Interview with Dr. Nkeiruka Duze
Dr. Nkeiruka Duze achieved balance in her professional life by balancing her roles as medical director and concierge physician.
Dr. Nkeiruka Duze earned her medical degree from Indiana University School of Medicine and completed her residency training at Virginia Mason Medical Center in Seattle. She is a board-certified Internal Medicine physician practicing exclusively in the outpatient setting.
Burnout and a desire for work-life balance led to her curiosity about non-clinical opportunities for physicians. Given her interest in medical coding, she worked to increase her knowledge in this area earning Certified Professional Coder (CPC) and Certified Risk Adjustment Coder(CRC) certifications from the American Academy of Professional Coders (AAPC).
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Medical Director and Concierge Medicine
Dr. Duze splits her time equally between clinical and non-clinical work. She is a physician advisor to the revenue cycle team and the medical director of value-based arrangements and risk adjustment coding at a large medical center.
Her primary responsibilities include coding education, liaison to payer teams who oversee value-based arrangements, appealing outpatient denials, and physician coder consultant.
In her clinical practice, she recently transitioned from traditional outpatient practice to concierge medicine. As a result, instead of managing over 1500 patients, she is now responsible for 180.
Here visits are now twice as long, and it is much easier to get to know each patient very well. She is beginning to share patient coverage with another part-time concierge physician in her group.
Satisfying Balance
Dr. Duze enjoys her work as a medical director and concierge physician. She is helping her practice run more efficiently, document care better, and bill more accurately. She also continues to provide high-quality medical care to her panel of patients.
Summary
Nkeiruka was beginning to feel the effects of a high-volume practice. However, by replacing some of her clinical duties with nonclinical management work, and the remainder of her practice to the concierge model, she is much more fulfilled in her job. The feelings of burnout have resolved. And she is caring for patients in more rewarding ways.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- Dr. Duze's LinkedIn Profile
- American Academy of Professional Coders
- Dr. Duze's Email Address:ncnwoko@gmail.com
- NewScr!pt
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Transcription PNC Podcast Episode 234
Achieve Beautiful Balance as Medical Director and Concierge Physician
John: Like others before her, today's guest sought to overcome burnout and find more balance by splitting her time between nonclinical work and her outpatient practice. But what I find so fascinating is her practice itself transformed from traditional to concierge medicine at the same time. I think that's super unique. Hello, Dr. Nkeiruka Duze.
Dr. Nkeiruka Duze: Hi, John. Thank you so much for having me on today.
John: I'm glad you're here because I think your story on the one side, it's like a lot of other people's stories in terms of trying to fight burnout and move forward in your career, but there are just some parts to it that I think are quite unique. Listeners, you're going to learn a lot today.
Dr. Nkeiruka Duze: I hope so. And thank you again for having me.
John: Oh, you are welcome. Like we usually do on the podcast here, tell us a little bit about your background, your education, the clinical background, and then I want you to end with what you're doing at this moment, but then we'll fill in the gaps later as I get into some more questions.
Dr. Nkeiruka Duze: Absolutely. In terms of my education and clinical background, I have a first degree in biology, which I got at Texas Southern University in Houston, Texas. And from then I moved on to Indiana University School of Medicine, where I got my medical degree, and subsequently to Virginia Mason Medical Center in Seattle, Washington, where I did my internal medicine residency.
In terms of what I'm doing now, post all my training, I really have two jobs. I have my clinical and my nonclinical roles. And my clinical role is as an outpatient primary care doctor. I still see patients in the clinic. And then my nonclinical role is as the physician advisor, as well as a medical director for value-based arrangements and risk adjustment coding at a large medical center in the Seattle area.
John: Very nice. Now, a couple of things, I'm going to just jump in here as we go through, because when I hear someone like yourself tell me what you're doing as an internist, then I automatically assume you're a hospitalist. Because just so many of the internists that I know they either do one or the other, of course, but your practice really has been mostly outpatient, right?
Dr. Nkeiruka Duze: Exclusively outpatient since finishing my residency training.
John: See, I could tell from the very beginning that you're always going in a slightly different direction than the majority of people.
Dr. Nkeiruka Duze: Well, I guess I don't like to follow the crowd.
John: Now you were doing just practice for a while, correct?
Dr. Nkeiruka Duze: That is correct. My transition into including the nonclinical job into my role or my practice started a few years ago, actually. As you mentioned, I was experiencing burnout and I started to explore what are some nonclinical opportunities out there that I could do while still practicing medicine, but then just kind of cut down my clinical practice. That is when I started to look into the possibility of becoming a physician advisor.
John: Yeah. It was very similar to what I did a long time ago. I thought, well if I can work an hour or two doing something else and use that to cover the cost of working less in the clinic that would be a good exchange. Because when you're doing the nonclinical, there's really no liability, there's no call. You're going to just put your hours in. It's a good way to segue and see if you like it.
Dr. Nkeiruka Duze: Absolutely. And I can tell you that comparing what my life was like when I was a 100% clinical practice compared to now, which is where I do 60% clinical practice, 40% nonclinical, the difference is night and day for me in terms of just overall wellness and quality of life.
John: Now, apparently, do you like doing the physician advisor work when you first started that? Was it enjoyable?
Dr. Nkeiruka Duze: Oh, absolutely. When I was exploring nonclinical positions to help combat burnout, the reason that I was drawn to the physician advisor role is that I've always had an interest and fascination with billing and coding. That was kind of what drew me to that particular nonclinical role.
John: Most of us think when we think of a physician advisor, or thinking like making sure that the procedure was done, was legitimate or it was a good indication for like utilization management, I guess I would call it. Sometimes you call it benefits management, but there are others. You mentioned the coding piece. Were you actually helping people with coding at the same time?
Dr. Nkeiruka Duze: Great question. Not until I actually got the role as a physician advisor. I think my journey has been somewhat unique in that when I was looking into the physician advisor role, certainly, I say it was mostly kind of a utilization review type position. But I learned though that the job of a physician advisor, it's actually more robust than that. There are so many things that you can do. Not only the utilization review but quality and performance improvement, appeals and denials management, and then suddenly with the coding and documentation support and education. I latched onto the coding support and education piece.
I think it was easy for me to do that because the medical center where I work already had an established physician advisor program. And I guess more accurately, I would define it as a clinician advisor program because it has physician advisors, but also has a pharmacist. And that particular program also had an outpatient physician advisor as well.
John: Now, when you were talking there about the way that these things overlap, it really is a good point because the core thing about that is for whatever reason, you're doing a review of a case.
Dr. Nkeiruka Duze: Correct.
John: And like you said, it could be a quality review. It could be just strictly a documentation and coding review, especially on the inside inpatient too, but the outputs the same thing, or it's utilization and they all overlap. And the coding effects, utilization because if you don't have the right documentation, you don't have the right code. Well, you're not going to order the right test, at least in the eyes of a reviewer. It's just interesting. And then you can kind of figure out which of those three and maybe there are other aspects that are the most interesting.
Dr. Nkeiruka Duze: Yeah. And even though I studied mostly with the coding support and education piece, I've been able to expand my responsibilities or roles since then. And that's the other beauty of a physician advisor role is that you can do as much as you want. And you can go as broad as you want. It just depends on what your vision is.
John: I suppose it depends on the organization and the size of it. And like you said, it had a well-established program already. So that helped.
Dr. Nkeiruka Duze: That helps a lot.
John: I've talked to physicians and I find this remarkable, someone recently said, "Yeah, I was the first physician advisor at this large hospital or this large system". I thought PAs have been around for 40 years. You're the first, it's kind of crazy.
Dr. Nkeiruka Duze: Absolutely. Well, in my case, I wasn't the first. Our institution was not.
John: Now, has that role evolved since you started? How long have you been doing that now?
Dr. Nkeiruka Duze: I've been doing the physician advisor role for two years. I actually started the role on January 1st, 2020. But prior to that, I already spent a lot of time looking up the coding certifications, preparing, just basically trying to get the knowledge to help myself in practice until a position opened up where I could actually be a physician advisor.
John: Now, at least in the past some systems have trouble finding part-time physician advisors, they usually look into their medical staff or the physicians that are already aligned with them, unless they're doing something where they're getting something that's a freelance or a third party to come in. But at the same time, it doesn't mean we shouldn't prepare for it. You did some things, I think to kind of say to you up for success. I know you got some additional certifications. Where did that come in?
Dr. Nkeiruka Duze: Great question. As I was looking into this nonclinical space and wanting and setting my sites on a physician advisor role, like most people, when you want to do something, you don't know where to start, you go to Google. So, I started off with Google and I basically came across through my search, and when I was thinking about coding and billing the American Academy of Professional Coders, AAPC. And it's from that organization that I earned my certified professional coder, which is the CPC certification. And then subsequently more recently my Certified Risk Adjustment Coder Certification.
John: Did you get the certifications after you had already started as a physician advisor or one before, one after? How did that timing go?
Dr. Nkeiruka Duze: Great question. With the CPC, I had already started preparing for it before I got the job. And then with the CRC, I did that while I already got the job.
John: I'm not sure I've ever heard of the AAPC. It would be odd that I hadn't, considering how many people I talked to that do revenue cycle and utilization management and so forth. I had talked to people from the ACDIS. Now that's more for coding. I'm sure the nurses that worked at my hospital were very familiar with the AAPC. Were there many physicians that have gotten that certification to your knowledge?
Dr. Nkeiruka Duze: Great question. I personally only know two-physician coders, but I suspect there are many more that I just don't know. And the two that I know were within our system. Even when I was already thinking about it, and at the time I got the job, I learned at the time that both of the outpatient physicians in the program also had a CPC certification.
John: Okay. It's funny because when we had consultants to our hospital to do utilization, that was mostly inpatient, but they were involved and they were certified whether by the AAPC or some other organization.
Dr. Nkeiruka Duze: Yeah. I do know, John, that the AAPC also has a CIC certification, which is a Certified Inpatient Coder certification.
John: That's probably what I had come across. All right. So you did that extra, you're working hard. Did that completely resolve everything you were looking to do as far as your burnout, your transition, your balance in life?
Dr. Nkeiruka Duze: Absolutely. I would say though that when I took on a nonclinical role it made a huge difference in terms of balance and quality of life. But then when I also made the transition from the traditional practice of medicine to concierge medicine, that took it again to another level where I really feel, and I'm fortunate to be at this sweet spot where I feel like this is really what I've been waiting for, for a long time to have this type of balance.
To give you, and your audience a little bit of a clearer picture of what I mean, when I was in the traditional practice of medicine, I had about 1,700 patients in my panel. And then with concierge medicine, which I'll expand on a little bit later in the show, I imagine, if I were still a 1.0 clinician, the maximum number of patients I could have would be 300, but I'm a 0.6 FTE. So the maximum number of patients I can have in the practice is 180 patients. It's a huge difference between 1,700 patients to 180 when you think about whether it be the MyChat messages or the phone calls or the lab results, or the notes you have to dictate, or the number of patients you have to see in a day to keep your practice healthy.
So, it's a very, very vast difference. Making the change to a nonclinical role, and then also making the change in the same year to concierge medicine, I think was really what made me get to this point where I can say, "You know what? This is what I've been hoping for and wanting for a long time."
John: I have a couple more questions about that whole thing, that whole transition. Now you said 1,700 in the basic panel before the concierge, right?
Dr. Nkeiruka Duze: Correct.
John: Now, was that the full time or the 0.6?
Dr. Nkeiruka Duze: 1.0 is 1,700. When I was in traditional practice, but if I had remained 1.0 when I made the switch to concierge medicine, then my maximum would've been 300 patients. But I'm a 0.6 so my maximum number of patients is 180 because 1.0 is 300 patients in our concierge world.
John: And I think you have, I don't know if it's completely unique, but when someone tells me, well, I'm going to do concierge medicine. I'm like, oh, wow, you're going to have a big transition because you're going to have to tell all your patients, and they're going to have to decide if they want to pay you that way. And you're going to have to start your own business. But you're talking about doing concierge medicine within a system that supports doing concierge medicine. You have to tell us how that works and why that even exists?
Dr. Nkeiruka Duze: Well, very great question. I would say it may be unusual now. Maybe then it was unusual. I don't know how unusual it is now, but I would say for sure that the medical center that I work for really pioneered concierge medicine in that kind of a setting, in that concierge medicine practice has been in existence for over 20 years. I believe it started in 1999.
But I do know that at least one other medical center in the area now does concierge medicine. I believe the Mayo clinic does concierge medicine. I suspect that it's not as unusual now, but it must have been then when the medical center that I work for began this journey into concierge medicine in 1999.
John: Now, I think that's very forward-looking. I'm not an expert on concierge medicine, but when I think of it, when I was in practice and I started reading about it, it was really something entrepreneurial. Individual physicians, small groups were doing it and saying, "Look, we're going to get outta the rat race. We're going to have a core group of patients. They're going to pay us as we go. And that's it. We're done with Medicare and all that".
Then there were these franchises that started too, where okay, well, you can sign up and we'll do this turnkey, but I had never actually heard of a system, although it made sense because I think even at the hospital I was at, they thought, well, should we consider doing concierge medicine within our physician group? Now, they only had like a hundred physicians. This wasn't a massive group, so I don't think they really seriously thought about it. But yeah, it sounds like where you've worked has really been on the cutting edge of that, especially for a large system.
Dr. Nkeiruka Duze: Absolutely. If any of your listeners are part of a large medical center that does not have a concierge practice, this might be your opportunity to suggest settling with their support, because I can tell you that there is a huge desire or need. A lot of patients are really seeking out this type of service.
Because we have currently in our concierge practice a waitlist at all our locations. I know that this is something that patients want. Patients want more time with their doctor, they want easy access. They really want to be able to have a doctor that can spend a lot more time with them, get to know them, and not really just be feeling like they're in a factory churning out patients. A lot of people will pay for that service. I believe that if you don't have it in your medical center, it's your opportunity to maybe suggest it and be someone at the forefront to help your organization kind of tap into this model of practice.
John: Yeah. That would be great. If our listeners could get that expanded into other organizations. Now I'm going to quiz you. You went down to your 180 patients. This is the thing that really amazed me about concierge practice. Now if one of your 180 patients pages you, texts you, contacts you, there's a pretty good chance you're going to actually remember who they are. Is that true?
Dr. Nkeiruka Duze: Oh, without question. Without question. Yeah. Because you only have 180 people that you're taking care of. You'll know not only who they are, but you're also going to know the husband or a wife's name, you're going to know the kids' names. You're going to know their pets' names. You're going to know them so intimately because you're going to have a lot of time to spend with them.
I'll give you an example that when I was in the traditional practice of medicine, for a long time, the appointment slots were 15 minutes or 30 minutes. 30 minutes for an annual check-up, et cetera, or multiple concerns. Otherwise, a routine visit would be 15 minutes, but over time in the desire to address burnout, the schedules became 30/30. You have 30 minutes per patient. I thought that was really great when the organization did that.
To the concierge model, in our practice a regular appointment is an hour, whereas your annual check-up is an hour and a half. You really get to know people intimately. You really get to support them in a more well-rounded way. Because if you're busy, you may not have time to hone in on something that they said about what it's happening at home or in their family, which ultimately, will impact their overall health.
I had a few patients follow me when I made the transition and of course, I did pick up new patients. For those that followed me from the traditional to the concierge practice, they also comment on the difference being night and day. And then I personally, in terms of on the other end, I feel like this is really what I had envisioned when I thought about becoming a doctor. It's to really be there for my patients and have time to take care of them.
John: Okay. The bit of advice that I'm going to garner from that whole thing is when you're looking for your first clinical job, work for someone that has the possibility of a concierge program in it, even if you're not going into the concierge.
Dr. Nkeiruka Duze: Right.
John: Oh man, that sounds so good. And the thing is traditional medicine, you mentioned it before that patients did have these long waits and everything, and a visit under traditional terms is usually pretty unfulfilling for the patient because they're in a hurry. They feel like they haven't even told you anything. And you're like, I got to go. We'll deal with one thing today.
Dr. Nkeiruka Duze: Another patient is waiting.
John: And then, of course, the physician isn't willing to treat something on the phone or telemedicine because they're not getting paid.
Dr. Nkeiruka Duze: Correct.
John: Now you just flip the whole thing around. I'm assuming you take care of a lot of patients just by email and texting.
Dr. Nkeiruka Duze: Well, we certainly have the ability to do that, to just have the patient call on your cell phone and have a conversation but I really believe in the value of actually having people come into the clinic. So that way you can naturally just have the focus time to talk about things and then also examine them. I always encourage my patients that if something's going on, let's make an appointment, and then suddenly if you're not certain, we'll talk through what the right thing is to do.
But suddenly there's some mild symptoms, people might express over the phone that it doesn't really warrant them coming in, but I still try to encourage people to come in. Not that it is required, but that is just what I found as the way that I find medicine fulfilling is to have that either face-to-face or virtual connection time set aside on my schedule for me to focus solely on you and any concerns that you have.
John: Now, that makes good sense. I'm just thinking of the one that calls in and says, well, I have athlete's foot, can you call something in for it? Or I have conjunctivitis. Well, I need to have you come into the office for that because otherwise I can't get paid.
Dr. Nkeiruka Duze: Correct. Yes. Basically, as you already alluded to, with the concierge practice the members pay a fee monthly, so regardless of whether or not you call me or see me, every month you're paying a membership fee. And when I do see you in the clinic, I'm still billing your insurance for any services that I provide. That membership fee truly is for the access that you just described, where you can call me on the phone and say, "Hey, I have athletes' foot can you send me an anti-fungal medication?" I'm like, "Sure. Yeah." So, when it's other things or multiple things and I tend to just have people come in. That's just my style.
John: There are a couple of other little background things we need to know about how this happened. First of all, it wasn't the type of thing where you were getting burned out, you just turned to the owners of the system and said, "I would like to do concierge medicine. Is that okay? Can I switch it over tomorrow?" There are some constraints on it. I think from what we were talking about before, in terms of who can do that, when they can do that, all that.
Dr. Nkeiruka Duze: Absolutely. Yeah. In order to make the transition, first, there has to be availability. There's got to be a spot that is opened up either because maybe someone is retiring or because they're expanding the program. And then in being able to be part of the concierge program, you have to have a certain number of years of practice. You have to have high patient satisfaction scores, et cetera. They're looking for a particular quality of physicians to join the practice.
John: And then the other piece, which I thought maybe you're going to go into since you're doing it part-time, that presents a little bit of an issue, doesn't it?
Dr. Nkeiruka Duze: Great question. Temporarily yes. To give a picture of what my schedule is like, usually, I'm typically in the clinic Monday, Tuesday, and Friday, and then my nonclinical days are Wednesday and Thursday. In the meantime, if a patient needs something on a Wednesday or Thursday, they can suddenly call my cell phone or send me a message to the patient portal. And then I respond during my admin days or my nonclinical days. But that is slated to change in the future because we're going to have a practice partner join me and we will both be then the first two real part-time concierge medicine docs. And on my nonclinical days, she'll cover me and vice versa.
But I must tell you, John, even on my nonclinical days I probably like on a busy day maybe get three or four emails or between emails and calls, maybe four, because again, we're talking about 180 patients. It's a small pool of patients. I'm not really getting a lot of people reaching out on the days that I'm not in the clinic. And if my patients do have to be seen on the day I'm not in the clinic, one of the other concierge medicine doctors is able to see them.
John: Well, it sounds like it's almost like a job sharing, but then again, if you're available, even when you're not officially on, it's not that big of a deal to respond.
Dr. Nkeiruka Duze: Correct.
John: All right. Well, where are things going? Where are things going? Are you going to do this for a while? Are you looking at expanding your nonclinical or do you want to hold things as it is for a while?
Dr. Nkeiruka Duze: I'm looking to expand my nonclinical role. As I mentioned earlier with the physician advisor role, you can do as much or as little as you want. And I've been focused a lot primarily on the outpatient, whether I be with education or outpatient denials and things like that, but I'm now hoping to expand to do more in the inpatient setting. When I think about where I'm going, I'm really going to be expanding my nonclinical role. And because it's concierge medicine as opposed to traditional medicine, I actually see myself being able to keep my 180 patients, and then just expanding my nonclinical role without having to cut back any further on my clinical role.
John: Yeah. Nice. It'll be nice if that works out. I remind people they ask me, "Well, should I quit doing clinical completely or not?" You could do a lot of executive positions without doing any clinical, but I remind people that the CEO of the Cleveland Clinic was doing clinical, the CEO of Mayo, the CEO of a lot of massive, huge organizations still do an occasional clinic day, just to keep that going. And this is even a different version of that. We'll have to wait and see. I want to right circle back with you in a few years and see what's going on.
Dr. Nkeiruka Duze: Absolutely.
John: What advice do you have if someone that was in the position that you were in where you are kind of getting burned to out and just kind of frustrated. Any specific words of advice you'd have for my listeners?
Dr. Nkeiruka Duze: Absolutely. And thank you for asking. I think three things that I would encourage you to consider. The first is whether you are a hospitalist or an outpatient doc, I encourage you to explore nonclinical roles. And the reason for that encouragement is that the nonclinical roles not only add variety to your career and your life but also, I think it's the quickest way to actually get that work-life balance that most of us desire. Because with clinical practice, as you know, when you see a patient, whether it be for 15 minutes or 30 minutes, there's a lot of work that has to be done just for that one visit, whether it be the messages you're going to get from the patient about that, or the lab results that you're going to have to respond to.
Essentially, I feel like full-time clinical practice is challenging and it's hard to have work-life balance if you're in full-time clinical practice in my humble opinion. My first encouragement is that no matter what you're doing, inpatient, outpatient definitely explore nonclinical roles, even if you're going to do that as a 0.1 or 0.2. Just to kind of give you a little bit of a break. So that way you can have more work-life balance. Life is too short.
The second piece of advice I would give is to be flexible. What I mean by that is two things. Be ready to pivot if you need to, when opportunities arise. And then the second is if you already have an opportunity, be ready and flexible to expand if needed because when opportunities come up if you don't tap into them, guess what? Somebody else will. Even if you've set your sites on something, then you see something else that looks interesting, that becomes available, consider it. You just never know. You might like it. My second piece of advice is to be flexible.
And my final advice would be to seek out mentors that are doing either what you hope to do or something similar to what you hope to do. Because I think that we can really learn a lot from each other. I've learned a lot from people along the way, like reaching out cold calls to people and saying, "Hey, can I just have 30 minutes of your time just to ask questions about what you're doing or how you got there?" I encourage people to at least seek out somebody, at least a person that can hopefully mentor you, as you make that transition of hopefully adding a nonclinical role to your career. And I'm suddenly happy to support or answer questions to anyone that needs that support. And I'm certainly happy for any of your listeners, John, to email me if they had questions. And my address is ncnwoko@gmail.com.
John: I got that written down. I'll put that in the show notes. And you are on LinkedIn and they can just go to LinkedIn and look up your name and they should find you. That's how I found you on LinkedIn. I had already been referred to you, but I did find you there.
Dr. Nkeiruka Duze: Yes, I am on LinkedIn.
John: All right. Well, this has been very interesting. I could go on asking you more questions, but I think we're going to have to go here because we're running out of time. I thought there are many unique things about your story, the certifications are not totally unique, but you proactively pursued that. And I think we sometimes forget that there are those kinds of things out there and the opportunity to switch to concierge and how much that helped. And if anyone can emulate that in some fashion either to get it established or expand it at your organization, that's another great way to balance the two.
Dr. Nkeiruka Duze: Absolutely.
John: All right. Dr. Duze, thank you so much.
Dr. Nkeiruka Duze: Thank you so much for having me, John.
John: It's been my pleasure. And I hope to catch up with you again down the road. With that, I'll say bye-bye.
Dr. Nkeiruka Duze: Thank you, John. Thank you so much.
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Transcription PNC Podcast Episode 234
Achieve Beautiful Balance as Medical Director and Concierge Physician
John: Like others before her, today's guest sought to overcome burnout and find more balance by splitting her time between nonclinical work and her outpatient practice. But what I find so fascinating is her practice itself transformed from traditional to concierge medicine at the same time. I think that's super unique. Hello, Dr. Nkeiruka Duze.
Dr. Nkeiruka Duze: Hi, John. Thank you so much for having me on today.
John: I'm glad you're here because I think your story on the one side, it's like a lot of other people's stories in terms of trying to fight burnout and move forward in your career, but there are just some parts to it that I think are quite unique. Listeners, you're going to learn a lot today.
Dr. Nkeiruka Duze: I hope so. And thank you again for having me.
John: Oh, you are welcome. Like we usually do on the podcast here, tell us a little bit about your background, your education, the clinical background, and then I want you to end with what you're doing at this moment, but then we'll fill in the gaps later as I get into some more questions.
Dr. Nkeiruka Duze: Absolutely. In terms of my education and clinical background, I have a first degree in biology, which I got at Texas Southern University in Houston, Texas. And from then I moved on to Indiana University School of Medicine, where I got my medical degree, and subsequently to Virginia Mason Medical Center in Seattle, Washington, where I did my internal medicine residency.
In terms of what I'm doing now, post all my training, I really have two jobs. I have my clinical and my nonclinical roles. And my clinical role is as an outpatient primary care doctor. I still see patients in the clinic. And then my nonclinical role is as the physician advisor, as well as a medical director for value-based arrangements and risk adjustment coding at a large medical center in the Seattle area.
John: Very nice. Now, a couple of things, I'm going to just jump in here as we go through, because when I hear someone like yourself tell me what you're doing as an internist, then I automatically assume you're a hospitalist. Because just so many of the internists that I know they either do one or the other, of course, but your practice really has been mostly outpatient, right?
Dr. Nkeiruka Duze: Exclusively outpatient since finishing my residency training.
John: See, I could tell from the very beginning that you're always going in a slightly different direction than the majority of people.
Dr. Nkeiruka Duze: Well, I guess I don't like to follow the crowd.
John: Now you were doing just practice for a while, correct?
Dr. Nkeiruka Duze: That is correct. My transition into including the nonclinical job into my role or my practice started a few years ago, actually. As you mentioned, I was experiencing burnout and I started to explore what are some nonclinical opportunities out there that I could do while still practicing medicine, but then just kind of cut down my clinical practice. That is when I started to look into the possibility of becoming a physician advisor.
John: Yeah. It was very similar to what I did a long time ago. I thought, well if I can work an hour or two doing something else and use that to cover the cost of working less in the clinic that would be a good exchange. Because when you're doing the nonclinical, there's really no liability, there's no call. You're going to just put your hours in. It's a good way to segue and see if you like it.
Dr. Nkeiruka Duze: Absolutely. And I can tell you that comparing what my life was like when I was a 100% clinical practice compared to now, which is where I do 60% clinical practice, 40% nonclinical, the difference is night and day for me in terms of just overall wellness and quality of life.
John: Now, apparently, do you like doing the physician advisor work when you first started that? Was it enjoyable?
Dr. Nkeiruka Duze: Oh, absolutely. When I was exploring nonclinical positions to help combat burnout, the reason that I was drawn to the physician advisor role is that I've always had an interest and fascination with billing and coding. That was kind of what drew me to that particular nonclinical role.
John: Most of us think when we think of a physician advisor, or thinking like making sure that the procedure was done, was legitimate or it was a good indication for like utilization management, I guess I would call it. Sometimes you call it benefits management, but there are others. You mentioned the coding piece. Were you actually helping people with coding at the same time?
Dr. Nkeiruka Duze: Great question. Not until I actually got the role as a physician advisor. I think my journey has been somewhat unique in that when I was looking into the physician advisor role, certainly, I say it was mostly kind of a utilization review type position. But I learned though that the job of a physician advisor, it's actually more robust than that. There are so many things that you can do. Not only the utilization review but quality and performance improvement, appeals and denials management, and then suddenly with the coding and documentation support and education. I latched onto the coding support and education piece.
I think it was easy for me to do that because the medical center where I work already had an established physician advisor program. And I guess more accurately, I would define it as a clinician advisor program because it has physician advisors, but also has a pharmacist. And that particular program also had an outpatient physician advisor as well.
John: Now, when you were talking there about the way that these things overlap, it really is a good point because the core thing about that is for whatever reason, you're doing a review of a case.
Dr. Nkeiruka Duze: Correct.
John: And like you said, it could be a quality review. It could be just strictly a documentation and coding review, especially on the inside inpatient too, but the outputs the same thing, or it's utilization and they all overlap. And the coding effects, utilization because if you don't have the right documentation, you don't have the right code. Well, you're not going to order the right test, at least in the eyes of a reviewer. It's just interesting. And then you can kind of figure out which of those three and maybe there are other aspects that are the most interesting.
Dr. Nkeiruka Duze: Yeah. And even though I studied mostly with the coding support and education piece, I've been able to expand my responsibilities or roles since then. And that's the other beauty of a physician advisor role is that you can do as much as you want. And you can go as broad as you want. It just depends on what your vision is.
John: I suppose it depends on the organization and the size of it. And like you said, it had a well-established program already. So that helped.
Dr. Nkeiruka Duze: That helps a lot.
John: I've talked to physicians and I find this remarkable, someone recently said, "Yeah, I was the first physician advisor at this large hospital or this large system". I thought PAs have been around for 40 years. You're the first, it's kind of crazy.
Dr. Nkeiruka Duze: Absolutely. Well, in my case, I wasn't the first. Our institution was not.
John: Now, has that role evolved since you started? How long have you been doing that now?
Dr. Nkeiruka Duze: I've been doing the physician advisor role for two years. I actually started the role on January 1st, 2020. But prior to that, I already spent a lot of time looking up the coding certifications, preparing, just basically trying to get the knowledge to help myself in practice until a position opened up where I could actually be a physician advisor.
John: Now, at least in the past some systems have trouble finding part-time physician advisors, they usually look into their medical staff or the physicians that are already aligned with them, unless they're doing something where they're getting something that's a freelance or a third party to come in. But at the same time, it doesn't mean we shouldn't prepare for it. You did some things, I think to kind of say to you up for success. I know you got some additional certifications. Where did that come in?
Dr. Nkeiruka Duze: Great question. As I was looking into this nonclinical space and wanting and setting my sites on a physician advisor role, like most people, when you want to do something, you don't know where to start, you go to Google. So, I started off with Google and I basically came across through my search, and when I was thinking about coding and billing the American Academy of Professional Coders, AAPC. And it's from that organization that I earned my certified professional coder, which is the CPC certification. And then subsequently more recently my Certified Risk Adjustment Coder Certification.
John: Did you get the certifications after you had already started as a physician advisor or one before, one after? How did that timing go?
Dr. Nkeiruka Duze: Great question. With the CPC, I had already started preparing for it before I got the job. And then with the CRC, I did that while I already got the job.
John: I'm not sure I've ever heard of the AAPC. It would be odd that I hadn't, considering how many people I talked to that do revenue cycle and utilization management and so forth. I had talked to people from the ACDIS. Now that's more for coding. I'm sure the nurses that worked at my hospital were very familiar with the AAPC. Were there many physicians that have gotten that certification to your knowledge?
Dr. Nkeiruka Duze: Great question. I personally only know two-physician coders, but I suspect there are many more that I just don't know. And the two that I know were within our system. Even when I was already thinking about it, and at the time I got the job, I learned at the time that both of the outpatient physicians in the program also had a CPC certification.
John: Okay. It's funny because when we had consultants to our hospital to do utilization, that was mostly inpatient, but they were involved and they were certified whether by the AAPC or some other organization.
Dr. Nkeiruka Duze: Yeah. I do know, John, that the AAPC also has a CIC certification, which is a Certified Inpatient Coder certification.
John: That's probably what I had come across. All right. So you did that extra, you're working hard. Did that completely resolve everything you were looking to do as far as your burnout, your transition, your balance in life?
Dr. Nkeiruka Duze: Absolutely. I would say though that when I took on a nonclinical role it made a huge difference in terms of balance and quality of life. But then when I also made the transition from the traditional practice of medicine to concierge medicine, that took it again to another level where I really feel, and I'm fortunate to be at this sweet spot where I feel like this is really what I've been waiting for, for a long time to have this type of balance.
To give you, and your audience a little bit of a clearer picture of what I mean, when I was in the traditional practice of medicine, I had about 1,700 patients in my panel. And then with concierge medicine, which I'll expand on a little bit later in the show, I imagine, if I were still a 1.0 clinician, the maximum number of patients I could have would be 300, but I'm a 0.6 FTE. So the maximum number of patients I can have in the practice is 180 patients. It's a huge difference between 1,700 patients to 180 when you think about whether it be the MyChat messages or the phone calls or the lab results, or the notes you have to dictate, or the number of patients you have to see in a day to keep your practice healthy.
So, it's a very, very vast difference. Making the change to a nonclinical role, and then also making the change in the same year to concierge medicine, I think was really what made me get to this point where I can say, "You know what? This is what I've been hoping for and wanting for a long time."
John: I have a couple more questions about that whole thing, that whole transition. Now you said 1,700 in the basic panel before the concierge, right?
Dr. Nkeiruka Duze: Correct.
John: Now, was that the full time or the 0.6?
Dr. Nkeiruka Duze: 1.0 is 1,700. When I was in traditional practice, but if I had remained 1.0 when I made the switch to concierge medicine, then my maximum would've been 300 patients. But I'm a 0.6 so my maximum number of patients is 180 because 1.0 is 300 patients in our concierge world.
John: And I think you have, I don't know if it's completely unique, but when someone tells me, well, I'm going to do concierge medicine. I'm like, oh, wow, you're going to have a big transition because you're going to have to tell all your patients, and they're going to have to decide if they want to pay you that way. And you're going to have to start your own business. But you're talking about doing concierge medicine within a system that supports doing concierge medicine. You have to tell us how that works and why that even exists?
Dr. Nkeiruka Duze: Well, very great question. I would say it may be unusual now. Maybe then it was unusual. I don't know how unusual it is now, but I would say for sure that the medical center that I work for really pioneered concierge medicine in that kind of a setting, in that concierge medicine practice has been in existence for over 20 years. I believe it started in 1999.
But I do know that at least one other medical center in the area now does concierge medicine. I believe the Mayo clinic does concierge medicine. I suspect that it's not as unusual now, but it must have been then when the medical center that I work for began this journey into concierge medicine in 1999.
John: Now, I think that's very forward-looking. I'm not an expert on concierge medicine, but when I think of it, when I was in practice and I started reading about it, it was really something entrepreneurial. Individual physicians, small groups were doing it and saying, "Look, we're going to get outta the rat race. We're going to have a core group of patients. They're going to pay us as we go. And that's it. We're done with Medicare and all that".
Then there were these franchises that started too, where okay, well, you can sign up and we'll do this turnkey, but I had never actually heard of a system, although it made sense because I think even at the hospital I was at, they thought, well, should we consider doing concierge medicine within our physician group? Now, they only had like a hundred physicians. This wasn't a massive group, so I don't think they really seriously thought about it. But yeah, it sounds like where you've worked has really been on the cutting edge of that, especially for a large system.
Dr. Nkeiruka Duze: Absolutely. If any of your listeners are part of a large medical center that does not have a concierge practice, this might be your opportunity to suggest settling with their support, because I can tell you that there is a huge desire or need. A lot of patients are really seeking out this type of service.
Because we have currently in our concierge practice a waitlist at all our locations. I know that this is something that patients want. Patients want more time with their doctor, they want easy access. They really want to be able to have a doctor that can spend a lot more time with them, get to know them, and not really just be feeling like they're in a factory churning out patients. A lot of people will pay for that service. I believe that if you don't have it in your medical center, it's your opportunity to maybe suggest it and be someone at the forefront to help your organization kind of tap into this model of practice.
John: Yeah. That would be great. If our listeners could get that expanded into other organizations. Now I'm going to quiz you. You went down to your 180 patients. This is the thing that really amazed me about concierge practice. Now if one of your 180 patients pages you, texts you, contacts you, there's a pretty good chance you're going to actually remember who they are. Is that true?
Dr. Nkeiruka Duze: Oh, without question. Without question. Yeah. Because you only have 180 people that you're taking care of. You'll know not only who they are, but you're also going to know the husband or a wife's name, you're going to know the kids' names. You're going to know their pets' names. You're going to know them so intimately because you're going to have a lot of time to spend with them.
I'll give you an example that when I was in the traditional practice of medicine, for a long time, the appointment slots were 15 minutes or 30 minutes. 30 minutes for an annual check-up, et cetera, or multiple concerns. Otherwise, a routine visit would be 15 minutes, but over time in the desire to address burnout, the schedules became 30/30. You have 30 minutes per patient. I thought that was really great when the organization did that.
To the concierge model, in our practice a regular appointment is an hour, whereas your annual check-up is an hour and a half. You really get to know people intimately. You really get to support them in a more well-rounded way. Because if you're busy, you may not have time to hone in on something that they said about what it's happening at home or in their family, which ultimately, will impact their overall health.
I had a few patients follow me when I made the transition and of course, I did pick up new patients. For those that followed me from the traditional to the concierge practice, they also comment on the difference being night and day. And then I personally, in terms of on the other end, I feel like this is really what I had envisioned when I thought about becoming a doctor. It's to really be there for my patients and have time to take care of them.
John: Okay. The bit of advice that I'm going to garner from that whole thing is when you're looking for your first clinical job, work for someone that has the possibility of a concierge program in it, even if you're not going into the concierge.
Dr. Nkeiruka Duze: Right.
John: Oh man, that sounds so good. And the thing is traditional medicine, you mentioned it before that patients did have these long waits and everything, and a visit under traditional terms is usually pretty unfulfilling for the patient because they're in a hurry. They feel like they haven't even told you anything. And you're like, I got to go. We'll deal with one thing today.
Dr. Nkeiruka Duze: Another patient is waiting.
John: And then, of course, the physician isn't willing to treat something on the phone or telemedicine because they're not getting paid.
Dr. Nkeiruka Duze: Correct.
John: Now you just flip the whole thing around. I'm assuming you take care of a lot of patients just by email and texting.
Dr. Nkeiruka Duze: Well, we certainly have the ability to do that, to just have the patient call on your cell phone and have a conversation but I really believe in the value of actually having people come into the clinic. So that way you can naturally just have the focus time to talk about things and then also examine them. I always encourage my patients that if something's going on, let's make an appointment, and then suddenly if you're not certain, we'll talk through what the right thing is to do.
But suddenly there's some mild symptoms, people might express over the phone that it doesn't really warrant them coming in, but I still try to encourage people to come in. Not that it is required, but that is just what I found as the way that I find medicine fulfilling is to have that either face-to-face or virtual connection time set aside on my schedule for me to focus solely on you and any concerns that you have.
John: Now, that makes good sense. I'm just thinking of the one that calls in and says, well, I have athlete's foot, can you call something in for it? Or I have conjunctivitis. Well, I need to have you come into the office for that because otherwise I can't get paid.
Dr. Nkeiruka Duze: Correct. Yes. Basically, as you already alluded to, with the concierge practice the members pay a fee monthly, so regardless of whether or not you call me or see me, every month you're paying a membership fee. And when I do see you in the clinic, I'm still billing your insurance for any services that I provide. That membership fee truly is for the access that you just described, where you can call me on the phone and say, "Hey, I have athletes' foot can you send me an anti-fungal medication?" I'm like, "Sure. Yeah." So, when it's other things or multiple things and I tend to just have people come in. That's just my style.
John: There are a couple of other little background things we need to know about how this happened. First of all, it wasn't the type of thing where you were getting burned out, you just turned to the owners of the system and said, "I would like to do concierge medicine. Is that okay? Can I switch it over tomorrow?" There are some constraints on it. I think from what we were talking about before, in terms of who can do that, when they can do that, all that.
Dr. Nkeiruka Duze: Absolutely. Yeah. In order to make the transition, first, there has to be availability. There's got to be a spot that is opened up either because maybe someone is retiring or because they're expanding the program. And then in being able to be part of the concierge program, you have to have a certain number of years of practice. You have to have high patient satisfaction scores, et cetera. They're looking for a particular quality of physicians to join the practice.
John: And then the other piece, which I thought maybe you're going to go into since you're doing it part-time, that presents a little bit of an issue, doesn't it?
Dr. Nkeiruka Duze: Great question. Temporarily yes. To give a picture of what my schedule is like, usually, I'm typically in the clinic Monday, Tuesday, and Friday, and then my nonclinical days are Wednesday and Thursday. In the meantime, if a patient needs something on a Wednesday or Thursday, they can suddenly call my cell phone or send me a message to the patient portal. And then I respond during my admin days or my nonclinical days. But that is slated to change in the future because we're going to have a practice partner join me and we will both be then the first two real part-time concierge medicine docs. And on my nonclinical days, she'll cover me and vice versa.
But I must tell you, John, even on my nonclinical days I probably like on a busy day maybe get three or four emails or between emails and calls, maybe four, because again, we're talking about 180 patients. It's a small pool of patients. I'm not really getting a lot of people reaching out on the days that I'm not in the clinic. And if my patients do have to be seen on the day I'm not in the clinic, one of the other concierge medicine doctors is able to see them.
John: Well, it sounds like it's almost like a job sharing, but then again, if you're available, even when you're not officially on, it's not that big of a deal to respond.
Dr. Nkeiruka Duze: Correct.
John: All right. Well, where are things going? Where are things going? Are you going to do this for a while? Are you looking at expanding your nonclinical or do you want to hold things as it is for a while?
Dr. Nkeiruka Duze: I'm looking to expand my nonclinical role. As I mentioned earlier with the physician advisor role, you can do as much or as little as you want. And I've been focused a lot primarily on the outpatient, whether I be with education or outpatient denials and things like that, but I'm now hoping to expand to do more in the inpatient setting. When I think about where I'm going, I'm really going to be expanding my nonclinical role. And because it's concierge medicine as opposed to traditional medicine, I actually see myself being able to keep my 180 patients, and then just expanding my nonclinical role without having to cut back any further on my clinical role.
John: Yeah. Nice. It'll be nice if that works out. I remind people they ask me, "Well, should I quit doing clinical completely or not?" You could do a lot of executive positions without doing any clinical, but I remind people that the CEO of the Cleveland Clinic was doing clinical, the CEO of Mayo, the CEO of a lot of massive, huge organizations still do an occasional clinic day, just to keep that going. And this is even a different version of that. We'll have to wait and see. I want to right circle back with you in a few years and see what's going on.
Dr. Nkeiruka Duze: Absolutely.
John: What advice do you have if someone that was in the position that you were in where you are kind of getting burned to out and just kind of frustrated. Any specific words of advice you'd have for my listeners?
Dr. Nkeiruka Duze: Absolutely. And thank you for asking. I think three things that I would encourage you to consider. The first is whether you are a hospitalist or an outpatient doc, I encourage you to explore nonclinical roles. And the reason for that encouragement is that the nonclinical roles not only add variety to your career and your life but also, I think it's the quickest way to actually get that work-life balance that most of us desire. Because with clinical practice, as you know, when you see a patient, whether it be for 15 minutes or 30 minutes, there's a lot of work that has to be done just for that one visit, whether it be the messages you're going to get from the patient about that, or the lab results that you're going to have to respond to.
Essentially, I feel like full-time clinical practice is challenging and it's hard to have work-life balance if you're in full-time clinical practice in my humble opinion. My first encouragement is that no matter what you're doing, inpatient, outpatient definitely explore nonclinical roles, even if you're going to do that as a 0.1 or 0.2. Just to kind of give you a little bit of a break. So that way you can have more work-life balance. Life is too short.
The second piece of advice I would give is to be flexible. What I mean by that is two things. Be ready to pivot if you need to, when opportunities arise. And then the second is if you already have an opportunity, be ready and flexible to expand if needed because when opportunities come up if you don't tap into them, guess what? Somebody else will. Even if you've set your sites on something, then you see something else that looks interesting, that becomes available, consider it. You just never know. You might like it. My second piece of advice is to be flexible.
And my final advice would be to seek out mentors that are doing either what you hope to do or something similar to what you hope to do. Because I think that we can really learn a lot from each other. I've learned a lot from people along the way, like reaching out cold calls to people and saying, "Hey, can I just have 30 minutes of your time just to ask questions about what you're doing or how you got there?" I encourage people to at least seek out somebody, at least a person that can hopefully mentor you, as you make that transition of hopefully adding a nonclinical role to your career. And I'm suddenly happy to support or answer questions to anyone that needs that support. And I'm certainly happy for any of your listeners, John, to email me if they had questions. And my address is ncnwoko@gmail.com.
John: I got that written down. I'll put that in the show notes. And you are on LinkedIn and they can just go to LinkedIn and look up your name and they should find you. That's how I found you on LinkedIn. I had already been referred to you, but I did find you there.
Dr. Nkeiruka Duze: Yes, I am on LinkedIn.
John: All right. Well, this has been very interesting. I could go on asking you more questions, but I think we're going to have to go here because we're running out of time. I thought there are many unique things about your story, the certifications are not totally unique, but you proactively pursued that. And I think we sometimes forget that there are those kinds of things out there and the opportunity to switch to concierge and how much that helped. And if anyone can emulate that in some fashion either to get it established or expand it at your organization, that's another great way to balance the two.
Dr. Nkeiruka Duze: Absolutely.
John: All right. Dr. Duze, thank you so much.
Dr. Nkeiruka Duze: Thank you so much for having me, John.
John: It's been my pleasure. And I hope to catch up with you again down the road. With that, I'll say bye-bye.
Dr. Nkeiruka Duze: Thank you, John. Thank you so much.
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