One Physician’s Memoir and Practical Guide To Career Fulfillment

Transcription PNC Podcast Episode 414

One Physician's Memoir and Practical Guide To Career Fulfillment

- Interview with Dr. Helen Rhodes

John: I've known Dr. Helen Rhodes for six years, having interviewed her for the podcast back in 2019. At the time, she was an ideal guest, I felt at the time, I think, because she was sort of like a typical listener. Somehow the healthcare system had either betrayed or disappointed her and she had to make some changes.

And so she had a lot of good things to tell us back then. I can't believe it's already been six years. I've kept in touch since then and she's a dedicated, creative, inspirational clinician who's really never stopped trying to find ways to better serve her patients.

And then she actually released a book recently called The Power to Pivot: A Physician's Journey to Career Fulfillment. Maybe I'll show it to you later, listeners. So that triggered me to say, okay, we got to have Helen back on. Dr. Helen Rhodes, welcome back to the podcast.

Dr. Helen Rhodes: Thank you, John. It's great to be back.

John: This is going to be fun. Catch up with an old guest and you've got more to teach us and I want to promote your book. I always feel like I, especially former guests, if they have anything going on that's new, I would like to learn about it and promote it. We'll start out by just having you tell our listeners a little bit about your background, education, and like your early practice.

Dr. Helen Rhodes: Thanks. I was born in the UK and moved over with my family to Austin, Texas when I was about four years old due to my dad's job and grew up in Austin, went to undergrad in Austin, went to med school in Lubbock and did my residency in Houston and have been in the Houston area ever since. I actually started in academic medicine and stayed there for a little while and have had a lot of jobs. Currently, I have a solo gynecology only direct pay private practice, which I absolutely love. And I pair that with side gigs.

John: Okay. Yeah. That was what attracted me the first time to your story and you've continued to kind of tweak those things over the years. We did have a chance when we talked the first time to already kind of hear about your academic background, the private group practice, some locums positions, and maybe one that I'd maybe have you, we're not going to go into everything, but talk about the plasmapheresis job because I think people find that particularly interesting.

Dr. Helen Rhodes: Absolutely. When I was first in private practice, the revenues weren't quite what I wanted and nowhere close to the income that I had realized when I was in academics. So I needed to look for other things. And one of my friends from medical school, who's also an OBGYN, told me about working as a medical director for the plasmapheresis industry, which I had never heard of. And with her encouragement, I applied for one of the centers, applied at one of the centers and did it for about, I would say four years. And I really enjoyed it. It was a total diversion from clinical medicine and gave me a better perspective about the plasmapheresis industry in terms of what they're actually doing and a little extra income for the practice.

John: That's how you do it. You know, that's great. And it's funny we think about, well my education as a physician is really what's going to pay the bills, but there's a lot of non-clinical or sort of part-time unconventional clinical jobs that they pay very well. And so you'd be surprised if you look around.

Dr. Helen Rhodes: It was an independent contractor job, which was nice. I could tie the earnings to my business and they would go directly into the practice bank account. And the commitment was four hours per week per center.

One point I was traveling to five different centers, but that was during the pandemic when I was out of the office because we were not able to see patients in person. So it worked out well. And it's more of an operations job where you're working with the team regarding suitability for the donors that come into the centers to donate plasma.

In exchange for their donation, they do get a gift card, which they can use for groceries, bills, whatever they need. And the medical operations team, which I was the director of at each site is responsible for ensuring the health and safety of the donors and handling any adverse effects or adverse events that might happen during the donation process.

John: I think oftentimes when you're doing a job like that, too, it kind of resurrects some of the things you learned in med school and maybe in residency that you hadn't thought about in a while. So it just, most physicians are pretty intellectually curious and like to stay up on those things if they can. So it sounds like you kind of enjoy just doing something a little different.

Dr. Helen Rhodes: Yes, definitely.

John: Now you've done a lot of things and I was planning to maybe focus on the things you're currently still doing, whether it's occasionally or ongoing. But before I leave this list of things that you've done in the past that you're not currently doing, do you have any, looking back, certain thoughts about those particular jobs or advice based on the experiences of doing these different things?

Dr. Helen Rhodes: Interestingly, I feel like I have ADD of my career where I've tried a lot of things and all the decisions I've made have not been purely financial. I mean, I've truly enjoyed the diversion and getting to know different groups of people and working in different teams along the way. In addition to plasmapheresis industry, I've done a little bit in telemedicine.

I've done medical file review, expert witness work, locum tenens. I've got several locum tenens jobs that are still ongoing. And all of these opportunities were interesting to me and provided both additional revenue as well as a diversion from the day-to-day clinical practice.

John: Do you feel like doing that in general maybe diversifying, even if you're, maybe you're in a full-time practice, but if it's not overwhelming, is there value in doing those kinds of things?

Dr. Helen Rhodes: I think so, because by nature we're curious as physicians and like to be intellectually stimulated and like to try new things and we're lifelong learners and you never know what might happen with your current employment situation if you're employed or private practice situation if you're self-employed. I think it's nice to keep side gigs active, just in case you need to pivot and change your revenue streams based on how your practice is going or how your employment status is going.

John: Yeah, I think we forget that bad things can happen. We go into practice and we feel, okay, I've been trained now, I'm going to do this for 40 years and it's going to be nirvana. And I can't tell you I know an anesthesiologist and a surgeon who became disabled, doesn't mean they couldn't work and do some of those other jobs, but they couldn't work in their primary role.

Others who thought they had a great job for life for the company that got bought a hospital got bought by somebody else and they just went through and made a ton of changes. I mean, things can change. So most of us can still rebound, but heck, it helps a lot if you have that something already that you're affiliated with and maybe doing part-time to temporarily lean on, I would think.

Dr. Helen Rhodes: Absolutely. And for women and men when you're starting out with your family and kids are young, sometimes it's necessary, I know I did, to step back to a part-time schedule. Some employment situations won't give you that option, and so it's nice to have something else in the wings that you can do part-time while your kids are little or whenever you need to take a break for family reasons, whether it's caring for your children or other members of your family.

John: Now, one of the things that is mentioned in your book, well, let me get the book up here. But you have a chapter on expert witness consulting, and I think it was mentioned during the previous podcast, but I don't remember spending much time on that particular thing. So why don't you give us a quick rundown on how that began, and I kind of get the feeling you're still doing some of that.

Dr. Helen Rhodes: I am. I really like it. The same colleague and friend that told me about the plasmapheresis job also told me about medical file review and expert witness work and encouraged me to look into it, and incidentally, she went back to school about the same time I went back to school, and she became an attorney. She's an MDJD, and what I did was I listed my name in one of the expert witness directories and got a case and learned how to review a case, kind of self-taught, actually.

I didn't go to a course. Now, of course, there's lots of ways to learn how to do this. When I went back to school, there was a psychiatrist in my class who was doing a lot of this, and so he really helped guide me in terms of the paperwork and the process and the fee schedule, but you can do a variety of things.

You can just do medical file review, where it's a quick report regarding the case and the facts around the case, or you can do something more lengthy, where you are actually giving an opinion on whether or not standard of care was followed for your specialty, and you can be deposed and testify in court. I've actually done all of that. One of my very first cases actually went all the way to trial, which is really unusual, and I learned a lot, a lot, lot in that process because I definitely wasn't expecting that.

I was a big fan of mystery novels or children's books when I was younger, and I do view this type of work as being a detective. I mean, we can rifle through hundreds of pages of medical records a lot more quickly and efficiently than attorneys can, and that's what makes it fun. You really are helping them expedite the process of a case, when you look through the records.

John: And this was a malpractice or a liability type of case?

Dr. Helen Rhodes: Yes. The medical file review usually are automobile accidents, where you're just commenting on whether or not, I'm an OB-GYN, so it usually involves a pregnant woman, whether or not her outcome had anything to do with automobile accident. Those are the things that I've done, and then the other cases I've done have been Medi-Mal cases, where there's been an injury due to a medical error or incompetence on the part of the treating team. More of the work is for plaintiffs, which might make some physicians feel uncomfortable, but I've also done work for defense attorneys as well. I have reviewed cases and then decided that it wasn't something I felt comfortable giving an opinion about, or that I didn't feel like there was a case, and all of that is valuable to the attorneys.

John: Well, I've heard that ending up testifying in court is a rare thing, but it does happen, so I just want to get your sense of whether you, did you look forward to that? Did you dread it? Most people that know what they're talking about and are sensible and calm do fine, so what was your experience of that?

Dr. Helen Rhodes: Well, I can't say that I was excited about it, but I did have some experience, because when I was a resident, I actually was called as, I was called in a trial as the treating physician, because I had taken care of the patient in the emergency department, so at least I had experience of being on the witness stand as a physician, but it's a very intimidating process in my opinion, because the goal of the opposing counsel is to discredit you, and that's a pretty difficult position to be in, but my, the attorney that I was working for really helped me prepare for testifying, and when it was all over with, I was like, okay, this is all right, I can do this again.

John: Did you have other opportunities to testify like that?

Dr. Helen Rhodes: Not yet.

John: You're ready for it.

Dr. Helen Rhodes: Not yet, I'm ready for it, though, yeah.

John: I went through several depositions, some not for my own cases, but a couple for mine, and yeah the attorney that you're working with is just so critical. I mean, the one I had, she was so good at preparing me, and for the deposition, I never testified, but I mean, I kind of enjoyed it because you feel definitely in the deposition phase you're definitely smarter than the person interviewing you in terms of your medical expertise, and probably you more so. I'm a family doctor, so I'm going to be at a general level for most things, but yeah, you get into, yeah you have the advantage unless they are really, really super sharp, I would think.

Dr. Helen Rhodes: You definitely have the advantage, and you have to remind yourself of that, and the counsel I received ahead of time, she did remind me of that, but also, we tend to talk too much, and say too much, and think out loud too much, so one piece of advice I got from her, and I've tried to impart to others, is say as little as possible, just answer the question, don't elaborate.

John: I've heard that myself many times, so yep, that is good advice. Okay, in general, your experience has been positive, you're still doing it, so for those listening hey, it's something to consider, and it generally pays very well. It does.

All right, now I was going to move to another topic, but I think we can talk about the book now, and then I want to start, well, and I want to just make sure I get to your current practice settings, but tell us about the book. Why did you write the book? When did it come out?

Dr. Helen Rhodes: It came out in March of this year. I wrote it, because along the way, because I'd done so many things, and found myself doing a lot of informal mentoring of younger physicians, especially when it came to work-life balance. I kept hearing, you should write a book, you should write a book, so I did, and worked with a wonderful writing coach, Dr. Deborah Blaine, and she's a physician author. I know she's been on your podcast, and she was so helpful in helping me put it all together, and get it published. I had been making notes in a journal of sorts for years, kind of weaving in different stories, and she just helped me get organized, and learn about the writing process, and publishing process, which is a lot more complex than you think.

John: Oh yeah, yeah, definitely. It's not like just putting some notes down, and proofing it, and it's ready to go. Now, the thing that I liked about it, well, I like most, a lot of things. It just covers so many different topics, and there was a book that came out about 20 years ago by a physician, and it was a series of questions that he went through. I wish I had the book, that's why I'm looking around, and see if I have it handy. It was very popular, because it just kind of addressed a lot of things that he had gone through, and at that time, there were no coaches to speak of.

I kind of think of this book like that, because it has so many examples of things that you've done, and little hints about how to pursue something like that, and then at the end of each, not every chapter, but I think at the end of many of these chapters, summary of some of the takeaways, which I found actually very useful as I was going through, because it's one thing to hear the story, and another to have you like provide your summation in a way of what you got out of that, and what you advise others to do. So, is that something that just kind of came to you to do, or did you plan doing it that way?

Dr. Helen Rhodes: It was planned. Deborah had suggested that you hit kind of the high points at the end of each chapter to sum it all up, and I've done so many things, and I've liked so many things for different reasons, and I didn't plan to do all these things. They just kind of happened, and really, my focus when I wrote the book was to encourage and empower the younger generation of physicians to think about multiple ways to practice medicine, and that they don't have to jump into a corporate medical career, that there's other things they can do, and they can do things side by side, so that they don't feel stuck, and I'm not a big fan of the word burnout, but we're using it so that they don't burn out as quickly as is currently happening. Give them hope.

John: Yeah, it does. I don't think you have a website just focusing on the book, so what's the easiest way for us to get a copy of the book?

Dr. Helen Rhodes: It's available on Amazon and Barnes&Noble in eBook, paperback, and hardback.

John: Okay, again, The Power to Pivot: A Physician's Journey to Career Fulfillment. I think in the book, you do spend a little bit of time talking about two of the things that you're still currently doing. So, the first I want to talk a little bit more about is just working at the Critical Access Hospital. That came about a long time ago. Tell us about how that happened, and I want to know if anything's changed since we talked to you last time, because you did mention that last time.

Dr. Helen Rhodes: When I was starting the private practice and feeling this revenue pinch and looking for side gigs, as an OB-GYN, there's a lot of work to be done in locum tenens, but I had not delivered a baby in over 10 years. I kept being told no because I hadn't done obstetrics in so long, and in parallel with that, I'd gone back to school and met a lot of really neat healthcare leaders in a master's program, and two of the people I met were from Kansas, from rural Kansas. So, long story short, they said, oh, we'd love to have you come up and teach our family medicine residents how to do GYN surgeries, and in return, we can help you get your OB case list back.

We'll put you on call, and this will hopefully lead to some locum tenens assignments, so I got my Kansas medical license. The contract with this particular hospital actually fell through, mainly for med mal reasons, but it led to me thinking I can look out of state, so I got my New Mexico medical license and started looking for jobs. I finally got one in the panhandle of Texas and in Kansas, and then eventually in New Mexico, doing OBGYN full scope in rural areas where they absolutely have no OBGYN, so they were more open to someone that had not delivered a baby in so long coming to help their hospitals.

The critical access hospital I work at in New Mexico is just a lovely group of patients and people in the town. I've been going there now since 2018. I was going once a month for about five days, and then I ended up having too many things on my plate, so I cut back, but I'm still going every month or two for shorter shifts, and I do clinic and call, and it's just been a fantastic experience.

John: I think you write in the book the experience of delivering that first baby after 10 years.

Dr. Helen Rhodes: Yeah, the very first job was actually in Kansas, not with the hospital that I had been negotiating with, but with another hospital, and I pack up. I get to the small town, and of course, it's three or four in the morning, and the phone rings in the hotel, and the nurse says, We have a patient here, and she's going to deliver, and I jumped up out of the bed, and my heart was racing. I said, I'm actually going to be delivering a baby again, and by then, it had been 13 years since I'd done a delivery, and I'm running around the room, and I'm trying to convince myself that I can do this, and then I've got to get to the hospital in the middle of the night, dark rural road, and everything went fine, but yes, it was a very special time.

John: So really, you've been there at the New Mexico location at least most of the time once a month or two, and for three, four, or five days at a time, and basically, that just has rolled on. It really hasn't changed much in terms of who you're serving and how you're doing.

Dr. Helen Rhodes: No, I actually have my own. I view it as a mini practice there because a lot of the patients I take care of there, I've been seeing the whole time. They come. They wait for me to come, which is really flattering, and then some of the OB patients are coming back for their second and third babies, so I get to see them again, so it's really kind of fun, and I've actually worked in six states now, probably at 20 different hospitals doing locum tenens. I'm cutting back now just because my age, I'm getting tired, and my cash-based private practice is really taking off, which I didn't really expect, and I have grandkids, and we have aging parents, all those things that happen when you grow up. Yeah.

John: It's hard to be away from home, particularly when you have aging parents.

Dr. Helen Rhodes: But I really loved locum tenens when I was doing it really a lot more than I'm doing now. It's just a great way to see how different health care systems work, travel, make extra money, and keep your skills up.

John: I advise people to get the book and look at that chapter. I think at the end, you just have a few tips for if you're going to do locums, like how to make it a little easier. Sometimes it gets complicated, I think. It does. Okay, so that brings me to what you're doing now with your own practice. You've had a private practice for, I don't know, eight or ten years. Is that right?

Dr. Helen Rhodes: Since 2013. In the beginning, I was sharing overhead expenses with two other physicians and then went completely solo, I believe, in 2017, so however long that is, and then dropped insurance this year.

John: All right, so tell us about that process and tell us what the practice was like in terms of even for just the last few years. How often are you there and what are you doing there and then what led up to this recent change in the way that you're interacting with insurance companies, which is without any interaction now.

Dr. Helen Rhodes: Yeah, it's always been a gynecology-only practice, office and surgical. I would spend three days a week in the office and two days a week in the OR in the beginning and then gradually whittle that down a bit and cut back on my OR days. The pandemic, of course, affected everyone and my surgical case volume began to decline and never really rebounded after the pandemic.

Reimbursements continued to decline and it got to the point that, financially, I had to make a decision. Am I going to continue to see my patients, continue my practice, which I absolutely love, knowing that the income was virtually nothing at one point, or try something else.

After talking to my two very dedicated staff, we really thought about it for about two years. We made the decision to stop contracting with payers, which is a big process. It takes about six months to do that. I did stay with traditional Medicare, but none of the Medicare Advantage plans. I also had to decide that it was time for me to stop operating, which I love to operate, so that was a big decision. When you're not contracted with payers, it's very difficult to have a surgical practice. Once I came to that conclusion, we notified our patients.

We gave them ample notice that we were making this business shift, dropped the payer contracts, came up with a price list. I've been seeing some cash-based patients in parallel with insured patients all along, so the prices were always on the website, but we were more transparent about it so that people knew exactly what to expect, should they decide to stay with my practice. January was when we launched this.

Yes, there are some patients that have left, and we've helped them find other physicians, or they come to see me for little problems, which are not as expensive for them to have me manage, but most of the patients have been extremely supportive and understanding because they get it in terms of what's happening to solo practitioners and reimbursements and overhead expenses. I've recently become a certified menopause practitioner, and that is probably the bulk of my new patient appointments currently. Women are seeking this kind of care.

There's not enough menopause specialists to serve women who want this care, and my prices are very affordable, so that was something I didn't expect to happen. Additionally, I have patients booking appointments for all sorts of gynecologic reasons, specifically because we don't accept insurance. They don't want to see a physician who accepts insurance.

I didn't expect that either, so they pay for the visit. They get an itemized receipt that has the ICD-10 and CPT codes listed, so they can either submit it for HSA reimbursement, or they try to get their insurance company to reimburse them for the visit or have it apply to their out-of-network deductible. It's their choice, but anything we do through the practice, labs, imaging, prescriptions, that all goes towards their insurance policy if they have insurance. So it's been really fun. And then I continue to do that.

And 1099, locum tenens jobs, I also do some nocturnist shifts to keep my acute care skills up. I work at a hospital in the community that's a teaching hospital as well as a community hospital as part of a nocturnist team. I do a couple of shifts a month. They're 10 hour shifts. I'm dead the next day. It tells me I can't do 24 hours in-house anymore, but it keeps my skills up and also brings a little bit of money into the practice. And I still travel to New Mexico and still do expert witness work, but I am slowing down.

John: Let me ask a couple of questions, though, about the private practice here that came up in my mind as you were talking. So when you say you're certified as a menopause expert, tell me about that.

Dr. Helen Rhodes: Certified menopause. The organization formerly was called North American Menopause Society or NAMS. They've recently changed their name to the Menopause Society because it's now an international working group of physicians who and mid-level providers who go through all the data regarding care of menopausal age and perimenopausal age women. Providing solutions for their symptoms, whether it's medications, lifestyle changes, and also information on the website to patients and those taking care of this age group. They have a formal certification program. It's basically a test. I studied for about, I don't know, three to four months for the test and did that last year. And then when you pass the test, hopefully you pass the test, you are a certified menopause practitioner.

Physicians and mid-levels can go through the certification process. And then they have on their website a list of certified menopause practitioners by zip code throughout the entire country. So patients who are looking for this kind of care can go to that website, plug in their zip code and the choices pop up. I'm now listed and that's driving a lot of new patients to my practice.

John: Nice. That's helpful. When I think about some of these things that physicians can get into, I'm also trying to figure out the difference between like the allopathic side and the natural or whatever you want to call it. There's functional medicine, there's this and that. So is this, because I know a lot of patients are probably looking for more natural ways to deal with certain symptoms than trying to just give me a medication that I have to take every day. Is that included in this kind of approach?

Dr. Helen Rhodes: Definitely non-pharmaceutical approaches are discussed depending on what a patient's symptoms are. I've always tried to blend alternative and complementary medicine to traditional medicine. I don't view myself as a functional medicine physician, but I try to be holistic.

My patients who are coming in now, a lot of them are in their 40s, 50s, 60s and older, and I talk to them about their cardiometabolic risk factors, neurodegenerative disease, bone health, brain health, not just typical gynecologic care, but I try to expand that. Today, I did ASCVD risk assessment for a couple of patients because they were worried about their cholesterol profile, and I reassured them that based on their other parameters, that their risk was not in the range that they needed a statin yet. It's not functional medicine, but I view it as more primary care for women, getting them to think about prevention of osteoporosis, prevention of diabetes and cardiovascular disease, rather than focusing just on treatment. It's fun. It's fun. I love it.

John: It's nice if your practice is fun. I don't remember my practice ever being fun. Maybe there were a few times. You should have been in OB-GYN. Yeah. Oh, that sounds like terror in the middle of the night. I did OB for eight years as a family doctor.

Dr. Helen Rhodes: Yeah, when things don't go well in obstetrics, it's terrifying. Yes, it is terrifying.

John: Something else you said, I have a question about what is the logic or that one of their main criteria is, I only want a doctor that doesn't take insurance.

Dr. Helen Rhodes: I guess they're sick of insurance.

John: They just don't want to deal with it either, or they don't have it.

Dr. Helen Rhodes: I have never asked really why, but I'm assuming that they just want to pay for their service and get their service and leave, just like they go get their nails done or go buy clothes or buy a car or anything else. They don't want to deal with insurance.

John: I know how they feel, but I think you and I probably deal with our practitioners. It's kind of that way that you show up, you pay your bill and you leave. It doesn't mean there isn't going to be some insurance involved, but it's like, let's not worry about back and forth and being billed.

Dr. Helen Rhodes: I also feel the insurance industry has made it very difficult for patients to understand, what am I getting for my monthly premium? It's a complex system. It's hard to understand, and it's frustrating. What is a copay? What is coinsurance? What is a deductible? What is out of network? You're listed in my insurance book as being an in-network provider, but you tell me you're not. It's very frustrating for patients and doctors.

John: Some of the people I've talked to on the DPC side, direct primary care, they deal with the same thing. They just save a ton of money because they don't have to bill insurance, don't even have to keep track of it, they don't have to do coding. One of the things is that we have such high deductibles for a lot of things that it's actually easier for me to go to my doctor and say, send me to the MRI facility down the road because they're going to charge me $400 or $600. If I go through my insurance, I end up paying more because they're going to be charging $3,000 of which I haven't met any of my deductible or copays.

Dr. Helen Rhodes: I think that people don't understand that you don't have to use your insurance. At every point of care in the healthcare process, you can always ask, what is the price if I don't use my insurance? I don't think everyone realizes that you have that choice. You don't have to use your insurance.

John: I think when the Medicare gets a little dicey, I don't know the answer, but it's sort of like for physicians, you're either in or you're out. You can't really do both, although the patients can choose to see you and pay for cash, I guess. It is very complicated to figure out as a patient.

Dr. Helen Rhodes: If you stay in network with Medicare, then you must bill Medicare as a physician. If you're going to do locum tenens, you must keep your Medicare number. You can't opt out of Medicare and be a locum tenens physician, and that's important to remember.

John: We've gone over our time, I think, for today, but let's just remind us again about your book and where we can get it.

Dr. Helen Rhodes: It's called The Power to Pivot. It's about my journey to career fulfillment. It's available on Amazon and Barnes&Noble.

John: Any last advice you want to give to anyone who's maybe in a similar situation as you, in the sense that you want to continue to work, but you don't necessarily want to work full time in a high-stress situation? Any advice for our listeners? Know your worth.

Dr. Helen Rhodes: You're a physician. You've spent years learning your specialty, and there is so much opportunity out there that is not corporate medicine or traditional physicians. I encourage everyone to look at all those other options. There's your podcast. There's so many other resources out there, and try it. If you don't like it, you can always stop.

John: Absolutely. All right. With that, then, I really want to thank you for being here. This has been very interesting, and you can get a lot more details by reading the book, so I'll send them there, and I'll put that link in. Can they reach out to you on LinkedIn if they have a burning question that only you can answer?

Dr. Helen Rhodes: Absolutely, or my email, which is drhellenrhodes@gmail.com.

John: Okay. I will put that in the show notes as well. With that, maybe we'll have you come back in another seven or eight years. We'll be retired. I think we'll both be retired. Anyway, thanks for being here. It's been fun, and I think really valuable.

Dr. Helen Rhodes: Thank you so much for having me.