Interview with Drs. Lev Grinman and Daniel Cousin
Today's podcast guests are two physician entrepreneurs who enable doctors to earn income working as a remote medical director.
Dr. Lev Grinman and Dr. Daniel Cousin co-founded Doctors for Providers. Their company matches collaborating physicians with nurse practitioners and physician assistants.
Dr. Grinman is board certified in neurology and sleep medicine and works clinically as a neurophysiologist. Dr. Cousin is a board-certified radiologist who is fellowship-trained and certified in PET-CT and nuclear imaging. Both physicians have experience with other entrepreneurial ventures.
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Find a Need and Fill It
Lev and Dan realized that the non-physician providers looking to start their own practices often need collaborating physicians. Even when not required by state regulations, such midlevel providers may need the relationship to meet health insurance requirements, or for easy access to advice about unusual medical presentations.
This relatively new company worked diligently during its first year to develop a database of close to 1,000 physician remote medical directors. And it has developed its model to reduce the risk to collaborators and providers.
The process of connecting the two includes collecting pertinent information from each party. Then Doctors for Providers develops a contract that spells out the services to be provided by the remote physician. The latter must be licensed in the state in which healthcare services are being provided.
Become a Remote Medical Director or Collaborating Physician
Lev and Daniel described why this remote, part-time position can be an excellent way to generate additional income for physicians:
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It does not involve a heavy time commitment.
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It's a remote job, similar to practicing telemedicine.
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Being a remote medical director generally presents a lower risk of being sued.
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Doctors for Providers makes monthly payments, so there is no billing involved for the remote medical director. And the business relationship usually runs for a year at a time.
Summary
This is an interesting new way for physicians to earn extra income doing a straightforward job. It is convenient, involves no travel, and poses a lower liability risk. And serving as a remote medical director in this way is a way to gain experience that will open doors to other jobs.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- Doctors for Providers Website
- Email for D4P: admin@doctors4providers.com
- The telephone number for D4P: 1-855-DOC-4-PRO (1-855-606-1686)
- How to Secure a Rewarding Medical Director Position – 088
- How to Find a Top Remote Nonclinical Career – 188
- NewScr!pt
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Transcription PNC Podcast Episode 240
Why Part Time Collaborating Physician Is a Great Job - Interview with Drs. Lev Grinman and Daniel Cousin
John: By now most of you know that I enjoy interviewing physician entrepreneurs, especially when it involves creating an opportunity for you to generate income in some new way. And that's why today's guests are here. Hello Dr. Lev Grinman and Dr. Daniel Cousin.
Dr. Lev Grinman: Hello, John.
Dr. Daniel Cousin: Good afternoon.
Dr. Lev Grinman: I'm happy to be here.
John: Awesome. I'm glad you're both here. I've done maybe three interviews with partners or people that are doing something together, but it'll be fun. We're going to learn a lot. My audience is a lot of physicians looking for side gigs, full-time jobs, different things, and a lot of them are entrepreneurs too. I think they can learn from you both. Lev, we'll start with you. Give us a little bit about your background and then we'll go over to Dan.
Dr. Lev Grinman: Sure. I am a board-certified neurologist and sleep specialist. I live in the state of New York. I am entrepreneurial, I guess by spirit. I have started a couple of different companies. I have a home sleep testing company that's based out of New Jersey. I am also part of a couple of different ventures related to intraoperative monitoring, which involves monitoring of the brain and spine during surgeries. My latest venture is what we're going to be talking about today is Doctors for Providers. And that's a company that matches collaborating physicians with advanced level providers, such as nurse practitioners and physician assistants. And we do this in all 50 states.
John: Okay. Dan?
Dr. Daniel Cousin: Sure. Tough act to follow that one though, I have to say. I am a radiologist by trade and I'm also somewhat entrepreneurial spirit. I started trying to get involved with various nonclinical consulting opportunities. And then I started teaching some of my colleagues about these opportunities and getting them involved to ranging anywhere from medical legal work, plaintiff defence work, acts reconstruction, determinations and authorization work, and gatekeeper work. The list goes on. There's so much that doctors can do outside of their day-to-day clinical practice to really give them a large breadth of fun. And Doctors for Providers is one of those things.
John: Awesome. Yeah. I'm pretty much intrigued by this. Like any new business, it's solving a problem and it seems like it's a problem that needs to be solved. So that's a good thing and it makes it likely to succeed, I guess, if you guys do everything right. Maybe I'll go back to you Lev, and tell me exactly what prompted you and Dan to start this?
Dr. Lev Grinman: Yeah. What we realized is that there are a lot of providers out there who are looking to start their own practices or businesses in healthcare. And many of them are very well qualified, but they still need physicians to be their collaborators, to oversee what they're doing, to review some portion of their charts, to consult with during the month to make sure that they're providing optimal care.
And personally, I've had nurse practitioners come to me and say, "Hey, I'm doing so and so. I'm doing televised visits with patients and for a company. And I need a collaborating physician." I've had nurses come to me or NPs come to me and say, "I'm doing visits to patients' home on behalf of a company. And for this, I also require a collaborating physician and I just don't know where to find one." And I had this light bulb moment where I said, "You know what? We got to help these folks. We got to help find collaborating physicians." Doctors may not be aware that this need exists and doctors may not be educated to know what to do if they want to be a collaborating physician. And that's where we started.
John: I guess I'd like to hear what steps you took once you saw that there was a need, what was the process you followed it. There's this chicken-egg thing of where do you start? How did you put it together? So, I'd be interested in hearing that.
Dr. Lev Grinman: We started slowly, we started putting out little advertisements for actually on both ends. We started looking for providers online who were interested in finding a physician, and we saw that there was a big need online as well. People were looking on search engines. People were looking on Google. People were looking on Indeed as well and other job search engines. Then we reached out to physicians through our own personal connections. And in other ways we started telling doctors, "Hey, if you're interested in being a collaborating physician, talk to us, become part of our database. Let's do this together."
And so, gradually we started accumulating names of doctors who have become collaborators with us. And now we have a database of probably close to 1,000 people. We vet our doctors in the sense that before any collaboration is to start for the first time, we talk to them on the phone. We make sure that we look at their credentials. We even have introduction with the provider, with the physician on. That's how we grew our line of business as far as the physicians are concerned. And gradually we started doing more advertising on the provider side and that's how businesses grow and there's a lot of demand. And so, we're trying to meet that demand.
John: All right. There's some kind of marketing to try and get interest and get the physicians lined up. It sounds to me a little bit like the initial need came from the nurse practitioners and the PAs saying "I don't know where to find a doctor." There's probably doctors out there. So, was that maybe a little bit easier piece getting the physicians lined up first?
Dr. Lev Grinman: I think we wanted to line up both sides first to make sure that there wasn't a rate-limiting step. We didn't want to have a lot of demand and then not have the doctors to provide and vice versa, we don't want to have doctors sitting around promising them that they're going to be making all this money and not having actual customers.
I think we went at it sort of equally on both sides and started building it independently from each other, but really in parallel, so to speak. I think that's why we've become so successful is because we were able to grow, with the demand that we've seen by being able to provide the right physicians at the right time and figuring out how to get to these physicians, where to find them, how to talk to them, how to get them interested, et cetera.
John: Now, how did the two of you get together to work on this project? You're in different specialties. I think you're in different cities. But what brought you guys together?
Dr. Lev Grinman: Dan, do you want to answer that question?
Dr. Daniel Cousin: Yeah. Well, we're both very handsome dudes and we just naturally gravitate toward each other. No, we both were in several companies before this and we were doing nonclinical consulting together. This was Lev's brainchild, and he graciously invited me to join based on my experience in recruiting doctors and trying to convince them why they need to do these fun things and not just day to day. But it's been great. We're very good business partners and we compliment the other person. For example, that's a very nice shirt, Lev.
Dr. Lev Grinman: Thank you.
John: Well, it's good when you complement one another, because partnerships can go sideways if the personalities and the thought process is not in parallel and aligned. So that's good. So, where are you finding these doctors? I'm obviously well aware that there's physicians out there thinking, "Oh gosh, I need to find something else to do part-time to supplement while I look for another job or get the heck out of clinical medicine, ultimately. So, how do you find these docs?
Dr. Lev Grinman: There's a couple of different ways. One of the things that we've done as we've grown, we've obviously added a lot of different staff members and people have now specialized in doing different things inside the company. And we have folks who are basically committed to recruiting physicians for us almost full-time. And that is important if there's a project that requires our collaboration for which there's an immediate need, and if we may not have the perfect physician, we'll go out and we'll actually look for physicians, we'll call their offices. We'll basically stalk them. We'll find them and we'll kill them. We'll get them to talk to us, we'll explain what's going on and why we want to talk to them.
Sometimes we actually go out and try to find specific physicians. For example, we have a lot of need for psychiatrists in the state of Texas. It's a big state. There are limitations as to how many providers one physician can supervise at once. And so sometimes our physicians max out, we want to go out and find other qualified people. We'll be calling and we'll be Googling and going on different search engines trying to find doctors that way. We also have running ads on the internet to actually recruit doctors basically saying, "Hey, are you interested in an opportunity outside of your general practice? If you may want to talk to us, go on our website, check us out, and register with us."
It's just general advertising and actually specifically recruiting doctors. And sometimes we will also use our personal connections, talk to people that we know in healthcare, talk to people in our sister company, stands IME company. We will sometimes talk to somebody and say, "Hey, I know you're already doing IMEs or expert witness work. Would you also be interested in registering for Doctors for Providers?"
John: Makes good sense. When you have this kind of thing where you're matching people, I've seen it in others that have tried to start locums' companies, or they've tried to, I don't know, match up people doing different things. It can be tough because one side of the other might be really dominating and you can't fill a gap. And then like you said, you lose your clients.
I guess I do like to talk a little bit about just being an entrepreneur and starting a business. Maybe we can take it at a level higher in general. Just basic things that physicians should know if they're going to start a business. What are the basic steps? Should everyone have an LLC? Should everyone have an attorney? Just a little bit of advice for physicians who are thinking of trying something.
Dr. Lev Grinman: It depends. I guess it depends. If this is a business that's not a true medical practice, some people do prefer LLCs because they're more protected in case of a lawsuit. Our company is an LLC. I think one of the biggest pieces of advice that I would give is just don't be afraid to try something, don't be afraid to fail.
I think the big mistake that a lot of people make that want to go into business, but never do is the fear of doing something wrong. Business just as everyday life is based on a lot of little decisions and not necessarily one big decision that will change your life forever. You have to be able to be ready to make a lot of little decisions every single day. And that's very true when you're first starting a business. There's going to be a lot of decisions that you make that you've never made before, but you should not be afraid to make those decisions.
And then realize that if one decision that you made wasn't the right one, you can always go back and say, "You know what? Let's start over and go in a different direction." I think that's the most important thing is to be able to move some of the needle forward and say, "Let's start something. Let's try it this way." And if it doesn't work, you fail quickly, you move it in another direction.
John: Now, the businesses that both of you have done, whether together or individually have they generally been kind of bootstrapped? Occasionally I'll interview someone who's gone through some private equity firm and had to borrow half a million dollars or something to get the business started. But most of the people I interview are really just building it themselves.
Dr. Lev Grinman: Well, I've been in a couple of businesses. One was a big company into which I sort of joined in and then grew within that company. And that was a private equity back company. Another company that I was in also started out with investors initially, and then could only grow because there were investors, the company wasn't profitable initially. I do find that that's certainly the way to go in some instances, but you always have to remember that you have less control and less ability to make certain decisions when there's people watching over you.
I think if you are able to finance the company yourself, if it's not a huge financial commitment, then I think you should, because then you don't have to answer to anybody. You're also not getting financially diluted or paying back loans for many years to your investors before you're able to take home some money.
With Doctors for Providers, we were fortunate enough knowing how to start companies previously, we were able to finance it ourselves and we were able to grow it organically. Fortunately, it's been successful, we're at a point where we're actually a profitable company. And so, I think we're very proud of that.
John: Dan, how about you? Same experience mostly starting from scratch and just kind of bootstrapping as you go?
Dr. Daniel Cousin: Yeah. I think any good idea that is going to have proof of concept on a small scale that may not require a huge financial overhead, until you're ready to do so once there's proof of concept. But I think also a lot of people, like what Lev was saying, maybe expect everything to work the first time.
I think part of the fun of starting a company is actually the troubleshooting. I heard Gary V say that once. Anyone can come with an idea, anyone could do all these things, but what really is the important part is the trial and error, troubleshooting day-to-day. That's the fun of building a company. There are so many people in life who just didn't have the recorded skills, like who started McDonald's? The Kroc guy, I think his name was. It just happened to all work out and he was ready to capture it. All your life experiences, no matter how many great ideas or whatever come together sort of at the same time cohesively at that moment.
Dr. Lev Grinman: I just want to add onto something that Dan was saying. I think that it's important to do a little bit of early trial of your idea. I think that's a great concept. I read recently that the most important thing that determines whether or not your company's going to succeed in the short term and sometimes long term is whether it's the right time and whether the demand is there and whether the product is applicable to what's going on with your consumers.
You don't have to commit all of your capital, all of your time to something. But what we realized with Doctors for Providers, we started doing it on a small scale initially, but we realized that the demand was there and that the process works. And that's when we really started to really dig in and invest more money and resources into the company because we knew that the concept works.
John: All right. Well, I'd like for the next 10 or 15 minutes to get into the actual nitty-gritty of Doctors for Providers with the idea to imagine that there's just physicians listening to us right now. They're like, "Okay, I've got some spare time or I need some income" or that kind of thing. Maybe we could start with why this would be a good idea for a physician to consider, because they can do locums or they can do telemedicine or they can do some other things. Why do this?
Dr. Lev Grinman: There's a couple of different reasons. Number one is, it usually is not a very large time commitment. Most of collaborations will be simple chart reviews, perhaps as I said earlier, something like 10% of chart reviews for the practice. There may be occasional questions, but they're usually far and few in between. And usually, if the provider does require more assistance, they should let us know ahead of time. And then the doctor's compensation can certainly go up because of that.
It's something that a lot of times could be done during your free time or off hours or on the weekends. It can also be done from the comfort of your home or your office. It can be done from anywhere. It's a remote job. It's very similar to just practicing telemedicine. And so, in addition to that, most doctors are able, the ones that like doing it, usually do a few collaborations at the same time. And so, the income potential goes up as you do more of the collaborations at the same time. And some doctors, especially those who are licensed in multiple states, the opportunity to do more collaborations goes up significantly.
John: Of course, for the collaboration you have to be licensed in the state with whoever you are collaborating with, I'm assuming.
Dr. Lev Grinman: Because even though you are technically not seeing the patient as their physician and you're not establishing a direct doctor-patient relationship, when you're reviewing the patient's chart, you are practicing medicine, you are viewing confidential information. You are in some ways potentially establishing a doctor-patient relationship because you may have comments that influence that patient's care. So, you have to be licensed in the state where you're doing this.
Dr. Daniel Cousin: Yeah. And I just wanted to add to that. We have some doctors who just see how amazing this is and just keep asking us, "Do you have any more collaborations?" They want to get licensed in other states so they can max out those collaborations that you can do because each state has a limit. It's really just recurrent passive income. Like Amazon Prime, compared to how much you have to work per dollar in your daily job, this is much less than that.
John: Well, I'm sure people are going to say, "Okay, well, what about the malpractice and the liability?" Who covers that? That's a potential expense.
Dr. Lev Grinman: Right. We always ask the providers to add the physician to their malpractice policy, which I think is the right thing to do. I think it minimizes issues if God forbid there was a lawsuit, if you're on the same team as the provider. All our research has so far shown that the risk of getting sued is actually quite low compared to what you're doing day-to-day as a physician, meaning being a collaborator puts you at much lower risk for being sued. But again, having said that, the malpractice should always be provided by the provider's malpractice carrier.
John: Got it.
Dr. Lev Grinman: There's no added expense to the doctor. We do have a couple of doctors who have decided on their own to get malpractice policy add-ons that will cover them as either a medical director or collaborating physician. And that's fine. But most of our doctors do not have that.
Dr. Daniel Cousin: And I would just add and say that in this country, of course, anyone can get sued for anything, but the risk is so much less than every one of the patients that doctors see every day in their actual practice. And if you go to a hospital as a patient, for example, if something goes wrong, you're probably not going to sue the medical director or whoever it was that credentialed with the insurance companies because you never really saw that person. You could. So that's what we're doing here. The collaboration, it would be a paper-thin lawsuit.
John: All right. I'm going to pause here because I have a couple more questions, but I want to make sure to inject how they get a hold of you right here, because some people don't to the end.
Dr. Lev Grinman: Sure. The website is doctorsforproviders.com, or you could even use the number four, doctors4providers.com. That'll work also.
John: And then there's some answers to certain questions there or at least an overview. And then they basically at that point, contact you through that website.
Dr. Lev Grinman: Register directly on the website. There's a registration button, if they click on that, it'll bring them to a link that will allow them to register with us. It'll answer certain basic demographic questions, licensing questions, and then they would automatically enter our database. They will then receive a welcome email from us, acknowledging that we have received their registration. And if they have any further questions, if they want to speak to us, our phone number is on the website where they can email us at admin@doctorsforproviders.com and somebody will call them and walk them through the process.
John: Excellent. Okay. Now, back to my questions. We'll reiterate that at the end as well and I'll put it in my show notes. So, nobody should worry that they won't have access to that information. I'm just trying to think how this works. Do I have to make a commitment to be available seven days a week for a month at a time? Or can I do a week on - a week off? What are the constraints on what I can do?
Dr. Lev Grinman: Essentially the way the collaborations work is it's a continuous collaboration, meaning that the doctors will be paid every single month that the collaboration is active. So, it's a recurrent source of revenue for the doctor. They will be paid typically at the very end of the month when they complete their first collaboration. And so forth, it'll be every 30 days.
There's really no reason why anybody should start and stop. It's a continuous process, but it's having said that, again, the doctors most of the time don't have to do this during their regular work hours. They can do this on weekends. They can do it on after hours, in the evenings, et cetera. So, it's going to be a continuous thing, but again, it can be easily fit into somebody's schedule.
John: I take it then most of the people that might be doing this, maybe they have a practice, might be using a service that has a practice. They're there during the day. Maybe they have a PA or NP working evenings or weekends when you're not there. So, you need someone to cover those periods of time or is it for the independent PAs and NPs, they're working solo.
Dr. Lev Grinman: Actually, it's mostly for the independent PAs and NPs. Say you're an NP and you open up your own practice and you don't have a physician on-site. The doctors that we're recruiting, the doctors who are going to be the collaborators are going to be collaborating with the nurse practitioner remotely. The nurse practitioners in many states don't even need a physician, they can practice independently, but in about half the states, they still need a collaborator or the doctor to review their chart notes and things like that. So, it's mostly for providers who are doing it full-time. And the doctor is technically overseeing them full-time, but again, at a much-reduced capacity.
John: And I know the other question that might come up until they've had a chance to look through your website is, "Well, let's see what is my relationship to you and to them? Am I getting paid by you, by them? Am I signing a contract?" How does it actually get set up?
Dr. Lev Grinman: The doctors do sign a contract with us. We sort of serve as their agents, and we will collect payments from the providers on their behalf. Therefore, this is good for the doctors because it ensures that they will be paid every single month. There's never a break for getting paid. And we have to make sure on our end that we get paid from the providers. The relationship is we are serving as the matchmakers but also their agent in the sense that we introduce them to the providers and we collect the monthly fees from the providers on their behalf.
John: It seems like a pretty straightforward process.
Dr. Lev Grinman: It is. And there's no fees for the doctors to join us. You're only going to get paid by us.
Dr. Daniel Cousin: Yeah. And they get the benefits of being a contractor, which is another perk actually, if you're otherwise an employee only, and you can can't deduct anything. But I'm not a tax financial professional.
John: Yes. But that's true though. It's pretty much general knowledge that if you're doing some independent work, then that gives you a little more opportunity to do those write-offs. You have to talk to your own accountant, of course, as you said. This has been good. Anything else you think would be helpful for us to know, for my listeners to know if they're thinking about reaching out and doing something like this with you?
Dr. Lev Grinman: Definitely just go ahead. If you have any questions, even if you're not sure that this is something you want to do, go ahead and reach out, email us, call us. We'll talk to you. You can talk to Dan and I also, and we'll answer any questions or any concerns that you may have. This might be a good opportunity for you if you're considering it.
Dr. Daniel Cousin: Yeah. And I would also add that, I think it's great professional development as well, because you're immediately a medical director. You can put that on your CV or whatnot. It's also very rewarding because just like in academics, whereas physicians like the self-fulfilling experience of teaching a resident or someone to become a full-fledged successful professional, it's similar in that. You're helping to spread care through these entrepreneurial advanced practice provider businesses. It's really the trend in medicine, there's not enough doctors to go around and provide care to everywhere that needs it in this country. So, this is something that's really fostered by governmental policies, and you're helping to contribute to spreading more care than there otherwise would be.
John: Yeah. Every place I've ever worked there's a shortage of physicians for sure. In Illinois, I'm not sure it's as easy for an NP or PA to start out on their own, although I know of some clinics, but in other places, it's pretty common. They definitely need those collaborators. All right. Well, this has been fun. I've learned a lot. I think our listeners will have something to think about and if they're interested, they obviously should go to doctorsforproviders.com and check it out. I'll have links in the show notes. I just want to thank you both for being here today and sharing this interesting venture.
Dr. Lev Grinman: Thank you so much, John. It was our pleasure.
Dr. Daniel Cousin: Thanks for having us. Good time.
John: You're welcome. It's been my pleasure. Take care. Bye-bye.
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Transcription PNC Podcast Episode 240
Why Part Time Collaborating Physician Is a Great Job - Interview with Drs. Lev Grinman and Daniel Cousin
John: By now most of you know that I enjoy interviewing physician entrepreneurs, especially when it involves creating an opportunity for you to generate income in some new way. And that's why today's guests are here. Hello Dr. Lev Grinman and Dr. Daniel Cousin.
Dr. Lev Grinman: Hello, John.
Dr. Daniel Cousin: Good afternoon.
Dr. Lev Grinman: I'm happy to be here.
John: Awesome. I'm glad you're both here. I've done maybe three interviews with partners or people that are doing something together, but it'll be fun. We're going to learn a lot. My audience is a lot of physicians looking for side gigs, full-time jobs, different things, and a lot of them are entrepreneurs too. I think they can learn from you both. Lev, we'll start with you. Give us a little bit about your background and then we'll go over to Dan.
Dr. Lev Grinman: Sure. I am a board-certified neurologist and sleep specialist. I live in the state of New York. I am entrepreneurial, I guess by spirit. I have started a couple of different companies. I have a home sleep testing company that's based out of New Jersey. I am also part of a couple of different ventures related to intraoperative monitoring, which involves monitoring of the brain and spine during surgeries. My latest venture is what we're going to be talking about today is Doctors for Providers. And that's a company that matches collaborating physicians with advanced level providers, such as nurse practitioners and physician assistants. And we do this in all 50 states.
John: Okay. Dan?
Dr. Daniel Cousin: Sure. Tough act to follow that one though, I have to say. I am a radiologist by trade and I'm also somewhat entrepreneurial spirit. I started trying to get involved with various nonclinical consulting opportunities. And then I started teaching some of my colleagues about these opportunities and getting them involved to ranging anywhere from medical legal work, plaintiff defence work, acts reconstruction, determinations and authorization work, and gatekeeper work. The list goes on. There's so much that doctors can do outside of their day-to-day clinical practice to really give them a large breadth of fun. And Doctors for Providers is one of those things.
John: Awesome. Yeah. I'm pretty much intrigued by this. Like any new business, it's solving a problem and it seems like it's a problem that needs to be solved. So that's a good thing and it makes it likely to succeed, I guess, if you guys do everything right. Maybe I'll go back to you Lev, and tell me exactly what prompted you and Dan to start this?
Dr. Lev Grinman: Yeah. What we realized is that there are a lot of providers out there who are looking to start their own practices or businesses in healthcare. And many of them are very well qualified, but they still need physicians to be their collaborators, to oversee what they're doing, to review some portion of their charts, to consult with during the month to make sure that they're providing optimal care.
And personally, I've had nurse practitioners come to me and say, "Hey, I'm doing so and so. I'm doing televised visits with patients and for a company. And I need a collaborating physician." I've had nurses come to me or NPs come to me and say, "I'm doing visits to patients' home on behalf of a company. And for this, I also require a collaborating physician and I just don't know where to find one." And I had this light bulb moment where I said, "You know what? We got to help these folks. We got to help find collaborating physicians." Doctors may not be aware that this need exists and doctors may not be educated to know what to do if they want to be a collaborating physician. And that's where we started.
John: I guess I'd like to hear what steps you took once you saw that there was a need, what was the process you followed it. There's this chicken-egg thing of where do you start? How did you put it together? So, I'd be interested in hearing that.
Dr. Lev Grinman: We started slowly, we started putting out little advertisements for actually on both ends. We started looking for providers online who were interested in finding a physician, and we saw that there was a big need online as well. People were looking on search engines. People were looking on Google. People were looking on Indeed as well and other job search engines. Then we reached out to physicians through our own personal connections. And in other ways we started telling doctors, "Hey, if you're interested in being a collaborating physician, talk to us, become part of our database. Let's do this together."
And so, gradually we started accumulating names of doctors who have become collaborators with us. And now we have a database of probably close to 1,000 people. We vet our doctors in the sense that before any collaboration is to start for the first time, we talk to them on the phone. We make sure that we look at their credentials. We even have introduction with the provider, with the physician on. That's how we grew our line of business as far as the physicians are concerned. And gradually we started doing more advertising on the provider side and that's how businesses grow and there's a lot of demand. And so, we're trying to meet that demand.
John: All right. There's some kind of marketing to try and get interest and get the physicians lined up. It sounds to me a little bit like the initial need came from the nurse practitioners and the PAs saying "I don't know where to find a doctor." There's probably doctors out there. So, was that maybe a little bit easier piece getting the physicians lined up first?
Dr. Lev Grinman: I think we wanted to line up both sides first to make sure that there wasn't a rate-limiting step. We didn't want to have a lot of demand and then not have the doctors to provide and vice versa, we don't want to have doctors sitting around promising them that they're going to be making all this money and not having actual customers.
I think we went at it sort of equally on both sides and started building it independently from each other, but really in parallel, so to speak. I think that's why we've become so successful is because we were able to grow, with the demand that we've seen by being able to provide the right physicians at the right time and figuring out how to get to these physicians, where to find them, how to talk to them, how to get them interested, et cetera.
John: Now, how did the two of you get together to work on this project? You're in different specialties. I think you're in different cities. But what brought you guys together?
Dr. Lev Grinman: Dan, do you want to answer that question?
Dr. Daniel Cousin: Yeah. Well, we're both very handsome dudes and we just naturally gravitate toward each other. No, we both were in several companies before this and we were doing nonclinical consulting together. This was Lev's brainchild, and he graciously invited me to join based on my experience in recruiting doctors and trying to convince them why they need to do these fun things and not just day to day. But it's been great. We're very good business partners and we compliment the other person. For example, that's a very nice shirt, Lev.
Dr. Lev Grinman: Thank you.
John: Well, it's good when you complement one another, because partnerships can go sideways if the personalities and the thought process is not in parallel and aligned. So that's good. So, where are you finding these doctors? I'm obviously well aware that there's physicians out there thinking, "Oh gosh, I need to find something else to do part-time to supplement while I look for another job or get the heck out of clinical medicine, ultimately. So, how do you find these docs?
Dr. Lev Grinman: There's a couple of different ways. One of the things that we've done as we've grown, we've obviously added a lot of different staff members and people have now specialized in doing different things inside the company. And we have folks who are basically committed to recruiting physicians for us almost full-time. And that is important if there's a project that requires our collaboration for which there's an immediate need, and if we may not have the perfect physician, we'll go out and we'll actually look for physicians, we'll call their offices. We'll basically stalk them. We'll find them and we'll kill them. We'll get them to talk to us, we'll explain what's going on and why we want to talk to them.
Sometimes we actually go out and try to find specific physicians. For example, we have a lot of need for psychiatrists in the state of Texas. It's a big state. There are limitations as to how many providers one physician can supervise at once. And so sometimes our physicians max out, we want to go out and find other qualified people. We'll be calling and we'll be Googling and going on different search engines trying to find doctors that way. We also have running ads on the internet to actually recruit doctors basically saying, "Hey, are you interested in an opportunity outside of your general practice? If you may want to talk to us, go on our website, check us out, and register with us."
It's just general advertising and actually specifically recruiting doctors. And sometimes we will also use our personal connections, talk to people that we know in healthcare, talk to people in our sister company, stands IME company. We will sometimes talk to somebody and say, "Hey, I know you're already doing IMEs or expert witness work. Would you also be interested in registering for Doctors for Providers?"
John: Makes good sense. When you have this kind of thing where you're matching people, I've seen it in others that have tried to start locums' companies, or they've tried to, I don't know, match up people doing different things. It can be tough because one side of the other might be really dominating and you can't fill a gap. And then like you said, you lose your clients.
I guess I do like to talk a little bit about just being an entrepreneur and starting a business. Maybe we can take it at a level higher in general. Just basic things that physicians should know if they're going to start a business. What are the basic steps? Should everyone have an LLC? Should everyone have an attorney? Just a little bit of advice for physicians who are thinking of trying something.
Dr. Lev Grinman: It depends. I guess it depends. If this is a business that's not a true medical practice, some people do prefer LLCs because they're more protected in case of a lawsuit. Our company is an LLC. I think one of the biggest pieces of advice that I would give is just don't be afraid to try something, don't be afraid to fail.
I think the big mistake that a lot of people make that want to go into business, but never do is the fear of doing something wrong. Business just as everyday life is based on a lot of little decisions and not necessarily one big decision that will change your life forever. You have to be able to be ready to make a lot of little decisions every single day. And that's very true when you're first starting a business. There's going to be a lot of decisions that you make that you've never made before, but you should not be afraid to make those decisions.
And then realize that if one decision that you made wasn't the right one, you can always go back and say, "You know what? Let's start over and go in a different direction." I think that's the most important thing is to be able to move some of the needle forward and say, "Let's start something. Let's try it this way." And if it doesn't work, you fail quickly, you move it in another direction.
John: Now, the businesses that both of you have done, whether together or individually have they generally been kind of bootstrapped? Occasionally I'll interview someone who's gone through some private equity firm and had to borrow half a million dollars or something to get the business started. But most of the people I interview are really just building it themselves.
Dr. Lev Grinman: Well, I've been in a couple of businesses. One was a big company into which I sort of joined in and then grew within that company. And that was a private equity back company. Another company that I was in also started out with investors initially, and then could only grow because there were investors, the company wasn't profitable initially. I do find that that's certainly the way to go in some instances, but you always have to remember that you have less control and less ability to make certain decisions when there's people watching over you.
I think if you are able to finance the company yourself, if it's not a huge financial commitment, then I think you should, because then you don't have to answer to anybody. You're also not getting financially diluted or paying back loans for many years to your investors before you're able to take home some money.
With Doctors for Providers, we were fortunate enough knowing how to start companies previously, we were able to finance it ourselves and we were able to grow it organically. Fortunately, it's been successful, we're at a point where we're actually a profitable company. And so, I think we're very proud of that.
John: Dan, how about you? Same experience mostly starting from scratch and just kind of bootstrapping as you go?
Dr. Daniel Cousin: Yeah. I think any good idea that is going to have proof of concept on a small scale that may not require a huge financial overhead, until you're ready to do so once there's proof of concept. But I think also a lot of people, like what Lev was saying, maybe expect everything to work the first time.
I think part of the fun of starting a company is actually the troubleshooting. I heard Gary V say that once. Anyone can come with an idea, anyone could do all these things, but what really is the important part is the trial and error, troubleshooting day-to-day. That's the fun of building a company. There are so many people in life who just didn't have the recorded skills, like who started McDonald's? The Kroc guy, I think his name was. It just happened to all work out and he was ready to capture it. All your life experiences, no matter how many great ideas or whatever come together sort of at the same time cohesively at that moment.
Dr. Lev Grinman: I just want to add onto something that Dan was saying. I think that it's important to do a little bit of early trial of your idea. I think that's a great concept. I read recently that the most important thing that determines whether or not your company's going to succeed in the short term and sometimes long term is whether it's the right time and whether the demand is there and whether the product is applicable to what's going on with your consumers.
You don't have to commit all of your capital, all of your time to something. But what we realized with Doctors for Providers, we started doing it on a small scale initially, but we realized that the demand was there and that the process works. And that's when we really started to really dig in and invest more money and resources into the company because we knew that the concept works.
John: All right. Well, I'd like for the next 10 or 15 minutes to get into the actual nitty-gritty of Doctors for Providers with the idea to imagine that there's just physicians listening to us right now. They're like, "Okay, I've got some spare time or I need some income" or that kind of thing. Maybe we could start with why this would be a good idea for a physician to consider, because they can do locums or they can do telemedicine or they can do some other things. Why do this?
Dr. Lev Grinman: There's a couple of different reasons. Number one is, it usually is not a very large time commitment. Most of collaborations will be simple chart reviews, perhaps as I said earlier, something like 10% of chart reviews for the practice. There may be occasional questions, but they're usually far and few in between. And usually, if the provider does require more assistance, they should let us know ahead of time. And then the doctor's compensation can certainly go up because of that.
It's something that a lot of times could be done during your free time or off hours or on the weekends. It can also be done from the comfort of your home or your office. It can be done from anywhere. It's a remote job. It's very similar to just practicing telemedicine. And so, in addition to that, most doctors are able, the ones that like doing it, usually do a few collaborations at the same time. And so, the income potential goes up as you do more of the collaborations at the same time. And some doctors, especially those who are licensed in multiple states, the opportunity to do more collaborations goes up significantly.
John: Of course, for the collaboration you have to be licensed in the state with whoever you are collaborating with, I'm assuming.
Dr. Lev Grinman: Because even though you are technically not seeing the patient as their physician and you're not establishing a direct doctor-patient relationship, when you're reviewing the patient's chart, you are practicing medicine, you are viewing confidential information. You are in some ways potentially establishing a doctor-patient relationship because you may have comments that influence that patient's care. So, you have to be licensed in the state where you're doing this.
Dr. Daniel Cousin: Yeah. And I just wanted to add to that. We have some doctors who just see how amazing this is and just keep asking us, "Do you have any more collaborations?" They want to get licensed in other states so they can max out those collaborations that you can do because each state has a limit. It's really just recurrent passive income. Like Amazon Prime, compared to how much you have to work per dollar in your daily job, this is much less than that.
John: Well, I'm sure people are going to say, "Okay, well, what about the malpractice and the liability?" Who covers that? That's a potential expense.
Dr. Lev Grinman: Right. We always ask the providers to add the physician to their malpractice policy, which I think is the right thing to do. I think it minimizes issues if God forbid there was a lawsuit, if you're on the same team as the provider. All our research has so far shown that the risk of getting sued is actually quite low compared to what you're doing day-to-day as a physician, meaning being a collaborator puts you at much lower risk for being sued. But again, having said that, the malpractice should always be provided by the provider's malpractice carrier.
John: Got it.
Dr. Lev Grinman: There's no added expense to the doctor. We do have a couple of doctors who have decided on their own to get malpractice policy add-ons that will cover them as either a medical director or collaborating physician. And that's fine. But most of our doctors do not have that.
Dr. Daniel Cousin: And I would just add and say that in this country, of course, anyone can get sued for anything, but the risk is so much less than every one of the patients that doctors see every day in their actual practice. And if you go to a hospital as a patient, for example, if something goes wrong, you're probably not going to sue the medical director or whoever it was that credentialed with the insurance companies because you never really saw that person. You could. So that's what we're doing here. The collaboration, it would be a paper-thin lawsuit.
John: All right. I'm going to pause here because I have a couple more questions, but I want to make sure to inject how they get a hold of you right here, because some people don't to the end.
Dr. Lev Grinman: Sure. The website is doctorsforproviders.com, or you could even use the number four, doctors4providers.com. That'll work also.
John: And then there's some answers to certain questions there or at least an overview. And then they basically at that point, contact you through that website.
Dr. Lev Grinman: Register directly on the website. There's a registration button, if they click on that, it'll bring them to a link that will allow them to register with us. It'll answer certain basic demographic questions, licensing questions, and then they would automatically enter our database. They will then receive a welcome email from us, acknowledging that we have received their registration. And if they have any further questions, if they want to speak to us, our phone number is on the website where they can email us at admin@doctorsforproviders.com and somebody will call them and walk them through the process.
John: Excellent. Okay. Now, back to my questions. We'll reiterate that at the end as well and I'll put it in my show notes. So, nobody should worry that they won't have access to that information. I'm just trying to think how this works. Do I have to make a commitment to be available seven days a week for a month at a time? Or can I do a week on - a week off? What are the constraints on what I can do?
Dr. Lev Grinman: Essentially the way the collaborations work is it's a continuous collaboration, meaning that the doctors will be paid every single month that the collaboration is active. So, it's a recurrent source of revenue for the doctor. They will be paid typically at the very end of the month when they complete their first collaboration. And so forth, it'll be every 30 days.
There's really no reason why anybody should start and stop. It's a continuous process, but it's having said that, again, the doctors most of the time don't have to do this during their regular work hours. They can do this on weekends. They can do it on after hours, in the evenings, et cetera. So, it's going to be a continuous thing, but again, it can be easily fit into somebody's schedule.
John: I take it then most of the people that might be doing this, maybe they have a practice, might be using a service that has a practice. They're there during the day. Maybe they have a PA or NP working evenings or weekends when you're not there. So, you need someone to cover those periods of time or is it for the independent PAs and NPs, they're working solo.
Dr. Lev Grinman: Actually, it's mostly for the independent PAs and NPs. Say you're an NP and you open up your own practice and you don't have a physician on-site. The doctors that we're recruiting, the doctors who are going to be the collaborators are going to be collaborating with the nurse practitioner remotely. The nurse practitioners in many states don't even need a physician, they can practice independently, but in about half the states, they still need a collaborator or the doctor to review their chart notes and things like that. So, it's mostly for providers who are doing it full-time. And the doctor is technically overseeing them full-time, but again, at a much-reduced capacity.
John: And I know the other question that might come up until they've had a chance to look through your website is, "Well, let's see what is my relationship to you and to them? Am I getting paid by you, by them? Am I signing a contract?" How does it actually get set up?
Dr. Lev Grinman: The doctors do sign a contract with us. We sort of serve as their agents, and we will collect payments from the providers on their behalf. Therefore, this is good for the doctors because it ensures that they will be paid every single month. There's never a break for getting paid. And we have to make sure on our end that we get paid from the providers. The relationship is we are serving as the matchmakers but also their agent in the sense that we introduce them to the providers and we collect the monthly fees from the providers on their behalf.
John: It seems like a pretty straightforward process.
Dr. Lev Grinman: It is. And there's no fees for the doctors to join us. You're only going to get paid by us.
Dr. Daniel Cousin: Yeah. And they get the benefits of being a contractor, which is another perk actually, if you're otherwise an employee only, and you can can't deduct anything. But I'm not a tax financial professional.
John: Yes. But that's true though. It's pretty much general knowledge that if you're doing some independent work, then that gives you a little more opportunity to do those write-offs. You have to talk to your own accountant, of course, as you said. This has been good. Anything else you think would be helpful for us to know, for my listeners to know if they're thinking about reaching out and doing something like this with you?
Dr. Lev Grinman: Definitely just go ahead. If you have any questions, even if you're not sure that this is something you want to do, go ahead and reach out, email us, call us. We'll talk to you. You can talk to Dan and I also, and we'll answer any questions or any concerns that you may have. This might be a good opportunity for you if you're considering it.
Dr. Daniel Cousin: Yeah. And I would also add that, I think it's great professional development as well, because you're immediately a medical director. You can put that on your CV or whatnot. It's also very rewarding because just like in academics, whereas physicians like the self-fulfilling experience of teaching a resident or someone to become a full-fledged successful professional, it's similar in that. You're helping to spread care through these entrepreneurial advanced practice provider businesses. It's really the trend in medicine, there's not enough doctors to go around and provide care to everywhere that needs it in this country. So, this is something that's really fostered by governmental policies, and you're helping to contribute to spreading more care than there otherwise would be.
John: Yeah. Every place I've ever worked there's a shortage of physicians for sure. In Illinois, I'm not sure it's as easy for an NP or PA to start out on their own, although I know of some clinics, but in other places, it's pretty common. They definitely need those collaborators. All right. Well, this has been fun. I've learned a lot. I think our listeners will have something to think about and if they're interested, they obviously should go to doctorsforproviders.com and check it out. I'll have links in the show notes. I just want to thank you both for being here today and sharing this interesting venture.
Dr. Lev Grinman: Thank you so much, John. It was our pleasure.
Dr. Daniel Cousin: Thanks for having us. Good time.
John: You're welcome. It's been my pleasure. Take care. Bye-bye.
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