The Second Annual Summit is Here – 348

In today's episode, John provides an overview of this year's Summit designed to make your clinical practice great or move on to a better alternative.

With a lineup of expert speakers and a comprehensive agenda, the Summit aims to equip attendees with actionable strategies for improving job satisfaction and exploring nonclinical opportunities.

The second annual Nonclinical Career Summit runs this week. It’s not entirely nonclinical in its scope, however. We have several presentations about starting and running a cash-based private practice. It features twelve experts who share inspirational messages and valuable know-how live over three nights.

It's called Clinical Practice: Make It Great or Move On

And beyond building your cash-based practice, our speakers will show you how to create an asset that can be sold later. Other experts will discuss MedSpas, Infusion Lounges, and other cash-only businesses, using Real Estate to diversify your income and assets, and several nonclinical side gigs including Expert Witness and Medical-Legal Prelitigation Consulting, Medical Affairs Regulatory Consulting, and remote SSDI Application Reviewer.

To learn more check it out at nonclinicalcareersummit.com. Remember that there is NO cost to attend the live event. And if you can’t participate in the Summit, you can purchase the All Access Pass videos (only $39 until April 16, 2024, when the price increases to $79).

Our Episode Sponsor

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

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

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

Trends in Addressing Physician Burnout

Physicians have faced increasing stress and burnout in recent years due to corporate employment structures in the healthcare industry. There are several basic approaches to preventing these common consequences of clinical practice.

1. Aggressive Contract Negotiation: Physicians are placing a greater emphasis on negotiating employment contracts to safeguard against burnout inherent in corporate settings. While not discussed extensively in the summit, this strategy is crucial for those considering employment.
2. Identifying Root Causes of Dissatisfaction: Physicians are focusing on identifying and addressing the underlying causes of dissatisfaction, whether it's related to the nature of their vocation, organizational policies, or interpersonal dynamics. Analyzing these factors allows for targeted solutions to alleviate stress and improve job satisfaction.

Highlights of the NonClinical Career Summit

The Nonclinical Career Summit starting on April 16th features a lineup of expert speakers covering various aspects of nonclinical career options for physicians. Here's a sneak peek at what attendees can expect:

1. Speaker Sessions Overview: The Summit will host twelve live presentations, spanning topics from evaluating the need to leave clinical medicine to exploring diverse career paths outside traditional practice settings. Each session offers actionable insights and practical advice tailored to physicians and other clinicians seeking alternative career paths.
2. Logistics and Registration Details: The Summit will run over three consecutive evenings, starting on April 16th, with sessions starting at 7 p.m. Eastern Time. Live attendance is free, but registration is required to access the sessions. Attendees can opt for the All Access Pass for $39, providing access to session recordings and bonuses.

Summary

This week's podcast previews the 2nd Annual Nonclinical Summit featuring 12 expert speakers addressing ways to create a clinical practice outside of the corporate style of healthcare and nonclinical career options. Attendees are encouraged to register early to secure their spot and gain access to valuable resources aimed at supporting career transitions and enhancing job satisfaction.

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

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

Links for Today's Episode:

• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit
• Information about the Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Episode 348 Transcript

Over the past few years, I've noticed that there is a backlash to the increasing stress and burnout in physicians resulting from employment by large corporations. It seems like the burnout's getting worse and it's related to being employed, losing their autonomy, and really working in that sort of healthcare industrial complex, seeing as many patients as you can in every hour. So in response to that, I think physicians have begun to implement various strategies to prevent or address the burnout, the stress, and the dissatisfaction that's coming.

So these are some of the four trends that I have seen. It's not everything, but I see these as something that's getting more and more common. So first is a bigger emphasis on aggressively negotiating employment contracts.

After all, if you understand that employment leads to dissatisfaction and burnout, and maybe if you've been through it once already, to some extent, you should be able to address the cause of that burnout by building safeguards into your contract. We won't be addressing that in this summit, but it is something I've noticed, and you can take a listen to my interview with Ethan Encana, who's an MBA slash JD, which was posted in February 13th of this year. So if you listen to that, we'll be talking a lot about trying to protect yourself from the things that cause your burnout in your contracts, if you decide to go with the employment route.

Now let's move on to the next one, which is more in keeping with what I want to talk about today. And that is a big thing that physicians are focusing on now, and people are teaching about is finding, identifying, and somehow preventing the root causes of your dissatisfaction and addressing it in new ways. So is it your vocation itself? Is it the practice of medicine? Or is it the organization you're working for and their policies and procedures? Maybe they don't staff properly.

Is it the boss that you report to that's causing your stress and anxiety? Sometimes a fierce conversation can solve the problem. Sometimes moving to a different clinic or hospital will work, but you need to spend the time really analyzing what's, what, what it is about the work that's making things worse. And is it something that you can resolve either in the current situation or at a future one? So that's something we don't talk a lot about on the podcast, although I have had one of our summit speakers, Dyke Drummond, on the podcast to talk about that, but that was several years ago.

Number three is the physicians are implementing new or updated practice models that put more control in the physician's hands. Things such as direct primary care, concierge medicine, and other forms of cash only medical businesses. And this can solve the problem in two ways.

Number one, a lot of times doing that requires you to be in your own practice. So you're starting your own business. So you're not working for someone.

Doesn't mean it's not busy. Doesn't mean it's not challenging, but now you have that autonomy and you're in control. And the other reason is that it's oftentimes the insurance companies, which are driving this whole approach to medicine, where you've got to see as many patients as possible, because they have certain schedules, payment schedules that are difficult to, you know, earn a living on.

And a lot of the drive to see a lot of patients is because of either Medicare and counting it worked RVUs or trying to see so many patients an hour. And that can be overcome by starting your own business and taking cash. And you figure it out in that setting.

Since you don't have to hire two or three people per physician to do the billing, you can cut costs in that way and you can generate income. So it's another thing that I see growing in the past two or three to five years, even. And then the other one is just finding a part-time job.

It's something you can do on the side because you can then either cut your clinical back to part-time also. And then you get to do two different types of jobs. One, a clinical, one, a non-clinical.

You can find, you know, you feel like you're seeing a little more variety of things. You have better hourly compensation sometimes with the non-clinical side, especially those we're going to be teaching at the summit. And again, if it involves starting something like either a practice that just doesn't bill insurance or a med spa or an infusion lounge or a weight loss clinic, you're still at the end of that able to sell it.

And that's a big asset that can really be a big chunk of your retirement and really builds to what I would call it through that process, some career diversity. The other thing that's nice about doing something like one of these side gigs or side jobs is that they can grow to be a little more part of your week as you retire from clinical, let's say, as you get older. The other is it's protecting you so that if your clinical job, which may depend on employment by a hospital or part of a group, that would be protected.

That gives you that leverage, that independence that you otherwise wouldn't have if someone decides to fire you. Okay. So that's why, because of those last three issues that I've been noticing, Tom and I both, that's why we're calling this year's summit clinical practice, make it great or move on.

So there are ways to improve your practice as it is, where it is, or ways to improve it by moving and doing other things. And there are ways to make it better by splitting it with another non-clinical career. And so that's what we're talking about at the summit this year.

And I think it's very apropos. And the tagline is recognize dysfunction, fix it and protect yourself or seek better opportunities. So you can see, as I go through what we're covering during the summit, it kind of brings all of those in and those kinds of terms will probably make better sense to you.

So let's get into the specifics of this year's summit. Last year, we were, just like last year's summit, we're holding it on three consecutive evenings, starting the day after this episode, day or two after this episode is released. I might be releasing it a little early to give people a chance to go through this before the summit actually starts.

And we're doing it that way in the evenings live to enable as many clinicians to attend the free event. So as many people can come for free, making it because we know that Tuesday, Wednesday, Thursday evenings are the best time. If we do it during the day or on a weekend, people usually cannot even come for one or two of the hours of presentations.

But by doing it in evenings and doing it live at night, people can carve out some time and maybe at least watch one or two or three of the sessions each night. Now it starts on April 16th at 7 p.m. Eastern time with four live presentations at the top of each hour. They'll end 50 minutes later, followed by a 10-minute break.

And each presentation includes a live Q&A during the last 10 or 15 minutes. It continues on Wednesday, April 17th and Thursday, April 18th, obviously each night starting again at 7 p.m. Eastern. We're holding it on a typical Zoom meeting platform that most of you are very familiar with.

Questions will be submitted using the chat. It could get a little bit confusing if you got a we're going to use the chat and either myself or Tom Davis will curate the questions. You know, sometimes we get two or three that are very much similar and we'll kind of bunch those together.

But that way we can spend 10 minutes at least getting, you know, answers to really the burning questions that come up during the presentation. I think I mentioned earlier, live attendance is absolutely free, but you have to register in advance to attend. That's the only way we can get you the link to attend.

So you just sign up on the link that I'll give you in a minute. And once you're registered, you can come and attend as many or as few sessions as you like. To save your spot, you're encouraged to register using the link that one of our speakers may have sent you.

You know, you might be watching this, but maybe you're already a student of Dr. Drummond's or Dr. Unachukwu or anybody that's helping us here, which I'll be going through in a minute. And you definitely can use their link and then they get credit. If it's easier or if you don't have any link from anybody else, then you should just go to nonclinicalcareersummit.com and you'll be given an option to sign up for the live free event.

And that's also the same link for purchasing the All Access Pass, because we understand that not everybody can attend all the live sessions. So we're making the recordings available for a very low price. That's just $39.

And given all the work that goes into putting this together, that's pretty darn reasonable. Now it does increase on the day that the summit starts. On Thursday morning, the price goes up to $79.

I'm sorry, not Thursday morning, on Tuesday morning, when the summit is starting later that day. But in the morning, it jumps to $79. That's on April 16th.

So if you want to get that really best price, you should sign up for the All Access Pass by Monday, April 15th. And again, it's $39. So you have to get that registration in by midnight on that date.

And again, it's also available at nonclinicalcareersummit.com or by using any speakers affiliate link if they're sending those out to you. All right, well, let's get into the details about the speakers and the lectures. Basically, like I said, we have four presentations per evening.

They're all live except one is being recorded ahead of time because the speaker is actually not available during the summit. But we didn't want to not include him in this thing. So let's just start with the first one.

And I'm going to say that these are not in the order in which they're being presented, but kind of in the order that they flow in my mind in terms of addressing the main thing we're trying to do for the summit. So for example, Dyke Drummond, Dr. Dyke Drummond, very well known. HappyMD is what he's known for.

He's got a podcast. He's been doing this a long time. He's coached thousands of physicians.

And he's going to be speaking on Tuesday night, the first night. And he's going to be answering this question. Do you really need to leave clinical medicine or is it just the job? And the official title, is it just a shit job or boss you want to escape? So really, it's not necessarily clinical medicine or clinical nursing or other clinical specialties that you're working in.

It's oftentimes other things that lead to the dissatisfaction and the burnout, the anxiety, things like that. So he's going to take that question head on. And how do you determine if this is really you should leave medicine or whether you should stick with it, but resolve the problem in a variety of ways.

And some of the ways he's going to talk about is just how you take control of what you're doing, listing the alternative practice models that might solve the problem. And if it is time to leave, let's put out that ideal job description process. So you can assess when you're going somewhere else, is it likely to be a better situation? So the next speaker I want to talk about is Mike Wu Ming, a very good friend of my podcast and myself, and he's written a book.

And he's going to build on what Dyke is telling us from the standpoint of what his experience has been with owning cash-based medical clinics. Okay, so it's still a practice. It's a medical clinic.

And he just describes sort of the mindset changes you have to go through to make this happen. He'll list the four or five financial levels of a physician, what that means, what it means to be a CEO, not only of your business, but of your life. He'll talk about ways to provide medical services outside the insurance industrial complex, if you want to call it that.

Let's see, he'll compare different types of cash-based medical clinics and where he sees future growth. All right, the third one, again, an expert on business in general, Dr. Una, Dr. Nneka Unachukwu. She goes by Dr. Una.

She has one or two podcasts. She's coaching a lot of physicians, and she's got many courses. And she's an expert and does a lot of speaking about creating a successful business.

In her case, I think is a good mix of people she's worked with who have created healthcare businesses, not necessarily a medical practice. Some have created different medical practices. And so she's going to talk about the business practices you must adopt to be successful, to get into a little bit about the importance of branding and marketing.

And again, she likes to focus, and I think she'll touch on this as well, how to build a practice or a business or both that has value and then eventually sell that business for cash out at the end, which again, I've mentioned earlier, is a great way to help segue into your retirement. And I've got just a hint of this because I'm currently in the process of helping my wife sell her own business, which she's been running for 15 years. And so we're going to just find out what it's worth at this point.

And it wasn't really something that we dwelled on up until the last couple of years. And I guess I'd mentioned now that if you do build a business of any sort, you should really always try to think of the eventual selling of that business because we all eventually go away. And even if it means turning it over to a partner in a medical practice, how does it happen? What's the value? Thinking about those things.

So those are the kinds of things that Dr. Una are going to be talking about. Then to kind of round that out and from another perspective, Joe McMenamin, who just was on my podcast, I think last week, but yeah, and he's going to be talking about corporate entities, meaning, you know, LLCs, corporations, things, how to create a legal situation for your business that makes it safe, protects you financially, keeps the tax concerns in mind. He's also going to touch a little bit on contract negotiations or starting a new business, other things to consider besides just the corporate structure.

And he'll be comparing those different legal entities that can help make your business successful. So the next is we're going to get even right into the nitty gritty of some of these cash-based businesses. See now a med spa, many physicians are familiar with, I wouldn't call that a medical practice.

And I don't think you need a license to run a med spa, although it helps if you're a medical director, if you're doing procedures that obviously are licensed and you have insurance for that. Now practice insurance, but she's going to talk about this. I believe she owned her med spa for 15 years.

She started it from the ground up. She grew it, she marketed it, she branded it and she sold it. And they happened not too long ago.

And she actually was able to segue into staying on as a part-time medical director. And so it really worked out well. She's very happy with how things went.

And again, I don't think she was thinking about the sale of it when she started it, you know, 10 or 15 years ago, but it worked out well for her. So she's going to share some of her experiences with that. Next two guests, our speakers are Jennifer Allen and Kimberly Lowe.

Now they're actually each doing an individual presentation because Jennifer is a physician and Kim is a nurse. They're going to discuss their particular experiences and reasons for going into starting an infusion lounge or an infusion center. And both of them will spend a little bit of time talking about what the heck is an infusion lounge.

And it turns out it can be a lot of different things. And let's see for Jennifer, she's going to be focusing too on the basic services they usually provide and how hers is different and who's sort of best qualified, or let's say has the best background and personality to do something like this. And a little bit about the first three steps, prepare to open your own infusion lounge if you decide to do that.

Now during Kim's session, and Jennifer's I think is on the first day, Kim's is on the third day. Again, she's going to tell you why she thinks it's a great investment and describe how the partnership model, you know, is working for them, for her in particular. She's going to hopefully mention some of the other businesses that nurses might be able to get into in healthcare that, you know, not everything is open to a nurse, you know, medical practice per se isn't.

But even in some places as an NP or an APN, you can do something like that. But she's going to talk about, you know, nurses and kind of side businesses that they might be doing that are similar to what she's doing. And she might end there with three mistakes that you should avoid when starting an infusion lounge.

Well, that brings us up to Paul Hercock. He's been on the podcast twice. He's from the UK.

And he created, well, he has a business that uses medical regulatory consultants or medical affairs, regulatory consultants to help meet the needs of the MDR regulations, medical device regulations in the UK and in the EU. Paul is a physician and he's been working in this field for a long time. And so he started hiring people to do this for him, for his business, which is called Mantra Systems, I believe, Mantra Systems.

And then because he was having difficulty finding people, he created a program to teach people how to become medical regulatory affairs consultants. So that's what he's talking about. And I think it's going to be very interesting.

You'll be working remotely for companies that are mostly in the UK and the EU, but you can work from the United States. In fact, we have a lot of people that contact me that are from the EU. You know, they maybe have traveled, they've immigrated to Europe and then they decided to come to the US and they may have a degree from somewhere in Europe, UK, France, you name it.

And there's no reason why they can't continue to do work back there remotely because things are just so easy to do in that way these days. And in fact, Paul told me that they often look to hire American physicians to do this because they have a lot more experience in dealing with the FDA. The MDR regulations are actually relatively new in Europe and the UK.

So that's going to be an interesting one. Very useful, very practical. Then Dr. Armin Feldman is going to come on.

He's been on the podcast a couple of times and he's going to tell us all about medical legal pre-litigation, pre-trial consulting. And I've discussed this before, but it's an awesome side hustle. Don't have to be licensed to do it, but you definitely have to have a medical background.

And he's going to explain exactly how that works, why there's a growing need for the service and how to get the necessary skills to do it. That brings us to Gretchen Green, who's pretty well known for teaching hundreds of physicians, how to become expert witness consultants. She's run her course nine or 10 times.

And so she's going to give us a quick overview of how to become an expert witness, how to build the business side of that, what to do, what not to do, what it entails. And so this is going to be really interesting and an overview for what she does. And then the last one is Tom Davis, known to many of you, I hope, as my past business partner in Newscript, which we've closed down back a few months ago.

But he's here helping with the summit. And he's been involved with companies that provide social security disability reviewers. And it's something that I didn't quite understand or wasn't well aware of.

I'm definitely aware of an independent medical examiner, but there are also other layers of the process of becoming, let's say, qualified for disability payments from social security. And it's a very niche area, but you can definitely get a remote position as a social security disability application reviewer. And it really piqued my interest.

I want to learn more about that. And so this is something that almost any physician can do. I believe they need to be licensed to start out, but I'm not sure you have to remain licensed.

And there are full-time jobs available as well as some part-time jobs, from what I hear. So I'm really interested in hearing Tom describe exactly what that entails and who's qualified and how we would apply for that. And then finally, did I say finally with Tom? There is one more, and it's kind of the icing on the cake.

And it's a little different, but we thought it would be nice to have Dr. Pranay Parikh talk about real estate and how it can make physicians' lives better. So we're not talking about becoming a full-time real estate investor or manager, but as I spoke about earlier, when you can build different sources of income, different sources of assets over time, then why not do that and add that to your portfolio of income streams? And so we thought, well, it's not a clinical type of thing. It's something many physicians are interested in.

So he is going to be talking about real estate. He spent, I don't know, the last five or 10 years in real estate. He actually has a real estate company that he's partnered with.

He's worked with others that you have heard of on the physician side of things. And there's so many different ways of investing in real estate. We thought, okay, Pranay, come on this summit and talk about how a side hustle in real estate can bring emotional and financial rewards, list the benefits and challenges of investing in real estate and describe, we're going to have him describe the three most popular approaches to investing in real estate.

That wraps it up. That covers the 12 lectures that we're bringing during the summit. I'm really looking forward to learning from all of our speakers.

They'll be sharing their wisdom. You'll be able to follow up with them later if you want to. Some of them are going to probably be promoting the summit with us.

Some of them are going to be providing their own bonuses. So if you are already following some of them or on their email list, watch out for their emails because they will be helping to promote it. So even if you're using the free version, if you register through them, you can get any bonus they might be providing as being part of this.

Our team is really excited to bring you this year's summit. We're doing our very best to bring you actionable advice that will help you to improve your current situation, establish your own practice or healthcare business, or create a lucrative side gig so that you can maintain your autonomy, improve your income and satisfaction and support your transition when you withdraw from clinical practice. So there's a lot of benefits to this year's summit.

Sign up for free right now or purchase your all access pass by going to nonclinicalcareersummit.com. The day that this is being released, the all action pass still only costs $39. And I think it'll be that way for another day or two. But if you're listening to this later, you'll have missed that $39.

So on Tuesday, April 16, the price will jump up to $79. Still a very reasonable price if you need to get the recordings. And then after that, when the summit's done, they'll actually jump up in price again.

But for right now, if you want to get in early, go to nonclinicalcareersummit.com. And to make things easier for you, instead of remembering that link, you can find the show notes and some other links by going to nonclinicalphysicians.com/make-your-clinical-practice-great.

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

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The post Make Your Clinical Practice Great or Move On appeared first on NonClinical Physicians.

Interview with Dr. Lisa Jenks – Episode 326

In today's episode, Dr. Lisa Jenks returns to the podcast to describe what she did to prepare to sell her MedSpa, a major milestone in her entrepreneurial journey.

Dr. Jenks' initial interviews with John, in 2018 and 2020, delved into the founding and growing of her MedSpa business. This episode unveils the third major milestone in the life cycle of her business.

Our Show Sponsor

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

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

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

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

Physician Entrepreneurs: Building a Business Beyond Clinical Practice

In this interview, Dr. Lisa Jenks shares her inspiring journey from emergency medicine to founding and selling a successful MedSpa business. Dr. Jenks recounts the challenges of entrepreneurship, emphasizing the importance of meticulous financial management, maintaining tight operations, and the necessity of good business practices.

She also highlights the rewarding aspects, such as creating a valuable asset, contributing to the growing field of med spas, and achieving a seamless transition into retirement.

Prepare to Sell Your Healthcare Business: Insights from Dr. Lisa Jenks

Dr. Lisa Jenks describes crucial insights you must understand as you prepare to sell any business.

1. Financial Management:
   Dr. Jenks places a high premium on meticulous financial management as a cornerstone of successfully selling a healthcare business. She stresses the importance of impeccable financial records, guided by a skilled financial advisor. A robust financial foundation, including well-documented operational systems and inventory management, enhances the perceived value of the business and streamlines the selling process.
2. Flawless Business Practices:
   To maintain a tight ship throughout the life of the business, she encourages constant vigilance. She highlights the subtle yet persistent rise of expenses if not kept in check. Lisa reminds us that potential buyers are keenly observant of how a business is run. This emphasis ensures that the business's value is in its profitability, bolstered by streamlined and efficient operations.
3. Unforeseen Time Commitment:
   Dr. Jenks candidly shares her experience regarding the time commitment inherent in the sales process. She points out that the process is more protracted and paperwork-intensive than many entrepreneurs anticipate. From the initial discussions with potential buyers to the finalization of contracts, the timeline can extend over many months. Dr. Jenks notes that having a realistic expectation of this time commitment is crucial. Moreover, she highlights the need for patience as negotiations unfold.

Summary

Dr. Lisa Jenks can be reached via email at lisa@genesis-medspa.com, and her work number is 719-579-6890. Additionally, you can explore more about Genesis MedSpa on their website: genesis-medspa.com. Feel free to connect for her insights into the world of MedSpa ownership and how to prepare to sell your business.

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

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

Links for Today's Episode:

• Genesis MedSpa Website
• How to Find Peace and Balance as a MedSpa Owner with Dr. Lisa Jenks – 065
• What Makes a Physician MedSpa Owner So Happy? – 131
• This Family Doctor Successfully Merged Medicine and Marketing in a Medspa – 318
• How This Consulting Business Grew Directly From a Patient Need – 289
• How to Fulfill an Academic Need and Spawn a Business with Dr. Jason Ryan – 081
• NewScr!pt

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 326

How to Prepare to Sell Your Growing Healthcare Business - Interview with Dr. Lisa Jenks

John: I've always been fascinated by physicians who left clinical practice to build a business of their own. And while it can entail some long hours and usually a sizable investment of cash to get any sort of major business going, I think to be able to control your own business and to create a valuable asset is definitely something to think about. That's why I'm so pleased to be able to welcome Dr. Lisa Jenks back to the podcast today. Hi Lisa.

Dr. Lisa Jenks: Hi, John. Thanks for having me back. I've been looking forward to this.

John: I'm just in the middle of so many weird things that are similar to this. My wife owns a business that she's in the process of selling and this whole concept of physicians building some business that's related to healthcare, related to medical care where you have the expertise. And then at what point does it become an idea that, "Oh, I'm going to sell that because it is a valuable asset?" Just remind us about your transition from emergency medicine to starting the med spa, all those years back. I think that was more than 15 years ago, wasn't it?

Dr. Lisa Jenks: It was. Yes, I started life as an emergency room physician, which I loved. But when baby three came along several decades ago, I threw in the towel. It was just unsustainable. I stayed home for a few years and then opened Genesis in 2007 and sold it in June of this year.

John: Wow. That is a very long story scrunched down into one sentence. But it's fantastic. Time flies and before you know it, we've got to make decisions like that. If I remember correctly, and I'll encourage the listeners to go back to our previous two episodes. I think one was in 2018 and one in 2020. They can get a lot more detail about the startup and the management of it. But give us a little taste of what you envisioned at the beginning and did you think about selling at the beginning when you opened it?

Dr. Lisa Jenks: John, I am embarrassed to tell you how naive I was when I opened my own business. I had no idea what it would entail, and I don't think at that point I was thinking about the end game. I was just thinking about what I could do within medicine, but with not within traditional medicine that would allow me to have a work-life balance and still feel like a doctor. And I decided to open a med spa and really didn't think through it very much.

About three or four years after I opened, another physician who was a pathologist started working very part-time for me. And another one or two years after that, she started buying into the business with the end goal being at that point that she would eventually take over. However, in 2020 for various reasons, she had me buy her shares back and she transitioned out of Genesis.

That was my original plan. And then in 2020 that proved not to come to fruition. And right about the time of 2020, certainly 2021, PE firms started acquiring med spas across the country. And it wasn't unusual for me to get two or three emails a month from a PE firm asking if I was willing to talk to them. And just about a year ago, 18 months ago, I started to think, "Okay, maybe I should talk to a couple of these guys." Because I knew that within the next three to five years I would like to sell, especially if the buyers would want me to stay on for two to three years. And so, then I started thinking more seriously about talking to these PE firms.

John: Nice. Well, when you talked about at the beginning, you had never thought about it. I think most of the people that I've talked to, physicians and non-physicians, when they're starting a new business, it's because they have this idea they want to do it. They want the freedom, although it does take a lot of work, running their own thing, and they never really think about that.

Now, if you talk to people like brokers, they'll tell you, "Well, from the day you start your business, you should think about how you're going to sell it." But very few people in my experience do that really. That's very common. Yeah, this is a very interesting story. Then it became apparent. Of course, you've been so involved in the med spa industry, I'm sure it all matured while you were doing this. And then there's meetings and all of a sudden you start hearing about, "Oh yeah, these private equity firms are buying people out, or people are selling, or maybe they're merging." I don't know. Were those kinds of things talked about in the meetings you would go to when you were with your cohorts who do the med spa business?

Dr. Lisa Jenks: Yes, they were, to some degree. Yes. But I think most of what really made me aware of how this was moving forward with PE firms across the country is, like I say, I just started getting a lot of emails and a lot of interest being shown towards Genesis.

John: Now, are there other entities from what you've learned since this all began, that have been looking at buying med spas or do maybe others? I guess I look at it like the urgent care business. That's how I can compare it. I know that in the old days, everyone just started their own little urgent care and somebody would put two or three together. And then lo and behold, about five or 10 years ago, now you're getting these mega groups where there's 20 and there's 50, and now there's a hundred of these things, and some are bought up by investors, but some are just bought up by larger networks that want to get bigger. Have you heard of other opportunities for those who are interested in maybe leaving or selling their med spa?

Dr. Lisa Jenks: Absolutely. I definitely know here in Colorado of multiple instances where, for example, there's a dermatologist who does aesthetic derm in Vail, and she recently bought a med spa, an existing med spa in Grand Junction. And I know that that has happened here in Colorado Springs in Denver, where a successful med spa owner buys another med spa either in the same area or the town over. But I think most of what's going on right now is PE acquisitions.

John: Tell me about that, when that first started and you said, "Okay, I think I'm going to talk to a couple of these just to learn what I can learn and figure out what's going on." What did you learn at that point that you didn't expect? Or were there things you thought, "Oh, I got to change things a little bit now because they're looking for X, Y, and Z that maybe I only have X and Z or something?"

Dr. Lisa Jenks: The thing that I learned is how long the process takes.

John: Okay.

Dr. Lisa Jenks: How much paperwork it involves and how important it is to have a good, good financial banker on your side who can help you go through your numbers. I have been really fortunate because I have worked with a phenomenal bookkeeper, accountant, and business advisor pretty much since I opened Genesis.

And to anyone who runs any business, and certainly once you start thinking about selling, having your financials just in absolute impeccable order is so, so important. And I feel very grateful that mine have been, and that made the process easier.

Keeping track of inventory and having a history of having done that, is so, so important. And having all of your operational systems written down is critically important too. So, those were the things that I was really proud and happy to realize that I had in good shape.

John: Now when this whole process started, and you were considering this, you had a pretty large team at that point already. Is that correct? From what I remember, you had all kinds of professionals working with you.

Dr. Lisa Jenks: Well, I have for the last, whatever, five years or so, had a staff of 17.

John: Okay.

Dr. Lisa Jenks: And then, as I say, just had a business advisor, outside bookkeeper and outside accountant working alongside of me ever since my inception.

John: Now, did you change anything once you really started getting serious about selling? Was there something you had to change or did you have plans that maybe you either accelerated or decelerate? Did that affect that process?

Dr. Lisa Jenks: One thing that I changed, on the advice of my business advisor, I increased the hours of my nurse injectors and decreased my hours a little bit. And the reason that I did that is I did not want new owners or potential buyers, potential owners, looking at my business and thinking that everything depended upon me being here. That I was the one bringing in all of the income. And because I've worked full time in the practice, I am responsible for a large amount of the income, but obviously new buyers know that I'm selling because I want to not be here in the near future. And so, having them able to look and see that other people are bringing in large amounts of the income is important. That was the one thing that I changed probably in 2020.

John: Okay. That makes sense. Yeah. This is kind of like the issue that comes up with trying to sell a medical practice, let's say a family physician or a pediatrician. They're generating all the income. So, what is the asset really worth? Without you committing to stay for the next 10 years it's not much you.

Dr. Lisa Jenks: Exactly.

John: Because you're going to have to hire your replacement or they're going to have to. Luckily the planning in businesses like you're doing, you can leverage yourself and to where you're supervising and other people are doing a lot of the face-to-face work. That definitely helps a lot.

Dr. Lisa Jenks: Yes, yes. And I'm sure you know that the way this works for businesses is they take your income minus things like taxes and interest and they multiply it by a certain multiple. And that varies from industry to industry is what that multiple typically is. And that's the rough idea of what you're selling price is.

To have a good financial banker that can help with this is really critical as well. For example, I give my staff, I've always given my staff a certain number of free services as part of their wages for working here. And we always subtract that from our income on our P&L. Because then to the IRS, it looks like I'm making less money, which is what I want to have happen in a perfectly legal way. But a good financial banker will then look at potential buyers and say, "You don't have to continue giving these free services. And if you had not, if you choose not to, then your potential income would be even more than the P&L is showing." So, having somebody to guide me through things like that was incredibly helpful.

John: Now, I know with some businesses that sell, a small businesses in particular, they'll use a broker, but it sounds like you didn't need to use a broker because you had enough of that expertise in your banker and your advisors and the other people you were working with.

Dr. Lisa Jenks: Well, that and these PE firms were searching me out. And I think if I had two years from now, been really, really ready to retire and nobody is contacting me, I would've had to have gone to a broker to try and put me in touch with interested buyers. It worked out very well. Yes, yes.

John: Good planning on your part.

Dr. Lisa Jenks: Thank you.

John: I think the planning is getting into a business that's very growing and popular. And luckily, definitely there were buyers out there looking to get what you had created. I was going to ask you what you would do differently at the beginning, but it sounds like you've covered everything in terms of how to prepare for the sale. Just good business practices, good policies and procedures, making sure everything's written down as far as how things are run. And once all your ducks are in a row.

Dr. Lisa Jenks: Another important thing, it's easy as a business owner to fall into a sense of complacency, especially if you're running in the black and if you feel like you're growing a little bit every year. But it's so important just to maintain a tight ship and it constantly astounds me how easy it is for expenses to just balloon a little bit and then balloon a little bit more. And it's nothing big, it's nothing extravagant. It's not that any of the staff are buying things that they shouldn't buy necessarily, but if you, as the business owner aren't really keeping track of all of that and aren't perhaps calling the phone company once a year to argue against the 20% increase that they're trying to give you, how the expenses can take over.

And so, I think just keeping those as low as possible at all times, which is tough when you're running a business and you want to provide your staff and your customers with the very best experience that you can, which takes money to do, but really, really trying to run a tight ship is so important.

John: You alluded to this earlier, but what was the whole process, the time of it? Did it take a year? Did it take two years, nine months? Where did you fall?

Dr. Lisa Jenks: August of 2022, they first approached me and they were a relatively small company. They seemed very personable. I had several phone conversations with them. They talked about their philosophy of maintaining the atmosphere. They buy successful med spas and they want to help them be more successful. They don't want to come in and change everything. And I really like that attitude. Then I sent them all of my financials, and we signed an agreement that I would not talk to other companies for, I think it was 90 days or 120 days while we went through the process. And probably December or so came up with a mutually agreeable price, but then it was not until June that all of the paperwork, all of the details got hammered out and it was June 9th that the actual sale occurred.

John: Well, the nice thing about selling to let's say private equity firm rather than let's say someone else that owns a little network or something, is they're going to have the process down pretty well from their previous purchases and they can pretty much demand it. This is what we'll do and this is what we need to see. If we can see this and we feel good about it, then we'll buy it. It's a little different when you're working with let's say someone else who owned two or three med spas and were doing things however they were doing it and never bought another one.

Dr. Lisa Jenks: Exactly. And this has been great for my staff. I was not able to offer health insurance to my staff, and this company is offering health insurance. Their benefits package is a little bit better as far as vacation and PTO and things like that. So, that's been nice to see.

John: Very nice. And it doesn't sound like... I would expect about a year on average for a relatively smooth just from the people I've spoken with.

Dr. Lisa Jenks: I think it went very well. And our plan is that I signed a contract to continue working about 25 hours a week for two years, and then we will reassess. And I'm working both as medical director and then also still seeing patients and doing what I love to do. But this has just worked out great. The money from the sale has allowed me to do some fun things like buy a cabin up in the mountains and spend more time with my grand babies. And yet I was not ready to completely stop working. So, this has just been a really, really nice way for me to ease into retirement.

John: Now, did you get a sense that if you were in let's say a lot bigger of a hurry to leave, did they seem to be flexible to do maybe a year or six months? Were they pushing for an extended period where you're there or was that pretty flexible?

Dr. Lisa Jenks: That's a great question and I'm not sure I know the answer to that because I think they were the ones that floated two years, and I was like, yeah, that sounds great. So we really didn't have any discussion or debate about that. I'm not sure what would've happened if I had said, "Sorry, you've only got me for six months." Or if I had said I want to be here five years, I don't know. They may not have wanted either one of those, or they may have been fine with either one of those. I don't know.

John: It sounds like the timing was just perfect though, because you were both looking at the same number in terms of "Oh yeah, this will work out." The only reason I ask is because for some people, it's like when you're in medicine and you get burnt out, you reach a point where you're done and you want to sell. And we think it takes a long time to get out of your practice when you've been in it for several years, but most people can get out in six months or less if they really push it. But you cannot get out of your own business in less than a year unless you have someone lined up ahead of time to buy it and they're going to want you to stay for a while. So, you just had everything worked out so great. You're just the prime example of how to sell your business.

Dr. Lisa Jenks: Well, thank you. It really did. I feel very, very blessed. And it did, the timing could not have been better.

John: I think this is just a great inspiration for physicians who have maybe thought about the idea, "Well, can I do my own business?" And really just hearing your story reminds us, "Okay, not only can I find something good that I want to do, that I'll enjoy doing, that'll pay well. And if I think in advance I'll have this asset I can sell at the end." I think it inspires all of us to kind of plan ahead and say, "This might be a definite option."

Dr. Lisa Jenks: Well, thank you. And I hope that anybody who has questions or wants to talk to me more will feel free to contact me. My email is lisa@genesis-medspa.com. And my work number here is 719-579-6890. I love, love, love talking to anyone about starting a med spa, running a med spa, and now I can speak to selling to a med spa.

John: Fantastic. I appreciate you sharing that. The website for the spas is genesis-medsspa.com, and they can use that phone number. I'll put all this in my show notes. They can use your email. They could find you on LinkedIn. And what else are you up to? I know in the past you were doing some mentoring, coaching, that kind of thing. So, tell us more a little bit about that, which is obviously part and parcel of your involvement as a med spa owner.

Dr. Lisa Jenks: One weekend a month I hold classes here at Genesis, and alternate months between teaching injectables, meaning neurotoxins and fillers and then teaching PDO threading. And I love doing that. The students for the class range from estheticians to MDs and everybody in between. They're very small classes, a lot of hands-on. And so, those are really, really fun and I would love to tell anybody who's interested more about that.

And then I do some consulting and mentoring, John. I love doing that. It hasn't really taken off as much as I had hoped perhaps it would in the early days, but I do every so often get emails from doctors who are wanting to start med spas and we'll have conversations with them. Some of them even have flown out to shadow me here at Genesis and just see a little bit more about what this world is like, which I really enjoy.

John: Well, that'd be a fantastic resource. If I was thinking of starting a med spa, that would be perfect. The old shadowing, like we did when we were in med school or thinking of going to med school and really see how things run. That'd be fantastic. And they can reach you just through the phone number and the emails that you talked about a minute ago.

Dr. Lisa Jenks: Yes.

John: All right. Well, I just want to say congratulations. You're making this fantastic transition, as you will, as you want to. Whether you retire or not retire, who knows what you'll do 3, 4, 5 years down the road. But this is really again, it's an inspiration to all of us. I appreciate you taking the time to come today.

Dr. Lisa Jenks: Well, thank you. I appreciate you inviting me and allowing me to share this exciting news with everybody.

John: It's been great. I was going to say who knew when you were going to emergency medicine residency that someday you'd be a business owner and med spa practitioner?

Dr. Lisa Jenks: I can tell you I sold my med spa for way, way, way more money than I would've sold my ER scrubs to the next doc coming in when I retired.

John: Yeah, there would've been no equity in that business. All right, Lisa, thanks a lot and maybe we'll follow up again sometime down the road but it's been a pleasure.

Dr. Lisa Jenks: Thanks so much, John. It's always good talking to you. Bye.

John: Bye-Bye.

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The post How to Prepare to Sell Your Growing Healthcare Business appeared first on NonClinical Physicians.

In today's show, Dr. Mike Woo-Ming returns to the podcast to explain how to start and grow a successful cash based medical practice.

You’re a clinician and you know how to care for patients. Finding a way to provide clinical care for patients who are willing and able to pay us directly sounds pretty attractive.

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Benefits of a Cash Based Medical Practice

Since it eliminates the hassle of billing insurance companies, a cash based medical practice brings more autonomy and satisfaction. 

There are several types of businesses that follow this model, including:

• weight loss
• skincare and aesthetics
• medical spas
• concierge medicine

Reviewing the Steps

During the conversation, Dr. Woo-Ming describes how he started, how his business has adjusted to meet market needs, how he added new services, and how he grew the number of clinics over time.

His advice is to keep things simple, start small, leverage your team, and take advantage of opportunities when they arise.

Best of Both Worlds

As a physician, you invested many years of your life, and a potentially sizeable amount of money to learn your profession. When overwhelmed or burned out, removing payers from the equation can make your practice more enjoyable and meaningful. Our guest, Mike Woo-Ming is a living example of that promise.

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

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Links for Today's Episode:

• Dr. Mike Woo-Ming's New Course
• How to Build a Terrific Freelance Consulting Business – 145
• Entrepreneur and Business Owner – Interview with Dr. Mike Woo-Ming – 019
• NewScript Nonclinical Career Summit
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 293

How to Start and Grow a Profitable Cash Based Medical Practice

- Interview with Dr. Mike Woo-Ming

John: Welcome back to the podcast, Dr. Mike Woo-Ming.

Dr. Mike Woo-Ming: John, it's always a pleasure, my friend. It's been a long time since we talked, and thanks for reaching out and wanting to find out more information about this.

John: Well, I can keep in touch indirectly by listening to your podcast and even going to one of your webinars if I want to, so that's nice, but it's not as good as actually talking face to face. But I have noticed you're always busy and you're always doing something, and it was time to catch up with what's new in the world of Mike.

Dr. Mike Woo-Ming: Yeah, yeah. There's been so much. I have I guess my day job, which is overseeing a bunch of cash-based medical clinics. And in the last six months, we opened two new locations, one in Orange County, California, and one in a town called Murrieta, California by a half hour away. And yeah, we've been pretty busy.

John: Yeah. Well, we're going to want to hear about that today and I'll mention why to me this is such an important topic. When I think about cash-based practices, I think what is the biggest pain in whatever from practicing medicine? Sometimes its long hours, sometimes if you're working for a big corporation you can get burned out, but basically it's all the rigmarole you have to go through to get paid if you're using care through an insurer, Medicare, Medicaid, you name it. You have to add more staff. You get paid less and less each year, despite the fact that we're in the middle of an inflationary time. I am assuming that was one of the reasons that you started all this years ago. What were the main reasons that you started cash-based businesses?

Dr. Mike Woo-Ming: This is now our 11th year of starting my first practice. As you know I'm kind of wired differently. I don't want to go back into my history, but I was a primary care physician, worked for someone for five years, and just like you, I learned firsthand about some of the frustrations and complications of dealing with insurance-based medicine. From spending long hours with the electronic medical record to trying to get something what I believe was the best treatment for my patients, but then getting a denial letter and then just having to do that dance just to see what we could do to best help our patients.

And so, I said out from the beginning, actually starting it, and probably pretty naive, was, "What could I do where I didn't have to rely on insurance based medicine?" And I just basically looked and learned about what are different ways that I could get cash to make sure I could not only myself get paid, but my employees who are very hardworking and that they deserve their rewards, and that we can do this and make it viable. And we certainly have had our ups and downs just like any entrepreneur, but like I said, we just celebrated, this will be our 11th year and we're expanding. So, we must be doing something right.

John: Absolutely, you've made it work. If I recall correctly, you've tried different things in the cash-based arena. Maybe give us a look at some of that. You can either walk through what you've done over the last 11 years, or just pick and choose whatever you think are the highlights we should know about.

Dr. Mike Woo-Ming: Right. Just as yourself, family medicine, we wear many hats, we know lots of different things, experts at none. But the first thing that I wanted to do was I wanted to start a medical practice on things that I was interested in. And at the time, gosh, this is probably late thirties, early forties. And I was looking at my mortality as I was getting older, and I was like, "Hey, what can I do to live longer, be there for my kids?" So, I was looking at things and I know your audience may or may not agree on some of these things, but I was looking at things like testosterone replacement, being in primary care I had patients who benefited from that.

And that was my first foray into that. And then it moved into different things. Weight loss was obviously something that I've struggled with, and I learned that there were practices that had done these, who had did this. They didn't take insurance, and they were pretty successful. And there was one in particular franchise out of Texas that was dealing with men's care, men's healthcare, and they were introducing these things. And I actually happened to meet with the CMO from there. He was interested in hiring me to become a medical director and bridge things in Southern California. And we opened two or three locations back then, but I didn't learn, I didn't learn that it might be more difficult to do this. And they actually stopped. They actually stopped putting in the funding for these clinics.

If you know anything about me, and you do, I'm a bit stubborn. And I said, "Well, there are things that they did, and I could learn from their mistakes and I could do things my own way." I also happen to have a good friend who would help open some weight loss clinics also in Texas. And she showed me some information. And so, I got that as well before I actually started my own.

Those were kind of my first forays into cash based practices. Just dealing with things that I wanted to do personally, that I was particularly interested. And I think if you want to be successful in a business, you got to do something that you are interested in and hopefully that you love doing, and then you're going to be more energized and ready to make it work. And those are my first few ways that I got interested in cash-based practices.

John: Well, it's funny you say how you should be passionate about and interested in. You might remember that about, I don't know, seven years ago I started urging care centers with some partners. And I think we're getting ready to open our third, although I've not set foot in the clinic in over a year and I did come to realize about two or three years ago that I kind of hate this. So, I don't tell anybody. I'm trying to extricate myself. And it's not a good plan for being committed to something in an ongoing fashion. So, you started your first clinic. You were doing some of those things that you just talked about. Now, did it stay that way? Did it morph over time? Did you add a clinic right away, or did you have that one for an extended period?

Dr. Mike Woo-Ming: My clinic is a little bit different in that I had this thing that maybe it was that Kevin Costner, "If you build it, they will come." Field of Dreams. And we started off doing hormone replacement. We started doing weight loss. I also had done a lot of different, as yourself, probably a lot of different sports physicals. We did some occupational medicine.

I wanted to do services not only that people wanted to do, but stuff they had to do. So things like employment physicals, DOT physicals, those kinds of things. They don't pay a lot, but it started to give us some regular patients that had to come in every couple years, at least in terms of DOT physicals.

And then I started getting into veteran's disability evaluations. San Diego was a big military town, and there's a big base nearby. And those were areas where I got paid for doing disability evaluations. We just slowly introduced different things. And then we had some cross promotions sometimes, patients who were coming in. They were also looking at our different weight loss treatments that we had for them. Then they got interested in those different things. About three or four years in, we added aesthetics. And my thing was almost like a one stop shop. We started introducing different treatments, different things just to get people into the door. And now we're well established into the clinic.

And then last year I just said it, I want to do this all again in a new location where they don't know anything about me. And that's what ended up happening. But people are getting the word out. We've actually had some interest in investors and such. I think we got to make it work. And I think if there's one thing that I pride myself on ever since this journey is that I've always made payroll. I've always made payroll and making sure that my employees got compensated. Because let's face it, I wouldn't have a business if I didn't have outstanding employees who are dedicated and loyal.

I certainly don't know everything. I'm always continuing to learn. There's always new ways to get into, there's always increased competition. You got to stay on your toes. But yeah, so far, it's made it work. And now I've been recently doing more training and consulting and helping other doctors learn how to do the same thing that I'm doing.

John: When I get out of that, then say you started with some core services that you knew well, you liked doing, and they were cash-based, and then you just found other new services that you could add over time that were also cash-based. You're not pouring into the insurance world at all from what I hear. So, that's cool.

I just want to spend a couple of minutes taking a real high view. What you're doing obviously is starting a small business. There's a whole process to that. So if someone who's thinking of doing this, what are those things that one should think about? Whether it's planning, financial, legal at a high level, what are some of the things that as physicians we don't necessarily know about, but you're going to have to master in order to create something like this or get consultants?

Dr. Mike Woo-Ming: Anytime you're starting on any business, of course, there are some things that you need to think about. First off, should you do it? Is this something that it's for you? If you're looking to "Hey, here's something that I can do that's going to be making some passive income." Well, this isn't the place for you. There's always real estate. There's always different things, syndications. There's always other things that you can be doing and putting in your money. For me, it was more of I have a medical license and I feel that I still should use it.

As you know, I actually had left clinical medicine for some time, started my own company. And I hear my mom, her son is the doctor. I come from a family of doctors and I still wanted to be able to use it. And even when I was out of medicine, I would still do some volunteer work doing sports physicals for my kids' games and things like that. But this was a way that I could leverage what I had.

I know we talk about nonclinical careers. I still wanted to do some clinical aspects in my life. And this allowed me to do it. But I think an important distinction between what I did, and sometimes I get some flak from other doctors, is I didn't want to be the one solely performing all of the different services. And I think that's where I differentiate myself from being just a solo practitioner, the solo doctor who's seeing all the patients. I know for some it can be very rewarding, but it also doesn't allow you to grow. You're still dependent on your income on how many patients that you see, as I've said many times.

And so, I wanted to create where I've trained all of the employees and I wanted to make sure that they're highly trained, but then be able to see the patients. So, I have nurse practitioners. I've hired physicians' assistants, I have RNs, I've had LVNs, I've had medical assistants. I'm not always in the clinic. That's allowing me to grow and scale and focus on my intention of what I need to do is to make sure that we're viable, that we're continuing to grow, that we're paying all the bills on time, that we're paying all the employees on time. That's what I do. I've then slowly given a lot of those different tasks and then delegated to my office manager and things like that.

I know I went down a tangent on there, but I think the first thing is to see if you actually want to do this. If you're someone who wants to do this, if you want to become your own boss, and that was again, very important to me to have some control dictated on the revenue that's coming in. Those are the first things to actually think about. But you have to actually look in to see what you can do. And you can start out small. You can start out small.

On my podcast, I interviewed a doctor who became a very successful med spa owner. She was an emergency room doctor, and she just said "I wanted to do something on my own. I'm interested in aesthetics, so I'm just going to rent a room for half day a week." That was her first beginning of it. And that's what I would actually recommend is actually just trying it out. Or even if you have an opportunity, shadow somebody for a month. Remember we used to do that in third year medical school and then we decided our whole career based upon that. It's surprising that I still see docs who said, I'm opening up a med spa, but they don't even know if they actually even like it. And they haven't taken the time to shadow and to actually see it. It's more than just taking a Botox course over the weekend. It's like, "Okay, this is how you get trained to actually do this procedure. But what about being the owner? What about having to deal with all of the other aspects of being an employer as you know a lot about?

John: Yeah, there's definitely a lot to it but I think you're right. Shadowing is awesome. I never used to put that, even for a nonclinical career, advice. I thought good about get mentors, maybe get a coach, do this, do that. But it was only recently someone reminded me you could actually spend time with someone and see what they're doing, shadowing that way. And you're going to learn a whole lot more than just talking for 10 minutes to a mentor or an hour to a coach. So that's really good advice.

Okay. Now you did allude to a little bit ago that through all this now, because you've been doing it for so long, and you've been doing this for a while, you're teaching other people how to do things. You've always done consulting or coaching or the merger of those two. Tell us now what's going on with that. I know you help us with the podcast, but you do these consulting and courses and so forth. So just lay out for us what you've got going on now and what you plan on doing.

Dr. Mike Woo-Ming: Yeah, I've always done consulting in this aspect. I have a small number of clients who I've helped over the years, especially during COVID. I wasn't doing any training as most people were doing but I would always get inquiries. I'm helping a doctor in Northern California building up a weight loss clinic. Another doctor out of Florida and we've helped them build up an anti-aging direct pay practice.

I have clients like this where they work with me, they pay me quite a bit of money to help them do it. It's not a small thing. But then when you look at terms of some of the revenue that they're generating, the average is at least $500,000 a year to a million, million plus a year.

And I'm short-cutting their success to actually do it. I feel that they get a bargain. But that being said is, I enjoy consulting and I enjoy training, and I like working with people who are starting up. And one of the reasons that I wanted to do more of this is because there are some changes that are happening in California where you can be a mid-level provider. I know that's a term people don't like, but you can be a nurse practitioner. I know, I'm just upsetting your audience, half your audience already, but they can now open up their own clinics. They can open up immense spas. And there's been a lot more competition.

I still want more physicians to be more empowered and to think that they can actually do this because there are non-doctors who are opening these kinds of things. I just spoke to a young man recently who's starting as an IV therapy practice. Nice guy but he is not medically trained. In my opinion, I feel that physicians should take back the role as being the main healthcare educator and leader in this. And so, I wanted to create more training to help doctors do this and make it seem it's not as difficult as could be. Kind of follow my lead into this.

So, I am doing some free trainings and some, and some other trainings if they want to take it even further where they can learn more about and just to see if this is something that they want to do. I'm creating some live trainings that are coming up that we're doing to kind of help that. And now, through the power of Zoom and everybody's doing virtual trainings, these kind of things, this has been more accessible. And so, I'm always eager to do this. I always have my teaching hat and love working with other doctors. And if they're so inclined and want to learn more, we've got some resources where they can find out more.

John: Now, I know people in my audience, although we talk about nonclinical careers, reality is most physicians really enjoy medicine when it's done appropriately and in a way that is good for them and not some assembly line worker in a hospital. But they don't have the business knowledge or the marketing knowledge that you have. So, if they want to learn more about this kind of thing, where would they go to find that?

Dr. Mike Woo-Ming: Yeah, we'll have a link. I assume you'll leave a link in the show notes. It's called bootstrapmd.com/go/cashpractice. And that's all lowercase. And that'll take you to the resources. You can watch a free training, learn more about my story, and then decide if this is something you want to proceed, I can give you different ideas where you could start your own practice. And I've helped doctors in so many different locations. If you want to build a med spa, you don't necessarily have to be on Park Avenue or Beverly Hills. I've seen aesthetic practices grow out of Fargo, North Dakota that are making multi-millions of dollars.

My own location, my main location, it's basically in a small medical complex. My other office is on a six story of a 12 story building, medical office. I've got a weight loss clinic that's in front of a strip mall. But it doesn't have to be very flashy. It doesn't have to be very expensive. I think in that training that I do, if they decide to look at it, I have one slide of my first picture of my first practice. And this furniture it's like the cost plus rejects. The blood pressure monitor, the automated blood pressure monitor is on like a student desk. Because I couldn't afford to get something but we made it all work. Although my medical office manager still says they don't spend too much on furniture.

John: They don't get enough money, a budget for that.

Dr. Mike Woo-Ming: Yeah. One of my RNs who actually does this kind of thing, I gave her a budget and she was able to make it much nicer. That's one of my weaknesses in some of these things. I don't have a very good interior decorating.

John: I'm with you there. I talk to my colleagues here who are burned out and so forth and I bring up things like DPC, concierge medicine, start something like, "Well, no, this is the wrong area." It's like, man, there's people here that have money that want to get these services. They're driving up to Chicago an hour away to get these things. But it's a mindset thing. And so, I liked your idea earlier too, of starting small and if it's working, then you just expand it. If it doesn't work, you try something else.

Dr. Mike Woo-Ming: Yeah. Yeah. I always will try something just to see if it works. As Thomas Edison say we're one step closer to success after all the failures that he had in creating the light bulb.

John: Absolutely. Okay. I will put that link in the show notes. I pretty much always ask my guests what advice would you have just in general for physicians who are in a situation where they don't feel happy, they're unfulfilled, they're suffering? They might have burnout, maybe not, but they're just not getting out of medicine what they thought they were going to.

Dr. Mike Woo-Ming: Well, the one thing, if they're listening to this, then I hope they understand that they do have options. They're different opportunities. If it is truly burnout and depression, please talk to somebody for this. Talk to a professional to see what that is. But if it is that you're not feeling that you're being fulfilled, which I wasn't, and I know you weren't as well in your career at one time, is that there are different options and to seek what you want to do.

I got an inquiry from somebody who say "Where is the best place where I can find a mentor?" Well, the thing is, there are people who are doing what you want to do. Seek out those people if that's what you want to do. If you want to start up a cash based medical practice come follow me. If you want to start up, get really successful in real estate, well, there are people who are very successful at real estate.

I think it's been amazing since you were starting your podcast and how much everything has been grown, and you can actually find different people who actually happen to be doctors, which I love, who are actually doing these kinds of things. They're developing businesses, they're developing telemedicine practices and they're doing these kinds of things. So seek them out. And if they have products and they have courses, well, the best way you can become a student is to purchase those products and courses and then just to see.

One of the reasons why I created this is to make something that's a little bit more affordable. You don't have to come to me for one-on-one coaching, which I've actually kind of put that on the back burner these days. It's to purchase these kinds of things and then not just have it purchasing it. Because a lot of people think just because I purchased it, then I've done it. No, you actually watch it, actually implement these kinds of things.

One of my courses that I have, not in this field, but in coaching, it's 33 hours and it's a lot of information. But most of them, and this is probably on me as a coach, is they don't get through the first few parts of it. There are some people who do complete everything. But it's more than actually just going through the material. You didn't become a doctor just because you showed up to the class. You actually had to pass the classes to get you to become successful in what you're doing.

John: Absolutely. You got to make that commitment and actually devote the time and effort. The information is there for you. And usually someone like yourself is also willing to answer questions, emails, and what have you, because they want this to work. They want this person to get that new skill and implement it.

All right, Mike, this has been very fascinating. I really am glad we were able to catch up again. I'll be looking to see what you're up to in the next six to 12 months. All right, Mike, with that, I'll say goodbye then. We'll see you next time.

Dr. Mike Woo-Ming: Thank you, John. Have a good day.

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Is it possible to establish a concierge practice while still in training? Dr. Brook Choulet is still in her child and adolescent psychiatry fellowship and runs a growing practice in Scottsdale Arizona.

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How to Establish a Concierge Practice 

Brook starts by explaining why she started her concierge practice. Then she explains how she boot-strapped the practice, starting with just one associate, while still in residency. She also explains the basic steps, from forming an LLC to finding her first location to see patients.

Just go for it… If I can do it with very little experience… then I have no doubt anyone can do it at any stage of their career. – Dr. Brook Choulet

We also discuss which other specialties would work best in a concierge model like hers. She runs a cash-only practice and is funding the growth of the business organically. And she explains how this model eliminates most of the headaches of typical employment.

Growing Her Business

Brook has hired therapists and wellness experts to meet the needs of her patients and clients. She started by sharing office space and has now moved the business into a dedicated office. The practice is now expanding to a second location.

Summary

If a psychiatric resident can open a concierge practice, certainly other physicians should explore this type of practice. It generally provides for a more balanced lifestyle that can also be quite lucrative. As the physician shortage grows, and insurance deductibles increase, patients will be more willing to use a direct-pay model to meet their healthcare needs.

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

Links for Today's Episode:

• Choulet Wellness
• Brook Choulet MD Website
• Dr. Brook Choulet's LinkedIn Page
• Entrepreneur and Business Owner – Interview with Dr. Mike Woo-Ming – 019
• How to Help Committed Colleagues Heal the World – 186
• Can Meditation Offer Help for Burned-Out Physicians? – 172

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 210

Want to Establish a Concierge Practice Before Finishing Your Fellowship?

Interview with Dr. Brook Choulet

John: When we as physicians become bored or frustrated with our practice or burnt out, our first instinct might be to leave clinical medicine. But we should stop to consider whether a different boss or maybe different partners or a different department in a big company or a different corporation or practice setting itself might be a really effective alternative. I know we talk about nonclinical careers here, but definitely non-traditional practice is another alternative. So, today we're speaking with a physician who has created a practice that avoids many of the traps of corporate medicine while she's still in training, if you can believe that. So, Dr. Brook Choulet, welcome to the podcast.

Dr. Brook Choulet: Thank you so much for having me here today.

John: Once I heard your story and I was talking with Brent Lacey, one of my podcasting friends, I thought this is really interesting because the things that you've implemented, I think are very instructive for many physicians who maybe feel trapped. And I thought, "Wow, this will be very good to share". Before we get into the specifics, why don't you tell us a little bit about your background and education?

Dr. Brook Choulet: Sure. I grew up in Cleveland, Ohio. And after many winters, my family moved to California. I finished high school in California, and then I ended up going to Kansas City, Missouri for the six-year bachelor MD program. My mom had actually done the same program and she really thought it was valuable and a good use of time. So, I was excited to head out there. I spent several winters again in Kansas City, and then I matched out in Phoenix for adult psychiatry residency at the University of Arizona College of Medicine, Phoenix. I did three years there, and then I transitioned to a child and adolescent psychiatry fellowship. And I'm currently in my last year of fellowship.

John: Awesome. That should be keeping you pretty busy but I think you have some other what we might call a side hustle or side gigs that you've been doing. Why don't you tell us what those are?

Dr. Brook Choulet: Sure, just to name a few. The first thing I did when the pandemic hit was I used some of that downtime when the clinic was in transition and residency to become a real estate agent. And that initially took me about a month and a half to complete that process and get my Arizona real estate license.

Then I started kind of thinking about what I wanted to do with the rest of my life after I was done with training and really decided I wanted to build a practice where things were on my terms and not the insurance company's terms. And I could actually spend time with my patients and spend valuable time hearing what was going on, hearing what their current life situation is. And that really led me to build this concierge psychiatry practice out here in Scottsdale. I started working on that in residency and it kind of took off from there.

John: Help define for us what concierge psychiatry would be?

Dr. Brook Choulet: Sure. There are a lot of different definitions of what concierge medicine is. I think to a lot of people, they might assume that it's a membership-based practice where you pay a retainer or you pay a certain monthly fee for access to the clinic. I think that psychiatry is such a unique field where you really have to connect with the person and the physician that you're going to. I wanted to avoid that model and I ended up just choosing a fee for service hourly rate model to really give not only the patients flexibility of where they wanted to get their treatment but also to make it more approachable for many patients who might struggle with the thought of a large retainer or membership-based fee.

John: Okay. That's awesome. And listeners, I want to make it clear. We are not going to go back and talk about real estate today. We're going to be talking about this aspect of concierge practice and maybe the general topic of just designing a practice that really meets your needs as a physician, rather than being sucked into corporate medicine, I guess, as some of us call it.

So, your concierge model is you have an hourly rate and you deal directly with patients. What about the payment? Is there any middleman in that payment model or not?

Dr. Brook Choulet: The clinic collects payments directly through credit card, we use Square and we use an EMR system where actually Square is integrated into the EMR system. So, there are actually no manual payments being run. You can set up a service, set up the price for it. And an hour after that visit it automatically charges for that service fee. And it really cuts out even anyone in the clinic having to run cards.

John: There's no billing per se or anything like that. Can patients take the information and then file a claim with their insurance company if they have one?

Dr. Brook Choulet: Yeah. There are a couple of companies out there. There are reimbursed five, better claims and they can assist kind of expediting that out of network claim, but that is up to the patient to do that part. The clinic is just responsible for providing that superbill.

John: That sounds like how it was maybe 30, 40 years ago when we would just have a paper, superbill and we would give it to the patient and say, "Well, this is what you owe us". And going through this, the rigmarole of trying to build these days, oftentimes even a small practice has hired like two or three people just to do that.

Dr. Brook Choulet: Yes, that is exactly why I looked at several different systems. And I really wanted to make things as efficient as possible, both on the clinic end and for the patients, because even nowadays I get invoices from outpatient clinics that are coming in paper mail, it has some access code. It wants you to go to a website, enter it, manually enter the payment. And for both the clinic and the patient, that seems really inefficient.

John: From what I know a practice like that is, like you said, it's more efficient and I use the word parsimonious, but you don't have to have a lot of staff to run it because you're spending the time with the patient generally and you have maybe a little bit of support. Tell us what that practice actually looks like in terms of staffing at this point.

Dr. Brook Choulet: We actually just went through a little bit of a hiccup, where the one staff we did have decided not to answer the phone and that's a pretty critical role in a clinic where we are providing such a high level of service. And so, we're currently in transition, but we have new staff starting on Monday. To answer your question, other than the physicians and the therapists that are talking directly to their patients, we just have one other staff member at all times.

John: There was a model in family medicine a while back, I forget what we called it, but it basically eliminated all the support. And there was actually a physician who was answering the phones, doing the billing, and running the EMR, but it was very limited and he spent basically 90% of his time seeing patients and didn't have to leave and have a receptionist, even though the office was open four or five days a week. There are ways of doing this in an efficient way that still serves patients very well. right.

I feel like there's still a lot of unknowns in how you put this together. How did this come about? You were in your residency, now you're in your fellowship. Maybe walk us through the steps, the "a-ha" moment, or what really inspired you to do this. And then what were some of the smaller steps in making this happen?

Dr. Brook Choulet: Sure. The smaller step is kind of what happened initially. That's building an LLC, getting a tax ID, opening a bank account. Kind of just some of those basic necessities of starting a business. Then you have to have your malpractice in place, consult some attorneys to figure out a business structure since there are so many different ways to structure a business. I think that's really critical. Without that step, you don't know where to go and don't know how to hire people. So, I think that was a big step.

And then really how this came about was almost random if you want to say. I had already started the practice myself, just seeing patients. I have an office and executive suites, very low overhead, just kind of doing my own thing. I was getting a facial and talking to the girl that was doing the facial about how unhappy she was in her current location. Just hearing some of the struggles she was going through. And I was talking to her about my desire or passion to build a large wellness center here.

We started talking and I kind of offered her a position on the spot. I'm like, I think it would be great if you join the center. I am not sure what I'm building yet, but I think you'd be a great addition. So, that's really the moment that put almost all the pressure on me. Like now I have to figure something out. I have to expand. Executive suites won't work because, in the state of Arizona, you need a sink and an aesthetician's room and executive suites don't have sinks. So, I started considering a larger plan. So, it really kind of grew from that point.

John: Okay. So, you're hitting on different things, mental health and then wellness and aesthetics. Has that grown from there to more services? You mentioned earlier like a therapist. So how does it kind of look now from the involvement of staff?

Dr. Brook Choulet: Initially it was really just me. Then I started talking to the facialist and then I started thinking, "Well, now we're focusing on mental and physical health and mind and body wellness and seeking inner peace and self-love and gratitude". So, I started thinking of what other services would be nice for that kind of space. Because right now, in Scottsdale at least, there are a lot of therapy clinics with a lot of therapists. And there are a lot of psychiatry clinics with psychiatrists, but there's no kind of wellness center with those two. And then separately, there are meds that fall on almost every block of Scottsdale. So, it grew into adding therapists, the facial aesthetician, a nutrition coach, and gathered this big team of people. And we're planning to move into a large space on north Scottsdale Road in November.

John: Okay. Is it the kind of thing where the patients will, and I guess clients if you're talking more of the med spa type thing, but they'll kind of self-select what they need and want? If you've got therapists, of course, there's going to be a lot of overlap with the psychiatry side of things. So, how do you anticipate that will work or has it worked?

Dr. Brook Choulet: Sure. I think a lot of times people have been calling saying, "I'm looking for a psychiatrist" and then you kind of triage them on the phone "Are you looking for medication management? Are you looking for therapy?" And then come to find out, maybe they meant therapy. So, I think the triaging part is really important because sometimes clients won't know what they're calling for. They'll just call because they want one of the services and then it's kind of our job to help match them to what they're looking for.

I think that's where that staff is really critical to the whole process because a lot of the private psychiatrists, at least here, will have all their new patient calls go to voicemail. And then they'll just answer them at the end of the day. But what I'm finding these days, as people want that kind of instant reward or instant kind of answer, so when they call, they really expect to talk to someone and that's something I wanted to provide.

John: Well, we all have our own experiences and our families and so forth where there's a need and when you need help, you need help. You want to get some kind of an answer or direction, even if the answer is "Well, we can't help you, but we can send you somewhere else". And it always amazed me why the psychiatrist didn't have closer relationships with therapists because invariably, oftentimes they're going to be making a referral, and pretty much they might give you a list or something and say, "Well, here pick one". It just doesn't make sense.

Dr. Brook Choulet: Right. I totally agree. It's much nicer for not only us because we know who the patient's seeing, we know kind of what their care looks like, but it's also nice that they can schedule their med check and then the next hour, they can see their therapist in the same office. One other reason I started considering some of those other services to add is that sometimes I have a lot of teens coming in and their parents are just usually waiting in the waiting room. So, if there's some other service they can be doing or preoccupying their time and making it a fun experience for them too, I think that's the ultimate bull.

John: How do you find time to organize and run this thing while you're in fellowship now? Or how did you do that when you were in your residency?

Dr. Brook Choulet: I now wake up very early. I go to bed very late. But pretty much outside of the hours where I was in residency year and fellowship, I'm constantly taking meetings on the phone, making sure admin stuff is running smoothly, making sure the people that are working at the clinic are happy because ultimately all I want is for this to be a happy positive environment where both the patients and the staff are really happy being there. That's my ultimate goal.

John: Now I'm going to digress for one minute because I forget sometimes that I have listeners who have never started a business. Maybe they went straight out of residency and they're working for somebody. And let me just run this by you. I mean, this is what I've done. If I want to start a business, I go to my accountant. I say I need an LLC or whatever structure you'd tell me. And I need a license to open a business in Illinois. And then I get an accountant to help me set up my books. That's basically it. Is that pretty much the same in Arizona?

Dr. Brook Choulet: It's pretty similar. Actually, what I tell all my friends too, who dabble in real estate or a side hustle or whatever it is, is make your own LLC. Don't pay someone else to do it. I think it took me a grand total of 25 minutes to fill out the form online. And you have an active LLC. Maybe in Arizona, they have a nice online system. I don't know what it is, but it was pretty simple. So, you do that, you talk to an accountant, you talk to an attorney and you open a bank account and you are kind of ready to roll.

John: Yeah. I think people think it's some kind of big mystery, but we have the benefit in most states in the United States that opening a business is easy. Now you still got to follow all the rules where it might get a little complicated later on. But if you have a good attorney and a good accountant, you can pretty much manage anything.

Dr. Brook Choulet: Right. And I tell people starting out too, if you go to executive suites and you rent an office there, you don't need a business license because the suite itself has the business license and you're just renting space out of there. So that is the lowest overhead way you could really get started with about $1,500 a month really, with all the things you need to kind of put in place between the suite, the accounting, all of these various aspects, and you could start out with pretty low overhead.

John: Okay. We're past that part. You've got this vision and you've started this. Now, you said you're in the process of moving into a bigger space now, where most everyone is going to be located, co-located.

Dr. Brook Choulet: Yes. We are moving into an office that's about 2,800 square feet and it has eight offices total. Everyone will be able to finally all be together rather than some of us are virtual right now, some have an office here. So, it'll be nice to be in the same space and for all of our clients to just come there.

John: What do you envision this will look like? Pick your number, two years from now, five years from now?

Dr. Brook Choulet: Yeah. I'm really hoping to have multiple locations in the next few years. I know I'm working with my mom right now who's a concierge psychiatrist on opening something similar there. So hopefully within the next year, we'll have something in San Diego as well.

John: Okay. Now we had talked a little bit before the interview. You brought up your mom as being a concierge psychiatrist, but from what I remember, her practice is different from what you're doing. And so, maybe you can compare and contrast the two and maybe the pros and cons if there are.

Dr. Brook Choulet: Sure. That's kind of where I got my idea of how to start everything really. She is in LA Jolla. Her name's Donna Kashani, she's an MD. She rented an executive suite and she does all of her own calls, billing, scheduling. It's really only her. She has someone that helps out with the billing at times. But other than that, she's the only one in communication with her patients.

John: And how long has she been doing that?

Dr. Brook Choulet: She has been doing that since we moved from Cleveland. So over 20 years.

John: Okay. I'm kind of working my way to asking you a leading question or one that will take some brainstorming. Maybe what other kinds of physicians do you think this would be doable for? We know concierge practices exist, but given that you're in the middle of it and kind of have lived it, do you think this translates to other specialties?

Dr. Brook Choulet: It definitely does. I did some coaching with someone in Florida who is an obesity medicine. My husband is also boarded in obesity as well as internal medicine. And obesity is something that could do really well. And I think it's a boutique practice. You just need an office. You need very minimal supplies and little overhead costs. So, I think that would be a good one. Integrative medicine, lifestyle medicine, functional medicine. And then really, I think some of the subspecialties could also probably do that, like endocrinology, rheumatology, maybe some of those too.

John: Okay. And I think what I was going to mention before when you were talking about the structure is basically, this is a cash-based business of which you've just mentioned others, the weight loss or the obesity and med spas and all that. So, would it be possible for an internist or a family physician who just wants to keep a small cadre of patients, would you say for them, would it be more of a membership model or the hourly type of model or either?

Dr. Brook Choulet: Right. I think that's why you do see so many internists and primary care docs with the retainer model because it's a little bit easier with internal medicine to know what you'll need throughout the year. You need an annual physical and you need certain kinds of sick visits, certain lab work. So, I think it's kind of a little bit more tangible to figure out what a package should include for internal medicine. With psychiatry, I have some patients I see every week, some patients I see every two weeks, some I see every month or every three months. So, to give a price on what that would actually look like would be really difficult. So, I think if a psychiatrist were to do a retainer model, they would have to have a kind of based number of services included and then an additional rate for any add-ons throughout the year.

John: All right. Well, before we get too far, I want to go ahead and put in the websites that the listeners might want to check out just to get an idea of what you're doing. And even if they're in the area, they could even look you up. So, you have your professional website brookchouletmd.com, which I think would probably have more directions to other things and links and so forth. But as far as the practice, it's at chouletwellness.com. Is that right?

Dr. Brook Choulet: Yes, that's correct.

John: It's very professionally done and very interesting. Well, stepping back, what do you think about physicians in general? Just sort of taking the bull by the horn and just trying to do something that isn't the standard cookie-cutter approach to medicine in general.

Dr. Brook Choulet: Yeah, I think it's amazing. I think at any point in anyone's career, whether you're in training, out of training, looking towards retirement, it's never too late. And I think it goes to show I'm kind of telling my mom like, "Hey, it's time to do something like this in San Diego". And she's used to her ways of doing things and it may seem really kind of scary or unknown to a lot of people, but once you start moving through it, you'll figure it out and put the pieces in place. So, I think it's amazing to kind of get out of corporate medicine and just make your own schedule and decide what you think would be a good work environment to go to every day.

John: It's hard to do because we sort of have this tunnel vision. We're focused on the traditional, what we thought was traditional, although once we get into the so-called traditional, it's never really what we thought it was going to be. So, we kind of break that mindset, I think.

Dr. Brook Choulet: Yes. And I see it because my husband is in corporate medicine in a large hospital system, and he's in the PSLF loan forgiveness program. So, he's kind of tied to that for a while, but there are pros and cons with the corporate jobs. There's security and income, you have a set schedule, but then the cons are that you're really not in charge of your own schedule. There's a certain way to do things. And some of the politics of the corporate medicine system may not be fun at times.

John: Well, that's absolutely correct, but I think a lot of people are fearful because of the financial aspects. Obviously, there's a risk involved, although if there's not massive overhead, the risks are minimal. But have you found in looking ahead, does it seem like from a financial standpoint and what the market will bear? Obviously, you've got to set your fees however you set them, and you have to find patients, you have to market. Maybe you could talk a little bit about that and then what's the response been once the patients see that you're out there.

Dr. Brook Choulet: Right. I think going to the first point, it's very important to think about finances when you're going into building something like this or something else because you really have to map out how much is this going to cost, what are the fees associated? And even though there's a lot of upfront costs, you don't want to kind of fall too far behind or put too much money and then not get that money out. So, I think it's really important to do that. And can you repeat the second part of that question?

John: Yeah. How did you get patients and clients? Is there a marketing plan? Was it kind of grassroots? How did that work out?

Dr. Brook Choulet: Yeah. So again, when you start a business, you want to run things as lean as possible from an expense standpoint. I just did it the old-fashioned way. I reached out to a bunch of therapists. I reached out to a bunch of the internal medicine docs I knew in town. I met with them for coffee, met for lunch, told them what I was doing. I ordered a bunch of postcards and sent them directly to physicians that were in private practice medicine or private OB-GYN and things that I thought my services would be helpful for. I really just tried to do it as kind of lean expense-wise as possible, and then also Google pay-per-click ads, and then having an SEO optimized website. Other than that, I didn't do anything really fancy.

John: All right. Well, I think there's a demand for that and there's getting to be more of a demand for a lot of these cash-based services because people are just tired. Well, they got huge deductibles to begin with anyway. So, sometimes you really feel as though you're uninsured. So, I think there's a growing demand. And then there's also the physicians who I think are going to be much more enthusiastic about running something that they control and not feel like they're being told how they're going to practice and when they're going to practice.

Dr. Brook Choulet: Right. I think that the most important point for the listeners to really consider is have you thought about days where you can decide when you go in and decide when your first patient starts and decide how you want to deliver care to the community, what you want to offer, what you don't want to offer? All the things that people get frustrated with when they work in a big outpatient setting or a big inpatient setting is a lot of those things are just out of your control.

John: Has there been much of a response from the medical students or residents or fellows around you that have seen what you're doing?

Dr. Brook Choulet: I try not to bring it up too much in training because it's just so different from what anyone else is doing or even has thought about. I mean, people are trying to get their medical license just to moonlight. So, I haven't talked too much about it and training, but I think maybe more people should, more people should know what the options are. I think it's definitely something that may be in my own fear of it not working out was holding me back from sharing it. But now that it's kind of up and running and things are going smoothly and we're getting a really good turnout of new patients for all of these people I've hired over the last two months then now I feel kind of more confident that this was a really good idea and I'm super glad I did it.

John: Do you feel like you're going to be involving other psychiatrists in the future?

Dr. Brook Choulet: Yes. I actually hired three psychiatrists in the last few months, so I have a few other MDs and a DO working in the clinic as well.

John: Okay. How was that from a contracting standpoint? Was that a challenge or is it pretty straightforward?

Dr. Brook Choulet: Pretty straight forward. Again, if you from the start have a business plan with your attorney and you knew what you wanted things to look like as you scale, then it becomes pretty straightforward. You go in knowing what you're offering, you know what's a good deal, you know it's really fair to the other physicians and it'll allow them to break free from the environment they are in.

John: That sounds good. They've started, right? So, they kind of know what they're getting involved with, and they've already been exposed.

Dr. Brook Choulet: I think that was a little interesting for a few of them. They're like, "Can I just ask how old you are and tell me about where you are in your training?" I think it was a little different for them definitely, to see that I was trying to scale this and grow this and that I really was confident and knew what I was doing. But they trusted, they jumped on board and it worked out really well for them.

John: Are these people that had been in practice for a short time, a long time, a combination?

Dr. Brook Choulet: Yeah, I think all three of them are in their forties.

John: Okay. So that must've been a little bit of a shift that none of them had tried their own concierge practice in the past.

Dr. Brook Choulet: A few of them are in other states. So, a few of them are providing remote services here and then another one is in person here and she has tried. The administrative part of things is very challenging. So, I think allowing that flexibility where you don't have to worry about scheduling and billing is really the best fit for some people.

John: Well, this has been fascinating. Any last bits of advice for any listeners today before we let you go?

Dr. Brook Choulet: Just go for it. That is my only advice. There's a lot to figure out and a lot to navigate. But if I can do it with kind of very little experience compared to some of the people who have been in practice for a long time, then I have no doubt anyone could do it at any stage of their career.

John: Yeah. That's very inspiring. You do have to be the type of person that wants to understand how to run a business. It is a business and you need to know those business principles. And that can be challenging, but it's certainly rewarding at the end of the day if you're not, basically, serving someone to someone else, some big corporation and you get to make the decisions and provide the best care that you can. All right, let me do those links again - brookchouletmd.com and chouletwellness.com. Check those out and see what Brook is up to. I guess that's all I have for today. It was very interesting.

Dr. Brook Choulet: Thanks so much for having me on today.

John: Oh, you're welcome. It's been a pleasure and I will have to check back with you in about a year and see how things are going.

Dr. Brook Choulet: Definitely.

John: All right. Bye-bye.

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Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

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

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The post Want to Establish a Concierge Practice Before Finishing Your Fellowship? – 210 appeared first on NonClinical Physicians.

In this week's PNC Podcast episode, we learn why private real estate deals are a great way to diversify income. And investing in real estate makes a very nice part-time side hustle.

Earlier this year, I was a participant in the Leverage & Growth Virtual Summit, organized by Dr. Peter Kim from Passive Income MD. It was a unique experience with about 50 experts providing valuable teaching over 2 weeks. I had a lot of fun participating as faculty. I also enjoyed watching the other videos that were posted. Many of you told me you found it helpful and inspirational.

Our Sponsor

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

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country, with over 650 graduates. And, unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. Recently, Economist Magazine ranked the business school #1 in the world for the Most Relevant Executive MBA.

While in the program, you'll participate in a company project, thereby contributing to your organization. As a result, the University of Tennessee PEMBA students bring exceptional value to their organizations.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

By joining the University of Tennessee physician executive MBA, you will develop the business and management skills needed to find a career that you really love. To find out more, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Private Real Estate Investing Is a Great Side Hustle

I wanted to get Peter on the podcast to learn more about his background, and his online ventures. Is he still practicing? Why did he create Passive Income MD? What new projects has he developed? Why is passive private real estate investing such a good side hustle?

As I have interacted with physicians seeking nonclinical careers, I found that many achieve fulfillment and balance by starting side hustles to complement their clinical careers. You’ll remember, perhaps, that Peter Steinberg really loved his work as an expert witness, while still practicing urology. And Dave Draghinas balances his practice with his podcast and short-term real estate investing.  Ideally, we ought to be passionate about these endeavors and they should help diversify our income.

Today, Peter discusses several important topics:

1. Why we should diversify our income streams;
2. Why private real estate investing is such a popular choice for passive income;
3. Which real estate investing options are ideal for busy professionals; and,
4. The Passive Real Estate Academy that he and his team have relaunched this month, and why you should enroll.

Peter really knows real estate, and it is so cool that he has spent the time and energy to create a place where we can learn from his successes and failures.

To learn more about his course, go to nonclinicalphysicians.com/prea (this is an affiliate link). 

SUMMARY

Peter provides a brief explanation as to why generating passive income using private real estate deals is such an important topic to consider. It is easy to learn. Most physicians have incomes to make it an appropriate investment. It will help us hedge against possible job loss or cutbacks as we've during the COVID-19 pandemic.

And for a very short time, you can have access to a free Webinar, or consider joining his Passive Real Estate Academy, where he'll teach you everything you need to know about creating a passive income stream with certain types of real estate investments.

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

The Clinicians Career Cooperative Is Live

This is the ONLINE MARKETPLACE OF IDEAS for nonclinical and unconventional clinical jobs and side gigs. It's a FORUM where you can ask questions of experts in multiple careers. We have some of the most influential names in career transition to mentor members in the Cooperative, including Maiysha Clairborne, Michelle Mudge-Riley, Tom Davis, Marjorie Stiegler, Phil Boucher, Mike Woo-Ming, Jarret Patton, Jill Wener, Christopher Loo, Lisa Jenks, Mandy Armitage, and Brent Lacey

There is an automatic Free Trial. So, this is a no-risk opportunity to connect with experts and begin your career transition today.

To check it out, head to the Clinicians Career Cooperative.

Imagine what it will be like 6 to 12 months from now to start a fulfilling career, and leave behind the headaches, long hours, and constant threat of a lawsuit. Joining the Cooperative is the first step on that journey!

So head over to the Clinicians Career Cooperative.

The post Why Should I Invest in a Passive Private Real Estate Deal? – 154 appeared first on NonClinical Physicians.

In this episode of the PNC podcast, John describes nine excellent books that will help educate you as you begin your career journey.

The first two books will get you in the right frame of mind. And they provide tools to help you to overcome the self-limiting beliefs that might hold you back. Then John presents four books written to assist you in your selection of a nonclinical career.

The last three of these excellent books are written to assist in your transition to a personal-brand business, freelance consulting, a cash-only business, or locum tenens. A locums job can be permanent, or a bridge to your nonclinical career.

Our Sponsor

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

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country, with over 650 graduates. And, unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. Recently, Economist Magazine ranked the business school #1 in the world for the Most Relevant Executive MBA.

While in the program, you'll participate in a company project, thereby contributing to your organization. As a result, the University of Tennessee PEMBA students bring exceptional value to their organizations.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

By joining the University of Tennessee physician executive MBA, you will develop the business and management skills needed to find a career that you really love. To find out more, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Links to the Nine Excellent Books 

Here are links to the nine excellent books described in this episode (most of these are affiliate links):

SUMMARY

If you're just getting started on your career transition, these nine excellent books will provide the tools you need to take your first steps. 

At a minimum, you should first read either Jenny Blake's Pivot or Gay Hendricks' The Big Leap. Then move to Michael McLaughlin's book, followed by Hiedi Moawad's book Careers Beyond Clinical Medicine and Sylvie Stacy's 50 Nonclinical Careers for Physicians. Finally, if you decide to follow one of these paths, then read the book listed below:

• Personal Brand Entrepreneur – Rise of the Youpreneur by Chris Ducker
• Freelance Consulting or Cash-Based Clinical Business – The Positioned Physician by Michael A. Woo-Ming
• Locum Tenens – The Locum Life by Andrew Willner.

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

The Clinicians Career Cooperative Is Live

This is the ONLINE MARKETPLACE OF IDEAS for nonclinical and unconventional clinical jobs and side gigs. It's a FORUM where you can ask questions of experts in multiple careers. We have some of the most influential names in career transition to mentor members in the Cooperative, including:

• Maiysha Clairborne
• Michelle Mudge-Riley
• Tom Davis
• Marjorie Stiegler
• Phil Boucher
• Mike Woo-Ming
• Jarret Patton
• Jill Wener
• Christopher Loo
• Lisa Jenks
• Mandy Armitage
• Brent Lacey

There is an automatic Free Trial. So, this is a no-risk opportunity to connect with experts and begin your career transition today.

To check it out, head to the Clinicians Career Cooperative.

Imagine what it will be like 6 to 12 months from now to start a fulfilling career, and leave behind the headaches, long hours, and constant threat of a lawsuit. Joining the Cooperative is the first step on that journey!

So head over to the Clinicians Career Cooperative.

The post 9 Excellent Books That Will Help Launch Your New Career – 153 appeared first on NonClinical Physicians.