concierge medicine Archives - NonClinical Physicians

It’s Time to Start a Direct Primary Care Practice

John Jurica — Tue, 04 Mar 2025 12:41:44 +0000

Never Bill Health Insurance Again – 394

In this week's episode, John explains why physicians should consider starting a Direct Primary Care Practice or DPC-style practice for specialists.

He presents DPC as a viable alternative that allows doctors to reclaim their autonomy, improve patient relationships, and create a more sustainable practice model without the administrative burdens of insurance billing.

This growing healthcare delivery model offers challenges and significant rewards for physicians willing to take a more entrepreneurial approach to medicine.

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The Medical Legal Consulting Coaching Program will teach you to build a nonclinical consulting business. Open to physicians in ANY specialty, completing Dr. Armin Feldman’s Program will teach you how to become a valued consultant to attorneys without doing med mal cases or expert witness work.

His program will enable you to use your medical education and experience to generate a great income and a balanced lifestyle. Dr. Feldman will teach you everything, from the business concepts to the medicine involved, to launch your new consulting business during one year of unlimited coaching.

For more information, go to nonclinicalphysicians.com/mlconsulting or arminfeldman.com.

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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 900 graduates. And, the program only takes one year to complete.

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

For Podcast Listeners

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

Understanding the DPC Practice Model

DPC offers physicians freedom from traditional insurance billing through a subscription-based payment model where patients pay monthly, quarterly, or annual fees directly to their physicians. With approximately 2,500 practices now operating across all 50 states, this model allows doctors to maintain smaller patient panels (typically 400-600 patients).

This enables them to spend more time with each patient (30-60 minutes per visit) and provide enhanced access through telemedicine, email, texting, phone calls, and home visits. The elimination of insurance paperwork and billing cycles creates a more efficient practice with significantly reduced administrative overhead.

Building a Successful DPC Practice

Starting a DPC practice requires careful planning, including:

developing a business plan,
selecting an appropriate location,
establishing pricing structures, and
implementing effective marketing strategies.

While initial startup costs typically range from $40,000-$100,000, practices generally reach break-even with 250-300 patient members. Once established, DPC physicians commonly earn between $280,000-$500,000 annually while enjoying greater control over their schedules and practice style.

This model works particularly well for primary care but can also be adapted for certain specialties focused on chronic disease management.

Summary

Physicians interested in exploring the DPC model can find extensive resources at DPCFrontier.com and through the My DPC Story podcast with Dr. Maryal Concepcion. While transitioning to this model requires planning and initial investment, it offers a path to greater professional satisfaction, improved patient relationships, and the opportunity to build a valuable asset.

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Transcription PNC Podcast Episode 394

It's Time to Start a Direct Primary Care Practice

- Never Bill Health Insurance Again

John: Let's get to today's topic of discussion. Recently, I've become more and more interested in DPC as a solution to the unfulfilling corporate employment and its lack of autonomy, the lower pay, the long hours, and the interference in the physician-patient relationship. I've been doing a lot of research on this and a lot of reading, and I want to explain today why I think you should really consider developing your own DPC practice.

Now, this is for those of you who have been employed with a large system or a large group and you're thinking, "Okay, I'm burned out. I need to go into something completely nonclinical or unconventional." And really, I'm starting to believe that DPC practice is one option for you to consider.

It has some barriers and some caveats that I'll explain in a moment, but it's really a way to recapture the joy of practicing medicine and seeing patients, if that's really what you want to do.

What is a DPC practice? Hopefully, most of you have heard of it, but a DPC is direct primary care practice, a model where patients pay a monthly, quarterly, or annual fee directly to their primary care physician, rather than relying on traditional insurance billing or really relying on insurance as a payment method at all.

If you think about when you get rid of the insurance involvement in care, you really enable a physician, yourself, to spend more time with your patients. You're getting paid at the beginning of each month or each quarter. There's no collections, there's no billing, there's no sending overdue bills to a collecting agency, and you don't have to hire the staff to focus on things like coding and documentation and billing and so forth.

It really takes away a lot of the headaches and frees up time to spend with patients and also reduces your documentation time and other things. So let me just give you a little background.

DPC model began showing up around the early 2000s, and over the years, it's begun to catch on and building up steam and growing. In 2010, the Affordable Care Act recognized direct primary care as a viable healthcare delivery model, allowing DPC practices to compete with other more traditional settings, traditional not insofar as like from 50 years ago, but traditional as of the last 20-30 years. And now there's, I think, about 2,500 known DPC practices in all 50 states across the country and in Washington, D.C. And so, it seems to be growing and there's much more interest in it.

One of the questions that people have when they first get involved with this and start thinking about it is, "Well, look, if I'm doing this, can we still use Medicare for DPC? And if not, well, then how's that going to work? Because so many people depend on Medicare, and it's hard to convince them to switch over to a DPC model."

Patients can continue to use Medicare when they're involved with a DPC, but it would be for anything not happening in the physician's office. In other words, you could still use it for hospital care, expensive testing, inpatient visits, imaging, prescriptions, things like that. It's just that when it comes to the day-to-day ongoing chronic care and treatment of acute illnesses in the office, everything can be put under this new type of model.

Most DPC physicians do opt out of Medicare because they really don't want to have to interact and meet all the requirements for any kind of a Medicare payment. So you're best to just opt out, although there are some exceptions. If someone has chosen Medicare Advantage, then there may be network restrictions and so on. There may be some challenges. And these are all things you have to figure out before you set up your first DPC practice.

Now, I'm going to pause here and say, what's the best way to approach this from the standpoint of, is this something I can go into right after residency or fellowship? And probably not, because it would take a lot of planning. You'd have to spend the last year of your residency or fellowship thinking about how you're going to do the DPC, learn about marketing, put aside some money or arrange to borrow some money to set up the practice. I think it has been done. But to me, it makes more sense, you're fresh out of residency as let's say, a primary care doctor, and you would go to work for a hospital system or a large group, get a guaranteed salary, have them help pay off some of your loans.

But you would have this idea that maybe in three or four years, you're going to go out on your own into this kind of a practice, which has more flexibility and a better lifestyle. And so, one of the things you want to do early on then as you're looking at those contracts is you want to think about, well, if I want to leave that practice and maybe pick up some of those patients in my new DPC practice in three or four years, what do I need to do to plan for that?

And that's where an attorney comes in and looking at your contract. Can you get rid of the non-compete that will prevent you from moving away from that practice to a new practice and take some of the patients with you? Even if you can't take away the patients, like there might be a limitation on marketing to those previous patients, you still want to have the ability to actually set up another practice without too much of a restriction.

If you have a six-month non-compete and then you can open your doors in six months, that's not too bad. If the geographic limitation is within driving distance, so you really want to have an attorney help you think through that when you're signing your first contract as an employee. So that's really all I'm going to say about that.

But to me, you start out when you're first on a residency or fellowship, it's good to have continued interaction with other physicians in your specialty in a controlled environment where you don't have to worry about all those things that we're talking about.

But then once you're out three or four years, you should feel confident to start your own practice if that's what you want to do. Now as an aside, I'll say right now there are DPC practices which are quite large where the physician is actually employed in a DPC practice, but I'll talk about that more in a minute.

Let me review again the key features of a DPC practice. There's no insurance billing, period. Patients are paying monthly, quarterly, or annually. Sometimes employers are the ones paying. If you have a large employer or medium-sized employer that would like to provide for the care of its employees and there's not a lot of good primary care nearby, you can sometimes get the employer to pay for some or all of this on a membership or subscription basis because it keeps the employees at work. And some companies are really facing problems with employees constantly being injured or sick and you can work with employers to address that issue.

But most DPCs, I think the majority are actually just taking care of patients, usually within either like a family medicine or internal medicine or pediatric type of practice where you might focus on just a certain age groups, pediatric age groups or some might focus on adults in the middle ages and then sometimes senior practices.

But the nice thing is you get the flat membership fee. You're not billing patients. You can usually have a panel of no more than six or eight hundred at the most, so you can spend more time with your patients. 30 to 60 minutes per visit is often quite doable. And a lot of the benefit too is the improved access in non-traditional ways. So phone calls, using email, telemedicine, just messaging them on your telephone and even sometimes home visits.

And that all enables you to reduce the expenses in the office and really help people more quickly. And most DPCs have openings pretty much within one to two days as opposed to a two or three week backlog of patients. And then in that situation, again, the patients are much more happy with the longer time you spend with them and the fact that they have improved access and they become very secure with that kind of arrangement, much like concierge medicine, but obviously done in to meet the needs of chronic conditions as opposed to concierge, which usually focuses on acute things or just some carve out a particular type of specialty. I could belabor that, but I think it's really a nice model. Income is usually pretty good, and I'll get into that in a minute.

What are some of the potential downsides? The main one is that you have to create your own business, your own new practice from scratch, and it takes a while to plan. You have to learn some new things, perhaps, in terms of how to run a business. If you're doing high paying procedures, that doesn't lend itself to any kind of prepaid monthly payment as opposed to fee for service. And you have to learn how to market yourself so you can build that panel. You want to get to two, three, four hundred as quickly as you can.

And so, the biggest barrier basically is that up front investment and need to do all this planning, find a place to work and hire at least one person maybe after. You can start with just yourself when you only have five or ten patients, but once you start to get more and more and you're doing some marketing and they're starting to sign up, then you'll probably need at least one staff. But it's really pretty limited, one or two, if you're doing that kind of DPC.

Now, you could do another thing, and that would be to look for a practice that already is employing physicians and you would be an employee, but it would still have some of the advantage of a DPC if it's set up that way, because you'd have your own panel and you'd have some coverage. And again, the lifestyle would be better and you wouldn't be filling out a lot of paperwork. And even the charting is easier because you're not doing charting just for the sake of billing.

All right, let's go in a little deeper about this DPC model. I've kind of described the basics, and if we're thinking about starting a practice like this, you have to think about different things. You're going to have to actually create a business plan. Now, a business plan is just a document. It can be relatively short. It says, what do you plan to do? Who's your intended audience or patients you're going to recruit? What are you proposing to charge? Do a pro forma and engage an accountant and say, okay, well, if this thing grows in a certain way, let's say we're picking up so many patients per month for the first year, how quickly can you get to 200 or 300 patients, let's say in a basic internal medicine DPC practice? What can we expect in terms of all the expenses that will be covered during that first year and then in an ongoing basis?

You have to estimate those things and try and work out a pro forma of how you're going to go from losing money at the beginning, which obviously, if you have no patients, you're going to have some expenses and no income. The income is going to ramp up over time. You're going to be doing a lot of marketing.

When's the break even point? When's the point when you can start taking a salary? When's the point where you have to hire one or maybe a second employee and so forth? You need to spend some time thinking about the location. You can get creative and share space and really try and minimize the cost of your lease and the overhead associated with the clinic location. You have to choose an electronic health record and patient management software, that kind of thing.

Again, you're going to have to work on your pricing model. From what I read, typically children, you're going to charge $25 to $50 per month. Adults, $75 to $100 per month. For young ages, let's say $18 to $39. For older adults, maybe $100 to $125. And then when you get above age 65, probably $125 to $150. If you're in an affluent area, you may be able to get up as high as $200 for the kind of special service that you're going to be providing as a direct primary care practice.

With the children, I had a guest on. He was really on my show to talk about a new product that he had developed that he was selling. It was a software to help run and market a DPC practice.

But he did note that the charges for children depend a lot on the vaccine. So if you're getting newborns and those up to 18 months, three years, and they're going to receive a lot of vaccines, you have to make sure that you include that, consider that in your fees. As they get older, of course, all they're getting is routine checkups with almost no lab tests and no vaccinations.

And so that's where that price can get quite low on a monthly basis just to see them once a year for their physical, assuming they don't have any chronic illnesses, which would be not that common in a pediatric practice.

You're going to have to build that panel. You're going to have to set up a website, learn a little bit, pick some social media sites that will help promote and market your practice. You want to do community outreach where you're doing things live at health fairs or visiting local businesses and networking and doing some education in the community, which will get your name and your face out there.

And then in some cases, you might partner with an employer, as I mentioned earlier, which would be a way to try and keep the workforce healthy, especially when there's a lack of primary care in the area.

Staffing can be an issue only because you just need to decide how many staff you need, what they're actually going to do. But again, the requirements are much less than in a traditional practice. You might have six staff supporting a single physician with the billing and the scheduling and so forth. But when you're in a DPC, you're probably going to get along with one or two at the most to begin.

You're also going to have to set up your finances. The payments are coming in regular, so you're kind of prepaid. When you're doing it monthly, you're actually getting paid at the beginning of the month for each patient. And so you can very quickly see what it's going to take to break even. And then as you continue to grow, start becoming profitable. Some of the startup costs, I'm just giving you gross numbers, but you could probably start it from $40,000 to $100,000 overhead for that first year if you include the lease, the medical equipment, all the supplies, malpractice insurance, EHR, billing software.

Again, it's really just making sure that the membership fees have been paid. Marketing website and office supplies. Most break-even practices occur or reach that level when they've got about 250 to 300 members. Actually, you can kind of keep in mind. Now, I'm sure there are multiple books and courses and things that you can take to help walk you through this process. And I will be putting some resources at the end of the show notes. I'll mention it right now by going to nonclinicalphysicians.com/direct-primary-care-practice.

I think I've given you enough to get some idea what we're talking about and really start thinking about this. The other question that comes up from time to time is, can physician specialists build a successful direct primary care practice? Well, obviously, it's not a direct primary care practice, but it's a DPC style practice. And sometimes, yes, it can be very successful. The model needs a little bit of modification depending on what you're doing, but the model can be used by specialists for high demand specialty services and sometimes for employer contracts.

Let me give you some examples for this. For example, cardiology. Well, hypertension, heart failure, arrhythmia, sometimes there's chronic ongoing disease management for that. And cardiologists could carve out part of their practice following that kind of model in which they're getting a membership type payment every month or quarter. Now you have to, again, revisit this issue of can you do that. You can't do that for Medicare patients, obviously, if you are still a Medicare provider.

Now, if you've decided to focus on just those under age 65, then you can just leave Medicare and just do that part. And again, as I mentioned earlier, the patients can still access their Medicare for the other parts of their care. But if you're going to do outpatient only and chronic disease management, you could do this model. And it might even be possible to mix both, but I think you really need to check with an attorney or do some more research on that. Obviously, endocrinology, you can do diabetes care, thyroid disorders, hormone therapy, dermatology, concierge type of practice, only prepaid rather than pay as you go.

It takes probably a little more research, a little more aggressiveness to figure out how this would work as a specialist, but it can be done. And I think the pediatric side wasn't one that grew a lot initially, but it seems to be catching up now because a pediatrician that I spoke with says they're trying to figure these out, these problems out and how to handle the injections and immunizations. And it can work out quite well.

The marketing is a little different for a specialist. You're probably going to market to your referral base rather than directly to patients, although you could do both. There are examples out there. There's a cardiology DPC that is charging $150 per month per patient for unlimited consultations and quick access to the doctor and stress tests and EKGs on a regular basis and being very successful. Dermatology, cash-based clinic with a $300 initial consult and $150 per follow-up. And it's mostly for cosmetic procedures like Botox and fillers and laser therapy.

I think there's a practice out West and one of my guests was doing in which she was seeing psychiatric patients on a DPC style of practice, prepaid membership type of care rather than the episodic and fee-for-service with insurers.

I think that that's all I have to say about the specialty side of things. It can be quite lucrative and it also, again, brings you closer to the patients and much higher satisfaction for both practitioner and patient.

Should a specialist consider this? Yes, if you specialize in a chronic disease management or cash pay procedures, should work okay. And you'll get less insurance hassle and more direct patient interaction and can be quite lucrative. Now, if your specialty requires hospital-based procedures, then it's probably not going to work out. And if you typically rely heavily on high insurance reimbursements for high cost treatments, then again, it probably won't.

I think this could be a solution for some of you to sum up here. If you've been in practice, if you're unhappy, if you have no objection to being involved in the business side, you can start your own DPC practice, I kind of like it because I think we know that in general, people who are the most successful financially in life are usually those that own a business.

You can get some high salaries and specialties and even becoming a nonclinical physician, a CMO at a hospital or something like that. But at the end of the day, when you retire, what you have is your retirement savings and whatever investments you've made with that money. But when you have a practice, you can grow that practice. You can hire other medical providers. You can leverage your own care with APNs and PAs. You can hire more physicians eventually if necessary to make it work. You could bring them in on as partners.

But at the end of the day, then you can sell that practice or sell it to your partners or get bought out. And in addition to the earnings that you've made, which are going to be quite positive. Again, I didn't say specifically, but it's very common for a DPC with a mature practice to be earning anywhere from $280,000 to $500,000 per year as a primary care. And specialists can do even better than that with a combination type of practice. That's why I encourage that if you have any inkling that that's something you think you can manage. You can hire an accountant and an attorney to set things up. Make sure you jump through all the proper hoops.

You can get someone to help you plan the business, but you need to be working and either having a lot of money saved up to start this thing or continue to work part-time and cut down on your traditional practice as you begin to accumulate patients. And then if you've got a hundred or so, you can cut those ties completely.

Most of the time, most DPC primary care doctors are going to have anywhere from 400 to 600 patients. And you can earn a lot more getting to 700 or 800, but then again, the lifestyle begins to suffer. If you want to learn more about starting a DPC, it will require planning, investment of time and money. But if you're successful, you'll find that you're much more satisfied, your patients are more satisfied, and you'll be able to make a very good income while enjoying a wonderful lifestyle.

Tell you right now that if you go to DPC Frontier at www.dpcfrontier.com, there's a lot of information there. There's been a lot published on this in the literature and there's a weekly podcast called My DPC Story with Dr. Maryal Concepcion. Since September of 2020, she's been doing a weekly podcast. There's lots and lots of success stories in that podcast. I will add more resources for you to look at, again, at www.nonclinicalphysicians.com/direct-primary-care-practice.

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The post It’s Time to Start a Direct Primary Care Practice appeared first on NonClinical Physicians.

First Consider 5 Proven Strategies To Save Your Career

John Jurica — Tue, 24 Dec 2024 12:05:41 +0000

Recent Trends Offer Options for Physicians – 384

In this podcast episode, John discusses how to save your career if you wish to continue working in clinical medicine.

John shares five proven strategies for physicians to revitalize their medical careers while maintaining patient care, drawing from his experience as a Chief Medical Officer to help doctors reimagine their practice rather than abandon clinical work.

Drawing on real-world success stories, he offers practical solutions for physicians who enjoy patient care but struggle with administrative burdens and work-life balance.

Our Sponsor

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

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

For Podcast Listeners

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

Taking Control of Your Practice to Save Your Career

Contract renegotiation offers a powerful tool for employed physicians to improve their work conditions. Key areas for negotiation include vacation coverage, and ensuring adequate support during colleagues' time off through locum tenens or community coverage. Working hours should account for documentation time, and supervisory responsibilities for NPs and PAs need clear boundaries.

When approaching renegotiation, physicians should review their contracts months in advance, engage legal counsel, and strategically time their negotiations, especially as healthcare systems face increasing challenges in physician retention.

Breaking Free from Traditional Constraints

You can explore various practice models to eliminate common stressors while maintaining clinical work. Options include direct primary care (DPC), cash-only practices, concierge medicine, or specialized focus areas. These models often eliminate insurance billing headaches and allow for better work-life balance.

Alternatively, you can consider micro-incorporation, forming an LLC to work as an independent contractor with hospitals, gaining tax advantages and greater flexibility while maintaining the appearance of traditional employment.

Summary

Each approach requires careful consideration and planning. However, there are solutions to the challenges in modern medical practice that preserve the physician-patient relationship.

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Transcription PNC Podcast Episode 384

First Consider 5 Proven Strategies To Save Your Career

- Recent Trends Offer Options for Physicians - 384

John: Okay, today I want to describe several ways that you can fight to save your clinical career. Normally, I talk about nonclinical and unconventional careers to consider when you're fed up or burned out from your practice, but I've learned that sometimes it's not practice per se, but the long hours, dwindling salaries, and unsympathetic bosses that lead physicians to leave practice. You may still enjoy seeing patients and working in a clinical practice if you could get rid of all the other nonsense.

I'm coming to believe that reimagining your practice might be a valid, maybe even a better way to save your medical career and get back on track than just abandoning it and doing something nonclinical, albeit still in the field of medicine or in the field of healthcare.

I've had several guests over the last year or two who have confirmed that belief, and I want to spend a few minutes today to provide a little bit of food for thought on a short list of strategies to get you back on track in your career, bring some happiness and satisfaction without leaving medicine. So let's get to that discussion.

All right, we're talking about considering five proven strategies, and these strategies are designed to save your career. Let me work from this premise that you're in this position and you actually still like seeing patients for the most part. You enjoy practicing medicine, and that's not the problem, but it's all the other stuff that gets in the way.

Things are happening, most of the time it's because you're employed, you feel you don't have a lot of control, and you know what's going on is not really aligned with your lifestyle desires or your values, that kind of thing. And you'd really like to be able to spend time with your patients, make a decent living, and maybe even not be sued and other factors that I'm going to talk about here in the next few minutes.

But while you're thinking about these strategies, remember several things, that most of these will require hiring an attorney, most of them or some of them will require moving at least to a new practice. You might not have to move from your city if you're in a big city where you can actually still commute, but some of these things I'm going to mention do require you leaving your current practice. And sometimes it might not only involve moving to a new practice, but it might involve starting a new practice. So those are big things if you have to sell a house and so forth, they can be a barrier.

But these are all situations where you can continue to practice. And in many of these situations, your practice is extremely rewarding. So I have five strategies for you to consider today, and I'll go through all five right now, and then we'll go through them one by one.

The simple one is to aggressively renegotiate your contract. The second is to hire an agent. Now that might seem kind of unusual. We don't think of using agents for physicians to negotiate their contract. This one usually applies for your first job, but it can apply to your second or third as well. If you can somehow eliminate the billing from insurance companies, that can sometimes eliminate a big chunk of problems in a practice.

Let's say you're in a private practice now, either alone or with others. If you can figure out a way to avoid the need to do billing, hiring staff, tracking it down, working with the big insurers, which is extremely frustrating, that might solve the problem. Possibly you can just narrow your focus, narrow your practice.

I'll give you some of my ideas on that. And then the other is maybe switching from an employee to an independent contractor, even in a similar situation, or what some people call micro-incorporation, that might solve the problem and bring you closer to the practice of your dreams.

Well then, let's talk about aggressively renegotiating a contract. Now this is for those who are already employed. And I have a fair amount of experience with this because I was a CMO for my hospital and I either negotiated or renegotiated over a hundred contracts. I even oversaw the hiring and then also the recruiting of new physicians from their own practice. In other words, we would buy their practice and we would add them to our group.

But if you're already employed, you have a contract, there are usually certain factors that cause the burnout, that cause the dissatisfaction. One could be the vacation coverage. And it's not that you don't have enough vacation. You may have two, three, four, even up to six weeks or so. The problem is that sometimes you don't take your vacation because you're so busy and you feel like your patients will be let down.

Sometimes you don't take vacation because you don't have enough coverage. And related to that is you don't take vacation because you realize the more vacation that you take, the more that the other physicians who cover you are going to take. And when they're gone, your own time is extremely stressful because you're covering for all their patients while they're gone.

So if you're in a group with six, seven, eight specialists in a certain field, it's not always a big problem to have only one person gone at a time. But if you have three and one leaves for two weeks, then that means the other two are on call every other night or every other day for those two weeks. And so, it's kind of a misnomer, and I realized this even when I was negotiating these contracts, but sometimes we just had these difficulties with the small groups of specialists that it's really not every third or every fourth call rotation.

Because let's say that you have four people working in that. Well, all four of those physicians could conceivably take off three weeks each year, which means during let's say the nine weeks when other people are taking call, you're no longer on every fourth night. Now you're on every third. So your contract is essentially in violation. What they're doing is in violation of your agreement. Really what you should be doing is plan those out well in advance and get locum tenants to come in and fill.

And it's even worse if there's only three of you or two of you, because then when one person's gone, if there are two, then it's extremely stressful. And yet they say, well, we'll work around it, but no, that can be devastating. So vacation coverage is a big deal. And that's something that should be really clarified that if you're really on every fourth, then that means when people are taking off, you should get locums in there to cover or pay somebody in the community to cover.

The hours and salary of course are big deals too, but it's mainly the hours that you're expected to work. And I think we need to start pushing back on the employer and say, okay, I'm including the hours of my documentation. So you shouldn't be seeing patients for eight, nine hours a day. And that's quote your normal office hours when you're going to be spending an hour or two at night doing your charts, there needs to be time taken during the day while you're seeing patients to do your charts. And if that doesn't work out, then you need to come up with another plan.

And the other one that came up a lot when I was doing this was working with physicians and getting enough supervisory time for the NPs and PAs that we had, because we were hiring a lot of them. And it really got to the point where we were struggling to get them coverage and sponsoring or collaborating physicians. And so they could be the designated coverage or sponsor for, let's say some PAs, it could be 5, 10, 12, 14 PAs that could be calling at any time that they're seeing patients. And this is like a minor thing in a contract theoretically, but it's really a big deal.

And so, what you need to do is look at all those things in your workplace that are making you unhappy and take the opportunity to plan for it and aggressively renegotiate your contract so that it actually provides you what you need safely and at a low risk of being sued. Some of these things lead to fatigue and leads to mistakes and all that kind of thing. So that's one option.

Now, this has always been out there, obviously. I think as hospitals and systems are having more difficulty keeping physicians, you can get a little more leverage now that maybe you had five or 10 years ago. So that's the first thing. You can definitely start by renegotiating aggressively. Obviously, you're going to need to have a good attorney and you're going to want to strategize with the months and months before it's time to renegotiate. And you're going to look at your contract and make sure that you give them enough notice that they don't just say, oh, it just rolled over for another three years because you didn't dispute it. That's enough of that one.

The next one is hiring an agent. And this is mainly for your first job and then subsequent jobs. But I interviewed a guest by the name of Ethan Encana. He was trained as an attorney and that was in February of 24. And he has a full time company job and associates who are hired by physicians as an agent to do the negotiation upfront for their jobs. And they're really serving more like they would for an athlete, a professional athlete. They're going to look after you. They're going to approach the organizations that have these jobs posted. And they're going to negotiate even before they get to the negotiation of the actual contract, the arrangement. And the arrangement is that they are going to pay the fee for this agent. And this agent is going to keep all of your best interests in mind and negotiate very aggressively to get you a contract that has all the things in it that you want and need.

And it's again, usually those same issues that include vacation, the hours and salary, the pay for supervising other medical providers, the restrictive covenant. It's tough to get rid of that restrictive covenant, but there's more and more examples where they are getting rid of that. So if for some reason you would want to go private at some point, then you can do that.

But you can actually hire an agent. And again, I had never even heard of this until earlier this year in 2024. And so, I'll put links in the show notes to any of these things that I mentioned in terms of previous guests and resources to follow up on these options.

Hiring an agent is an option. Maybe they can get you a better deal that is to your satisfaction and has a great life work-life balance and so forth. And particularly if you're willing to look not maybe rurally for sure, because they're really having trouble, but even in the suburbs and stay away from the big cities, you're going to find a lot more opportunities because they are struggling to find physicians, but you're going to have to keep them honest in terms of what their contract requires them to do.

The next one, number three is eliminate billing. Particularly if you're already in your own practice. It seems like it's that whole issue of billing and hiring more staff to do the billing and then have to go after payments that are declined, costs a lot of money, you spend a lot of time, you might have to be doing a lot of paperwork and signing off on paperwork to challenge these billing decisions. Really, there are different ways of doing that. But we know, of course, that DPC, direct primary care is a great one.

I've had, I think, two or three guests on. And let's see there. Also, I talked to someone who is doing an infusion lounge, which is cash only. Direct primary care most of the time is cash only based on a membership fee. Concierge is very similar, kind of high end, more expensive.

A lot of the DPCs, the monthly cost is reasonable and patients really are not opposed to paying that because they have such high deductibles and copays that they do better doing DPC. A med spa is another example. Or you could really narrowly focus your practice and do cash only. You could do functional medicine, I think even lifestyle medicine are ways that you can eliminate third party billing. It's not that the patient can't access their billing, they can do that. You just have to give them records that they can then submit their own reimbursement. Of course, a lot of people have health savings account and similar accounts.

So, if you're in your own practice and that's one of the things that's really making your life miserable, then you want to move to a model that doesn't require you to do a lot of billing. Well, at least not billing of the insurance companies because that's where you really get killed. Normally, if you're doing DPC or even free for service, you're going to get paid by your patients because they'll be afraid that they can't keep you as a primary care doctor. Now, if you're doing urgent care, you could do cash only urgent care. Of course, you do need to be paid at time of service for that.

So, let's move along here. Another thing you can do is narrow your focus. We'll look at this and start in a pretty general practice and that's what we get overwhelmed with. Sometimes, if you can focus on just one sub area or two sub areas of a practice, then you have the ability to systematize things. You can master the billing. So, even if you're doing billing, usually if you're only using, let's say, a handful of codes, you know how to document and how to get paid for that.

I'll give you an example. I have a friend, he's sort of pre-retirement. He's a pediatrician. Obviously, he did a lot of different things, was working in the hospital for a long time, eventually stopped doing hospital work once we got some pediatric hospitalists in town. And then he decided that he wanted to simplify his life a bit and so he started doing only care for attention deficit disorders.

Now, he's still charging fee for service and he's not using a DPC model per se, but you could. You can do either one. But the patients that he has, they are so happy to have someone who's really focusing on this area that they'll pay the money rather than go to a general pediatrician who's doing so many other things and isn't necessarily able to sit down and spend the time and doesn't have the staff in the office like this friend of mine who since we're all on the same page, we're all working on the same problems with these patients. Everyone's very knowledgeable and they get a lot of personal care and they're happy to pay for it.

And so, you can do things like that. I can imagine a neurologist focusing on Parkinson's disease or something with some other neurodegenerative disease and have just a lot of patients with that particular condition or certain cancers or certain cardiac disease. And so, think about ways you could focus down, simplify your practice. Again, you'd have to be in practice to do this. In some cases, you might be able to do it in a large group, but you may end up on your own or with a small group to be able to do this. But at least you're still practicing and your patients will really appreciate you.

The last one, number five here is what I'm going to call microincorporation. I spoke with Todd Stillman back in October of this year, 24, and he was recommending, and there's a reason why this makes so much sense too, besides the fact that it's just another option to get more independence. But you're thinking what I just described in terms DPCs and concierge and med spas and narrowly focused practices, you have to build a practice. It's expensive. You have to market it. You have to have space. You have to pay rent. You have to hire staff. You have to have someone to help you with the billing if you're doing the billing. But you can avoid all of that. And to get a lot of the benefits of being in your own practice by forming an LLC, but then using that LLC to become a pseudo-employee of a hospital system or a large group.

And basically you're a 1099, you're an independent contractor, and you negotiate a contract with the hospital. And the hospital contract is not an employee contract. And so they are alleviated of some responsibilities. They don't have to treat you as an employee. They don't have to give you any benefits. So you have to make sure on the other side of the equation that you make up for that.

But the thing is when you incorporate as an LLC or whatever other PLLC, each state's a little different. You work as an independent contractor, but you look as though you're employed by the hospital and you're not opening. As a matter of fact, you're working in one of their clinics and one of their offices. When I was talking to Todd Stillman, he was funny because he actually had owned an office. Now he was leasing that office to the hospital, which was then allowing him to work in that space. And so he was actually making money by leasing the space to the hospital and other physicians have done this.

And then granted, you've got to cover some things like your own health insurance, but you can find good policies and you have more options as an LLC or PLC to actually diversify your income. You can, through that LLC, do other things. You can have much higher limits on a 401(k) and other tax advantaged investments and so forth. And there's a lot of other tax write-offs that can be used legitimately.

If the first three or four options that I talked about involve starting your own practice, it seems too onerous and you don't want to borrow $100,000 or $500,000 to do that, then this micro-incorporation is another way to really achieve the type of practice that you want to achieve, but mostly onus of the investment on the hospital and still kind of maintaining that arm's length relationship, which enables you to do these other things that make up for it, which includes investing in other ventures and maybe even have other side jobs.

And by the way, nobody else needs to know that this is how it is. You can be doing this and to everyone else in the hospital, in the community, it will look as though you're an employee of the hospital, but you've created your own mini-corporation to get the advantages of the flexibility and so forth that you desire. And yet everyone else and you're still participate with committees at the hospital and stuff to meet all the requirements as a physician, but it does add a lot of flexibility. And I think there's two episodes. I'll put links to everything here in the show notes.

There are five ideas for trying to improve your lifestyle, improve your satisfaction without leaving clinical medicine. Some of the prep will involve really start by reviewing your contract right now, even if it's not due for a year, look in there, see what you're restricted. What can you do? What can't you do? How much notice is required? Early on in the process, as you're reaching that deadline, you need to let them know early and say, look, I'm not leaving. I have no plans to leave this organization, but I want you to know that I have some things I'm not happy with and I'm going to be renegotiating this contract. So if that requires me to give you six months notice that I'm leaving, then I'm going to then you give that notice in writing.

But even in that letter, you can say, I'm planning to stay, but I'm giving you notice as required by my contract that I might not stay if some of the concerns I have about my contract are not addressed. And it doesn't have to be anything onerous, doesn't have to be very confrontational. You go in professionally, you talk with your attorney and you go in and say, here's what I want.

From a negotiation standpoint, I would always ask for the moon. And if you have three or four issues, you start with putting it out there and say, I don't want a restrictive covenant. And then you can come back and negotiate maybe something that's much less restrictive than it was in the past. I don't want to work in this office, or I don't want to supervise 10 NPs and PAs. It's too much work unless I get a lot more compensation and cut back my hours in other areas. These are things you can do. You definitely want to talk to either an agent, as I said, or an attorney, and then discuss your options and negotiation strategy before starting that process.

That's basically it for me today. You know, if you find yourself on the way to burnout, consider taking some of these steps now and go to the show notes for links to the interviews mentioned so that you can learn more about each strategy. And to find those, you can go to nonclinicalphysicians.com/save-your-career.

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The post First Consider 5 Proven Strategies To Save Your Career appeared first on NonClinical Physicians.

How the Medical Matchmaker Provides a Solution to Burnout – 273

John Jurica — Tue, 08 Nov 2022 13:15:54 +0000

Interview with Dr. Lara Hochman

This week, we discover that the Medical Matchmaker has a traditional solution for burnout: joining the right medical group.

Dr. Lara Hochman is a Family Medicine physician. She graduated from the University of Texas School of Medicine and finished her family medicine residency at St. Anthony North Hospital in Oklahoma City.

Solving the Burnout Problem

Dr. Lara Hochman is the “Medical Matchmaker.” She fights to protect the wellness of her medical colleagues in the face of escalating burnout and unhappiness. Her own experiences inspired her to research how physicians lose their autonomy and how they might regain their commitment to treating patients.

In order to connect physicians with successful, physician-owned private practices where they can once again enjoy practicing medicine, she launched Happy Day Health, a boutique physician-matching business.

Our Sponsor

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

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

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

Happy Day Health Services

Dr. Hochman loved medicine but detested the healthcare system. So, she founded her company to provide a remedy for the burnout it produces. She steps in to act as a medical matchmaker, connecting doctors to physician-owned practices.

Happy Day Health assists physicians in locating practices that closely reflect their personal and professional values. In the process, it helps practices find physicians. Dr. Hochman also provides advice to physicians about creating their resumés, understanding their contracts, and preparing for interviews.

Building the Medical Matchmaker Business

During the interview, Lara describes how starting a business requires accepting uncertainty and learning as you go. In medicine, we are taught to aim for perfection and spend many years learning the rules. In business, however, it is sometimes necessary to learn on the fly, make mistakes, and course-correct as needed along the way.

This process can be exhausting and emotionally distressing, but it will lead to a point where you feel confident in what you're doing. By following your instincts, and maintaining a commitment to make a difference you find satisfaction and encouragement to keep going.

Challenges for Physicians Going ‘Private'

When comparing private practice with hospital-based practices, salary is often the driving factor that influences a physician's selection. But that can be short-sighted. In a small practice, you have an opportunity to be a decision-maker. And the long-term benefits of autonomy and becoming an owner should be considered.

Working with and for other physicians is a much more collegial situation. It is less likely to create an inflexible corporate environment driven by patient volumes and the need to push downstream revenues.

Dr. Hochman's Advice

When it comes to salary… it can actually potentially be much higher in private practice. You just have to be able to delay gratification a little bit longer… Also, if you find a practice that you feel will treat you well and pay you a salary that you're happy with, do it. Don't wait.

Summary

Dr. Lara Hochman has dedicated herself to connecting physicians with private practices run by other physicians. In the process, she is helping to prevent and overcome the burnout that occurs when working in a high-volume corporate environment. And by doing so, she overcome her own disappointment in the U.S. healthcare system and discovered her purpose.

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 273

How the Medical Matchmaker Provides a Solution to Burnout

- Interview with Dr. Lara Hochman

John: In the town that I work in, well, I still work here, but when I used to practice here, both hospitals, small town outside of Chicago, I would see these groups come and go where a physician would hire a partner and then they'd leave after two or three years. And it's really uncommon to find a really well-run practice. But I have a friend who's a gastroenterologist, he's got eight partners. They've had a practice who's going for over 30 years and it just runs so well. And they have no trouble recruiting and they're all happy. They like what they're doing. So that's what we're going to talk about today.

Now we normally talk about nonclinical jobs or careers, but one of the principles I go by is that I think physicians should be happy, and I believe in physicians working for other physicians as opposed to working for corporations. So, with that, I want to welcome today's guest. Hello, Dr. Lara Hochman.

Dr. Lara Hochman: Hi. Thank you so much for having me today.

John: You're welcome. Yeah, this is not going to be about a nonclinical job. This is how to find a clinical job where you can be happy and fulfilled and wake up in the morning and actually look forward to going to work. So, tell me and our listeners here who you are, what you do, and maybe a little bit about your background.

Dr. Lara Hochman: Sure. I'm the medical matchmaker. I help physicians find practices that will really closely align with their value systems. And on the flip side, I also help practices find physicians. And then throughout that process I really help out with a lot of kind of coaching through what to talk about in the interview, all of those things. Negotiation, all that stuff.

I'm a family medicine physician. I still practice. I do locum tenens here where I work, where I live locally. And that's because I actually still love medicine. I do this in large part because I personally have been burned out and thought I hated clinical medicine and left medicine entirely thinking I was going to figure out what else to do. And then just this seemingly perfect job felt in my lap. It was terrifying because I was like, "But I don't like medicine anymore."

I decided to just take a risk and do it and figured out that I loved medicine. It was just the system I hated. I see that over and over again in so many people and I would like to be a part of the solution. I think once you're past the point of no return, then of course, clinical medicine may not be for you anymore. But there's so many of us that love clinical medicine and love everything. We just don't like the system. So, I'm out there to try to change it.

John: That's fantastic. Now when I think of clinical situations that physicians might enjoy, I do think about locums because although it's hard to necessarily set it up initially, it actually provides a lot of options and flexibility and so forth. I think of DPC and concierge care. But obviously, I also know of people, as I mentioned in the opening, that are working in jobs that they like because they have partners that they like. They have a practice that works well, the patients like them, and they're actually practicing traditional medicine even though we're in a system that tends to not favor that. Definitely I like to hear stories like this about someone who's doing the matchmaking.

So, how did you make that transition? It is difficult to start a new career and starting a new business is very challenging. So just a little bit about how you overcame some of the mindset issues and did you have to deal with family and say "Here's what I'm going to do." How did that come about?

Dr. Lara Hochman: Oh, my goodness. That is such a big question. Yeah, it was very interesting. There were parts of my family that I thought would be supportive that weren't, and there were parts that I thought would not be supportive and were. So, it's interesting. I think overall they accept and support me in what I'm doing. They're there to cheer me on and to pet my back when I'm feeling down. But it really was a challenge. There are no words for how difficult it was. It puts medical school to shame.

John: Oh, really?

Dr. Lara Hochman: And it's a different type of difficult. Medical school is like this firehose of information. This was more "I taught myself how to do what I'm doing." I had no training in business, no training in I would say traditional recruiting. I don't consider myself a recruiter, but I didn't know how to find people. I'm not a salesperson. All those things that I have no idea.

I was teaching myself something how to do something very difficult. I don't often feel comfortable talking to new people. And so, here I am calling complete strangers. I've learned a lot of what to do and what not to do and what I can deal with. But talking to strangers is tough and that's a huge part of what I do.

There were so many challenges and the financial part of starting a business is just... There's a lot. The first thing that I did was even just deciding to start the company. There was a lot of mind drama that I was having about it. I never wanted to be a business person. I never wanted to start a business. I'm a physician at heart, that's what I love. I never saw myself doing this. I actively did not want to do it. But I just felt there was so much that needed to be done for physicians. And so, that kind of mission of trying to be a part of the solution really just overtook that. And it turns out I actually love it. This was such a nice surprise.

I would say the first step, even before I started a business, I've been working on facing my fears for years in other ways. And so, that probably helped as a precursor. In medicine, we're trained to do what we're told, we're trained to follow the steps and study what we need to study. And so, that was a big shift in "I'm going to do what I'm going to do, and there's no blueprint for it."

That was really interesting. Like most people that probably are listening right now, I'm a total perfectionist. I don't like to do something unless I already know how to do it, which you can't do in entrepreneurship. Someone once said, not even to me, it was in a conference, they said, "Start before you're ready." And I was like, "Oh my gosh, okay, I'm not ready. I'm starting." And I started that day.

John: Nice.

Dr. Lara Hochman: That was huge. And realizing that I'm going to do it imperfectly, and that's okay and I have to make mistakes in order to be better, that was okay too. All of the mistakes I've learned from. And there was a period of time, near the beginning, where I would sit down every morning, and have a big old cry. It was so hard. And then I was like, "Okay, what's bothering me?" And then I'd kind of think through "I don't know how to do this" or "I'm having a challenge with that."

I would actually take that. I was so drained and emotionally sad and I would just take that and turn it into, "Okay. Well, obviously something is not working. Let me see what I can fix." And it was lots of little changes over time that I had to figure out what to do. I think I will be figuring it out till the day I die. But it's gotten to the point now that I'm so much more comfortable with what I'm doing. I've figured out so many things and it's satisfying. I'm so satisfied with being able to create real change and affect lives and have an impact far greater than I could if I were still just seeing patients myself, which I still love doing.

John: Nice. A couple of observations. When you have such a principle or a passion, whatever you want to call it, something you're committed to, that can push you through the end a lot of times. So, that's awesome. And you said you were teaching yourself. Well, you had a great student because you're a physician. You've already demonstrated your ability to solve problems and research things and read and learn. That's one thing we forget. Yeah, if we go through med school and residency, we can certainly learn how to start a business if that's our desire. And I do think it's definitely needed.

Now I have interviewed several people that had startups of various sorts. Some were selling products, but typically the ones that are doing more of a service are connecting, are usually connecting one person to another. They tried to start a locums company, recruiting company or some other type. And it's always a chicken and egg because you're doing the recruiting on both ends at the same time. You need physicians who are looking for a job and then you need the companies that are looking for physicians. Was that a challenge for you or did you find a simple solution to solving that problem? How did that come about? Where did you start on that part of it?

Dr. Lara Hochman: Yes, that will probably be my biggest challenge always. Because my whole business is predicated on finding people and speaking to people. It came from putting myself out there just saying, "Hey, this is what I do." I was one of those people who wasn't on social media. I don't like my face in public. I'm a very, very private person. Sort of. I'm an open book, you can ask me anything, but at the same time, I was never that person. Just putting myself out there and letting people know what I do was big. Something that I'm still learning to do is tell people, "Hey, tell other people about me. Do you have friends? I can help you. I can help your friends." That was really important and still is. Going out and meeting as many people as possible is part of my job. And I actually love that. I may be shy on the inside, but I'm actually an extrovert. I love being around people.

John: Okay, nice. Now what kind of things do you look forward in a practice? Or do you have some way of knowing that "Okay, since I'm promoting that I'm going to match somebody with a practice where they're going to be very happy?" Are there certain characteristics of those practices that hopefully will at least try to ensure that there's going to be a good fit? There are always personalities and so forth, but just give us your take on that.

Dr. Lara Hochman: Yeah, the first thing that I look for in a practice, even deciding if we're going to work together or not, is how I feel that they would treat their physician. A part of it is "are they financially stable?" Does it make sense financially for them to hire someone? Because if they can't, then you have a physician who maybe even moves cross country to work there and then they close their practice or they're not happy, you're not able to be paid. That's scary. Making sure they're financially stable is super important.

And then of course, just as important to that is the feeling that I get on how they will treat their doctors. A lot of it is what they say and what they're looking for. And a part of it is when they talk about "I want someone to be happy here." The kind of person that would really fit well as someone who is comfortable. Whatever it is. I want to hear from them why it's good working for them and I hear such great things. And of course, not everyone is going to be happy in every other environment. What is perfect for you would be different from what's perfect for me is different from what's perfect to the people listening. It's not necessarily that I'm looking for a specific thing other than I feel like they are going to be valued and have a voice and really cared for in a way and respected. Those are the main things I look for.

John: Are you able to find out what kind of turnover there has been at some of these practices? I suppose if they're pretty large, you can just ask around. Because to me that would be evidence of it. That's what I was talking about as I was introducing you, is that I've known many groups here where I am with one or two doctors to hire and they're just turning through them every two years because what they do is they treat them like residents. They never really talk seriously about partnership. And so, I figured they're always going to be a failure, but there's this other group that is very stable. So, is it possible to kind of get that information and to kind of key some of your decisions on that?

Dr. Lara Hochman: Yeah, that's huge. I think the biggest way of knowing if a practice will treat you well is how many doctors have come and gone. A lot of the practices that I work with are just single-physician practices that are ready to expand. I'm not going to get a good sense of if the physicians have come and gone. But I do get a sense of how they talk about their practice, how they talk about what they're looking for, how they talk about the kind of person that they would be to work with, and the rest of their staff turnover.

One of the practices I'm working with now, it's a single physician. She's had her practice for 12 years and she's looking for a true partner. She's looking for someone who will bring ideas and who will not just be a partner financially and business side, but really come up with their own ideas and be a part of running the practice. And her employees have been there six years or longer. More than likely, she's going to treat her physician well if she treats the rest of the office staff well.

John: Absolutely. Well, let's see. We've seen in general over the last decade or two or longer, migration to more employment with large corporations, hospitals, health systems and so forth. Which brings me to the next question. The reason for that is it seems like they have more money sloshing around and they can buy your practice or they can recruit you even if things don't work out and they end up firing you in two years, they have you tied in.

So, what kind of things do you tell your clients, the physicians, in terms of what to expect when they're looking for a job like this? And are they going to have to take that into consideration that they might benefit on this side, but maybe the monetary will be later? How does that work?

Dr. Lara Hochman: Yeah. And before I even go into that, I'll say that different physicians are at a different point of being able to hear that, like truly hear that or be open to that. That conversation isn't really important to them. When it comes to hospital versus private practice, I would say probably the biggest one that affects people is salary. We forget that we are still in a business. The practices that we're working for still have to make money. The smaller practices are putting a lot of money into.

The physician owners actually don't take a salary while they pay you your salary versus the hospitals who are getting money from the imaging and the labs and the referrals and all the things that they do. And some of them are hiring people who will order more of those tests and make more money and that's where your salary is coming from. So, they are happy to lose money on the clinic visits themselves because they know they're going to make it up in all these other ways. I do hear from physicians, "I just want to be paid fairly" without a true understanding of what that actually means.

One of the downsides of private practice is that it's a smaller system and this could be a benefit, pro or a con being smaller, but one of the cons is that it doesn't have those large systems set up to be able to provide these giant salaries and amazing health insurance benefits and paid time off. But with that, that's what we call the golden handcuffs. So, you go work for these systems and you get used to be paying whatever salary it is that you're used to, and then you feel like you can't leave no matter how they treat you.

That's one of the most important things that I see, I see doctors who go work for hospitals and maybe have an idea going into it that they're not going to be so happy, or it's wonderful, but then administration changes and it's time for them to get out of it because they're just miserable.

The biggest thing is to really prepare for those circumstances. That means not signing a non-compete where you wouldn't be able to work in the city you live in if you were to leave them.

If there is a non-compete, there has to be a way to get out of it. If they fire you, maybe the non-compete is void or you can have what's called a sunrise or a sunset close on your non-compete where it's not valid after a certain number of years working there. There needs to be some sort of wiggle room so that when you sign that contract with the hospital, you have a way of leaving them. Because they know that they've got us, they have us. We are not leaving because they're giving us the salary, they're giving us the time off and the health insurance and all these things that are amazing. And if we leave, we have to leave town. They don't care about us. If they actually cared about their physicians as human beings and medicine in general, and patients, they wouldn't be doing these things. They'd be retaining us by treating us well rather than retaining us by not giving us a choice otherwise.

John: No, that's absolutely true. And it's a reason you need to have a good attorney look at these contracts because there's usually some wiggle room. But if you don't even ask, you're not going to get the concessions. It's a really good point.

The other thing that I've seen in the past when I was working as a CMO is we would try to put the onus for the malpractice sometimes, or at least part of it on the physician. If they left after a year or two, they were going to be subject to tail coverage or something like that, which I've come to believe that's just ridiculous because it's a cost of doing business. If they won't do that, you shouldn't even consider working with an institution like that because again, it's the worst of the handcuffs and it's not fair.

Given that though, you might have to go with a private partner and what have you. The income at first might not be as high as what's published by hospitals, but long term you're going to be a lot happier and have a lot more satisfaction. Let me pause here, by the way. Give us your website address right now so I don't forget. Some people don't listen all the way to the end. So, we're going to find Happy Day Health where?

Dr. Lara Hochman: It's happydayhealth.co. And you can find me on LinkedIn as well. It's Lara Hochman MD.

John: Okay. We'll put that in the show notes and we'll talk about that again at the end here. Have you gotten any feedback from people that you've placed with these practices? Have you heard back from how things are going three, six months in?

Dr. Lara Hochman: Yeah, they're doing great. They're so happy. One guy said I saved his life, and there are no words for that. They're just happy and they're like, "I didn't realize, I had no idea what I was missing" or "Thank you for opening my eyes up to." I had a DBC recently, "Thank you for opening my eyes to DBC." Even a physician who I didn't place has said, "Thank you so much. You've changed the way I practice. You've changed the way I look for practices." So, it's a lot of fun. It's very rewarding and doctors are just happier. Some of these were physicians who were considering leaving medicine entirely and they're really enjoying it.

John: Any general advice now? Because someone who's been in practice has been burned out, they know they're looking for something different. But let's say you're coming out of residency and you really don't know, and again, you're going to be pulled into that funnel, you're going to see all these ads. Other advice or just things that they should think about a little bit before necessarily ruling out one of these potentially lower-paying but more life-affirming positions?

Dr. Lara Hochman: Yeah. Oh, my gosh. I have so many things to say. When it comes to salary, the few things to know are to look at the starting salary and the potential earnings because it can actually potentially be much higher in private practice. You just have to be able to delay gratification a little bit longer. Also, especially for the new grads, I see very frequently where doctors want to interview at so many different places and then in the process, they may actually lose the perfect job where they know it's the one they want, but we're not used to making decisions and so we overanalyze it and take too much time and then can lose that.

I would say if you find a practice that you feel will treat you well and pay you a salary that you're happy with, do it. Don't wait. You don't want to lose out on something awesome because you were just kind of all over the place.

And I understand if you've never worked in a practice before as an attending, then how do you know what you're looking for? But as long as you protect yourself like we spoke about with a non-compete and all of those things, then you're good. But yeah, I would say pick the practice that will treat you the best because life is a journey. We're not racing to retirement. You want to enjoy every day.

John: Maybe if you're a resident or fellow and you're coming out and you've been in an academic situation or something, maybe you need to spend a little bit of time just talking to a couple of people who are in private practice as opposed to maybe everyone who's surrounded and they're in an academic practice or they're in a large hospital practice. Maybe talk to a few of those people that have been by themselves or in a small group or even a large group that's run by doctors. Maybe that'll give them a little insight into trying to make those decisions. Because you're right. It's easy to fall into that thing of just going with the higher salary and the upfront benefits, but later on you might regret it.

Dr. Lara Hochman: Yeah.

John: All right. Again, the website is happydayhealth.co. They can reach you, Dr. Lara Hochman on LinkedIn. I think this is really exciting. I hope you all the success. You need to keep us posted. Even if you want to do a little recruiting here, let me know. I'll put the word out if you're really having a hard time finding somebody because I'm sure some of my listeners are like, "Yeah, nice practice is just as good a way to solve burnout as becoming an MSL or something." Anyway, it's been my pleasure talking to you and I really appreciate you coming on the podcast today.

Dr. Lara Hochman: Yeah, thank you so much for having me.

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

Dr. Lara Hochman: Bye.

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Achieve Beautiful Balance as Medical Director and Concierge Physician – 234

John Jurica — Tue, 08 Feb 2022 11:10:51 +0000

Interview with Dr. Nkeiruka Duze

Dr. Nkeiruka Duze achieved balance in her professional life by balancing her roles as medical director and concierge physician.

Dr. Nkeiruka Duze earned her medical degree from Indiana University School of Medicine and completed her residency training at Virginia Mason Medical Center in Seattle. She is a board-certified Internal Medicine physician practicing exclusively in the outpatient setting.

Burnout and a desire for work-life balance led to her curiosity about non-clinical opportunities for physicians. Given her interest in medical coding, she worked to increase her knowledge in this area earning Certified Professional Coder (CPC) and Certified Risk Adjustment Coder(CRC) certifications from the American Academy of Professional Coders (AAPC).

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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.

Medical Director and Concierge Medicine

Dr. Duze splits her time equally between clinical and non-clinical work. She is a physician advisor to the revenue cycle team and the medical director of value-based arrangements and risk adjustment coding at a large medical center.

Her primary responsibilities include coding education, liaison to payer teams who oversee value-based arrangements, appealing outpatient denials, and physician coder consultant.

In her clinical practice, she recently transitioned from traditional outpatient practice to concierge medicine. As a result, instead of managing over 1500 patients, she is now responsible for 180.

Here visits are now twice as long, and it is much easier to get to know each patient very well. She is beginning to share patient coverage with another part-time concierge physician in her group.

Satisfying Balance

Dr. Duze enjoys her work as a medical director and concierge physician. She is helping her practice run more efficiently, document care better, and bill more accurately. She also continues to provide high-quality medical care to her panel of patients.

Summary

Nkeiruka was beginning to feel the effects of a high-volume practice. However, by replacing some of her clinical duties with nonclinical management work, and the remainder of her practice to the concierge model, she is much more fulfilled in her job. The feelings of burnout have resolved. And she is caring for patients in more rewarding ways.

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

Links for Today's Episode:

Dr. Duze's LinkedIn Profile
American Academy of Professional Coders
Dr. Duze's Email Address:ncnwoko@gmail.com
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 234

Achieve Beautiful Balance as Medical Director and Concierge Physician

John: Like others before her, today's guest sought to overcome burnout and find more balance by splitting her time between nonclinical work and her outpatient practice. But what I find so fascinating is her practice itself transformed from traditional to concierge medicine at the same time. I think that's super unique. Hello, Dr. Nkeiruka Duze.

Dr. Nkeiruka Duze: Hi, John. Thank you so much for having me on today.

John: I'm glad you're here because I think your story on the one side, it's like a lot of other people's stories in terms of trying to fight burnout and move forward in your career, but there are just some parts to it that I think are quite unique. Listeners, you're going to learn a lot today.

Dr. Nkeiruka Duze: I hope so. And thank you again for having me.

John: Oh, you are welcome. Like we usually do on the podcast here, tell us a little bit about your background, your education, the clinical background, and then I want you to end with what you're doing at this moment, but then we'll fill in the gaps later as I get into some more questions.

Dr. Nkeiruka Duze: Absolutely. In terms of my education and clinical background, I have a first degree in biology, which I got at Texas Southern University in Houston, Texas. And from then I moved on to Indiana University School of Medicine, where I got my medical degree, and subsequently to Virginia Mason Medical Center in Seattle, Washington, where I did my internal medicine residency.

In terms of what I'm doing now, post all my training, I really have two jobs. I have my clinical and my nonclinical roles. And my clinical role is as an outpatient primary care doctor. I still see patients in the clinic. And then my nonclinical role is as the physician advisor, as well as a medical director for value-based arrangements and risk adjustment coding at a large medical center in the Seattle area.

John: Very nice. Now, a couple of things, I'm going to just jump in here as we go through, because when I hear someone like yourself tell me what you're doing as an internist, then I automatically assume you're a hospitalist. Because just so many of the internists that I know they either do one or the other, of course, but your practice really has been mostly outpatient, right?

Dr. Nkeiruka Duze: Exclusively outpatient since finishing my residency training.

John: See, I could tell from the very beginning that you're always going in a slightly different direction than the majority of people.

Dr. Nkeiruka Duze: Well, I guess I don't like to follow the crowd.

John: Now you were doing just practice for a while, correct?

Dr. Nkeiruka Duze: That is correct. My transition into including the nonclinical job into my role or my practice started a few years ago, actually. As you mentioned, I was experiencing burnout and I started to explore what are some nonclinical opportunities out there that I could do while still practicing medicine, but then just kind of cut down my clinical practice. That is when I started to look into the possibility of becoming a physician advisor.

John: Yeah. It was very similar to what I did a long time ago. I thought, well if I can work an hour or two doing something else and use that to cover the cost of working less in the clinic that would be a good exchange. Because when you're doing the nonclinical, there's really no liability, there's no call. You're going to just put your hours in. It's a good way to segue and see if you like it.

Dr. Nkeiruka Duze: Absolutely. And I can tell you that comparing what my life was like when I was a 100% clinical practice compared to now, which is where I do 60% clinical practice, 40% nonclinical, the difference is night and day for me in terms of just overall wellness and quality of life.

John: Now, apparently, do you like doing the physician advisor work when you first started that? Was it enjoyable?

Dr. Nkeiruka Duze: Oh, absolutely. When I was exploring nonclinical positions to help combat burnout, the reason that I was drawn to the physician advisor role is that I've always had an interest and fascination with billing and coding. That was kind of what drew me to that particular nonclinical role.

John: Most of us think when we think of a physician advisor, or thinking like making sure that the procedure was done, was legitimate or it was a good indication for like utilization management, I guess I would call it. Sometimes you call it benefits management, but there are others. You mentioned the coding piece. Were you actually helping people with coding at the same time?

Dr. Nkeiruka Duze: Great question. Not until I actually got the role as a physician advisor. I think my journey has been somewhat unique in that when I was looking into the physician advisor role, certainly, I say it was mostly kind of a utilization review type position. But I learned though that the job of a physician advisor, it's actually more robust than that. There are so many things that you can do. Not only the utilization review but quality and performance improvement, appeals and denials management, and then suddenly with the coding and documentation support and education. I latched onto the coding support and education piece.

I think it was easy for me to do that because the medical center where I work already had an established physician advisor program. And I guess more accurately, I would define it as a clinician advisor program because it has physician advisors, but also has a pharmacist. And that particular program also had an outpatient physician advisor as well.

John: Now, when you were talking there about the way that these things overlap, it really is a good point because the core thing about that is for whatever reason, you're doing a review of a case.

Dr. Nkeiruka Duze: Correct.

John: And like you said, it could be a quality review. It could be just strictly a documentation and coding review, especially on the inside inpatient too, but the outputs the same thing, or it's utilization and they all overlap. And the coding effects, utilization because if you don't have the right documentation, you don't have the right code. Well, you're not going to order the right test, at least in the eyes of a reviewer. It's just interesting. And then you can kind of figure out which of those three and maybe there are other aspects that are the most interesting.

Dr. Nkeiruka Duze: Yeah. And even though I studied mostly with the coding support and education piece, I've been able to expand my responsibilities or roles since then. And that's the other beauty of a physician advisor role is that you can do as much as you want. And you can go as broad as you want. It just depends on what your vision is.

John: I suppose it depends on the organization and the size of it. And like you said, it had a well-established program already. So that helped.

Dr. Nkeiruka Duze: That helps a lot.

John: I've talked to physicians and I find this remarkable, someone recently said, "Yeah, I was the first physician advisor at this large hospital or this large system". I thought PAs have been around for 40 years. You're the first, it's kind of crazy.

Dr. Nkeiruka Duze: Absolutely. Well, in my case, I wasn't the first. Our institution was not.

John: Now, has that role evolved since you started? How long have you been doing that now?

Dr. Nkeiruka Duze: I've been doing the physician advisor role for two years. I actually started the role on January 1st, 2020. But prior to that, I already spent a lot of time looking up the coding certifications, preparing, just basically trying to get the knowledge to help myself in practice until a position opened up where I could actually be a physician advisor.

John: Now, at least in the past some systems have trouble finding part-time physician advisors, they usually look into their medical staff or the physicians that are already aligned with them, unless they're doing something where they're getting something that's a freelance or a third party to come in. But at the same time, it doesn't mean we shouldn't prepare for it. You did some things, I think to kind of say to you up for success. I know you got some additional certifications. Where did that come in?

Dr. Nkeiruka Duze: Great question. As I was looking into this nonclinical space and wanting and setting my sites on a physician advisor role, like most people, when you want to do something, you don't know where to start, you go to Google. So, I started off with Google and I basically came across through my search, and when I was thinking about coding and billing the American Academy of Professional Coders, AAPC. And it's from that organization that I earned my certified professional coder, which is the CPC certification. And then subsequently more recently my Certified Risk Adjustment Coder Certification.

John: Did you get the certifications after you had already started as a physician advisor or one before, one after? How did that timing go?

Dr. Nkeiruka Duze: Great question. With the CPC, I had already started preparing for it before I got the job. And then with the CRC, I did that while I already got the job.

John: I'm not sure I've ever heard of the AAPC. It would be odd that I hadn't, considering how many people I talked to that do revenue cycle and utilization management and so forth. I had talked to people from the ACDIS. Now that's more for coding. I'm sure the nurses that worked at my hospital were very familiar with the AAPC. Were there many physicians that have gotten that certification to your knowledge?

Dr. Nkeiruka Duze: Great question. I personally only know two-physician coders, but I suspect there are many more that I just don't know. And the two that I know were within our system. Even when I was already thinking about it, and at the time I got the job, I learned at the time that both of the outpatient physicians in the program also had a CPC certification.

John: Okay. It's funny because when we had consultants to our hospital to do utilization, that was mostly inpatient, but they were involved and they were certified whether by the AAPC or some other organization.

Dr. Nkeiruka Duze: Yeah. I do know, John, that the AAPC also has a CIC certification, which is a Certified Inpatient Coder certification.

John: That's probably what I had come across. All right. So you did that extra, you're working hard. Did that completely resolve everything you were looking to do as far as your burnout, your transition, your balance in life?

Dr. Nkeiruka Duze: Absolutely. I would say though that when I took on a nonclinical role it made a huge difference in terms of balance and quality of life. But then when I also made the transition from the traditional practice of medicine to concierge medicine, that took it again to another level where I really feel, and I'm fortunate to be at this sweet spot where I feel like this is really what I've been waiting for, for a long time to have this type of balance.

To give you, and your audience a little bit of a clearer picture of what I mean, when I was in the traditional practice of medicine, I had about 1,700 patients in my panel. And then with concierge medicine, which I'll expand on a little bit later in the show, I imagine, if I were still a 1.0 clinician, the maximum number of patients I could have would be 300, but I'm a 0.6 FTE. So the maximum number of patients I can have in the practice is 180 patients. It's a huge difference between 1,700 patients to 180 when you think about whether it be the MyChat messages or the phone calls or the lab results, or the notes you have to dictate, or the number of patients you have to see in a day to keep your practice healthy.

So, it's a very, very vast difference. Making the change to a nonclinical role, and then also making the change in the same year to concierge medicine, I think was really what made me get to this point where I can say, "You know what? This is what I've been hoping for and wanting for a long time."

John: I have a couple more questions about that whole thing, that whole transition. Now you said 1,700 in the basic panel before the concierge, right?

Dr. Nkeiruka Duze: Correct.

John: Now, was that the full time or the 0.6?

Dr. Nkeiruka Duze: 1.0 is 1,700. When I was in traditional practice, but if I had remained 1.0 when I made the switch to concierge medicine, then my maximum would've been 300 patients. But I'm a 0.6 so my maximum number of patients is 180 because 1.0 is 300 patients in our concierge world.

John: And I think you have, I don't know if it's completely unique, but when someone tells me, well, I'm going to do concierge medicine. I'm like, oh, wow, you're going to have a big transition because you're going to have to tell all your patients, and they're going to have to decide if they want to pay you that way. And you're going to have to start your own business. But you're talking about doing concierge medicine within a system that supports doing concierge medicine. You have to tell us how that works and why that even exists?

Dr. Nkeiruka Duze: Well, very great question. I would say it may be unusual now. Maybe then it was unusual. I don't know how unusual it is now, but I would say for sure that the medical center that I work for really pioneered concierge medicine in that kind of a setting, in that concierge medicine practice has been in existence for over 20 years. I believe it started in 1999.

But I do know that at least one other medical center in the area now does concierge medicine. I believe the Mayo clinic does concierge medicine. I suspect that it's not as unusual now, but it must have been then when the medical center that I work for began this journey into concierge medicine in 1999.

John: Now, I think that's very forward-looking. I'm not an expert on concierge medicine, but when I think of it, when I was in practice and I started reading about it, it was really something entrepreneurial. Individual physicians, small groups were doing it and saying, "Look, we're going to get outta the rat race. We're going to have a core group of patients. They're going to pay us as we go. And that's it. We're done with Medicare and all that".

Then there were these franchises that started too, where okay, well, you can sign up and we'll do this turnkey, but I had never actually heard of a system, although it made sense because I think even at the hospital I was at, they thought, well, should we consider doing concierge medicine within our physician group? Now, they only had like a hundred physicians. This wasn't a massive group, so I don't think they really seriously thought about it. But yeah, it sounds like where you've worked has really been on the cutting edge of that, especially for a large system.

Dr. Nkeiruka Duze: Absolutely. If any of your listeners are part of a large medical center that does not have a concierge practice, this might be your opportunity to suggest settling with their support, because I can tell you that there is a huge desire or need. A lot of patients are really seeking out this type of service.

Because we have currently in our concierge practice a waitlist at all our locations. I know that this is something that patients want. Patients want more time with their doctor, they want easy access. They really want to be able to have a doctor that can spend a lot more time with them, get to know them, and not really just be feeling like they're in a factory churning out patients. A lot of people will pay for that service. I believe that if you don't have it in your medical center, it's your opportunity to maybe suggest it and be someone at the forefront to help your organization kind of tap into this model of practice.

John: Yeah. That would be great. If our listeners could get that expanded into other organizations. Now I'm going to quiz you. You went down to your 180 patients. This is the thing that really amazed me about concierge practice. Now if one of your 180 patients pages you, texts you, contacts you, there's a pretty good chance you're going to actually remember who they are. Is that true?

Dr. Nkeiruka Duze: Oh, without question. Without question. Yeah. Because you only have 180 people that you're taking care of. You'll know not only who they are, but you're also going to know the husband or a wife's name, you're going to know the kids' names. You're going to know their pets' names. You're going to know them so intimately because you're going to have a lot of time to spend with them.

I'll give you an example that when I was in the traditional practice of medicine, for a long time, the appointment slots were 15 minutes or 30 minutes. 30 minutes for an annual check-up, et cetera, or multiple concerns. Otherwise, a routine visit would be 15 minutes, but over time in the desire to address burnout, the schedules became 30/30. You have 30 minutes per patient. I thought that was really great when the organization did that.

To the concierge model, in our practice a regular appointment is an hour, whereas your annual check-up is an hour and a half. You really get to know people intimately. You really get to support them in a more well-rounded way. Because if you're busy, you may not have time to hone in on something that they said about what it's happening at home or in their family, which ultimately, will impact their overall health.

I had a few patients follow me when I made the transition and of course, I did pick up new patients. For those that followed me from the traditional to the concierge practice, they also comment on the difference being night and day. And then I personally, in terms of on the other end, I feel like this is really what I had envisioned when I thought about becoming a doctor. It's to really be there for my patients and have time to take care of them.

John: Okay. The bit of advice that I'm going to garner from that whole thing is when you're looking for your first clinical job, work for someone that has the possibility of a concierge program in it, even if you're not going into the concierge.

Dr. Nkeiruka Duze: Right.

John: Oh man, that sounds so good. And the thing is traditional medicine, you mentioned it before that patients did have these long waits and everything, and a visit under traditional terms is usually pretty unfulfilling for the patient because they're in a hurry. They feel like they haven't even told you anything. And you're like, I got to go. We'll deal with one thing today.

Dr. Nkeiruka Duze: Another patient is waiting.

John: And then, of course, the physician isn't willing to treat something on the phone or telemedicine because they're not getting paid.

Dr. Nkeiruka Duze: Correct.

John: Now you just flip the whole thing around. I'm assuming you take care of a lot of patients just by email and texting.

Dr. Nkeiruka Duze: Well, we certainly have the ability to do that, to just have the patient call on your cell phone and have a conversation but I really believe in the value of actually having people come into the clinic. So that way you can naturally just have the focus time to talk about things and then also examine them. I always encourage my patients that if something's going on, let's make an appointment, and then suddenly if you're not certain, we'll talk through what the right thing is to do.

But suddenly there's some mild symptoms, people might express over the phone that it doesn't really warrant them coming in, but I still try to encourage people to come in. Not that it is required, but that is just what I found as the way that I find medicine fulfilling is to have that either face-to-face or virtual connection time set aside on my schedule for me to focus solely on you and any concerns that you have.

John: Now, that makes good sense. I'm just thinking of the one that calls in and says, well, I have athlete's foot, can you call something in for it? Or I have conjunctivitis. Well, I need to have you come into the office for that because otherwise I can't get paid.

Dr. Nkeiruka Duze: Correct. Yes. Basically, as you already alluded to, with the concierge practice the members pay a fee monthly, so regardless of whether or not you call me or see me, every month you're paying a membership fee. And when I do see you in the clinic, I'm still billing your insurance for any services that I provide. That membership fee truly is for the access that you just described, where you can call me on the phone and say, "Hey, I have athletes' foot can you send me an anti-fungal medication?" I'm like, "Sure. Yeah." So, when it's other things or multiple things and I tend to just have people come in. That's just my style.

John: There are a couple of other little background things we need to know about how this happened. First of all, it wasn't the type of thing where you were getting burned out, you just turned to the owners of the system and said, "I would like to do concierge medicine. Is that okay? Can I switch it over tomorrow?" There are some constraints on it. I think from what we were talking about before, in terms of who can do that, when they can do that, all that.

Dr. Nkeiruka Duze: Absolutely. Yeah. In order to make the transition, first, there has to be availability. There's got to be a spot that is opened up either because maybe someone is retiring or because they're expanding the program. And then in being able to be part of the concierge program, you have to have a certain number of years of practice. You have to have high patient satisfaction scores, et cetera. They're looking for a particular quality of physicians to join the practice.

John: And then the other piece, which I thought maybe you're going to go into since you're doing it part-time, that presents a little bit of an issue, doesn't it?

Dr. Nkeiruka Duze: Great question. Temporarily yes. To give a picture of what my schedule is like, usually, I'm typically in the clinic Monday, Tuesday, and Friday, and then my nonclinical days are Wednesday and Thursday. In the meantime, if a patient needs something on a Wednesday or Thursday, they can suddenly call my cell phone or send me a message to the patient portal. And then I respond during my admin days or my nonclinical days. But that is slated to change in the future because we're going to have a practice partner join me and we will both be then the first two real part-time concierge medicine docs. And on my nonclinical days, she'll cover me and vice versa.

But I must tell you, John, even on my nonclinical days I probably like on a busy day maybe get three or four emails or between emails and calls, maybe four, because again, we're talking about 180 patients. It's a small pool of patients. I'm not really getting a lot of people reaching out on the days that I'm not in the clinic. And if my patients do have to be seen on the day I'm not in the clinic, one of the other concierge medicine doctors is able to see them.

John: Well, it sounds like it's almost like a job sharing, but then again, if you're available, even when you're not officially on, it's not that big of a deal to respond.

Dr. Nkeiruka Duze: Correct.

John: All right. Well, where are things going? Where are things going? Are you going to do this for a while? Are you looking at expanding your nonclinical or do you want to hold things as it is for a while?

Dr. Nkeiruka Duze: I'm looking to expand my nonclinical role. As I mentioned earlier with the physician advisor role, you can do as much or as little as you want. And I've been focused a lot primarily on the outpatient, whether I be with education or outpatient denials and things like that, but I'm now hoping to expand to do more in the inpatient setting. When I think about where I'm going, I'm really going to be expanding my nonclinical role. And because it's concierge medicine as opposed to traditional medicine, I actually see myself being able to keep my 180 patients, and then just expanding my nonclinical role without having to cut back any further on my clinical role.

John: Yeah. Nice. It'll be nice if that works out. I remind people they ask me, "Well, should I quit doing clinical completely or not?" You could do a lot of executive positions without doing any clinical, but I remind people that the CEO of the Cleveland Clinic was doing clinical, the CEO of Mayo, the CEO of a lot of massive, huge organizations still do an occasional clinic day, just to keep that going. And this is even a different version of that. We'll have to wait and see. I want to right circle back with you in a few years and see what's going on.

Dr. Nkeiruka Duze: Absolutely.

John: What advice do you have if someone that was in the position that you were in where you are kind of getting burned to out and just kind of frustrated. Any specific words of advice you'd have for my listeners?

Dr. Nkeiruka Duze: Absolutely. And thank you for asking. I think three things that I would encourage you to consider. The first is whether you are a hospitalist or an outpatient doc, I encourage you to explore nonclinical roles. And the reason for that encouragement is that the nonclinical roles not only add variety to your career and your life but also, I think it's the quickest way to actually get that work-life balance that most of us desire. Because with clinical practice, as you know, when you see a patient, whether it be for 15 minutes or 30 minutes, there's a lot of work that has to be done just for that one visit, whether it be the messages you're going to get from the patient about that, or the lab results that you're going to have to respond to.

Essentially, I feel like full-time clinical practice is challenging and it's hard to have work-life balance if you're in full-time clinical practice in my humble opinion. My first encouragement is that no matter what you're doing, inpatient, outpatient definitely explore nonclinical roles, even if you're going to do that as a 0.1 or 0.2. Just to kind of give you a little bit of a break. So that way you can have more work-life balance. Life is too short.

The second piece of advice I would give is to be flexible. What I mean by that is two things. Be ready to pivot if you need to, when opportunities arise. And then the second is if you already have an opportunity, be ready and flexible to expand if needed because when opportunities come up if you don't tap into them, guess what? Somebody else will. Even if you've set your sites on something, then you see something else that looks interesting, that becomes available, consider it. You just never know. You might like it. My second piece of advice is to be flexible.

And my final advice would be to seek out mentors that are doing either what you hope to do or something similar to what you hope to do. Because I think that we can really learn a lot from each other. I've learned a lot from people along the way, like reaching out cold calls to people and saying, "Hey, can I just have 30 minutes of your time just to ask questions about what you're doing or how you got there?" I encourage people to at least seek out somebody, at least a person that can hopefully mentor you, as you make that transition of hopefully adding a nonclinical role to your career. And I'm suddenly happy to support or answer questions to anyone that needs that support. And I'm certainly happy for any of your listeners, John, to email me if they had questions. And my address is ncnwoko@gmail.com.

John: I got that written down. I'll put that in the show notes. And you are on LinkedIn and they can just go to LinkedIn and look up your name and they should find you. That's how I found you on LinkedIn. I had already been referred to you, but I did find you there.

Dr. Nkeiruka Duze: Yes, I am on LinkedIn.

John: All right. Well, this has been very interesting. I could go on asking you more questions, but I think we're going to have to go here because we're running out of time. I thought there are many unique things about your story, the certifications are not totally unique, but you proactively pursued that. And I think we sometimes forget that there are those kinds of things out there and the opportunity to switch to concierge and how much that helped. And if anyone can emulate that in some fashion either to get it established or expand it at your organization, that's another great way to balance the two.

Dr. Nkeiruka Duze: Absolutely.

John: All right. Dr. Duze, thank you so much.

Dr. Nkeiruka Duze: Thank you so much for having me, John.

John: It's been my pleasure. And I hope to catch up with you again down the road. With that, I'll say bye-bye.

Dr. Nkeiruka Duze: Thank you, John. Thank you so much.

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The post Achieve Beautiful Balance as Medical Director and Concierge Physician – 234 appeared first on NonClinical Physicians.