketing tactics were off the table. And a lot of the speakers as well, and even the coaches, sitting in front of a camera and trying to be entertaining when you don't have a thousand people in the room who are giving you energy, there was people who were losing their career because they couldn't pull it together on camera.

A lot of them were coming to me to be training, "How do I use my hands? How do I use the space? How do I use the actual camera to be engaging so that I can get back on track?" Because the pandemic landing zeroed the field for speakers. These people who were famous for 30 years, who were amazing in a room were terrible on camera and they realized it very quickly. And so, they had to develop a new skill set. I acquired a lot of those coaching them on camera as well as building out their social media presence so they could go out and reach and hunt new people into their business.

John: All right. Very good. Now that brings us up to almost the present here, unleashing influence. Is that right?

Dr. Angela Mulrooney: Yes.

John: Okay. Tell us about that in more detail and then I'll have some more questions about that.

Dr. Angela Mulrooney: Sure. After moving to Nicaragua, I started to really realize I did not want to work hundred hours per week. That had been my norm for the past two or three years. And so, I started to realize, "Okay, this social media agency with all these team members is just not good for my health." I sold it to one of the team members and then I was like, "Hey, this coaching company for dentists, this is not really where my heart is." Because every time I walk into a practice and or talk to a practice that's not as passionate about dentistry as I am and I'm like "I want people to practice on my behalf because I couldn't anymore" it was like someone ripped a scab off my heart. So, I decided to sell that one as well and just go all in on what I did best, which was really cracking clients open, helping them to see their potential, see what they could be in the marketplace. And also helping them to really step into their genius and fully own that and be able to burn away everything that didn't belong.

So, that's what I hunkered down to. And for three months after I made that decision, there was money coming in after selling the other two companies, but it wasn't super confirming that I'd made the right decision. So, I was a little scared. And then about three months to the day after selling the last company I got a deposit from a client which was paying in full for my services. And it was more than I would've made full-time working as a dentist. I was like, "Okay, that's a sign. This is going to work." The ball is rolling so I let it keep rolling.

I let that develop out and because I changed what I was showing on LinkedIn, people started to contact me saying, "How can I work with you?" And suddenly my book of business increased and I was like, "Oh geez, if we keep going down this path, I'm going to be back to working a hundred hours a week, back to being addicted to be an entrepreneur." And that's not what I want.

So, I took a step back and looked at what I was doing and really I was saying the same thing multiple times a week. I had these really talented clients who were feeling very alone in their journey. When you step out of corporate and step into being an entrepreneur, people think you're insane because you've taken a massive risk, especially after you've had a 30, 40 year career and now you're like, "Yeah, I'm going to do what I want instead." They had a lot of misunderstanding from the community and they also had a bunch of genius.

I decided to have some hard conversations and say, "Okay, this one-on-one thing is not working and I want you to trust me to do this group coaching thing and let's just see what happens." And it was like magic. What used to take so many years to get people through, in 90 days, we could collapse two years' worth of work into 90 days and get the massive outcomes. So, that's what Unleashing Influence became, is a coaching company and that's what I do for a living now.

John: Awesome. I think the next part is going to sound to my listeners perhaps as an advertisement for you, but really I want to hear the cases. Give us specific examples of some of the success that your clients have had just because it's fascinating and we can learn from what they learned. So, just a few cases would be fantastic.

Dr. Angela Mulrooney: One of my clients, she was former CIO of NASA.

John: That's a minor job. Yeah, right.

Dr. Angela Mulrooney: After 40 years in the tech industry, she came to me and she's like, "Okay, I don't want this anymore, I want to pivot." And originally she thought she wanted to be a professional speaker and I'm like, "Well, let's have a conversation about professional speaking looks like." Because I had done that before the pandemic had hit. And so, after our conversation, she's like, "Okay, I want to do what you're doing." I'm like, "Okay, let's do that."

She went through the accelerator with the other people in the group and she was able to close $150,000 the first month of working out of the accelerator. She was able to pivot fast and get her programs up and running.

I'll give you a dental specific one. She was making good money but she was working all one-on-one. So, she could only take on 10 practices and she was also traveling to the practices. And we have taken all the travel off the table and made it all online because she was like, "I want to be able to be geographically free like you. Not necessarily traveling the world, but at least have some freedom to move around without being stuck. I have to go to this practice this week, I have to go to this practice this week."

We were able to redesign her program to 10 times her hourly rate and decrease how many hours she was working a week by a 10th. Then that freed her up to design a new program that allows her to keep condensing things and stay with the group programs and be able to move that into the future.

So, what I really like doing is helping people to get away from the one-on-one because if you've done any one-on-one, you go in with your idea and someone comes in with whatever happened that day and they're knocking you off.

John: I see.

Dr. Angela Mulrooney: Off your path. And you're like, "Okay shoot, we didn't stick to the curriculum." But with group, especially if you're doing a high caliber per group, and I recommend creating boutique groups, not your down sell of "Oh, I'll do one to a thousand." No, these are six people in your group and they start together and they finish together and they're going through a very specific curriculum and there's a very specific outcome that they are going to be achieving. People are so dedicated to that because no one wants to show up being the kid who's like, "Well, the dog ate my homework." They're all high caliber individuals. The dog didn't eat your homework, you just didn't do it. So, it's a very different approach versus one-on-one. And what I found is what I help people to do is some of the fluff that they were putting into their one-on-one coaching, we get rid of that. It's like, "What is the 5% that is creating 95% of outcomes?" That's all that goes in your program. So, that allows us to time collapse because they're not spending time on fluff and then the outcomes become huge.

John: Okay. I hear questions coming in right now. One of the question is going to be without going into too many specifics is what did the NASA person do in terms of just what was the general feel that they went in where they could generate that with just refocusing and reapplying some of the things that you've taught her?

Dr. Angela Mulrooney: She stayed in the tech industry. As a woman in tech, she shouldn't have been able to achieve what she did achieve with being the gender that she was being in the generation that she was. She goes in and works with Fortune 500 companies and helps a cohort of women to be able to raise their hand be like, "Okay, here's the innovation I want to bring into this company. Here's what I want for it." They're helping to elevate the company and they're also helping to elevate their own status within the company because that's what she did her whole career. So, we just took what she naturally did. This is what I do with everyone is, "What do you naturally do? How can we take what's happening in your beautiful brain and turn it into a curriculum that we can teach other people how you naturally did that?"

John: One thing I would add to that, and it sounds like I'm maybe disagreeing with her, but actually if you're a minority, if you're gender is woman or whatever, anything that's different companies are looking for that.

Dr. Angela Mulrooney: They are now. Yeah.

John: Don't let that hold you back. Let's boom, let's do it. All right. That's awesome. Okay, other examples? Have you worked with many clinicians as a background doing something like this, abandoning the old?

Dr. Angela 0Mulrooney: Yeah, I've worked with a few dental clinicians as well. Some of them are getting injured out and they're like, "I can see the end coming" which is nice if you can see the end coming. And some of them are just like, "I'm just done. I just want to move on to other things." And again, take what they naturally do that is so unnatural to everyone else and be able to teach them a process to get to the next level.

John: Okay. Now let me ask you, there was another question I had. I'm going to ask you about LinkedIn for sure.

Dr. Angela Mulrooney: Sure. That's my favorite topic.

John: Yeah, that's what I thought. The groups, and I think you mentioned this on your website, but what you sounded like you were describing is what some people call a mastermind. It's like group coaching but you're all holding each other accountable. Is that a separate thing, the mastermind, or is that just basically part of this process?

Dr. Angela Mulrooney: The first thing that they have to go through is the pivot accelerator. That gives them the foundation. I'm taking whatever they've got. If they already have one-on-one coaching or if they're coming from corporate and building out a new program, I do what's called a "crack you open" session. They always say that it's like "You took a look at my soul." And then you look at my experience, your expertise, passion, and then I package them and give them their brand in the marketplace. Then the accelerator is building out everything from building out their personal brand, learning how to be good on camera to create awesome content, building out their curriculum, learning how to actually sell themselves because selling for another company versus selling for themselves is a different story. And then also all the tech that they need behind it so that they can run a seven figure company with a part-time VA supported by a tech platform for it. That's the first level that they have to get through. And then once they graduate, then they can qualify to become part of the Badass Entrepreneurs Club, which is what we do to continue to become masterful at the program that they created while also scaling it to the next level.

John: Very nice. All right, we're going to get on LinkedIn, but why don't you go ahead and tell us your website URL so we at least have that now before the end of the episode.

Dr. Angela Mulrooney: Sure. It's unleashinginfluence.com.

John: Okay. That's easy. Unleashing influence. Of course, that'll be in the show notes. Now tell me why do you like LinkedIn so much? It sounds like you use it a lot. And I don't know if you use it to find clients or to just promote yourself. Just tell me your LinkedIn story.

Dr. Angela Mulrooney: LinkedIn is a beast. And a lot of professionals, including medical, dental, avoid LinkedIn. When I was first building my business coaching company for dentists, they're like, "You need to be on Facebook, you need to be on Instagram." I'm like, "My bet is on LinkedIn." Because no one else was using it. I was able to build a six figure company in six months just leveraging LinkedIn. And all I was doing was sending out messages, putting out content that was speaking to what I believed in and that got me clients. Then when I built the social media agency for professionals, LinkedIn again was our main tool. And I have dabbled with Facebook. I've tried Facebook ads. Meta has now eaten my lunch a few times without giving me a single client. $60,000, $70,000 worth of ads with no return. Yeah. I'm not a fan of Meta. But it's still a good platform, it's just not good for me and for the clients that I'm going after.

You have to really pick your platform based on what are you offering and who are your clients. There's tons of people who do well on Facebook. There's tons who do well on Instagram. For the clients that I work with, they're professionals speaking to professionals. That's why LinkedIn is so powerful. Yeah, that's how I built a social media agency. That is how I've built Unleashing Influence as it currently stands. All my clients come from LinkedIn.

John: Now, when you are using LinkedIn, I've never used an add-on software or tool for LinkedIn. You are just using basic LinkedIn, maybe Premier. How do you use LinkedIn and how do you reach people? Are you just one at a time reaching out?

Dr. Angela Mulrooney: We use Sales Navigator. With all my clients we get really specific about what are the degrees that we should be going after. Sometimes it's gender specific. Some of my clients only work with men, women, some of them only work with men. And then it's also figuring out what year would they have likely have graduated to be a certain age. We comb through those details. Sometimes it's also specific to a part of the country. Sometimes it's specific to a part of the world. It depends on the time zones that they want to work in and whatnot.

But we do get very specific about those things because LinkedIn has taken away people's ability to spam and behave badly. Now you only get 20 new connections per day on average. And so, you want to be very careful with how you're spending those 20 connections, especially if you want to get profitable fast, you want to be getting in touch with the right people. The more drilled down you can get into that as to the things that I talked about, the better off you are. And then not only do you need to be finding the right people, you need to be sending the right message to them.

I always talk about being polarizing, and it's not to be a badass or anything like that. It's just to be like you either want people to be a "yes" or "no." Not a "maybe." Because you don't have time to be talking to people who are "no." The people who are "yes", that's what you want to figure out. And you want to slowly get them dialed down by having conversations with them, getting them into an event and then getting them onto a call to become part of your program. And the faster you can push people out who are not appropriate, the faster you're going to get the result.

And a lot of people, I'm going to refer to my nationality here, are very Canadian about this and they're like, "But I started a conversation so I have to finish it." And it's like, "Well, you don't actually." You can politely find your way out of it. And lots of people, they don't come back onto LinkedIn for like six months. The fact that you didn't respond to someone who was not appropriate to you, it's not going to be a big deal. No one's going to shoot you over that.

John: I like it. Good advice. What I noticed when I'm looking at your website, and I actually signed up for one of your courses, I think it was one of the intros, but I think you used that. So, explain how that works for those that might be the right process. You have something out there, you have a LinkedIn profile, maybe you're reaching out to people. I gather the thing you want to do is just get them into that first exposure to you at some level. So, just map that out for our listeners.

Dr. Angela Mulrooney: Right. After we found the right people, we're going to send a message, start a conversation, and then I take over the conversation until I get them to the point where I'm like, "Okay, this seems like the right fit of person." If they're like, "I really need to talk to you because I've shown them what I do", then I will get on a call with them. But I don't really want to close them on that first call because I want them to have time with me in the room. That's what my events are for. I do five day challenges and five hour intensivess. And what those are is me taking people through what it would be like to be in my classroom, and helping them to move into a transformation. Usually what I focus on is a mindset transformation. I'm going to give you technical things to do as well, but the biggest shift is getting out of your own way. And we talk a lot about burning things away, which is usually what's holding people back. Because they're like, "Oh, but I've always done this" and so I need to keep doing it. They carry all this garbage with them and they keep redoing the things that aren't actually making a difference. So it's like how do we pair this down to the 5% that's giving you 95% results.

And so, when people experience that, they're either a "yes" or a "no" for actually becoming part of my program, which makes it easy for me. And I'm also a "yes" or a "no" for them being part of my program because I'm seeing how do they behave in the room? Do they play well with others? Are they willing to be vulnerable? Because I ask some pretty hard questions in it. So, I want to make sure that they are actually going to be willing to be truthful, not posture about what is actually happening in their life.

And also are they responsive to inputs? If they're like, "Oh no, no, no, I already knew that", they're not really likely to be coachable. That's going to make it not very fun when they're in my accelerator, or intensely trying to get through things, resistance is not great. For people who are resistant, I'll recommend that they do the Unleash Your Badass Self Profitability, it's a 30 day mindset program, and to see how they come out on the other side of that. Because it really makes it clear what your programs are, what your resistance is, what has been holding you back. But yeah, it gives people, for my clients to use it as well because of the same reasons. You get to see who's in the room, you get to see how they act, you get to see if you're a good chemistry together or not and decide whether you want them in your program.

John: Interesting. Yeah. It reminds me of someone I heard say when asked the question of whether they're interested in something. If it's not a "hell yes", then it should be a "no." That's the old adage. Okay, we are actually out of time. We went over a little bit, not a big deal, but we are going to have to wrap up. Actually, if you want to tell us anything more about what you do and convince some of the listeners to get off their something and take action, I'll give you a couple minutes to do that and then we'll wrap up.

Dr. Angela Mulrooney: Sure. My suggestion is if you have been plateauing for a while, you've got to decide if you want to stay plateauing or if you want to get out of your way. And if you come to one of the events, either the five day intensive or five day challenge or five hour intensive, you are going to see things about yourself that you can't unsee that are going to propel you forward. It will make you break through your plateau. It's really hard to go back to what you were before the event started. So, if you are feeling stuck and you're looking for possibilities and want to get some ideas, I highly recommend that you attend one of those.

John: And that would apply to even someone who's maybe unhappy in their clinical situation now, but still wants to see patients somehow, but just needs to have a breakthrough or something that would apply to them as well. Correct?

Dr. Angela Mulrooney: Absolutely. Absolutely.

John: Okay, good. Because I tend to get focused on taking people out of practice and move them into utilization management or this or that or starting some kind of company. But there's really no reason why they can't apply these principles to what you're doing now and just make it like you said, something that you love to do and get rid of all the stuff you hate. Okay. Again, how's the best way to get ahold of you?

Dr. Angela Mulrooney: The best way to get ahold of me is on LinkedIn. My profile is Dr. Dr. Angela Mulrooney.

John: Okay. That's easy to find and I'll put that in the show notes. We've got your website, unleashinginfluence.com, which I'll put in the show notes as well. We've learned a lot here in the last 30 minutes. This has been fantastic, Angela. I really thank you for taking time on your world travels. We didn't tell the listeners when we started, where are you right now?

Dr. Angela Mulrooney: I'm currently in Paris and in two days I will be moving to Greece.

John: Paris, Illinois. No, I don't think so. Paris, France, and going to Greece next. Oh, that is awesome. And I guess you are working obviously.

Dr. Angela Mulrooney: Yeah.

John: All right, with that Angela, don't hang up on me, but we're going to say goodbye for the podcast. I really appreciate you coming here and I hope to talk to you again soon.

Dr. Angela Mulrooney: Perfect.

John: All right, bye-bye.

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Interview with Dr. Lawrence Huntoon – 341

In today's episode, Dr. Lawrence Huntoon offers insights into sham peer review, an all-to-common abuse of the peer review process.

Dr. Huntoon is editor-in-chief of the Journal of American Physicians and Surgeons and an expert on this topic. During our discussion, he highlights the importance of early recognition, prompt legal representation, and aggressive defense in response to sham peer review to safeguard your career. 

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The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

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Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Understanding Sham Peer Review

Dr. Lawrence Huntoon defines sham peer review as an abuse of the peer review process, emphasizing actions taken in bad faith for motives other than improving quality care or patient safety. He delves into the various tactics and underlying motives hospitals employ. And he emphasizes the importance of recognizing early signs of sham peer review.

Protecting Against Adverse Actions

Exploring the consequences of sham peer review, Larry describes the devastating impact on physicians' careers, such as adverse action reports to the National Practitioner Data Bank. He provides insights into the fraudulent tactics employed by some hospitals. He urges physicians to be vigilant during informal meetings, emphasizing the value of legal representation to navigate these complex situations.

Dr. Lawrence Huntoon's Advice on Preventing Sham Peer Review

Be aware of underlying motives: Sham peer review often occurs due to personal animus, retaliation against whistleblowers, anti-competitive purposes, racial discrimination, or other improper motives. Recognizing these motives early on can be crucial.

Summary

For further information or assistance, Dr. Huntoon suggests contacting the Association of American Physicians and Surgeons (AAPS). AAPS provides resources, including a sham peer review hotline and limited legal consultation services. You can visit the AAPS website for more information or call their hotline for assistance.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• Association of American Physicians and Surgeons website
• AAPS Sham Peer Review Resources
• AAPS Sham Peer Review Hotline: 1-800-635-1196
• Why You Must Wake Up Before Bad Behavior Ruins Your Career – 296
• The Interesting Life of the Professional Development Coach with Dr. Ryan Bayley – 064
• Dr. Debra Blaine's Coaching Services

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 341

The Ultimate Swindle Known As Sham Peer Review

- Interview with Dr. Lawrence Huntoon

John: Several years ago, I was at a conference in Chicago and I was there to learn about nonclinical careers, and there were a bunch of doctors there that were seeking to leave medicine. Most of them were because of burnout or just didn't like the lifestyle, but there were several that left because they were forced out of medicine for a variety of reasons, most of which involve being reported to the National Practitioner Data Bank. And since that time, I've learned more about this, and I was reading an article in the Journal of the American Physicians and Surgeons about Sham Peer review. I thought I'd better find out more about that. And I think it's something you'll want to learn about too so maybe you can avoid this particular reason for leaving medicine. With that, I'd like to welcome Dr. Lawrence Huntoon to the show. Hello, Dr. Huntoon. How you doing?

Dr. Lawrence Huntoon: I'm very well, thank you. Thank you for having me on the podcast today.

John: Yeah. I'm really happy to have you here because I have several questions. I will say for the listeners that there is a lot that Dr. Huntoon has written about this topic, so we'll be just scratching the surface. But before we get into that, just tell us a little bit about your background, Larry, and how you got into this.

Dr. Lawrence Huntoon: First of all, I'm a physician. I'm a board certified neurologist. I also have been trained as a medical scientist. I have a PhD in physiology with specialization in neurophysiology. And back in 2003, an award-winning journalist by the name of Steve Twedt, did a series of articles for the Pittsburgh Post-Gazette called The Cost of Courage, where he discussed a lot of instances where physicians were whistleblowers, were retaliated against by hospitals, and in some cases that involved sham peer review. Hospitals don't always like to hear what's wrong as far as in their facilities. Maybe they haven't got equipment that works, maybe there's problems with the staff, but sometimes they don't like to hear about that. And so, instead they go to kill the messenger. And that's what that series of articles was about. He's no longer with the Pittsburgh Post-Gazette, but at that time the AAPS board of directors said, "Look, we're starting to get a lot of calls from physicians that this is affecting throughout the nation. We need to do something to investigate this and see how we can help these victims of sham peer review. Early in 2004, the AAPS Board of Directors formed the AAPS committee to combat sham peer review, and I became chairman of that committee, and I have done that ever since.

John: Okay. You've seen a lot of examples of sham peer review and have been involved heavily in that. Can you tell us maybe a little more specifically what you define as sham peer review? And we'll go from there.

Dr. Lawrence Huntoon: Well, I'll go over the concise definition, then I'll go over the legal definition. Basically sham peer review is abuse of the peer review process for some purpose other than quality care and patient safety. The definition that I have published is sham peer review is an adverse action taken in bad faith by a professional review body for some purpose other than the furtherance of quality care or patient safety, and that is disguised to look like legitimate peer review. The hospitals have found lots of ways to abuse the peer review process, make it look like they're doing legitimate peer review, when the purpose that they're doing it for has nothing to do with patient quality or patient safety.

John: Now, I'm assuming, and I think from reading the journal that you believe and as I believe that a good peer review is appropriate and makes sense and it can help protect patients. The distinction is in the sham peer reviews, they're using a process that was designed to help the patients, but it really isn't being used for that purpose at this point.

Dr. Lawrence Huntoon: Right. And I want to make clear that I support, as does the AAPS, we support a good faith peer review. We support that. The only type we oppose is that type that's done in bad faith, again, for some underlying motive that has nothing to do with quality care or patient safety. We support a good faith peer review.

John: Now, in my recollection, medicine has evolved hugely in the last 30 or 40 years. There's always been some type of so-called quality improvement, and in fact, peer review was probably the main way that we did quality improvement, let's say 30 years ago. But now we can measure performance in different ways. And then the Medicare or CMS started saying we need to do specific types, what was it the acronym FPP? Did you see an increase in sham peer review when they started pushing all of this other type of more formalized peer review that was mandated?

Dr. Lawrence Huntoon: Not really. It's sort of just kept studying even increased over time. That what you're talking about is something that the Joint Commission came up with. It must have been about 2008. They defined OPPE as Ongoing Professional Practice Evaluation. And this is the type of peer review that occurs, and every physician in the hospital is subject to that. They will pull charts based on certain criteria, a patient that readmitted to the hospital within 24 hours after discharge, or died within 24 hours as a complication of surgery. And they have various criteria. All doctors are subject to that. It's kind of a screening type of peer review. And then the joint commission also defined FPPE - Focused Professional Practice Evaluation. And as that name implies, that's a type that is focused on a specific physician and would otherwise be characterized generally as a physician peer review.

John: Okay. But the big distinction here is if someone was having a subject as FPPE for legitimate reasons, fine, it's just something a joint commission requires, and you're going to go through that process. But really the sham peer review is when it just starts from the wrong place for the wrong reasons. And maybe you can explain some of the reasons that the hospitals or other members of the medical staff or other interested parties might start to invoke some type of sham peer review.

Dr. Lawrence Huntoon: And I've written an article on this, "Risk Factors for Sham Peer Review." I've given presentations on this. But there are many underlying motives that we've encountered for sham peer review. It might be retaliation against a physician whistleblower, and I don't particularly like the term "physician whistleblower." These are basically strong patient advocates who speak out in favor of things for the patient. And that's what gets characterized as physician whistleblower. Also sham peer review is often used in cases of personal animus. Maybe the people get in power and they don't like this particular doctor and they're going to get him. It will be done for anti-competitive purposes if there's maybe two or three of that type of doctor in that specialty at the hospital. If one of them gets in power, they may look to eliminate some of the competition. I've seen racial discrimination under underlying sham peer review. There's just a ton of improper motives that we've encountered that underline sham peer review.

John: Can you give us some examples? I know you've been involved with many cases, and I think you actually testify in some of these cases that make it their way to court. But what do they look like at the beginning? How might we recognize that "Wait a second, this doesn't sound like the kind of peer review I'm used to?" And we'll go from there.

Dr. Lawrence Huntoon: Yes. I'm a court qualified expert in sham peer review in federal court as well as a number of state courts. And you asked how do you recognize it early on? And I would say if it smells bad, it probably is bad. But what you're looking for there is you begin to encounter things that just don't seem fair at all. And of course, I've written articles on tactics that are characteristic of sham peer review. I've given talks on that.

But you start seeing things like the ambush tactic. And the ambush tactic is a tactic that's characteristic of sham peer review. That's where they invite the doctor into maybe the administrator's office, and they don't tell the doctor what it's about ahead of time. And they tell the doctor, "Look, this is just an informal friendly meeting. We want you to come." And the doctor may ask, "Well, what's it about so I can prepare?" And they don't tell him. And then the doctor gets into this so-called friendly informal collegial meeting, and he finds himself sitting across the table from the CEO of the hospital, the chief of staff, and probably the attorney for the hospital. And every one of those individuals knows exactly what it's about. The only one in the room who doesn't is the doctor that's been called in for the ambush. There's a lot of tactics like that. And the thing they have in common is they violate due process and fundamental fairness.

John: Now, I'm going to get to the meat of some other cases. But just to kind of jump ahead a little bit, what is the devastating outcome if this doesn't go as we plan as physicians, but as the way the administrator or the other physician wants it to go? What does that usually result in if we don't know how to defend ourselves?

Dr. Lawrence Huntoon: Well, it results in an adverse action report to the National Practitioner Data Bank. And the National Practitioner Data Bank was created as a result of a law passed in 1986 called the Healthcare Quality Improvement Act. And the Data Bank actually went into effect in 1990. And so, what the Data Bank is, it's a national repository for adverse actions that have been taken against physician hospital privileges or medical licensure actions, that sort of thing.

And there's other types of Data Bank reports. The one I'm talking about here are the adverse action reports. And what it does, it basically transforms a local action at a local hospital to a devastating national action. Because here's what happens. Every hospital is required to query the Data Bank before they admit someone on staff. They're also required to query that Data Bank every two years for renewal of medical staff privileges. If you're applying to a hospital and you have one of these adverse action reports in the Data Bank, the hospital basically considers you to be damaged goods and they don't want to put you on staff. You will have trouble getting on medical staff, you'll have trouble getting the medical license. You'll have trouble staying on insurance panels if that's what you're doing, renewing staff privileges or renewing licensure. It creates an incredible number of domino effects that are very bad for the physician.

John: It might result in you getting kicked off the staff that you're on now or being somehow penalized, which has to be reported. Basically it can destroy your career overnight.

Dr. Lawrence Huntoon: Yes, it can totally ruin it or end it.

John: Exactly. It's like one of those things where you spent whatever number of years of your life with your education, your training and experience, and it's pretty much gone if there's an adverse listing in the Data Bank. Now we get reported, of course, for lawsuits. I don't think a single or a couple lawsuits on the Data Bank means that much depending on the size and the frequency and so forth. But this is a different situation where there's definitely an adverse result that's reported that usually indicates a negative. It is supposed to be evidence that you're at some level a poor physician, I guess is the way I would say it.

Dr. Lawrence Huntoon: There are five different types of Data Bank reports, and I've found that hospital attorneys just love to confuse the Data Bank reports when you get into trial in front of a jury. And they bring up this idea of these Data Bank reports having to do with malpractice actions and malpractice settlements. And they say, "Well, it didn't seem to hurt the doctor that much. He's got two of these malpractice reports or settlements in the national practitioner Data Bank. What's the big deal?"

And so, I explained to the jury, that the types of reports involving malpractice settlements and whatnot, that's maybe like getting shot in the foot. You can continue to limp along, whereas one of these Data Bank reports having to do with removal of hospital privileges, it's like getting shot in the head. It ends your career and ends your world as you know it.

John: All right. Well, let's get back into how we can try and avoid some of this. I read something you wrote, I believe, or maybe it was in a video, that there are certain physicians who seem to be at risk. It doesn't have anything to do with, let's say, the quality of their practice, but because of adverse relationship with the hospital or financial situations. So, what are some of those that if you fall into this category, you might be a little bit more aware that this could come up?

Dr. Lawrence Huntoon: Well, of course, any disputes with the hospital administration is likely going to put a target on your back. But we've been able to identify certain specialties that get attacked more than others. And I think that those specialties that are at the top of that list tend to be those that receive very high compensation. These might be neurosurgeons that involve spine surgery, maybe anesthesiologists, and I've listed the whole list down there as far as risk fact, the article I wrote on risk factors. A lot of that has to do with money. Again, you're looking at anticompetitive type actions in some cases where you can get rid of a competitor, that leaves a bigger pie for the person who did the sham peer review.

John: Yes. Now I think you also mentioned sometimes, maybe a solo practitioner, just for whatever reason, they are a little more independent, a little more autonomous, they want to do things their own way, and all of a sudden we find that the hospital thinks, "Well, we've got to get them off the staff."

Dr. Lawrence Huntoon: Yes. The main reason solo physicians tend to get attacked is not because they necessarily like to do things their own way. It's because they don't have any support structure in the hospital. If you're a member of some big group, you've got that big group kind of supporting you and protecting you in the hospital. Solo physicians or those who are new on staff may not have that, and therefore they're vulnerable. Foreign physicians, the same thing. They tend to be vulnerable to these types of attacks. And sometimes the attacks are based on discrimination, blatant discrimination.

John: Now, I would think, "Well, let's see if a physician is actually employed by a hospital or a health system, they have a contract, they can always cancel a contract if they don't like this particular person." But that doesn't necessarily prevent you from this sham peer review.

Dr. Lawrence Huntoon: There's two different issues there. There's an employment issue and a medical staff privilege issue. And a lot of these employment contracts, almost all of them are going to have a no cause clause in it whereby they give a certain number of days notice, maybe 90 days notice, and they can terminate your employment contract without giving a reason. That's a no cause clause. And they often do that. They may have a non-compete clause as well.

When they terminate your employment, you're not allowed to work within a certain number of miles of that particular hospital. Having your employment terminated does not get reported to the Data Bank. But if they decide that they want to take a privileging action against you, that is one way they look to terminate the contract and harm you at the same time. These contracts require, of course, that you maintain medical staff privileges at the hospital where you have the contract. And if they can get rid of those privileges, that ends the contract and they get to harm you as well.

And so, in one particular case I saw, the hospital had recruited a specialty surgeon in to start sort of a new area of specialty in that hospital. And after about a year, the hospital determined, "Well, this doctor is not bringing in as much revenue to the hospital as we thought, so we need to get rid of that doctor." And so, rather than just terminating the contract and letting the doctor move on, they did a sham peer review. They brought false charges against the doctor, fabricated charges, and they got rid of the doctor's privileges. And of course, that got rid of the contract as well.

John: One of the things I remember when I was a CMO of a hospital was that we would sometimes face an issue like we thought the quality could be bad but because we didn't do this very often, it didn't really seem like we knew what we were doing in terms of trying to just go through this process, keeping it up and up. But at the same time, the CEOs talking to the COO and the CFO have their input and he's a finance guy, he is not really a quality guy. And then all of a sudden, "Well, we got to bring our attorney in." And so, now, the whole hospital has started to amass this whole thing involving multiple parties and not even necessarily the medical staff yet at that point. And then here you are, the physician come in for this informal meeting, as you mentioned earlier. Can you expound on how some of the cases have gone when they get to that point?

Dr. Lawrence Huntoon: It's been my experience. I've encountered a lot of people in the hospital administrations who don't know what they're doing at all. That includes the hospital leadership, maybe the chief of staff and whatnot. They don't know what they're doing at all. Maybe they haven't done it before or have not done it that much. And the problem is they tend to look to find an outcome that they desire and they don't really care about following the medical staff bylaws. Well, the medical staff bylaws are there to provide some due process and fundamental fairness to the accused physician. And if they've got some outcome in mind, well, it doesn't really matter, and they don't follow the bylaws. I encounter that I would say fairly frequently. And it does happen in places where they don't do many of these or have never done them before.

John: Yeah. And if the idea is maybe they have some kind of inkling or they just don't like the person, like you said, and so everything is jumbled together, the emotions. Maybe the doctor irritated someone by something that they said or could be anything I can imagine. And now they have this little ball rolling, this snowball, and it's like, "Okay, let's figure out how we can use all, whether it's our contract, whether it's our bylaws or a combination of those to get our end result, which is we just maybe decide we don't want this person here." They don't really seem to be too concerned about "What is the final consequence for the doctor?" All they want is for the doctor to be gone.

Dr. Lawrence Huntoon: Right, right. And the other thing I'd point out is sometimes you'll hear these peer reviews go forward and people will testify, "Well, I would've done that surgery differently. I don't take that approach. I take a different approach." But that shouldn't be part of taking an action against a physician. There's always room for improvement in our care. But what the important thing is, did the care provided, did that fall below the standard of care? Not "If you didn't do it my way, then you're not doing it right." No. That's not the standard of care. And sometimes they will portray it wrongfully as that. I see that a lot.

John: One of the things that was mentioned in one of the articles you wrote that I read, and I've heard this before, but if you're in the middle of this process, at whatever level, you're the physician and one of the things you hear is this comment. "Well, maybe if you just withdraw now, either this privilege or withdraw from the hospital, we won't do a report to the Data Bank." And so, why is that a huge red flag?

Dr. Lawrence Huntoon: Well, number one, that's fraud. And I just wrote an article about that in the December, 2023 issue of the journal. I see that a lot. A lot of the hospital administrations and leadership, including the chief of staff will tell the doctor, "Look, this will go better for you and you won't have to engage in all this messy peer review if you just resigned now and we won't report you to the Data Bank." That's fraud. And it's totally false. What happens is they get the doctor, the naive doctor who doesn't know any better. "Oh yeah, that sounds good to me. I'm getting out of here. I don't want to be here anyway, I'm resigning right now." After that, what we see is the hospital reports the doctor to the Data Bank the very next day. And the report that is made has standardized language, which says, "Doctor resigned while under or to avoid investigation." That makes the doctor look like he pled guilty. He just wanted out of there or didn't want to face the music or whatever.

And the other thing hospitals like about that, number one, they get to harm the doctor. They like that. Number two, once you resign, you don't have any due process rights like a peer review hearing or appeals process because you are no longer a member of the medical staff. So, it's a big win-win for the hospital when they can convince a doctor to resign while under or to avoid an investigation. And of course, we're beginning to see lawsuits where the hospital attorney, the hospital CEO and others that have been involved in that fraud are sued for fraud. And there is no immunity for fraud.

John: Interesting. Have there been some successes in that realm where they were found guilty of fraud?

Dr. Lawrence Huntoon: What happens is, when you sue a hospital attorney, he doesn't particularly like being accused of fraud. And that may not go too well in terms of his reputation. What you see is, all of a sudden, the hospital may have been dragging its feet and saying, "No, we're not going to settle this case. We're not going to avoid that report in the Data Bank because we're legally obligated to report you." You sue the hospital attorney, CEO and maybe the chief of staff for fraud because they committed fraud. And all of a sudden, things change. And so, what I've seen recently is, for example, a settlement where the hospital agrees to void the Data Bank report and put the doctor back on staff without restrictions. And of course, provide the doctor with some compensation for what they've done. They don't want to go to trial on that at all.

John: Yeah, that makes sense. Well, to give you a lot more leverage than it sounds like there has been in the past. So, that's good to know.

Dr. Lawrence Huntoon: And I'll say that it's very important to know that once you get a Data Bank report, it's impossible, nearly impossible to get that out of there. And the hospitals will always claim, "Well, we can't void a Data Bank report. We're required by law to report it." And they'll whine and whine but they can, and they do when you've applied the right leverage to get it done on.

John: Okay. Well, we've learned a lot so far. I want to ask one more specific question, and then I want you to tell us about the AAPS and the journal and that sort of thing. And you probably addressed this earlier, but let's say I'm brought into one of those meetings, all of a sudden I'm looking at the CEO and the chief of the medical staff and an attorney. They're saying they're going to have a conversation. Should I just run out of the room immediately and call my lawyer? Should I just listen? I think in one of the articles you gave us advice on how to go into that meeting, what you could do, at least if your spider sense is going off a little bit. What are your suggestions for that if we find ourselves in that situation?

Dr. Lawrence Huntoon: Well, it's hard to avoid the meeting. Because if you avoid the meeting, they'll say, "Well, the doctor's not being cooperative. We're just trying to help him by tying him to the post in front of the firing squad. We're just trying to help him." And so, you can't really avoid it without them portraying it that way. You can listen. And again, the ambush tactic is done for one purpose and one purpose only. It makes the doctor look guilty. Because if they're talking about maybe three or four patients that they feel you provided poor quality care to, well, you didn't know about that ahead of time and you're busy trying to remember while you're sitting in this stressful meeting, "What? These patients? I don't recall exactly what I did at that time." And so, when you flounder around and you're trying to remember to defend yourself, and you do a poor job of defending yourself for that reason, you look guilty. And again, that's the purpose. They want you to look guilty in front of the assembled members at such a meeting like that.

John: Oh boy. Yeah. Maybe you should bring someone with you to any meeting, so at least you have... And who would know what kind of meeting it's going to be if it's not got a label or a purpose?

Dr. Lawrence Huntoon: Here's the thing. The medical staff bylaws often forbid the physician to bring anyone with him, most certainly not an attorney, to one of these informal, friendly, collegial meeting. We're just a bunch of friendly doctors getting to gather to discuss things. They also often won't allow the doctor to bring an attorney to a meeting before the investigative committee to explain his side of the story. And oftentimes, most times, they will not allow a doctor to bring an attorney to a meeting before the MEC, the Medical Executive Committee to explain his care.

Now, they've gone even further than that in some cases. Going to peer review, once they've proposed an adverse action, you have the right to peer review and appeals in the hospital. Guess what? Some hospitals tell the doctor, "Yes, you can bring your attorney to the peer review hearing, but no, the doctor can't talk." The doctor can't raise objections. The doctor can't cross examine witnesses and doctors are not well prepared to do that. Doctors who don't have a JD degree aren't attorneys and they've function poorly as attorneys. They've done that in some cases. And to me, you have a right to representation under the Healthcare Quality Improvement Act. But to me, that's not representation when you put a piece of duct tape over your attorney's mouth and he sits there in the peer review hearing and can't say anything.

John: Wow. It doesn't sound like it's very hopeful that you're going to come out successful in these, unless you do everything right along the way. And then once the process gets going, of course, you want to have a good attorney, as you mentioned earlier, that knows how to deal with these kinds of situations.

I'm going to have another question to ask that's related, but first, tell us about the association and why listeners might want to get the journal, why they might want to join the association, that sort of thing.

Dr. Lawrence Huntoon: The Association of American Physicians and Surgeons was established in 1943, and we have been the voice for private physicians ever since. Our motto is "omnia pro aegroto" which in Latin means "all for the patient." And that's where we stand basically. And we believe in protecting the sacrosanct patient physician relationship. We believe that physicians are the ones that should be practicing medicine as opposed to insurance bureaucrats and government bureaucrats, often who are not physicians at all, not licensed to practice medicine, yet they tend to direct the way medicine is practiced.

One of the three benefits you get as an AAPS member is that you get access to the AAPS sham peer review hotline. And I have run that hotline on a pro bono basis for 20 years now. And so, that gives you, as soon as you join, you have access to the AAPS sham peer review hotline. You also have access to the nation's top attorney in sham peer review matters. We call it our AAPS Free Limited Legal Consultation Service. And you can discuss these things with a very knowledgeable attorney. Know that I'm not an attorney, I don't give legal advice or legal opinions, but we have an attorney who is very experienced at that. Those are some of the things you get as benefits as an AAPS member.

John: What is the website? Is it aaps.com?

Dr. Lawrence Huntoon: No, it's aapsonline.org. The best way to join probably is the 800 number. 1-800-635-1196. And as soon as you join, like I said, you have access to those free benefits.

John: Actually, I joined today. I thought I was a member already because I get the journal.

Dr. Lawrence Huntoon: No, you were a member back in February.

John: Oh, was I? Oh gosh. Okay. Well, I just renewed it. They get the journal automatically if they're a member, correct?

Dr. Lawrence Huntoon: Yes. Yes.

John: What's usually in the journal?

Dr. Lawrence Huntoon: It's the Journal of American Physicians and Surgeons, and we're a member of the Directory of Open Access Journals. And what that means is we don't charge people to download our articles. Our articles are downloadable free of charge, the full article. We don't require any usernames or passwords. You just go on the website. If you find an article you want to read, you download it and read it. That's what the journal is about. And it's been in existence since 2003 and I've been the editor and chief since 2003.

John: Okay. Let's see. Other things I wanted to mention or have you even tell us about. Supporting this relationship between the physicians and patients and the original way that medicine was to be practiced. One thing is insurance out or no interference. There is a big interest in direct primary care and cash-based businesses and other iterations. And so, I think you were telling me that you do or the association does presentations to physicians who are interested in learning more about how to make the transition. And that would include being off of Medicare or CMS.

Dr. Lawrence Huntoon: Right. AAPS has run "Thrive, Not Just Survive" workshops for many, many years. And those talks and presentations are all available on the AAPS website. I myself ran a third party free opted out of Medicare practice, and I was in solo neurology practice for 34 years until the government put us out of business in 2020 by these harsh, unwarranted and totally ineffective lockdowns that were done. And that put us out of business. It put a lot of small businesses out of business, and we were a small business.

John: Yeah. That was really harmful to a lot of businesses, a lot of physicians, small groups and so forth. And in retrospect really to pretty much almost totally unnecessary I would say. That's my belief. It's a little bit political, but whatever, we won't get into that right now. But another resource for listeners, if they're thinking, "Wow, I'd like to opt out of Medicare, I'd like to opt out of all insurance companies." There's some resources there at the association.

All right. Anything else I'm not asking you about that is important for us to know about the association or about the journal at this point?

Dr. Lawrence Huntoon: No, but I think you asked the question "Is there any way that we can avoid this at my hospital, for example, sham peer review?" And the answer to that unfortunately is no. Sham peer review does not occur in a vacuum. It occurs in an environment of turf battles and personal jealousy, personal animus, and a whole lot of things like that. It really isn't possible to find a way to prevent it at any particular hospital. And the trouble we have is trying to get support from a number of physicians, particularly in the hospital where they know sham peer review is going on against one of their colleagues. These are the so-called bystanders, who know what's going on, turn their head away and don't do anything to help stop it. And this is like bullying. Sometimes all it takes is one of these bystanders to stand up and say "We don't think this is right what you're doing, and you ought to stop it" to derail the thing. But many of these bystanders think "This'll never happen to me because I'm a good physician. I practice very good medicine. This won't happen to me." So, they don't want to get involved.

John: Yeah. I suppose there's some risk in doing that. Looking at it though from the other side as a physician, there are surgeon centers. Some surgeons can work there and not have to rely on the hospital, and if that's owned and run by physicians, hopefully they won't be pursuing sham peer review in that setting and avoiding the insurers. At the end of the day, maybe the only way for some of us to have traditional good relationships with our patients and practice medicine is to opt out of some of those onerous systems.

Dr. Lawrence Huntoon: One thing I'd like to point out is some people say, "Oh, the doctors are doing that for greed." And that generally from my experience is not true, certainly in the AAPS. What they're doing is they get tired of these bureaucrats interfering with the way they practice medicine and they kick these bureaucrats out of their exam room. And that's the real benefit. And you can set your own prices at reasonable levels that patients can afford.

John: Yeah. And we've talked to physicians here on the podcast who can spend more time with their patients. The patients are happier, the physicians are happier, and it doesn't cost the patients any more if it's set up properly and they get better care really. All right. This has been very inspirational. It's scary, but the fact that there are resources there to help us. Did we talk about the hotline for sham peer review? Is that the same 800 number?

Dr. Lawrence Huntoon: Yeah, they call the 800 number and they join and then they just ask the business manager who's going to be answering the phone, "How can I get access to the AAPS sham peer review hotline?" And he'll put them in contact with it. I'm always happy to talk with members about their individual situations and offer helpful information, particularly early on. Don't wait until the matter has been going on for four or five years and you've gone through a massive litigation and then "Can you help me?" Early on is best.

John: Yeah. I can see how that'd be a fantastic resource and just help point them in the right direction and some of the articles and the videos and giving advice and talk about maybe how to find an attorney. That can all be very helpful early on, obviously, than waiting into the second or third year or longer. This has been really great, Larry, thanks a lot for coming on the podcast and sharing this with us today. I think it's an important message.

Dr. Lawrence Huntoon: It's been my privilege. Thank you for having me on the podcast today.

John: All right. With that, I'll say bye-bye till next time.

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Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so does not affect the price you are charged. I only promote products and services that I believe are of high quality and will be useful to you. As an Amazon Associate, I earn from qualifying purchases.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

The post The Ultimate Swindle Known As Sham Peer Review appeared first on NonClinical Physicians.

PNC Classic Episode with Dr. Rich Berning – 340

Today's podcast episode features Dr. Rich Berning, who explains the truth about medical specialists and UM jobs. It is loaded with practical advice on how to pursue a job as a health plan medical director. He also describes how to find similar positions at an Independent Review Organization or hospital UM department.

Dr. Berning graduated from the University of Cincinnati College of Medicine. He completed his pediatrics residency at Stanford University and his cardiology fellowship at the University of California San Francisco, and he practiced pediatric cardiology before moving to his first nonclinical position.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Navigating a Non-Clinical Career Journey in Healthcare

Rich Berning's insightful discussion covers two crucial aspects: his journey from clinical practice to full-time utilization management work, and the multifaceted role of medical director in the healthcare industry. Berning shares his experiences navigating nonclinical career paths within healthcare organizations, shedding light on the opportunities that arose when he transitioned to a state-level plan in the Mideast.

The discussion seamlessly transitions into an exploration of the responsibilities of the medical director role. Rich provides valuable insights into utilization review, case management, and the collaborative efforts required to succeed in this position. 

Negotiating Salaries in Nonclinical Positions

In this segment of the conversation, Rich discusses how the base salary for nonclinical positions can surpass that of clinical roles and the potential for salary growth over the years. They compare the stresses associated with clinical and nonclinical roles, highlighting the distinct pressures in each domain.

Dr. Berning's Advice

Physicians like to take care of patients. That's what we want to do. So, this is just a new way to do it, and it's an important part of the whole system.

Resources and Networking for Aspiring Medical Directors

The conversation shifts to valuable advice for physicians aspiring to become medical directors. Rich describes organizations like AHIP and the American Association for Physician Leadership (AAPL) that provide courses that aid in professional development. 

The discussion concludes with practical tips on enhancing visibility, such as updating LinkedIn profiles, attending conferences, and networking. Rich stresses the importance of leveraging personal connections and reaching out to colleagues in the field for mentorship and job opportunities.

Summary

Dr. Rich Berning shares practical insights on transitioning from clinical practice to nonclinical roles, focusing on medical director positions with large healthcare insurers. He underscores the importance of networking, updating LinkedIn profiles, and attending conferences for career advancement. Rich provides a realistic view of the responsibilities and challenges associated with being a medical director, encouraging listeners to connect with him on LinkedIn for further guidance.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for today's episode:

• Dr. Rich Berning's LinkedIn Profile
• Milliman Clinical Guidelines (MCG)
• InterQual
• AHIP
• American Association for Physician Leadership
• The 5 Most Popular Home Based and Remote Careers – 291
• Dr. Debra Blaine's Coaching Services

Disclaimers:

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business. 

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career. 

Download This Episode:

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Podcast Editing & Production Services are provided by Oscar Hamilton

The post The Truth About Medical Specialists and UM Jobs appeared first on NonClinical Physicians.