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 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. 

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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.

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.

Podcast Editing & Production Services are provided by Oscar Hamilton

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

Email Download New Tab

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.

Podcast Editing & Production Services are provided by Oscar Hamilton

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

Email Download New Tab

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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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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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

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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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Interview with Dr. Mark Olsyzk – 356

In today's interview, outstanding CMO Dr. Mark Olszyk provides his advice and that of his co-authors from The Chief Medical Officer's Essential Guidebook. 

He discusses the critical skills required for effective medical leadership and practical tips for navigating complex healthcare challenges. And he emphasizes the importance of continuous learning and collaboration among healthcare professionals to be successful.

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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.

The Journey to Becoming an Outstanding CMO: Insights and Experiences

John leveraged resources from the American Association for Physician Leadership (AAPL), including its Certified Physician Executive (CPE) program, to enhance his leadership skills. That is where he met Dr. Mark Olszyk, a seasoned physician leader with a rich background in military service and medical administration.

Dr. Olszyk, co-author and editor of “The Chief Medical Officer's Essential Guidebook,” shares his extensive experience in medical leadership. From his early days in the Navy to his decade-long tenure as a Chief Medical Officer (CMO), he highlights the importance of learning from successes and mistakes. The book serves as a comprehensive guide for aspiring CMOs, offering practical advice and lessons distilled from the experiences of various medical leaders.

The Role of a Chief Medical Officer: Responsibilities and Challenges

Dr. Olszyk outlines the multifaceted role of a Chief Medical Officer, emphasizing the importance of building bridges between various stakeholders in a hospital. He describes the evolution of the CMO role from the Vice President of Medical Affairs, focusing on credentialing, privileging, quality reviews, and regulatory compliance.

A CMO is a liaison between the medical staff, hospital administration, and the board of directors, ensuring effective collaboration. Dr. Olszyk also discusses his journey in medical leadership and the fulfillment he has experienced during his career.

Advice for Aspiring Medical Leaders: Steps to Take and Skills to Develop

Mark offers practical advice and steps to gain relevant experience for those considering a career in medical leadership. He encourages involvement in leadership roles within hospitals and joining professional organizations like the AAPL and the American College of Healthcare Executives (ACHE).

He also emphasizes the value of networking, seeking mentorship from current medical leaders, and continuously developing leadership skills through education and practical experience. By engaging in paid and volunteer leadership opportunities, physicians can significantly influence the future of healthcare while developing new skills, on their journeys to outstanding CMO.

Summary

In this interview, Dr. Mark Olszyk shares his extensive experience as an outstanding CMO and co-author of “The Chief Medical Officer's Essential Guidebook.” For those interested in purchasing the book, it is available on Amazon or through the American Association for Physician Leadership (AAPL) website, where volume discounts are also offered.  You can reach Mark directly via LinkedIn.

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

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Links for Today's Episode:

• Dr. Mark Olszyk's LinkedIn Page 
• The Chief Medical Officer's Essential Guidebook
• AAPL: The Chief Medical Officer's Essential Guidebook
• 4 Things the CMO Should Never Say to the CEO – 251
• 6 Important Assignments of a Hospital CMO – 218
• What Makes a Great Health System Chief Medical Officer?
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 356

The Essential Guidebook to Being An Outstanding CMO

- Interview with Dr. Mark Olszyk

John: During my efforts to improve my skills as a physician leader, I naturally took advantage of the AAPL, the American Association for Physician Leadership, including its CPE program. And it was during the final week of that CPE program that I met today's guest. He's a consummate physician leader, starting with way back when he was in the military. He may still be in the military, I'll ask him about that. But anyway, he's held numerous leadership and executive positions, and he's also the co-author and editor of a new book, well, it came out last year, The Chief Medical Officer's Essential Guidebook. Let's welcome Dr. Mark Olszyk to the show. Good to see you again, Mark.

Dr. Mark Olszyk: Good to see you, John. It's been too long, but thanks for having me and inviting me to your podcast. I'm really excited to be here.

John: Excellent. I have brought up the issue of physician leadership, and especially in the hospital setting, many times over the years on the podcast. And as far as I know, there are books written about the job and different aspects. But really, when I saw this book, with excellent collaboration with the AAPL and yourself with all your experience, this is just perfect for those in my audience who are thinking about moving along those lines, and actually a "how to" to get there. I really appreciate you putting this book out there.

Dr. Mark Olszyk: Oh, well, thanks. To answer your previous question, I'm not still in the military. I got out in 2003, kind of hard to believe, but I'm a proud Navy veteran, and my son is an Army ROTC. So, get that out of the way.

John: Nice.

Dr. Mark Olszyk: Yeah, yeah. The book, I think everybody at some point in their lives, reflecting on their experiences, and their travels and their journey, say, "Yeah, I should write a book about that." And I'm no different. But I've been a CMO, chief medical officer for about 10 and a half years. But I've been in medical leadership since the first year after finishing residency, I went into the US Navy. And the military, unlike almost any other sector, will put you in to leadership positions as soon as possible. And you find a way to get the skills and find the maturity and the leadership is thrust upon you and you have to rise to the occasion. I've always been grateful for that.

But I had gone to conferences at AAPL, others where I met other chief medical officers, and we would share stories. And I thought, boy, it'd be great to write this stuff down and distill this because these are some really valuable lessons, not just the things that we had done correctly, but all of the mistakes that we had made. And wouldn't it be better for other people to learn from our mistakes rather than repeat them themselves.

I guess it came to a head in our system. Physician was made chief medical officer of another hospital. And I just kind of casually passed along here's 10 things to do, like the 10 commandments, but not nearly as inspired, but just 10 things. And about six to eight months later, I guess he lost it. It was that impactful. But he lost it and said, hey, can you send it to me again? I just didn't have it. And I thought, "You know what? If I'm going to write some stuff down, let me make it into something." And it just kind of grew. And I talked to some of my colleagues and contacts. And I said, would you guys be interested in collaborating on a book? Because I think it'll be enormously boring if it's just me telling the stories. But if we have a whole chorus of voices, I think that might really strike a note.

I just had no idea how to publish a book. I just didn't want to do it on my own. I approached AAPL. And Nancy Collins was very gracious. We actually met in a Starbucks in Maryland. And she showed me some of her other publications that came out recently, one of which was a collaborative effort. And it just kind of grew from there.

I reached out to everybody I knew in my life who was a CMO or medical leader. And there was a lot of enthusiasm. I learned a lot in trying to shepherd people together for a collective effort where I was not their boss. They were not getting paid. And there was no way I could really enforce any sort of deadlines or standards. That in itself could be a book, a book about how to write a book. But it was a fun journey. I'm glad it's out there and I've received some excellent feedback.

John: Yeah, when I look through it, of course, most physicians, actually, most clinicians, of course, they like teaching, like helping their peers and so forth. And I think many, if not all, not all of the section writers or physicians, of course, you tapped into other expertise, which I like. There's a lot covered there.

And when I think about the CMO role, it's in my mind is like this iconic what does a CMO do? But everyone does it differently. Everyone does different aspects, more depending on each job. It's unique. But yet, I think you covered everything that I could think of in terms of what questions would I have if I was thinking about being a CMO or I was and I was missing something. So tell me a little bit more about the process. How did you herd all these cats and get this thing done? How long did it take you to do?

Dr. Mark Olszyk: From start to finish, it took about a year. Some of the author contributors returned their submissions in two weeks. Others took about eight months. Some needed multiple revisions, some needed none. I did recruit two co-editors, Aaron Dupree and Rex Hoffman. They helped out a lot.

I learned a lot about copy editing and all of the back office productions and placing it and formatting it. From what had existed only as a series of, I'll say, not too well organized Word documents on my desktop, to see that transform into an actual written book was pretty fascinating and eye-opening. But originally I had an idea for a structure and like all initial ideas, it went away pretty quickly.

And so I just asked people to write about what they felt that they were knowledgeable about or passionate. And the outlines of a puzzle began to come together. And then after about 75% of the submissions were in, at least an outline form, then I could actually target what was missing.

As a frustrated or wannabe classicist, I used the model of the medieval concept of the human being. The first set of chapters, the first section is about the anatomy of the CMO, the basics, the blocking and tackling, metrics and patient experience and all the quotidian day-to-day activities that were going to be the guts and the sinews and the bones.

And then we would move on to the heart, which is all about relationships and how the CMO relates to the chief nursing officer, the chief executive officer, to the board of directors, to departmental chiefs or chairs, and also their perspectives, what they think a CMO should be, or how a CMO should act to be successful in their eyes.

And then we moved on to the brain, the strategic thinking, extra hospital relationships, like how do you deal with third-party rating agencies and auditors and joint commission and dealing with the media, especially when the memories refresh from the pandemic, what if you're asked to appear on TV, on live TV, on the radio and newspaper articles how do you prepare for that?

And then finally, the soul or the spirit, which would be the transformational values and ethics and diversity, inclusion, aspirational type things. It was kind of a journey from the very basic things that a CMO would do day-to-day to the more long-range aspirational goals or values. And I think the way it's written, you can skip around. You can say, gee, I want to learn more about how to prepare for a media interview or how to relate to the board of directors. And you can go right to that section. So it doesn't have to be read in order. It can be used as a reference or it could be read as a story in itself.

John: I think it's pretty comprehensive. And probably in anyone who serves as CMO may not even be exposed to all the things that are covered. There's so much and again, because each role is slightly different. So it's awesome. One of the things I like to do when I'm bringing on an editor and author is pick their brain. So I have an ulterior motive for having you here other than just to talk about the book, although again, it's fairly comprehensive.

But just to keep what our audience's appetite here for this job because some are a little reluctant maybe they have a negative feeling about working in hospitals being abused by somebody or another, but there are good systems out there. And the other thing is being the CMO, you can make a big difference in how that organization is run. Tell me what you would say, if you were to boil it down, what are the most common areas that a chief medical officer is sort of responsible for? Maybe another way to look at it is like who reports to them, because it kind of makes me think about, okay, well, I do this because this person reports me. So however you want to answer that question in terms of the core roles of a CMO.

Dr. Mark Olszyk: I think the CMO role evolved from what was previously and still exists, usually in a hyphenated title, Vice President of Medical Affairs. That being the mechanics and the support staff for the organized medical staff. And every hospital per joint commission guidelines and through history, has had an independent organized medical staff who are largely responsible to establish their own standards for credentialing and privileging. And that was made ever more important back in the 1960s, when there were landmark cases, lawsuits, where patients began to sue hospitals. And the hospital said, hey, we have to really have some quality standards, and we're going to ask the medical staff, almost as a guild to police itself. But the medical staff have full-time jobs taking care of patients, and it's hard for them to keep the files and the minutes and the records and organize the meetings and stay abreast of all of the regulatory changes.

There is an Office of Medical Affairs in every hospital. And the Vice President of Medical Affairs, now the CMO, is largely responsible for ensuring the quality of the medical staff, making sure the medical staff leaders understand what they're supposed to do, making sure that they do it. And it's challenging in that the medical staff can be employees of the hospital or healthcare system. They can be contractors or vendors, or they can be completely independent. And when I started out at this hospital, it was about one-third of each.

To get all those different folks with their different interests aligned in a common effort proved to be a challenge, but one I thought was very fun because I had to look at their world through their eyes and also convince them that what we were doing was necessary and important and create a team not of rivals or competitors, but of people who didn't necessarily all fall into the same silo.

We're largely responsible for the credentialing, privileging, presenting those applications to the medical executive committee and to the governing body, which is usually the board of directors, making sure everyone is completing their FPPEs, their OPPEs, the ongoing professional performance assessments, making sure they're up to standards with joint commission, reviewing and knowing the bylaws. I probably know the bylaws better than anybody in the hospital. We've rewritten them 10 times since I've been here. Quality review, and then making sure that the medical staff were involved in all of the various intra-hospital, extra-hospital committees radiation safety, prescribing, that sort of thing.

What I'd like to say is that the chief medical officer is a bridge builder between the hospital administration and the medical staff, but also between the medical staff and the board of directors, between the hospital and the community. Sometimes the CMO, I found myself as the spokesperson during the pandemic especially. It was on local radio, on TV trying to break down in very understandable terms what was happening, but also bring back to the hospital and tell them, hey, this is what the community is concerned about. Here are the questions they have.

We have to be mindful of that, responsible for that. Also within the hospital, being a bridge builder between the various departments translating the needs of the hospitalist team to nursing or between medicine and surgery and sometimes refereeing, sometimes being just the host getting folks together.

But I always come back to bridge building. And again, if you look through history, through cinema, through literature, bridges always figure prominently in history, battles of the Milvian Bridge with Constantine changing the nature of the Roman Empire, Stamford Bridge, which ended the Viking Age in England. All these great events happen on bridges. Even if you've seen Saving Private Ryan, which came out, in 1998. The last ultimate scene, Tom Hanks losing his life is actually on a bridge. And if you're a fan of The Lord of the Rings, that's where Gandalf the Grey transforms into Gandalf the White. And again, Jimmy Stewart, It's a Wonderful Life. The transformational scenes occur on a bridge.

I was a scoutmaster. When the Cub Scouts become Boy Scouts, they cross over this bridge and they don't really pay much attention to it. But I gave a little speech to the parents, like, look, this is a special time, you're going from one part of your life to another. And this is punctuated by going over a bridge. Bridges represent liminal spaces, liminal time, when you're not here, or there. Bridges are a great metaphor, because they're very narrow. And they're very risky, because if you fall off one way or another, if you don't keep a straight path, if you don't keep your eyes on the goal, tragedy can ensue. And sometimes it's foggy, sometimes it's slippery. So, it takes somebody who's been back and forth a few times, who's surefooted, who is focused to to cross that bridge.

And bringing together all those communities, translating their needs and their goals and their concerns from one party to another, can be very risky. If you don't do it correctly, it can really backfire. That's why I consider the role as bridge builder. The Pope himself is the official title is Pontifex Maximus. The greatest bridge builder. I don't think the CMO is the Maximus, but I think it's a very important bridge builder, we can all build bridges. And hopefully, the CMO can exemplify that.

John: The ironic thing is that if you go back the last 20-30 years, for a while there, there weren't that many physicians in leadership positions, at least on the community hospital side you always had academic hierarchies. But I think in the 50s, up to half of hospitals might have been owned by physicians, and then over time, it just everything got split. And so I think what you just said, it's important that physicians be in those roles. So I'm glad that there are more physicians and when I started as VPMA, our hospital had never had a VPMA or a CMO. So many hospitals now do.

Building on that, tell me in your opinion, the pros and cons of being a CMO. Like I say, I have many people that are a little reluctant to make that commitment. But to me, it was a natural thing to pursue. So, what are your feelings and some of the challenges and also just what you love about it?

Dr. Mark Olszyk: Yeah, for me,this can sound a little pollyannish or saccharine, but for me, there's no downside. I guess it just fits my personality. When I was a brand new attending physician, I would see these larger forces at work in a hospital, budget, staffing challenges. And I'm like, man, I just want to be able to fix that I want to get involved in that. So it was kind of a natural course. I got my MBA so I could talk the talk and understand some of the discussions a little bit better, and then got more and more involved.

And it's just hard for me to resist trying to represent my fellow medical staff members, physicians, but pretty much trying to weigh in. If we're planning an expansion to the hospital or adding a new service line, or how do we go about on some major quality initiative, I really want to have a seat at the table and have a voice. So the best way to do that is to get into the C-suite, you get into medical leadership, develop those relationships and connections.

What I love most about the job is probably as a CMO, I'm an ambassador, plenty potentiary, I can go to any clinical department, I can go right down to pathology right now, talk to my chief pathologist. And he's got a two sided microscope, and he'll show me some slides which look like pink and purple squares. And he'll say, what is this, and I'll get it wrong every single time. Then we talk about his family. I get to know him as a person. And that builds a bond of trust, it furthers our relationship. I can walk out of there and I can go up to radiology and look at some of the images with the radiologists. And then I can walk in to the surgical suite and get gowned up and just see what the surgeons are going through, see what their day is like. Yeah, I can do the same thing for the hospitalists, for pediatrics.

I actually like being a medical student in my third and fourth years because you have a different rotation every month. It was always fresh, it was always interesting. And that's why I went into emergency medicine where you're expected to be somewhat proficient in almost anything because you don't know what's going to walk through the door. So, you have to know about pediatric medication doses, you have to know how to treat people struck by lightning or bitten by rattlesnakes or CHF in a hundred-year-old.

So, you have to know everything you have to know enough about every specialty. And then you wind up calling every specialty, sometimes in the middle of the night, but often during the course of your shift, either for follow-up or for intervention. And so, you have to learn how to speak their languages. And I just never really wanted to give that up. I didn't want to find myself just in one specialty and not continuing to learn and stay abreast of all the others.

So, I think that's the most fascinating aspect of being a CMO is, I'm pretty much given a hall pass to go wherever I want in the hospital and no one questions that. In fact, they kind of expect that. And that carries over. I get to go to the board meetings, to the finance meetings.

I can drop in on the chief nursing officer, chief quality officer. So for a person who's emergency medicine docs tend to be a little bit restless and always looking for some new stimulus, that was just a perfect job for me. So, that's my favorite aspect and one I would not ever want to give up.

John: Excellent. Now, it's interesting. We all have our own particular things that we like. I loved interacting with the board. I was on the every board meeting. I had an official presentation and I actually love spending an hour or two preparing that. I like being alone in my office and doing things to prepare for that. Whereas other people are like I want to be out there in the public. There's so many different things that one can do.

So, if there's someone in the audience who's either thinking about, well, would I like this or should I do this? Or I'm about 50% sure that I want to do this. What advice would you have for that person early in the thought process of pursuing a leadership position, let's say, rather than and it may be eventually CMO?

Dr. Mark Olszyk: Yeah, I'll approach that a little bit obliquely. So, I've given a number of leadership talks over the years and folks are always asking, well, how do I get experience being a leader? I'm like, there's no end of opportunities. Having been in the Boy Scouts, I have three sons, and they're all Eagle Scouts now. But people are always looking for leaders. And it might not be the thing you want to do forever.

But whether it's your church or civic group, the schools, they're always looking for someone to step up. And I said, boy, if you can be a Scout leader, and hold the attention of 60, 10 and 11 year olds for 90 minutes, you can do anything. First of all, brush up your leadership skills wherever you can find the opportunity doesn't have to be in the hospital.

Secondly, the hospitals are always looking for medical leaders. I've seen a ocean sea change in the last 10 years. It used to be that our medical staff meetings, our quarterly medical staff meetings, were raucous affairs, we would have 60 or 70 people there.

As our models have become more contracted or employed physicians, I guess they don't have the same feeling of being community stakeholders as when it was mostly independent physicians in the community who had been there for decades. Now the days are long. And I think after a 12 hour shift, the hospitalists want to go home. And there's also the opportunity to Zoom into a meeting. So we don't see as many people attend in person. And it's getting harder and harder to get people to volunteer to spend an hour or two, even if it's once a month, in a peer review committee, because it does take some commitment to read over the cases and then show up for the committee. And we don't stipend or remunerate anyone except for the chair or the chief.

So it's volunteer work. We're always hungry for that. I'm sure every hospital has opportunities. If you want to get involved in peer review or bylaws or credentialing, or on the pharmacy and therapeutics committee, there's definitely opportunities there. Or the foundation or fundraising, or there's lots of opportunities.

And then you begin to network. I guess the next opportunity would be just to ask your chief medical officer. You could probably shadow him or her for the day. We all like to talk about ourselves. I'm doing it right now. If someone came to my office and said, hey, I'm interested in one day being a CMO or an assistant or vice, what's the path? And it depends on the person, on their personality, what they would like to do. Everyone does it differently. Every hospital has a different set of requirements or needs. So it's dependent, but I would be very willing to talk to them. I think anybody would.

Next you could buy the book and look through that. A little selfish promotion, or you could join one of the organizations, AAPL, ACHE. States have their own chapters. Every specialty has its own chapter as well. I think there's lots and lots of opportunities. You can write articles. Journals are always looking for articles. So there's a lot of ways to just get more involved. I don't think anybody in a medical leadership position would be reluctant or hesitant just to make the time for someone who expressed an interest and wanted to learn more.

John: The other thing I found useful, I don't know if it's still the same, but talking to the CEO, hey, what's your perspective on physician leaders and what should I do if I want to get up and be part of the senior executive team? So there's tons of opportunities.

Dr. Mark Olszyk: Absolutely.

John: But we are going to run out of time. So let's talk about the book again. Let's start with what do you think is the best way to get the book? Should we go to the AAPL? Should we go to Amazon? Are there other ways of finding the book?

Dr. Mark Olszyk: Either one of those is fantastic. If you go through AAPL and you want to order a lot, there are volume discounts or you can go to Amazon, it's easy. You can type in chief medical officer or even my last name, which is not too common, Olszyk book, and it'll pop up. You'll see a couple of Amazon reviews. Unfortunately, some were written by my children. Ignore those. And if your listeners or podcast watchers do get a copy, please do leave a review. It's important. But yeah, either way, you go through AAPL. I think there are some other platforms out there, but those are probably the two most common and easiest to go through.

John: That makes sense. What if they have a question for you? Can they reach out to you?

Dr. Mark Olszyk: They can reach out to me. Yeah, I'm on LinkedIn, as you know so you can direct message me. People have done that and I've responded quickly.

John: Okay, good. Excellent. It's good sometimes just really to talk to the editor or author. Of course, you wrote several of the sections of the book in addition to being the chief editor and you said you had some help with that. But okay, well, any last bit of advice before I do let you go in terms of the future of medicine and physician leadership therein? Any other words of wisdom before I release you from this torture?

Dr. Mark Olszyk: No, it wasn't torture at all. I really enjoyed it. It's good seeing you again. And again, thank you for the opportunity. Clearly, like everything else, medicine is going to change more in the next 10 years than it has in the last two generations. So if you want to be part of that change, get into a leadership position, let your voice be heard. I think a pessimist is someone who takes no joy in being proven right. And an optimist is someone who thinks the future is yet uncertain. So if you want to help craft the future, get involved.

John: That's awesome advice again. And I think physicians do resonate with that for the most part. I want to thank you again for being my guest. I might have to have you come back and dig into one of these topics that's in the book, maybe in more detail at some point, but it's been great talking to you again. We appreciate you sharing your expertise with us today.

Dr. Mark Olszyk: Cool. Thanks, John.

John: You're welcome.

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Interview with Dr. Jennie Byrne – 354

Today's episode features my interview with the author of Moral Injury: Healing the Healers.

We explore the concepts of burnout and moral injury within the healthcare profession through a detailed discussion with Dr. Jennie Byrne. Dr. Byrne shares her insights and experiences, highlighting the evolution of these issues, their impacts on healthcare professionals, and potential solutions.

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The Evolution from Burnout to Moral Injury

Burnout has long been recognized as a significant issue in healthcare, intensifying in discussions since the 70s and 80s. However, Dr. Jennie Byrne and others have shifted the focus to “moral injury” as a more accurate description of what healthcare professionals experience.

Moral injury involves:

1. participating in or witnessing events that conflict with one's personal or professional values,
2. under directives from superiors,
3. in which high stakes are involved.

This concept, originating from military contexts, provides a deeper understanding of the profound, soul-wounding experiences of many in the healthcare field.

Personal Stories and Systemic Issues

Dr. Byrne shares her journey and experiences in healthcare, from her varied educational background to her work in psychiatry and healthcare consulting. She highlights the systemic issues that contribute to moral injury, including the intense pressures and emotional challenges faced by medical professionals.

Personal anecdotes, such as her experience with a medical board investigation, illustrate how non-workplace-related events can also inflict significant wounds. These stories underscore the complexity of moral injury, extending beyond workplace stress.

Healing Strategies and Systemic Changes

Addressing moral injury requires both personal and systemic approaches. Dr. Byrne emphasizes the importance of open conversations and peer support as initial steps toward healing. Creating safe spaces for healthcare professionals to share their experiences and feel seen and heard is crucial.

On a systemic level, having dedicated resources such as a Chief Wellness Officer and structured support systems can provide lasting solutions. Additionally, small acts of kindness and advocacy work play a significant role in the healing process, fostering a culture of empathy and support within the medical community.

Summary

Dr. Jennie Byrne can be contacted and found through her professional website DrJennieByrne.com, where you can learn more about her background, services, and resources. Additionally, she shares insights and updates on her LinkedIn profile, where you can connect with her professionally and stay updated on her latest activities and contributions. Dr. Byrne's blog, also accessible through her website, offers information on various topics related to her fields of expertise. 

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

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Links for Today's Episode:

• Dr. Jennie Byrne's LinkedIn Profile
• Dr. Byrne's Website
• Dr. Byrne's Private Psychiatry Practice
• Moral Injury: Healing the Healers, by Dr. Jennie Byrne (This is an Amazon affiliate link).
• Dr. Warren Kinghorns's LinkedIn Profile
• Amy Story's LinkedIn Profile
• Humans in Healthcare
• Monica Bean, BSN's LinkedIn Page
• Dr. Tammie Chang's Website
• Dr. Paul Dechant's Website
• Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine (This is an Amazon affiliate link.)
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 354

How to Recognize and Overcome Moral Injury in Healthcare

- Interview with Dr. Jennie Byrne

John: The concept of burnout's been around for a long time, I don't know, maybe decades if not centuries, but it seems like in the 70s and 80s, it started to be applied to healthcare just because of the intensity and the long periods of education and so forth. And I remember talking about it with colleagues, early in my career in the mid 80s. And then at some point, it started to evolve into this concept of moral injury as a better descriptor of what's actually happening. And so I thought it was about time that we just address that issue here on the podcast. So to that end, I'm very happy to have Dr. Jenny Byrne here on the show today. Welcome, Dr. Byrne.

Dr. Jennie Byrne: Hey, great to be here.

John: I'm really looking forward to picking your brain. You know, you've got the book and I was able to go through the book, but it definitely hits all the points that I'm interested in hearing about. So I'm glad to have you here and have you talk us through this. But I always wanna give my guests a chance to talk about themselves for a few minutes. I've had a very long and illustrious career, but talk about your medical training, what you do, what you do now for the most part, and then we'll get going into the topic of the day.

Dr. Jennie Byrne: Great, so I'm originally from Pennsylvania, and I don't know, I know you have a lot of physicians listening. I did not know I wanted to be a doctor when I grew up. I was a music performance major. Going into college, became a French major so I could live overseas. And it really wasn't until I came back, took a class in brain and behavior and fell in love with it. So pretty much my whole career circles around brain and behavior in some form or fashion. So I did an MD PhD. I don't know if you have any MD PhD listeners. Mudfud's out there, but I did an MD PhD in neurophysiology. Again, love the intersection of human brain and behavior. So I trained as a psychiatrist. I did my MD PhD at NYU, and then I did psychiatry at Mount Sinai. So I lived in New York City for a very long time, which was very exciting. And then I did a leap of faith down here at North Carolina, which is where I live now and I love it here. And I've done a whole bunch of different stuff. I'm always curious, I'm always learning, and I'm always saying yes to things and that's led me in a bunch of different directions. I've had a outpatient practice that I sold a couple of years ago. I grew that out over about nine year period. So I've practiced psychiatry for over 20 years. I got involved in Medicaid in North Carolina, helping design programs for integrated care, worked a lot with primary care docs, real fondness for primary care. Then I went to work as a national executive for a company called CareMore out of California. ran all of behavioral health and specialty for them nationally. So I saw what like a fully scaled healthcare organization looks like and kind of behind the curtain of what it's like to be an executive at some of these companies. But I love early stage. So that's what I do now. I advise early stage healthcare companies, a lot of which are mental health, but also value-based care and really just human behavior because that's pretty much everywhere in health, including physician behavior. You know, we're, human too, even though we don't like to admit it and we do dumb human stuff like everybody else. So that's what I focus on now. I do see patients a little bit and I have a practice that is not publicized, but for you all listening may be interesting, I take care of other physicians. So I have a really cool AI hybrid infused practice where I can care for other physicians as a psychiatrist, a therapist, or a coach.

John: That's all very interesting. And you talked about the healthcare advising that you do, I think, and there's probably at least five or 10 different things we could talk about on another podcast episode. But so I'm really glad you took the time to join us though to talk about this topic, moral injury. You know, I just, you know, like the book is what attracted me and because I had this question, a lot of bunch of questions about moral injury and what it means. And so let me, let's go to why did you write the book?

Dr. Jennie Byrne: While I was thinking about it, and I have to say, writing my second book in under a year wasn't really on the top of my list for this year. Um, but the reason I wrote it was because I, I feel passionate and I felt there was a real urgency to talk about this, now this year. And it really started where I was just having conversations with folks like your listeners or you, or, you know, colleagues, physicians, other clinicians. And maybe because I'm a shrink, people just tell me stuff, but What I heard really upset me and worried me. It's really bad. It's really bad out there Medical students are ready to leave the profession before they even get started Residents are ready to leave. People who are amazing clinicians are ready to leave people retiring early. I mean There's a reason for all of this and my kids Pediatrician left and it really threw me for a loop. I was like this was someone who was I don't know maybe late forties, early fifties, seemed to love her job and, and she just kind of disappeared and that really, you know, struck a chord with me. Like what is going on? And of course, in my private practice, I've taken care of physicians and I know that, you know, sometimes we look at our peers and they seem like they have everything together, but behind closed doors to their psychiatrist, you know, they'll tell me they're thinking about suicide or they're, they're paranoid or not to go off on a negative tangent, but you know, it's really bad. So I really wanted to figure this out and I wanted to know what was going on. So I started just doing some research, talking to people and came across the idea of moral injury from a colleague in North Carolina, whose name is Dr. Warren Kinghorn. He is a psychiatrist, but he also works with the veterans of the VA. And he also has a divinity degree. So he's got this really interesting intersection of faith, military and psychiatry. And he told me about moral injury. It's a concept that comes from the military.

John: You know, I have to admit too, that I've heard the same thing, because I'm talking to people looking about getting out of medicine. And what I've heard is that, you know, the med students will say, oh, I got to tough it out. You can't get any worse. And then they get in the residency and the burnout, whatever you want to call it, seems to be worse. And each year it gets worse, you know, depending on the residency. And it's just not very hopeful at this point, if that's kind of the way our system is built.

Dr. Jennie Byrne: So, so the definition of moral injury. So this is where kind of this topic about burnout versus moral injury. I think that words matter. I'm a psychiatrist. I think words matter. I think it's important for us as physicians and others to articulate what we feel inside. And that's particularly hard for us because our culture is one of, you know, repression and denial and all those coping skills we got to get through school. So we feel bad inside and we don't know why. So moral injury, the definition is threefold. The first is that you are part of something, do something, witness something that goes against your values, whether that's personal values or professional values. Second, that it is ordered or condoned by somebody superior to you. And third, that the stakes are high. So you can imagine all these military folks coming back from maybe combat zones where they weren't really in the line of fire, but they just really struggled to reintegrate into their lives and it wasn't PTSD and it wasn't depression. And it was really this like, I think about it as like a wound on your soul. And that's different than burnout. Burnout is more of this industrial energy concept that we're tired and fatigued and burned out and we just need to go recharge our batteries or take a vacation, do some yoga and come back and we'll be just fine. But I think it's like this wound, this metaphor of a wound really resonated with me. And so that's why I really liked this concept.

John: So that kind of gets to the root causes, I guess, is what's behind it. I mean, we have, like you said, what we're doing generally, depending on the circumstances, they're high stakes and yet we don't feel supported, we're being told what to do that may be against even what we think we should do. I know, did you get the sense during the pandemic that this was just like an overdrive?

Dr. Jennie Byrne: The problem predated, clearly the pandemic, right? Clearly, but the pandemic just put it into stark relief. And then post pandemic, there wasn't a period of healing. So the wound, if you think of, I talk in the book about staging it like a wound, the wounds were bigger, right? The pandemic really, really made those wounds gaping. And then we didn't have any opportunity to heal post-pandemic. So those wounds are still there and they're for most people still pretty gaping wounds.

John: Yeah, I think that was one of the notes to myself was to ask you to expound on that issue of like sort of using the pressure ulcer as, as you mentioned in the book, and I thought it was a pretty good analogy.

Dr. Jennie Byrne: I love the good visual, right? So I told a story in the book about one of my worst rotations in med school. I was at Bellevue training and I had to do vascular surgery because I couldn't get my top elective choice. For some reason, they put me in vascular surgery. I don't know why. And it was awful. And I got to know wounds really, really well during that rotation. And some of them were just horrific. And so this idea of what it really means to heal wounds. I think that's a great metaphor for a moral entry because you can look at a pressure, we stage pressure wounds in particular. So you kind of say, okay, stage one, there's redness, maybe a little tenderness. You can tell something's brewing in there, but if you just let it be, it'll probably be okay. To me, that's kind of the burnout, like take a vacation, change jobs. you know, something like that, that'll heal on its own. Then you break the surface, you know, the stage two, the surface is breached. Okay, well now the burnout's worse, and I don't think it's just gonna heal on its own. It needs something, maybe your own psychotherapy or coaching or adding consulting, doing something different, you know, maybe that will heal it, maybe that gives you enough to heal. And then you get to stage three where it's pretty messy. It's a pretty messy wound and there's really, you need systemic healing to be in place. You need the system, the environment around the wound to be properly maintained. It has to be clean, it has to be dry. Maybe it needs antibiotics. You know, you gotta do some stuff for that to heal. And then you get to stage four where you're, you know, you're in there looking at the bone. And that's what I remember from my vascular surgery days. You know, there were days where I was packing things where I could see the bone. And that is a whole other ball game. And some folks are at that place. And that's where, unfortunately, physicians in particular can internalize and go to really dark places. Or they can externalize and get really angry and hostile, which can lead to other problems. So I like this idea of a wound, because we can all kind of imagine that and understand healing, not fixing. I don't like the fix. I don't like burnout that we're gonna fix it. I think these are wounds, and wounds require healing, not fixing.

John: Now, the other thing that has occurred to me thinking about this topic is, and you mentioned the military, and we're talking about medicine. It's basically a workplace-related situation, is it not? I mean, I guess there might be other circumstances, but in most cases, the things that you've described are happening in a workplace of some sort. So it would seem to be something that OSHA or some other organization besides just the maybe the physician or the others affected by this, the military and so forth would have to address. What do you think about that?

Dr. Jennie Byrne: I think yes and no. I think sometimes that wound is the workplace. You know, the death by a thousand cuts, the EMR clicking and the, you know, 10 patients an hour and the blah, like, yes, yes. But there's more to it than that. And I think this is where the conversation gets interesting for me. So in addition to the workplace kind of injurious things, you know, I opened the book with a very personal, vulnerable story about an incident that somebody reported me to the medical board. That had nothing to do with the workplace. That was purely about me having to deal with someone questioning my values and my skills as a clinician, even though I was not in the wrong. And at the end of the day, it didn't really matter. But I had to go through this huge process where other physicians on the medical board had a process which wounded me. And I had to go take a class on controlled, on opioid prescribing, which was ironic because I wasn't even prescribing opioids. And when I went to that class, they flashed slides of jails where they send doctors who prescribe opioids. That was what I sat through, you know, and that wounded me at such a deep level. I can't tell you, even writing about it for the book really was painful. And my hope is that by writing and sharing the story, it heals me as well as maybe healing others who have had similar things. So Sometimes the injuries don't come from the workplace. Sometimes they come from a lack of respect in the community, the way we're treated. Sometimes it comes from our peers who injure us, whether intentionally or not. Sometimes it comes from just the difficulty of managing chronic illness with so much information that we can't possibly keep up. Our human brains can't possibly keep up. Sometimes it comes from trying to manage this increasing intersection of things like gender and politics and sexuality and like culture and like, you know, and it's really hard. It's not like it used to be. I have a grandfather that was a doc in the 40s, you know, and I have his little black bag sitting over here. You can't see it. Things were a lot different back then and it's just not that way anymore. So I guess the answer is yes to the workplace but also other things which we don't talk about as much.

John: Well, that in my mind also kind of points to, let's say being sued, a lawsuit, I would think. That adds like a whole another layer of pressure.

Dr. Jennie Byrne: And I'm sure you have people listening who probably have had these things happen and they've never told anyone. I didn't tell anyone about my medical, I was so embarrassed, ashamed, you know, pained by it. I didn't even tell anybody. So I'm sure there are folks listening who've had, like you said, a malpractice suit, a patient complaint, a medical board issue. You know, people don't talk about these things. I'm sure that people out there have had this happen and I'm sure that it was wounding to them the same way that it was wounding to me.

John: This is a little bit of a left turn just for a moment, but one of the things that you just mentioned is I did an interview some time back about sham peer review, where the peer review process was actually being sort of misused to get someone off staff, destroying their career and so forth. I don't know if you've experienced, if you've coached, if you've treated people under that, that could be almost unbearable kind of pressure.

Dr. Jennie Byrne: I have. And it's something that unfortunately that's kind of part of our culture, you know, the old school medical culture, right, of being a resident and being shamed, publicly shamed in front of others as the way to learn. That's just kind of part of our culture and it doesn't make it right. But we still do that to each other. And it's not, I don't blame, I don't blame the other physician doing it because when you're in a negative, stressed burned out, time crunched, injured mindset, is very easy to injure somebody else, whether intentionally or not. So I don't blame them. I have deep empathy for them as well, because I know that under other circumstances, they probably wouldn't do that to their colleague.

John: Well, I think we should shift gears and talk about what are the solutions or what can we do to at least ameliorate, if not eliminate this problem eventually. What thoughts do you have on that?

Dr. Jennie Byrne: Well, one of the best news is, I know this is kind of a serious topic, but one of the best news is that just talking about it is part of the solution. So we know this from the military. Just talking about it, being able to identify that feeling that's inside of you, being able to share your story in a safe place, not that the other person can change what happened to you, but feeling seen and heard by a peer is incredibly healing. So, talking about it, having the words to describe what's going on, and having others in our ecosystem listen to us and giving them the language to talk to us about what's going on. Because I can tell you, I work with a lot of administrators, executives, tech people. They're not greedy, evil people. I know that's the narrative that's convenient. No, it's a convenient narrative. And sometimes it's true, but mostly they're trying to do the right thing and they could make money more money doing something else too. So they lack the understanding of what it's like and we don't help them. We don't give them the language to talk to us and we act like we're perfect. So I think just talking about it and giving others the tools to have real conversations is something which actually doesn't cost any money and is incredibly healing. So that's the first thing. Yes to the system change. Yes to the like designing clinical products for clinicians, understanding the psychology of clinicians. Yes to all of those things too. And then I think, you know, I write about in the book, I do believe in butterfly effects, especially from one clinician to another. Or as a patient, like I'm a patient, we're all patients too, right? It's not just us as clinicians, we're all patients too. And I always tell someone, you know, when you see your clinician, tell them thank you for all you do. Just do that. Like small acts of kindness, they don't fix the wound, but they can really help. So the more small acts of kindness and empathy that you can show others or call your peer. I had a psychiatrist that was a mentor of mine send me an email today. He said, I read your story in the book and I can't believe I was so upset by what you wrote. And he said, I had something happen to me like that. And I never told anyone. And I was like, I can't believe, you know, and just so that sharing and that kindness, especially from one peer to the other. So taking that five minutes to write that email to your peer, like, you know, I was in a really tough spot the other day and you came and you told me this, that really helped me. Or if you see your colleague who's struggling, say, I don't know what's going on. It seems like something's gone on and I'm here if you want to chat with me or what, you know, like these small things I believe really matter. So in addition to the bigger systemic change, I do think there are things that we can do right now that actually don't cost any money.

John: You know, as you were talking, it occurred to me something else that I've experienced for times in my life where there were issues. One was a support group for divorced men and I for a reason that I won't disclose now, but I mean, I attended Al-Anon and you know, those are supposed to be private and not anonymous per se, but they're not discussed outside and it's supposed to be supportive and all that. Have you ever seen that ever used with physicians?

Dr. Jennie Byrne: Yeah, so for example, some resources to check out for your audience, so Amy's story, She is a PA by training. She has a company called Humans in Healthcare, and that's exactly what they do. It's clinician groups where they share stories. Sometimes they grieve together for patients that have died or their own losses. She's doing amazing work. There are a ton of coaches out there. So if you're a nurse, probably don't have nurses listening, but. There's a woman, a nurse, Monica Bean, who does this for nurses. She's a nurse by training. Trying to think of some others. I could, you know, have people reach out to me. I can share some of these resources, but there are lots of groups of physicians coming together. There's one woman that focuses on moms, physician moms. And I did forget to mention one thing that's important for your audience to know that. One of the ways you can heal that I've heard from my interviewer interviewees is through advocacy and through feeling like you're part of the solution. So if folks are thinking about advising other companies, taking a leadership mentorship roles or being an advocate for even if it's just a single patient or another physician or that really can help you heal too. So If you find a way to have an impact that's not just your day-to-day with patients, often that's quite healing.

John: Well, I just took a quick peek back at the index of the book, Moral Injury, and I think a lot of these things are really addressed there in much more detail, so I would encourage everyone to get the book. So let's talk about that. How do we get the book, and where do we find it, and so forth? And how do we find you?

Dr. Jennie Byrne: So if anyone else has written a book, you'll know that Amazon is where all the books are. So the book is on Amazon as well as my first book which is called Work Smart. And if anybody is interested in a book club or sometimes we'll go do a talk where we get a whole bunch of books, just reach out to me if you're interested in anything like that. In terms of getting a hold of me for questions about advisory work, again, LinkedIn is a great place to just send me a message. I do have a website, drjennieburn.com, which is kind of a list of some of the stuff I've done. And then I'm gonna share with this group. I don't share this with all the people I do podcasts with. I have a small private practice that is not advertised where I care for other physicians, whether that be coaching, psychotherapy, or I think 12 states I can do medications as well. And that is called constellationpllc.com So you can also just reach out if you need help. If I can't help you, I'll do my best to find somebody else in your state or wherever you need help.

John: I'm gonna put a dig in here against the industry right now just for a second, only because I think I read in the book that the number one cure for moral injury is not resilience training. Is that my off base there? But because I get offended when they tell me that, that's the solution.

Dr. Jennie Byrne: I think that's happily falling out of favor this year. My statement in the book is I believe clinicians are inherently resilient. I don't know how on earth anyone gets through all that training without being resilient. I mean, seriously. So that doesn't mean we're not human and we need help. But I think if my point is if a clinician of peers, they're not resilient, you should be asking what's going on.

John: Hmm, because they've reached -they've gone way beyond the point where it's not dangerous, you know. Have you seen any big organizations? This is what I keep looking for because I know of physicians who have addressed burnout, moral injury, you know as a coach or something and they'll spend a lot of time with an organization But have you seen any put into place something that is lasting and is effective over time?

Dr. Jennie Byrne: So I think the most effective long-term solutions come from leadership when they put, when they basically put money into it. So when a leader, a CEO or something, you know, creates a wellness group, like a chief wellness officer, and really devotes significant resources to it, that's probably the best long-term solution is to actually have people internal to the organization who are driving it forward. So I, one of the people I talked to was Dr. Tammy Chang. So she's been doing this for a long time. She's a great resource to reach out to. She's at a health system as their chief wellness officer and she's just a wealth of information. And then there's some others who do like private interventions, but company solutions. So Dr. Paul Duchant does that. So he's a good resource. He and Diane Shannon wrote a really good book on physician burnout, which I recommend as well. So there are folks who do it. Now, he leans a little heavy on the operational end of things, and I'm more the shrink. I really think that the healing has a lot to do with our hearts, not just operations. So we, I don't wanna say we disagree. We don't disagree. I just, I think we undervalue the emotional component of change. And I think it's, it's actually easier than we think it is sometimes to connect with someone at that like heartfelt level, and make a real difference in their life. I don't think it always has to be fixed the EMR fixed. I mean, yes, do those things, but and have that human connection that heart part because I think that's how we heal. It's not just our bodies, right? Like our hearts have to heal.

John: Very good. But I appreciate you taking the time and sharing all this with us, giving me a little more clarity on exactly what it is. And like you said, the metaphor, the pressure ulcer, trying to explain it to people. And you gave me a little hope there at the end that there are people that are making a difference in this area. So I'm going to have to let you go soon. We're pretty much out of time. But I guess, do you have any last words of advice for, let's say, the listeners who might feel... I mean, one of the reasons they're looking sometimes to change their career or their life is because they're having this particular problem. Any other advice for them individually to how to find a solution for themselves?

Dr. Jennie Byrne: Yeah, the main thing is really you're not alone. There are a lot of us out there, we're feeling the same way, we may not be talking about it, and you're not helpless. A lot of us, we get in that negative mindset, we feel very helpless, you're not helpless. You have tremendous skills, you're in tremendous demand, you've come a long way, right? Like you have more control than you think you do, and there are people out there who will help you. So I guess my only precautionary thing would be, leaving the practice of clinical medicine altogether may not heal all those wounds. So I still see patients, it's important to me and I do advising for a living. So just a little like, you know, it may not heal everything just to leave. So if you are interested in doing clinical practice and doing something else, you can do both. You don't have to give up one for the other. It may not fix all your wounds just to leave clinical medicine because it's probably, there was a reason you went through medicine in the first place. And that part of you is important.

John: I used to focus almost entirely on like, what are the options for just getting out? But I'm convinced now that there's so many options for staying in. If you can kind of carve out the things that are making your life miserable or that you're just reacting to in whatever way you're reacting to, get rid of the bad parts, keep the good parts. And there are more and more ways of doing that, even though the employment has been going up, I think we're reaching a point where you can do DPC and whatever, other forms of practice and just set boundaries and write your list of your must haves and really start to take control. But what you said earlier, people don't even realize that they're in the midst of burnout or moral injury. So they don't really look at it that way and take a step.

Dr. Jennie Byrne: And one final thing would be too for those who are a little later in their career, a little older like me, sometimes being a mentor, being a support for younger early stage folks, that's really rewarding too. So if you decide I just can't go back to clinical practice and maybe you wanna do advisor or other work, but you can still find ways to support those who are coming up who maybe have a little more energy. And maybe you can prevent them from feeling so wounded so they can go and do that good work. That can be a really wonderful way to stay connected with clinical medicine in a way that maybe supports you in whatever stage of your career that you're in.

John: Awesome. Thanks for that. Thanks for taking the time to talk to us today. I really appreciate it. I advise everyone get the book, go to Amazon, Moral Injury. Let's see, what's the byline? Moral injury?

Dr. Jennie Byrne: Healing the healers.

John: Healing the healers, okay. I had that written down here somewhere, but it's really good and it's pretty comprehensive. I mean, there's a lot in there starting from recognizing it to even potential solutions. So it's a great resource. Okay, thanks Jenny, I really appreciate it. And hopefully maybe we can have you come back and talk about some of the other things you're up to at some point.

Dr. Jennie Byrne: Thank you for having me and to everyone out there listening, be well, please take care of yourselves, please. Please get help if you need it.

John: All right, bye now.

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The post How to Recognize and Overcome Moral Injury in Healthcare appeared first on NonClinical Physicians.

Interview with Dr. Luissa Kiprono – Episode 334

In today's episode, we explore the entrepreneurial journey of Dr. Luissa Kiprono who recently decided to start a new telemedicine service. She is a maternal-fetal medicine specialist who transitioned her traditional practice into telemedicine with the creation of TeleMed MFM.

The interview delves into the pivotal moments, challenges, and strategic decisions that led to the establishment of this innovative healthcare model. During our conversation, Luissa describes the importance of self-discipline and adaptability when making such a significant commitment.

Our Show Sponsor

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

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

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

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

Our Episode Sponsor

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

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

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

Evolution of TeleMed MFM: Dr. Luissa Kiprono's Entrepreneurial Journey

Dr. Luissa Kiprono faced challenges when her previous practice closed unexpectedly, leading her to choose the less-traveled path of starting TeleMed MFM. Motivated by a desire for independence and the vision to extend high-risk pregnancy care globally, she committed to a telemedicine-centric approach.

Her strategic decisions included establishing TeleMed MFM as the first to integrate telemedicine into maternal-fetal medicine services so completely. The practice adopted a hybrid model, combining consulting and procedures. Dr. Kiprono started by partnering exclusively with a prominent organization in Kansas City.

Push, Then Breathe: Dr. Luissa Kiprono's Memoir and Thought Empowerment Platform

Dr. Kiprono also described the other major project she has been working on for the past few years, her memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,“ revealing her experiences from the time she was a 19-year-old immigrant to becoming a successful American doctor. 

Summary

To connect with Dr. Luissa Kiprono and learn more about TeleMed MFM and her upcoming memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,” you can reach out to her at (210)-660-9906 or via email at DrK@TeleMedMFM.com.

Visit the TeleMed MFM for information on the practice. For updates and insights, explore Dr. Luissa Kiprono's thought empowerment platform at drluissak.com and sign up for her newsletter by emailing hello@drluissak.com. Stay tuned for the release of her memoir on February 13, 2024, available in hard copy, audiobook, and Kindle formats through major retailers in the United States.

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

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

Links for Today's Episode:

• TeleMed MFM
• Dr. Kiprono's New Book Website
• Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor on Amazon
• How to Be a Leader and Humanitarian Improving Maternal-Fetal Health – 204
• How Do I Generate Awesome Income with Telemedicine Services? – 222
• What Is the Best Way to Leverage Telemedicine? – 181
• What Is the Latest Telemedicine-Supported Specialty? – 173
• Debra Blaine's Coaching Page

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 334

- Interview with Dr. Luissa Kiprono

John: Today's guest first appeared on the podcast in July of 2021, and since then a lot of things have changed. She's a maternal fetal medicine specialist who's now providing care using telemedicine. I definitely wanted to hear about that. She's a University of Tennessee physician executive MBA graduate and holder. I just remind you of that because that's one of our sponsors. And she's also the author with a soon to be released memoir. This should be fun and interesting. Welcome back to the podcast, Dr. Luissa Kiprono.

Dr. Luissa Kiprono: Good morning, John. I'm very excited to be here. Thank you for inviting me back to your podcast, Physician NonClinical Careers.

John: Yeah. I think it was very inspirational last time, what you were doing then. And now some new things have happened, which I find extremely interesting and again, inspirational. Let's just get right into it. For the listeners, if you go back to episode, I think it was 204, you can learn more details of Dr. Kiprono's background and so forth. But to get us started, just go through a little bit of a list of what's happened since we talked back in 2021, if you would.

Dr. Luissa Kiprono: Okay. In August, 2022, right at the conclusion of the COVID pandemic, my organization pediatrics decided to shut doors of the practice I was leading at the time, Texas Perinatal Group. That came as a surprise, I have to say. And at that time, I really came at a crossroads, whether to sign another agreement with another organization or to take a different road, that less travel road, and that is to open my own practice. And really I realized how exhausting has been to invest in someone else's dream and in someone else's endeavor. I said I might as well just start investing in my own. So that is how TeleMed MFM was born.

John: Now, was that from the very get go going to be heavily involving or solely involving telemedicine type of interactions?

Dr. Luissa Kiprono: It was started a hundred percent with a vision to become telemedicine. I have to say that I had plenty of experience in the matter due to the way COVID kind of pushed us with medicine and medical practices. But also I was the first practice in both CompHealth agency, which is the Locum Tenants Agency, and in pediatrics medical group that as a maternal lymph fetal medicine practice would hire and maintain telemedicine in their services. Not only during the pandemic, but also up to the day that the practice closed in August, 2022.

I did have experience in the matter, and I think that's where it kind of started. I was like "I know what to do, I know how to handle it, and it works." But it was scary. I have to tell you, it was exciting and it was scary, to both start a new practice in my fifties and also to start not only just any practice, telemedicine in maternal fetal medicine.

John: Yeah, anytime you make a change like that, it's both. You've got all the business aspects of it, and then also like, "Okay, how am I going to deliver care? What's the best way to do it?" And in telemedicine, I have zero familiarity with. That's like how in that environment you deliver your services. You're to be commended for that and I think when you do that, while it's very stressful, and it probably takes some time and some money, as you mentioned, you have more freedom and independence. So, it's a trade off.

Dr. Luissa Kiprono: Yes, it is. You are your own boss. You also are doing telemedicine, you practice medicine from the comfort of your private office, home office. But I always give award to the wisest, to the newly grads, and the newly grads are excited. Let me tell you. This generation is like, "Oh, yes, this is so exciting, we're going to do telemedicine" and so forth. It does take a lot of self-discipline, and it does take a lot of fortitude to not cut corners because it's easy. Just think about what used to happen during COVID. When Zoom meetings start, you're like, "Oh, I got all this freedom. I can also check an email. Oh, I can also do this. I can also do that." So here you are at the end of the meeting, you're like, "What exactly the meeting was all about?" Those same dangers come when you do telehealth. But it comes with a price.

So you do have to be self-disciplined, you have to say "How it would be if I am the patient and the physician that can renders care on the other side, doesn't pay attention, and they don't give me the best care that is because they do it through telemedicine or they miss something?" You do have to have respect, and also you be yourself like your watchdog, "Hey, I got to do it, this is my job." It's only the place that's different. The care, the connection with the patient, the services render for the patient. They should always be there just like I would be physically in the same office with them.

John: One of the things that attracted me to want to talk to you about this, that prompted me is that I get questions all the time from I'll just say specialists. Some of them are surgeons, some are medical subspecialists. And in their minds they're like, "Well, yeah, primary care, urgent care, that's fine. Telemedicine is very common. People have low risk, colds and respiratory, and they can get treated over the phone or the telemedicine service for a UTI or something."

But it's a different type of telemedicine when you're a consultant. And I've seen surgeons and other specialists do this, but never have I talked to a perinatologist that has done this. And so, my question is, tell me a little bit more about what the interactions are like. Since you have really a close relationship normally with the obstetricians as well as the patient, are you interacting with both and do you do some consults with an obstetrician in which you don't actually talk to the patient? Or are they always involving the patient directly?

Dr. Luissa Kiprono: It is very involved. Communication is the key, at least when it comes from me. My advice is always, always communicate. I'm an over communicator. I speak with my obstetrician, that if I make any changes to the care and we switch gears, I call my referring OB provider, and I say, "Hey, this has come up. This is how I recommend." Then I speak with my patients after I discuss it with the obstetrician. Just imagine everything the same like you would go in a doctor's office. The only difference is through the screen. We are talking live here doing a podcast. Same thing I'm talking live with my patient. Patient comes in, whether it is a video consult from the comfort of their home, or it's a telehealth consultation that is in the practice in the hospital or in the MFM practice where the patient is scheduled to come.

The patient gets an ultrasound. I read the ultrasound, and then we have a consultation. And I conveyed the findings to the patient. We discuss just like you would talk face-to-face with the physician. Medical history, go through the entire finding of the ultrasound, counseling, render an assessment and discuss the plan. And then I finish a consultation through the EMR and sign it. And that's it. It's very, very doable. It goes very seamless. There will be things. Think about it when you are in the office. Does your computer need an update? Sure. Is your computer maybe going to crash and you need to reboot? Yes. Do you have EMR when you go and work in a brick and mortar office? Yes. Or in the hospital? Yes.

All those are happening. The only difference is I am not physically with the patient in the room but my sonographer are by my nurses. If I need to send the patient to the hospital, I call the nurse, let her know. I call the obstetrician and the nurse calls the hospital and the patient shows up just like that.

There are a couple of procedures that obviously I cannot do like amniocentesis, DBS. Those are for prenatal diagnosis of congenital or genetic abnormalities. But that is when the physician who is physically in the office comes into place. And that brings me to my next point, hybrid practice. The hybrid medical practices of healthcare are here to stay because you have to have the hybrid. Think about if you have a team that some of them do just consulting, but some of them do also procedures. People who do procedures have to be during the procedure in that room, in the operating room, or if I have an amniocentesis, the physician, the MFM that is in the office that day, they will go ahead and they take care of that for us.

John: Ah, okay. I've talked to people that are doing telemedicine as primary care. They're constrained by where they're licensed, states they have to be licensed in multiple states, although I know some of that during the pandemic was a little loosened up a little bit. It was a little easier to get. Do you focus on certain locations? Is it kind of local, even though it's telemed or is it countrywide? How does that work?

Dr. Luissa Kiprono: I am licensed in multiple states. Every state has its own slight differences. Now we have Compact. Compact made it easier and more streamlined to be able to be licensed faster in different states. I personally hold multiple licenses, but right now, as a matter of fact, my practice has signed an agreement, an exclusive agreement with a very well-known large organization in Kansas City, Missouri. TeleMed MFM is providing maternal fetal medicine services virtually for their patients.

John: Okay. Yeah, that kind of segues into my question I had about how do you get the word out and where do you find business? And so, it sounds like at least one way is to identify a particular organization, work directly with them. Tell me a little bit more about that.

Dr. Luissa Kiprono: We did a lot of marketing, but when I say marketing, it's not like you've got to put an ad in the paper or an ad in YouTube. That doesn't work that way. A lot has to do with your expertise. Maternal fetal medicine, it's a very close knit environment. The MFM subspecialty really was formed 50 years ago. 50 years ago next year. It is a relatively new specialty. And there are about 1,300 of us, but only about 900 to 1,000 that practice full-time. Now, if you take that to 340 million United States citizens and 77 million women between the age 15 and 49, which we consider the fertile age, you can imagine how big the need is, how tiny the group that we are in of specialists.

To go back to your question, when it comes to marketing or advertising, I started working for this organization through an agency, through my company. My company was contracted by the agency to work for this organization, and they learn how I work, they learn my practices. They were very impressed with my ethics and my expertise. They say we just would like to contract directly with you and do partnership between your company and our organization. Without saying, I was extremely excited. And we actually just executed the partnership last month.

John: Nice. Excellent. How does the lifestyle for you doing your practice this way, have you stuck pretty much to the same kind of hours? Or is there more flexibility doing it this way? That's one of the things that attracts certain physicians to telemedicine because they don't have to travel, obviously. It's very much more efficient. Tell me how it's affected your lifestyle.

Dr. Luissa Kiprono: I worked the same hours that I were before. Actually, I worked more. I work more now than I worked before. When you look at any company, any business that you start, I want to make a caveat, you will work a lot more in the beginning to start it. It just has to. It's just thinking about building momentum to have this business going. But I do work the same, if not more, because when I'm done with my clinical duties, then I start working the administrative duties after hours for my practice. And also now with my adventure, you do have to have the electronic capabilities. I do have literally six monitors in my office. And so, I high grade monitors. I have to have a high speed internet, camera video equipment, audio equipment. That is my livelihood. That's my job is to read ultrasound. I just don't have small screen laptops and have large screen monitors because I read ultrasound about 90% of the time with or without consultations.

That are the requirements that have to be in place in order to do this kind of endeavor. Yes, it is more relaxed because I work from my home office, from my private office. But again, going back to that same caveat that I made the beginning of the podcast, be your own watchdog. Stay disciplined. Because it's easy to become relaxed because you are at home. Well now, you're still at work, you are not at home, you are at work. Home is you go to the other room after your work is done.

John: I'm not exactly sure how your practice worked before. This question might be stupid, but I can imagine especially in MFM, maybe you're doing the ultrasound yourself physically, or you have ultra-sonographers that you typically work with. And now I'm assuming that you're actually getting a lot of different ultrasounds that you're reading from different ultrasonographers maybe. How is the quality? I know you've got the technology, I'm just wondering if it's affected your ability to feel the confidence in what you're looking at.

Dr. Luissa Kiprono: It is an excellent question. It is not a silly question. As a maternal fetal medicine physician, we do have highly trained sonographers. They are not radiologists and they are not OB-GYN sonographers. They are sono techs who spend about 18 months to specialize in fetal ultrasounds. When it comes to that, I had other offers prior to this and they said, "Well, you're just going to read the ultrasound, that an OB tech is going to do it." And I said, no, it just doesn't cut it because I am not there to be able to troubleshoot and I need certain images.

What happened is the maternal fetal medicine, sonographers are going by strict guidelines, imposed by AIUM. They are ARDMS certified and fetal echo certified. Think about this. Just like everything else, if you have a radiologist that reads general X-rays or general MRIs, then he'll have a radiologist who specialized in fetal MRIs, and then you go further, radiologists that have specialized in neuro fetal MRIs. That is so important for me to be able to have this at my fingertips, to trust my staff. I have to trust my sonographers because they are my eyes. And let's say they didn't get the image. I would just ask them, "Hey, can you get another image for me?" And they know exactly what I'm looking for.

Otherwise, the learning curve is very steep. Especially if I'm not there, the trust is not there. Just like you said, the liability is very high on my end because if they miss something, then I miss something, then the patient doesn't get the counseling they should have. The follow-up is not the proper follow-up. And then at delivery, the baby doesn't get the care that they should have been anticipated otherwise.

John: Yes, we don't like surprises in medicine and we really don't like surprises in maternal fetal medicine. I happen to have two daughters that are pregnant at the moment. I'm hearing a lot of things third hand. And one thing is not an ultrasound that's not given the right answers. That was very interesting. We're going to run out of time soon and we're not going to run out quickly because I have a whole other topic I want to talk to you about, but I do want you to go ahead and give the website for the telemedicine MFM business just in case there's physicians listening who may need your services or want to learn more or even contact you on LinkedIn if they're starting something similar.

Dr. Luissa Kiprono: Sure. My practice number is (210)-660-9906. My website, you can find me at telemedmfm.com. And my email is DrLuissaK@TelemedMFM.com. If you go to my website, you can always find there the contact info. And please send me an email, ask me a question. I'll be very, very happy to share my knowledge with you and my expertise. Both how to launch a telemedicine practice, and also how to navigate through the intricacies with both medical but also insurance and licensing.

John: Excellent. I will put all those in the show notes, of course, and even in the email that I send out about the episode. We'll have all those links and a few others that we're going to talk about. But in the process that you've described, you've been busy starting this, but in the meantime, you've also had another activity. I guess I wouldn't call it a hobby, something going on, and it's about a book, a memoir. And so, we definitely want to hear about that as well. When did that start to come up as something you wanted to do?

Dr. Luissa Kiprono: Five years ago I embarked on this journey writing my own memoir. This memoir takes the reader on a journey that I have started back in 1987 as a 19-year-old woman immigrant who came to America for two months. I came to America to meet and know my father. And that turned into a lifetime. And without spoiling the drum roll and transferred the book, it's been a journey. It's been a journey of a lifetime. And that journey of 15 years really takes me and it takes the reader all the way to my graduation date in 2002.

And at this time, I'm thrilled to announce the debut of this first nonfiction book. Its name is Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor. At the same time, I'm launching my platform, it's called Dr. Luissa K. And it is a thought empowerment platform in both leadership and overcoming trauma and thriving by achieving one's own potential. Date of release is February 13th, 2024, and it's going to be launched at all the major retailers in the United States in hard copy, audiobook and Kindle format.

John: Nice. Is this like a traditionally published book through a large publisher?

Dr. Luissa Kiprono: It is a hybrid publishing. The publisher is Greenleaf Publishing Group.

John: Now, we always have questions to address with authors and writers. It's not easy, it's not easy to organize. What method did you use to write? Some people will do blocks three or four hours at a time. Other people will maybe work on a weekend. How did you actually sit down to create this book?

Dr. Luissa Kiprono: I started the first chapter of this book 35 years ago in Romania. Then I wrote that first chapter and I put it aside because life got in the way big time. About five years ago, I found myself recording every morning for about half an hour. I was very intent into doing it. And it lasted about two weeks. When you run a practice, at that time as I was running that huge 52 employee practice. And then also you have a family, children. Life, let's call it. I said I really want to write this book, but there is no way I can write this in my lifetime at the pace I'm going. I started looking at ghost writers and I partnered with my book coach and ghost writer. And that is how the book was finally written through both our collaborations.

I want to tell you something that we all physicians and really some non-physicians, but usually type A personalities, we feel that we must write this book like as if I have to physically write it. But what I can tell you is that the thought out there is that it's actually smarter to work with a book coach and a ghost writer than trying to do it yourself.

It's like delegating. Think about if you are in your office and you're trying to do everything. Trying to vitalize somebody, take fetal heart tones, put the patient in the room, do the ultrasound, be the physician, check out the person, and start that again. How long can you last? You won't last. It's not sustainable. Probably you'll last about three days.

Same thing here. Can you be a full-time physician and write the book and be a mom or a dad and do it all perfectly? No, you can't. You have to A) prioritize, B) work smart. It still took us a couple of years. The book was finalized in December, 2022, which was last year. And then in March was accepted for publication by Greenleaf Publishing Group. And it's now in print, the audiobook is on the way. And it's happening. It's really, really close. The hybrid publishing it's very, very convenient. They work very well in many, many ways. It's hybrid. You do have to put your buy-in and you have to do work and also financially you will have an interest in it.

However, they will put all the wills in motion for publishing and marketing the book. You tell them how much or how little you want them to do, and they will do it for you, and you will approve everything along the way. I would be more than happy John to have a separate podcast to just talk about the process. It is an amazing process that I knew nothing about, like literally nothing. It's unnerving. And I can say it's like rapid fire sequencing. We have to do this, we have to do this, we have to do this. Why? It has to be approved by you, the author. Because at the moment, they accept you and then you sign the agreement with them. We'll also sit down and figure out when do you want this book to be released? And now everything starts dominoing backwards because you are on a schedule. And everybody's going to know that your book comes out, in my case February 13th. Well, we don't want to arrive on February 12th and realize there is no book to be presented.

John: Yeah, absolutely. If I'm not mistaken, and I've talked to other authors, some of the benefits of doing the hybrid is you definitely have more control. If you do a big publisher, one of the big three or four, number one, you lose pretty much all control and they're going to tell you what title they want and how the chapters are going to be put. And it takes a lot longer. And in a hybrid, I think you get to reserve a little bit more of the income that comes into. I'd say most of the guests I've had that have written books have gone that route. Now I've got a few that will self-publish, but I think most everybody's going the route you've gone, especially with one of the really good top-notch hybrid publishers. Boy, this sounds fantastic.

Dr. Luissa Kiprono: Well, just to put a little bit of data out there. 80% of people want to write a book. Out of which 1% finish writing the book. Out of which 1% get accepted for publication. Even with all that, there are about a million books coming on the market every year in the United States, and 4 million all comers, meaning 1 million that are accepted for publication and four millions that includes also self-publishing a year. It's crazy. That's just amazing to me how much influx it is.

John: Well, congratulations.

Dr. Luissa Kiprono: Thank you.

John: Here's what we're going to do. You're going to have to remind me about a week or two beforehand so we'll promote that at that time. And we can obviously promote it through this podcast, which it'll probably be the beginning of January when people see this and hear this. But definitely do something special for that February date. That'll be fun. Tell us where to go to look for that.

Dr. Luissa Kiprono: Okay. To learn more about my book and my platform, my website is www.drluissak.com. My email is hello@drluissak.com. If you sign up for my newsletter, you're going to get it in the mail, but also bring up the updates, any news that come out. And also just to put it out there, just in case anyone wants to join me, February 13th, that will be a destination book launch.

John: Okay. You're going to have to send me the specifics on that so I can put that in the show notes.

Dr. Luissa Kiprono: Sure, we can do that.

John: All right. I think we are getting out of time at this point, but this has been a very interesting episode. We learned a lot about how to implement telemedicine, the pros, the cons, some things to keep in mind. Definitely some good advice. And then about a memoir that's coming out... From the time this is posted about a month after this is going to be posted. So, maybe we'll have some people follow you for that as well. Any last words of advice to our listeners about anything that we've talked about today before I let you go?

Dr. Luissa Kiprono: What I would like to say is that my advice regarding personal growth, follow your heart's desire. If there is something that keeps you up at night, an idea or a goal, whether it is opening a practice, starting a business, or just open up a flower shop. And if that is what you really truly want, if when you talk about it, your eyes are sparkling and your heart starts beating faster, do it. Just do it because you'll never regret it. And don't be afraid that you're going to fail because you know what? You are never going to know unless you try something, especially when you really, really are passionate about it.

John: Thank you for that advice. Very inspirational. You've got this book pretty much in the can we would say. Are you thinking of doing another book later? I'm going to ask that question. Or are you going to rest for a while and think about it?

Dr. Luissa Kiprono: I am going to rest for a while. These last few years have been quite eventful, especially last year with the practice and the entire book publishing. So I will take a break and let's just see. I won't smell the roses for a couple before I decide where am I going to move, what's my next steps are in life.

John: Yeah. Okay. Well, I'll be watching from the sidelines and if you do something else really interesting, I'll have you back on the podcast. Thanks a lot for being here today, Luissa. It's been very fun and educational really.

Dr. Luissa Kiprono: Thank you. I really appreciate the time. And thank you for inviting me for this conversation, John. Happy holidays.

John: You too. Bye-Bye.

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In today's episode, Dr. Latifat Akintade describes how to generate more money with less hustle as she tells us about her newly released book, Done With Broke: The Woman Physician’s Guide to More Money and Less Hustle.

Dr. Latifat is a Gastroenterologist and founder of The Money Coaching School for Badass Women Physicians. She combines her interest in personal finance, her training as a certified life coach, and her passion for physician wellness.

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 that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Building Wealth as a Physician: The Hustle and Broke Mindset

As physicians, we often find ourselves caught up in a hustle of energy where we're always searching for the next big thing to make money. This mindset can be detrimental, leading to a fear of missing out and causing us to focus on short-term gains rather than building wealth in the long term. However, with focused energy and strategic planning, there are many ways to build wealth and achieve financial stability.

This mindset can be changed. By acknowledging our past experiences and focusing on simple, timeless principles of investing and building wealth, we can overcome our fear of financial instability and live confidently with our money working for us. By cultivating new habits and a wealth-building mentality, we can live our lives without ever being afraid of being broke again.

Done With Broke: The Woman Physician’s Guide to More Money and Less Hustle.

Dr. Akintade wrote a book to share her wisdom on wealth building and money management, which is accessible to many people and inspired by her own journey. It advises people to identify their risk tolerance and invest based on the seasons of life they are in.

For those who are busy and don't have much time to actively invest, passive investments such as the stock market or partnering with trusted people could be a good option. Diversification is crucial, and not just in stocks and bonds. One should consider conservative and less conservative investments, short-term, medium-term, and long-term.

Summary

With her extensive knowledge and experience, Dr. Latifat is a trusted expert in the field of personal finance for physicians. She has been featured in several media outlets, including KevinMD, and has spoken at conferences and events on the topic.

If you are a woman physician looking to take control of your finances and achieve financial freedom, The Money Coaching School for Badass Women Physicians is the perfect place to start. With Dr. Latifat's guidance, you can achieve your financial goals and live the life you've always dreamed of.

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

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

Links for Today's Episode:

• Dr. Latifat Akintade's Website
• Link to Done With Broke: The Woman Physician’s Guide to More Money and Less Hustle
• MoneyFitMD Podcast
• Dr. Latifat Akintade's LinkedIn Page
• How to Run Your Business and Master Your Finances – 176
• How to Prepare Financially for a Career Pivot with Ryan Inman – 071
• Do You Want to Live Life and Practice Medicine on Your Own Terms? – 237
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 300

Top Advice for Generating More Money with Less Hustle

- Interview with Dr. Latifat Akintade

John: Well, I love to bring guests on who are doing non-traditional or nonclinical jobs, side jobs, side gigs, people doing interesting things and particularly a physician who has written a book or is getting ready to release a book. And so I want you to welcome Dr. Latifat Akintade today. Welcome to the show.

Dr. Latifat Akintade: Thank you so much for having me here. I feel privileged to be here and almost feels like an imposter because I don't think about myself as being cool enough to be considered nonclinical by the way but I'm excited to be here. Thanks for having me.

John: You're welcome. That's going to be fun. You're an ideal guest for us here because we're going to learn a lot from you. And then at the same time, I just love promoting physician's books because writing a book and getting it published is not an easy task. And of course, a lot of my listeners like to learn about side gigs and you talk a lot about making money and some of the traps that physicians fall into.

So, before we get into that though, why don't you tell us about yourself, your story and what you're doing clinically and nonclinically. And then we'll get into some of these more pertinent topics related to your book.

Dr. Latifat Akintade: Absolutely. Thanks everybody. I'm Dr. Latifat. I'm a GI Doc. I'm a mama of three little ladies, ages five to 10. They keep me really busy and alert and I'm also the founder and creator of MoneyfitMD, which is a platform that is focused on helping women physicians create true financial and life freedom, to be honest with you.

I've been talking to people more recently because of the book that's coming out and it's really gotten me to reflect even a little bit more on my journey than I may have had in the past. And sort of going to how did this journey even start? How did I get here? How did I even think that financial and the life freedom was something that was important to me? And I think for me it goes back to, I moved to the US about 25 years ago. I moved from Nigeria with my siblings. Our parents stayed back in Nigeria at that point and we were staying with family members that were kind enough to house us and all those sorts of things.

I went to undergrad in LA, I went to UCLA and then med school in San Francisco at UCSF and then New York Mount Sinai and then fellowship at UC Davis in Sacramento. And what that meant was I was dragging myself around student loan and debt and all that stuff. And I literally hit some of the most expensive cities, which means that I was hecka broke at the end of all this stuff.

But at no point did I actually think that money was important. At no point did I really sit down to think about it because I was just busy with my own family responsibilities. When I was in med school, five of us, my siblings will live together, the youngest was in high school. And so, the focus was on making sure she did okay in school and didn't go to school without clothes on and all those other stuff. I had a lot on my plates. So I wasn't really thinking about money per se.

It really wasn't until fellowship that I'm so grateful I had this moment where I just saw my attendings who are amazing, smart, intelligent, loved humans, but I just noticed that I was seeing that people were having the slump on their shoulders where they were tired, not advocating for us completely in a way that we felt like they could advocate for us. And it almost seemed like they had given up and they were part of a system where they're just doing what they were told to do.

And for me, my path to medicine, my journey here wasn't like smooth sailing. There were sacrifices that I made, there were sacrifices my family made and people that I loved. And the worst thing for me was that I was going to be in medicine and not have a choice in how I lived my life.

At that point I knew I was going to be a GI doctor with an emphasis in Crohn's and colitis and the best settings that I wanted to do that in at that point was going to be academia or a large hospital system. So, I knew that I was probably not going to be my own boss. Somebody was going to tell me what to do and God forbid they tell me what to do with my patients and I hated it. I don't agree with it and I think I'm stuck. That was going to lead to me regretting my journey and literally burning out because that's not who I am.

And so, for me that was my motivation that okay, how do I always make sure that I have a plan B? How do I make sure I figure out my money stuff? And so, my journey literally to money started seven years ago where I decided that my fear of living a life of regret, my fear of not having a choice in how I took care of my patients, was the biggest factor for me.

And so, everything else, like my fear of not knowing money, my fear of how hard it was going to be to learn money, all that became silent relative to my fear of living a life that was dependent on anybody else and not being able to live in the way that I wanted to practice my life and be a parent. And so, that was my story of how I decided that money was something I needed to fix for myself at that point.

At no point did I think I was going to teach people because I knew zero. I didn't even know what I owed. I didn't know how much student debt I had and none. I didn't have a 401(k). I knew zero. I didn't even know what a 401(k) was. And so, all this idea about being able to teach people didn't start until years later when I realized that I'd really figured out how to understand money in a way that made sense to me in English in a way that was didn't feel like a conflict to my goal of serving and helping people and hopefully creating a better world.

And that's when I realized that okay, more people like me needed to learn money, more people that were not like me needed to learn money so that we could have more things to fight about because that makes life more interesting. And that is what led me to now doing what I do with MoneyfitMD through the podcast and also through my community for women physicians.

John: Very nice. When you're talking, I'm thinking back. I remember after being in practice for three or four years and I realized, I looked at my partners and we were in a private practice. We have no pension plan. I knew what an IRA was, that was about it. I didn't know about stocks, I didn't know about mutual funds. So, I spent the next two or three years learning everything I could. And just to get to the point where we could just start at 401(k), let's at least do the basics.

I think as physicians we just put all that stuff off. We go into huge debt and then some of us get more interested in others in learning this stuff, which obviously you have spent a lot of time doing and helping others, which once you become a teacher then you really learn more because you know you have to know what you're doing. That's a really interesting story. Okay, I'll stop talking. I need to get to some practical things because I want to pick your brain a little bit and help our listeners here. First tell us about the podcast. What kind of topics do you do and do you have guests, do you do solos?

Dr. Latifat Akintade: Yeah, absolutely. I have a mixture of solo and guests. What I talk about is all things money and mindset, which means anybody that I know, especially women physicians or physicians in general, to be honest, that are doing interesting things, creative things when it comes to building their own money and also the mentality and habits that helps build wealth. And that could be decreasing burnout. That could be health in terms of our physical health, could be mental health. It's wealth in the way that I think about it, which is expensive and goes beyond money.

But the episodes are either myself or I have someone come in and talk about it. And the way that I think about it, it's building wealth from the inside out as opposed to outside in, which is how most people think about it. People think "When I get to the certain number, I will finally have wealth, I will finally be wealthy, I will finally be considered rich." And for me, I believe that's an internal job that we start first and then that trickles into external where that affects how we spend, how we invest, how we spend our time, how we practice our medicine so we can actually live a life of wealth and not waiting for some magical light at the end of the rainbow when we're going to be able to consider ourselves wealthy.

John: Okay. So, let's get into that a little bit because the title of today's episode also includes a part of the title of your book. I guess that's one thing. In a nutshell or how would you create more wealth with less hustle? Because those are two things, more wealth but less hustle. That I would like to know how you would do that.

Dr. Latifat Akintade: Absolutely. I'll start with the hustle part because as physicians we go from this, "No one has taught us about money, we focus on everything else, but how to be the CEO of our finances" to now, "Okay, I want to figure out my finances and everybody says I want to make money, I want to diversify." And there is this energy, that hustle energy is very different from working hard and diligently. I'm very pro working hard focused diligently, but what I'm not pro is this hustle energy where it's like eyes darting everywhere trying to figure out like, "Okay, what am I missing?" It's like this FOMO, fear of missing out energy where it's okay, is it crypto today? Is it gold tomorrow? Is it this little thing tomorrow? And what that does is, number one, it's almost like when you think about being in a basement with your phone and it's trying to find reception. That kills its battery faster, right?

That's the same thing that happens when we have that hustle energy because our energy has not been spent productively moving forward. It has been spent focusing on what we don't have, focusing on what the next secret is. What the key is, is there are so many different ways you can build wealth. There is almost nothing you can do that will not lead you to wealth if you continue focusing on it diligently and spending your energy going forward as opposed to that darting energy.

So, that's what I focus on because again, we are busy as physicians, we're taking care of patients, we're taking care of our families. When we start to think about how we can build wealth, it's important for us to be strategic. Focused energy, not looking for short term gains only, but understanding that wealth is something that is built in the long term so that we can stay the course regardless of what's going up and down and be able to create it.

Because whether you're doing e-commerce or you opening your own business or you investing in other people's business or you do in real estate, all of those individual ways can lead to you having a lot of money if you're willing to focus your energy and be able to build behind it. So, that's a hustle part that I think is important for us to talk about.

And then the broke part of it, the way I think about it, broke is a mindset. Let's look at the landscape of medicine today. Let's look at burnout in medicine. Let's look at the fact that physicians are practicing in systems and structures that doesn't always have the focus of the patient and physician wellness in mind. If we look at that and we are smart humans, we've sacrificed so many years to be where we are today. There is no question about our commitment, but the reason why we stay in situations that is not in line with what our patients need, what we need is because of that subconscious and sometimes conscious fear of the fact that "If I leave this, I'm not going to have money. I don't want to be broke."

So you don't have to be broke to decide to be done with broke. And that's why I didn't call the book "Done Been Broke" because this is not for people that are been broke, it's for people that have that subconscious or conscious worry that they will be broke. And I want to make sure that I'm being understanding of where people are coming from because your audience are very genius.

There are some people that grew up having lots of money, there's some people that grew up not having any money. And if you're someone that grew up not having money or you grew up in a family where conversations about money is not being had, it is completely logical and understandable that you may be living your life more in fear of the thought that you maybe broke at some point.

And I think part of it is acknowledging that part of your story and knowing that everything that we are today is the result of everything that we've learned throughout our journey. But now it's time for us to be conscious about, "Okay, what do I now want to create? Do I want to train myself to understand that I can learn how to do money, I can learn whether I like budgeting or not? I can learn how to see my money as seeds that I can plant into trees. I can start to see my money as something that can serve my life's purpose as opposed to something that's just happening by default because I'm not telling my money where to go. I can learn how to invest in a way that is simple and diversified." And simple can be as simple as the index funds that we're just talking about right now, about how I can invest in a way that is diverse, simple and successful. Do I want to work for my money? Do I want my money to work for you?

A lot of these are simple, timeless principles that we were never taught in medicine and has nothing to do with what the climate is or what the sexy thing that people are talking about when it comes to investment. If we can learn the foundations, if we can learn the principles, if we can change our own mentality and get new habits that build wealth in the long haul, we will live our life not being ever afraid of being broke ever, because we know how to do it forever.

John: Okay, that is a lot to think about. I'm just going to paraphrase here. Basically I hear you saying your relationship with money, the fear of going broke, some of it is just mental and saying, "Look, we do have a lot of control. We're physicians, we make decent money." Does it get into the podcast and possibly in the book, does it get into "Should I just become an investor and a startup?" That sounds a little bit extreme as opposed to, "Let's be conservative, let's save so much money, let's put this money in really logical places." Tell me more about the philosophy that you follow.

Dr. Latifat Akintade: Absolutely. I don't go into specific details of this is what you should invest in specifically, but what I do tell people in the book is the way that I think about it. And the way that I think about it is deciding what your risk tolerance is. What your risk tolerance when it comes to investment is. Also trying to decide based on the seasons that you're in in life, what makes more sense for you to invest in.

If you're a busy resident or you're a busy fellow or you're a busy attendant with four kids at home and you are a single mama may not be the best time to necessarily start thinking about doing something else actively. It may be time for you to think about passive things like again, set it and forget it in the stock market or now learning how to partner with people that you can trust to the best of a human ability and you can leverage their own time because they may have time to look into investments. How do I invest with them passively?

Even if it's things like syndications. How do I do things? Do I want to be a hard money lender knowing that now this is more risky? It may have a higher return but it's more risky. But the main thing is choosing how to diversify not just in terms of stocks and bonds, but also diversify in terms of conservative, less conservative. Investing for short-term, medium-term, long-term. Those core principles are the ones that I believe that when we learn, then the answer becomes really easy for our own individual specific scenario based on what season we have, what season we're in, our risk tolerance and those other things.

John: Okay, that makes sense. And that's an approach that pretty much everybody can take and not be afraid of making some of those decisions. Well, I have a friend, he's retired now, but I swear, he only put cash in the bank and he never invested in stocks, never invested in real estate. And I'm thinking, "Boy, you're going to have to save half your income for the next 30 years if that's going to be your approach."

I know you're covering a lot of these things in the book, so tell me more about the book. Maybe there's some things in there that you haven't mentioned yet and then we need to learn how to find the book. So, tell us about the book and what led you to write it and how did that go and all these kind of questions.

Dr. Latifat Akintade: Absolutely. And I love that you shared about your friend because there's an example that I shared in the book specifically about that. It was a fact that if I'm trying to go from California to New York, there are many ways to do it. I can go by train, I can drive, I can fly. My condition at the end is going to vary based on what route that I take and how quickly I get there is also going to be affected. And in my opinion, flying is a compound interest. It's a gift that we've been given. So I do talk about that in the book.

And honestly, the reason why the book came about was I have this knowledge that I'm so grateful for and I take credit for some of them, but there's some of it that I don't take credit for. I believe it's just a gift to be honest in terms of the people call it sage wisdom. I have a lot of sage wisdom when it comes to money and wealth building in general and life to be honest with you.

And so, when I think about the people that I can't help, physically in my own time limitation as a human being, that is going to be less compared to the number of people that can grab my book, that can get an audiobook and get some of this wisdom at a really cost effective 20 something dollars or so is what the price is going to be. And a lot of us are driving, we're taking the train and all those things and those are the times where we can start to build our own knowledge and start to change the foundation of our knowledge. So, in my opinion, the best way to be able to make this accessible is what you're doing through podcasting and getting information to people easily. And that's why I decided to write the book.

The funny thing is, that I'm going to share this because there are people that are going to be listening to your podcast that may want to do different kinds of businesses or follow different pathways and maybe thinking that I'm not equipped for it, I don't know how to do this. I've never done something like this before.

And that was my story even with my business with MoneyfitMD but even with the book that I'm doing. I thought I was a bad writer. For the longest time I had the story in my head that I don't know how to write, I have too many memories of being in college in the bathroom crying over English papers. And so, to think about writing a book seemed impossible, but what I try to remind people of is we are physicians and we are expert evidence for ourselves of someone that can go from knowing little or nothing about a topic and become a master of that topic. Because we've done that with medicine.

So if we can take that same skillset and reproduce it into anything because the only reason why we may not be able to do it or be good at it is because we haven't focused on it. It's literally just as simple as that. If we focus on it, we will learn it. So, whatever skillset that is for you, whether it's to write a book, whether it's to start a podcast, whether it's to start investing, whether it's to start your own company, the only reason why you may not be good at it yet is because you haven't focused on it. And all you have to do is focus, learn, find people that can mentor you like this podcast you're listening to, find communities that can help you, whether it's money you want alone. Find those people that speak your language and that can help you. And for me, if you take anything away at all from the book and this interview of me and my journey is the fact that there is literally nothing we cannot do. We just need to decide and fuel that journey and it will happen.

John: Excellent. Now, one thing I have failed to do at this point is I haven't told people where to find you. So, let's start with the website. You're at moneyfitmd.com, correct?

Dr. Latifat Akintade: Absolutely. You can find me on the website.

John: And they can find pretty much everything there I'm thinking.

Dr. Latifat Akintade: Exactly. You can find the information for the podcast and the book is going to be on Amazon, but you can get it directly from my website as well.

John: Okay, good. So we can go to the website, I got it pulled up right now and there's the book. We could get the book there or we could go to Amazon and I'll have links for that as well. Of course, you can look up MoneyfitMD podcast on any podcast player, correct?

Dr. Latifat Akintade: Absolutely.

John: Okay, that's good. We know where to find that. Now the book is not actually out as of the recording. It will be out when this is released. It'll probably be out for about a week. So, we need to pile on and get as many by five or 10 of the books. You got to get a little bit of action going on Amazon and other places so that our physician friends can do well with their books.

You've told us a lot so far. This has been very interesting. I usually go to last minute advice for our listeners, but I think they're going to be a little more motivated if you could share with us what we talked about before we got on here in terms of what you're doing right now at a high level because I think they'll get motivated if they understand what you're up to right now.

Dr. Latifat Akintade: Absolutely.

John: If that's okay.

Dr. Latifat Akintade: No, that's definitely okay. I am currently in the middle or at the beginning of a year-long family sabbatical that I'm taking with my family. We have three kids, my husband and I. And honestly, this was not like a dream list thing. A year ago I would not imagine that I was going to take a sabbatical. I love medicine, I love my patients, I have the best colleagues. I was not burned out at work. I just decided that I wanted to take time away for my family to explore the world. And that's what I did.

And the only reason why I could give myself that gift was because of the investment and the prep that I had done even before I knew that this is going to be something that I wanted to do. And that same thing is learning where my money is going, diversifying my income so that I'm not tied to clinical income only.

And if you are a physician, this is so, so important for all of us because in order for us to be well in anything, we want to have the freedom to be able to do what we want and that's a gift that we can give ourselves. But right now we're encourage out, I wish I could show you my view, but the light is so bright outside, the camera doesn't do a good job, but the goal is just to slow down. In my opinion, we're not taking a vacation, we're just leaving through the world. So we've been in New York/Jersey. We're in Carissa, we're doing Aruba, we're doing Europe, we're doing Nigeria, we're doing Southeast Asia. And I'm just excited about who my kids get to be at the end of this. I'm excited about who I get to be at the end of this. And I'm also excited about what the practice of medicine is going to look like for me when I go back next year.

John: Oh, this is fantastic. And I'll tell you what it reminds me of. I read a book, I don't even remember the title of it. But one of the principles of the book was one of the things we do in life is we create memories. And what is the value of a memory? It's hard to put a dollar value on that, but one part of the value of a memory is how long you have the memory. If you make a memory when you're 83 years old and you die when you're 84, that memory has a very low value. But if you make memories in your 30s and 40s, we have to carve out that time to make some of those memories, whether it's at home or elsewhere. And I think that's what's impressive to me is you are making so many memories over this next year that they have an immeasurable value.

Dr. Latifat Akintade: Thank you for sharing that. I hadn't heard about that memory in terms of the length and that is going to motivate me to gather even more memories. And honestly for me, I've always had the intentionality about life because I truly believe that our life is a gift and all of us went through the pandemic and a reminder that life is a gift.

And for me, I lost my dad about two years ago. He died at an age that you would call three years after what you'd consider a traditional retirement age. And it wasn't like that changed me dramatically, but it just became another evidence of the fact that it's not our money or our life, it's not our career or our life. It is both, both of those two things.

I think I need to make a recording on my podcast about this, but I really believe that we're mentally five lifetimes in one, which is where we give ourselves the permission to reset sort of our seasons of life, whatever that is. Maybe the season I'm going to be a hundred percent full-time, maybe the next season I'm going to be part-time, maybe the next season I'm going to do something else. And just give ourselves the freedom of living life fully and like you said, creating even more memories for a longer period of time for as long as we give to be on this planet. So I love that you added that on.

John: Well, you're welcome. And I had never thought of it that way until I read that book. I have done that a little bit. I'm not going to get into that. But I think looking back, those memories are still there and I really enjoy thinking and sharing those with people when I do.

Again, moneyfitmd.com, that's the website. The book is called "Done With Broke: The Woman Physician's Guide to More Money and Less Hustle." That sounds like a good combination there. More money, less hustle. I will still ask you if you have any last words before we let you go today.

Dr. Latifat Akintade: No, I want to say thank you for what you do for bringing guests on here to share. The way that I think about it, there's a lot of noise about medicine and whether it's worth the debt that we get and all the sacrifice. And I honestly am a firm believer that it is. It is if we truly understand the gift of our degree. Our degree is not a terminal degree. Whether you're MD, MD-PhD or whatever you are, in my opinion, our degree is a potent seed that we can grow into any avenues that we want.

My hope is that more physicians will start to see that, so that when and if we decide to stay in clinical medicine, we know that we're there by choice. And that way we are living our life and we get to serve our patients at the highest level. So, thank you for doing what you do and thanks for serving us this way.

John: I love that, what you just said. Again, I thank you for being here on the podcast today, Dr. Latifat. It's been fun and we'll talk again soon, I'm sure.

Dr. Latifat Akintade: Thank you so much for having me here.

John: Bye-bye.

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Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so 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.

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

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

The post Top Advice for Generating More Money with Less Hustle – 300 appeared first on NonClinical Physicians.

In today's episode, John invites Dr. Katrina Ubell back to discuss her business and new book How to Lose Weight for the Last Time: Brain-Based Solutions for Permanent Weight Loss.

She began her journey from practicing pediatrician to master-certified life coach while taking a break from practice. She found that she quickly connected with medical professionals struggling to lose weight. 

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 that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Dr. Katrina Ubell's Journey

Dr. Ubell's battle with her own weight started in medical school, where physicians typically learn to “eat when you can, and sleep when you can.” Like many physicians struggling to maintain a healthy weight, she found that her clients were emotional eaters who consume food even when not hungry.

The approach she uses addresses feelings, thoughts, and beliefs differently, as often the root causes of our poor eating patterns.

Beginning with one-on-one coaching, Katrina developed her flagship program “Weight Loss for Doctors Only,” which has been very successful in helping members to achieve a harmonious relationship with food and the permanent weight loss they seek.

How to Lose Weight

Dr. Ubell shares the strategies for weight loss from her flagship program in her recently released book “How to Lose Weight for the Last Time.” The key, she says, is not to be found in unrealistic diets, unsustainable supplements, or demanding workout regimens, but to follow the brain-based strategy outlined in her book.

Dr. Katrina Ubell's Advice

 Once I understood how to asses and act upon my true physiological hunger, the weight started to come off…

Summary

You can find Dr. Ubell's book, and the audiobook version that she recorded, on her website at katrinaubellmd.com, and at major bookstores. After buying it, you can enter the order number on her website to gain access to a free 90-minute workshop called “Ensure Your Weight Loss Success.” 

You can also find information about her podcast “Weight Loss for Busy Physicians,” and several free downloadable resources on her website.

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

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

Links for Today's Episode:

• Dr. Katrina Ubell's Website
• How to Lose Weight for the Last Time: Brain-Based Solutions for Permanent Weight Loss
• First, Optimize Your Attitude – Interview with Dr. Katrina Ubell – 035
• How to Be an Author and Nonclinical Career Expert with Dr. Heidi Moawad – 063
• How to Build a Platform and Create Authority with Dr. David Geier – 049
• How to Become an Author, Consultant and Online Authority with Dr. Tom Davis – 047
• How Physicians Can Use Online Courses to Boost Income – 239
• How to Get Started on Your Nonclinical Online Business
• How to Select the Best Online Business Niche – 110
• NewScr!pt

Download This Episode:

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so 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.

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

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

The post Inspiration from the Author of ‘How to Lose Weight for the Last Time’ – 279 appeared first on NonClinical Physicians.