In this podcast episode, John shares his transformative journey from clinical practice to becoming a Chief Medical Officer, offering valuable insights for physicians considering leadership roles in healthcare organizations.

His experience highlights how physicians can leverage their natural leadership qualities developed through medical training while acquiring essential new skills in management and organizational leadership.

The transition from clinical practice to executive roles requires strategic learning through professional organizations, advanced certifications, and continuous education in management principles. Most importantly, John emphasizes that successful physician executives must master three core attributes.

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The Art of Total Immersion in Healthcare Leadership

John's approach to leadership development centered on complete dedication to learning and growth. Like his earlier experiences in medical training, he found that total immersion was key to mastering healthcare administration. This meant joining professional organizations like the American Association for Physician Leadership, pursuing additional certifications, and continuously expanding his knowledge through various educational opportunities.

This commitment to learning helped him transition from a practicing physician to an effective healthcare executive while maintaining a better work-life balance than clinical practice often allows.

Building the Bridge from Clinical Excellence to Organizational Impact

The transition from clinical practice to leadership requires a fundamental shift in perspective and approach. John emphasizes how physicians must evolve from individual contributors to organizational leaders. This means developing new skills in strategic planning, team management, and organizational development.

The reward comes in the form of broader impact – while clinical practice allows physicians to help individual patients, leadership roles enable us to improve healthcare delivery systems that serve entire communities.

Core Attributes to Be a Better Physician Leader

Three essential qualities are key to succeed as a physician executive:

1. Accountability,
2. Optimism, and
3. Humility

John emphasizes that accountability means following through on commitments and addressing challenges directly. Optimism drives organizational change and inspires teams, while humility ensures leaders remain open to learning and value input from all levels of the organization. These attributes combined with physicians' natural leadership qualities create a foundation for effective healthcare leadership.

As healthcare continues to evolve, the need for physician leaders becomes increasingly important. John's journey demonstrates that while the transition from clinical practice to leadership presents challenges, it also offers remarkable opportunities for professional growth and a broader impact on healthcare delivery.

Summary

Physicians who are interested in transitioning to healthcare leadership roles can access the resources through the American Association for Physician Leadership (AAPL) and the American College of Healthcare Executives. These organizations provide essential certifications, educational opportunities, and networking opportunities for developing executive capabilities.

Success in this transition requires the same dedication that drives clinical excellence and a commitment to continuous learning and professional development.

Links for today's episode:

• American Association for Physician Leadership (AAPL)
• Medical College of Wisconsin's healthcare executive education programs
• American College of Healthcare Executives
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 381

To Be a Better Physician Leader

John: Now I spent many years in management and leadership roles in the hospital setting, which culminated by working as a chief medical officer or CMO. And while moving from part-time physician advisor and medical director to chief medical officer, I took advantage of educational opportunities at the Medical College of Wisconsin, the American College of Healthcare Executives, the American Association for Physician Leadership.

And I'm a certified physician executive and a fellow of the AAPL, and I hold a master's in public health. So today I want to revisit the issue of physician leadership, encourage you to consider moving in that direction, and offer some advice about how to get started. So let's get to it. I think that I'm going to be talking about being a physician leader today, and I'm going to start by sharing my story about total immersion.

What do I mean by that? You know, this is something we do when we're trying to learn something new. So all of us have gone through medical school and residency for the most part. And of course that was pretty traditional type of education. And I found that once I got into practice, everything was going well. I was building my practice. I was working at the hospital to see my patients, nursing homes and in the office. And eventually I started to free up a little bit of my free time and became interested in learning other things that are important, like things like protecting your income, how to invest, maybe trying to find some ways to stay healthy, physically fit. What I've tended to do when I began to get interested in something like that was to just to totally go in a hundred percent and bury myself in information to help me learn about that. So that's what I did after about five years in practice. I realized that I did not have in my little three-man practice, we didn't have an IRA, we didn't have a 401k or anything like that. So my partners and I got together and we started talking about how we could set that up. And then I thought, well, I need to learn about how I'm going to invest because all these concepts were kind of new to me, you know, investing in the stock market, mutual funds, individual stocks, dividends, non-dividends, paying stocks, money market accounts, things like that.

And so I just went all in. I mean, I read everything I could possibly read. I listened to podcasts about the topic. I bought books. I subscribed to certain magazines. And so it was kind of a total immersion into the concept of investing and planning for the future financially. And I even ended up starting investment club with some friends I got so interested in. And in fact, still over 30 years later, I'm still involved in that investment club. Well, as I started dabbling in being a physician advisor and then a medical director, similarly, I didn't really know what I was doing. I mean, basically I had learned a little bit earlier in my life by being the chief in my residency and participating in a bunch of committees at the hospital and becoming the chair of a committee. And then I learned about how meetings worked and how minutes worked and all that kind of thing. But it was a pretty superficial exposure. So I thought, well, I've got to get involved in learning more about physician leadership and management. So that's when I started joining these organizations.

And reading about it, starting to subscribe to different podcasts, newsletters, magazines that told me a little bit about it. That's what I want to talk to you about today. Before getting into that, I would say that I really do promote the idea of getting into hospital management. If you're already in the hospital as a hospitalist or an ER doc or anesthesiologist or a surgeon or any of the other specialties that spend at least 20, 30% of their time or more in the hospital, I think it's a great place to work because you're providing very intense medical care. And in my opinion, we need more physician leaders in these settings. Most hospitals are run by people with an MBA or an MHA. They may have never done anything clinical.

There's some exceptions to that, like nurses who end up being in leadership positions. And they follow a path very similar to many physicians. In other words, they start out clinical and then they become a manager or they become a director. And actually there's a significant number of hospitals that are run by nurses, probably many more run by executive nurses than are run by executive physicians. And so again, I would encourage you to look at this path. The thing I like about it besides that it's intellectually stimulating and really it's something that any physician can do if they're interested is that it's a way to really help more patients. When I was seeing patients, I was dealing mostly with the healthy, worried well people came in with minor problems, really, that probably didn't really need a visit. Yes, you've got a lot of the screenings we're doing and health maintenance, but most things that come in are acute and they're relatively trivial, and then once in a while you see a really sick patient, get them admitted, and nowadays, if you're a family doctor, of course, you probably won't even be going to the hospital. The thing is, when I started getting into management, I found I was helping patients in new ways.

And at the same time, my lifestyle was better. The more I did in the hospital as a medical director and then ultimately as CMO, the less time I spent in the office, the less time I spent on call, and the more work-life balance I had. And it was something also where when you're in residency and early practice, you're challenged quite a bit because you're still learning and taking on new responsibilities, but then it becomes a little bit routine. And so when I started doing more and more in leadership, I really enjoyed learning more about how to manage, you know, learning about HR, learning about leadership and strategic planning and communication styles beyond those as a physician. And so there's a lot to it. And it is quite interesting. Let me talk a little bit about that. Is this right for you? Yeah, I don't think becoming a manager, director, or CMO in a hospital is necessary right for everybody. Because you have to be willing to take on some new skills, learn some new ways of doing things. I think there's some areas in particular that you really should try to strengthen and learn as you decide to do this. But let's think about how we should look at this and let's reflect in review some of the things that we should consider before making this move. So first of all, let's reflect about our motives.

You know, I have to admit that when I started getting into the physician advisory role, that was mainly to just make a little extra money. It was almost like moonlighting, but it was really non-clinical. But even as I became medical director, part of it was that I was really getting a little bit burnt out and I was trying to exchange hours of care as a medical director for hours of work as a primary care physician. So ultimately what that meant was I was getting paid on almost an equal basis for the medical director duties, but it didn't involve any call. And so over time I was cutting my call responsibilities back. And at some point later on, I actually hired my own hospitalist to start taking my in-house call. So if the motive is just because you're burnt out and fed up with medicine, that's probably not a good motive and it won't, you know, you'll end up a year or two later in the same situation, five years later, still burnt out and not happy. But if at least you have an interest in management and interest in learning new things, you have an interest in a specific area of management that might be fun, like when it's quality improvement or, um, CDI, clinical documentation integrity or informatics or, you know, one of the things we really normally get involved with as a medical director, then by all means, think about proceeding.

Reach out to your colleagues. If you've been out for a few years, you're bound to have some colleagues that are doing at least part-time work, and you may have even gone through residency and fellowship with someone who immediately went into a non-clinical role, although possibly related to their specialty.

Reach out and just talk to people, get their feedback and find out what it's like to make this transition, and also what it's like to be in a full-time management or leadership job. Read everything you can about it. Of course, when I say read, that includes online, that includes books. A lot of books written about this, a lot of articles written. When I say read, I also mean maybe listen to some podcasts like this one or others.

Go to websites and try and get a take on that. Then there are some formal places where you can go and you can register, meaning you should register or enroll with some of these professional societies. Of course, the one that I think is the best and probably most appropriate for those thinking about doing leadership roles and advanced management positions is the American Association for Physician Leadership. Now I've been a member of the APL for over 30 years, taking many of their courses. I've really been involved heavily in fact, that was the chair of the CCMM, which is a community that oversees the CPE designation and the requirements and the work that's done to apply for that recognition. So I've been heavily involved with it. I am not promoting it. I'm not paid, you know, but I got myself involved because I believe in what I did. It is always looking for new ways to expand and grow and provide more services to its physician members to become great leaders.

Now, I do believe that physicians are natural leaders and I don't say that they're born leaders because I think a lot of the leadership skills that they develop come as a result of their medical training. There's a lot of characteristics that we have that we're either born with, nurtured while we're young, and then are nurtured further as we go through our training. I'm going to talk a little bit about that in a minute.

These are the kind of, I guess, attributes that I see that physicians have. Obviously, the intellect is there, very focused. Most physicians I know are quite accountable. They've got the ability to handle complexity, so they can think through problems well. Their communication skills are usually pretty darn good and are usually improved while they're going through training. Now, a lot of that is with communicating with small teams and with patients and with patients' families and so forth. So sometimes you've got to learn a different type of communication as you get into leadership, but very good perseverance and patience and keeping on problems, not easily distracted. Decisive is another good attribute that physicians generally have that's encouraged and grown during their training. They don't tend to be wishy-washy or indecisive. So that's good. And a lot of people are prone to that indecisive nature because they're not confident. Commitment, altruism, and a people orientation, now, doesn't mean that we're not sometimes introverts. In fact, I think probably the majority of physicians or at least a little more than 50% are somewhat introverted. So it's not like they feel comfortable in a large group giving a presentation necessarily, although most of us practice that during our training. But we went into medicine because it's a combination of science and also the health professions helping others, that kind of thing.

So it makes for fairly natural leader. A thing is though, physicians do have to evolve. They have to add new skills and new attitudes to really be an effective leader at the level of, an executive in a hospital, which is what I'm really promoting here today. So we need to, if we tend to be a little reactive, because we're in the mix of things, if something happens, we respond immediately, that's fine. But when you're in a business setting, when you're in an organizational setting, a big organization, whether it's a hospital, large pharmaceutical company, health insurance company, anything like that, you really need to be more proactive. So you need to kind of migrate from reactive to proactive when looking at things. When you're managing large groups of people and people in big organizations, you need to be proactive. So that's something you have to develop. You need to stop.

Or I would say add to being a performer or a doer to being a planner. You know, we don't necessarily go into our office seeing patients planning what we're going to do for each patient before they show up. A lot of times we wait till they show up and then they, we assess them and then we make a plan, but to run an organization and have two, three, four, five, 10 people reporting to you, running a budget of 1 million, 5 million, 20 million, 50 million then you need to plan and you need to be proactive. You need to kind of move from tactical to strategic thinking. So this is, again, you know, we're talking about annual goals, maybe a two or three year strategic plan. These are fairly common to do when you get to the VP level or higher in a big organization.

And we need to go from being deciders to delegators. We have to feel comfortable. If you're like, I'll tell you, when I was, I don't know, I'd say, I wouldn't say at my peak, but there were times when I had six or seven directors reporting to me. And my main goal was to help them develop their goals every year and maintain some kind of tool that we could track their performance.

And then encourage them and push them to meet their goals and exceed their goals. But I really wasn't there to tell them how to do their job. I was really there more to keep them honest and to make sure they were pitching in and to also coordinate with other senior leaders to make sure that all of our directors and managers were working together collaboratively.

And working for the benefit of the whole organization, not for just their department. So when you delegate, that means you can't really look over the shoulder and everything they are doing. But you have to feel comfortable with tracking their performance and their progress and meeting their ongoing goals and performing according to your expectations. We have to migrate from being independent, working independently to being more participative. So working on a team, not a team that we're necessarily always leading, we might actually be just the co-members of a team. For example, for the first few years that I was working as chief medical officer, I always thought my team was the directors and myself, the directors that reported to me and myself, area they had the utilization management, the quality, the medical staff office. And then at times I also had always had the pharmacy and then sometimes radiology and lab. And it was more about, like I said, quality and performance. And we were still responsible for budgets, of course. I came to find out later, or I came to realize later, that my real team wasn't all those people reporting to me.

Like I was the coach and they were my team. My actual team were my co-VPs, the people on the senior management team. There were 10 of us, if you include the CEO, usually the CFO, the COO, the CMO, CMIO we had for a while. We had the VPs for HR, VP for lab, VP for maintenance and facility and so on and so forth.

And that was really our team, but we spent a lot of time bringing that team together as a cohesive unit. And where at that point, the way we looked at it was, we are there to make sure that our departments, that level of team are actually working together to achieve the organizational goals, not to just make sure that their particular department looked good or had good numbers. So that was an interesting evolution that I observed. And we're usually practice focused. And in a hospital, if you have several hundred or a thousand physicians, depending on the size of the organization, of course, we're all focused on our own practices, our own groups. And once you move into the executive level of hospital management, then you really have to have this organizational focus. And basically you're trying to get everybody on the bus, you might say, or everybody rowing in the same direction on the boat. And it's a little different than just running a small business like a practice or even a large business is a multi-specialty practice or single specialty practice. Or even if you run your own surgery center, that's even there, you start to get a little different feel than running just to practice. And then you need to really go from, you know, patient accountability, which is important in terms of you're accountable for the healthcare of the patient, which even in a hospital executive position you still are, but it's organizational accountability and it's different. You're no longer a lone wolf. You're working as a unit with others at your level.

And you have to learn to be accountable to one another and to the CEO. So let's focus on three of these aspects in a little more detail. So that accountability part is pretty darn important. And basically one way to define that is that you, you do what you said you would do when you said you would do it. And sometimes we'll add and the way you said you would do it. Now, in some things that you're saying you're going to do, you're gonna get done, you don't really care how it gets done. You know, if you're supervising some director, you say, look, you told me you're gonna do X, you're gonna meet this budget, and by six months from now, you're going to have this project halfway completed, fine. Just make sure you do what you said you would do when you said you would do it.

On occasion, you want to add the way you said you would do it. So sometimes the way you achieve something is important. Obviously, it has to be quite legitimate and honest and straightforward and not underhanded in any way. But as a leader, sometimes you don't want to worry so much about the way things are done. If they have a goal and the outcome is important, and as long as we're being authentic and we're being honest, then, you know, there are multiple ways to achieve the same goal. But again, if you want to quote this, do what you said you would do, when you said you would do it, the way you said you would do it, if you want to be accountable. And this could be to your team or to your boss. And when you don't achieve that, then you need to make amends.

So, the other thing that's really important is if you committed to something, if you promised to do something or just even agreed to some goal, you need to learn to apologize appropriately when it's not achieved. And that's what accountability is. And that means that, and this came up a lot in our senior management teams, we would meet and say, "Hey, you know, two weeks ago, this was what you said you were going to do. And you said it was going to be done by this meeting. So what have you got to show us?" And if one of us didn't have it, it meant that we had to say, "well, you know what I did, I committed to doing that two weeks ago. And I admit that I have not completed that. I don't have a reason or a good excuse was bad planning, timing and so forth on my part." So that's the first step is just admitting your mistake or your failure to comply with your own commitment, explain how you will rectify it. "I will get that done. In fact, I'll have that report that you needed by the end of the day tomorrow", commit to a deadline, which I did there.

That's basically it. Now, when you're being accountable and when you're stating that you did not meet the goal that you said you would meet, didn't complete what you said you would do, we never phrase it like this. Like, "I'm sorry" if, like, let's say that you were going to communicate with somebody and you ended up doing, you know, saying something that was not accurate.

You don't say, "well, I'm sorry if what I said bothered you. I didn't mean to bother you or to insult you." That's not really an apology because you're putting the if sentence in there, we're just putting it on them. Like if they took it the wrong way, you just say," I'm sorry, I offended you and I won't do that again," or in this case, to be accountable.

"Yes, I made a commitment. I did not meet that commitment. I'm sorry about that. And I make a recommit myself to completing this project by the end of the week. I will not fall behind in this project again." So you have to really commit to and not repeating your mistake. So accountability is a big thing. And a lot of physicians, I mean, we're accountable to our patients doing the right things and not doing something we're gonna get sued about or get reported about. That's one level of accountability. But when you're in a team for a large organization, you all have to make your commitments, stick to them and be ready to admit your mistake if you don't and move on. The other thing is it has to do with optimism. I think it's easy to become pessimistic and angry in healthcare.

You can, you know, you get, you feel like you're overwhelmed sometimes you're burnt out. And when you get that way, then you start to lash out, start to act negatively. You start to become resigned and that's not good for a leader. A leader cannot be depressed and resigned and feel like they have no control and they have to maintain a certain level of optimism that they and their team and the organization itself can solve important problems, can move forward successfully, and should not get that resigned feeling like nothing can change and we're not making any progress. Leaders with that attitude really don't last very long at all. So you have to avoid the negativity, defeatism, apathy, resignation, all those things I've mentioned.

You should embrace positivity, be kind of faithful, have faith, be inspired, be easy to encourage and encourage others. You know, always have hope and expectations that things will continue to get better because we're all working together to make things better and more successful and more responsive to our patients and to the community. So optimism is really important. If you can't...

If you can't be accountable and you cannot be optimistic, you really can't be a good leader. Then the other thing is humility in spite of all this. You're learning a lot, you're taking ever increasingly important levels of responsibility, working your way up to the C-suite, maybe even eventually become the COO or the CEO. But you have to have humility because again, you don't do anything by yourself. You should avoid being self-righteous if you'd fallen in that trap in the hospital and the operating room and the delivery room. If you become condescending, a part that goes back to being burned out or overwhelmed, but you have to stop that. You have to maintain some humility.

Continue to always be curious, meaning welcoming other people's opinion. When you're in a leadership role, it's not that you're making all the decisions without input from your peers and from the people that are reporting to you. You should focus on listening more than talking. You know, just because you're the chief medical officer doesn't mean when you're with your directors or with your teams, it's so-called that report up to you, they have the frontline observations. They have the frontline knowledge of what's actually going on day to day. You have to remain curious, you have to listen first. And then if there's a sort of a solution that's self-evident and a decision has to be made about, are we gonna invest money here? Are we gonna share personnel?

Are we going to try and find other ways to meet a goal? Then you might have to make that decision, but you need all the information first and that means being humble. I guess what I want you to just realize is that leading is a skill that builds on what you learned during your medical training, but it involves listening and inviting others to embrace your vision. And you know, you think about when you're a leader, you're always on stage and your patience, dedication, and integrity become a role model that are key to recruiting others to join your organizational journey as a leader. You're trying, like I said earlier, to get everybody on the bus that's going to debut. I mean, it's a metaphor, but it's one that one of my CEOs used all the time. It's like, we're all going to get on this bus and we're going together.

We're all going to hop in the boat and row in the same way, in the same direction. There's no sense us all being in the boat. We're all rowing in a different direction because then we're not going to move. And so really one of the core responsibilities for a leader is to inspire your team and to get them to want to join, not be forced to join.

Bottom line is if you are successful and you get 90, 95% of people to row in the same direction and hop on the bus that you're taking to debut, then if there's five or 10% that can't do it, won't do it for whatever reason, then they should be left behind. That means they should go find a job where they're going to be happier and more productive. So if those are the kinds of things when you're listening what I just talked about sound like fun. Well, then by all means, that's an indication that you should consider strongly to start your leadership journey. You've probably already been on it. If you're a physician and you're probably asked to do things and take on responsibilities where you're not just pitching in as a member of the team, but you're leading part of the team or leading the entire team.

Maybe you're working on temporary committees to solve a problem. Maybe you're chairing a committee that's really important. Or maybe you're on the board of a hospital or a public health organization, hospice, something like that. If you like that and what I've talked about today sounds like a fun, like I said, then go ahead and take off and continue your leadership journey.

I'll be coming back to talk about more issues related to management leadership in coming podcasts in addition to interviews with more that are also doing non-clinical jobs outside of leadership.

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Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

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

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

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The post To Be a Better Physician Leader appeared first on NonClinical Physicians.

In this week's Classic Podcast Episode from 2020, Dr. Jennifer Spector describes how to become a medical editor. Unlike other medical editors who spent years as a paid medical writer, Jennifer parlayed her involvement in a professional society and unpaid writing to land her new editor position.

Jennifer is a Board-Certified Podiatric Physician and Surgeon with 14 years of clinical experience. She spent over 5 years in national leadership positions at the American Association for Women Podiatrists (AAWP). She’s had a long-term interest in education, writing, and consulting. She is passionate about educating others. In June 2019, she became the Associate Editor for Podiatry Today.

She received her DPM degree from the Temple University School of Podiatric Medicine. Then she completed a three-year residency in podiatric medicine at Christian Care Health System.

Our Sponsor

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

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

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

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

How to Become a Medical Editor

Medical writing and editing are great careers. They come in various arrangements: freelancing or employment; working remotely or in an office; technical, journalistic, or educational. And there are positions open to physicians of all backgrounds.

After completing her residency, Jennifer spent several years building her practice. She later volunteered at the American Association for Women Podiatrists. She chaired several committees. Then she held several leadership positions, becoming President of the organization in 2018.

There are so many things that we might have dipped our toes into in clinical practice without realizing how they can apply outside of actual practice. – Dr. Jennifer Spector

While at the AAWP she was responsible for writing and editing the newsletter and other documents. That experience enabled her to land her position as Associate Editor for Podiatry Today.

After working in that position for about 20 months, Jennifer was promoted to Senior Editor followed by Managing Editor at Podiatry Today. In July of 2022, she became one of the Assistant Editorial Directors at HMP Global, the parent company of Podiatry Today and a market leader in international healthcare education and clinician engagement.

Finding Editing Jobs

Today’s conversation with Jennifer clarified her process to become a medical editor for a news journal like Podiatry Today. Jennifer reminds us to develop a portfolio of writing and editing samples to share with prospective employers. She was able to do this while volunteering with the AAWP.

If you’re looking for freelance writing opportunities, you should look at the portfolio of journals published by the parent company of Podiatry Today, HMP Global. There are 12 journals and over 100 Online Digital and Learning Networks under its umbrella.

Summary

In today's interview, we learned what it takes to become a medical editor. This is often a natural step for established writers to pursue.

Links for Today's Episode:

• Dr. Jennifer Spector's LinkedIn Page
• Podiatry Today
• HMP GLOBAL
• AAWP
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

Download This Episode:

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The post How to Become a Medical Editor – A PNC Classic from 2020 appeared first on NonClinical Physicians.

In this podcast episode, John sits down with Dr. Neetu Sharma, who recently transitioned from a demanding nephrology practice to a health insurance medical director while maintaining a virtual clinical presence. 

In sharing her story, Dr. Sharma describes the challenges of managing patients at six hospitals, taking weekend “call” duty covering up to 120 inpatients, and the added stress of COVID-19 that led her to explore alternative career paths, ultimately finding fulfillment in utilization review.

John and Neetu discuss the realities of working as a medical director, debunking common misconceptions about insurance companies. And they explore how physicians can achieve improved work-life balance.

Our Sponsor

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

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

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

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

Inside the Role: What a Health Insurance Medical Director Does

The transition to medical director involved a structured 9-to-5 remote schedule, reviewing cases for compliance with CMS guidelines, and ensuring appropriate resource utilization. Dr. Sharma debunks the myth that insurance companies focus solely on denials, explaining how the role involves complex case reviews, peer-to-peer discussions, and collaboration with clinical teams.

Before starting her primary duties, the insurer provided comprehensive training. Neetu quickly developed the skills to handle cases from regular inpatient admissions to complex long-term acute care situations.

Creating Your Unique Path: Blending Tradition and Innovation

One of the most interesting aspects of Dr. Sharma's transition is how she's created a hybrid career model. While working as a medical director, she maintains clinical skills through virtual practice and weekend calls, launched an online wellness program, and is expanding into nationwide virtual care.

This approach enables Neetu to leverage her expertise while maintaining a better work-life balance.

Summary

Dr. Sharma's journey, which included certification by the American Board of Quality Assurance and Utilization Review Physicians and training with the Institute of Functional Medicine, offers a blueprint for physicians seeking similar career changes.

For those interested in learning more about utilization review or career transitions, Dr. Sharma welcomes connections through LinkedIn, email (staff@zealvitality.com), or her website, where you can schedule a call to discuss your career path.

Links for today's episode:

• Dr. Neetu Sharma's LinkedIn
• Zeal Vitality's Website
• American Board of Quality Assurance and Utilization Review Physicians
• Institute of Functional Medicine
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

If you liked today’s episode, please tell your friends about it and SHARE it on Facebook, Twitter, and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 379

Health Insurance Medical Director Is Still A Popular Job

- Interview with Dr. Neetu Sharma

John: It's been a long time since I interviewed a physician who recently left traditional clinical medicine to start a career as a medical director for a health insurance company. But I recently connected with someone on LinkedIn who's doing just that. And she's also maintaining a clinical practice and mentoring physicians and doing some other things. Dr. Neetu Sharma, welcome to the podcast.

Dr. Neetu Sharma: Thank you, John, it's my pleasure to be here.

John: I'm really happy to hear your story. This is going to be interesting. I think it's good to have someone who's recently made a transition and because there's a lot of physicians listening who are thinking or have been thinking about it for a long time and haven't done it. They can get some good inspiration from you. So, yeah, just tell us a little bit about your background and your medical education and clinical practice and things that were going on before you made a shift.

Dr. Neetu Sharma: Yeah, thank you for having me here, John. I have been listening to your podcast and got a tremendous help with my career. So thank you for doing that. And I wanted to give back to your community. So that's why I'm here today. I did my residency in Detroit with internal medicine, then went to University of Cincinnati for my fellowship in nephrology.

And I have been Michigander, I've been in Michigan for a while. I returned here for my clinical practice after my training. And I was with a private practice for the past eight years, but I have been in clinical practice for about 15 years going. And I was, to be honest, getting to the point where I was getting burned out. As a nephrologist, you have to go from clinics to the hospitals, to dialysis clinics. So it's a lot. And I was on call every other weekend and when you're on call, you're seeing, pretty much I was covering six hospitals and seeing about 120 on average patients on that weekend call. And I wasn't getting any day off after that. And you come back on Monday tired.

And so, it took a while for me to look into different options. And last year I actually ran into somebody who was doing utilization review for insurance plan. And he kind of gave me an overview how happy he was, how he had a control on his life. Then I thought it's interesting to know, and I started digging more into it. And I happened to listen to a few of your other interviews about utilization review, got a tremendous help from that. And I became a member with the American Board of Quality Assurance and Utilization Review of Physicians, got certified with them last year. And then started my journey with interviews with the health insurance plans and ended up with a major health plan starting this year as a medical director.

John: Very good. Okay, I'm going to go back to the whole beginning of this. To some extent, how long was it that you were feeling kind of overwhelmed and kind of, I don't know, overworked before you decided, like in your mind, you said, "You know what? I'm definitely going to make a change." Obviously if you signed up to do the education, that was really concrete, but what was that timeframe like for you?

Dr. Neetu Sharma: John, COVID changed a lot of things and it was around 20 when the COVID hit. I got pay cut. I was working overtime. I was taking care of patients in the hospital. I was completely burnt out to the point that I started thinking there shouldn't be a better way of practicing medicine. Especially in nephrology, I can tell you that other nephrologists might relate to it that we deal with very complex patients who are having life-threatening disease.

And we lost a lot of patients during COVID and that was quite depressing. I felt like I wasn't making a difference in the lives of these patients and there was no job satisfaction. At that point, I started looking into other answers, functional medicine, and I became a fellow with the Institute of Functional Medicine, got some training in that. I decided that I want to transition and do a holistic approach to help my patients. And then at the same time, I started looking for utilization review jobs too.

John: The story that you're telling is not uncommon and there's a lot of physicians still where you were a year or two ago. Did you get a sense that the organization you were working for, like, had any sort of recognition that the physicians were getting burned out like yourself or were they putting in place any plans to try and address that? Or were they just saying you got to do what you got to do and that's just the way it is?

Dr. Neetu Sharma: The way things are, unfortunately it's all run around and seeing more patients and working hard, but not getting the reward for it or getting satisfaction of taking care of those patients. Because if you have five minutes to spend or 10 minutes to spend in the office with it, how much difference you can make in the lives of your patients? You are just giving out pills. And that did not set with my principles, with my goals of becoming a physician. And I wanted to do something more for my patients. And that's what led me here where I am today.

John: Just for background, about how big was the group that you were actually working in?

Dr. Neetu Sharma: We started with five physicians. When I joined, I was the third one. We grew the group to five. Then slowly, everybody left the group.

John: It sounds like that's kind of how it goes often, especially if you don't have a large group that can kind of absorb the ins and outs of employing physicians in a group or being partners. But okay, let's see. Let's get back to your new career now. Did you say someone had recommended this? You had talked to someone about it? Sounds like you zeroed in on that particular career pretty quickly. Was there other things you had considered?

Dr. Neetu Sharma: Yeah, I was looking into different things at that time. I was looking into pharmaceuticals. I was also looking with the FDA. I actually got offered from the FDA as well for the medical device position because they deal with a lot of the international investors who bring the medical devices to US and they have to make sure it's not a public hazard. So for public safety, they have engineers, they have physicians who are looking into those devices and other technology to make sure they are compliant. And that was the position I was offered. But then I ended up with this major health plan, which was local. So I thought it would be nice to see the team once in a while to have more collaboration and face-to-face interaction. And that would lead to the position.

John: Okay, you did, obviously you're in a big metropolitan area, fairly big. And so, the company that you chose had at least one office in that area. So that was one of the big draws for you?

Dr. Neetu Sharma: Yes.

John: Okay, but that leads me into this question about what's the job like? Because I have a feeling you probably don't spend nine to five at that office every day, do you? What's that like, the actual job? And is it remote and how remote and all that?

Dr. Neetu Sharma: Yeah, right now it is a remote job from nine to five, eight to five, I would say. My day starts at eight o'clock and I am in utilization review as a medical director. So my main job is reviewing all the cases and making sure they are in compliance with CMS published guidelines and with the medical policies in place and making sure the resources the institute utilize is appropriate for that particular member.

I deal with different appeals and also collaborate with the clinical team, pharmacy and other clinical providers. I do have peer to peer calls on a regular basis. And my day ends by five, if not like 5.30, depending on how busy we are. But it's interesting because you're always in, you're talking to your team over the team meet or you are in a queue where you are interacting with the other team members. And you are also encouraged to go to the office once a week. So if I choose to go there, I can. But mostly the team that I could work as remote, so you don't get to see many people. But we do have team meetings every month where we collaborate, we see each other and celebrate the organization. So that's really nice.

John: Now, what's the job like? Because this is what people always are interested in terms of not only exactly what are the duties, but in terms of, is it really rushed? Are you expected to go through so many cases on a given day? Does it feel like a little bit overwhelming or is it a pretty relaxed feeling where you get a chance to really get into the cases, determine what you need to make a decision and then have a conversation and peer to peer if necessary?

Dr. Neetu Sharma: Yeah, as a major corporation, they have set certain goals for the team members, including the medical directors. So we have certain goals to achieve, which also includes the number of cases you're doing every day. But in reality, many of these cases are complex cases.

They are high risk patients and it needs reaching out to the team, to the acute care hospitals, to other providers to get the feel of what the members have been going through. Always taught in a public view that insurance companies are there for denials, but that's not true because we really look into the utilization of resources and whether they are done appropriately. So we try to actually approve the cases if possible for the member and keeping members in mind, it is important to know what they're going through. Some of the complex cases take longer and it's not realistic to put those goals into that basket. Sometimes you meet those goals, sometimes not. But I think the leadership, they understand the complexity of this job.

And to be honest, I haven't, so far, like three months I have been with this health insurance plan. I haven't had any interaction where they're telling me that you haven't reached your goal today because they know that I am working hard to understand the utilization better, to help the members better. So our goal as an organization is mainly the member satisfaction.

John: Now, the medical side of what you're looking at and the records you're looking at and so forth, obviously is pretty straightforward for an experienced physician like you. But doing all the things you are doing with that information and then you've got reports to fill out and you're doing the communication, might be with nurses or other physicians or peers. How much training is involved and have you felt like that's gone pretty well in the first few months that you've been there?

Dr. Neetu Sharma: Yeah, so it's a dynamic role because I will be doing different kind of cases. Sometimes we have complex case reviews, sometimes we are dealing with LTACH patients. Sometimes we have regular inpatient admission reviews where we are seeing the utilization of resources or the length of stay.

Those cases, they may vary and we get trained for at least a couple of weeks to get used to review those kinds of cases effectively. So I would say two weeks to one month is needed for each kind of category of the review you're doing. And it's an ongoing process.

It's training on jobs. So once I was trained on one particular area, I've been doing that for a while to get more proficient in that area and then I will be moved to some other area where I'll be reviewing more complex cases.

John: Yeah, in most of the physicians I've talked to over the years, it hasn't been a lot, but it goes back about seven years now. They tell me that basically there's a set of criteria they probably changed over the years, but just getting used to how you have to demonstrate compliance with whatever, the Medicare if it's a Medicare and you have certain different formats for doing that. But in any way, they say you just have to learn the system basically.

And when you're a generalist and someone who's an internist and a nephrologist, you know so much medicine. I had a pediatric cardiologist that went in doing the exactly the same thing you're doing. And it took him a little longer to kind of get the feel for things because he hadn't taken care of adults for 10 years. So I think you're in a good position.

Dr. Neetu Sharma: Yeah, thank you. Yeah, my team is actually very diverse. We have pulmonologist, we have ER physician, we have pediatrician. So it's a very diverse team and we all are doing the same thing. And the learning process for everybody is different.

John: And it's new, something new. You're getting into it, but now that you're at this point is it kind of what you thought it would be? And are you so far, are you satisfied with the way the work is going and the support at the company and that kind of thing?

Dr. Neetu Sharma: Yes, absolutely. I have a great team. They're very supportive and they listen to you, they listen to the feedback and they always put an effort to improve things.

John: Now, what I've heard sometimes is you can definitely do this full time and not do anything else, I think, but some of the companies do like to have their clinicians continue to have some activity so that they can, makes it a little easier to be current and in the treatment of certain conditions. So, you are still doing some clinical. So, if you don't mind telling us about that so we can see how that kind of fits in.

Dr. Neetu Sharma: Yeah, these health insurance plans, they actually encourage you to do clinicals and get up to date with that because when you review the cases, you can relate to it better. So, I'm also doing some virtual practice and I also reached out to my previous practice to do some clinicals with them over the weekend, some weekend call, which I'm getting credentialed for. So, I don't want to lose touch with clinicals for sure, but I launched an online wellness program and some virtual care for nephrology patients as well.

John: Okay, now on the virtual side, were you doing any remote kind of virtual work before?

Dr. Neetu Sharma: No, this is all new for me. It's a learning curve.

John: Are you limiting the virtual care to the state you're licensed in now or are you licensed already in multiple states? How's that working? Because that can be a barrier sometimes.

Dr. Neetu Sharma: Yeah, that is in process. I'm getting licensed throughout the US so that I can see some virtual patients. But right now I'm just offering a group program which is more like a health coach program.

John: Ah, okay. That one doesn't really have all the risk and the other aspects of sort of a true virtual remote telehealth or telemedicine type practice and the need to get to have your DEA and your licenses and all those things wherever you might be interacting.

Dr. Neetu Sharma: Yeah, no, if you're seeing the patients and you're posing as a physician, then the risk is there, John. So, I would advise to take the full precaution. I have my malpractice insurance and I am doing my due diligence to be compliant with all the procedures involved with the virtual care. So, that is something we have to keep in mind.

John: Yeah, absolutely. You've got to know where you need those protections for sure or you'll end up in trouble. All right, well, thinking back your process seemed to go pretty well in terms of from the time you were burnt out and said something has to change to actually making the change. Do you have advice for others that might be in the situation you were in back a year or two ago?

Dr. Neetu Sharma: I would say that look for what you really want to do and get the feel of it. If you like utilization review, I would advise to start from your organization, from the hospital you are in or in a practice you are in to do some kind of utilization review, whether to join independent review organization and start reviewing those cases or participate in the hospital quality assurance, different committees to get the feel of the job. And if you really like to do that and then get serious about it and start applying.

John: Yeah, that makes sense. I have a friend who's... Well, now he's a CMO for a hospital, but that's what he started doing as a physician advisor for utilization management. He was reviewing charts, interacting with physicians. And then he took on more and more roles and he ended up staying in the hospital setting. But I think a lot of the people I've talked to started out just doing those kinds of things in the hospital setting. And then it makes it, I think, a little easier to transition to the payer side of things because you're not going into a blind.

Dr. Neetu Sharma: Yeah, I'm sure those roles are overlapping.

John: I think some of our listeners will have questions for you, I'm sure. So let's see, one way they could reach you, I think, from talking before is basically LinkedIn. That's probably a safe way to get in touch with people. And if you just look up Neetu Sharma, you'll find her pretty easily. That's how I found her on LinkedIn pretty simply. But what other ways can they get ahold of you if they want to follow up or have questions for you?

Dr. Neetu Sharma: Yeah, they can either email me directly at staffs@zealvitality.com or reach me on my website, zealvitality.com. But LinkedIn is a safe website and they can reach me. Neetu Sharma MD is my profile on LinkedIn.

John: The zealvitality.com is actually the website where you're doing some of this outreach and ongoing clinical or right now, I guess it's a group coaching type of thing.

Dr. Neetu Sharma: Yeah, it has a schedule call through that website and they can put in the notes that they just want my advice or whatever they want to know about utilization review, I'll be happy to touch base with them.

John: Okay, the way things are going so far, you feel like this is something you can do for a while and really expand your challenges and your practice and your knowledge of medicine and patient care. It sounds like that's the direction you're going.

Dr. Neetu Sharma: That is true. So, it's a learning curve. A lot of things to learn about in medical school, you don't get taught about these entrepreneurship and you learn on your own and in this world where we are living virtually on social media, it is even more important to learn all that.

John: Yes, yes, it is. I think it can be daunting. It can be a little bit scary, but if you can get to residency and fellowship and practice, and like you said, working a hundred hours a week and challenging all these life and death decisions, you can start a side job or pursue a career with some kind of industry, whether it's like you did or pharma or hospital or whatever. But yeah I think it's easy to get kind of bogged down and forget that it really is something that thousands of physicians have done. So I think you're a good example of that.

Dr. Neetu Sharma: Yeah, I think the challenges are definitely there, but I am a big believer in delegation. So if you don't like to do something, then you delegate your work. And I think that will make your life much more easier and you pursue what you like to do.

John: Neetu, thank you so much for being with us today. I think that's about it for today. We're kind of out of time. So let me say goodbye and hopefully we can maybe get together again down the road.

Dr. Neetu Sharma: Thank you, John. It was a pleasure.

John: Okay, bye-bye.

Dr. Neetu Sharma: Bye-bye.

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The post Health Insurance Medical Director Is Still A Popular Job appeared first on NonClinical Physicians.

In this podcast episode, we revisit our enlightening conversation with CDI Expert Dr. Christian Zouain. He shares his journey from foreign medical graduate to a Clinical Documentation Improvement (CDI) specialist.

Dr. Zouain reveals how his transition from pursuing a traditional residency path led him to discover CDI. There he found his calling in ensuring accurate medical documentation. This critical aspect of the medical record impacts patient care quality and hospital revenues, which creates excellent opportunities for CDI consultants and medical directors.

Our Sponsor

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

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

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

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Daily Life of a CDI Specialist

Working as a CDI specialist involves reviewing patient records, collaborating with physicians, and ensuring accurate documentation for both quality care and appropriate reimbursement.

Dr. Zouain describes the evolution from traditional paper-based systems to modern electronic health records, emphasizing how technology has transformed the way CDI specialists interact with healthcare providers. The role offers regular working hours (typically 8-4 or 9-5) and provides opportunities for both on-site and remote work.

Growing Opportunities in the CDI Field

The CDI field continues to expand, offering various career paths from hospital-based positions to remote consulting roles. Dr. Zouain emphasizes the importance of starting with hands-on hospital experience before transitioning to remote work.

He recommends three helpful steps to consider when pursuing this career:

• joining professional organizations like ACDIS and AHIMA,
• pursuing certifications such as the CCDS (Certified Clinical Documentation Specialist) and CDIP (Certified Documentation Integrity Professional), and,
• networking within the CDI community.

Summary

Whether you're a foreign medical graduate, practicing physician, or healthcare professional looking for a change, CDI provides a promising career alternative that leverages clinical knowledge in a new way.

Want to learn more about CDI? Connect with Dr. Zouain on LinkedIn or check out ACDIS's apprenticeship program. Your journey into healthcare documentation excellence awaits.

Links for today's episode:

• Dr. Christian Zouain's LinkedIn
• ACDIS
• ACDIS Apprenticeship Program
• AHIMA
• Follow This Plan to Establish a Solid Hospital CDI Career
• Why CDI Medical Director Is a Great Nonclinical Job – 224
• PNC Podcast Blast from the Past – No Residency Is No Problem – 211
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

If you liked today’s episode, please tell your friends about it and SHARE it on Facebook, Twitter, and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 378

Become a CDI Expert

- A PNC Classic from 2019 with Dr. Christian Zouain

John: Hello, Dr. Christian Zouain, welcome to the PNC podcast. I'm happy that you're here with us today.

Dr. Christian Zouain: Oh, Dr. Jurica, thanks for having me. I'm a frequent listener, I really appreciate you having me today as a guest.

John: Awesome, one of my three listeners. I'm glad to hear. Hi, mom. No. Kidding. So, no, I really wanted to get you on here. I did listen to a recent podcast where you were a guest and it was really interesting. I personally have this interest in CDI, which we'll explain what that is in a minute, but I thought you'd be a good one because you've had some recent experience in different venues, and I thought, okay, let's get Christian on the podcast.

Dr. Christian Zouain: Great, thanks. Yeah, sure.

John: good, it'll be fun. All right. I'll have recorded a short intro. It gives a little background about you, but why don't you tell us just a little bit, if you want to give us the brief history and a little bit about what you're doing right now?

Dr. Christian Zouain: Yeah, sure. I am a foreign medical graduate, originally from the Dominican Republic. I moved to the United States in 2011 to pursue residency initially, and while I studied for the boards, I worked as a medical assistant, later as a medical scribe, later landed a job in case management, utilization review at a hospital, as a means to get closer to the hospital setting and make connections, meet the doctors and obtain a residency position.

This is when I started doing research and looking into other non-clinical options, which I've never, had never done before. To me, the only path was obviously coming from the Dominican Republic was going into clinical or that's it. I knew a few people that were doing research, but I started exploring the other options. I remember I attended the SEAK non-clinical careers conference in Chicago in 2015, which is the one you've mentioned in your podcast a couple of times already.

John: Let me break in here and clarify that the SEAK non-clinical careers conference is spelled S-E-A-K, and it's not an acronym for anything. There's a reason why it's spelled that way, but it really doesn't relate to the content of the conference. It is still running annually in the Chicago area as far as I know. They just had their most recent annual big non-clinical physicians conference this past October, a few weeks ago, and I believe they will continue to do this annually. It's held not too far from O'Hare airport. They say it's in Chicago.

It's really technically in a hotel at Rosemont, Illinois. Next year will be the 20th event. Most physicians find it really useful because it presents about 20 live lectures over two days, plus access to 40 mentors, more or less during those two days. And they also have, I think, one or two pre-conferences. there's a lot going on. And I thought I would just mention that, and let's get back to our conversation.

Dr. Christian Zouain: And it really helped me realize that I was not alone in my decision to pursue a non-clinical path. then I enrolled in a clinical documentation improvement and ICD-10 coding course at New York University through the advice of a friend. This was actually new because ICD-10 was coming up. It was 2015. It was a big change, October 1st. they were saying that CDI was a growing career that actually needed a lot of healthcare professionals to jump in.

And while taking this course, I learned a lot about the impact that a complete and accurate documentation had in all areas of healthcare. I became really interested in that, and I eventually just decided to jump all in into CDI as a career path. At that point, I also became more involved with the use of social media, LinkedIn. And through there, I was able to land my first position in CDI. right now, yeah.

John: That's great. Let me stop there because I want to check a couple of things with you because some of what you said resonates with me. My recollection when I was working in the hospital setting was, I was involved with UM and CDI both. And at least my recollection was anything having to do with utilization management and the cost of care and even quality, much of it depends on the documentation. it's a natural partner in that whole process of trying to at least improve how things look on paper in terms of the quality. Would you agree with that? Was that part of this thing that led you to the CDI?

Dr. Christian Zouain: Yeah, definitely. Everything, all aspects of that, I would say would fall into place after you would get that true clinical picture of that particular case with the documentation. It's not just about... Initially, I remember I was thinking, okay, it's about reimbursement. And that caught my attention. But then later I started to find that a lot of things besides the reimbursement had a huge say with documentation.

John: I remember when we had projects and we were working on some quality project or some UM project or whatever, we always had the director for, well, it was health information services or whatever it was, but basically it was the coding experts who were at every darn meeting.

Dr. Christian Zouain: Yeah, and that's a huge part of it. In my previous job as a CDI, I was the only CDI, and I was involved particularly with all the administration. I had to report directly to the CFO. And it was a new venture for me because I came from my first experience, which was a department of 12 CDI specialists. We were just there reviewing charts and closing our records, dealing with the coders. But now I would have to go to all these meetings with the administration. I had to interact with the doctors, with case management, with quality management. I would see how it all blended together. I had to be there. I had to be in those meetings. And it's actually also a good opportunity to let them know up front what things need to be done. When they discuss cases, I can just jump in and let them know, this is how we can better document this particular situation for next time, just we don't have to go through the query process. And that way you also work to educate the physicians.

John: Absolutely. The other factor that's heavily dependent on documentation and coding, and we're not talking a lot about it here today, maybe a little bit we're touching on it, but it's the perceived quality of your hospital. The risk-adjusted mortality, complications, and length of stay depend on the accuracy of coding and understanding of inclusion and exclusion criteria and risk adjustment related to preexisting conditions versus those that develop during a hospital stay.

So for all those top 100 hospitals and all those five-star hospitals and forth, they heavily depend on very complete and accurate documentation and coding to demonstrate the quality of care because of those factors I just mentioned. All right. Let's get back to our interview. we're going to go back and go through the detail of how you actually made that transition.

You started to tell us about that, but I want to put a plug in for myself right now, only because I did a podcast early on in one of my, I guess I'd call him a friend, although we don't keep in touch, but we were working together at the hospital I worked at, and that was Cesar Limjoco, who's sort of this icon in a sense of CDI. I think you've probably heard of him, and he's got this massive following on LinkedIn and everything.

Dr. Christian Zouain: Yeah, I do. I do follow him. I haven't been able to, probably this year at this conference, I think he usually presents every year. Probably I'll go ahead and meet up with him. I mean, I know him. I've seen his articles. I follow him on LinkedIn, and he has really good information.

John: Yeah. And the thing that it was, in doing that interview, I mean, I really liked it because he gave like his whole perspective, but the thing is he is unique in the sense that he's been doing this consulting for long, and now there's other companies that are doing it, and really the starting point for someone like you or I back years ago was not what he's doing because he's been doing this for long. So I've been wanting to get a hold of somebody like yourself who has been a more recent entry into this, and again, that's just another reason why I'm happy to have you here on the podcast today, but I will say that was episode number five for anyone that wants to listen to it.

Dr. Christian Zouain: Yeah, I do remember. That was actually, I think, that was the first episode I heard from your podcast when I heard his interview. Yeah, because I was, I really wanted to know more about his journey as well.

John: Well, now we're going to supplement with your journey because you're following in the footsteps.

Dr. Christian Zouain: Thank you.

John: you had been exposed to UM, you became interested in CDI, you actually took the ICD-10 course, but then what are the steps did you take to try and make that leap into basically was essentially a brand new career for you?

Dr. Christian Zouain: Well, I was doing case management and utilization review, and what really caught my attention again was the contribution that Accurate Documentation brought to the process of healthcare. And I mean, I just decided that at that point, clinical medicine wasn't for me. I think that I just saw value and importance of helping the hospitals, helping the physicians in this current profession. that's why I decided eventually to take it on as a career path. I don't know if I'm correctly answering your question. Just let me know.

John: Let me ask you this, and I'll ask you some leading questions. were the hospital, where you're doing the UM, did they have a formal CDI program and did you end up working for them or did you end up going somewhere else?

Dr. Christian Zouain: Oh, no, I ended up going somewhere else. I believe they did later. I would find out later. They have some sort of CDI program that was starting. But I, again, I started doing research. I started being more involved with LinkedIn. So I started following all these hospitals. I was back in New York. And I would follow their HR department and this particular opportunity came up where they said that they were looking for professionals in the healthcare arena to go into CDI.

It was actually a dinner conference. if you had some sort of exposure or knew a little bit about CDI in some formal way, you could attend that meeting. I, at the time I was doing, I was doing the course at NYU. that was my ticket to go, to get into that dinner conference. And that's where I met my future boss. And eventually I was hired as a CDS.

John: now this was part of their recruiting process for people.

Dr. Christian Zouain: Yes.

John: Okay. Where were they promoting that? Where did you see that?

Dr. Christian Zouain: On LinkedIn.

John: On LinkedIn, was it a company that you were following or did they reach out to you?

Dr. Christian Zouain: It was a company that I was following, a health system. And yeah, they posted the human resources recruiter, posted the ad on LinkedIn. And I contacted them, send them all the information. At first they were hesitant because the course at NYU was new. they didn't know, but they wanted to. But I sent them the curriculum and everything and they said, "Okay, you know a bit about CDI. You've been studying for a while on that. you're good to come in." And I remember I was expecting for it to be a big conference or at least a lot of people to join in because I got new at the moment. That's all I would hear about how the CDI profession was growing. I was thinking I don't have the experience.

I was told by a friend initially that you might have to take a pay cut from your case management position because you don't have experiences in CDI. But I was willing to do that because I knew there was a better path for me in CDI. I actually went and it turned out to be the opposite. I didn't end up taking the pay cut. It was actually more. Well, I didn't have the experience, but at that point, there weren't a lot of professionals that had experience.

So I remember I showed up to the dinner meeting conference and we were like five applicants only. we had, there was the health system, each director for CDI of each hospital, which were around five. There were only five people that showed up that were interested. Two of them I remember were also foreign medical graduates, but didn't live close by. And one of them was a nurse who worked on the floor still. I was the only one who, okay, I was already taking the class of CDI and I had good interactions with the other directors.

The little I knew at that time, I was able to discuss during the dinner because they had a presentation, but then we had a moment where we would sit down at the table and meet the other directors. each one of them, I was able to interact with at some point. And one of them actually caught interest in me and decided to interview me and I was in.

John: No, that sounds excellent. That is such a good example of networking, getting in front of somebody who is in a position to make a decision about recruiting and forth. Let me jump in again on this point. LinkedIn is extremely useful. And I would say a necessity if you're looking for a non-clinical job. There is a lot of recruiting and hiring done directly through LinkedIn for many of these non-clinical jobs and some clinical. Many recruiters use it as their number one way to find and contact eligible candidates.

So it behooves you to optimize your LinkedIn profile and understand how to use it. If you're not comfortable setting up your LinkedIn profile and how to use LinkedIn effectively, I recommend you purchase the course called LinkedIn for Physicians by Dr. Heather Fork. Now, this has been out for, I think, at least three years. And she does updates on it every often. It's quite comprehensive.

And you can go find her website at doctorscrossing.com or you can go to my link and check it out at nonclinicalphysicians.com/linkedincourse. That's all one word. nonclinicalphysicians.com/inkedincourse. And I do receive a small payment. If you purchase using my link, the cost is the same either way. But this is an affiliate link. Okay. Now, let's return to the conversation. Now, at that point, were you already a member of any kind of professional society or organization? I mean, is it the ACDIS or there's other organizations? How does that fit into this whole scenario?

Dr. Christian Zouain: No, not yet. At that point, I remember I was still deciding. I was still studying for my boards and et cetera. I wasn't fully in. I haven't decided yet. I was still thinking about CDI as an approach to continue to work with the doctors and acquire experience and make connections.

But then it was that my director at that point, when she was a nurse, but she'd been doing CDI for 15 years. And I remember her telling me, "If you know CDI, if you learn to do CDI well, if you know the basics and acquire experience over time, this experience will take you a long way. You can do a lot of things. You can jump into different areas of healthcare, not necessarily clinical." I think that was the last step for me when I decided, you know what? I think I'm sticking with CDI instead of going into clinical.

So when I made that decision, I started reading more. I started getting more involved with the associations with ACDIS. After two years, I was able to, I got my ACDIS certification and also obtained the one from AHIMA, the CDIP. The one for ACDIS is the CCDS, which you're allowed to obtain two years after, with two years of experience working in the field. at that point, yeah. they have a lot of resources. So I really jumped in. I purchased. They have books, they have guides. that was a good turning point right there because even if when I took the class, I wasn't really sure until you get your hands on in the actual work, you start realizing what it's really about. when you combine that with the resources that are available out there, it makes it much easier. it makes much more sense.

John: let me just clarify for the listeners. the ACDIS is one big organization of people that are involved in CDI are with. Now AHIMA is A-H-I-M-A, right? Is the acronym?

Dr. Christian Zouain: That's correct.

John: Yes. That's more about health information.

Dr. Christian Zouain: Yes, that covers a lot more. That covers HIM, medical records, coding. ACDIS is focused on, exclusively on clinical documentation.

John: Allow me to clarify here a little bit. There are two major organizations that Christian discusses here. The first one is the ACDIS, Association of Clinical Documentation Specialists. You'll hear later in the interview about their apprentice program. But what they're really known for is the CCDS certification, that Certified Clinical Documentation Specialist. And you can find that at acdis.org. So that's the first one. And then the other organization is AHIMA. That's A-H-I-M-A, AHIMA, American Health Information Management Association. And it has at least eight different certification programs. Usually, I think the CDIP is the one most applicable to physicians, which stands for Clinical Documentation Integrity Professional. And that's a CDIP certification, can be found there at ahima.org, A-H-I-M-A.org.

Okay. Now, let's get back to the interview. And I think this is my last interruption. Now here's a question I have because you brought up ICD-10. Which is kind of, that's on the, pretty much the diagnosis codes basically, right?

Dr. Christian Zouain: Correct.

John: How important is that? I mean, that's important in inpatient and outpatient. We're talking mostly inpatient right now in terms of where you were, is that right?

Dr. Christian Zouain: Yes, yes. ICD-10 works, you have on the inpatient side, you have ICD-10, and for clinical codes and for procedures, you have ICD-10 PCS. In the outpatient, for clinical codes, you have ICD-10 and for procedural codes, you have CPT. that's something different right there. there's a lot of, yeah.

John: Now, in my recollection, sort of the coding, the documentation, the risk adjustment was more or less based on the MS-DRGs, but the ICD-10 feeds into the MS-DRGs. Is that how it works?

Dr. Christian Zouain: Yes. It's a bit of a complicated subject, but you have the right path right there. You have ICD-10, which then bundles up the list of diagnosis and then you obtain an MS-DRG, which is then what you use to then bill and what reflects the severity of the patient's condition while he was treated. Or outpatient.

John: there's many different directions we could go, but let's focus on your career at this point. what were you doing in that first job? If I remember, that was a hospital-based job and you're basically helping them better demonstrate the documentation and you can maybe tell us how that day looked like for you and what were the benefits for the hospital as well when you're discussing that? Maybe you can address that.

Dr. Christian Zouain: Sure. my first experience is CDI. we would basically come in CDI, you work Monday through Friday, it's office hours, but it also depends on the hospital and the hospital needs. You might be working with a specific department. It could be surgery. You might want to come in a little bit earlier because surgery is rounding at 7:00 a.m., 6:00 a.m., but our hours were around 8:00 to 4:00, 9:00 to 5:00.

So we would come in, we would have a list of records that we would need to review, particularly at, let's say, at the two-day, three-day mark after the patients were admitted. Not just right away because we wanted to give time to the physicians they could document, we could have enough documentation. It wasn't just like, okay, we just have an HMP, let's go with that. No, we wanted to give the admitting physician and the consultants to take a look at what was going on with the patient and then review.

So we would have a set number of cases that we would do in the morning, my colleagues and I. And in this particular hospital, it was still hybrid. it wasn't completely in... the medical records weren't completely in the electronic medical system. the progress notes were still in paper. we would have to go to the floors and it was a good opportunity as well because there we would see the doctors from time to time they were around or their residents or the physician assistants if we needed to ask them right away.

But we would, this is how the process goes, we review the cases. We would leave a query if we needed clarification on a case. We will leave a paper query inside written document, inside the record. they would see and remember it was a green fluorescent color. they wouldn't miss it. And once they opened that, they would look at the query and they would respond on the next progress note accordingly. And that we will leave there. We would come back the next day and follow up if the cases were not to see if the cases were answered or not. If they didn't, then we would escalate if it had been a couple of days. But particularly most of the time they would ask or we would see them around in the hospital. we would ask them just like I told you earlier, right there and there. And they were either document, agree or disagree. Then we would bring it back, close the cases. And once the case was already sent to billing in this particular hospital, we were involved with coding and we knew at the end what the final DRG was. we were able to make sure to see if we had impact or not on that particular case. we would start with what's called a working DRG, which is the initial DRG that reflected that patient when we first reviewed that case.

Once we obtained the further clarification, the diagnosis with more specificity, then we would change to DRG. we would have a system that would compare both and would tell us the difference that we had achieved on that particular case. I know that that's one of the metrics that we were able to capture with our program and see how good we were doing. We would also get feedback from the coding department. They would receive their denials.

So we would know if a particular case that we had impact had been taken back and it was denied because it didn't meet criteria. we knew what action to take further next time if we needed to change the criteria we were asking the doctors and what to do forth.

John: Yeah, and I want to jump in here and try and for you listeners that are maybe not used to hearing about CDI, I mean, if you work in a hospital, you're pretty much aware of it because you're going to be having these conversations. But the thing is, I mean, it can make such a big difference in both the payment that might because it's DRG based and if you're in a low DRG versus a high DRG, but the quality, that was my big thing when I was chief medical officer is that your risk adjustment's going to look lousy if your documentation's not good and someone who really has renal failure as opposed to, let's say, mild renal injury or something or you name it.

I mean, it becomes important to capture this information and to have basically these consultants like yourself, Christian, walking around helping the physicians. Now, they don't necessarily always want the help. Some do. I guess that's my question for you. Were they already used to having CDI people around and did your relationship with the physicians, was it pretty good there?

Dr. Christian Zouain: Yeah, this particular hospital, it was a big hospital. It was a 900-bed hospital and I know the program had been there for a couple of years already, but being that they were still in some part in paper, it would make it a bit, let's say, annoying for them because now a lot of programs, they use either email or you can send the queries through the actual medical record. in this case, you would have to leave everything, leave something in the medical record.

You don't know if they probably missed it or they didn't really want to answer the query. And in this particular hospital, it was interesting. Some of them were okay because coming also from a clinician's background, being a doctor myself, I know what they go through, what they're going through. So they have tons of other people calling them all the time. They have nurses, they have discharges that they have to do, they have case management, they have people from that administration calling them. with us, if we needed to contact them, we had to page them.

John: Right.

Dr. Christian Zouain: I knew that they were for me when I first started I said, oh my God, but a page that's for emergencies. And sometimes when I would call when I would page them with my number. I would pick up the phone I said I would say, "Good afternoon, CDI clinical documentation. This is Christian." Let's say, is this an emergency? This is not an emergency. I mean, you're paging me. So from that point, it was a bit difficult. Some of the doctors they would just run away. Sometimes we had to be a bit inappropriate because we would see them maybe in the cafeteria or just walking into the hospital. We tried to be as polite as we could they just let them know, "Doc, you have a query in one of your records would you mind taking a look when you have the chance or where can I find you later?"

That's what we don't have to do it right here and there in the cafeteria. Maybe they're taking a break. But yeah, those particular hospitals if it's a big facility and I would say with the inconvenience that this system is not fully automated it could be a bit of a hassle. Later when I was in my second job as CDI where I was the only one, everything was electronic and it was a smaller hospital, but I didn't have a problem there with going meeting with the physicians because it was mostly internal medicine doctors and they were all pretty good. So it depends a lot on the exposure that they have and if you're working with different specialties that could also be something to take in consideration because going from a multi-specialty hospital to internal medicine, basic medicine institution it's a big difference. You're able to handle it better.

John: Let me ask you, Christian. based on those first two experiences. I mean, how were you feeling? Were you pretty happy with the way things were going? Were you pleased that you had made that transition? I just want to understand how you were feeling and whether you feel like it also was a fit like with your personality and what advice you would give to others in that regard?

Dr. Christian Zouain: Yeah. It was tough. At that first one, it was tough because I wanted to let the doctors know that I wasn't there to really bother them again. The majority if we could handle it with the residents or with the PAs up front we would do it. But if it was, say, a surgery attending someone that's really, really busy, sometimes I would think twice on it. Maybe should I go? Should I do it?

I had my ups and downs on that particular job. But I knew that it was different because I've in other places because I would talk to other colleagues. I knew that it could change, that it was just the part that it was starting ICD-10 and in the whole process of documentation on the day until doctors would actually get readjusted. And until they would find update upgrade the system. it would make it easier for them. Because the way it was, it wasn't particularly really convenient for them right now, until later once I started my second job it was particularly way much easier. Now I had control electronically, the doctors could just come in and see my notification there and answer right away. They wouldn't have to be bothered with a call or a page unless they didn't really answer I did have to call them. Yeah, just to answer your question it was, initially I had my ups and downs. But I knew it was going to get better because it was just a particular case of where I was at the time.

John: Okay. Let me ask you this, because this can be a big impact on the way someone in your position is working and feeling. Did you feel like both institutions they had the support of leadership? I mean, here's what I experience is that sometimes the CEO or the COO doesn't want to have that conversation with the medical staff to say hey guys and gals, this is important, and we want to do a good job for you, we want to pair a nurse as well. We want to get paid and the only way we can do it is if you document and we support what we're doing here. We ask you to support it. I mean, did you feel like you had that kind of support at the institutions generally?

Dr. Christian Zouain: Yes, yes, but especially at my second job, because now I was, like I said, I was more involved with the hospital's administration. I was there at every meeting. The doctors already knew me. I remember when I first came in, they actually, they introduced me to the whole staff at one of their monthly meetings, to all of the attending docs. And I felt like I was really important. They really paid attention. And that's a good point you're making when you have the support of your CFO, your CEO when they back you up and they see that importance, they see that it's really necessary.

And especially when you're working in conjunction with the other disciplines again when I worked with case management and quality altogether. Sometimes the case management department would call me, the nurses would call me and will tell me, "I just saw that this particular GRG for this patient it's only giving us three days. Can you take a look at the case?" And sometimes I would say, "Oh." Especially turns out that this case, I had a query for one of the doctors until he answers if he answers, I mean, in the way that I'm expecting, it might change.

So I would tell them, "It might change, it might not. I just have to clarify. Well, I'm thinking of something but I just have to clarify the information with the attending." they would help me, once they had that conversation with the doctor in the floor, they would tell them, "Listen, Christian told me that you had some pending documentation that you need to further clarify. can you please go ahead go down to the floor where he's at and work on that to see if we can move this patient around, if we can keep him or what's going on." at that point, I had good interaction with everyone. we were all working together with a common goal.

John: Excellent. that's good. Yeah, I think that when you're working on a team and you have the support of administration, it's great. maybe that's even something to look at when someone's looking for that second or third job, maybe the first one. Now, I don't want to get bogged down here. you've been involved in a big institution with lots of staff. You've been involved where you're like the solo person, the solo at least the physician CDI person. then you made another change, right? you're doing something different now within CDI. why don't you explain that to us?

Dr. Christian Zouain: yeah, right now I'm working for a company. The company works for, I work remotely. Exclusively remote. I work from home. I know it's a big change. And I decided to make that change because I wanted to experience something different than just being in the hospital. I know there's a lot of these companies out there that they help in some sort of way. They either take over a whole CDI department for a hospital just like they did in the first hospital I used to work, or they help at the back end with physician education, denials management, and CDI. I was looking for that because I saw a trend and that's why I wanted to experience that. And also, I wanted to get to work in an environment with a lot of professionals from different backgrounds. CDI is a field that you're constantly learning new things and you don't know everything. That's why you have to stay updated, continue to read, go to conferences.

I like to be in an environment when I have all these professionals interacting with one another where you can get help in a particular thing to see what can you do in this particular situation? Do you have experience on this? that's also what caught my attention. that's what I'm doing right now.

John: now with that, how does that compare in your mind? Do you feel like this remote CDI activities, do you think that's going to be something that grows? Is it difficult to do when you don't actually have let's say a face-to-face relationship with somebody? What's your opinion on that?

Dr. Christian Zouain: Well, in this particular situation, I feel like the doctors have already, physicians in the hospitals that we work for, they've had some previous experience with CDI in the past couple of years. Every time if I'd contact them through email most of the time. But if they do have any questions or anything, they can just contact me. They can call me. But I haven't seen the need in this particular case to have that face-to-face because I think as time has gone by, they're used to the whole process. they know what CDI is looking for. I rarely get here and there a doctor that's asking me, "Do I have to do this same thing for every case that I have?" And I say, "No." Obviously. But that's one in 100. I mean, I think they're getting used to it and the whole process. I mean, it's still the process that we follow still has their CDI on site, which they can go to. But I mean, they can basically reach out to us via phone or email.

John: Okay. Now, would you say that if you were giving advice to someone who's thinking of moving out of clinical into CDI would it be, is there a better way to go would they try to find one of these companies that are completely remote? Or would it be better to start on the ground with colleagues that you can consult with? What do you think about that?

Dr. Christian Zouain: Yeah. I think it would be better to start in the actual hospital and get familiarized with the whole CDI process as much as you can. See, if you're a practicing physician at the hospital you can visit their CDI department, get to meet everyone and express your interest in CDI. If you can shadow them or they can sit down with you while they review your cases it's even better because these discussions between the CDS and the physician, the treating physician are a great learning experience for both of them and it will save a lot of time in the front and in the future just they don't have to query that much that the doctor knows up front what they need on a particular case.

John: Okay. That makes sense. That's what I assume but no, much is being done remote nowadays. Most people, let's say physicians even practicing telehealth or telemedicine, of course, started with you know live face-to-face patients, but I wonder if there'll come a time when they'll skip that step. But I did want to circle back to something and you went through your process and the fact that when you finished med school and then moved here to the States, but I do want to get your opinion on this because you were able to make this transition.

You did not end up doing a residency and becoming board certified and all that, which is fantastic because I have a lot of listeners who are for whatever reason finished med school whether it's in the US or elsewhere. Didn't do a residency and they're really saying okay, what are my options and there's several things out there. This is the first time that I've talked to anybody that's done that in the CDI realm.

So I just want you to comment on that and maybe what would be the difference if any between someone who maybe did have some clinical experience residency training and they were working for a while versus someone in a similar situation to you. How would the approach be different if it would be in your opinion?

Dr. Christian Zouain: I think that just like I mentioned, if you're already working at a hospital if you have the clinical experience could be easier because you've been already been exposed to CDI. You've had to work with them. The difference would be I would say if you're non-clinical if you're working somewhere else, and if you're interested in CDI you could enroll in a basic coding course of ICD-10. Again, get familiarized with the concepts and the guidelines, get involved with ACDIS. They actually right now they have an apprenticeship program that teaches the principles of CDI.

Which is also a good start if you don't have the experience and it will be valuable to employers later on. ACDIS has local chapters in every state you can look them up on their website. They have meetings every month, some of them maybe more frequent. And just like we said earlier networking is very important they can, both parties, I would say, the ones that have clinical experience and the ones that don't, they can become part of the meetings and go and attend, join ACDIS and the coding classes.

John: Now, you mentioned an apprenticeship. How does one find those or who are those through?

Dr. Christian Zouain: That's in the ACDIS website. I think you can just Google ACDIS apprenticeship program.

John: Okay. I'll definitely put links in the show notes. I'll track down all the URLs for these and listeners can do that, but yeah, another tool, another tactic I guess to really get experience.

Dr. Christian Zouain: Right. Definitely. Yeah, that will help a lot.

John: Any other bits of advice for someone thinking to go into this career that we haven't touched on already?

Dr. Christian Zouain: I would say, don't be discouraged if, this happened to me, if at the beginning you just don't understand right away how all of this works, how the coding side of healthcare works just like we were talking earlier about DRGs and ICD-10 and ESMs and all that. I know for a lot of us, we were not trained in this particular field in school and yet when we start working on it, we feel like we should be able to figure it out right away. But it really takes time to adjust your thought process into the CDI and the coding mindset.

I remember when I started I used to work with a group of nurses that were also CDS's and one of them told me once you have to lower your clinical brain a little bit. You turn down your clinical brain a little bit because as physicians we're taught to look at a case and diagnose, make a diagnosis, make a decision for management. Here we are looking for the wording and how it relates to codes it's different. We might see exactly what the treating physician is trying to portray but we have to be mindful of the coding guidelines and how it's supposed to be written. So that's different and it can take a while to make that transition. for those interested, if you start, and you start feeling like you quite don't get it, believe me, with enough practice and time and studying you'll get there.

John: Well, you're serving almost like a translator in two different languages in a way because the coding language is not meant to be or didn't, I mean it just it's like a legalese in a sense as opposed to what we learn as clinicians, this is what we mean when we say heart failure. But it may not be exactly the same when you're talking in coding language. yeah, you're translating being [inaudible 00:47:40].

Dr. Christian Zouain: Definitely.

John: Well, I think we're getting near the end here. what would be a way to maybe we could reach out to you if somebody just wanted to touch base and maybe follow what you're doing should they go to your LinkedIn page or what do you think?

Dr. Christian Zouain: Sure. Sure. Yeah. LinkedIn, you can send me a message. I have my email there and also my phone number which surprisingly I don't think people realize that because they usually send me messages. But yeah, I mean, if anyone has any further questions...

John: Yeah, I think that's great.

Dr. Christian Zouain: I'm glad to help.

John: And just to have that LinkedIn, it gives them, it's like a little bit of a barrier there. You got to make a little effort you don't get swamped with questions, but I'm not going to put your phone number out on the show notes but it's pretty easy to get through on LinkedIn. And sometimes if there's an issue, sometimes if you're like a third degree connection, you can't always, it won't let you necessarily ask to connect people can go to my LinkedIn page because some of my listeners probably already linked to me and then I could password along or whatever.

Dr. Christian Zouain: Yeah, sure. Definitely.

John: That would work. All right. Well, Christian, anything else you can think of we need to talk about before I let you go?

Dr. Christian Zouain: No, that's it. I think we have covered a lot today. Thanks for having me. Yeah.

John: No, I really appreciate it. And I think those that have even the slightest thought of going into CDI, here's a comment I was going to make earlier, but I guess I'll throw it into my little cynicism is that we have these cottage industries, which are now big industries that have all grown up because CMS has put processes and barriers in the way in a sense whether it's our views for capturing what we do in the clinic or UM there's just tons of rules and now CDI and for what it's worth I think we need physicians like you, Christian, in there serving as experts to translate all those crazy rules for us physicians. So, thanks.

Dr. Christian Zouain: Yeah. Yeah, definitely. There's a huge opportunity for right now just like you're saying, with all these companies developing and they're in great need of good clinicians to work for them and eventually take those things forward.

John: It didn't sound like there's a lot of call involved. that's a good thing.

Dr. Christian Zouain: I'm sorry?

John: It didn't sound like there's a lot of on-call duties involved as many of our non-clinical careers.

Dr. Christian Zouain: Yeah.

John: If you take a slight hit on the income, boy, you're going to make it up in terms of time with your family and free time and giving up the pagers. that's another positive to keep in mind.

Dr. Christian Zouain: Yeah, definitely. Definitely. Absolutely.

John: All right. Well, thanks again for joining us today, and hopefully, I'll get a chance to catch up with you again in the future, Christian.

Dr. Christian Zouain: Okay. Thank you, Dr. Jurica. It's my pleasure.

John: Okay. You're welcome. Bye-bye.

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The post Become a CDI Expert – A PNC Classic from 2019 appeared first on NonClinical Physicians.

In this podcast episode, John brings Dr. Heather Fork back to the podcast to share her secrets for overcoming procrastination.

Dr. Heather Fork is an ICF master certified coach helping physicians find their best career path forward, whether in medicine, a nonclinical career, or something else. Heather is passionate about making it easier for physicians to navigate their careers.

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• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
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• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

Procrastination: A Barrier to Success

In today’s interview, Heather helps us understand the root causes of procrastination. She describes how destructive it can be in keeping us from reaching our goals. It can be caused by simple disorganization, lack of planning skills, or deep-seated emotional barriers.

When trying to achieve any important task, procrastination can completely derail us. And the procrastination itself can be a source of negative self-recrimination.

Heather shares a model for thinking about procrastination. She breaks it down into three levels of tasks being avoided:

1. Small tasks that get overlooked because they are insignificant or non-urgent;
2. Mid-level tasks that require focus and planning that may take several steps;
3. Big, overwhelming projects that may be emotionally charged.

Strategies for Overcoming Procrastination

Here is a list of strategies to address procrastination, starting with the simplest:

1. Schedule 30 minutes to tackle a group of small non-urgent tasks in one sitting;
2. Set up rewards for yourself for completing an overdue task, or create a punishment if a deadline is not met;
3. Apply restrictions until a task is done (for example: if your delaying a drop off of clothing to Goodwill, restrict yourself from buying any new clothing until the old is dropped off);
4. Schedule procrastinated times on your calendar as an appointment;
5. Recruit an accountability partner to help you with your procrastination while you help them with theirs;
6. Spend time analyzing negative thoughts you have about a task, write them down, and reframe them more positively.

Bonus Strategy

Heather closes by describing how to use Artificial Intelligence (AI) to help you to eliminate this roadblock to your progress. Heather provides a detailed description of how she uses ChatGPT to help prevent or overcome procrastination.

You can use it to break down tasks into smaller steps, create schedules, and provide emotional support. You can start by going to ChatGPT.com and asking it to create a manageable plan for breaking down a large project into smaller steps, an outline for having a dreaded conversation, or ways to become more efficient, in general.

Summary

In this interview, Dr. Heatehr Fork draws on her years of coaching physicians to help us identify and understand procrastination, and implement some simple measures to overcome it.

Links for today's episode:

• Dr. Heather Fork's Doctor's Crossing Website
• The Doctor's Crossing Carpe Diem Podcast
• Recent interview on the Carpe Diem Podcast with Dr. John Jurica on the topic of Retirement
• ChatGPT
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

If you liked today’s episode, please tell your friends about it and SHARE it on Facebook, Twitter, and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 377
Secrets to Beating the Top 3 Categories of Procrastination - Interview with Dr. Heather Fork

John: Well, I'm very pleased to have today's guest back again. She's been here before. I think we both think it's been three, although I didn't go back and count, so awesome. I'm glad she's back for another episode of the podcast. She's been an awesome source of support and advice for struggling physicians with their careers for many years. Many of you should already know her very well. She's a well-known coach and an expert on resume writing and LinkedIn, using LinkedIn. So she has courses on those that you should take advantage of. And what they represent to me, like some of those things that we need to know when we're getting into this whole idea of maybe moving to even if it's a new clinical or a nonclinical position, you're going to need a resume. You're going to need a LinkedIn and tons of other things to prepare for it. And one of the things we're going to talk about today that really has a big impact on your moving forward or not. So with that, I will stop and say hello to Dr. Heather Fork. Welcome back.

Dr. Heather Fork: Hi, Dr. John Jurica. It is an honor to be back on the podcast. And actually the week that we're recording this, the podcast that you did with me on The Doctor's Crossing Carpe Diem Podcast is out this week, and it's all about part-time opportunities for those of you who are thinking of slowing down nearing retirement. But all of those things can be good for anyone at any age and stage, and I really thank you so much for coming on and doing that with me.

John: Oh, it was fun. And, this is a few weeks later, of course, by the time this gets posted, but I will put a link in the show notes. So I would recommend if you want to hear more of Heather and myself talking, then you can listen, especially in that one with a lot of ideas if you're getting near retirement. So you've come on before and you've talked about what you do, and by the way, we're on a first name basis, of course, Heather and John. So, what I want to know is what has happened, if anything new or if you've shifted gears in any way in the last couple of years, and just also mention just all the things that you do so for those that haven't heard you before, they'll get a better understanding.

Dr. Heather Fork: Oh, thanks, John. Well, my job keeps me out of trouble. I love it very much. I get to help physicians at the crossroads, and that can be through the podcast, the Doctor's Crossing Carpe Diem Podcast. I also do coaching. So I have a one-on-one coaching program, but I also offer one-off consultation. So if you just would like some perspective on your career, but you don't necessarily need a program, you can inquire about scheduling a paid consultation for an hour on Zoom. I also have, as you mentioned, the LinkedIn course, the resume kit, and a bunch of freebies on my website. So if you just go to the doctor'scrossing.com website, and it's a freebie tab, there's a bunch of different PDFs you can download.

John: Excellent. So again, there'll be links to the website and those other things at the end here. But before we get there, then I want to bring up this topic that we're going to be talking about, because it is a barrier to moving forward if you're frustrated, if you're burnt out, whatever it might be. There's a lot of reasons to change what you're doing. And this is like a basic one, and it's extremely common, and it's not just when it comes to career change. And so, I want to hear Heather deals with this and coaches people about this particular problem, and the problem is in procrastinating. So this is going to be fun, and we're going to get some tips and how to think about it. So, do you think this is, where does this rank in terms of things that hold people back?

Dr. Heather Fork: Oh, John, I think it's enormous. Absolutely. It's enormous. And it can have minor consequences. For example, if you want to take some clothes to Goodwill and clean out your closet, well, if you delay that, like who's really harmed by that?

John: It's true.

Dr. Heather Fork: Nobody, seriously. And at the other end of the spectrum if you, for example, delay seeing a doctor, we all know, because this is what we do, that this can have really serious, even life threatening consequences. And it makes me think of when I was a resident in dermatology at the VA in Miami, there was a patient who came in and he literally looked like he had a brand muffin stuck on his forehead. It was just this huge brown glob that looked like a brown muffin on his forehead, and it turned out to be a basal-cell carcinoma. And I asked him, "What made you decide to come in now? Why did you wait?" And he goes, "Well, it's been there for decades. And I just, I got sober." And he came in.

And this story in some ways, I think explains some of the complexity across the nation, because there can be things going on just with your personal life. It can be fear, such as, I see this thing's growing on my forehead. It could be a cancer, but I don't really want to know it's a cancer, so I'm just going to pretend it's not there. And it can be the problem of, well, who do I call? I need to make an appointment and getting to the appointment. Maybe I don't have transportation. So I like this topic of procrastination because it's actually fairly complex and there's not a one size fits all answer. So there's a lot we can talk about and hopefully give people some help for whatever they're dealing with.

John: Is there a way that you think about procrastination, or well, just tell us when it comes up as being an issue for maybe some of your coaching or even in your own life, how would you start trying to compensate for that or overcome that?

Dr. Heather Fork: Well, I recently came up with a framework because I've been listening to a lot of podcasts on procrastination, reading about it, I did a podcast myself on it. And the basic gist of that podcast was that it's not that you're lazy, that you're procrastinating, there's some kind of underlying internal conflict. So that's often there, but doesn't explain all types of procrastination. So to try to capture more the breadth and depth, the procrastination, I came up with my three different types. You ask yourself this question, is it a mouse, a monkey, or an elephant that I'm procrastinating on?

John: Interesting. Okay. Well, that helps us remember the three, but I have no idea what the three things relate to. So, go ahead and tell us how does that help us break this down?

Dr. Heather Fork: Absolutely. So, well, let's start, let me just ask you, John, first is, what's something that you may procrastinate on? And we'll see maybe what category it fits in.

John: Well, the thing that I think about when I'm thinking about procrastinating is I hate to talk on the telephone. So it affects every part of my life. For example, I try to stay in touch with my children. One's married, one's not married. I mean, my three step kids are married and I hate calling them. I just don't like getting on the phone. So I will procrastinate on that knowing that, gosh, they're going to think I'm not thinking about that. That's one side. The other side is like, as let's say the medical director for the urgent care center, some things come up, behavioral issues come up with the PAs or the NPs, or potential, maybe complaint or something, who knows.

And so then I'm talking to the CEO or to one of the managers and they say, "Well, could you call this person and talk to them?" I'm like, "Yeah, certainly that's something I should do." And I just dread it. And I don't dread it because I'm afraid of it. I just don't like being on the phone talking. And so I have to try and come up with a way to put a deadline, like I have to do this by this date or I'm just not going to do anything else. So those are the two types of things, but to me, that's one sort of minor in a way. And one big one, or maybe they're both big.

Dr. Heather Fork: All right. So those are really great examples about really not liking to talk on the phone. And it affects different parts of your life, and certainly too, if you have to have a bit of a challenging conversation. So we'll go through the mouse, the monkey, and the elephant, and we'll see where you feel like it fits in. And we'll also look at strategies to address each of these. And then just procrastination in general. So the mouse, as the name implies, is like, it's a small sort of issue that you're procrastinating on. It's not big like an elephant, it's annoying. Maybe it squeaks at you sometimes, but often it just screws away and hides and it's off the radar, so you don't really deal with it.

So some examples of things that could be in the mice category would be making a doctor or a dentist appointment, hanging up or framing a picture in your house, sending an email, making a phone call, paying a bill, returning an item to the store or to Amazon. These don't tend to be things that have a lot of underlying emotional content to them. They're just sort of nuisancy things. So that's in the mouse category.

John: Okay.

Dr. Heather Fork: Do you think either of those things are in the mouse category?

John: The way I laid it out, I made it sound like calling my daughter, for example, was on the mouse, but it really isn't because that's one of the most important things in my life or my relationship with my kids. Yeah. So I don't think that either of those are mouse categories now that I think of it.

Dr. Heather Fork: Okay. Good. Okay. So let's go on to the next category, which is the monkey category. So monkeys, obviously, they're bigger than mice, they're smaller than elephant, and they jump around and they're curious, they're wily, they can have a sense of humor and be pesky. So there's a lot of nuance to monkeys. So some examples of what might be a monkey is preparing a presentation, a talk that you have to do, decluttering your closets, going through piles of paper or stuff that's in the garage, or attic. It might be planning a vacation. So it could even be something positive, but you might feel like, oh, I can't leave my practice. I don't get paid when I am away and I don't know where I want to go.

So it can even be fun things we procrastinate on. It could be finding the right help, that might be a house cleaner, a therapist, a tutor, a handyman, or a doctor for yourself, for your child, could even be doing a hobby or interest that you enjoy, maybe playing that banjo like you do you play your banjo. Maybe it's being neglected. Doing artwork, writing, learning a language. So these are bigger things and they may be bit more thought and emotion that comes up when we try to address them.

John: Yeah, that's definitely, those are much bigger than some of the more trivial mouse type things. I'm thinking that for me, actually, as you were talking, I'm thinking both of the ones I mentioned are probably in this category, because I think the elephant category is going to be really, really a critical big thing. So I'm thinking these are both things, although maybe the not talking to the employee in a timely manner can become an elephant thing. Because if I let it go too long, then it's definitely going to have a consequence. So that one might be on the edge.

Dr. Heather Fork: Right. Absolutely. So they do sound like monkeys, and so they require some more focus, they require more planning, and you may have to do a little internal inquiry to understand why the procrastination is happening.

John: Absolutely. Yeah, which makes me want to think of what an elephant one will be for me. So, well, let me hear you tell us about the elephant.

Dr. Heather Fork: Okay.

John: Unless you have other examples you want to give on that one.

Dr. Heather Fork: No, sure. I think it's a great time to go onto the elephant. So obviously elephants are big and we often talk about, oh, the elephant in the room, the thing we don't really want to address, but it's there and it's big and it's looming. And so these are often tasks, or goals that are emotionally charged, and they can feel daunting and they can create a lot of avoidance and have pretty serious consequences because they are more major things in our life. So, for example, for listeners out here that could be addressing your career situation, I often talk to physicians who've said, well, I've often talked to physicians who say, oh, I've been listening to your podcast for two years, three years, four years, and they're very unhappy, but they still haven't made any changes. And so might be like, well, if your happiness is a 3 out of a 10, what's happening? Because it's obviously a serious situation.

It could also be something like creating an online course. I know definitely procrastinating on those things, writing a book. It might be addressing a significant relationship issue. Maybe you're feeling that your marriage is in trouble, but it just, you can't even just imagine thinking, unpacking all that. Or maybe you want to meet somebody. You want to meet your soulmate, but when you think about getting out there on the internet and doing online dating, you just shut everything down because that sounds really scary and potentially hurtful to yourself. Rejection is definitely a reason to stay safe. So often when we want to keep ourselves safe, we stay stuck. Could also be taking on a personal challenge such as an exercise program or weight loss program, can be addressing your finances, looking at debt, looking at your budget, looking at how you are spending your money. If you have enough retirement, you may not want to peak and see, oh my God, this means I have to work another 10 years.

John: Yeah. I remember talking to a lot of people, I don't do coaching like you do, but I've had several mastermind groups and this thing comes up all the time. It's sort of like, we've been talking about a certain issue. They all want to do something different. I mean, that's why they were in the mastermind and yet they might come back month after month after month as come together as a group and they may have had things they were supposed to work on, are they committed to working on. And really were making zero progress in spite of having been given a lot of good suggestions and encouragement and so forth. In a mastermind type situation, you don't necessarily get to the root cause of it.

You're hoping that just by interacting and having that accountability that they'll take the bull by the horns and move forward. But it's pretty common. And I would say for me, and this probably maybe affects a lot of people that are getting right at the point of retirement, yeah, I've definitely retired from seeing patients face to face. But it's the financial. We had a plan for while we were working and we were saving money, but then, do I really know, this came up for me this week actually, do I really know whether and how I'm going to now start to access those funds that I've put away? Do I need to change the way I'm managing them? I'm putting them? It's a whole different thing. And I've definitely been putting that off for months, if not years, so I can fall into that category of type of procrastination.

Dr. Heather Fork: Yeah. And so when we look at strategies to deal with procrastination, it's obvious just from the conversation we've had that different strategies are going to be better for the mice, the monkey or the elephant. Some will apply to all of them, some may be helpful to you, but not to me. And sometimes something works one day for us and the next day we're like a stubborn petulant child and nothing will work.

John: Yeah. Yeah. So I'm interested in hearing what types of, approaches we can take for the various levels of procrastination. And then maybe I can apply one of those to the areas that I'm procrastinating in right now.

Dr. Heather Fork: Okay. Well, I like to think about this as a continuum. So for things that are more like mice, we can use some of the simpler ones. And then as we get into the elephant, we're going to involve some more complex things that really deal with emotions and the conflict that's going on. But some of the simpler ones could also apply for the big ones. So it's really just a smorgasbord. And you get to pick and choose because like anything that's challenging, just like a disease that's challenging, we often have a lot of different therapies that we may use because there's no one thing that actually wipes it out.

All right. So let's start very simply. Like number one could be just make a list. And I have a whiteboard in my kitchen and I have different quadrants on it where I put something like the easy ones, like the mice will be up in the top right corner. And I like to batch my mice. So if you've heard that term, batching, just like, instead of making like one cookie, you make a batch of cookies, it's just easier. So with batching your procrastination mice, you just say, okay, there are these five things I'm going to do and I'll do them all at one time. So batching works really well for mice, but making a list can work for any of these things. And I think so many of us as physicians, we're big list makers and we like to cross things off. And sometimes we'll even add something on that we already did, just so we can get the dopamine hit of crossing it off.

John: Sometimes if you have those lists and you've been crossing them off, I don't keep my list, but some people do. And it's like, if you keep those cards or even while your whiteboard's going to run out of space. But sometimes looking back and saying, holy macro, I actually did so much this week or this month, it's incredible. But it's just everybody has a lot of little things they have to do and definitely don't want to put them off too long.

Dr. Heather Fork: Right. And we always hear about when you set goals, you need to set a deadline. So it's good to have some type of timeframe that you want to achieve this goal by. If it's something like making a dentist appointment, well, it could just be, okay, by Saturday I will have done this by the end of the week. If it's preparing a presentation, then you might say, okay, I'm going to do this by the end of the month. I need to change my career, you might give yourself one year or two years, you might say, by six months I want to have narrowed down my options. So you adjust the timeframe to what's appropriate.

And it's also helpful to let somebody know. So this is where accountability can come in. And some days this works, sometimes it doesn't. I know I've definitely told Katie, my assistant, okay, I'm going to have this to you by this date. And then if not, I've even said, "All right, I'm paying you $100."

John: Oh, wow.

Dr. Heather Fork: Well, I hate to admit it, but I said, like, certain date, I was going to get so many videos done and I didn't get them done, and then I paid her $100. So sometimes these things work and sometimes they don't, but they can help you get closer to your goal even if you don't quite make it.

John: That's a good one. Putting some money attached to it. There'll be different ways that you could do that. I was just thinking of something else that I procrastinate on and I've got to figure out which category it's in and what kind of technique I can use. I do editing of manuscripts for CME. I've mentioned this to listeners before. I've been doing that for 20 years but they arrive randomly in my house. And I don't really set aside any particular, there's not a regular schedule. And so sometimes I'll get them done within a week or two, and other times I'm looking at, it's like, oh my gosh, it's already been four weeks. And so it goes from maybe something that's relatively minor to something that can get really serious because the longer it waits, there's somebody there waiting for that to be published.

Dr. Heather Fork: Right.

John: So I have to use a combination, I think of these methods to tackle that one.

Dr. Heather Fork: It's absolutely true. And I think one of the challenges we have as physicians is that when we think about our training, we've done all the things that are hard in terms of why people procrastinate. Like people procrastinate because they don't want to feel incompetent. They are perfectionist or they don't like uncertainty or they don't really want to put all the effort in. But in our training, we had to do all these things, work hard, be accountable, show up when we're tired. We had to take our tests when the tests were scheduled. There were a lot of negative consequences for procrastinating. And so we were in a container. And that often works well when someone else is putting in the deadlines and there are these adverse consequences. But then when we get out sort of free, we're free people floating around and we have to put those restraints and guardrails and deadlines and accountabilities in for ourselves. It's harder. So it's almost like, that muscle of personal accountability got weak because we had so much external accountability.

John: One of the things I did when I was working as CMO, and it was a little easier because that was a very structured environment and there were certain things I didn't look forward to doing. But I would just put it on my, I would have my assistant put it on my schedule and that time was blocked only to do that thing. Not that it was due that day, but that I had blocked the time out so that I couldn't the next day or a week later, say I didn't have time to do it because it was on the schedule.

Dr. Heather Fork: Yes, John. And you must have ESP or you read my notes or something. Because one of the strategies is to do what I call schedule to a time. So I had a friend when I was growing up, Jenny McLaren, and she had this sign in her room, we were like 12. And it said, "I'll do it when I get around to it." And it was TUIT. So I used that recently because there was this dress I wanted to post on Facebook marketplace to resell, but I've been procrastinating on it so much that it was a spring dress and now it's fall and I hadn't done it. So I said, I'm putting to a time on my calendar, and it was going to be one hour to do all these mice. And the interesting thing is, once I had that to a time scheduled a couple days before, I just did the things, I did my mice. And it was, yeah, there was something about knowing how time set aside that I wanted to beat the clock. And I just, and this thing I've been procrastinating on for half a year, I just did it. So that's to a time.

John: Keep going. We got a lot to learn here.

Dr. Heather Fork: So another one is use a reward or restriction approach or and/or. And so when I wanted to get this dress on Facebook Marketplace, because I bought it, and when I thought I'd look great in it, but I looked like I should be on the set for a little house on the Prairie. It wasn't the western cowgirl look I was going for. But I just dragged my feet. And so I said to myself, you can't buy anything new until you put this dress on. And I'm not a huge shopper, but I like going to Marshall's and just finding a little treasure here and there. And so I said, okay, and you can't buy anything new. Well, for months I didn't buy anything new. I think I just get it up there but I didn't. So then, that was a restriction.

So the reward could be, I can get to get something. So you can reward yourself. And I think, that's really helpful. Sometimes just accomplishing it is reward enough, but if there's something like, hey, you want to go out to dinner with your friend or your spouse, or you'd like to make a small purchase, or you'd like to set aside like a fun day or get a massage, use a reward. But restrictions are important too. Like, hmm, sorry, you can't do X, Y, Z until you get this accomplished. We're used to the punitive approach I think as doctors.

John: I'm going to have to think of how I can punish myself if I can stay on track, I got to make sure it'll be something I will hold myself to though if I do that. But that's a good one. Or reward. I mean, rewards sometimes even work better if it's something you've really put off for a long time and wanted to do or have or use.

Dr. Heather Fork: Yeah. And so getting to the more complex issues like the elephants, and we can use this for your situation, is to really dig deep and understand what is the internal conflict that's going on. Because I think for so many of the things that we, as physicians, especially at the crossroads struggle with in procrastination, there's internal conflict under theirs, which is, I want to change my job, but I have these fears. So it's usually addressing the things that we're concerned about or we just have issues with. So in your situation with not liking to be on the phone, what's that about? Like, can you tell us a little bit more about that?

John: Oh, let's see. I can try. Number one, I'm an introvert. I'm not an outgoing person. I don't get thrilled by being with people. I feel most comfortable and actually most powerful when I'm by myself doing something and recharging, that usual introvert extrovert thing. So that's part of it. I'm a people pleaser. So if this phone call involves trying to have a difficult conversation with someone, they might take it a certain way. So I don't want to hurt their feelings, but any good manager or director or spouse or whatever needs to be able to have those uncomfortable conversations. But I think that's part of it. I suppose things like not like fearing the pushback or the negativity coming back at me, if it's, again, a difficult conversation. I guess those are some examples of why, that internal conversation that's going on before I make a phone call or whether I even realize it or not.

Dr. Heather Fork: On a scale of 0 to 10, John, with 10 being I really don't like talking on the phone phone and 0 being, oh, I'm fine with it, how much do you dislike talking on the phone?

John: I dislike it? Well, I would say about a seven, seven or eight. Right now, if I look on my phone, I have a weekly reminder to call my daughter. Now, I don't really plan to call her every week. But I put it on there weekly because then at some point I'm going to see it and then I'm going to do it. But if it wasn't on there, I might just put it out. So, yeah. So I mean, I just, I don't know again exactly the why so much, but that's the scale. Yeah. It's fairly, it's just when I'm on the phone and I'm already engaged, it's not a big deal. It's just the act of initiating it and just doing it. Getting it going.

Dr. Heather Fork: Well, you make a really good point there that often the biggest barrier is that first step and makes me think of this quote, "The heaviest weight at the gym is the front door." I love that. "The heaviest weight at the gym is the front door." So, like you said, initiating the phone call is the hardest part. And that's true for so many things we procrastinate on, which is another clue as to a great strategy, which is make that first step a baby step. For example, if you're trying to write a book, write a sentence, or if you're having trouble looking at your finances, the first step is to just gather the information. So if you think about what you procrastinate on, say what's the lowest barrier of entry? What's that door at the gym, if I can just get in that door, I'll be okay and start there.

Don't think of all the billion things that you have to do. Like if you say you are in a difficult relationship, and every time you think about a addressing that, it's like, oh my God, the kids, the money, the house, so this and that, that's paralyzing. But if you said, the first thing I might do is I just might talk to a friend or I just might write down why I need to do this, why this is bothering me, and just something simple. And then don't think any further than that.

John: It'll help break it down.

Dr. Heather Fork: Break it down.

John: And lower that barrier.

Dr. Heather Fork: So I know we're getting close to time here, but I do want to mention, in addition to finding your why, which is something we just talked about, that's important to just look at why accomplishing this goal is important to you. What will it do for you? How could it change your life? And if you look back in one week, one month, one year, five years, what will be different? Will that be worth it? That can be motivating. But this next thing that I want to mention to me is game changing. It can be life changing. Do you know what this next one, can you guess what it is? It's a great new resource.

John: No, just tell us.

Dr. Heather Fork: Okay. Okay. Using artificial intelligence, so ChatGPT.

John: All right. Now, how on earth is that going to help us with procrastination?

Dr. Heather Fork: It's phenomenal because so many of the things we procrastinate on, not so much the mice, but the monkey and the elephant, the monkeys and the elephants. If we say, okay, Chat, I need to address my finances. This is my situation. These are my student loan debts, this is what I'm doing for investment. I don't have a financial advisor. First you go on to ChatGPT, it's free. So just get on there and then chat. It's like having a conversation with a super smart, empathetic, compassionate person who thinks in seconds, incredibly fast. So then you just type in whatever your situation is. And then say, "Can you give me a strategy or a plan or steps to start addressing this?" And then as soon as you press enter, you count to three seconds and you have your answer there. Whatever it is.

Say you need to do a talk on something, just still chat what the talk is about and say, "Can you make 20 slides for me? Or can you make an outline?" Or if you have to, let's say career change. I did a whole podcast on using ChatGPT to help you with looking at your career. And that can be from, help me understand what nonclinical options are chat. Or help me convert my CV to a resume. Help me understand better what to put in my summary on LinkedIn. And the cool thing is chat is also like a Dear Abby, so you could even say this. So maybe try this, John, say, "I'm introverted. I don't really like docking on the phone, but I have to have these conversations. And sometimes they're where I have to give some constructive feedback and it's challenging for me, can you help me out with this?"

And chat will give you an answer. And the neat thing is, is this is a conversation. So it's not like Google where you Google something, you get an answer and you're done. But then you can follow up and say, "All right, chat. Well, that's awful. But what I really have trouble with is when I'm afraid that person's going to be mad at me. That I'm going to hurt their feelings. Can you help me with this?" And whenever I use ChatGPT with my clients and they have something they're trying to address and I show them online how to use it, all of us have the same response. Our jaw drops every single time. People are like, "Oh my God." And they usually just start laughing and can't stop because it really is mind blowing.

John: No, that's very interesting. You telling me that, yeah, my barrier to asking ChatGPT something which I don't use routinely, but would be zero. I mean, it's an inanimate thing. I can ask it. Because I Google things all the time and to me that's yeah, it's just a step beyond that. So no, that's interesting. In fact, I should probably just use that for a lot of other things. Just like to get ideas. But particularly whether it's with procrastinating or with creating something or with doing something else, it sounds like, yeah, I've never actually sat down and used it.

Dr. Heather Fork: Okay. Well, tonight, promise me tonight, John, and any one of you listening out there, whatever it is you're struggling with. And like I said, it can be a logistical thing, a practical thing. It can be emotional, psychological. It can be like I have, you might say, well, I'm dealing with loss of self-respect because I've been procrastinating so much on this and I just feel bad about myself. I'm telling you, Chats worth the best paid therapist, really, like you can get really great therapy for free.

John: All right. Well, this is how much of a novice I am. So would I just go to chat gpt.com or how do I access it?

Dr. Heather Fork: Yeah, you can go to chatgpt.com. It's also called Open AI, but go to Chat, G as in George, P as in Paul, T as in Tom. And then there's a free version 3.5. The pay version is 4.0 and it's $20 a month. I use the paid one because if you do so many searches or queries, you run out of time, you run out of searches basically. But I would start with the free version and it's just a prompt. There's a space, like a search bar that you just put in the prompt and you can also set up your computer where you can just speak. For me, I press like Ctrl twice and then my microphone comes on and I just talk to chat. I explain the situation, what I'm dealing with, and I say help me out.

John: Nice. That is awesome. Well, that's a great bit of advice in addition to everything else. Thank you for that.

Dr. Heather Fork: Oh, you're welcome. You're welcome. I'd say, that may be one of the most powerful anti-procrastination device that we have so far. So please check it out.

John: All right. This has been awesome. Anything we didn't hit on that you think we need to know about or other ideas for addressing this problem? If not, feel free to tell us again about where we can reach you.

Dr. Heather Fork: Oh, absolutely, John. So I think just to summarize look at whether it's the mouse, the monkey, or the elephant. And then there's so many different ways that you can use to help in terms of strategies such as making a list, having a whiteboard, setting a goal, getting accountability, putting something on a calendar like your to a time. When you're going to actually do these things. Get somebody to be an accountability partner. Look at your why, why it's important to you. Break it down in steps. Lower the barrier of entry to that first step. Do a really mini baby step.

Reframe your fears. Like if there's things that you're worried about, like your income going down, have you changed careers? Try to reframe that and say, well, I can look into options. I know other doctors do this. They're actually jobs where people make more. So I didn't really talk much about reframing the fears, but that's a big part. And that's mostly what I talk about too in my podcast that I did on procrastination. So yes, doctor'scrossing.com is where you can find me and I'd love to help anybody. I'd like to reach out.

John: Well, I am always amazed when I have you here on the podcast, Heather. I guess you always come up with some outstanding topics and issues and solutions and you're just such an experienced coach. So I mean, I really appreciate you. Not only have you helped a lot of physicians working their way through their careers and so forth over the years, but we've known each other for a long time and I really feel like I've gotten a lot of support from you as well. So I do appreciate you and I advise everyone particularly, I mean, if you think you might need coaching, I like the idea of a one-off. If you just want to get a sense of what the coaching would be like. A lot of us have never actually been coached.

And so we don't really know what coaching is. We think it's like someone's going to tell us what to do and I suspect it's not that at all. And so you might just do the one hour, but anyway you have so many things available on your website and the big ones that, like I mentioned earlier, that I find so useful are those pertain to the resume and the LinkedIn because they're so practical. But obviously there's a whole lot more than just that to making a major change in your life, whether it's your career or something else. So thanks again for being here today.

Dr. Heather Fork: And thank you, John. I'm a huge fan of yours. I recommend your podcast all the time and the courses and the summits that you offer and that's why you've been on my podcast multiple times and people really enjoy your episodes and get a lot out of them. So thank you so much. I'm a big fan.

John: You're welcome. So with that, I will say goodbye and maybe we'll see you back here on the podcast again down the road.

Dr. Heather Fork: All right. Well, thanks again, John.

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The post Secrets to Beating the Top 3 Categories of Procrastination appeared first on NonClinical Physicians.

In this podcast episode, John interviews Dr. Greg Gilbaugh to learn how to beat burnout for good. Greg is a seasoned dentist, practice owner, author, and business consultant.

His career involved overcoming multiple practice-destroying disasters and transitioning away from clinical work due to health issues. In addition to leading and managing his practice, he now helps other healthcare professionals build fulfilling practices that enhance, rather than compete with, their personal lives.

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

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

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• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
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The Missing Link in Healthcare Leadership

Most healthcare professionals receive minimal business training, leading to adopted rather than designed practice models. Dr. Gilbaugh emphasizes a fundamental shift: start with a vision, not a strategy.

What good is it to build the practice of your dreams only to find out it robs you of the life you always wanted? – Dr. Greg Gilbaugh

This approach has helped numerous practitioners, including a surgeon whose practice was crumbling, rebuild with purpose and direction.

Summary

Whether you're feeling trapped in traditional practice models or seeking meaningful transformation, the path to change starts with a clear vision. Dr. Gilbaugh's experience shows that healthcare professionals can build thriving practices while maintaining personal fulfillment.

Want to explore these concepts further? Check out Dr. Gilbaugh's book Letting Good Things Run Wild [Amazon affiliate link*]or visit kalosbusinessgroup.com for free resources, including practice development guides.

Links for today's episode:

• Dr. Greg Gilbaugh's book: Letting Good Things Run Wild [Amazon affiliate link*]
• Kalos Business Group's Website
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 376

How To Beat Burnout For Good Without Leaving Your Practice

- Interview with Dr. Greg Gilbaugh

John: I recently ran across a dentist, former pastor, and consultant who experienced many of the same challenges that many of you physicians have experienced over the years. I thought it'd be fun to get him on the podcast and ask him a few questions about how he has faced those challenges. So with that, I want to introduce a dentist, Dr. Greg Gilbaugh.

Dr. Greg Gilbaugh: Thanks, John. It's a pleasure to be here. I'm looking forward to a chat with you.

John: Yeah, because you're a business consultant, that's the thing that really piqued my interest and being a dentist, a lot of what you've experienced over the years is very similar to what we physicians go through. So I thought definitely we could learn a lot from you. So maybe you can start by just telling us a little bit about yourself and the story that brought you through to what you're doing now.

Dr. Greg Gilbaugh: No, thank you. Yeah, I came to the University of Iowa when I was a young lad. I came here on a football scholarship. I was an offensive lineman. I wanted to come here and play Big Ten football and go to dental school, and I was able to do that. Bought a small practice in the area, got married, and it was the start of a wonderful season of growth. My wife and I, we currently are standing at nine children that we love nurturing and releasing. But for me, I love the field of dentistry. I love leadership and business. The practice has gone through a lot of what I call significant growth strategies where seven years into the practice, the building was struck by lightning and burned to the ground.

John: Oh, boy.

Dr. Greg Gilbaugh: So that was a time where we said, okay, let's take some insurance money. Let's glean what we know is working well, and now let's next step of growth. So we found a place to lease, started practicing again, and then our community endured what was considered a significant 100-year flood, which brought eight feet of water into our clinic space. So we had to regroup, take an insurance check, rebuild, regrow, and then we had a nice location, nice facility. It was at that point in time out of debt. Personally, professionally, I was thinking about my next stages. We had 14 families that were working with us. And then we had the catastrophic 500-year flood that devastated the area of town where I was in, but this time, no insurance coverage for flooding.

So I was 50 years old. I came home to nine kids and a wife, and we were essentially wiped out. We had nothing left. Decided that at this point in time, I was too young to give up, and I really, really felt it was in my best interest to continue on. So we found a new location. We just restarted from scratch. And I knew at that time, it's like, this is now a much bigger office. Mistakes are costly, so I really took a deep dive into business and leadership. No margin for error.

And what we found was that in five years, we doubled our clinic space, doubled our number of doctors, doubled our number of employees, and significant growth was going on. We had learned a lot. Started to build then another clinic facility, and it was during that time that, real quickly, my hands lost their fine motor skill and fine sensation, and we found out that it was due to some brain trauma from playing football, and I had a significant mold infection from probably walking around and enjoying the floodwaters of the great Midwest.

So that was my transition out of clinical care and then into this world of coaching, leadership, helping healthcare physicians. I'm still at the two clinics four and a half days a week. I love coming here, but I think that what I have learned is of some great benefit to others. So that's where I find myself. I'm still in the game, but it's from a leadership perspective, and then branching out to help others.

John: Wow. Well, probably the pandemic for you is like nothing compared to those first two or three events.

Dr. Greg Gilbaugh: We were able to weather the storm well. It's like, and again, we had told the people, yeah, during the pandemic, "We've gone through stuff before. We've been able to come through on the side. We're going to make it. We're going to make it. So let's come up with a mission. How we're going to do this." And we got through it.

John: So now you're focusing on the business aspects of the practice. Can you give us an idea of the scope in terms of maybe how many are working with you or that kind of thing?

Dr. Greg Gilbaugh: Yeah, I've got a larger general care and orthodontic clinic where we've got four doctors and 30 staff here. This one has been in business for 38 years now. And then right across the parking lot, we purchased some space. And now we've got a pediatric children's clinic that works hand in glove with us at this location. And that one has just gone over four years. We started that from scratch. That now has two doctors working in there and a staff of 12. So I go back and forth. They're both very different. One's just starting out. One's a very mature growing one. So I get to see both ends of the stick, so to speak, keeps me sharp.

John: All right. So you've had to rebuild numerous times. Now you're involved in this. And so at some point, a couple of things happened I think from what I know about you, you decide to help others build their businesses, I think, other professionals in health care. And somewhere along the way, you also wrote a book about doing that. So you can take either one of those and just tell me how that all developed.

Dr. Greg Gilbaugh: Well, when I was out of clinical care and wanted to get my thoughts onto paper, that's where the book came from. I have a relationship with a gentleman. He's my personal executive coach. We've formed a great, fond relationship. He's wrote a number of books. He encouraged me to do the same. And so what I saw really was that there is for us in health care, we get very, very little training and exposure to how do we do the business end of this? We have to figure that out on our own. And then also like, how do we lead people? Very little exposure to that. Leadership can be taught, and it can be embraced and it can be learned and you can become very skillful at it.

The other aspect that I found personally and with many others is that when it comes to the issue of faith, I help them to be able to connect their faith to their profession. There's a big chasm, I think, there where they go to their local church. They're not getting the help they want. They're professional organizations. They're not speaking to it. And there's this big chasm. And when they can connect that, they feel that they have got something significant going on. So the book actually is like integrating your personal faith into your practice so that not only does your faith get deeper, but we talk about basic business fundamentals, and then leadership over a lifetime. And so it gives them a foundation that they can now start to build their specific practice how they want to in a way that will grow and be very fulfilling for them. That's how I serve my clients.

John: Well, as I was looking through the book, I mean, I just want to throw out some of the things that stood out to me for the listeners in case they're thinking of picking it up. But there was a lot in there about stewardship, integrity, service, vision, mission, leadership was a big part of it. So it's not just, okay, here is an integrity of how you do certain business practices, but more of a global and oversight in terms of why you're doing this business and how to do it and the values and so forth, principles that go into it. So that sounds very helpful. Now, what's the name of the book? So we can go find it.

Dr. Greg Gilbaugh: Yeah, the name of the book is Letting Good Things Run Wild. And that can easily be purchased on Amazon, whether an ebook or the paperback. They can also get a copy at my website, which is Kalos Business Group. That's K-A-L-O-S, kalosbusinessgroup.com. They can go there. I also have on there for people that are interested, just a free PDF on key performance indicators.

And I say, here are three, just three key performance indicators. You focus on these, and you will find that your revenues will increase pretty significantly over six months. That could be true in the dental field, that can also be true in the medical field. So there are some things that are free, there are some books to be purchased, I think that you'll find it very encouraging. Because it goes over essentials of building a business, which starts with what is your vision for your business?

This is where I find many people in business, but especially healthcare, when they sit down, and they first come to me, and they'll say, "I need some help." I'll give you an example. I have a physician, a surgeon that I'm working with right now. And I met him last year having a chat in a parking lot of all places, never met him before. We started talking. He had an incredibly a walk through hell of a private practice. Partner docs that left, partner docs, it blew up lawsuits, defamation, slander, disaster, and felt bad for him as he's a great physician. And so I said, "Okay, so how'd you get here?"

And he said, "Well, I hired this guy because I knew him from residency thought he was good." And I said, in essence, he said, "This is what other surgeons how they run their business. So I decided this is how you must run your business. No one ever taught me. So I'm looking at the veterans. This is how they're doing it. And it just totally blew up." And I said, "Okay. So what would you do differently?" And he goes, "I would do this, I would do this, I would do this. And I would do this." And I said, "Well, then, why don't you build that kind of a business?" He goes, "Well, can I?"

I go, "You absolutely can." And just saying, "What is your vision? You know, you've got a great opportunity to start all over here. So what kind of private practice surgical business do you want to build? What does it look like? Where are you going?" And then it's like, how are you going to get there? What's your current reality? Which looks like hell right now. But it's like things are, as I continue to meet with them, it's like, yes, now, our current reality is here, and it's already so much healthier, because he has a vision. There are people who left, but there are people who stay because they go, "I like the vision of this place, it resonates with me. This place is going somewhere, it's doing something." And it's like, okay, how are you going to get from where you're at to where you're going? And what are your next steps?

And then how are you going to help to encourage, lead, serve your team to get there? Whole perspective has changed. He's still in the same location. It's just that the guts of his business have radically changed. And all I've asked him is like, "What do you want to do?" He's never taken the time. And as physicians, you know what it's like, John, it's like everything is so busy, that we don't take time to say, "Where do I actually want this place to go?" That's what leads to burnout. That's what leads to frustration.

In some of our email exchanges, you asked a really good question where you said, "Can a group of physicians, can an individual physician, can they build a private practice that really offers excellent service, a personal fulfillment and a generous income without becoming burned out?" And the answer is a resolutely yes. But it hinges on this, personal fulfillment, what is it? What actually is your personal fulfillment? And so what I do when I work with physicians, dentists is I first work with them, I call them, "What's your life plan?" They go, "Well, what's that? No, what I need, Greg, is I need to know how to hire better staff. I need how to do this. I need new software."

And it's like, those are tools for the trip you're going on. Where are you going? And so we work with them, offer help. Sometimes I say, get away for a day. And I give them a tool. It's like, "What's important to you? What are your main responsibilities right now?" And then they list them. And I said, this is what's important to you right now in your life. And of course, business is one of them. How satisfied are you with all these things? But it gives them a snapshot of their life. And it's like, "What do you want these areas of life to look like in three years, five years, whatever?" Because this is what you're responsible for, like John. This is what's in your lap. What do you want this to look like? Too many times, physicians want to have a independent vision for their business that starts to compete with their life. That leads to frustration.

I remember about eight years ago, when I was talking to a group of about, I think it was about 16 dentists at a mastermind with the intention, all of these dentists want to build multiple practices. It's like the new way. It's like, look, if my profit margins are down to here, I'll have to build multiple so I can get it back up. They were going through an exercise about really their vision. What kind of practice do you want to build? And when I had a chance to talk with them I said, "What good is it to build the practice of your dreams only to find out it robs you of the life you always wanted?" And it was at that moment, I was early in this kind of stuff, but I remember it was like dead silence. Pens stopped working and everyone's eyes got big and they looked at me. I go, "I think I just struck a nerve." Which is like, yes, it doesn't mean you can't build the practice of your dreams.

But if it robs you of that life plan, it's like if it totally sucks you out, you know in medicine and in dentistry it's like we're up at the coaches AP polo, like with divorce and job dissatisfaction and alcohol abuse. And it's like, we're not a real healthy group when we get. And it doesn't have to be that way. And I think if early on, it's like, look, the practice of your dreams, maybe the practice of your dreams that you see like 30 years down the road, that's great.

But what is it going to look like in the next five years? Because your responsibilities are different. Time is God's way of making sure that everything doesn't have to happen all at once. Let's take the long view and make sure that you're genuinely fulfilled so that when you're at work, it's like, I like coming home or I like here. And then when you come home, it's a fulfilled life, not just a career with a bunch of zeros where it's like, I hate going to work. The only reason I go to work is for money.

And then it's like, it's not a very gracious master. When they say, look, this is what will give me fulfillment, which is very different from I'm working with a younger dentist who contacted me because he's like, "I'm in this group practice. I've got a four-year-old, a two-year-old and mum is seven months pregnant. And I feel like I've got no time for myself. I'm living out of fear." And it's like, "That's normal, young man. That's normal, okay? You're just transparent enough to admit it. Okay. You fear failure. You fear the future. You fear finances. I would say you're secure enough to admit it."

So we're working on his life plan. Eventually it's like out of a good, healthy life plan will come your vision for your business. Okay. So it doesn't compete. It enhances your life. So that when you have all of these things starting to grow that you're responsible for, that is fulfilling, that is passionate.

And yes, you can have an incredibly fulfilling life. Now, when you say like a generous income, financial reward, that's the fruit on the tree. That will come when you start serving your people, serving your practice, because when you are a fulfilled physician and you are, when you're fulfilled, you're passionate. That is where burnout starts to go out the back door. Because it's like, I love what I'm doing because I see what it's doing to enhance my life, my family, what I'm called to be, what I really, really, really want to do and become that's fulfilling.

That's why I say Monday is one of my very favorite days because I get to come back here. Because I find where I'm at and how I want to finish my life, I'm a young 65. It's extremely fulfilling for me. That's why we chose to build after natural disasters. That's why we chose to go on after becoming disabled. I find a lot of fulfillment .And the practices have built to such a point. It's not like, wow, that is so unique, Greg. It's like, no, this can happen to others.

John: Let me jump in for a minute here, because I want to reflect on some of the things you've said. I mean, first the vision part of it. So many professionals, they just don't really think about the vision. They think, okay, I'm going to get through school, residency, whatever it is to get that licensed, to get that degree and certification.

And this is the way you practice. And when they step back and say, what's really important to them, as you mentioned, they can see that I don't have to keep doing all of this stuff. That's not fulfilling. That's frustrating. That's not in the line with my principles and my values. And I've just been amazed by the way some physicians have focused more narrowly, maybe, on the part they really love.

Um, and again, that gets back to, you're talking about the vision. And we tend to think, well, these things can't change because it is the way it is. And they become afraid of having those conversations with their partners or their boss or whoever. So do you go into a little bit of that, how to communicate your vision, how to get everybody on the same page so that we're all rolling in the same direction?

Dr. Greg Gilbaugh: That is so key and so important because as let's say the leader, which I always, I make synonyms like you're responsible here. Okay. You communicate it. This is where I really want to take the practice. And if you're with others, you need to communicate. It's like, "Look, this is where I feel it really would benefit the practice." It's so much easier when you start at the beginning, when it's just you and you're starting out. And it's like, this is the trajectory so that when you hire other doctors, come on, it's like, "This is where I'm taking this ship. Um, would you like to join us? And do you bring something to enhance this journey? Don't bring in a competing vision. This is what we are. This is what we're about. This is what's important. And this is where we're going." And you keep communicating that to your people.

People want to come to a place of work that's going somewhere so that they can see what I do today is actually making progress towards what I'm here for. I'm not just going around the cul-de-sac over and over. Okay. And then checking out. I'm actually helping this place move somewhere. And it's a preferred future. It's something that's like, yes, I want to get there. And you repeat it over and over and over. And as the leader, you say, I usually stress to the doctors, find your team, your support people. And if they're doing something well, according to where you want to go, and then our core convictions, the six behaviors that we say are essential for success, you find someone doing that. And it's like, you know what, "Hey, time out. Do you see what you're doing? That's exactly what we're about here."

And then as the old football player say, "Helmet sticker, okay, really good job." And you reward those. You say, "This is what we're about." When you're bringing on staff, help people to join. If you're bringing on a partner, it's like, "I just want to let you know, this is what we're about." You will find that there are people out in your profession, in your lane, in your specialty, subspecialty, they're looking for a place just like that. That's who you want to join.

There are other people's like, might be highly skilled, brilliant, really good. But they have a different preferred future. And it's like, that's okay. Well, which one's better? Well, I'm not going to say which one's better, but this one's mine. This is what we're about. So God bless you and go over there and prosper. Yes. But we can't have competing visions for the limited time, resources, and energy that we have here. So let's all bring it to row in the same direction. When you've got a clinic that's moving in that direction, that is life giving, it's encouraging, it's passionate. And when you hit the bumpy waters, like reality gives us, it's like, we're going to get through this. Because I want to get through this. I'm determined to get through this. And we're going to keep going because there's something so fulfilling and satisfying by experiencing this.

John: Let me shift gears for a minute here. Let's say that I am one of those physicians, I'm in my 50s or 40s or whatever. And I do want to build something of my own. And it's not been working. What does working with you look like? What is an engagement with you in terms of what would someone expect? Because most physicians have never engaged a consultant to help them. So maybe you can just share how that looks.

Dr. Greg Gilbaugh: No, that's really good. First of all, we have a lot of conversations to onboard them, and what are you looking for? What is your desires? And I will, I start off with big picture life plan vision. What are you responsible for? You got a guy that's 50. And it's like I've got maybe two kids and they're college age. Okay. So the parenting is little, we're almost done. Okay. So where would you like to go? What's important?

Okay, and then these things. And then okay, and business is part of it. It's like, okay, where are you at? What's your current reality? Well, I'm a partner or I'm a partner in a practice where I'm solo practitioner and I do like this. I don't like this. What are my passions? What are your strengths? And we do some assessments. It's like, "Hey, you're really good at this. This is how you like to lead. These are your strengths. This is what you bring to the game. So what would that look like if you want to change? If time and money were not a problem, what would you do?" Oh, I'd probably do this. It's like, how realistic is this? Do you see you can do this. And I ask a series of questions like, "Are you willing to pay the cost for this?" "Yeah, because this is what it'll get." "Okay. How do we do this? How do you think, now you know where you're going, what are we going to do in the next year? The next two years? What are your next steps that are going to cause you the most success or the most progress in this journey?"

John: One of the things that I hear a lot from my listeners is that they would like to get to the point where you are now. Now you were sort of you didn't have a choice because of some of the challenges, the health and so forth. But can you encourage them or support them and give them advice for how to get to the point where maybe they just want to run the practice, have other physicians that are on the same page, but really focus on the business, the marketing and the growth and not really the grind of working in the hospital or that kind of thing?

Dr. Greg Gilbaugh: Yeah. That is a great transition, because I feel the greatest asset to a private practice is the people. I mean, as physicians, it's like, look, you're all smart. You all have access to you can go to the bank and get finances, you all have a good career, you can get like, training, equipment, whatever, everyone's got access to what differentiates your practice from another, and it's the people that are in it. When you are then saying, I want to move out of the clinical area, from being a provider, to now developing and leading people so that they are now the multiple providers, okay? You now have time to invest in developing your people and getting them actually better.

Now have more time to focus on the vision. Let the others, some business paradigms call them integrators. They're the people who love all the details. They love to get in there and do all the work. They love being on the front lines, let them do that. Then asking them, what do you need to succeed? I will do what I can to make this place even better.

You always have the commander of the ship, so to speak, it's like I'm going to take responsibility for making this place better. Some physicians, some people find like, wow, this is an avenue that I only thought was possible. This is exactly what I want to do. You think of someone in their 50s like that. Here's a person who's got more, probably discretionary resources, finances, wants more discretionary time and you are at the top of your apex of wisdom. Dude, now is the time to, you have so much to give. You have so much to give.

I just read a great book. It was called Full-Time about work. And the authors, one of the premise they said goes, "You know what happens when we ask people to retire in their 60s and get out of the marketplace, we are actually cheating the 30 year olds from great mentorship." And it's like, that was highlighted over and over. It's like, yes and amen. You have so much more to give now in developing people and really making your clinic, your practice become a place that is just exceptional, exceptional. And people want to work there.

John: I think a lot of us would love to do that. If we're in that situation, we can just figure out how to make it work. We're going to run out of time, so I guess just any closing remarks. So first, again, tell us about the book, where we can find the book and the website, and then any advice for again, mid-career physicians who are just feeling frustrated and they're not sure what their next step should be.

Dr. Greg Gilbaugh: Yes. Again, thank you, John. The name of the book is Letting Good Things Run Wild, the integration of faith into your business so that your faith deepens, your business actually gets much better, and your leadership impact becomes incredible. You can find it on, of course, Amazon Bookstores, but you can also get it at our website, Kalos Business Group. That's K-A-L-O-S businessgroup.com. You can order it there. Again, there's also the free PDF on the three key performance indicators, and if you focus on them, you're going to find some good results.

Again, I think that if they want to check out my website. It'll have a lot of stuff there, and if they want to set up a call with me, there's a place to set up a call, and we can just talk, because sometimes doctors in healthcare, dentists or physicians, chiropractors, whatever it is, they don't know what's actually possible. They only know what they have been experienced in their lane, and it's usually like, I'm frustrated, so I'm going to find a different line of work, or I'm just going to retire and get out of the psych.

That's only two options of a plentiful banquet, okay? There's a lot of stuff to choose. You just don't know what's being served, and what's possible. And again, I serve clients by not telling them, this is what you need to do. I try to ask them questions and try to pull out within them what their desires and what their passions are, and then ask questions to find out, is that something that you would like to pursue? Because then I think I can help you in this new journey.

And sometimes it's the second wind that many of them really want, because they, why did you get into this profession in the first place? Well, I want to help people. A lot of ways to help people, and you don't have to throw away all of this experience that you have gleaned over decades. Maybe it's being prepared to do this in your final season of life, which could be your most enjoyable, fruitful, and impactful season of your life.

John: Yeah, it's true. And we've experienced, you've seen people that have done it, obviously I have as well. So it's just a great message. Well, I want to thank you, Greg, for being here today, sharing your wisdom and your resources with us. Be sure I'll have those links for my listeners. They can go and take a look at the PDFs, the downloads that you have, and also learn more about your consulting business. So I guess with that, I'll say goodbye.

Dr. Greg Gilbaugh: Dr. John, one of the highlights of my day. Thank you for letting me come on and visit with you. It's been a pleasure.

John: Okay. Take care.

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The post How To Beat Burnout For Good Without Leaving Your Practice appeared first on NonClinical Physicians.

In this podcast episode, Dr. Tod Stillson explains more about the benefits of a professional corporation and the steps to take in forming one.

This week we build upon our previous discussion where he introduced the concept of employment light and shared his journey from traditional employment to independent contracting. 

Our Sponsor

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

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

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

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

Making the Transition Without Rocking the Boat

Our first episode focused on how doctors can win as a micro-corporation and negotiate better contracts. Part 2 reveals practical strategies for a seamless transition and income diversification through professional incorporation.

The beauty of transitioning to a professional corporation lies in its seamlessness. As Dr. Stillson explains you can maintain your regular clinical presence while restructuring your business model behind the scenes. He continued wearing the same lab coat, attending medical executive meetings, and maintaining hospital relationships – but with one significant difference: a $200,000 increase in compensation.

You don't need to shout it from the mountaintops… You just need to ask for it very quietly. – Dr. Tod Stillson

The key is creating a win-win situation where your hospital isn't paying more, but you receive fair market value for their services through a more powerful business structure.

Benefits of a Professional Corporation and Income Diversification

The medical landscape is evolving, and with it, new opportunities for income diversification are emerging. Today's physicians are exploring:

• “Job stacking” – strategically combining part-time positions
• Direct primary care models
• Telehealth and “practice without walls” concepts
• Multiple revenue streams from different medical services

Dr. Stillson successfully monetized various aspects of his practice, from clinic work to sports medicine coverage, ultimately creating multiple distinct income streams. This approach not only increases financial stability but also provides greater professional autonomy.

Summary

For those ready to dive deeper into professional corporations, you can find Dr. Stillson's comprehensive guide Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy on Amazon. His website offers both free resources and paid courses to help you navigate this transition. As part of his commitment to helping physicians thrive, Dr. Stillson also offers a free eBook titled 20 Reasons Every Resident Should Start a Corporation During Their Residency. 

Links for today's episode:

• Part 1 of this conversation can be found at Now Every Doctor Can Win As a Micro-Corporation
• Dr. Tod Stillson's Website SimpliMD.com
• Free Subscription: Subscribe to the SimpliMD Blog.
• Dr. Tod Stillson's Book: Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy
• Employment Lite: Check out our Employment Lite landing page on why this hybrid model of employment and private practice is so appealing to many doctors.
• Free E-Books: Choose from a large menu of free E-Books that support your micro-business journey as a self-employed doctor.
• Professional Business Network: Our vetted and preferred network of small business professionals and resources that will support your professional micro-corporation journey.
• How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256
• Check out the 2024 Nonclinical Career Summit to learn about MORE unconventional career options.

Paid Resources from SimpliMD:

• $199 Course: Creating A Practice Without Walls.
• $99 Consultation: 1:1 Micro-Business Consultation.
• $500 Micro-Corporation Start: A Business Consultation + Connection to Legal Professionals to Start Your Professional Micro-Corporation.
• $99 ($10 for residents) SimpliMD Membership: Join our community of self-employed doctors and receive exclusive perks for members only
• $2000 SimpliMD Coaching: 1:1 holistic coaching with a small business focus.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 375

More On The Benefits of a Professional Corporation

- Interview with Dr. Tod Stillson Part 2

Dr. Tod Stillson: And I'll say back in the day when I did this tenure over a decade ago, John, my simple goal was to let everybody in the community, including my own peers, have no idea that it was happening. In other words, I still wore all the same lab coat. I still wore all the branding of the hospital. I still did every bit of work that I was doing. It really looked like no different. I still even went to the medical exec meetings, the staff meetings. I participated. I was very willing to participate. On many levels, it looked like I was doing exactly the same thing.

But behind the scenes, the business model was dramatically different. And that's what was empowering in terms of my autonomy and in terms of my taxes and really the financial side of the equation, as I mentioned. And when I made that transition, I got a $200,000 raise just by making that transition. And so an amazing amount of money. But the point is, is that I wanted to do it seamlessly. And that's how I encourage most doctors to do it.

You don't need to shout it from the mountaintops. You just need to actually to make it the most win-win. You just ask for it very quietly, okay? And for the hospital, they're not paying you more in this system. In other words, you're not asking for a raise. Now, you're listening to me go, wait a second, you said you got paid $200,000 more. Well, I did. And that's because their stupid employee contract was a stupid employee contract that wasn't paying doctors fairly, okay? I just was now getting paid fairly for what I was worth in the marketplace. And it's that simple.

So that's not more, that's just fair, right? And that's important for a hospital. I see it in that way. I have plenty of hospitals that also pay doctors in employment-like contracts on salaries too. It doesn't have to be productivity-based. There's all sorts of PSA structures that a doctor can use that makes sense for them if they prefer that. But the point is make it win-win.

John: Excellent. Now, I don't know if you mentioned this earlier or I heard it somewhere else in hearing about your background in that.

So if you're currently employed and you have a non-compete, does that itself become a barrier in any way? Or do you still have a non-compete under your professional incorporation?

Dr. Tod Stillson: It's all about the negotiation. One of the elements that the hospital wanted to put in place with my new PSA contract when I made that conversion, they wanted to put a non-compete in that basically was non-compete in the essential services the hospital was performing while I was engaged in the contract. It didn't have a one year or a 30 day or 90 day, one year, two year wraparound non-compete around it. It was just literally during while the contract was in place. That was all about negotiation. So the point is, it's all about what you want to negotiate.

So if you convert it over and if they're like we had a one year non-compete when you were an employee. We want to have a one year non-compete in this employment-like contract. If you're okay with that, they're okay with that. But it's also a point in time where as an independent contractor, you might say, well, let's negotiate that down. Okay. Let's take that down to three months, six months, eliminate it altogether.

And as your listeners know, this is something that's a hot topic in medicine anyway, right now that it may get eliminated federally all across the board, or at least get put back into the state's hands. And there's just a whole bunch of stuff going on in that context. But the answer is, this is an opportunity when you reformulate a contract to determine the exact terms of it.

I'll bring this point up again to your audience. This is the point where I did what I would recommend them to do. I hired a lawyer who understand healthcare contracts, who negotiated and worked on my behalf. And that was one of the smartest moves I made. And one of the best return on investments that I ever made when it came to this, because they knew and understood things. And they could speak the language, but the hospital lawyers that they needed to hear and communicate it in a way that was best for me.

So when you try and negotiate it yourself, you're not going to typically beat the hospital layers. Okay. You aren't. No matter how kind they seem to be to you, they-

John: They're smiling all the way.

Dr. Tod Stillson: They are smiling all the way. And that's because they're going to kind of, because of information asymmetry, oftentimes, they're going to list that contract more towards them. That's their job. That's who they represent, then towards you. So don't be afraid to hire a contract review or negotiation lawyer. We have them as SimpliMD people that we work with. And so that's another take home message for your audience.

John: Yeah, I'm glad you brought that up. Because I get that question occasionally, it comes up, do I need an attorney to do this or that? And actually, when I close out each podcast episode, I say, get an attorney, get an accountant, do these things. And it's just, I mean, it's not cheap, but it's worth it. You're going to end up just being in a much better position if you really have someone who knows what they're doing, advising you and maybe even creating the documents.

Dr. Tod Stillson: That's exactly right. And I'll say when you do it like I've done as a micro corporation so my own PC professional corporation, that's a business expense. So it's not even coming out, unlike when you're traditionally employed, all these things come out of your personal pocket, right? So that's post-tax dollars. And it's feels a whole lot better spending on professional services when you're using pre-tax dollars to spend on those professional services.

John: Now, are there some other things I think, because you've written a lot on this topic, other things that you can think of just offhand that using this new model for yourself, that it enabled you to do that did end up, ultimately, basically diversifying your income or assets. Let's put it that way.

Dr. Tod Stillson: Yeah. So what's your question specifically?

John: So when you've switched to this model of interacting and creating your own micro business, there's other things you can do with it.

Dr. Tod Stillson: Oh, I see. Yeah. Got you.

John: Yeah, that are beneficial.

Dr. Tod Stillson: So first of all, it's about diversifying your income channels. And so then anytime you as a professional can diversify your income channels, the better off you're going to be. Now, a traditional employee, professionally, most of their work is being done with that one prime employer, right? So that's one income channel.

And there's doctors that do side work. They can do 1099 side hustles. Like I said, 40%, 50% of doctors will do that. And so you can have those. That's a good example of just professional income diversification, right? In today's world of younger doctors that I talk to all the time, we call this job stacking. The younger doctor, the younger population call that job stacking. And in today's world of job stacking is really cool, John, because Kate, for you and I, we grew up in this mentality of like, you work for one part, one employer, one job, one income. You're kind of, we're all in, in one place.

And that's just how you did it. And there's a lot of loyalty involved in a lot of these things because they are intertwined in that. But younger doctors don't have that same amount of loyalty. They're smartly, they don't have as much loyalty. They think about lifestyle. So what they do, their end point is not just setting down in a community and working a job for 40 years. Okay. Their goal is a certain lifestyle that they're going to then do the backwards math of saying, what number of jobs that I need to take on that will give me the lifestyle that I want to live and the income that I want to have to connect the dots to that process.

So younger doctors are not uncommon for them to not have a 1.0 full-time job with somebody. It's for them to take on a 0.5, a 0.6, a 0.7 full-time equivalent, and then take the extra time they have and stack in other professional income or non-professional income sources. So they can use their time wisely to create income channels that are not reliant on one big source, but reliant on multiple sources. That allows them to then pick and choose the levers moving forward of how they want to increase or decrease when depending on how it's going to still meet the lifestyle they desire.

Okay. So that's called job stacking and younger doctors will get that. And they are doing that more and more. I don't have to remind your listeners this, that more than, it's actually a little bit more than half of doctors now in training are women as opposed to men, and women in medicine, not to say they can't be full-fledged all in. But we see more and more women not wanting to work 1.0 full-time jobs because they've put off having kids and then they're going to start their family. And they do want to sit down in that a little bit more.

So we're seeing a lot more employers offering 0.5, 0.6, 0.7 FTE positions because you have to for the workforce, especially the women, but even for men. So there's a lot of opportunities that exist in the workforce now to do this job stacking. And that all comes back to your concept that you said, multiple income sources.

So now if you roll back to what I did 10 years ago, I developed multiple income sources and income channels out of the work that I had been doing, that was one source. So what I did was I monetized my clinic work. I monetized what I was doing in the hospital. I monetized my call. I monetized my unassigned hospital newborn call, my unassigned obstetrical call, because those are different nuances when you're covering your own practice and when you're covering the hospital's service, so to speak. And so all of those things got monetized.

I monetized my sports medicine work. I've been the local team physician for the high school for years and oversaw athletic trainers. I monetized the nursing homework that I was doing. And then I began to diversify my income channels through things outside of the hospital's control, okay, including real estate, right? So I'm medical office building. Remember you heard me say I started the medical office building and began to receive income related to the medical office building.

And we really just began to diversify other real estate related elements and other income sources that at the end led to about, all said and done, probably 8 to 10 income sources that were all contributing to my household benefit that was beyond just the one that I had when I was traditionally employed. And that diversification is number one, empowering, but number two, it's also a better way to grow your financial footprint and your financial health because you're going to grow more wealth that way.

John: Excellent. Wow. That's a lot.

Dr. Tod Stillson: That's a lot. I know. I know it's a lot. I'm sorry. No, it is.

John: I'm probably going to, we're going to run out of time here in a minute. I do have one more question I want your opinion on, although you may not be an expert because I'm going to ask you about something I don't think you've ever done, but when you do talk to people in one of the options that some physicians have come up with to say, I want to do my practice in a completely different way. So I'm going to do some kind of cash only practice.

I'm going to do a DPC. I'm going to do this, that, do you have an opinion about just the pros and cons of that model versus doing what you're describing? Is there such a thing as a combination? I don't know.

Dr. Tod Stillson: Well, they're kind of, anything's possible nowadays. So I can say that it'd be tough because of the non-compete part to do a combination. But here's what I would say is number one, employment light is hybrid. So it's like having your foot in both doors, like a private practice and a hospital employee altogether. So it's a hybrid model, if you will.

And I found there to be some great strength and benefit for that. I can see though, that there is great, one of my best friends and my former practice partners here in my local community has a direct primary care model in our local community. So when all that went down to over a decade ago, he left, he went to work for basically a bank, became their little contracted family doctor in the bank, big bank. Okay.

John: Corporate medicine, huh?

Dr. Tod Stillson: Yeah. Corporate med. He went and did a little corporate medicine in a different way, but he got away from the thumb of the hospital. And then he eventually came back into the community and started a direct primary care practice. And he's been wildly successful at that. And I know he's a good friend. I talk to him regularly and I support everything he's doing, even though you kind of, in one level, we might be, "competing" with one another. We're not. But I love that model.

I think for patients, it's a tremendous winner. I think for doctors, it's a tremendous winner. I think that there's huge amount of space and opportunity for direct primary care and kind of going, I call it going off the grid medicine where you're just doing cash only. And I think this is a great place for that. It's not going to be the right thing for every doctor, but it fits into this idea of what I, and it's really what I encourage doctors to think about is micro corporations. So back in the day, John, we would think about medicine fit into one or two boxes, A, private practice.

You ran a business, you had HR, employees, lab, building, a lot of things about running a business versus the other end of the spectrum, being an employee where they ran the business and they just gave you a paycheck. I mean, and that was the two models that have existed for about 20 to 30 years, mostly.

Now we're seeing this growing space of cash only practices. Fantastic. Love to see that. Micro corporations, which is what in some regards what I did. I mean, I'm a little small corporation who has, well, two employees, myself, my wife's my bookkeeper. So there's some reasons that we benefit from having her being a bookkeeper in that. But really only person I have to manage is myself. So that's a micro corporation, and really direct primary care is oftentimes similar version of that, right?

A direct primary care clinic might have their own building. But there's usually going to be one doctor, maybe a nurse, maybe a receptionist, it's very lean. It's that almost again, lean versions of private practice is what direct primary care is in some regards. But I'd also say in this world that we're in, John, for doctors, there's also, and this is one of the courses I teach and people can get on my website to check it out. It's called the practice without walls, how to create a practice without walls, because that's the emerging space that a lot of doctors are inspired to do. And that is exactly what I have done.

Incorporate yourself and then contract out your professional services to anywhere in the world who virtually needs your professional services. So telehealth would be a classic example of that. And so, you can be doing telehealth and while you're living in California here in the Midwest, right, you can do that from anywhere you want in the world. And this practice without walls concept is just growing significantly. Think about Hims & Hers and there's doctors behind the scenes who are filling those prescriptions. Has to be a doctor behind the scenes, right?

John: Yes, exactly.

Dr. Tod Stillson: And so those doctors are working virtually somewhat in a telehealth model, doing that, easy money, easy work for them, so to speak. All right. So there are all sorts of ways that doctors can do location independent work. You had mentioned, I think even before we got online here, that you're still an administrator with the urgent care company that you've been working with. So that to a large extent, location independent work, right? So you don't have to be there. You can do that from your home. That's your professional work, both clinical and non-clinical that doctors can do a whole lot of that.

There's legal work, there's administrative work, just a massive amount of things that doctors can do that isn't just in that traditional private practice model. Okay. So the world is our oyster. There's a lot of options and I like to just inspire and encourage doctors to look at all options rather than just blindly following the herd into traditional employment and saying, this is my lot in life. Because quite honestly, that's a miserable lot to be in nowadays.

John: For sure. For sure. Well, I think you mentioned earlier, we're going to end in a minute here, but I think you mentioned your son is in training. Has he figured out what he's going to land in when he's all done?

Dr. Tod Stillson: Oh, I literally just talked to him today and I said, "John, have you figured out yet what you want to do?" And he loves medicine, and he gets that from his dad. I love medicine. In a family medicine, there's just so many options, right? So he's still trying to figure out how he wants to land the plane, whether he wants to do direct primary care, he might do some emergency medicine too. Even today he's like, "Dad, I might just take a year. We might go out to California." Because his wife's from Alabama and they're having their first child. They're going to end up in Alabama. Let me just put it that way. I know that.

But he's like, "We might take a year when it's easy to travel and go out to California, go somewhere we want to be and just work." Again, he's a good example, creating the lifestyle that you want and then working backwards to do whatever work supports that work. And in family medicine, John, you and I know, you can go a thousand different directions when it comes to the work you want to do.

And so he's got options. I don't know where he's going to land and what he's going to do, but I can tell you this much, he's going to be a great doctor. He's a great young man. I love him. I have five children. I love all five of my children, but he's going to be a good young doctor. A lot of the things I teach, I've shared with him one-on-one and he gets it. And so he's well-equipped. He's already started his own corporation. He's using it for moonlighting while he is in residency.

And so he's doing, like I told you, he's doing what I would have told my younger self to do so that he can thrive in the marketplace. And I really have a, in fact, one of the free eBooks that I have online is 20 reasons every resident should start a corporation during their residency. I feel strongly that if a resident can enter the marketplace by saying to the marketplace, I'm a business, I'm a micro corporation, and I want to be identified as a micro corporation, not as a traditional employee, when they enter the marketplace, that's the key spot because once you get started, even 3 to 5 or 10 years in, just because of the forces of physics, it's hard to make a change.

Okay. It's true. But if you can start out at the beginning by understanding and empowering yourself in that way, you'll likely stay in that space and really learn from it.

John: Okay. Well, I think that if your son was already in practice, the advice you just gave would be just as good. And the reason I say that is because listeners, that's your advice. Look at these things and choose an option and check it out and see if you can make things better for yourself. Tell us again, the website, the name of the book, where we can get all that stuff before we let you go.

Dr. Tod Stillson: So simplimd.com, S-I-M-P-L-I-M-D.com. And my book is Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy. You can get that on Amazon. I have lots of free and paid resources on my website. Listen, John, this is my passion project. I retired after 30 years in the clinic and I'm doing this as a passion project, as well as a very novel telehealth business I'm going to be getting off the ground in the next three months that's going to be really cool for doctors.

Think of Hims & Hers in the form of acute infections for the world to be treated in. As a family doctor, we're experts in acute infectious treatment, right? So I'm starting a site to work on that. But I love medicine. I love our tribe in medicine. And my passion and my retirement is semi-retirement, I would call it, my wife would agree, is to help our tribe and help our world be a better place than it currently exists.

And the system is rigged and broken right now. We've got to make changes. And I'm going to keep shouting it from the mountaintops. There are alternatives. There's a better place for us to land. And I want to see us all end up in win-win relationships.

John: Bravo. I'm glad to hear that. And I think if we have more people like you pushing it and sharing and educating, we'll get there eventually. So thanks, Tod, for being here today. I really appreciate it. I've learned a lot. And I think the listeners have too.

Dr. Tod Stillson: And John, thank you for your seven years plus of doing this show and really making a difference in the world. I realize sometimes it feels like, kind of feel like you're in an echo chamber sometime. But the reality is you're making a difference one person at a time. And it's a great effort that you're making. And I appreciate you inviting me to be a part of this. It's a kind of join arms to help people.

John: Yeah. Well, I appreciate that. Thanks a lot. Bye now.

Dr. Tod Stillson: Bye-bye.

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The post More On The Benefits of a Professional Corporation appeared first on NonClinical Physicians.

In this podcast episode, Dr. Tod Stillson describes how to win as a micro-corporation. For the past 10 years, Tod has been working under a professional services contract, rather than as a direct employee, providing him with greater autonomy and income.

Dr. Stillson shares his journey from a traditionally employed physician to an independent contractor. In this revealing interview, Tod introduces the concept of employment light and explains how doctors can negotiate better contracts with their current employers.

Our Sponsor

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

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

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

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Rise of Corporate Medicine and Its Impact on Physicians

Corporate control of healthcare has led to decreased autonomy and increased burnout among physicians. Tod describes how arbitrary compensation caps and a lack of understanding from administrators have contributed to this problem.

He emphasizes the need for doctors to stand up for themselves and take control of their professional lives. And he describes the simple change he made to accomplish that goal.

Empowering Physicians to Win as a Micro-Corporation

Recognizing the lack of business education in medical training, Dr. Stillson created SimpliMD, a resource for doctors to improve their business acumen. He emphasizes the importance of understanding:

• The true value doctors bring to healthcare systems, including downstream revenue,
• How to negotiate fair compensation based on productivity, and,
• The power of business knowledge in preserving professional and personal autonomy.

Summary

In Part 1 of this two-part episode, Dr. Tod Stillson offers valuable insights for physicians looking to regain control of their careers and achieve a better work-life balance. Dr. Stillson's experience and resources provide a roadmap for doctors to navigate the complex world of healthcare employment and find success on their own terms.

Part 2 of this conversation follows in the next episode of the Physician Nonclinical Careers Podcast.

Links for today's episode:

• Dr. Tod Stillson's Website SimpliMD.com
• Free Subscription: Subscribe to the SimpliMD Blog.
• Dr. Tod Stillson's Book: Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy
• Employment Lite: Check out our Employment Lite landing page on why this hybrid model of employment and private practice is so appealing to many doctors.
• Free E-Books: Choose from a large menu of free E-Books that support your micro-business journey as a self-employed doctor.
• Professional Business Network: Our vetted and preferred network of small business professionals and resources that will support your professional micro-corporation journey.
• How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256
• Check out the 2024 Nonclinical Career Summit to learn about MORE unconventional career options.

Paid Resources from SimpliMD:

• $199 Course: Creating A Practice Without Walls.
• $99 Consultation: 1:1 Micro-Business Consultation.
• $500 Micro-Corporation Start: A Business Consultation + Connection to Legal Professionals to Start Your Professional Micro-Corporation.
• $99 ($10 for residents) SimpliMD Membership: Join our community of self-employed doctors and receive exclusive perks for members only
• $2000 SimpliMD Coaching: 1:1 holistic coaching with a small business focus.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 374

Now Every Doctor Can Win As a Micro-Corporation

- Interview with Dr. Tod Stillson

John: All right, NonClinical nation. I think today's interview might potentially change your lives. Our guest today is going to explain how he was able to work in a fulfilling medical practice as a pseudo-employee while maintaining his professional autonomy and earning a much higher income. That seems like nirvana to me. So let's welcome Dr. Tod Stillson to the podcast. Hi, Tod.

Dr. Tod Stillson: Hey, John. It's great to be with you and I'm excited to share my journey with your listeners.

John: Yeah, I'm excited to hear this story from the horse's mouth, so to say. I mean, I've read about you and looked at some of the things you've done online, and this just sounds like an exciting option for some of the people out there that are unhappy in their practices.

Dr. Tod Stillson: It is one of many options that exist, and I tell you the beautiful thing about the marketplace today is although corporations strongly control it, there are lots of new developments happening for doctors to regain their autonomy and not feel like they have to end up as a corporate employee, or really what I call a high-paid factory worker, okay?

John: Yeah, that's definitely what it feels like. I mean, that's what I hear constantly. In lack of autonomy and overwork, they don't understand what a physician does.

Dr. Tod Stillson: Oh, yeah, 100%.

John: It's going to lead to the demise of the profession unless we do something.

Dr. Tod Stillson: John, you and I trained at similar times and have similar experiences as family doctors, and you're exactly right. It's the undermining of the professionalization of our great work as doctors that all doctors across the country do, but it has been eroded. I'm a fan for doctors standing up and saying, that's enough. Let's take control of this ourselves.

John: Awesome. Yeah. Well, tell us a little bit about your background and the mission that you have to educate physicians on how you have found a way to make things better, even if you're, "employed by a hospital system."

Dr. Tod Stillson: Yeah, and I'll tell you the short story, and then we can get into more details later if you want, but I grew up in the Midwest and did my training in Indiana and went out to Virginia to do my residency in family medicine as well as surgical obstetrics. Came back to Indiana and worked here basically in a primary care clinic in rural Indiana for nearly 30 years. And when I came back to this area to begin working, there was the opportunity to work as an employee of a hospital and really just receive a paycheck for it.

And this is way back in the day when it felt like everybody was in a win-win relationship, right? Where you were given a fair compensation. They still gave you a lot of autonomy in the practice. And as long as you know your downstream was good and everybody's working well, everybody wins. And it was very somewhat simple, but really great. Over time, though, as you know, the corporization of America really came into play. And even our little rural hospital began to lose its autonomy to a larger health system that began to take more control and try and crank out more money and in the process remove more and more.

It's the same script that we've heard from doctors all over the country, right? This just happens and happens and happens. And over time, for me, what happened was because I was a full-service family doctor, meaning I did inpatient care, newborn care, OB care, surgical OB, I really did everything in the hospital, okay? We were busy. I mean, in a rural place, any of those doctors out there that work in rural places you know back in the day, especially, you could be very, very busy. Consequently, I earned a lot of RVUs.

And I mean, I really cranked out a lot of money, if you will, and was paid fairly for it at the time for the hospital myself. They really still came out ahead because of the downstream, okay? But nonetheless, the hospital system that owned them came in and began looking at some of our rural family doctors' pay compared to the city people that were working. And they're like you guys are making a lot more money, and that just doesn't seem right. We're going to kind of level the playing field and we're going to put a ceiling on how much you can earn. Arbitrarily.

John: It sounds like my CFO when I was CMO of the hospital, you know?

Dr. Tod Stillson: Okay. Yeah, makes sense to them, right? Put a ceiling on this. How could a family doctor make that much money, right? And so, I'm like, all of us are like, "Wait a second, what are you talking about? We work hard for our community and for the sake of our hospital, and you want to just give us a pay cut and expect us to go, 'Oh, thank you very much. That's okay.'" So, the long and short of it is, as all these things kind of get dragged out, as they often do, our group of about eight doctors, we saw five of them leave, basically, over a year's time. They're like, "I'm not staying around for this." This left about three of us holding the balls up in the air, meaning we were working harder and doing more work, but still the ceiling loomed.

And eventually, we were just like, what are we going to do? Do we want to go out into private practice together here? Because none of us wanted to move. Do we want to just say, okay, thank you very much. I'll accept this contract or something else. I was wise enough to know, like most doctors are, I was business illiterate and also relatively financially illiterate. So one of the greatest moves I've made in my life was I reached out to some business consultants in healthcare and said, "Hey, this is the situation. What would you recommend to me to do?" And in the process, they unfolded this employment light concept to me that was newer and just coming out and people were using it in the marketplace.

And they proposed that model to me to take back to the institution I was working for. And lo and behold, because I was in a bit of a position of power, because I had a lot of patients, but number two, fortunately, my contract did not have a non-compete in it. And so, they knew that I had some power to take my 5,000 plus patients to any healthcare company that wanted a contract with me. And so, they were somewhat incentivized in that moment in time to say, "That's a good thought to make you an independent contractor that looks like you're an employee still, but really you're an independent contractor." And that's what employment light is.

And they agreed to that while I was in it and while the moment was in my favor, my business consultants also recommended you might consider purchasing a medical office building and having them lease it from you, wisely said and wisely done, they agreed to that. And so, and then really beyond that, I then negotiated an employment light agreement that is basically productivity-based, so compensation-based. If you remember, they wanted to have a ceiling for that productivity. But that was, here's the seat, that was for their traditional employees, their traditional employees they control, right?

Independent contractors, they have the freedom and liberty to form individual contracts. And so, I could then say, this is what the MGMA data is for what a family doctor in a rural area is doing. This is what I should be paid as work RVUs for that. And they agreed to it because they weren't forced to comply with the corporate employee model. Now, I have an individual one-on-one contract that quite honestly, John, I wasn't asking to be paid more than I was worth. I was just being asked, I was asking to be paid for what I was worth.

And they agreed to all that. And so, the long and short of that was the rest is history. That was over a decade ago. I've loved every minute of that decision. And that's led me to SimpliMD because that experience and my wonderful experience of seeing how that revitalized my professional autonomy is the message I have to doctors all over the country. This is possible. You can do this. It's not visible. It's not seen. Employers are not telling people about it, but it's possible. And that's the story I have.

John: That's awesome. Let me ask you a couple of questions that pop into my mind. And as I said as a CMO, I was sometimes, actually, I was doing a lot of the negotiating for contracts. And that was the thing, the contracts need to be somewhat consistent.

Dr. Tod Stillson: Sure they do.

John: But I think I've heard you speak in other settings about sometimes even given that if you're really producing a lot of RVUs because you're doing certain things that maybe the other doctors aren't, they want to put that cap on what you mentioned earlier.

Dr. Tod Stillson: That's correct.

John: So I guess my two questions, did you still somehow have any kind of a cap that affected you once you had made this change number one? And how do you avoid burnout? Because there's still the incentive, I think, is to work your tail off in a way. Maybe that's two questions.

Dr. Tod Stillson: That's a fair question. Spoken like a true doctor about the burnout side. So number one, I had no ceiling in it. And so I negotiated that in the contract, no ceiling. And in fact, I normally, and it's called the professional services agreement. You know that from being a CMO. By the way, for your listeners, professional service agreements are traditionally where locums are seated. Okay. If you want to think of it in a simple way, that's often what locums do, that's contracted labor, and that's often called the professional services agreement.

Employment light that I'm talking about, in my experience, is also a services agreement. So that's the big box that it goes into. And in my professional services agreement, it's a three-year agreement that renews. But we renegotiate at the end of every three years. And I had an elevator for my work RVUs in it as well. So I didn't just get paid a dollar value per work RVU per year. Each year that went up. Okay. And so because, right, because we have issues like we're all experiencing right now, inflation, right? So numbers tend to rise. And if you keep it static, you're going to end up on the backside of that. And a lot of physicians don't understand how that works.

So anyhow, I had that built into mine and there was no ceiling, and it was just fair compensation for the work that I was doing. Now, I will tell you this much, the moment that I turned that on and began doing the same number of work RVUs I'd been doing the prior year, I made a couple hundred thousand dollars more. I mean, literally apples, apples, not doing more work, not doing anything more, literally just being paid fairly, it led to a couple hundred thousand dollars difference in pay annually.

Now, to answer your second question though is, is there some challenges with that that you get into when it comes to, do you sometimes incentivize yourself to work harder than you need to, right? And I think any self-employed doctor, especially if you've ever been in private practice or ran your own practice in any way will ask themselves that question. And you have to guard yourself from going into that rabbit hole.

All right. Do the work you enjoy, do it at a pace you enjoy, do to the rhythm you enjoy, meet the expected requirements that that pseudo employer has for you, if you will, at least be a mid-level performer, if you will. And let it fall from there. I took five weeks of vacation every year. Okay. And by the way, in the model that I worked in, today's where people always talk about pay time off, right? PTO, all that business. Nope. In my model, when I was working, I got paid.

If I wasn't working, I didn't get paid. And I know what that opportunity cost was for me. If I took a week off, it was going to cost me about $14,000 of income. Just that's what it was. But you know what, for my own sense of well-being and my own sense of sustainability in it, it was very important to take that time off because indeed, I was a high-performing doctor, did a lot of obstetrics and was available a lot. But that was a rhythm and pace that I enjoyed. So your listeners, if you do get engaged in a contract like this, you definitely want to guard yourself from overworking because you're sort of incentivized by that carrot. Find that sweet spot, so to speak.

John: I'm going to have a series of questions here now to put you on the spot. But because I'm going to do that, I want to early in this game here, remind our listeners that you do teach other people how to do this in a variety of ways. And so tell us about, before I get into my laundry list, SimpliMD and everything you're doing to help physicians learn more about this.

Dr. Tod Stillson: Yeah, I'm glad to do that, John. One of the fundamental problems in my story that you heard was I had business illiteracy. Most of us go through our medical training and unfortunately, there's not a lot of financial or business literacy that exists, right? Now, we have a lot of organizations that have been populated out there for doctors to become financially literate, and it's for doctors, things like White Coat Investor, et cetera, that are really nice resources that are filling some gaps that exist in helping physicians. And I love that that's happening.

The reality, though, is there's not a lot of business or micro-business resources like that for doctors. And so I chose to develop SimpliMD as a micro-business competency website that would help doctors flourish and thrive by understanding their business powers and really understanding that doctors are a business individually. And so I have a whole bunch of resources and assets from courses, to consultations, to coaching, to free eBooks that can be found at simplimd.com, and that's spelled S-I-M-P-L-I-M-D.com. And so your listeners are more than welcome to go to that, take a look at the various products that exist.

They can look at the header and find everything. I love helping doctors. I just love helping them learn from what I've discovered and learning how to thrive through the preservation of their professional and personal autonomy. So it's a really powerful idea. And I can tell you at SimpliMD, I don't want to go too far around this rabbit hole, but pretty much the system is rigged against doctors. Yeah, I don't know if you know this yet or not, okay?

John: Yeah, it is, pretty much.

Dr. Tod Stillson: Systems rigged against doctors, okay? And it's because the corporatization of medicine has really stolen that autonomy we have. And then they funnel us all into W-2 workers, right? And then the federal government, who's the other force at play here, they love hiring doctors, hiring taxpayers like doctors who are W-2 employees, because they got no place to turn, right? And that we literally are the targets that they are looking at and saying, oh, you guys are the ones that make a lot of money. We're going to be happy to take all that from you as a W-2 earner.

And so there's not a doctor I don't talk to that doesn't say taxes are killing me. They're horrible. So whether it be burnout or taxes, doctors are having all of this erode that deep sense of when you and I became doctors. We're like, you know what? I don't need to be a gazillionaire, but I certainly look forward to the good life of a doctor, where I have some professional autonomy, where I have some personal autonomy, where I can make a good living and not feel like I'm being picked apart day by day. That's what doctors are looking for.

In today's world, there's so many forces that push back against them. And what SimpliMD is about, and some of the work you're doing I know as well, John, is all about re-empowering doctors in the marketplace to say you don't have to give into those two things. And there is a different path and a different space you can go into. That's what I talk about at SimpliMD.

John: A couple of things I wanted to say. First of all, reflecting again back to the day when I was working at the hospital as an executive the CMO, well, not CMO, the CFO, the CEO, the COO, they're going to want to get out as much as they can from their physicians. They want them to be productive. They want a bottom line. They're driven by that. And they actually, they really do not understand a physician's life. I mean, I actually had to do a lecture for the team explaining to them that when we go home at five o'clock, if we go home at 5:00, that's not the end of our day.

Dr. Tod Stillson: That's correct.

John: We could be busy doing records and answering phone calls, being on call, coming back, going to the nursing home, so many other things. And they just, they don't get it.

Dr. Tod Stillson: No, they don't.

John: So when you were talking about that, it really rang true for me.

Dr. Tod Stillson: Yeah. So there's two things to keep in mind and you understand this as a CMO. Number one, what the work you do in the clinic or face-to-face with patients, your professional services, so to speak, that's just a little, that's a small part of the bucket of what that hospital system is really looking at. They're really looking at the downstream revenue of what your work produces and it's the churn. In business world, we call that the churn, right? The churn of what you produce for them and every doctor who's in an employee situation, you need to know what your churn is. That is exactly what the real value is to your health system to them. And that is that downstream revenue.

Spoiler alert, that's usually worth anywhere from $2 to $5 million, depending on your specialty per doctor. Now translate that $2 to $5 million churn that you're creating for them, not just seeing patients in the clinic, but the whole churn and they're micromanaging every click of the mouse that you have in that clinic space and all the while are making a whole bunch of money on that churn that exists for you downstream. That's what burns out doctors. And that's where you begin to feel undervalued, uncared for, and misunderstood.

So understanding that you do have a downstream revenue beyond what you're doing in the clinic is an important part of the business model that when you become an employee, you're engaged in. And you're exactly right. The administrators don't fully respect and understand what it's like to live under that microscope that you are churning out for them and the difficulties and challenges of it, because they're really looking at you as a number on the spreadsheet.

You're an impersonal number on the spreadsheet. And here's how it looks. Physician labor, expense, period. Okay. That's your salary plus your benefits and anything else that you're doing to create money, to make the system pay for you. Okay? And then the, what you're doing in the clinic plus the downstream revenue. And that's the equation. And you need to understand the dynamics of how those things interplay and the power you have as a doctor to stand up for yourself and say, wait a second, you're undervaluing me and you're underpaying me.

John: Yeah. Now, the other thing I wanted to mention before we move on to my next question is that I did look thoroughly at your website and I felt like I was in a YouTube thing because, not because there's all videos, really, it's a lot of blogs, but the titles and the questions you're answering there are so damn interesting. You know, it's like, damn, I wish I knew that 10 years ago. Damn, I wish I knew that when I was in practice. So I mean, there's a ton of free information and it really gets to all these issues and it addresses maybe some of the questions I'm going to continue to ask you here in a minute, but I really recommend people go and check that out.

Dr. Tod Stillson: And I appreciate that, John. And I will say, I'm so thankful you said that, because to be honest, I created that website and that business with just that in mind. What would my younger self like to know and what can I communicate and share with the rest of my physician tribe that the younger version of myself, now I'm 30 years into practice and so forth, that I wish I would have known.

And part of that, John, and I really write about this in my book, Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy. That book was written, a little bit of my website was written with my son in mind. He's currently a third year family medicine resident in Dallas, Fort Worth with John Paul Smith Residency Program. I just was thinking, and it's really what inspired all of those, what's the best advice I can give my son to thrive in the marketplace? And all of that really somewhat began to inspire the whole work that I did with the book, SimpliMD. So intentionally, you're right. That's exactly for the viewpoint that I write those, getting those resources that can make their life better, if I would have known that 10 years ago or earlier.

John: All right. I'm glad you did it.

Dr. Tod Stillson: Yeah, thanks.

John: That's very interesting. And even though I'm never going to be practicing again, once I fully retire. Okay, here's a question. You're in the setting as a physician of being employed, you're subject to all these issues, you're burned out or what have you. I can imagine that it's not necessarily an easy conversation to say, okay, guys, I don't want you to get worried that I want to leave. I don't want to leave, but I don't want to be employed by you anymore. And I don't want to go into private practice. So I have this idea. So you help people work through that I think.

Dr. Tod Stillson: I have.

John: How do you approach that?

Dr. Tod Stillson: So there's a couple of things about it. This is important for your listeners to know. Number one, a professional services agreement and employment light, virtually every hospital knows about it. And here's why they know about it. That's because this is the pathway and the bridge they use to bring private practice doctors into their safe harbor. This is the same pathway they use. They use it virtually every year, all the time. And it's that bridge, but they want to make it a one-way bridge. They kind of want to go, well, this is what we do to engage private practice doctors to come in and become employed doctors. And this is the pathway for it.

But if you're already employed with them, it's like they've got this big kind of bar in front of them and go, you can't go the other direction with this. The reality is that they know about his existence, but it's in what I call the hidden drawer. Let me just use a real Midwestern analogy with you. I like going to the dairy queen. We've got a great dairy queen in our little community. And the day went that my wife and I went to the dairy queen and we both are going to order peanut buster parfaits. And so I order peanut buster buffet with the fudge and all that stuff was really good.

And my wife got up and she said, "I want the peanut buster parfait, but I want peanut sauce substituted for the chocolate." Okay. And I looked at her, I'm like, "Well, that's not on the menu." And she's like, "Oh, but it's on the secret menu. You have to ask for it. And as soon as she said it, they just like, "Okay, we can do it." Well, secret menus exist in all restaurants just as an FYI. Okay. But number two, secret menus exist for all employment contracts.

And the first drawer that they're going to pull out for you is the boiler plate traditional employment contract for every doctor. That's what they're going to go first. And they're going to make you think that is your option. And you have to have enough savvy to say, number one, you know there's some other contracts in your drawer there that we could also talk about. And my preference is to be considered an independent contractor, not an employee. So you have to have the business awareness and your own self-awareness to say that.

Now, if you're a doctor who's been traditionally employed and then your contract's coming up for renewal, or you want to have a conversation with your CMO, again, you got to have the awareness that this is one of the contracts that you would potentially talk about transitioning to. You're like, and here's how I coach doctors to say it. And this is exactly how I said it to my CMO.

I said, "Look, I like wearing our team jersey. I'm all for wearing our team jersey. I want to see our organization succeed, but I want to do it in a little bit different way than what we've been doing it before as a traditional employee. And I think we can do this in a win-win relationship where I'm an independent contractor that still does all the same work, still produces all the same downstream, still gets all the fair compensation from you. But what I gain from that, Mr. CMO, is A, a little more professional autonomy, and then B, an amazing amount of tax efficiency. I have now added a whole bunch of tax tools to my kit that I no longer am targeted as a just a sole W-2 employee. Now I can save 10% to 15% of my income, which for a doctor is a lot of income annually, in that model.

So guess what, Mr. CMO? I want to see you guys win. I want to see me win, and we can do this in a cost-neutral way so that everybody wins. How about it? Let's have a conversation, talk about this, and let's pull that secret menu contract out of your drawer, and let's talk through this." And honestly, it's that simple. Now, there's a couple of caveats here I want to bring forth to your listeners, John.

Number one, to be considered an independent contractor, you can't have that hospital work that you're doing as your sole contract, okay? Because the IRS is going to look at the hospital as like, hey, you're just trying to avoid FICA tax by employing this person as a contractor rather than as an employee, and they get a lot of penalties, and that's where hospitals get really uptight about these things, right? So they're like, wWell, we can't do that because we could get in trouble from the feds," and dah, dah, dah, dah, dah.

So it's very simple, right? How many doctors do you know that don't do some side hustle of some type? I mean, gosh, the studies show 40% to 50% of doctors do. I mean, it's very common. But to be considered an independent contractor, you'd want to have that primary contract and then a job stack, a secondary work that you do as an independent contractor. It could be nursing home assistant director.

It could be taking call. It could be doing telehealth. It could be, in today's world where there's physician jobs that are location independent, like gobs of them, there's all sorts of things you can do. And it's really not so much about the amount of money that you're making in those independent positions. It's that you're doing it. So in other words, you can demonstrate to the IRS and to the employer that you indeed are doing more than one job, okay?

That's the definition of an independent contractor, all right, you're doing more than one job. So that's an important caveat, but it all begins with you going to your superior and saying, "I'm interested in a win-win conversation, okay? This is not me against you. This is not me getting away from you. This is about us doing this together.

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The post Now Every Doctor Can Win As a Micro-Corporation appeared first on NonClinical Physicians.

In this podcast episode, we learn more on how to publish a book and promote your business, in Part 2 of our interview with Dr. Debra Blaine.

Dr. Blaine, a former physician turned full-time author, continues to share her insights on the writing and self-publishing process.

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

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

For Podcast Listeners

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Overcoming Writer's Block and Setting Realistic Goals

Dr. Blaine emphasizes the importance of manageable writing goals, suggesting that aspiring authors shouldn't feel pressured to write a 300-page book immediately. She recommends breaking the writing process into smaller, less overwhelming pieces.

Dr. Blaine also shares tips on crafting engaging openings and maintaining reader interest throughout a book, including using “hooks” at the beginning of chapters and “cliffhangers” at the end.

Practical Writing Tips from a Seasoned Author

Dr. Blaine offers practical advice for aspiring writers, including keeping detailed notes on characters and plot points. She discusses her current projects, including a guide on the elements of fiction writing and a new trilogy.

Debra emphasizes the value of consistent writing habits, suggesting that authors find a routine that works for them, whether it's writing every morning or setting aside specific times during the week.

Summary

To learn more or connect with Dr. Blaine, you can visit her website, allthingswriting.com, email her at db@allthingswriting.com, or find her on LinkedIn. Debra's books are available on her website and at Amazon, and she offers a free novella titled Deadly Algorithm through her website, providing an excellent introduction to her writing style and themes.

Links for today's episode:

• Dr. Debra Blaine's Website: All Things Writing
• Debra's book on self-publishing, The WriteR Stuff: Step-by-Step Guide to Self-Publishing and Worldwide Distribution
• Debra's latest book on writing a novel: The WriteR Stuff: Secret Sauce of Writing Fiction
• For an example of Debra's writing download a free copy of Deadly Algorithm
• Vellum, the software Debra uses to write her books (this is an affiliate link)
• Debra's LinkedIn Page
• Part 1 on How to Publish a Book and Promote Your Business
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

If you liked today’s episode, please tell your friends about it and SHARE it on Facebook, Twitter, and LinkedIn.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 373

Part 2 - More on How to Publish a Book

John: The question is when you're doing the coaching and people need help, you said it was the creative side.

Dr. Debra Blaine: It's the creative side, and feeling overwhelmed. A lot of them thinking I can't write a whole book. And so, the first thing is you don't need to write a whole book. Nobody eats a slice of pizza in one bite. You write a piece of the book and it doesn't have to be a 300 page book. It can be a 100 page book. It could be an 80 page book. You can sort of figure it out so that you don't overwhelm yourself. That and getting organized, helping them to organize.

John: Okay. I'm not going to jump into writing the memoir of my entire family, my nine siblings and all of their families and my parents and aunts and uncles and everything in over a span of 80 years or something. No, I'll remember not to do that for sure.

But I did notice recently, and I don't know if it was, I was reading a book or watching a movie or both was that I need something to get me interested in the first page. Like you said, if there's something happening right now, you just into it, you have no idea who you're reading about, what their motivation is, what's going on, except something is happening. That's a good way to get me at least interested in the book.

Dr. Debra Blaine: Yeah, and that's called the hook. And not only do you want your title to represent the book and be a little bit of a hook, your metadata, the book description, that first line that says what the book is about, that's got to be a hook. But then when you start your first paragraph should be a hook. One of the things that a lot of new authors do, in particular, is they start off the book with it was the best of times, it was the worst of times, which is great, because they had a longer attention span back then. But when I write a book, a lot of times when I consult with my author clients, I have them jump into a scene, it's already happening around you. It doesn't have to be the main character. But what is the emotional stress on this character? And why? And so, immediately, who is the person? What is the conflict? Why do we care?

And so, not everybody's going to love every book, right? But for those who are going to be your readers, they're going to eat that up. And then they're going to keep going. And at the end of every chapter, you don't want to leave the end of the chapter, "Okay, and she went to bed feeling much better." Chapter three. I can put that down and I forgot to pick that up. Oh, three months later. She went to bed, but the question was still in her mind of what happened to whatever, fill in the blank. You always want to end the chapter with a little bit of a hook that makes the reader want, I don't want to see what's happening and turn that page.

John: Isn't that how soap operas do it? There's a cliffhanger at the end of each episode. And so you'll come back next week.

Dr. Debra Blaine: Yeah, exactly. Right.

John: Something like that. Yeah. I don't know, when you get older, it seems like time is going faster. This is totally off the wall, but I just mentioned when I'm reading a book, each chapter towards the end seems to go faster than the ones that were the first half of the book. Is that just my imagination?

Dr. Debra Blaine: Well, it could be. In my books I tend to write short chapters, although this trilogy that I'm writing, I've noticed that the chapters are longer, but it depends. Some authors write shorter chapters. Take a look, look at the old books, the days of your, and if the chapter was 25 pages, and then this one is only five pages, well, then it's not you.

John: I see, they're manipulating me. Okay. I was going to ask you about some lessons you've learned that want to make sure prospective writers or current writers might learn from to make things a little easier for them if they decide to do this kind of thing.

Dr. Debra Blaine: I didn't know anything about really book writing when I started. I had this story to tell and I mixed it in. I had the story to tell about what's happening in healthcare, but I mixed it in with this medical thriller about people hacking into our EMRs and extorting money and killing the patients. I didn't have a sense of... I read a lot when I was a kid. I kind of understood instinctively the arc of a story and that I wanted my characters to be really interesting people and what makes somebody interesting. They learn things about themselves, but there were so many things I didn't understand. And even though I worked with a mentor for a year and he helped me tremendously. I used to say that I got my master's from Rich Cravolin because he used to be a professor at the University of Southern California, but he didn't send me a certificate. But there's so much more, I guess the PhD version. There's so much more.

I love that you're familiar with my books. I wrote Undo Influences and then I wrote Beyond The Pillars of Salt. And then I wrote the Meraki Effect and that was followed by the Meraki Nexus. In trying to put those together, what I didn't know then is that a series sells faster. Now, when I was writing my first book, don't talk to me about series. I got this one book and that's all I can handle, but series sell faster. And since in those three books or four books, I kind of used the same characters. I liked the characters. I had developed the characters. I liked what they stood for. There was one that I didn't like too much. So I knocked them off, which is something you can do when you're an author.

But the difference was, is that the first one, Undo Influences is a conspiracy thriller, a government conspiracy political thriller, takes place in 2020. Beyond the Pillars of Salt is sort of a natural progression of what happens to those people and to the world with climate change and dictatorship like government that we seem to be headed for, at least at the time. And so, then that became more of a dystopian. And then like a dystopian is almost by definition, science fiction. And then what did they do? They had to leave planet earth and figured out how to do that, try to make it as realistic as possible. And then they got to planet Meraki. And so, that was a pure science fiction colonization, space opera, whatever.

I tried to put them together. I completely confused the Amazon algorithm. Seriously, it's an algorithm. It learns some things, but it's also kind of stupid. But it's a political, contemporary political thriller, dystopian science fiction, and then pure science fiction. Dystopian fiction, mostly on earth and then science fiction on another planet. And my sales went like through the floor. The things that I didn't realize is, this time I'm writing this trilogy and I'm going to keep it all in one genre and I'm going to write it to market.

The interesting thing is, I know self-published authors. I personally know self-published authors who are five, six, and seven digit authors. And I know of traditionally published authors who are probably five, six, and seven digits or more like James Patterson or somebody who has other people write most of his books now, by the way. But I know these people, I've spoken to these people. They're my coaches. They've told me how to work things. I didn't know this stuff before. And so, it's really helpful.

I've also heard and seen that most writers don't make it big until they've published a number of books. One of our colleagues, Freda McFadden, I'll throw in a plug for her though, not that she needs it. She is a neurologist. She has written, she has completely dominated the top 20 Amazon thrillers for the last six, eight months. She earned so much money from that. I don't know how much exactly, but I can promise you, she's probably in seven digits at this point. But she told me it took her nine years to become an overnight sensation.

John: Right.

Dr. Debra Blaine: She's got like 20 books out. My friend Christina's got 20 books out. A lot of hers are novellas. People do it with novellas too. But the magic number they said is about five or six where you start to see that you really can, because there's so many books out there. And when people buy a book, they want to know if they like it, that the author's written other things because they want to stick with that author.

John: Let me ask you a quick question. In the online world, there's this thing, you've probably heard of it, a thousand true fans. If you have a thousand true fans, whether you're selling photos or you're selling books or whatever, or a podcast or whatever, if you have a thousand true fans, which means they'll buy anything you produce. Have you ever calculated whether that would be sufficient to meet a certain level of success?

Dr. Debra Blaine: Well, you need to sell more than a thousand books.

John: But if you have 10 books out.

Dr. Debra Blaine: If you have 10 books, now you've got 10,000. And if they're true fans and they tell other people. So if you figure the average royalty, if you do it yourself is between... Well, the little guy, it's less because it's a small book. I can charge less because the printing cost, the paper costs and the paper costs has gone up. With an eBook, most of the places, if you self-publish will give you 70% of the profits as opposed to Ingram says they give you 70%, but I never got more than a buck and a half. And whatever their processing fees are.

But let's say you're getting $4 a book and you sell a thousand in a month, then you got $4,000. Once you start selling, that's how my little guy got to be number one and stay there for so long. Because I sold 52 copies in the first week. And when that happens, once it starts selling, then Amazon, the algorithm again, starts saying, "Okay, this book, people like this book", and it starts showing it to random people. Even if they're not the people that heard about it from me from somewhere.

And so, the more popular your book is, this is the way all social media works. When you post something on Instagram, if somebody likes it, that's great. But if they comment on it, then the algorithm thinks, "Oh, people like this", the more people that have commented on it, the more people Instagram will show you or not hate Instagram, I can't really figure it out. But the algorithm part I understand. And it's the same for Facebook, for LinkedIn, for Amazon, for any of these places. The more people are interested, it thinks more people will be interested. And because Amazon wants to sell books, it wants to present the one that seems to be selling so we can make even more money.

John: Right. It behooves us to maybe if we're doing something like that, to get a big bump at the beginning somehow.

Dr. Debra Blaine: Well, that's what I did. Actually when I published this little puppy, I put it up for the first week for 99 cents. And a bunch of people bought it. Now, I don't think 52 people that I presented to bought it. But a lot of other people bought it when it was on sale for 99. So now it's $3.99. But other people bought it. And then it stayed up there for two weeks. It was in the top five.

John: When I want to learn something, it's been a while, but I would just go on to Amazon and look, they have free books and then they have 99 cent books. And so, if I say, well, I want to learn about this, I'm just going to buy the first five of those books for five bucks. And so, there is some motivation there. People are looking for that because they know there's a good chance it's going to have good information. It's not going to usually be garbage or the person wouldn't have taken the time to produce it and get it out.

Dr. Debra Blaine: You'd be surprised. Some things are.

John: But some things are.

Dr. Debra Blaine: The thing with that is Amazon doesn't really want you to put your book up for 99 cents because they don't make any money. What they do is if your eBook is between $2.99 and $9.99, they give you 70% in royalties. There's no printing costs or anything. If it's below $2.99 or if it's above $9.99, they give you 35%. 52 people bought this, but I didn't make any money on it. It was more to get it up there and get it to where it was going to be seen. They each have their and the printing price when you go to put something up when you self-publish it, it's going to tell you as you're in the different stages that you enter it, it's going to tell you, okay, this is your book. This is how many pages it is because it's going to have looked at it before you get to that stage and it'll say the print cost will be, and it can be $2 if it's a tiny book, or it could be $5 or $6, or if it's a hardcover, it's going to be maybe $12 or $14, which is why hardcover books cost more. When you calculate your royalties for a print book, you're going to take the cost of the book. Amazon gets 40% of anything in print. Take the 40% off, then take the cost of printing and subtract that from what's left from your 60% and the rest is yours.

And when you punch it in, you say, okay, I want to charge $8.99 for this book and it'll calculate and say, this is going to be your royalty. I want to charge $12.99. Okay, this is going to be your royalty. I want to charge $4.99 and say, nope, can't do that, it's costing us more to print that. Really, you're not blind to it. You know exactly what you're going to get.

John: All right. Well, I think we're about out of time here. We've covered a lot of things, answered a lot of my questions. All right. Did you already mention what you're working on now?

Dr. Debra Blaine: I'm working on the sister to this guy, which is going to be about how to organize your book. What is a story arc? What is a character arc? How do you develop characters? How do you write convincing dialogue? The basic elements of fiction and applying it. And then I even have one example of taking a story, "Sue found a cat under a bush and took it in." Well, that's a plot, but the whole story arc, I go into this whole thing and what she was feeling when she found it and what happened when she picked it up because it's a scared cat and the vet bill. I created a story arc, but I also use examples from real time, like movies that we know and books that we know. That's that book.

John: I have a question about that.

Dr. Debra Blaine: Yeah.

John: That comes in my head also while you're talking. Do you have to keep a bio on your characters handy, or do you remember everything about how your characters think, what they would do in this situation, that situation, or you just wing it? How do you figure that out?

Dr. Debra Blaine: Great question. No, I can't keep all that on hand. Sometimes I can't even remember the name of what was her husband's name. But what I do is when I write, I have two documents going. I have the book and then I have the notes for the book, kind of like your show notes, maybe. And I list things. First of all, I'll write out the general arc of the story. I'll write out who are the characters and I'll put something about each character. And then when something significant happens, I'll add it. Okay, this woman was actually married to that guy and he did this. And I'll add those things and I save that.

And I do a lot of research when I write my books. Some of it's scientific, some of it medical, some of it physics, whatever. And I'll copy that and put it in too. I have it all so I can go back to it, not just in writing this book, but for the next book. Yeah, I can't remember all that.

John: I would think you'd need some kind of cheat sheet.

Dr. Debra Blaine: Yeah, how do you do that? I don't know anybody who can just sit down and... Maybe Frida can, I don't know.

John: I like to read series. As you mentioned, those are very popular. So I have this Michael Connolly has a series, he's like up to 30 books now. There's no way you could remember the characters, especially when he skips a book or two and then goes back to these old characters.

Dr. Debra Blaine: Right, right. Instead of reading the book again. But the other book I'm working on, which I'm really excited about, because this one it's more of a term paper kind of thing. I just started a trilogy. And did you read? Now I'm not intimidated by the idea of I'm going to write a trilogy because, well, yeah, I've written I've written seven books. Why can't I have a trilogy? So I can write three more. I don't know if you read. I put out a little freebie reader magnet Deadly Algorithm.

John: No, I have not read that. I saw it on your website.

Dr. Debra Blaine: Yeah, I can send you if you're interested. We can put the link in there because it's free if anybody wants it. It does put you on my newsletter, which is something I learned that authors need to have. But in that book, it's a medical thriller and it's got some EMR things and quirks. But what happens in the book is the mother. There's a child, a four year old child that has to be left behind with the dad.

And so, what I'm doing now is it's 12 years later and that child is looking for her mother. And so, this is going to be the quest and the bad guy, the antagonist in in the novella in Deadly Algorithm is basically corporate greed insurance companies, big pharma, they don't want to pay for health care anymore. So there they want people to die. And this particular character, who's the main character of that story, doesn't have any medical problems, but they give her one, a medical problem for which the cure will kill her. And so, why is that happening? And she has to run. Anyway, you can get that in just the blurb about it. So this is not 12 years later.

And now it's going to be where the real bad guy is way bigger than big pharma. And in the first part, the first book is going to be about Jenna searching for her family and what leads her to have to do that. And then ultimately, the population of the earth has been thinning due to climate change and people and too many resources depleted. And where is that going? I don't want to say the end of the book, but it's going to be that she said that that's a cat. She said, No, don't do it. But the bigger antagonist, the bigger evil is going to be way, way bigger. And it's going to have something to do with artificial intelligence. That's all I'm going to say, because that's the big thing these days.

And this time, I've got a lot of detail on that first book. I've got the second book, sort of roughly outlined, but I know where I'm going with it. And the same with the third. And I'm really excited about it, because this time, I'm writing it to market. I'm putting in the things that I didn't know to do before. So, how do you write to market? You find books that are like the book you want to write. And you look at them and compare them. How old is the protagonist? What's the setting? What's the year? Where are they? What are the common? What are the tropes that you find in there? What are the flaws of the characters? Now, that doesn't mean my book is going to be anything like them. But to just make sure that readers who expect those kinds of emotional bounces, we'll get them.

John: Nice, nice.

Dr. Debra Blaine: I'm excited about it.

John: Okay, that's going to be good. That'll be good for another podcast episode then. Okay, where should we find you? allthingswriting.com? Is that the best place to start?

Dr. Debra Blaine: That's my website, allthingswriting.com. And you can also find me on LinkedIn. And you can email me at db@allthingswriting.com. I don't know if you want to put in, there's a Calendly link, which you can find on my website. It's hard to know if I was able to get it into LinkedIn, I don't think I was. I was trying to figure that out.

John: But I always ask authors this, writers this. Probably you've already answered it. But should they go to your website to buy the books? If you go to your website anyway, to check them out, but I do end up just pushing them off to some other site or do you sell from the website?

Dr. Debra Blaine: I haven't started selling from the website because it's complicated. But Amazon is a great place to go. You can just do just do a Google search Debra Blaine books. And you'll come up with my books. And the nice thing is that the more even though I would get more money if I sold them myself, the more people buy it from Amazon, that algorithm kicks up. So it helps.

John: Right, right. Okay, well, I'm going to let you go now here in a second. You have a minute or two, if you have any bit of last minute advice for the listeners, maybe try to convince them to become a writer or not become a writer or a novelist.

Dr. Debra Blaine: I had a note about that, but I can't find it. My advice is write. If you have a story in your head, we call it a word dump. Just start writing it. Don't edit it while you're writing it. It's a first draft. It's a rough draft. It's not even your first draft. Because you can get so bogged down. And you don't have to figure "I'm going to write 80,000 words." You don't even think in terms of words. Put the word ticker on later but if you don't start writing, nothing will get down there. I used to have a mantra when I was writing Code Blue. And it was, "It's not going to write itself." Because I was one of those people who wanted to have written as opposed to wanting to write. But it doesn't happen like that.

John: Are you disciplined now? Can you black out so many so much time where you're going to write? Or do you kind of wing it now when you feel real productive to do more and then other days...?

Dr. Debra Blaine: I try to write every morning. My brain is crisper in the morning. And that's still that whole COVID thing. And I schedule clients usually in the afternoons and evenings. And even if I feel like I'm waning, I don't want to say sundowning. But if I'm waning, once I'm talking to someone, that energy that we bounce off each other, that ignites me and that's really helpful. It's a different part of my brain, but to sit and to write and to do the research and go back and forth. I try to do that in the mornings. And I try to write every morning.

John: Nice. That's good. That's good. Sounds like something that we should emulate if we're going to try and do that.

Dr. Debra Blaine: You don't have to do it every morning. As long as you put aside whatever time it is for you. And let's say it's only three times a week. Three evenings a week I'm going to tell my family, please just give me an hour. And it's the inertia I think of, you need to get started. Sometimes I'll say I can only write for 20 minutes and it'll end up being an hour and a half because it's getting started.

John: Once you get going, it's like a lot of things. I might have to split this into two episodes, Debra, but it's okay. Because then I don't have to do another episode. I'll just spread this out. Nobody wants to listen for an hour and they can break it up themselves, but I tend to go. I'll think about that after we hang up here.

All right. But with that, I'm going to say goodbye officially from the podcast and thank you for spending all this time with us today.

Dr. Debra Blaine: Thank you. Thank you so much. I always love talking to you.

John: You should read the books guys, because they're entertaining. It's an escape. Reading, relaxing, walking.

Dr. Debra Blaine: And you write the best reviews for me too. Well, that's the other thing. Please write review. The reviews are the hardest thing to get. It's really hard.

John: I'm going to put that in the show notes too. I'm going to say, here's the link. If you want to look for the books or you can go to Amazon here and always write a review if you do that, because the author definitely needs that. All right, then, you take care.

Dr. Debra Blaine: Okay. Thank you so much, John.

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The post More on How to Publish a Book appeared first on NonClinical Physicians.

In this podcast episode, John interviews Dr. Debra Blaine, a returning guest from 2022, for Part 1 of a discussion on how to publish a book and promote your business.

Dr. Blaine, a family physician turned full-time author, shares her experiences transitioning from medical practice to writing and self-publishing seven books since 2017.

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

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The Power of Self-Publishing

Dr. Debra Blaine shares her journey from medical practice to full-time author, having published seven books since 2017. She discusses the advantages of self-publishing, including greater control over the publishing process, faster turnaround times, and significantly higher royalties.

Self-publishing allows authors to maintain ownership of their work and make decisions about cover design, titles, and content without interference from traditional publishers.

Crafting Compelling Fiction

Drawing from her experience as an author and coach, Dr. Blaine offers insights into creating engaging fiction. She stresses the importance of a strong story arc, believable characters, and natural dialogue. The post discusses techniques for hooking readers from the first pages and creating emotional connections with characters.

Summary

In Part 1 of this 2-part episode, returning guest Deborah Blaine discusses her transition from physician to full-time author. She explains the benefits of self-publishing. She also shares insights on self-publishing, including tools, techniques, and the importance of effective book design and metadata. Finally, she offers her advice on crafting compelling fiction, focusing on the creative aspects of writing.

Links for today's episode:

• Dr. Debra Blaine's Website: All Things Writing
• Debra's book on self-publishing, The WriteR Stuff: Step-by-Step Guide to Self-Publishing and Worldwide Distribution
• Debra's latest book on writing a novel: The WriteR Stuff: Secret Sauce of Writing Fiction
• For an example of Debra's writing download a free copy of Deadly Algorithm
• Vellum, the software Debra uses to write her books (this is an affiliate link)
• Debra's LinkedIn Page
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 372

How to Publish a Book and Promote Your Business - Part 1

John: I really enjoy reading novels. I've slowed down recently, but I probably read 10 or 15 novels when I was really in the mood to read some years. But that's in addition to all the business and self-help books, things like that over the years. And I've always been impressed by the combination of creativity and discipline that successful novelists have. So, I think of people that are creative as being creative. But to be creative and disciplined, that's something a little bit different.

Anyway, I invited Dr. Debra Blaine back to the podcast now because she's a novelist. She's been writing for years. She's been on the podcast two or three times before. And she just recently self-published a book on self-publishing. That was very Meta. So welcome back, Debra, to the podcast.

Dr. Debra Blaine: Thank you so much, John. Thanks for having me.

John: It's always fun when we get together. We have a lot to talk about, but you've been very busy. I don't talk to too many writers that can say that you've written how many books in how many years now?

Dr. Debra Blaine: Well, I started just writing a first draft in 2017, but I have now published seven books.

John: Okay.

Dr. Debra Blaine: And I'm working on some more.

John: That's quite a lot of productivity there from the writing standpoint. So if you can keep that up, then you'll have a lot of books out there over the years. And the other thing, of course, the listeners should remember that one of the things that makes you unique, I've had other writers on, but they're mostly medical writers, but you made a commitment. You decided, "You know what? I'm going to stop practicing and I am going to try to grow this writing thing to be sort of my new vocation." Is that what I recall correctly?

Dr. Debra Blaine: Correctly.

John: Okay. And you're actually the only one I've ever interviewed that has written a novel or six. And I had one poet once that wrote a book of poetry. I don't know if that that doesn't quite count. I don't think so. Anyway, let's get into what's new with you. Fill us in since you know what's been going on since we talked. Oh, it's been about almost two years ago.

Dr. Debra Blaine: Great. It's interesting. You said I decided. I was writing as kind of a side gig. Sometimes life comes along and kicks you in the butt and says, okay, you're really miserable practicing medicine and you're not going to do this anymore, even though you think that maybe you should or whatever reason. I got Covid about 18 months ago and it completely changed my life. I'm a very special person. I'm one of the seven percent who got long Covid. And I still even now, I cannot focus for 12 hours straight. I don't have the stamina to go from room to room, to room, to room and spend every moment of those 12 hours concentrating or treating patients thinking I need to take breaks. And what they told me was when I asked them and I said, "Listen, I'll come back to work, but I'm going to need to take a 10 minute break every three or four hours." And they actually wrote it in a text. "Unfortunately, there are no breaks in urgent care."

And so that being said, I resigned. I was on disability for six months and then that ran out. And then life kicked in and kicked me in the butt and said, okay, you have the side gig. And I think that even if that hadn't happened, I feel like a lot of my life and a lot of perhaps other people's lives is constantly redefining where we're going. It's like if we're headed in one direction, sometimes it's not quite due north. Maybe it's northeast a little bit. Or maybe I need to take a detour over here. It's kind of a zigzag finding my way. It has been for me to find my way into what I really enjoy doing and to be able to throw myself into it.

I started writing in 2017, a few words scribbled on a couple of pages. I published that book in 2019. And since then, I've put out six more books. And this summer I put out two books. One of them is really short. The self-publishing book is pretty short. And I'm working on I'm working on two books now. And one of them is also a nonfiction, it's going to be a guide. And I'm going to come up with a better name for it, but a guide to fiction writers, the elements of fiction. What do you need to put in? How do you how do you determine a story arc? How do you develop characters so that it's more of a how to without having to get a master's degree in writing. Just in a short little book bum, bum, bum. These are the things to put in. This is why. And these are tips. I'm going to hopefully have that out in a couple of weeks.

John: But I have a question since you mentioned writing two books. The most writers, this is how I would think of it, would I would keep I would try and work on one till it was pretty much done and then go to the next as opposed to going to write two or three or four all simultaneously. I assume different authors, writers just do it differently.

Dr. Debra Blaine: Yeah. I thought I was absolutely out of my mind. But to me, they're different sides of the brain. Writing a guide about how to write fiction is kind of like writing a term paper, but making it interesting and fun. Whereas the trilogy I just started is a complete my right side of the brain. And it's a whole different kind of thinking. So they don't really clash. But the one of our colleagues who said she kindly said she would take a look at it when it's finished to tell me if I forgot anything. She said she's working on two books right now. And so she would get to a couple of weeks. I said, oh, I'm not the only one.

John: Yeah.

Dr. Debra Blaine: So I guess not. But yes, I think common sense. And certainly if you're a beginning writer, I would focus on one.

John: Yeah, that makes sense. I can imagine, though, the great writers that we all have our favorites. I could imagine if that was their full time occupation and they were really putting 40, 50 hours a week in it, that they might have three or four things going on at once, because I know there's certain times of the day, certain days of the week. And just the way your mind works, sometimes it's more focused on certain things than other things.

Dr. Debra Blaine: And some of them have ghostwriters for them, too.

John: Well, I got some questions for you today. We'll just kind of go wherever you want to go, but tell us about the self-publishing book. Why did you write it? And then you can tell us, some of the advantages to self-publishing while you're talking about that.

Dr. Debra Blaine: Okay. Just as a caveat to that, I'm going to say or a segue into that is that I think I've spent as much time studying, learning, going to webinars, reading about the authorship process, including publishing, as I did in basic sciences. And so, I learned to self-publish. And when I did that, everything changed for me. I could put books out so much faster. I could do it on my timeline. And I wanted to share that. I wanted other people to know that there's other options. If you want to go the traditional publishing road, you have to query an agent and the agent has to find a publisher. And the process can take forever and literally because you may not ever find someone. Agents, I think they get like 200 queries a week and they have to go through. And most of the time, traditional publishers will not entertain your submission without it coming through an agent. And then there's hybrid publishers, but I wanted to be able to offer people how do you do it yourself because you can use a hybrid, which is a whole other thing.

Hybrids are pretty pricey. They go anywhere from like $5,000 to $7,000 to $15,000 to $17,000. I know one of our colleagues spent $17,000 on a done for you that was not really done for you. And I was like, wow, I did all that for a client and I didn't charge nearly that much. And I couldn't. I wouldn't ever do that like in in good conscience. I couldn't do that. But just to be able to show people that it's not hard.

I'm a technology challenged individual. If it's a software, I'm leaving. Until a couple of years ago, I didn't think I could handle anything like that. But when I spoke to, actually, it's the same person who's going to look at my book coming up and tell me if I'm missing anything. And she's published like twenty five books now. She's a successful author. I only knew her from the women physician writers group and Facebook group. But I remember I messaged her that I was thinking about using this self-publishing company and she messaged me back immediately "Stay away from this company." I was like, whoa. And then we got on the phone a few days later and she spent 45 minutes with me just telling me, "Okay, this is what you do. You do this, this, this and this. You know all the parts that go in the book because you already published two books with the hybrid. And I recommend that you set up accounts with each distributor."

It's a pain in the butt, but for her it was worth it because of the control she had and the visibility that she had and the ability to get paid quickly with royalties. I ended up doing that. That first book that I self-published was Beyond the Pillars of Salt. And from the time that I finished my final draft, which is when I would have sent it back to the hybrid because they were willing to publish another one for some another exorbitant fee. I think it would have been $9,000. From that day to the starting from there. I sent it to an editor. I got a cover designer. I got my ISBNs. I filled in everything I needed to do. I set up the accounts to the time that it was released and available everywhere around the world was 67 days.

The first two books, first they said six months and it came out in eight months. The second one, they told me six months. It came out in 11 months. And then for this third book, I was like, "Well, how much can you promise me? Because I want to wait a year with this." And they said, "Well, we can promise to a year", which could be 18 months. And so, that's when I said, okay, I'm going to try this. And I kind of very gingerly stepped into it.

And you can't tell that it's self-published. It's printed. The people who print it are the same people who print the traditionally published books. And as long as you have the software that I use, I use Vellum software, and it gives you all this. It creates the beginning of your copyright page. It creates your table of contents. It offers you a dedication page and an acknowledgement page and all the things that you want to put in. And now it's come up with things where if you add back matter, we can talk about back matter in a bit. It'll save that and add it to all your other books. If you want to say here's how to get in touch with me, you don't have to put it in every single time.

And the price, you can't beat the price because you pay once. First of all, you don't even pay right away. This was what helped me because they said I can download the software. I can play with it. I can put my stuff in. If it looks like I like it and I want to generate a book, then I pay them. I can hold on to it for six months and never use it. Whereas there's another one called Vellum is only good for a MacBook, Apple. But there's another one, Atticus, which is very popular, which is you can use on either PC or a Mac. They make you pay up front, but you have a 30 day where you can return it. I would guess, and I don't know this for sure, but I would guess that if you use it to generate books, you can no longer return it. But with either of these, you get unlimited books, eBooks or print books. When I generate files, I have separate files for Kindle, Nook, a generic EPUB, Apple Books, and a print. And it breaks it down for me. So when I go to upload those books, I just choose the correct file and there it goes.

John: All right. So let me ask a question here because I'm thinking some of our listeners are like me, like total novices. And what I know a little bit about is, there's a lot put out there about how to make money on the internet, writing books and that. But the whole gist I got from that was that if you put something together and it's done well, and it's helpful to people and you put it out there, someone's going to buy it. And if you can cut out the middleman, you can make more money selling it. But it never occurred to me, if you have this software, whatever it might be, Vellum, you mentioned, once you're using the software, you can write the book in Vellum, right? Isn't that how that works?

Dr. Debra Blaine: You can.

John: Do you do it like in Word or something else?

Dr. Debra Blaine: I do it in Word and then I upload the file. You can do it in Vellum. It's a different screen and I like the features that I have in Word better.

John: Okay. But it converts that easily, right?

Dr. Debra Blaine: Oh, yeah. It's got to be a DocX file.

John: Yeah.

Dr. Debra Blaine: Or a Word file or a Scrivener file.

John: But I'd never thought about that. Well, once you've done that, as you said, I never thought that, "Wow, if I write another book and then load that, everything else is already in there from the first book."

Dr. Debra Blaine: Yeah. You have to set it up for that.

John: Yeah. Awesome. Well, that's cool. Anyway, go on. Let's see, where were we? We're talking about, you learned all this and you've been using it. What are the other advantages besides the time component and the fact that it's really not that costly, but the other advantages to self-publishing?

Dr. Debra Blaine: Okay. I want to just add on, did you ask me why I started doing it? One of the things that I do for clients, for authors, is I help them self-publish their own book, which is often about their side gig. Because when you have a side gig, if you have either an eBook up on your website or a book on Amazon, and by the way, it can be available anywhere. You can have it go through IngramSpark and be distributed wherever you want. It's an unconscious assumption. If they have a book, they must know what they're talking about.

John: Right. That's right.

Dr. Debra Blaine: I had encouraged a lot of people and worked with people to write a book about their side gig and I hadn't done one myself and I thought, "Well, that's really stupid." That's why I started that. But the advantages are, there's two major advantages. One is the control that you have in terms of your timeline and the fact that you own your book. And the other big one is the money, the royalties.

When I took my books back from the hybrid and put them up myself, my royalties increased four times. And not only that, but when someone else is publishing your book it takes six months for them to tell you, "Okay, this is what you earned." Your earnings are a pittance and you don't see what's happening in between unless you bug them and ask them. And if they're in a good mood, they might tell you.

But when you self-publish, with Ingram, it's still the same. You can see what's happening, but you don't get paid for six months. But for example, on Amazon or Kobo or Apple or Barnes & Noble, you see day by day, how many people are buying your book and you get paid every 30 days. I think Barnes & Noble won't pay you unless you've got at least $10 in royalties, but hopefully you will. And they'll pay you direct deposit to your account. You set up your own accounts. Nobody else is putting their fingers in the middle. And it takes that whole part of when you're wanting to write a book and then you finish the book and you think, oh, great. And it's like, oh, I got to publish it now. That means you got to write a query letter and you got to find an agent and every agent wants a different kind of query letter.

So you can't just make one letter and send it to a bunch of people. You have to tailor it to each person. It just takes so much of that stress out of it. And then you have the control. If a traditional publisher picks up your book, they'll pay for everything, but they'll also tell you you're using this cover. We don't like your title. We're using this title. And you know what? This chapter doesn't fit. We want to get rid of it. We want you to write a chapter like that.

One of our colleagues has done well in terms of getting her books published.    I think on the third book, she's with a traditional publisher. She wanted to write about a male main character, a male hero, instead of a female. And they said, no, we won't publish that because we have you in the female lead and we don't need you as a male lead. So you lose a lot and you don't own your book. And this way I own my books.

John: Okay. Now I was going to ask you to go over at the high level, the process of writing a book, but we might as well stop right here and just tell us about your book about self-publishing because bottom line is they're not going to remember everything that we talk about today, unless you're really taking great notes. And what they need to do is just get your book on self-publishing. So why don't you give us that information right now?

Dr. Debra Blaine: Okay. What I have in the book, actually I didn't want to miss anything. I wrote it somewhere so that I could take a look. I talk about the different kinds of publishing. I talk about how to get an editor. I'm an editor too, by the way. I learned to do that. How to get a cover design, what you want from your cover design. People do judge a book by their covers and how to figure out what's going to be effective because there are strategies to this.

See, I didn't know any of this before. The hybrid completely got the cover wrong for one of my books, Undo Influences. And I was told by someone that it looked like a psychology self-help book and it's a political thriller.

John: Yeah. I think the original has a picture of a brain on the front.

Dr. Debra Blaine: It does. You changed it.

John: You changed that. You got rid of that.

Dr. Debra Blaine: I got rid of that. I got rid of it. And now it looks like a thriller. And the sales went up and my royalties went up because for every sale, my royalties went up. I talk about how to format, setting up accounts, metadata and back matter. Once you have a couple of books, you may want to put in the back of the book, "Hey, see my other book? If you liked this book, go to this book, join my newsletter." I talk about how to do that and where to do that, because there are certain places where it's like the classic book, you think of once upon a time and then the end. The moment you write the end, Amazon, for example, if you're on a Kindle, we'll stop showing you the rest. You can go to it, but it'll immediately flip you to something else to buy because the book is over. So how do you get your messages, your links in before the end? Well, for one thing, you need to write the end and you don't end the chapter. When you finish the story, you put an ornamental break in there. And then if you like this, Amazon thinks it's still part of the algorithm, thinks it's still part of the meat of the book. Your reader will know that it's not part of the reader. If you wrote a good ending.

So, there's so many things that I've learned about, and I try to put a little bit of everything into that book I just published. I didn't want to put everything in, all the detail. Because it is overwhelming and I don't want to overwhelm anyone. That book is really for people who have written what they want to write and they're ready to publish and they know a little bit about it. They know my book needs, I want to put a dedication in it. I want to put an acknowledgement in it. I want the different things that they want to add about the author. They want to know where can I put a link to something else? Where do I put my other books? And that's what the purpose of that book and how to format and how to use software.

I also talk a little bit about how to write metadata. Metadata is your book description. I think it's official that human beings have the attention span of a goldfish. Have more attention than we do. We're just bombarded with so much information and people scan, but to get them to stop and read, you have about three seconds or less. You got to hit them with a hook, something that immediately makes them say, "Oh, I want to read about that." And so, you want to target that hook to the people who would be interested in your book. You don't want to hook someone who wants a great cooking recipe and then talk about a cozy mystery. You want to be appropriate.

I talk a little bit about writing metadata, the keywords, where you find your keywords. I didn't know anything about keywords and categories. And when I was getting it published by the hybrid, and certainly if a trad publisher, did they choose all that for you? Sometimes they're not working so well.

When you do it yourself, you can go right back in and change your keywords. You can change your categories and you can test it and say, "Okay, let's see if that works better." And I talk about how to calculate royalties. Just down to the nitty gritty, down to the penny. How do you calculate the royalties? What happens when you have so many fingers in the pie and where the money goes? Or in the case of Ingram, sometimes we don't really know where the money goes. It just disappears. And some of the common mistakes that authors make.

And then I have a checklist at the end for do it yourself. Bum, bum, bum, you're going to do this, this, this. While your book's being edited, you're going to get your cover designer. You're going to set up your account. I try to put it in a really simple format.

John: Nice. It sounds pretty comprehensive, but not overwhelming. Now you mentioned that you help others do this personally. And I think you have training as a coach.

Dr. Debra Blaine: I'm certified as a coach and a master trainer coach as well.

John: Oh yeah, that's right. I forgot about that. You have all the skills already to facilitate people on whatever it is they're doing whether it's life skills or writing a book. So what is the typical person come to you for now in terms of helping them? Is it the software? Is it more of the creative process, all the above?

Dr. Debra Blaine: I have more clients for the creative process, which is why I'm going to release another self-help book. My books are called the "Writer Stuff. And this is going to be the second one. And it's going to be just outlining what is the story arc and why is it important? How do you create dialogue that doesn't sound like he said, she said? How do you develop your characters so that they're believable and they're deep in there and people can get emotionally connected with them?

Characters drive your story always, and you have to care about your character. There's a book that was written called Save The Cat. I'm just going to work from the title because I'm not working from the whole book, but the idea that if you have a villain who you start the book, because you always want to start your book with something that draws the reader in. If the reader is not interested in the first two pages goldfish mentality, they're going to look inside, they're going to be like, "Yeah, I'll look for another book."

So you had to draw the reader in. So you got this guy, he's running because he just killed three people and he's slashed another one and he's running away. And then the police are after him. And as he goes into an alley, he hears a cat stuck on a fire escape and he stops and he brings the cat and he gets the cat to the ground and then runs off. Now, the police are even closer to him. So now it's like, okay, this is some evil dude. He's a murderer, but wait, he saved that little cat. So that idea, to make people care about this guy who's not just a murderer. We don't know why he murdered them yet, but we do know that there's something in him that's a good person.

That kind of stuff that gets a reader just interested enough to keep reading and want to keep reading. People when they read novels, they want to feel emotions. If they're reading a textbook, they want information. If they're reading a novel, they want to feel things. And especially in our day and age when there's not a lot of time spent on our feelings. I think when people read, they get into that. There's been studies shown that people who read fiction have a much reduced incidence of dementia later on.

John: Oh, really?

Dr. Debra Blaine: Not nonfiction, fiction. And I'm thinking it's because there's so many subplots that they're following along and it's a different part of the brain.

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