Transcription PNC Podcast Episode 393

Valuable Resources For Doctors Exploring New Job Possibilities

John: As I mentioned a minute ago, today I'm going to share some of the free and paid resources that you might find useful. Some are freebies that I created, others are paid courses that I or a colleague have created to help you on your career journey. They include a few written resources, other in video format, and one that's actually a recurring live event. I'll describe each one, explain if there's any cost involved, and I'll read off the link to where it can be found. And of course, to make it easy for you, I'll place all of these links in the show notes for today's episode. So let's just jump right in.

Here are some of the valuable resources for doctors exploring new job options. This is actually not everything I've ever promoted or shared with you, obviously, but these are some of the major ones. I'll start by telling you about my academy. It's called the Nonclinical Career Academy. It's found at nonclinicalphysicians.com/joinnca. It has about 30 courses and lessons. Some are single videos, some are multiple. And it has a pretty good cross section, especially if you're just getting started, overviews and introduction to certain topics that maybe you're not familiar with, certain careers, certain side jobs, and forth.

And then there's a fair number in there to talk about how to work in the hospital environment as a medical director and a VP and the CMO And forth. So there's a lot in there. And actually, if you're, if you join the NCA as a member, you get access to everything and you don't have to go through everything.

And when you sign up, there is a little bit of an instruction there about how to navigate the different courses that are available, depending on your interests. So you can look at that. You can do a one-time purchase where you get everything forever. And even as I add things like new courses, which I haven't added many in the past year, but I am still putting out weekly Q&A sessions, which could get added to that about once a month. Those are short 10, 15, 20 minute Q&A sessions where I address one particular aspect of one particular career or approach to pursuing a new job or things such as that.

You can get that for one price, or you can do a monthly membership. That monthly membership currently is at $57 a month. And that's there so that you can get in there and just spend two or three months, four months really intently going through it and then just dropping off. Or you've got the one-time purchase so that those fees don't continue forever if you're taking your time.

Now you can use for the monthly membership a code FIRSTMONTHFIVE. That indicates that you can get your first month membership for only $5. And you can look around and make sure it's right for you before continuing your membership. You can always leave, if you're on the monthly membership, you can leave at any time. That's the first thing I wanted to mention. It's been there for several years and I am still adding some content to that, and there can always be more in the future.

The next one is my free Five Career Guide. Now that's a 19 page, I think. Yeah, I think it's kind of like an eBook, 19 pages or so long, and it's free. And you can get that at nonclinicalphysicians.com/freeguide. You see a pattern here, right? All these are going to be nonclinicalphysicians.com/ some keyword. This one's nonclinicalphysicians.com/freeguide. It's all one word. It's a 19 page eBook.

It's one of the first things I put together. It provides advice for pursuing a career as a physician advisor for utilization management, as a physician advisor for clinical documentation integrity, which most hospitals have these days, as a medical informaticist, as the VP for medical affairs, which definitely is a step up. Those are all obviously in the hospital setting. And then I also added one which is very commonly pursued and is very popular, and that's how to pursue being a medical writer.

On each of these topics, there are some multiple resources, really. I'll look through the first one here and kind of tell you, this is kind of what how I've broken it down. I'm talking about the supporting circumstances, which might help you get into one of these, the typical job listings, the steps to take, and then some useful resources for each of those five. And that's a good starting point if you're interested in one of those jobs. Now, if you're not interested in that, and you're talking about something in pharma or in health insurance or life insurance, or who knows, then this would not be all that helpful.

Then let's step to the next one. Again, this is one I produced several years ago, and I keep adding to it. It's called 70 Nonclinical Careers Checklist. It's the 70 Nonclinical Careers Checklist. It actually has 73 specific unconventional and nonclinical jobs for physicians on it. So it's growing. I think I've caught all the major ones. And it can be found at nonclinicalphysicians.com/70jobs. You have to give your email address to pick this one up and the previous one as well.

But in this one, it's a list. It's about three or four pages long. It's got 73 specific unconventional and nonclinical jobs for physicians. And most of them, the vast majority of them have some kind of a resource listed that goes along with trying to get this that would support your ability to learn more about it, and maybe to even find some resources to pursue that particular job.

Most of those resources are either a professional organization, or some other useful website that will provide support for you as you narrow that list down to one or two or three, and start working on how you might pursue that job.

All right. The next one is actually a course. It's one single course within the Nonclinical Career academy that I mentioned earlier. And it's very popular because it's a type of job that's very popular because pretty much any physician can pursue it. And it is a segue into the pharma industry. If you don't have any other way in, you don't have a background in research or anything like that. It's a course called Build a Rewarding Lucrative Career as a Medical Science Liaison. And you can find that at nonclinicalphysicians.com/MSLcourse. That's all one word.

This one does have a price tag. I think this is probably the most expensive on this list. It's a little bit under $400 unless sometimes I do specials. But as I said, it's a popular job. And by going through this course, you'll learn the proper lingo, you'll learn where to look, you'll learn about all the resources that I've identified for helping anybody become a medical science liaison.

You could be in an unhappy, unfulfilling job that you're starting to really burn out from. And by going through this course and implementing the things in there within six to eight months, you'll be ready to apply for your first job as an MSL. That's something that's been out there for several years.

And then speaking of courses, here's a course by someone other than myself. And it's one I've been promoting recently. It's closed right now for membership. However, this one is reopened at least twice a year. And this is called Expert Witness Startup School. It's at nonclinicalphysicians.com/ewcourse for expert witness. This is Dr. Gretchen Green's very popular course for becoming an expert witness consultant.

I'm not going to go into great detail here. But if you're in clinical practice, and if you're not averse to working with attorneys, it could be very fun for those that are in the right frame of mind. The course is excellent. It's extremely popular. It consists of four weeks with content for each week and then live sessions with Gretchen, a lot of supporting materials. And if you are thinking, "Okay, I'm a little burned out here", what you can do sometimes is start to do witness, expert witness consulting. And it generates enough revenue that you can cut back on your clinical time to the point where you might be doing I'd say 10 or 20 hours a week of expert witness startup, expert witness work, and then cut your clinical down by at least 20 hours, you'll still end up making a lot more money because the expert witness work is much more lucrative.

I throw that out there because it's been around for over five years. Several of my followers have taken the course and I know that hundreds of other physicians have taken it and successfully started their own expert witness consulting business.

All right, the next two actually are resources that have been created by Dr. Heather Fork. The first one is LinkedIn for Physicians. For many, many careers that you might pursue, whether clinical or non-clinical, a LinkedIn profile is important to create and to maintain. And you can try and struggle through setting up your LinkedIn profile by yourself. And LinkedIn does a fairly good job of walking through it.

But this course by Heather Fork is really a comprehensive LinkedIn course specifically for physicians. It tells you in there how to build your LinkedIn profile so that you'll be attractive to people out there looking for physicians with certain skills and physicians interested in certain types of side gigs and or moving into a nonclinical or unconventional clinical job. If you don't do this right, you can be lost in the mix. But if you have a good LinkedIn profile, as Dr. Fork recommends, it's very useful and very effective for finding those jobs.

Now, the link for this is nonclinicalphysicians.com/linkedIn. That's actually one of the affiliate links that I have on this list. That means that I get a small commission for sending you to her. The same is true for the Expert Witness Startup School and for Dr. Heather Fork's other course, which I'm going to describe in a minute. It doesn't affect the course cost, whatever it is, at whatever level that Heather's asking. It's exactly the same. It's just that because I can send her someone perhaps that she couldn't reach by herself, I get a small commission for that.

It's definitely the best course for learning how to use LinkedIn for physicians. There are other courses out there for the general public, but she even gets into how to network using LinkedIn and specifically as it relates to physicians networking for nonclinical careers. So, it's extremely helpful.

The next one, again, is Dr. Heather Fork's Carpe Diem Resume Kit. This is really an awesome course for creating a really excellent resume. When you're looking for an unconventional or nonclinical job, you usually don't use a CV. You use a resume. It's structured differently and it does take some skill in putting a resume together. And her course walks you through the process and it consists of digital guides and video tutorials, templates, skills builder exercise, because there's certain types of words that you should use. And she goes through and kind of explains the types of words to use, keywords and so forth.

She has actual samples of resumes and a whole lot more in that. That's called the Carpe Diem Resume Kit. And this one can be found at nonclinicalphysicians.com/resumekit. And again, very reasonably priced and will really help you to get that resume in a position where it's going to clearly meet the needs of the company that's recruiting you and the headhunters that are looking at your resume and including all the keywords and other things that make a resume stand out from everybody else's.

All right. The next one is another course called the Medical Affairs Associates Program. It's found at nonclinicalphysicians.com/mantra because it is produced by Dr. Paul Hercock at Mantra Systems. And that's in the UK. This one is rather unique. It's a medical affairs training course suited to physicians and other medical and scientifically trained professionals looking to explore certain jobs in the medical device regulation industry in the UK and then the EU.

Paul Hercock has been on the podcast two or three times. Several years ago, there were some new requirements put in first in the UK and then the rest of the EU where there are medical device regulations. I think that was in 2002. Paul created this short course to teach you how to understand the regulations and how to help to support that. And partly because he hires people to do that. Even if you're in the US, you can do this for Mantra Systems. And for a small price, you can take the course. And then once you've taken the course and demonstrated that you understand the MDR and associated regulations, you can then apply for a job at Mantra or elsewhere for that matter. Again, that one is not an affiliate. There is a price, it's a very small price for what you get out of it. I would recommend you check it out at nonclinicalphysicians.com/mantra.

Well, those are the main ones. But the last one I want to mention before I go, and I do usually promote this on my website and in my podcast episodes, but we're still doing a weekly Nonclinical Physician Q&A. Those currently are being held every Thursday at 02:30 P.M. Eastern, 11:30 A.M. Pacific. I'm in central time. I'm basically logging on at 01:30 in the afternoon on Thursdays, my time. And we hit almost every single week unless I'm traveling or something.

You can access that going back to that nonclinicalphysicians.com/joinnca and looking for the Q&A sessions themselves, which you can sign up for only $5 a month and you'll get three to five posts a month with particular Q&A related to nonclinical and unconventional clinical careers. In fact, another way to access that directly would be go to nonclinicalcareeracademy.com/p/weekly-qa. I'll put that link again in the show notes, but nonclinicalcareeracademy.com. You go there and just scroll down to through all the courses and you'll see the Weekly Q&A and you can sign up and then for very nominal fee, you'll have access to those. And then you can actually join us live for the Q&A.

Probably the easiest way to find out about those is to go to nonclinicalphysicians.com/dailyemail, and you'll be sent emails on a regular basis. They won't be daily, however. Again, that's nonclinicalphysicians.com/dailyemail.

That's it for the free and low cost resources. I wanted to mention today, I'll probably do another episode like this a few months down the road with some of the other resources that I've come across over the years. But for all of today's links and a transcript of today's interview, go to nonclinicalphysicians.com/valuable-resources.

If you like these interviews, then please leave a five-star rating and a review on your favorite podcast app, such as Apple Podcasts or Spotify and also you can share it with a friend.

Transcription PNC Podcast Episode 392

Exploit Your Medical Knowledge In New Ways

- Interview with Dr. Robert Cooper - Part 2

John: Well, let's go back to another one then. I think that's one that you've been doing for the most amount of time and have spent the most cumulative hours on, and that's the disability file reviews. So how did you find that? Did someone point you to it? Were you just searching around the internet? I mean, how did you find that? What should we do if we're interested in it? Because I have looked into this a little bit myself. And I'll just say, as a family physician, they're usually looking for a specialist. I mean, there's a lot for neuro and physiatrists and that, but I know they're out there for primary care at times when they just need the general. So any tips on that? What's it like? How long does it take? We'll kind of do that first, and then we'll move on to the next one.

Dr. Robert Cooper: Sure. The first gig, I think, was through the New England Journal of Medicine. Like I said, I answered that in the New England Journal of Medicine. Small company, I went out and learned how to do it, and they trained you to some degree—not terrific. And I started doing it. I like it because it's almost like taking raw materials, right? Looking through a file like a detective and trying to figure out what's going on. What you're trying to do is determine the level of impairment of a claimant—we call them claimants. There's terminology involved, but you have to know what you're doing when you're going through this. It's a method for actually sorting out the file, figuring out where it is, where the pieces are, how to put it together, and the different components.

I have not found really good training in this, honestly speaking. I took a course in it, but it didn't help me—I had done it before. So I think really providing nuts and bolts is important. I worked for three companies, but there is another way to find it. I'm not gonna mention the specific companies, but I will say that NAIRO—N-A-I-R-O, the National Association of Independent Review Organizations—has companies on there. Now, here's the important thing. Here's the important point for viewers: don't be undersold, okay? A lot of these companies are paying rates that are ridiculous.

What's happened in the disability world, unfortunately, is that they're moving a lot of stuff in-house to do full-time physicians come on board, and they're taking it away from some of that. I found that that's happened over the last five years. I told you before, I worked 10 hours a week for a major insurance company as an independent contractor. So I was doing that in addition to the other vendor companies. It was just a lot of work—10 hours a weekend. But I learned a lot from doing it. Then they stopped that and moved it in-house. So you have to be careful.

There are companies out there who ghostwrite reports. I'll just tell you that what they do basically is—they write the whole report up, and you just sign it. And they pay you very little money to do it. They're trying to save money. That is something you want to avoid. Okay, I won't mention any specific companies except to say that you don't want to do that. You want to really be legitimate about this. This is important. If you're doing this kind of work, it's important to be fair and impartial and to look at the work and come up with a conclusion that's reasonable. And that's what they want, actually—insurance companies want. Unfortunately, they're constrained like everybody else financially, so they're looking to cut corners. Unfortunately, that doesn't work too well when it happens.

So you have to be careful what you're getting yourself into. It's very important to pick and choose who you're working for carefully—not just in terms of what they're paying but also if they're ethical and so forth.

John: So does it seem like that's one of the things that's sort of changed since you've been doing this, right? I mean, heck, you started probably doing this before the pandemic, and then the pandemic hit, and everything's going online. Any other observations about what we should look for or not look for when looking for disability evaluation file reviews?

Dr. Robert Cooper: I mean, a reasonable rate is reasonable. I mean, I don't want to go into exactly what I mean. The ranges generally are, just to give you a range, I mean, $150 to $200 an hour is reasonable or over that. Some companies—I mean, I've not settled for $50 an hour or $25—I mean, it's ridiculous. Some companies that are actually coming into play, I would just walk away from them. Again, walk away. Instead of walking away, they get in trouble with that.

I will make a comment about something you said, John. There are a lot of family physicians doing this—general physicians. It's not actually—it’s just as much general physicians as there are actually specialists doing this because you need to have a holistic point of view of some of these patients. They look for this, and they want somebody to go through everything, all the problems, and come up with a conclusion. So, it's very much driven by primary care, family medicine, and internal medicine. In fact, the whole segment of that, in the company I worked in, was for that. So, you could do that.

You could also use this, by the way, any of these things, as a segue. I mean, mine is the expert network consultant, but a segue to get into full-time work. If it is what you choose to do and say, "Listen, I just don't wanna do clinical medicine anymore. I have to determine this is not for me." I mean, unfortunately, that's what happens sometimes. It's nothing—somebody's choice.

You could use this because many of these companies will ask you, "Have you had any work before? Have you done this before? Have you done disability file review? Have you done medical assessment review before?" Yes, I have. I've done, you know, X, Y, and Z, and this is what I've done. "Okay, great." And they'll interview you. This is why people have a problem getting in at the ground floor if they want to convert to full-time. If that's what they choose to do, it's because they don't have the experience. This is a way to get experience.

John: One of the things in my little research I've done on this topic is looking at Social Security disability file reviews. And that one seems to be a unique animal. Have you ever done those for Social Security? I think they have different companies specifically that only do SSDI-type reviews.

Dr. Robert Cooper: I have a friend that does that for endocrinology. But the problem is they don’t pay well. Private insurances, the vendors, the ones that deal with private insurance, pay much more. So it's not uncommon to get about a third or a half. She actually looks at me and says, "Oh my God, you're getting that kind of thing for doing it for the vendors? That's ridiculous, I'm getting nothing." And so I don’t, and I get those rates back, and they come back to me. And then, you know, people come to me and they'll approach me all the time. Today I had three of them approach me. "Would you like to do some work for us?" And I just look at it and say, "It's not worth it for me to do what I make." It’s not gonna do it. And I think once you get to the point where you're comfortable doing this, you’re gonna realize that and say, "You know, I’ve just not." It’s better to walk away.

John: Well, that’s good to know. I’ll just stop even trying because it’s been difficult to get any information on the SSDI ones, but they don’t pay well. What’s the point? Are there other types of chart reviews? This one, I get this question all the time. I know, for example, that state medical societies, you know, they have quality reviews. Those are pretty few and far between. But any other types of, you know, more or less paperwork, file review, based on your clinical knowledge that you've done or that you know of?

Dr. Robert Cooper: The medical necessity ones are good ones actually too, because they could be quick sometimes. Unfortunately, they don’t pay as much as the disability ones. But some of the private vendors will pay fairly well for a medical necessity review. The big thing about— I didn’t talk about this—but the peer-to-peer phone calls, those can be challenging. So you have to have a thick neck about you, particularly when you're doing a peer-to-peer for a medical necessity review. But I worked full-time for the insurance company. Every day was filled with these peer-to-peers. And eventually, after about two or three months, I said, "Uh-uh, no more." I went back to clinical medicine because I just didn’t want to. I was just... But doing it on a part-time basis, you know, and calling up, you can conduct these, and it's an act of doing this. You have to have a knack for doing this and calling up, but it’s a challenge sometimes. Because physicians are generally, you know, not going to be amenable. You know, they’re frustrated and upset. You’re calling them up and telling them that you're going to deny something or you don’t have the adequate information, and they're gonna come back at you. But there’s a way to handle yourself in both these things. And that includes disability file reviews too, because there’s peer-to-peer for that as well when you're calling up the attorney position. So you get that a lot too. So you have to be willing to do that. Some people are, some people aren’t. And just handle that. I mean, everything has its pros and cons. Every one of these things, okay? So you have to kind of take the good with the bad when you're doing it.

John: Well, yeah, I guess, you know, each person has to sort of assess what they’re good at, what they’re interested in. You know, I’m a meticulous person. Maybe that helps in certain situations. Maybe it doesn’t help in others. I was going to also ask your opinion, switching gears here, on some follow-up on—you've been, in the past, an expert witness, which, you know, as you mentioned earlier, in the field of endocrinology. But what advice would you have for physicians who maybe are still working, you know, part-time, thinking about entering that field?

Dr. Robert Cooper: It’s a good field. It’s very lucrative. I mean, it’s not uncommon for somebody to charge upwards of up to a thousand dollars an hour in some cases for some specialties. I mean, it sounds great, but it has its problems too. I mean, you have to have a thick neck. I mean, just sitting in the seat I'm in right now—I told you last week, I had a deposition. I was deposed actually on a case. I have another case that’s going on that I’m getting subpoenaed in. I might have to travel to a different state—it’s a criminal case that spun out of a civil case. I mean, I’ve never had that happen before in the years I’ve been doing it, but I mean, these things happen, and they can be disruptive to practice. They can be disruptive to doing it. You have to have a contract in place. I mean, all these things are important. They're not something that you just kind of throw yourself into. And you have to be able to carry yourself well to be able to do that.

I mean, writing an expert report is very important. I mean, SEEK has some courses on this, how to do it. There's a great book on that too, but I think also being coached—like, how do I write a report? How do I put one together that's going to make sense, that's going to flow? Because the better your report is, the less chance you're going to be deposed or put to court because it's going to settle most of these cases. So you have to learn that. It's the kind of thing that you learn as you go along.

So again, you need to enact this—kind of figuring out what is the best way to put a good report together, different stages, learning a little bit about law and how it works, and the evolution of a case. How do you get deposed? When you get deposed, how do you handle yourself during a deposition? How do you handle yourself during a trial? These are all things to consider because if you screw up a couple of times, you're not going to get asked again to do any cases.

So it's all about putting your hands into one thing. You know, I always step back and say, "You know what, I want to do a good job. I really do, as an expert witness." But if, for some reason, something out of my control happens—and it does sometimes—that I get looked upon or frowned upon negatively for whatever reason, I have something else to fall back on. I can do other work. I don't have to throw myself into one particular thing. That's how I always look at it. I still want to do a good job.

John: Let me ask you this, because this comes up, I think, in others I’ve spoken with who are looking to get more and more into expert witness consulting. I guess, marketing themselves—how do they find clients or attorneys? Do they just come to you when you've done this just because of your local notoriety? Or do you have a process for trying to get visibility for some of these attorneys who are looking for help?

Dr. Robert Cooper: First off, you have to be careful with that. If you start listing yourself all over the place, that's going to come up during deposition. It came up last week. "How many directories are you in, Dr. Cooper? How many times do you do this? What are you doing?" Because they're looking for people that are hired guns and trying to nail them on that. So actually, I don’t list myself in anything except SEEK. SEEK is the only directory I list. I’ll make a little plug because they’re a good company.

I just had somebody call me right before I got on the phone with you, saying, "You know, the spam call—it wasn't a spam call—it was somebody trying to get me into a directory." I just quickly got them out of there. "How much money is it going to cost me? What is it going to do?" I really don't have a need to list myself in 16 different directories. I've never really found it to be helpful.

I think the best thing is word of mouth. When you do a good job, the next thing that happens is the next attorney tells somebody else about it. Then they call you and say, "You know, you worked with my friend on a case, and I want to work with you too as well. I've heard that you are pretty good. You're responsive, you get back to me, and you're available."

I think calling people—like if an expert, if an attorney calls you—you need to get on the phone with that attorney the same day, within an hour or two. Get on the phone and respond to that attorney, saying, "What's the deal?" And also, you're interviewing them too. You don’t want to get involved with any type of attorney who’s not doing anything ethical. Everything has got to be ethical. It’s got to be impartial. You don’t want to come across as somebody who’s biased during a case.

These are all things you learn as you do it. There’s a way to conduct yourself. It’s very, very important. You don’t just jump into these things—you have to know what to do to provide a good product.

John: I think that particular one—the expert witness—it’s a good combination because you're acting as a physician, as an expert, as a professional, but at the same time, it’s a business if you decide to continue doing it on a regular basis. So you have to know about those resources, like the SEEK list of available consultants.

And again, there are places where you can learn—SEEK included—that, you know, maybe give you a little advice on how to prepare for these things. And if you're doing your first deposition, that kind of thing. So that's always been interesting to me.

Dr. Robert Cooper: Yeah, oh, sure. It's a very interesting thing. I mean, I've done probably over 100 cases in expert witness work over the last 10 years. And I would say that I've had everything from somebody having a terrorist attack and blowing up the pituitary gland in our country and having me testify in that to, you know, hypoglycemic episodes in jail and things like that. I've had cases like that. I mean, it's so fascinating. It really is. You find yourself like a detective. Many times, I've come back to an attorney and said, "You know what, you don't have a case here." They don't want to hear that, but you don't have a case. You have to be honest, very honest with your attorneys that are coming to you. Very ethical and very honest. This is very important, any of the work you do.

John: Well, they might not like to hear that, but better that than they waste tens of thousands of dollars and find out at the end that they don't have a worthwhile case at that point.

Dr. Robert Cooper: That's right.

John: All right, well, have there been any of these other side gigs, consulting types of things, and reviews that we haven't learned yet from you, any others, examples, or have we kind of covered the majority today?

Dr. Robert Cooper: Well, there is another thing I do—I love actually too. I teach actually, I teach at a, there's a company called MCE—I'll just be specific I guess about that. Cause I teach that once a year or twice a year, they have me fly out somewhere and teach primary care and I love it actually. I really enjoy it. We have about 150 people there sometimes and it's on it, usually it's on endocrinology review for primary care. And I've enjoyed that. I've had two stints in Disney world already.

John: Oh yeah?

Dr. Robert Cooper: Where I've gone out there and done that. And I love having people respond back and ask questions.

John: So that's just like a continuing education for physicians?

Dr. Robert Cooper: Yeah, that's right. That's right.

John: Okay.

Dr. Robert Cooper: Another part of this that we didn't talk about actually, too. Maybe we should at some point. Maybe we've done now. Locums. Locums are a way to freedom, actually, too. And I think I've done that. I've done a lot of locums work in the past. I don't now. I'm permanent. But it's some of the best freedom you can get. And if you're like in this position right now where you're kind of considering, like, I think I would just say to your viewers, if you're in a position where you say, "Oh my God, I can't go back to work," and you have that feeling in your stomach on Sunday night, like I've had a couple of times, think back for a second and say to yourself, "Hey, why do I feel that way?" That's the first thing—introspection. Why do I feel that way? Is it something that I could change in the environment I'm in first that could actually make things better? Or, if it's not, is it a different environment clinically that I could be in? Or do I need to figure out a way to integrate this other stuff maybe into place that I could do it so I could cut back on that? Because I don't think it's all or nothing.

I see people at SEEK when I taught this year. They come up to me at lunch and say to me, they sit down—we have like a group of, like, I have 50 people sitting next to me—and they say, "How do you kind of get away from this?" One physician came to me and said to me, "When I was pregnant, I was sitting on my bed. They were giving me an epidural, and the administrators were coming over to me, saying, 'Look at the computer at the CMR, at the letter on medical records, and go back to the records.'" And I said, "I can't believe that." She said to me, "How do you function in that environment? This is what I'm going through," she said. "I have to find some relief," she said, "because I don't have a break ever." I find that so difficult to deal with. I mean, you have to be able to practice. Medicine is a great field to be in. It's a great thing to be a physician, regardless of what specialty you're in. But I think you have to do it on your own terms. You can't have that plugging and deal dread and stuff. So that's the important point, actually, too.

John: Yeah, absolutely. And... You shouldn't put up with being burnt out and frustrated and unfulfilled for too long. You can do it for a little while, but you don't need to put up with that. Because really, as you said earlier, physicians, they have a lot of information, a lot of knowledge, skills, and it's all very valuable if you can leverage it to your advantage.

Dr. Robert Cooper: I think the thing about locums, I was going to say before, just to get back to that for a second, we used to think of locums as being outsiders. But the truth of the matter is that locums are actually becoming sort of the norm, almost.

John: Right.

Dr. Robert Cooper: That's not a great... I mean, it's getting competitive, actually, to get a locum position or something like that. Because there's a shortage of positions, people are looking. But there are some great companies out there that do locums kinds of activity, a call, and they can really provide you with some great experiences to do it, too. I mean, it may not be for everybody, but it's a way to sort of break away.

John: Yeah, I think if you're feeling desperate, you might as well consider everything and narrow it down, maybe, to what fits best. But locums and part-time work and consulting and telemedicine, you know, is another option.

Dr. Robert Cooper: Yeah, right.

John: So, let's see. So, you told me that you like to help other physicians learn this stuff. You're teaching at SEEK and other places. So, let's see if someone would want to get a hold of you, learn more about what you've been doing, and get some help. I think you are on LinkedIn, is that correct?

Dr. Robert Cooper: That's right. I have a website. You have it there. RJCmedicalconsulting.com.

John: Okay. RJCmedicalconsulting.com. Okay, go ahead.

Dr. Robert Cooper: Correct, correct. I'm looking at some point maybe in... I actually developed a course already for leveraging medical. I haven't done it yet. I'm looking to see if there's any traction, if people want to take it. And when I get a critical volume of people together, I might do that, actually, too—online or in person at some point. And I, you know, all these topics, I think, as I mentioned before, preparation and learning how to do it is very important. So, you know, you could direct them there to that website, and certainly, they can.

John: Yep, I will put those links in the show notes, along with a transcript of our whole conversation. And yeah, maybe they should reach out and at least maybe follow you or connect with you on LinkedIn and then look at the website for more information.

Dr. Robert Cooper: The other thing I haven't done, but if anybody is interested, if they want me to come out and give a lecture at one of the meetings, either a keynote or something else on this particular topic, I'm happy to come out there too. So I'll just ask you that.

John: Yeah, absolutely. In fact, I'll mention this. I haven't talked about this in the podcast much, but when you talk about these opportunities and sort of the non-clinical side of things, most of the time, it still qualifies as CME. So, some of these organizations can actually give you CME credit for it because it's something that supplements your practice. And, as I think you have said in the past, you know, like when you're doing expert witness work, you actually become a better physician. To prepare for that, you have to. So, that's all good stuff for CME.

Dr. Robert Cooper: Absolutely right, absolutely right. And even expert network consulting stuff—you learn things. And things that you wouldn’t know are coming—ARE coming and are the wave of the future. And it really keeps you up to date on what’s happening. It makes it diversified. So it gives a different meaning to going in every day and seeing patients.

John: Exactly.

Dr. Robert Cooper: When you're doing it.

John: Exactly. All right, well, I think we're pretty much at our time now. So I want to say thank you very much for joining me today, Robert. This has been great. And I think the listeners will really appreciate all the wisdom you've shared with us today.

Dr. Robert Cooper: Thank you for having me on. I hope that reaches people and hopefully, we can help them.

John: I'm sure it will. All right. Bye now.

Dr. Robert Cooper: Thanks, John.

Transcription PNC Podcast Episode 391

How To Be A Stunning Success Doing Part-Time Consulting

- Interview with Dr. Robert Cooper - Part 1

John: Today's guest is a specialist as a practicing physician, but I bring that up because in the world of physician non-clinical careers, I consider him sort of a generalist because he's done different side gigs and actually some things that are clinical and unconventional clinical. And so he's worked so many numerous side jobs that they're very interesting. And I thought, well, this is going to be really good because doing this kind of helps you avoid burnout. It's interesting, keeps things interesting. You make a little extra income and there's lots of opportunities for physicians. With that, welcome to the podcast, Dr. Robert Cooper.

Dr. Robert Cooper: Thank you very much for having me. It's a pleasure being here, both an honor and a pleasure. I can tell you, I listen to your podcast all the time and it's my favorite thing to do on the treadmill when I'm listening. I've got some great segments there that I've listened to and learned from too as well. So I'm happy to be here contributing. Thank you so much for having me.

John: I love that. I love that. But I think you have a ton to share and maybe some of the things I don't know if you found all these things yourself, or maybe there was something mentioned by one of my guests. It doesn't really matter. This is all going to be helpful. And I'm really happy to have you here to tell us about some of these things. So let's start by just introduce yourself in terms of who you are, what you do, mainly your clinical background, maybe, and clinical work that you've done through your career.

Dr. Robert Cooper: I'm a regular doc. I'm an endocrinologist. I started my training in New York. I trained at Albert Einstein in the Bronx, went on to do a residency at Long Island Jewish, then went on to do a fellowship at Long Island. And I have an entrepreneur spirit about me. So when I finished my training, I was the first endocrinologist out in the Hamptons.

And I enjoyed that, but having your own practice is very difficult these days, even then. When I first started medical school, I had no idea of managed care. I came in because I wanted to be, I actually wanted to be a family doc and I wanted to have people come to my house and set up a shingle.

I went to a very expensive medical school as I said, and I am still paying back my loans, but anyway, but I enjoyed, I enjoyed medicine to this day. I know my son is a medical student. He's a fourth year medical student now, finishing up his rotations and actually going for the match. And he's asked me many times would you go into medicine again? I said, absolutely. I think this is a great time to be in medicine. I actually despite what people say and the naysayers, I love what I do. I love practicing. I love seeing patients, but I like doing it on my terms.

That's the key thing here, John. When I was out in practice, I then got recruited to Western Massachusetts to a place over in Western Massachusetts to run the fellowship there. And I did it the traditional way. And I was in academic medicine and so forth. And there was issues and things like that. And I've been in different places in Western Massachusetts. About 10 or 15 years ago, I looked at, well, I'm not going to go any further. I want you to ask some questions.

John: No, tell me what happened then. Something changed at that point. Practice was okay. It was good. It was fun, but what happened?

Dr. Robert Cooper: It's always been good. But I think I answered an ad actually to do disability file reviews in the New England Journal of Medicine for a company, a small company at that point, so small that my son actually went out to Maine actually. And we went to dinner with the CEO of the company actually. And he still remembers that this day he's 24 years old now. And I started doing disability file reviews at that point. I learned how to do it. You have to learn how to do this stuff. It's very important to learn and to produce a good product. You can't just get thrown in there.

I think there's something I had to learn on my own over years. And that was my first real stint towards nonclinical medicine. And then I learned other companies and I learned how to do it well. And at points in time, I've taken other nonclinical responsibilities as well. That was my first break in to nonclinical. But what I like about it is that I could do things, as you said, in combination. The key to this whole thing, I think, and this is a little words of wisdom if you're going for practicing 30 years, is not to put your hand into one thing. I always say, I taught at SEAK as you mentioned before at SEAK. And when I put my hand, you put your hand into one thing, I tell the audience, it gets chopped off your hand.

And that's true of clinical medicine. That's true of being all in full time sometimes. That's true of being an all in employed as an insurance person. That's true as being all in you do it in little bits of pieces of each thing, actually, too. It makes the best thing because nobody has complete control of you. You have control of yourself. It's on your own terms. We as physicians are very independent people. That's why we went into medicine to begin with. And then now what happens is that all of a sudden we're being controlled. And we don't like that. I don't blame anybody for doing that.

And the problem is as you pointed out, I said before about burnout. And I hate to see physicians burn out. We have a shortage of physicians right now, a shortage of primary care, a shortage of specialists. I would like to see people remain in medicine, quite frankly, but to a certain degree. it's not for everybody.

But I think at some point also in time, if somebody could combine the nonclinical and leverage that as well and stay in clinical medicine, we'd be all better off as well as the person, maybe if they wanted to be and the population at large.

John: Absolutely. That's actually one of the reasons why I wanted you to come on, because I've seen this before where still being in clinical, but maybe cutting back a little bit, doing other things to give you that feeling of autonomy, give you that sense that, okay, you're not if this company goes out of business, if this hospital closes, I'm not going to have a job. And it also helps prevent burnout because it's just the variety and the interest. And I think there's a lot of advantages to it. I'm interested in hearing more. Why don't you run down a list, maybe without going into any depth, just in some of the things you've done over the years, even some of those things, maybe that you're not doing any longer.

Dr. Robert Cooper: Yeah. I'll outline the four things I think I do the most of, and some of it fades in and out. It depends. The thing I do, I mentioned before, disability-followed consulting. I've done that both with the vendors, part-time basis. I've also worked as an independent contracting physician for a major insurance company, 10 hours a week. And that required a little stress. You have to understand something else. I just want to step back for a stressful situations because it can be just as stressful as clinical medicine.

You want to step back and look at this and how much you could take on and so forth. And so I did that, that medical necessity reviews is also part of file review. And that's also something that I've enjoyed doing through vendors. I also worked full-time for a short period of time for an insurance company doing that as well. I didn't care for it too much. I can tell you, it's my own personal thing, but I just say, it's not peaches and cream that people would say, come on sometimes.

That's another end of it, the whole thing. I've done all, the thing I really like doing, and I've done more recently is expert network consulting. That is a wonderful way to do it. People don't know about this. I've gotten into in terms of providing expertise to nonclinical people, Wall Street people, in a way that provides just public information to platforms, but not getting specific about the platforms, but I it is something that is very lucrative. It pays almost as much or as much as expert witness consulting, which I've done also, another one of my things.

I find it to be very fascinating and I love teaching. To me, teaching is teaching fellows and residents in the past. Here, I'm actually teaching people that are brokers or people that are actually doing, or they're sometimes scientific people trying to develop a drug and diabetes or something. I'm an endocrinologist, so I'm doing that. And you could teach people how to, but basically any specialty can do this really, as long as you're doing a little bit of practice most of the time, I think, and you could combine this.

And I can tell you, I will say to you this, that with the nonclinical stuff I did, I told you before, I have a son in medical school who has a huge tuition in Boston and a very good school. I doubled my salary clinically as an endocrinologist last year, last two years doing this, working four days a week, full time. And one day a week doing the nonclinical stuff. If that's your avenue is to get in and make more money and you don't necessarily want to cut back your clinical stuff, that's okay too so you can do that. And it's been really great that way too.

You have to know how to do these things. It doesn't come just with sitting down. We didn't go, we didn't just get put into an exam room and have to examine patients. We went through years of training and residency and so forth, the same thing here. You'd have to know how to do it. You have to know how to be coached, what to do, and kind of how to come up with a good product.

People want a good product like anything else. And when you have to produce that good product, they keep coming back over and over and over again, and they'll pay you what you want, quite frankly.

I think having that, I tell my son who's graduating. I said he's going to go on and do a residency. And I said even if you didn't have that residency, you should have, I'll finish it and do it. But just having that degree, the fact that we went through what we did is, you mentioned this many times on the podcast I've listened to before, being a physician and having that amount of knowledge and be able to pick up on things, we're in a perfect position to do all this type of consulting.

And so, the thing is that doctors don't realize is they're in demand, not just clinically, but nonclinically. They're in huge demand, but they undervalue themselves. This is an important point. And this is another Cooper point.

Number two, I'll just say, it's this, walk away from an opportunity that doesn't pay, that undervalues you. People gravitate to these opportunities that I find disgraceful, actually, in terms of what they do. And that can be any breadth of thing, of the things I'm talking about. Walk away. It's more important to walk away, actually, and not get the opportunity, but to take the opportunity and undersell yourself. Very important point that I've learned.

John: Yeah, I think there's nothing wrong with trying different things. But as you said, if it's not really going to be worth the time, because our time is probably our most valuable asset other than our medical knowledge, then you just should move on or take the time back and spend it with your family.

Dr. Robert Cooper: Exactly right.

John: So let's see, why don't you pick one of those? I'm interested in everything you've said so far, but the expert network consulting, how did you personally find this? Is there any ideas you can give us in terms of how to locate some of those? And then what is it you need to know to be able to do? What are they actually looking for based on what you've done so far with that?

Dr. Robert Cooper: They're looking for people who practice, who have some sort of basis, but actually could even do it without practicing. They had knowledge of the scientific basis behind it, some consults. You get these surveys sometimes that come to you through, I guess, a company called Sago or Schlesinger or other companies like that.

I don't want to go into specific companies, as I said before, but I could certainly talk about that individually with the guests that want to do that. But I think that you get these companies that will approach you sometimes and ask you for your expertise, spend an hour or so. In fact, before I got on the line with you today, I spent three hours downstairs working on three different consultations, three different ones today, because I'm "off" on Fridays.

I was working on that, but really, it's just phenomenal in terms of that. So how did I come into this? All of this is really, things just come to me, I think, somehow. When you put yourself out there, that's the key. I have a LinkedIn page and I'd like myself open to opportunities. People will come to you and they see your profile, but the most important thing is when they come to you is being receptive, A. B, providing a good product. When you're on the phone with an hour with somebody coming on that's asking you about a diabetic product or something, or asking you about the sensors or something for how you feel about this different sensors, you want to provide insight into what you do.

We all know this already. I don't have anything non-public. The key thing you have to worry about with this is that you don't want to provide anything that's non-public. That could be construed as you get arrested for doing something like that or have really a problem. So you want to provide all public information that you're not from clinical trials or anything, but I don't know anything non-public. Most of us don't. We're not involved in clinical trials. We just do what we do each day, but that's what they want to know about.

These platforms, expert network platforms are looking for people. They keep asking me, can you refer somebody an endocrinologist, another endocrinologist? I get things that sometimes are outside my field of expertise. I never take anything that's outside my field of expertise. I will not feel uncomfortable with that. I will not do it. I will pass up on it. That's important actually not to do that, but I will go on and I will refer people sometimes to it. I've never actually gotten a commission for doing it.

If you refer people and they actually do consults, you can actually get a commission for it, but I've never actually seen anything like that, but that's okay. But anyway, I think you could get, there's multiple different platforms that are out there that you could look up and research, expert network platforms and do it. It's not perfect.

There are downsides to it. I taught a course at SEAK last year on this, and I think they're making that, they're a good organization, SEAK, and they're making it available too. I think they recorded me part of it, but I think they're making it available as well. But I also have my own course that I've taught already at SEAK.

John: Well, let me ask you this thing just to dig into it a little bit. When I'm online, I've had a LinkedIn profile for a while. And then again, the email addresses get out there, but are you saying that of the expert network consulting platforms, most of those coming through LinkedIn? Do you ever get just blind emails coming in?

Dr. Robert Cooper: Yeah, I do get blind emails coming in from different companies I even heard about before asking me, I've heard that you do this kind of work. Are you interested in joining our platform? Are you interested in doing a one-off consult? The nice things about these one-off is that you don't have to really, but I do prepare for it. There is a way to prepare for it. I wouldn't say I didn't prepare for it. And I could certainly go into elaboration about that in terms of looking at investor conferences. I find myself sometimes looking at that more than I do scientific conferences on different drugs and things like that. So I do prepare for it.

I want to provide a good product when I get online for an hour. Because if you spend an hour and you don't provide anything, I don't think anybody's going to want to come back to you again. It's like anything else. Even the expert witness work, you want to provide a good product when you're going through that. Disability file reviews, anything.

I think that it's important to prepare and to be ready for it. You also have to have a certain mindset when you do these consults. You have to be relaxed. I think the best investment you can make is to buy a headphone, a head jack, just to put it on because it frees you up and you can look at the computer at the same time. You want to get information. That sounds like a simple thing. I think it was a few dollars to buy the headphone investment for me.

But that was a very important thing. I'm not fumbling with the phone when I'm doing it. These are little tricks that you learn as you go along that you wouldn't know about. How do you conduct yourself? How do you continue to keep the conversation flowing? That's an important asset to have that. If you just stay still and don't elaborate or know something and don't talk about it, you're not going to get that across and you're not going to get the best outcome. So I think that there's a way to train people how to do this, I think, to some extent, to make them more effective.

John: Let me ask one more question about this and then we'll move on. I've never participated in that kind of thing, but I always kind of get the sense that from the invitation, sometimes it sounds like it's a one-on-one conversation. Other times it sounds like it's kind of a panel. For the ones that you've experienced, what is it like? Is it just getting on a Zoom call with somebody? Is it more of a multi-person call?

Dr. Robert Cooper: It's all the above. The ones that are multiple ones. Sometimes I'm actually listed as, I do a lecture actually, where I'm lecturing to a group of investors actually. For that, I charge more money for that. I actually have rates that I charge. And that's another thing. I'm not going to go into that now, but I would tell you that I do that and I charge more and I charge a minimum of 60 minutes. That's another important point. I don't prorate it because I don't want to be on a line for 15 minutes and waste my time when it's an hour I could be getting from somebody.

There's a whole series of things I've learned, how to maximize your time and your profitability when you're doing this. But it can be, I actually had times when I've actually had to travel New York City or Boston, I live in Western Massachusetts, to do something.

I always tell the story at SEAK when I'm there, that they had me, it's a funny story actually. They had me actually go to Boston to do, I think it was Sago or one of those companies, to go to Boston to insert into a dummy, a device for diabetes. They had me come there and they were actually paying $1,500 to do this plus travel for an hour's worth of work. Think about that for a second. That's not uncommon, by the way, to have that happen. I got this thing and I went and traveled into Boston. I'm sitting there, there's a one-way mirror actually on this place that I'm working on. I'm trying to put this thing and I was a cardiology fellow before I became an endocrine fellow for a couple of months. A little bit manual, not that disastrous. I'm trying to put this device into the dummy and I can't do it. I'm putting it in the wrong place. They must've been laughing at me behind the mirror. I can guarantee you.

And then they came out and I said, oh my God, they're not going to pay me because I didn't do anything right. They came back and they handed me a check and they said to me, that's exactly what we wanted to know, Dr. Cooper. We wanted to know how to put it in. We wanted to figure out whether endocrinologists were capable of doing this. That was the whole point of this. Thank you so much for your help. And they handed me a check.

John: Interesting. They learned they have to change it if they're going to involve an endocrinologists I guess.

Dr. Robert Cooper: That's right. But they're looking to learn. Exactly.

Transcription PNC Podcast Episode 389

Have Faith in Your New Life Insurance Medicine Career

- Interview with Dr. Megan Leivant

John: Over the years, I've had the occasion to meet physicians who work in the life insurance industry, not health insurance not doing UM, but actual life insurance. And I've been sort of very interested in that topic. Those that I have spoken with informally, not necessarily on the podcast have said they really like those jobs. I've been interested in finding someone who's doing life insurance medicine. And so that is today's guest. I'm very happy to have the opportunity to talk to her. Hello, and welcome to the podcast, Dr. Megan Leivant.

Dr. Megan Leivant: Thank you so much for having me.

John: I think this is going to be fun. I wanted to learn more about this for years. And it's not as common a full time or even part time position as let's say, someone working in health insurance. I don't know about disability. Anyway, tell us a little bit about yourself, your mainly your education and clinical background that will get into what you do professionally now.

Dr. Megan Leivant: Sure. Well, thank you so much for having me on the podcast today. I'm really excited to be able to talk about life insurance medicine. It all started for me. I went to DePaul University for my undergrad, and I majored in biology and did a minor in French and then went to IU School of Medicine, Indiana University School of Medicine, and followed that up with my residency in internal medicine at Northwestern in Chicago. And then actually practiced outpatient internal medicine for 10 years.

And I did that in a variety of settings. I started out in a traditional private practice, and then I moved to the VA, and I worked at the VA for about five years. And then I was in more of a hospital based community practice before I made my transition. And then I did have a lot of teaching appointments throughout that period of time as well. And that was something that was really important to me.

John: Very nice. Well, then the obvious question that comes up is when a physician transitions from clinical to nonclinical, what led to that decision?

Dr. Megan Leivant: I would say several years before I transitioned out of clinical practice I realized that I was having an increasingly difficult time coping with the demands of outpatient clinical practice, which I know that many people are feeling that way. And present day. And so I actually started working with a physician career coach, Dr. Heather Fork, through Doctors Crossing, just to see what I could do to help my situation. Because at that point, I wasn't sure if I wanted to leave clinical medicine. I just wanted to try to figure out could I could I do better? Were there changes that I could make to try to make the day to day a little bit more manageable?

And we worked together for a good while. And I ultimately realized that transitioning to a nonclinical career was the path that I needed and wanted to follow. So through coaching, I learned a lot about my interests and my dislikes. We did the Enneagram and talked about marketable skills and personality traits. And it was really just a great growth experience to learn all that stuff and then help leverage those findings to apply them to different nonclinical career options. So part of that process, I attended the SEEK nonclinical careers conference to help jumpstart my research and look into other career options and reached out to former colleagues to kind of explore what they've done in the nonclinical realm.

I made new contacts on LinkedIn. it was a very kind of vulnerable, exposed experience putting myself out there to try to just figure out what was next. And I even tried some telemedicine during that transition. I did a little utilization management just to see what else is out there. But I kept hearing about this life insurance medicine career. And the more I heard about it, the more I thought it would be a really good fit. And so that's ultimately how I got from point A to point B.

John: Well, what you described is really, it could be considered like a model in some ways. These are things we always talk about in the podcast. Okay, getting a coach, using a coach. Heather Fork's been a guest here at least three or four times, and I've been on her podcast several times as well. And so she's kind of an icon from the standpoint of coaching physicians. There's many out there now. But while you've hit on a lot of the points we've talked about Seek here before. Many of the people I've interviewed have actually been alumni from Seek as speakers. So you can add your name to that list now. I guess you've been a mentor there, I believe?

Dr. Megan Leivant: Heather. Yes, I was actually a mentor just this past October, and that was a great experience.

John: I guess I'll go off a little longer on Seek. It's only like 45 minutes from where I live. It's held near Chicago, and I live south of Chicago. I've driven up there and attended a couple of times to meet some of the mentors and the speakers. So that is good. I mean, I think that'll inspire some people to get off the dime because I get asked a lot about what about coaching. And in the old days, Heather and a couple others were like the only ones. I don't know when you started.

Dr. Megan Leivant: Yes, yes, there are a lot of physician coaches out there.

John: It's always something to say, oh to try if that's if you're kind of stuck. All right. You kind of looked at your skills and your interests and what's out there. And then the lifestyle, I think, is always part of that decision. So why don't you start by next telling us what are the duties of a medical director? That's the really the entry point for most if they're going to do life insurance medicine. What does that look like?

Dr. Megan Leivant: Exactly. Yeah. And it is a bit of a of a frame shift, but at the core, I like to think of the primary duties of a life insurance medical director as three pillars. Case consultations are definitely the biggest pillar. And I'll talk about that a little bit more. Teaching is certainly part of that.

And then research. At a very basic level, you're assessing the morbidity and mortality risk of insurance applicants. And so they can be applying for many different types of life insurance products, but really at the core it's mortality and morbidity. And as a physician, really, that responsibility lies in understanding disease processes, their associated risk factors, and how that's going to impact morbidity and mortality. So that's where that frame shift comes in a little bit. as physicians, we are thinking certainly more in the moment, treating what is in front of us.

I think that's probably one of the biggest pivots that has to happen. But there's a number of areas of risk selection. So there's that life mortality risk, there's disability, there's critical illness, and then there's long term care, which is more that morbidity component.

Really a day in the life, the bulk of it is those case consultations. So an underwriter will send over a consultation. And I almost liken that to presentations on rounds. They ideally are sending over, this is a 58 year old male with X, Y, and Z medical conditions. Here's my question. And so, as a medical director, you were there as a consultant to give your opinion. And you provide your opinion back to the underwriter. You're also fielding messages from them and calls and that kind of stuff. But that's, that's, I'd say the bulk of the day to day.

But then you're teaching the underwriters are there to learn from you as well. So that's what I really enjoy about this career is I still get to teach. And it's formal, it's informal you could be giving an external presentation to a room of underwriters, or you're just teaching over over the phone or through one of your consults.

I like that piece of it as well. And then research we're always needing to research these medical conditions that we're encountering. I feel like I've learned so much more in this career, I could probably go back and be a much better clinician. I think from my experiences, but you're doing projects, you're helping update the manual, the manual is what you use to help rate the impairments that the applicants have. That's at the core, I think what the primary duties look like for a medical director.

John: The scary part of that might be if I'm imagining that I'm thinking about taking a job like this, it's well, how I have an understanding of how different illnesses impact one another and why having hypertension might be a risk factor for something involving cardiac problems and so on and so forth. But I'm thinking that people might be like, but I don't know how to quantify that. Where does the quantification come in? Does that come from the underwriter or is that working together or is there a book that has numbers in it? There's some training involved on the job, right?

Dr. Megan Leivant: Oh, yes, absolutely. And I would say it probably takes a good six to 12 months just to really feel comfortable with that. So yes, to your point, when an applicant comes in and presents with, let's say diabetes or heart disease we all have 100% mortality that's a given, right? We all know that. But in the life insurance industry, we use what are called table ratings. And so they go up by 25 increments. 125%, 150%. And that corresponds to a person's mortality. So the higher that number gets the more medical impairments they have.

And every company uses a manual. And that manual includes those conditions like diabetes, heart disease, cancer and there's ratings that are associated with those disease processes. And that can vary. And it does vary per company. But that is where that risk is then assigned to the condition. And then as a medical director, where we come in is, well, what if you've got someone who's had diabetes and heart disease and prostate cancer? Is that a risk that we can consider that the company wants to consider? And from a medical standpoint, can we put all that together to determine if that applicant is suitable for a policy? Jennifer That's a great question.

John: Dr. Justin Marchegiani. But just like anything that you're doing, when you're going from clinical to non-clinical, there's obviously something you're doing in that new job that, well, it uses those skills and that background. It's different because it's a different industry. And I think that's what stops some people. And the thing is, all of these things have been figured out. whether you're going to health insurance or life insurance or pharma, these are not mysteries to the people that are on the other side. And usually they are well-prepared to train you. Now, there isn't really any certification that a physician would typically pursue or do other education before maybe applying for their first job as a medical director in the insurance industry.

Dr. Megan Leivant: That's correct. there are definitely a number of things a person can do to build their knowledge base. But there are a number of directors, myself included, where I walked into this industry very green. I'd had no experience in life insurance medicine, and I was trained on the job. And I've done a lot of those additional classes and certifications now as a director within the industry.

John: I want to hear more about what your career has done since you've been there. But why don't we go first into the obvious question? Maybe they've talked to people that have started doing this, they really love their job, their lifestyle is good. How would I start to look for those jobs and or prepare for the job?

Dr. Megan Leivant: Yeah, that's a great question. So I think there's a number of ways to start looking into this career. And I think there's not just one pathway, probably one of the most useful tools would be to consider joining AIM.

And through that organization, this is kind of like our governing body, if you will, of within insurance medicine. So it's a group of insurance medicine directors, but there are also underwriters and that are members as well. And when you become a member of AIM, you actually can get paired up with a mentor. And the mentor is usually a director who is already in the industry. And I have really found that that's been a great way for individuals who are interested in getting into the industry. they now have a point of contact.

And that really can be a great nurturing relationship to help jumpstart that interest within insurance medicine. But then I think it's a lot of the other things that individuals do to look for new jobs, right? Look for job postings on LinkedIn, get your LinkedIn profile spruced up, try to reach out to if you happen to know anybody that's in the life insurance industry, certainly that's always really, really helpful.

Let others know that you are looking for a new career or that you're interested in this. Connect with an industry recruiter. they are definitely out there. Depending on where you live most of our positions are remote. There are some that are hybrid, but research life insurance companies that are in your hometown that could always potentially provide an opportunity, whether it's a bigger name or a smaller name. And attending a meeting.

That's an absolutely wonderful way to get to network and meet other industry directors, industry professionals. And there's a number of those. So, AIM has its own meeting every fall. And then there are several others that also could provide really good opportunities to try to help kind of jumpstart that career.

John: That sounds logical. Yeah. And I, one thing that I ask about, because we, for some of the big industries, there are these things like LinkedIn groups and Facebook groups. Do are there any such entities that you're aware of for life insurance medicine?

Dr. Megan Leivant: AIM does have a presence on LinkedIn, and I would say that would be a great place to start. I am not aware of any specific life insurance medicine, Facebook groups or anything, but, but AIM again has so many great resources. And so, that's where we end up directing a lot of our individuals that are interested.

John: Okay. So, I'll be sure to put a link to AIM in the show notes.

Dr. Megan Leivant: Yes.

John: So, now let's talk more about you. A couple of things. Maybe you can tell us a little bit about what you like about it and, and, and then what you've done because you're, I think you're no longer an entry-level medical director. We'll just kind of talk about both of those issues.

Dr. Megan Leivant: Sure. I'd say what, what keeps me coming back every day is that this is a really mentally stimulating job. I've really enjoyed, and I continue to enjoy the, the challenge that comes from reviewing these cases that come through every day. This is why I went into internal medicine. I love to solve problems. So, it really gives me the chance to still continue to do that on a day-to-day basis.

There's a ton of variety. I'm seeing diseases that to this day, I still had never seen before. So, I'm still getting to use my medical, medical degree. I'm growing my knowledge base, and, and that was really important to me as I was considering the, the pivot. But it's also a small industry, so there's a lot of great networking opportunities. I've really been able to kind of expand a different part of my marketable skills, if you will.

I miss seeing patients, but I'm still able to create relationships. It's just done in a different way now. And so I'd say that those are probably the big things that kind of keep me coming back every day. It's critical thinking, it's teaching, it's teamwork and collaboration. So, I'm getting to still use a lot of those skills that I used when I was a practicing physician. Yeah, as far as my kind of course throughout my career so far, I've been in the industry over six years, and I started out at what's called a direct life insurance company.

So, a direct life insurance company would be the company where you apply for your life insurance policy. So, they directly, they do that underwriting, and I worked there as a medical director for just under two years, and I got that experience. And then I've, since then, have been working for reinsurance companies.

There are a lot more direct life insurance companies than there are reinsurance companies. So, reinsurance companies help to insure the direct insurance companies. That's probably a very high-level way to kind of describe it, but, but so our clients are the direct insurance companies.

We still, as a medical director, are doing very much the same thing on a day-to-day basis, whether you're at a reinsurance company or a direct insurance company. But in a reinsurance company, we're probably seeing cases that might be a little bit more medically complex. There are certainly some differences there. But at the core, like I said, this is ultimately, it's still the case consults, but there's more teaching, there's more research, and that's kind of helps keep it really interesting and a lot of variety.

John: I wonder I was a CMO for a hospital for a while, and our hospital insured itself from liability. We're talking a little different than life insurance. But they had a consortium, they were so, quote, self-insured. But they did have a reinsurance company, I think, on top of that. Like, there's things that happen that they can't really predict or plan for. So, it's kind of the same idea.

Dr. Megan Leivant: Exactly. if I had a whiteboard, I could draw a diagram the direct companies would be in the middle, and then the reinsurance would kind of be a bubble around it. So, here's an extra layer of protection. We might take on the full risk that a direct company doesn't want to take, or maybe we share that risk because it's a really high net worth case. There's just so many different permutations. But that is a great way to describe it.

John: All right. Now, let me ask you this. Do most of medical directors for a reinsurance company come from a direct insurance company, or are they just out there trying to grab anybody that comes along?

Dr. Megan Leivant: No, that is a really, really great question. I would say, on the majority, physicians that are within reinsurance companies usually are coming to those companies with some direct experience. Now, I'm going to say that's not an absolute, because I do know of some directors that started out in reinsurance. And you're going to get that on-the-job training, no matter where you are. But I would say, on the majority, that's probably the path that you normally see is a direct to a reinsurer.

John: Now, in other industries that are similar, in my mind, to this, they have this whole hierarchy of medical directors and senior medical directors and executive medical directors, and then they get into the VP level. And again, kind of mirrors even the hospital setting. medical director is still involved in the clinical stuff a lot.

The VP or the chief medical officer is really an executive position. So how does that work? The physicians, because I did know one VP of a life insurance company. I haven't talked to him in many years, but I didn't know exactly what he did as a VP, which was different from what he maybe had done prior in previous roles.

Dr. Megan Leivant: Yeah, that's a great question. I think it really, at least what I've seen, is that it really varies per company. I know a number of medical directors, whether they're in a direct company or a reinsurance company in that core role, they have a VP title associated with what they're doing. And I can't speak to the full industry as far as how many are VPs, but I think generally you're going to see that title or you will have that title as a medical director coming into a role, but it's very company specific.

The step up after that, though, is that, yes, depending on how big the company is, then some of them do have a chief medical director, and that's where you start to see some of that delineation as far as the administrative duties etc. Usually the chiefs are probably doing less casework and they're more involved with maybe research or product development or kind of higher level higher level concepts.

John: Yeah, that makes sense. And we see that in a lot of other industries where they just they just have a cascade of titles just to recognize the skill, the experience, and so forth. And then in some cases, it really means you're part of the senior executive team, which does a lot of the strategic planning and creating new service lines and things like that. So each industry, I think, has its own specific ways of doing things.

Dr. Megan Leivant: Definitely.

John: All right. Well, have I forgotten any important questions to ask you? I'm going to let you go in a minute. I definitely shed a lot of light. So any last comments or other things maybe that we've missed in this last 20 minutes or so?

Dr. Megan Leivant: Sure. Well, I think one thing you asked earlier was about prerequisites in a way of getting into the industry. And while there isn't anything that you need to specifically do to get into the industry, there are definitely once you are in, like, we actually, insurance medicine is a boarded specialty.

After you've been in the industry for several years, and there are definitely other courses you have to take and criteria you have to meet, but you can be boarded in insurance medicine. I'm actually working towards that myself. So I did want to kind of add that. And we do what's called a basic morbidity and mortality course that is part of that board preparation. So there are definitely all these opportunities to get that teaching that is needed as just part of the core function of our roles as medical directors.

John: Yeah, I would bet 99.9% of physicians coming out of the training would have no idea that there's such a thing as board certification in life insurance medicine.

Dr. Megan Leivant: Oh, sure. And it's both a written exam and an oral exam. So it's a process that can take up to a year really to kind of go through both of those.

John: And I saw that there's some certifications. Again, I'm assuming that those kind of things are sought after you're in the industry, but I noticed that there are certain things maybe you can explain a little bit about that.

Dr. Megan Leivant: Absolutely. There's a lot of, like I said, a lot of different initials, you can get after your name, a lot of certifications. And these are the courses that the underwriters take. There's LOMA courses, which is Life Office Management Association. And then there's ALU, which is the Association of Life Underwriting. And there are a myriad of different courses within each of those groups.

And those you take those and they're great courses. They really help teach you about the life insurance industry, especially the LOMA courses. Those are definitely more geared towards life insurance, just basic knowledge financial underwriting, risk management all of that. So yes, you can take a number of those courses and then ultimately get different designations depending on what combination of those courses you've taken.

John: Very good. Appreciate that. Yeah, I don't know. I'm a little too old to apply for a life insurance medicine job, but it sounds like the course might just be interesting.

Dr. Megan Leivant: Maybe not. And it depends on the company not everybody needs to be boarded. I think that's very company specific. There are definitely companies that might lay that down as an expectation. But I know there are directors out there that might do this part time and that's not an ask for them. So it's not I think there's definitely a spectrum.

John: Okay. Well, that's really good to know. Maybe they could create a career where they're doing half clinical and half something like this whether it's in this industry or even UM, whatever, that sometimes can be very positive from a lifestyle standpoint.

Dr. Megan Leivant: Sure. And I know of directors that are still doing that very thing. I do know of some that are still practicing clinical medicine, and then they do their life insurance job as well.

John: Excellent. Well, you did mention earlier, this whole thing about networking, tracking down your colleagues and former co-residents and so forth. But one of the things that I'm sure that our listeners might want to do is reach out to you. Hopefully that would be okay to do on LinkedIn. At least you can control that somewhat.

Dr. Megan Leivant: Yes, I'm happy to certainly connect with anybody that would like to do that through LinkedIn.

John: Okay. I'll put your LinkedIn, a link to your LinkedIn profile in the show notes as well, although if they just input your name, they're going to find you. So, all right, Megan, I think we've learned a lot today. I know I have, and I've appreciated this. I really encourage people who are listening to consider this because again, it's a small number, but the people I've talked to, some of them, they just love their jobs, you know? And so there's just something about applying your medical knowledge in this way that just so lines up so well with a lot of our intellectual stimulation, what we love and challenges. And so, I really appreciate you for describing all this and sharing this with us today.

Dr. Megan Leivant: Thank you so much for having me. Yes. Medical directors in this industry are very happy.

John: Nice. All right, Megan, you take care.

Dr. Megan Leivant: Thanks, John. Appreciate it. Bye.

John: Bye-bye.

Transcription PNC Podcast Episode 387

Be Creative And Flexible to Love Your Career

- A PNC Classic from 2019

John: Dr. Helen Rhodes, welcome to the PNC podcast. I'm really glad to have you here today. I always like to give my audience a little, let's say, preview as to why we're talking today. We met through a mutual friend and from what I know, you reached a point in your clinical career where you were, just needed to make a change for reasons which I think you'll describe. I thought your story sounds quite interesting and hopefully very inspiring. Why don't you describe a little bit about your background?

Dr. Helen Rhodes: Well, I did all my training in Texas. I grew up in Texas and I finished OB-GYN residency back in the early 90s, so that would be last century, I guess, technically, and was actually recruited by an academic institution here in the Houston area to do GYN only. And it was an academic position without any obstetrics, so I was pretty fortunate and it was very unique to have that opportunity right out of training, but I quickly discovered that I really wasn't ready for academic medicine.

I wasn't even 30 years old yet and so, after a couple years, I left that institution and worked in the Houston community doing full scope obstetrics and gynecology, various practice opportunities, multi-specialty group practice. I worked part-time, I worked full-time, I worked at a managed care group, and then, interestingly enough, about 10 years after doing that, I really was having difficulty with the lifestyle of obstetrics, primarily, and actually went back to the institution that I left 10 years earlier into the same position of GYN only and stayed there for almost another 10 years, but I always wanted to have my own solo practice and after my youngest finished high school, I made this big leap and left academic medicine again and started a GYN only solo private practice in a bedroom community south of Houston.

It was pretty risky to do that because it's really hard to start a private practice, especially mid-career with really no patients to follow you, starting it from the ground up, and not doing obstetrics financially, it was very challenging, so I started looking for ways to supplement my practice income, looked at clinical and non-clinical options, and did medical file review.

I actually, for a little bit of time, sold supplements in my office, did some testifying for legal cases, and got into locum tenens opportunities. Initially, just outpatient locum tenens opportunities because without doing recent labor and delivery work, I couldn't get any jobs in L&D anywhere, and there's really no retraining for obstetricians once you've stepped away from it for a couple of years. There's no way to get back into it. The American Board of OB-GYN doesn't have a formal retraining program. You really have to get lucky.

John: Helen, let me jump in there for a second. You were trying to get locums without the OB, and did you have any success at that, or was it pretty much a wash?

Dr. Helen Rhodes: I did have some success. I was able to do outpatient gen-like physicals for an underserved area in town. They weren't a federally qualified health clinic, but they were state-funded health clinics, so I was able to do that on Saturdays and some Fridays when I was not seeing patients or in the operating room.

I did that for a while, and I just got an hourly rate and saw the patients that they had scheduled. They weren't my own patients. I also was able to get an outpatient job with Texas Children's Health Plan, which is affiliated with Baylor College of Medicine, and did OB and gen, so that was good.

That way, I was starting to at least see obstetrical patients in the outpatient setting and relearn prenatal care, high-risk prenatal care, but at that point, I wasn't able to do anything in labor and delivery. I did have some success.

John: How easy is it to find locums? Is there a clearing house? Is it word of mouth? Do you just go on Google? How do you even start to look for positions like that?

Dr. Helen Rhodes: You have to throw a lot of lines in the water. You get on a lot of the recruiting sites and submit your CV, answer a lot of emails, texts, phone calls. I had a lot of dead ends because of the lack of recent labor and delivery work.

John: Okay, so that was a challenge.

Dr. Helen Rhodes: Yeah, very challenging.

John: Now, as you were going through this too, you started your practice. Was the issue in terms of the gross revenues or what have you, was it the fact that it was a startup or did you look and say, even when I'm busy, this is not going to be something that is meeting the financial levels that I think I need?

Dr. Helen Rhodes: Yeah. I think there's a lot of reasons that the revenues weren't where I wanted them to be. I had come from this academic salary and that was my benchmark. It was a pretty high benchmark because once you're in solo practice, you don't have anyone paying your benefits or contributing to your retirement or paying your liability premiums, etc., etc. That all comes out of your revenue. You can either do a couple of things.

You can see more patients because we are reimbursed per patient in this fee-for-service world of OB-GYN. We're primary care, specialty care, stuck in between. I had already lived that life of seeing lots and lots of patients and not getting to spend time with patients.

When I started my practice, it was very important to me to spend time with my patients. I wasn't seeing the volume that I was seeing before and I didn't want to see the volume I was seeing before. The overhead is higher and because I wasn't increasing my volume and doing tons and tons of surgery, my revenues were less.

John: Okay. You're looking at locums. You're trying some different things out. Take us down the next few steps in this process.

Dr. Helen Rhodes: It's an interesting story. For some reason, I wanted to go back to school and learn business. I did a hybrid program where we spent four residential sessions over an 18-month period and then did online coursework, lectures, projects. I did that between 2015 and 2017 through a business school and connected with some really innovative healthcare leaders in my class and the class ahead of me from rural Kansas. Until I met them, really my search for locums work had been confined to the state of Texas because that's where I had my license. One of the individuals that I met through the business program said, hey, we would love to have you come to Kansas.

Kansas is not that far. It's a couple hours. I ended up getting my medical license in Kansas. Well, that opportunity with my business school colleague fell through for various reasons, but another Kansas opportunity came up through one of the locums recruiters that I had been working with. This time, even though I hadn't delivered a baby in 13 years, the little hospital in the middle of Kansas said yes, and off I went. I did my first delivery in 13 years.

John: Oh, boy. Yeah. What was that like?

Dr. Helen Rhodes: I was very nervous. Very nervous. Of course, it happened at three in the morning, and I didn't have much time to get to the hospital and think about things, but that was the beginning of thinking outside the box in terms of, wow, if I can go to Kansas, I can go to other places too. I eventually got my license in New Mexico, and there's lots and lots of work in underserved rural areas of New Mexico, so one of those opportunities has actually turned into a permanent position.

John: Okay.

Dr. Helen Rhodes: Yeah.

John: So there was a locums opportunity in New Mexico?

Dr. Helen Rhodes: Yes.

John: And was it another sort of a smaller type location or?

Dr. Helen Rhodes: Yeah. It's definitely rural. It's about an hour south of Albuquerque, and the hospital is a critical access hospital, so by definition, it has less than 25 beds, but they have a very unique model for taking care of their OB-GYN patients.

There's a certified nurse midwife who lives in the town and knows all the patients on our service, and then there are four board-certified OB-GYNs. I live in Texas. Two others live in other parts of New Mexico, and the fourth actually lives near Washington, D.C. Yeah. So between the four of us and the nurse midwife, we cover the service. So I go there for just under a week, once a month. This small hospital is actually affiliated with a larger healthcare system in New Mexico, one of the bigger systems, so is able to keep things running because they they're a small hospital within a big system, so they can achieve economies of scale, et cetera, et cetera, from the business perspective.

John: Okay. Now, are you still balancing that with the other clinical activities in your private practice at home?

Dr. Helen Rhodes: I am. Because I don't do OB in my private practice, it's pretty easy for me to leave. As long as I feel like I can get all my patients seen in a timely manner here and get the surgeries done, it's really not a problem to leave and go work in New Mexico once a month. And having an electronic health record that I can take with me, essentially, as long as I have internet access, I can communicate with my patients here, check their lab results, communicate with my staff. I have two employees. Things keep running even when I'm not here. So it's wonderful.

John: That makes me think of, and I don't know if this is even doable, but would it be possible to do some kind of telehealth, telemedicine? Are there certain types of things that you could do? I've never talked to an OB about that.

Dr. Helen Rhodes: Yeah. So I've actually been talking about this with my office manager and my nurse that there are certain types of patient appointments that I think would be very amenable to the telehealth platform. It just became legal in Texas.

We really haven't had a lot going on with telemedicine until very recently. Some of the bigger hospital systems are now doing it and I'm looking to see kind of how they're doing it and to see if I can incorporate that into my practice. But I see a lot of young girls that I start on contraception and then they go off to college.

And I really like to see them two to three months into that rather than waiting for them to come home during the summer, the holidays. And so telehealth would be great because in the evenings or while I'm in New Mexico, or when I'm not seeing patients here, I could have a quick tele-visit with them or telehealth visit with them and see how they're doing. Similarly, my post-op patients, they could take a photograph of their incision and I could look at it and do a telehealth visit. Those are the two types of visits that I'm looking into for telehealth.

John: It wasn't that long ago I talked to an orthopedist and he came to realization because he was off visiting someone else. He happened to have a patient in the town who was a hundred miles away from where he did surgery. And while he was there, he just went to visit the patient to look at his wound.mAnd then when he got back, he said, this would be perfect for telemedicine. That was three or four years ago. So now that's what he does because he has such a large drawing area. He's a pediatric orthopedic surgeon. So he does a lot of his follow-up visits with telemedicine. So that'll be interesting.

I'll have to follow up with you down the road and see how that pans out. But you're doing some other things, right? Aren't you into something that is a non-clinical or it's sort of clinically related, but not patient care? Tell us about that and how that fits in.

Dr. Helen Rhodes: When I was in business school, I really had two main goals. One was to learn more about the business side of medicine and possibly go into administration. And the other was to teach others what I learned or become a consultant regarding healthcare economics, et cetera.

I found out from a friend of mine who actually, she's an OB-GYN that went back to law school about the time I went to business school. And she had told me about the plasmapheresis industry, whereby they hire physicians to be the medical directors for each of the plasma centers. So when I initially heard about that job, which was a couple of years ago, I wasn't very interested. I didn't think it was a good fit. But then after I finished my business school education, I thought, wow, this is, now I understand more about operations management, working in teams. So this might be a good fit. I ended up doing that to help supplement my income. And I really enjoyed it because it's completely different from clinical medicine. You deal with a lot of federal regulations and guidelines for the industry.

And you're dealing with a population of individuals that are extremely impoverished for the most part, don't have access to healthcare. And really your job as medical director is to make sure that the donors are eligible for plasmapheresis, that they're healthy, and also to keep the medical operations team credentialed. There's very specific credentialing that's required by the FDA and industry regulations. And you're responsible for that. And you're also responsible for medical education of the medical operations team. So it's very interesting work. Since I've gotten so busy with the work in New Mexico and other places, I've had to cut back on the medical director work. And I'm now a backup director for a couple of the centers around here.

John: Do you have a sense for how much demand there is for that kind of a position in case someone might be thinking, well, this is interesting?

Dr. Helen Rhodes: There's a lot of demand. There's several companies throughout the United States. It's not just one company. And they pay an hourly rate. The training is paid. They pay for your mileage.

The commitment is four hours a week. I know one person in our group, I believe she was a pediatric emergency room physician. She's given that up. And now she handles five centers in the Houston area. She's a medical director for five centers. But essentially, she's working five, four-hour shifts a week and making good money. And she doesn't have any overhead. She just drives from center to center and takes care of her responsibilities and has a lot of time with her family.

John: Sounds very nice.

Dr. Helen Rhodes: Yeah.

John: For you, how does that compare, let's say, to the various clinical things you're doing? I mean, just from a payment standpoint without giving necessarily an hourly rate. But I mean, when you had the time, it was definitely worthwhile doing.

Dr. Helen Rhodes: Yes. Yes. I actually first took on that position because I had a small business loan for my practice. And I had this goal of paying it back in a certain amount of time. And that's why I originally took the position. Because all the money that I was earning from being medical director went directly to the loan repayment.

But then once I paid it off, it was a nice little extra check every month. But yes, I think the compensation for that work is very fair and very comparable to what you would earn in a clinical job.

John: Without any call?

Dr. Helen Rhodes: No call. And you only work four hours a day. I mean, there's nothing else. There's only so much you can do there. Now, I don't know anyone who's doing more than a four-hour shift. I don't think they allow it. But four hours is plenty. It's a very different kind of work.

John: You have to be very focused, very meticulous in doing that?

Dr. Helen Rhodes: You have to be focused. Yeah. You're basically reporting to the center manager and to the quality department. And it is a very tightly regulated industry. As it should be.

John: Yeah. It falls under the FDA, does it? Basically, the regulations?

Dr. Helen Rhodes: Basically, the plasma that's collected is actually sent over to various centers in Europe. Depends on which company you're working for. At one point, I was working for two different companies.

And one of them had a processing plant in Spain and the other company had a processing plant in Germany. And so in Europe, the plasma is made into pharmaceutical products, which are then sold back to the hospitals here in the United States. They also make a lot of vaccines, as well as fresh frozen plasma and all the clotting factors.

John: Okay. So, it's a pharmaceutical business, definitely. Now you've kind of reached, it sounds like at least for now, a point where you seem to have a balance. You've got some stability. The private practice is pretty stable. You're thinking maybe of adding telemedicine if it works out. And you have this pretty stable situation. It used to be locums, but now you're employed or it's more of a stable situation with the New Mexico practice. And you're working with three other physicians there. So how do you feel?

Dr. Helen Rhodes: I feel great. I feel great.

John: You're still glad you left that group?

Dr. Helen Rhodes: Which one?

John: Whichever group. The original, the one 10 years later. You don't look back and go...?

Dr. Helen Rhodes: No, no. I think I love the autonomy most of all, because I'm doing exactly what I want to do. There's things obviously I can't control. I can't control what I get paid by the insurance companies for the work that I do for my patients, but there's so much that I can control. And it's very rewarding when I go to New Mexico because I deal with some very underserved women who really have limited to no access to quality care. And it's great to be a part of that team. And I get to be in the mountains once a month. I live by the shore here, live by the beach. So I get the best of both worlds. I get to travel and I love it.

John: When you go and you're in New Mexico, I'm assuming that the organization, the hospital, the clinic, whatever, and the patients are happy to see you, right? They don't take you for granted, don't yell at you because you're five minutes late or anything like that?

Dr. Helen Rhodes: No. I feel very appreciated. I actually am developing my own kind of practice within a practice there. I have patients that wait for me to come and they're my patients. And then we all take care of the obstetrical patients, but the surgery patients, I'm starting to do some surgeries there. They're very excited about that.

They've worked with me in terms of which equipment I need. And there's a general surgeon actually that comes two weeks a month. He actually lives in Florida. He was doing what I'm doing now. He had his practice in Florida and he was working at this hospital in New Mexico. And then he decided to close his practice. Basically he works two weeks a month and has two weeks a month off. And he's very happy. But yeah, I feel appreciated. I have friends there. I have an apartment there. I have a social life there. And the climate is so much better than what I have here. There's no humidity there.

John: Well, okay. What kind of advice would you have for physicians who are kind of plugging away and maybe they're unhappy or they're frustrated or they're actually burnt out or whatever?

Dr. Helen Rhodes: Yeah. I think most importantly is you just have to think outside the box and look at many, many opportunities and cast many lines in the water and expect to get a lot of no's and don't get discouraged. Cannot underestimate the power of networking and mentorship.

That's so important. To connect with another professional that's doing what you think you'd like to do and brainstorm with them. I've been doing some mentoring of individuals who are burnt out. I've been helping a couple physicians transition. We can help each other. Don't give up your licenses. You hear a lot, people step away from it for a couple of years and then they go back. I think it's wise to keep your board certifications and keep your licenses active. And for an OB-GYN, I would say don't step away from OB for too long because it's really hard to get back into it.

John: Even if you were doing, let's say, OB maybe temporarily for a few months each year somehow, or backed up other people one week, a quarter. I mean, would those things you think would keep it up enough to satisfy the hospitals?

Dr. Helen Rhodes: Yes. I think doing what I'm doing, because I'm not only going to New Mexico, I'm still doing weekend locums at other places in Kansas and Texas. And there's such a need right now, especially in OB-GYN, especially in rural areas. They don't have enough doctors and there's lots of opportunity where you could do it one weekend a month. To keep your skills up. It's very feasible.

John: Now, I'll digress for one minute on the locums. Do you find that there's much flexibility in your ability to negotiate? I mean, I've heard horror stories of someone saying, well, they're only going to pay this much and turn around and found out they would pay like almost 50% more than that if you just asked or kind of held to your guns.

Dr. Helen Rhodes: Yes. We are terrible negotiators as physicians. It's very important to learn that you are really in the driver's seat. You are providing the service that they need and want. So, don't be afraid to negotiate for what you want.

John: Okay, good. Good. That's what I have heard, but I've never done locums, so I don't know how aggressive one can get. But if you have information, if you've done it at other places, at least it gives you some benchmark. But if you're going in for the first time, you probably have no idea.

Dr. Helen Rhodes: And it's best if you can negotiate directly with the hospital system, if possible, and not through a recruiter. That's pretty difficult to do because of liability. Usually the recruiting company is going to pay your liability, which for OB is kind of high. It is high. But if you can get the middleman out of it and directly negotiate with the hospital, you're going to get a much higher rate of pay.

John: Awesome. That's good to know. Well, this has been very inspiring and very interesting and helpful for everybody. And you talked about you mentoring a few people. So if somebody would like to reach out to you just for a question or something, shall we use the LinkedIn? I know you're on LinkedIn.

Dr. Helen Rhodes: LinkedIn is great. Or my email address is hrhoads62@att.net. And I'm happy to communicate with people who are interested in my story and how I can help them.

John: I think especially people in your specialty everyone kind of naturally wants to hear it from someone that has had a similar training and background. So it's good to if there's someone who's doing OB out there that might be struggling, then hey, why not reach out? Like you said, networking is awesome. Mentors are great.

Dr. Helen Rhodes: Absolutely.

John: All right, Helen. Well, I really appreciate the time that we spent together today. And we'll have to keep in touch. And you can let us know if you ever get that telemedicine going or anything new that comes in with your practice. But thanks again so much for being here with us today.

Dr. Helen Rhodes: Thank you very much.

John: Hey, you're welcome. Bye-bye.

Dr. Helen Rhodes: Bye.