consulting Archives - NonClinical Physicians

Make Your Clinical Practice Great or Move On

John Jurica — Sun, 14 Apr 2024 02:29:44 +0000

The Second Annual Summit is Here – 348

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

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

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

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

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

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

Our Episode Sponsor

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

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

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

Trends in Addressing Physician Burnout

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

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

Highlights of the NonClinical Career Summit

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

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

Summary

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

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

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Today's PNC Podcast Transcript

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Episode 348 Transcript

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Expert Witness or Medical Legal Consulting: Which Should You Pursue?

John Jurica — Tue, 28 Nov 2023 16:06:35 +0000

Episode 328

In today's episode, John helps listeners to decide whether expert witness or medical legal consulting best aligns with your needs.

From decoding the nuances of medical documentation to navigating the uncharted waters of depositions and court testimony, John shares a roadmap for physicians eager to diversify their careers.

Our Show Sponsor

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

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

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

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

The Role of Physicians in Translation and Interpretation

John sheds light on the pivotal role physicians play in translating and interpreting complex medical concepts. He highlights instances where clinicians, whether employed or in a consulting role, act as bridges between the clinical and administrative realms.

Examples include positions in clinical documentation integrity (CDI), quality improvement, utilization management, and informatics, where physicians serve as interpreters for those without a clinical background.

Nonclinical Career Paths: Expert Witness Consulting and Medical-Legal Consulting

Delving into nonclinical career options, John explores two distinct avenues—expert witness consulting and medical-legal consulting. He elaborates on the differences between the two, discussing the responsibilities, compensation, and prerequisites for each.

Expert witness consulting, involving legal testimony, is contrasted with medical-legal consulting, a role centered on reviewing, summarizing, and advising on cases without the necessity for courtroom appearances or depositions.

Both freelance consulting businesses offer the benefit of producing hourly revenues that exceed those of typical clinical activities. Yet, they can be done remotely, and with no risk of the kind of lawsuits that practicing physicians must endure.

Summary

For those considering expert witness consulting, John suggests Dr. Gretchen Green's comprehensive course and SEAK, an organization that offers resources and directories for physicians learning to be expert witnesses. Dr. Armin Feldman's offerings cater to those interested in medical-legal consulting. Both courses cover essential aspects, from legalities to business setup.

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

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

Links for Today's Episode:

Download This Episode:

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

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 328

Expert Witness or Medical Legal Consulting: Which Should You Pursue?

John: I am doing this on my phone. I think the clarity will be a little bit less than usual. I did a dry run earlier and it was kind of breaking up a little bit, but we'll do our best today. I just want to spend 10 or 15 minutes talking about a particular topic that interest to me, and it's something I've noticed. And then I will talk about the generalities and then work my way into two different nonclinical careers that one might consider to do either as a side gig or full-time, although only one of them can be done as a full-time job.

I'm in Scottsdale, Arizona. I normally am in the Chicago area where I live most of my time, but my wife and I bought a small house out here and it's been getting renovated and we're just kind of out here to check on things. And so, that's part of the issue. But let me get started.

One of the things I've noticed when physicians or other clinicians, anybody's looking for a new position, a new job, particularly in healthcare, even if they decide to do some consulting or even if they're employed, that the jobs that open up for physicians and other clinicians involves either translating or interpreting things.

Because what you do is you start with your one foot in the healthcare medical world and then you obtain some expertise in another area that benefits physicians, benefits healthcare organizations. And then as an employee or as a consultant, you can be the person who can educate and interpret the language and the concepts that maybe are foreign to one side or the other, just like the CEO of a hospital doesn't really understand what a physician goes through for their education, training background and all that. It doesn't really understand how nurses and physicians and therapists interact with patients and kind of bond that we have.

And this is why we get in trouble sometimes because we're trying to fit a square peg in a round hole because the CEO is thinking in terms of the bottom line and finances and making things as productive as possible, and the physicians, nurses, therapists and others are thinking about, "How can I make this patient better? How can I help this patient understand what's going on?"

That comes up a lot and I'll give you some just simple examples. These are jobs I've always talked about in the healthcare field, in hospitals. Let's say clinical documentation improvement. That is a position as a physician advisor or medical director where you are explaining to your colleague physicians the rules and regulations around using the ICD-10 or the DRG system or whatever it may be. It's not really intuitive, it doesn't correlate directly with what we do clinically. In the CDI world, there's different levels. Usually three levels on the inpatient side for heart failure, for pneumonia and so forth. But they're all based on trying to figure out the complexity and then paying a higher amount for the more complex.

But it doesn't directly correlate with what we've learned as physicians and nurses in terms of treating those patients. And so, the physician advisor or medical directors interpreting and translating the concepts from one group to another. That's a great place to be. And there's a lot of jobs and they pay very well when you can find yourself in that important position of making that translation and making that connection and helping others get what they need. And at the same time, capture the true medical information.

Well, the same thing is true in informatics. A medical informaticist is translating to his or her colleagues. Concepts that need to be understood in terms of using an EMR or even beyond that, tracking data. And then it kind of extends into quality improvement where we have to maybe explain the statistical factors that are used in analyzing billing data to measure quality.

And again, it's not an easy to understand topic, but a quality medical director would spend a lot of their time explaining the p-values we use when we're looking at those statistical differences. And the reason why we feel that these comparisons between patients, between groups of patients, groups of physicians and their quality is really truly statistically significant and at the same time is risk adjusted, which is the big issue a lot of times in accepting quality improvement data.

Again, these are all interpretations and translations between these groups of people and get them to buy in and understand then learn how to do it better. UM it's the same thing. We don't think in terms of utilization management or benefits management when we're trying to take care of our patients, but if we do understand it better, then we can actually be more effective.

But one area where this comes up, which we don't normally think of as specifically this issue, but it is, and that's in any kind of consulting. And the type of consulting I am going to talk about today is legal. Medical legal types of consulting. And when I think about that as a nonclinical job, I think of maybe two sides of the same coin. Probably the most common areas where attorneys and physicians interact. And that is on one hand being an expert witness consultant or starting on expert witness consulting business, and what many of us now call medical-legal consulting.

Those are two really different ways of interfacing with the legal system as a healthcare provider. There are some opportunities in both of those for let's say a nurse or a physical therapist, something like that. Probably more opportunities for physicians. That's what I'm going to be speaking about for the next five minutes or so.

Let's compare those two types of consulting. Expert witnesses. Most of us understand what that means. Basically, we will provide services to an attorney and usually picking one side or the other in this case because it's usually because of a lawsuit that has been filed. And in this case it's often a medical liability lawsuit. And so, as an expert witness, you can be on the side of the patient who's accusing the physician of doing something wrong or missing something or failing to document something or failing to communicate. There's a whole lot of reasons why you can get sued.

And other expert witness consultants are going to be on the acute side, the physician side, explaining why the physician really did follow the standard of care. And that sometimes things just don't go well because it's the nature of medicine. We all die, we all get sick, we all have injuries that hopefully we treat properly and within the scope of practice and within the standard of care.

Now, an expert witness, number one, it's a very highly compensated physician. Let's say that you're going to be an expert witness for a family physician. Let's say you're a family physician. Now many expert witnesses, of course, are board certified, fellowship trained even in specific subspecialties, but there are a lot of internists, ER docs, family physicians who do expert witness consulting because you just have to talk to the standard of care, which most of us know very well because we work in it every day.

But it's very good pay. So, we'll start with that. Let's say I'm on a three star scale. I would say its three stars. Really as a family physician or an internist, if you take all the hours you work doing your medical records and everything into account, you'd be lucky to make $100 to $150 an hour. Because usually, let's say you're making $200,000 to $300,000 a year. If you're working 60 or 70 hours a week, that doesn't come up to that much. As an expert witness, you are going to be charging 2, 3, 4 times that amount on an hourly basis, and you get paid for every minute you spend doing that work unlike in clinical practice, which is why the numbers don't look so good.

That's one good thing about being an expert witness. However, most expert witnesses have to be in practice, active practice because they start to lose their credibility if they start to do that full-time. You can definitely cut back on your hours in clinical. And what I often talk about is spending, let's say you could easily drop 20 hours of clinical practice to do 10 hours of expert witness care or expert witness consulting and make equal to or more than you would've clinically. So, it is very well paid, and the more experience you get and the more time you've done it, then the better the pay gets and you can charge higher levels.

As an expert witness, you're doing three things. Basically you are reviewing charts and writing reports about your opinion. And then you might be attending a deposition and you might end up testifying in court. Now, most attorneys don't like to... Well, it's not that they don't like to go to court, but they prefer to have a settlement if they can. I think the patients prefer that. Oftentimes the physician prefers that or whoever else is being sued.

When you're involved as an expert witness, you're doing mostly chart review and report, and then you're doing a smaller percentage of depositions and then some go quite a while before they ever have to testify in court. But eventually it will probably happen if you do it long term. You obviously need to be licensed because you need to be in practice and you probably need to be board certified to do that.

Now, there's a different type of expert consulting called medical-legal consulting, specifically as a terms coined by Dr. Armin Feldman, who to some extent has actually created this specialty. And what's nice about medical-legal consulting is it still pays very well, probably double what you would make an hourly basis as a physician.

But it does not require testimony in court. It does not require even doing a deposition. And you're not acting as an expert witness. What you're doing is you're reviewing records here, organizing records, summarizing records, and then providing feedback to the attorney about whether the case should be pursued or not.

And these cases, which usually fall into this category are personal injury cases, workers' comp, automobile accidents, which is a type of personal injury. And so, you're putting what can sometimes be a very complex situation and in which an insurance company has refused payment or the insurance company of a business has refused payment. You've heard of these cases, you've probably been involved in these cases where one of your patients gets injured and it's sometimes hard to know for sure how much is organic, how much is secondary gain, are there ways to sort that out?

And so, Dr. Feldman came up with this pre-litigation medical-legal consulting where you as a physician will help to sort through that. And the thing about this is you don't necessarily have to be in active practice to do this. You just need to have a medical degree. It helps to be board certified in something. You don't necessarily have to maintain your maintenance of certification because when you're doing these reviews, you've narrowed your focus now down to injuries. And really you just need to know the basic physiology and the basic approach to evaluation and treatment. You can learn as you go and you can become an expert in this area with just a little bit of time and effort. And you're not worried about having this go to court. If one of these does go to court and you need a medical expert, then that will be an expert witness consult that will take care of them.

But as a physician, you can analyze, and again, some nurses do this as well looking at it from the nursing standpoint, but physicians are in a particularly good position to say that within a reasonable degree of medical certainty, either A, this is caused by the accident or isn't. B, what are some of the unrecognized illnesses?

And your main goal is to try to maximize the support and the payments to the patient. And if you look at it from that perspective, you're not trying to gain the system or take advantage of the insurance company or the employer. Usually workers' comp covers this obviously, but you're just trying to make sure that all those things that resulted from the accident, from whatever happened, are fairly compensated. And we've all seen patients who have what seemed to be a minor accident and then a year or two later they're still having problems.

They might have developed some long-term complication, what we used to call reflex sympathetic dystrophy, which is severely debilitating. And there have been many times where patients were not compensated and didn't receive the care they needed for something that was a delayed result of an injury like that. So, it's really an interesting area.

Again, it involves interpreting and advising and translating information and then putting things into a report. Both of these that I've talked about today are good ways to reduce your burnout, do something that you enjoy, apply all the medical knowledge that you have garnered over the years to a particular field. And in the case of expert witness, over time you can cut back your clinical time to 10 or 20 or less hours a week, do some expert witness consulting and make a better income than you would have burning both ends of the candle doing clinical work.

And in the medical-legal consulting, again, you could do that part-time, you could do it full-time and you can definitely make a lot of income without the stress of working in a high pressure corporate style environment.

Now I want to talk to you a little bit about some resources that we have available to us. And some of these I have promoted in the past. I'm not an affiliate for either of these experts I'm going to mention, but let me just tell you what I know here. If you're interested in becoming an expert witness, there are courses you can take to build the business standpoint how to do that legally and how to set up things as well as understanding how attorneys think, how they speak and being able to talk their language.

I've had Dr. Gretchen Green on my podcast two or three times, and she produces a very, very good expert witness course. I think it's completed over four or five weeks. It's rather intense. It has a lot of homework, it has a lot of supporting materials. Really she's been doing this now for three or four years and I've spoken with some of her graduates and they are definitely pleased with it. So, you can find that at theexpertresource.com/enroll if you want to learn specifically about that course. Because I think she has some other courses.

Now, there's also another resource for becoming an expert witness, which is SEAK. It's the same organization that puts on an annual nonclinical career meeting on a weekend in October. I think they're up to the 14th or 15th iteration of that. But one of the things they're also well known for is teaching physicians how to learn to be an expert witness. They have resources where you can get your name put in these directories that they then share with attorneys.

There's a lot out there about becoming an expert witness. And rather than struggle through it, you'd probably be best to take advantage of one of these resources. I think the SEAK resources mainly are on a CD or online, although I think they also have a live version of that. That's just something to think about as you can kind of morph your practice into half expert witness, half regular clinical practice.

Now on the other side, medical-legal consulting, Dr. Armin Feldman has his course. He does it in different ways. I actually took his course over a period of four or five weeks. There was a series of videos although he also sometimes does a live version of that. He also has a one year coaching program where he'll walk you through the entire process. I think it's a combination of videos and a lot of coaching from him to where you can have your practice set up.

This could be something for people that are in active practice, something where you're maybe semi-retired and there are definitely retired physicians who do this as well. As long as you stay current in this particular field, you can write wonderful reports, really help your attorneys to decide whether to move forward, whether to settle and you help get your attorney client's patients all the help they need for some long chronic result of an injury that occurred either through an auto accident or work related.

Dr. Feldman's website is mdbizcon.com. If you go there, there is a little intro where you'll learn more about it and they'll give you an opportunity to learn in a really quick fashion. Again, I took the course. I have, I don't know how many files that I've downloaded and went through multiple times. He walks you through, he shows you how to create letters to generate business. So you've got setting up the business, marketing, and so forth.

A lot of things Gretchen Green talks about in her course. It's pretty similar no matter what sort of side gig you're doing, you got usually involved in setting up an LLC and setting up your accounting and then doing marketing, creating all the fields, maybe setting up a website. And these are the kind of things that they both talk about in their respective courses.

The other thing that Armin has, which is really interesting, is he created a podcast which is designed for the attorneys themselves so that they understand how to work with a medical legal consultant and help them understand the lingo that we're using. And that podcast is called Physicians Helping Attorneys Helping People, although if you look up Physicians Helping Attorneys, you'll get to it. I think it's got at least 30 or 40 episodes now. It was just started about a year or so ago. I've listened to just about every episode. It's extremely interesting and very helpful and for no cost whatsoever you can really get an idea of what a medical-legal consultant does in this role.

I'm just looking at my notes here to see if I forgot anything. Nope, I think that's it. Remember that in a lot of your nonclinical jobs, you're going to end up being in the middle as a consultant who does interpretations and helps other people understand the other side of the equation of whatever it is you're talking about. And specifically the medical-legal has a lot of opportunities. And you might consider expert witness consulting or medical legal pre-litigation consulting.

All right, with that, I will close for today and I hope to see you next week.

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The post Expert Witness or Medical Legal Consulting: Which Should You Pursue? appeared first on NonClinical Physicians.

5 Reasons to Consider a Healthcare Management Consulting Job – 302

John Jurica — Tue, 30 May 2023 12:00:17 +0000

Discover Healthcare Management Consulting

In today's episode, John presents a career not previously highlighted: healthcare management consulting.

John will focus on the role of employed physician consultants within the vast landscape of national and international healthcare consulting firms. These firms address hospitals' (and other healthcare organizations') needs and provide innovative solutions to tackle complex challenges.

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.

Job Advantages Uncovered

When it comes to healthcare management consulting, there is often a focus on independent consulting roles, but the realm of employed healthcare management consulting jobs holds its own unique advantages. In these positions, professionals have the opportunity to leverage their medical expertise and practical communication skills to offer valuable solutions and advice to healthcare organizations.

High demand for these services – so new consultants are constantly being recruited.
Jobs are available for experienced and novice physicians, even those without board certification.
The pay is good and the benefits are very good.
Opportunity for professional growth and development.
These roles offer exposure to diverse fields (start-ups, hospital management, pharma, practice management).

Industry-Leading Healthcare Management Consulting Firms

John provided a list of national and international healthcare management consulting firms that offer specialized services in these domains, including the demand for physician consultants within these teams in a list. But here are some of the larger consulting firms:

Summary

John sheds light on the lesser-explored field of healthcare management consulting jobs with prominent national and international firms. Drawing from his experience as a hospital CMO, he highlights the prevalence of consulting firms within healthcare organizations. And he notes that most of these firms employ physician consultants.

To further assist readers, he generously provides a complimentary downloadable list featuring 25 major healthcare management consulting firms.

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 302

5 Reasons to Consider a Healthcare Management Consulting Job

John: Today before we get to our main topic, let me ask you a question. What do the following services all have in common? Coding and documentation integrity, health informatics, strategic planning, revenue cycle expertise, evaluating vendors. Let me add some more to those. New service lines. Operational efficiency, utilization review, and case management. Well, you may recognize that those are all very important topics. They're very important fields and expertise that will allow hospitals to perform well. You find those in other businesses as well, other parts of healthcare, but definitely hospitals.

Second thing is though there are national international healthcare management consulting firms that provide consulting services in those areas for hospitals and actually for other healthcare related businesses like large practices. And many of those consulting teams hire and employ physician consultants.

I've talked to you about physician consulting as like a small business. You can do expert witness consulting, you can help practices if you're an expert in marketing and promotion. But there's this whole other side of consulting where you are employed. So, that's what I'm going to talk about today, positions as an employed physician consultant.

The thing is, the physicians who do these jobs are employed by one of these typically large national or international healthcare management consulting companies. Sometimes I just call them management companies, sometimes just healthcare management companies. There's even the smaller kind of niche companies that will focus on one or two specific domains, but there are a lot of these firms. Actually later on today's episode, I'm going to list some of those for you. And I have at the end a downloadable resource with 25 of the largest and most well-known healthcare management firms. So, listen to the end and I'll tell you how you can get that.

But anyway, these consulting firms assist hospitals and other healthcare organizations in solving problems. The reason I'm kind of familiar with this, and in some ways very comfortable with and very familiar with it is because when I was a hospital chief medical officer, I interacted with a number of different firms that came in to help us. And it was interesting because we normally had 2, 3, 4 of these consulting firms in there helping us with something or another. At any given time you could come in and last year's firm is gone, and now we have a new problem and the new ones come in.

And so, I'll give you some examples. We had a firm come in and help us implement our first lean process improvement program. We did that for the laboratory. It was an inpatient laboratory, which also did outpatient labs. And that was an area where lean process improvement, which was adopted from Toyota, was first applied in healthcare. Now you see it all over the place. You also see Six Sigma. Sometimes they're connected or combined into a single kind of process improvement approach to the hospital environment and also other big healthcare firms outside the hospital. So, that was a big one.

When we were looking at selecting our first hospital-wide electronic health record, we had consultants come in and help us with that. When we decided to start an open heart program, which we didn't have at the time, we were a medium size community hospital. Most of the places we could send patients to that needed open heart were at least an hour away. We were a little bit isolated. So we decided at one point to start our own program, and we had a firm come in and help us plan that. So you can think about that.

Any new service line, it's likely you can hire some consulting firm to come in, help you do the groundwork and implement that program. Now you have to pay for that, obviously, but usually when you get these companies in, that allows you to implement a lot quicker because you're using a lot of expertise that they already have that you don't have.

When we were looking at selecting the best inpatient management quality tool that would integrate with our EHR sometimes we would have a firm come in and help us walk through that process. We had the same thing done by multiple consultants over a period of 10 or 15 years to help us with our CDI program, to help us look at the models we were using for utilization management and case management.

We had consultants come in and help us with our bond issue. Even as a medium size community hospital, yes, we could issue bonds and people would buy those bonds that would provide money for investments at the hospital. And now that was one that probably didn't have any physicians on the team since it was strictly kind of a banking and financial situation. But there's always something going on at the hospital.

When you're starting a new service line or a new program, like when hospitalist programs first came out, there were a lot of consultants helping with that. When observation units first came out. And now every time there's a new type of service line, I can guarantee you there's going to be a management consulting firm that can help you with that, and they're going to be physicians on that team generally.

It's a big area. And one of the things I wanted to talk about is really why you would consider a job on one of these teams and what of the advantages are? Because I really haven't spent any time on that particular topic, I don't think I've spoken with an employed management consultant on this program ever.

I ran into a physician who was working for McKinsey a few years back and talked to him about what he was doing, but he was not able to come on the podcast. I think at the time when I invited him, he was having some health issues. So, I never really found another guest. I'm just going to tackle this topic today. I'm not going to get into great depth, but I'll give you some resources and some advice and I'm going to start by talking about five benefits of this job, or what are the five good strong points that make this job attractive to physicians who are looking to get out of the grind of everyday clinical care.

Now the first thing I'm going to mention is most of these jobs are full-time. Most of them require a little bit of on-the-job training because they're going to utilize your expertise in medicine, your knowledge of healthcare, your knowledge of the system, particularly in the United States and what's specific to it. But it's like you already have some transferrable skills that can be applied. But let me tell you the five really interesting benefits of considering this job and landing a job like this that you might want to keep in mind as you're thinking about doing it.

First of all, there's a huge demand for these services. In other words, not just for the physician components, but there's always new things coming up in healthcare. A lot of it's been driven in the past by new regulations by the federal government. We are super highly regulated and every time there's a new rule, like when Medicare was putting in the new quality metrics and length of stay, penalties, and coding and documentation changes and when quality measures are implemented, it takes time to learn those things.

And you can do it on your own if you have enough expertise in-house, but a lot of times it's quicker, easier, obviously a little more expensive to hire a firm to help you do those things. So, there's always a high demand. These healthcare management consulting firms are very large, some of them billion dollar companies and they have different subgroups within them, different divisions, different departments that some address mainly the financials. Some address more of the quality, some address more of the informatics.

And then you also have the niche companies that really only focus on one or two of those areas. But someone might say, "Well, they do consulting for revenue cycle." Well, revenue cycle covers a lot of different things, and part of revenue cycle is directly related to coding, documentation utilization and so forth. Some of it's just financial in terms of accounts receivable and how to do billing better and so forth.

But there's always jobs there for physicians. Because of that, these things are changing constantly. There's always new types of consulting being developed to meet those demands. And so, there's always lots of new jobs. Partly it's because healthcare is complex and partly because federal government and other agencies are imposing new requirements for you to meet.

I think it's built in. They do that on purpose so they can pay you less, whether you're a hospital or a physician until you get caught up. And then once you master that, they add new rules to make it more difficult again. So it's not a great system, but there is a great demand for meeting the growing changes in the healthcare environment to get paid and to be able to remain in compliance with certain rules and regulations.

That's number one. Always a high demand for new things coming down the pike. Number two, consulting jobs for physicians in these companies include jobs for both seasoned, board certified, very experienced physicians. I've worked with them. And those that are fresh out of med school even that don't have residency. In fact, that consultant I talked about earlier, a few minutes ago, he told me that there are many times where they want the novice physicians, they just want the medical school education background, understanding of how to read articles and interpret research and quantitatively and qualitatively understand working with patients, but in some ways they don't want them to have bad habits that you can get in practice.

If you've been in practice for 20 or 30 years, you're going to have certain ways of doing things. You're going to be used to being in charge. And on a lot of these teams, they don't want you to be in charge. They want you to be a member of the team that can help to do your part, focus on your specific area, then work together with the rest of the members of the team, to provide the services that your client basically has arranged to get from the company.

Anyway, you can be at any stage in your career and you'll probably be able to find a company that's looking for a physician with your background, expertise and amount of education. The pay is good, it's competitive. If you go in straight out of medical school, of course, you're not going to make the same as someone with a longer history of employment. But the only way they're going to get a physician with 20 years of experience is to pay them a salary that makes a commensurate with that.

Now, the salary is what I tell people of course, always, is consider the time you're spending and the other aspects of work. You're not going to need liability insurance. All your expenses are paid. So you might want to compare let's say a $200,000 job in consulting and be equivalent to a $250,000 job clinical where you're actually working 60 hours a week and doing charts at night and being on call and so forth. So, always keep that in mind. But the pay and the benefits are really good.

There's a lot of room for advancement. So, that's the fourth issue. A lot of room for advancement. As you learn these new skills which I'm going to talk about in a second, you'll have the ability to move up and be a senior member of the team, more pay, more benefits, things like deferred compensation and more vacation, things like that.

And then that brings me to the fifth benefit of working for one of these companies is you will learn a lot of new, very useful transferable skills that will set you up to do things in other companies. It'll set you up to work and move to. Maybe you start a niche company and then you move up to a larger company where you can head a department or lead a division if you're talking about CDI or something like that.

But you'll learn how to do project management. You'll learn how to work on an interdisciplinary team other than a healthcare team where there's a different relationship. You might learn sales and marketing, you'll learn about finances. You'll probably learn something about human resources. These are all skills that would become very useful if you go to another company that does healthcare consulting.

If you go to hospital management or large group management or maybe a startup, these can be very valuable skills and attitudes that open up doors to the business world that wouldn't normally come from just say working as a clinician.

Those are five of the big benefits that I'm aware of. I think you should consider a job in one of these large firms. And what I would do to get started, if you're thinking about this, is just start to look at some of these firms. I'll mention some of the companies now that hire consultants and hire physicians to be consultants. IBM has all kinds of divisions doing consulting, and some of it's in healthcare consulting. The big names we usually hear are Accenture, Deloitte used to be Deloitte & Touche, McKinsey, Huron. Really there's at least 25 very large national and some of them are international.

And so, I have created a list of those firms. You can go to them, look at their websites, go to their career sections or career pages, start to look at the job descriptions, look at what the requirements are. Again, depending on the niche and the area that you're looking at. Some will require more experience than others. There isn't really any special degree that you would need. You don't have to have an MBA or an MHA. That's not necessarily going to help you. They've already got the finance people and the sales people.

Oh, that's another thing, maybe I mentioned. But sales and marketing you'll learn because a lot of times you'll be doing pitches. And so, that might come in handy for starting your own business or heading up a startup or something like that, or being on the board of a startup.

That's pretty much all I wanted to say today. I would say go to nonclinicalphysicians.com/healthcare-management-consulting. That's the blog post for today's episode. And then I'll have a link there to related content as well as a link to this free downloadable list of 25 national and international healthcare management consulting firms with links to both their main site and their career pages. And you can use that.

You can also look them up on LinkedIn and learn more that way, or search on LinkedIn for healthcare management companies or healthcare management consulting companies. Before I go, I want to let you know that we're running a promotion for access to the 2023 New Script Summit recordings. We finished the summit a month or so ago. We have 12 fantastic lectures with a live Q&A for 10 of those, actually 11. The other one was a recorded Q&A. They're really fantastic. There's a lot of information there. I don't expect you to buy it just based on this, but if you go to nonclinicalcareersummit.com you will get the page where you'll see that you can get all 12 of those lifetime access to those recordings for $249.

You can get a discount if you join NewScript. You can go to newscript.app. Join NewScript and there will be some promotions going on in the near future where NewScript members can get a discount 15% on that. But either way, if you want to just buy it directly, go to nonclinicalcareersummit.com and buy the all access pass for $249.

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The post 5 Reasons to Consider a Healthcare Management Consulting Job – 302 appeared first on NonClinical Physicians.

The 5 Most Popular Home Based and Remote Careers – 291

John Jurica — Tue, 14 Mar 2023 13:30:54 +0000

This List Keeps Growing

In today's show, John will provide an in-depth overview of some of the popular home based and remote careers.

There have been some significant developments in recent years. Multiple podcast guests have addressed remote careers and utilization management, in general, consulting, coaching, and so on.

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.

Benefits of a Remote or Home Based Job

Being able to work remotely or from home has several benefits:

flexibility
convenience
lower costs for transportation
availability for family members

Categories of home based and remote careers:

Chart reviews
This includes utilization management, medical legal consultant, expert witness, clinical documentation improvement, and quality improvement.
Medical writing
There are several major categories of writing, namely: technical medical writing (CROs and pharma companies), medical communication (marketing agencies), continuing medical education and continuing education for other healthcare professions, patient education, and journalistic writing for clinicians or for the general public.
Telemedicine
This includes direct primary care services, specialty consults by expert physicians to other physicians, remote patient monitoring, remote imaging, and remote medical director services.
Consulting
The options here are to develop your own freelance consulting business or work for a large national or international consulting firm, much of which can be done from home.
Coaching
You can do one-on-one coaching and progress to group coaching remotely. You can work as an employee or as a freelancer.

Summary

There are both positive and negative aspects to working remotely. There is less structure with home based and remote careers, but with increased freedom and flexibility.

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Transcription PNC Podcast Episode 291

5 Most Popular Home Based and Remote Careers

John: These are the most popular home-based and remote careers. And this is going to be an overview. There have been some new things that have come up in the last few years, and that's why I wanted to revisit this topic. I've had several guests who have talked about remote careers and utilization management, generally, consulting, coaching, and some of the other things we're going to talk about today. But today I want to also go ahead and give a broader overview and maybe mention some types of jobs that we haven't really specifically talked about in the past.

Before I do that, I do want to talk about the benefits of a remote or a home-based job. They're pretty self-evident. I could skip this part, but just to remind you of the convenience, for example, with childcare. It doesn't mean that you can work at home and attend to an issue, or an emergency while you're working. But being at home and working from home remotely allows you if you have school-aged kids and they need a little bit of supervision, but pretty much have things to do on their own, you're available.

Especially, this is true when you have other members of your family who need care and you can't be gone for days and weeks at a time or gone 8, 9, 10, 12 hours a day when maybe your next-door neighbor happens it'd be your senior mother or father or down the street, somebody close by. And it's nice to have someone like you at home working, but available if there's an issue if there's a problem. And so, it's convenient in that sense also.

Then there are cost savings. If you don't have to pay for a car and gasoline insurance upkeep on the car and so forth, it's going to save you a significant amount of money. In fact, one of the best advice I've ever heard is for someone new starting their career, one of the things you can do to maintain balance in your finances is trying to find a job or move your home to within walking distance of that job. And you can avoid all that expense and get a little bit of exercise at the same time.

Obviously, it's more flexible. And the flexibility means, okay, in the middle of the day, maybe you can answer the door and accept the package. Maybe you can let in a contractor who has to spend an hour or two in your garage fixing something and then you go back to work. So, having someone at home, it just adds a lot more flexibility.

In one form of that flexibility is the ability to travel. We are calling it home based or remote careers, but it can be remote from anywhere. A couple of examples. Probably the most extreme example is Dr. Chelsea Turgeon, who I've interviewed here on the podcast before. And she's also a mentor for the upcoming summit that I mentioned earlier.

And basically for the last four years, she's lived in various international locations building and now serving her consulting business. She consults mostly with people in the United States, but she does live in the United States. I don't think she's lived in the United States in over four years. I believe most of her travel's been in Europe, also the Far East. She worked in Korea for a year teaching English. I think she's lived in Central and South America.

And she continues to travel. She was actually changing her location monthly and now she's settling down to a one-year position in another foreign country. But she's able to work and make a really good living remotely while she's traveling. We've heard about my colleague at NewScript who oftentimes does telemedicine while he's on the road, whether it's in the East or in the West Coast or Texas or Florida. And so, that's a really good benefit for these kinds of remote careers.

Okay, let's get into the options. Some of these are going to be reviewed I'm sure again because I've had guests in the past who have done some of these jobs and we've talked about them specifically. But again, since we're doing an overview, I want to try to include everything that might fall into this category.

Some form of chart review. That's kind of a generic term, but it does cover a lot of things. I'll get into the specifics, but let me go over the major five because I did say we're going to have five categories or five jobs today. And the reality is I'm going to be talking about a lot more than five jobs, but there are five general categories of jobs.

The first is chart reviews, and the second is some form of medical writing. Third is telemedicine and telehealth, fourth is consulting, and fifth is coaching. So, you've probably heard me talk about all those and I've addressed specifics, but there have been some new things that have come up. So I thought I would expand on each of these and tell you what kinds of jobs are in these major categories.

So let's start with chart reviews. Again, I was starting to talk about utilization management. We've talked about that a lot. There's more utilization management typically if you're working for an insurance company or a third party that's providing those benefits management. But it is reviewing records a lot of times, and then sometimes you'll actually have to pick the phone and call somebody or receive a call from someone who's appealing something.

You're in the comfort of your own home. My daughter is a social worker and she does utilization review for mental health, or she had before remotely. And so, she was at home checking these things, approving, disapproving, calling, and sometimes attending. The same thing that a physician would do in this position. Sometimes it doesn't require actually calling different types of utilization management jobs, benefits management, case management, and so forth. But sometimes it does.

Then we have disability workers comp, which is basically a subset of utilization management, but there are different rules and sometimes it's just an up or down call on whether someone qualifies for disability for a certain type of insurance or whether they qualify for workman's comp when it turns out the accident they were involved with occurred in a time when they weren't at work, or the nature of it is an illness, not so much an accident. And so, they're definitely jobs in that arena that are slightly different from the usual UM jobs.

Then we've got all the medical legal type expertise or the typical classic expert witness. That part of their job is just doing a chart review and providing an opinion. In some cases they have to do a deposition, but those are usually remote or online as well. In rare cases, they will have to testify in court. And even some of those situations were able to be done remotely, especially during the pandemic, although I think that's more 50-50 or less in terms of you might actually have to show up in court, maybe even travel if you're working on a case that's at distance from your home. But technically speaking, that is a remote job. It doesn't require an office. Usually it's part-time because most expert witnesses also continue to practice part-time.

And then there's the other version of that, another form of forensic medicine called medical legal consulting, which is also done from home. It involves usually worker's comp and personal injury. It's pre-litigation. It does not involve depositions or testifying in court. It's almost completely remote, although in some cases you'll want to interview the client of the attorney who you're serving, which will mean either a Zoom call or a possible face-to-face. And there are rare occasions when you might have to go into the attorney's office to meet with a patient.

And then if you're doing something called an IME - Independent or insurance medical exam rebuttal, you might need to actually attend the IME visit. So, it's 99% or 95 plus percent remote, but sometimes you might have to do those other types of activities for that particular type of legal witness.

Another type is clinical documentation. Couldn't do this in the past when we had all paper charts, but now that all of our charts are electronic, you can review that chart anywhere. And as a result, a lot of CDI, clinical documentation improvement, or clinical documentation integrity jobs are remote. You can work remotely for an insurance company. You can work remotely as an employee for a third-party CDI service company and you can be a solo consultant. You can work one-on-one as a freelancer doing CDI for one or two or multiple hospitals. So, that's another type of chart review.

And then there are some chart reviews that are mainly focused on quality improvement. I think some governmental agencies like Public Aid and Medicare will sometimes ask for quality improvement reviews for various reasons. A lot of state licensing boards will hire people to review charts for purposes of determining whether there is a quality issue with one of its licensed physicians in that state. And there are other opportunities like that. There are some chart reviews you can do remotely that don't involve a lot of interaction with other people. You don't have to show up. And so, keep that in mind.

All right, the next big category we mentioned is medical writer. I've talked a lot in the past about medical writing and medical writers. You can categorize these by either freelance or employed. In freelance, you're starting slowly. You're learning how to be a medical writer. You're contacting different editors and publishers, and you're starting to write, you're creating a portfolio and eventually, you're just writing after you develop these relationships with these companies, usually if you have four to six or seven publishers that you work with or less oftentimes. You can have a regular income, lot of stability, and you can get paid well because a lot of times you'll get paid let's say as a CME writer, the hourly rate might be less because you're creating let's say a new CME program or event. It could be an enduring material, which basically is something that's available online or on paper.

But when it comes time to renew those things, a lot of times the upgrade and the review and the editing are very minimal. And you can actually make more money per hour doing that because you were the original author, it makes it a lot easier to do that second and third time around.

You can do the same thing as an employee. And remember, there are five or six major categories of writing, everything from technical writing for a pharma company or medical device company or, for a CRO (contract research organization,) which works for the pharma companies. And you've got the technical, then you've got things like educational. You can do CME or CE for different clinicians. You can write educational for patient education, put together brochures, and other forms of education for patients that different organizations need to produce and customize over time.

Then you can do more journalistic type of writing for physicians and other clinicians. Updates on certain medical conditions. There are a lot of articles written about COVID, for example, during the pandemic and still to this day. And then there's also education for the public and journalistic writing and newspapers and magazines and health magazines and all kinds of things like that. And again, you can develop relationships as a freelancer or you can go work for those companies.

And then you can also find a job as an editor who is really oftentimes called the medical director, for lack of a better term I guess. And that means you could be doing the classic editing that you would do, overseeing someone else's writing, but you might also be part of the management process for reviewing and coordinating with the other writers at your company.

I had a guest who went from really full-time podiatrist and she happened to have some leadership positions at the podiatry association that she was a member of, and she had been hired in as an editor for one of the podiatry magazines that get sent to physicians to podiatrists. So, don't forget about those editorial-type jobs other than just the writing jobs.

All right, telemedicine. This is a big area, but I wanted to mention it because it's not nonclinical, it's obviously clinical, but it's non-traditional. We always talk about non-traditional remote jobs and home-based jobs. So you've got the classical type of telemedicine jobs. You can do those either freelance or as an employee, just like most of these jobs can be done.

And we usually push the freelance version of this because it has a lot more flexibility, and takes more upfront work. It's fairly straightforward to obtain a list of the top 10 telemedicine providers, maybe talk to your friends about the ones that seem to be the best to work for, apply, get a job, and then they just start sending you, and you agree to a certain schedule and you just start seeing patients online in various ways, which I'll talk about in the moment.

But the freelance type where you're independent, you work for multiple platforms, and you're not really constrained with other things that you can do, there's no non-compete when you're freelance, generally if you sign the right kind of contract. So, being employed is fine, it's a good way to get your foot in the door. But as colleagues and NewScript mentors like Dr. Cherisa Sandrow have taught us and actually teaches others to do, the freelance form of this is usually much more lucrative. You can often work 20 or 30 hours a week and make a full-time salary. So, that's what we usually recommend.

Now the freelance form of that is being a primary care physician and doing one-on-one short visits, much like you would do in urgent care, not actually face-to-face, but remotely. That's probably the most common and the most lucrative. But there are other things that you can do. You can be involved in remote patient monitoring. RPM - Remote patient monitoring. Usually, the actual monitoring would be done by another type of clinician, a nurse, or a technician technologist. But a lot of times with the RPM, they'll need medical directors and need physicians to supervise and to create protocols and things like that.

So, keep your eyes open for remote patient monitoring companies that are growing. There aren't a lot of them, they're not that active, but I'm sure they will be more and more active over time. If you're a radiologist, you can do remote imaging. That actually was one of the earliest forms of telemedicine.

I've had a guest that came from Doctors For Providers. Actually two guests, the two co-owners. And this is a way to provide remote supervision. So, I'm including this as a form of telemedicine. I don't know if technically it is, but there are urgent care centers that employ PAs and NPs. There are independent APNs in certain states who have their own clinics. There are some legal constraints here. And buyer beware, make sure that your malpractice is covered completely and that you're not getting into a high-risk situation.

But there are many physicians currently doing remote monitoring, and collaboration supervision. They might be doing chart reviews to help with the quality improvement for the staff at the remote site, and they never set foot on the site, and they can do this even while they're working another job. Because as long as you can break away and do some collaboration and consultation, and also if you're doing chart reviews or doing reviews protocols, those are all done on unscheduled time at your own pace.

I would just remind everyone that telehealth is a huge field and there's a lot more to it than just face-to-face visits. The remote consultations also include specialists consulting with primaries, so they're not actually seeing the patient, but they're communicating with you as a primary if that's what you're doing to help you address a problem. And then obviously they can do remote consultations with patients as well, but sometimes I prefer just to work with the physicians rather than the patients in some situations.

Okay, now we've used the term consulting, but this time I'm going to focus specifically on the classical form of consulting, which again is either freelance or employed. Now, I threw boutique in here too because that's a term that's thrown around. But basically, the freelance is a one-person shop. Most of the time you have an area that you're an expert in, that you're passionate about. It could be inside the bubble of a medicine, inside direct patient care or it could be outside. Maybe you are an expert at marketing your practice. And so, you develop some courses, some consultation, and you can do these things remotely to help other practices do their marketing in an efficient and effective way.

On the other end of the spectrum, you have these national and international healthcare consulting firms. Places you may have heard like IBM has a large component, $50 billion-plus per year. Accenture, Deloitte, McKenzie, Ernst & Young, Huron. I've lifted these here. There are at least 40 more that do consulting to hospitals and health systems and large groups and telemedicine companies and other consulting firms and other delivery firms in healthcare and pharma and you name it.

I put the boutique in because you could start out as free freelance and then if you're doing that, let's say that marketing, you might end up hiring a copywriter part-time. You might end up hiring a social media expert. You might end up hiring an email expert. And then you're doing the basic marketing. And so, now you've developed a small free-standing consulting firm, which from the hospital side, health system side that I was involved with. And we would decide, do we want to get one of these huge international or national firms, or we want to find a boutique firm that has a smaller crew, but they're more focused on a very specific problem. So, that's another great remote and home based career. When you're doing freelance, it's probably more remote and more home based. When you work for a large firm, sometimes you do have an office to go to from time to time, and you do travel quite a bit. So, it might only be partially home based.

And the last category that I want to talk about today is coaching. 10 years ago, I think we were not aware that there were that many physician coaches around and there were some people who have been coaches for a long time, physicians coaching other physicians that are quite iconic. I won't mention any names, but nowadays there are literally thousands of physicians who are doing coaching.

There's a fuzzy line between coaching and consulting. But when we talk about coaching, we're talking about mostly starting with one-on-one coaching. It can be life coaching, it can be career coaching. There are at least 10 types of coaching, and there are probably more that I haven't even seen or heard about in the past.

But business coaching, professional coaching, and then even what you do as a consultant in a way is a form of coaching. But I've even seen yoga coaches in our physicians, meditation coaches, and success coaches. I've interviewed many coaches, and several of the coaches, in fact, at the summit that's coming up in April about seven or eight of the people that are presenting their formal job as coaching and training other people to do things that they've done and that they're experts. So we have a telemedicine coach and we have a locums coach and we have a pharma coach and so forth.

I won't get into the names right now, but suffice it to say it's a very popular type of job and it's one where you become an expert in something and you're just going to do one-on-one and help to train them. You can be employed. There are firms that employ physician coaches and that takes away some of the risks of building a business.

Most coaches that I know are either freelance or run some kind of a coaching business, and they may actually recruit other coaches, although they may not truly employ them. They might be more of a 1099-type relationship. So, technically, they're even sort of semi-freelance, although they have that relationship and they get some of their clients from this coaching company, they both exist.

And sometimes being employed first, as long as you don't have some kind of an exclusive contract that goes beyond a year or so, then you can move from employed to freelance if you want to do that.

Most coaching starts out as one-to-one. It oftentimes moves into group coaching. I've interviewed several successful very busy coaches, whether it's Heather Fork or Katrina Ubell who coaches for weight loss, or you name it, people that coach for doing real estate and coaches for starting a practice, coaches for being a medical legal consultant or for being an expert witness. There are all kinds of coaches and there's a blurry wall between coaching and consulting.

That's really what I wanted to do today. I've probably described at least 30 or 40 jobs depending on how you want to break it down.

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How This Consulting Business Grew Directly From a Patient Need – 289

John Jurica — Tue, 28 Feb 2023 13:30:01 +0000

Interview with Dr. Eleanor Tanno

In today's interview, Dr. Eleanor Tanno explains how her consulting business grew directly from the needs of some of her patients.

She received her medical degree from the U. of Maryland School of Medicine. Then she completed her residency in Family Medicine at Virginia Commonwealth University. She works as a full-time primary care family physician as a partner in a multispecialty medical practice. She founded Advance Directive MD as a side project to assist people in creating meaningful advance directives.

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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.

Dr. Eleanor Tanno's Journey on Side Business

The concept for this firm occurred to her very early in residency, while she was at the hospital working in the Intensive Care Unit. She observed that many families were unprepared to handle queries concerning end-of-life care. And most did not have an advance directive in place.

And those that did have advance directives had been prepared with the help of an estate attorney. They were frequently outdated and didn't contain the information to make end-of-life decisions in the hospital setting.

That's when Dr. Tanno started to envision a part-time business devoted to addressing this issue. Towards the end of the COVID pandemic, she started educating patients and helping them complete their advance directives

How Her Consulting Business Grew

She began listening to podcasts regarding nonclinical careers. And took online courses to learn how to start a small business. She learned how to create a website, create a business plan, and market her business.

She marketed her services through word-of-mouth, presenting to groups, writing articles for the public, and holding workshops to teach patients and their families about advance directives. And she collaborated with attorneys to help their clients complete the medical portion of their advance directives. She was very pleased by how quickly her consulting business grew.

Dr. Eleanor Tannor's Advice

We're so locked into this idea that we're in clinical medicine and that's all we are doing. But the more people I talk to about this, the more physicians I meet doing things that are out of the box.

Summary

You can get a look at what Dr. Tanno has built by visiting advancedirectivemd.com. There you will find articles and workshops, webinars, speaking events, corporate events, and lectures for medical professionals.

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

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Transcription PNC Podcast Episode 289

How This Consulting Business Grew Directly From a Patient Need

- Interview with Dr. Eleanor Tanno

John: I connected with today's guest several months back on LinkedIn, and I found her side venture so interesting that I thought I had to have her join me on the show. So, Dr. Eleanor Tanno, welcome to the show.

Dr. Eleanor Tanno: Thank you. Thank you for having me. It's such an honor.

John: Well, it's going to be fun because I find myself interviewing physicians who are practicing and they're happy in their practice. Not everyone that comes on this show is seeking the exit. But it seems like physicians are curious and when they find a problem, they want to solve it. And so, many physicians do something on the side like you're doing. And I thought it'd be very interesting to hear your story and walk through how you got involved with this and how things are going.

Dr. Eleanor Tanno: Thank you.

John: With that, first, tell us about your educational background and clinically what you've done since finishing your residency.

Dr. Eleanor Tanno: Sure. Since finishing my residency, which is in family medicine, I joined a large multi-specialty private practice in Rockville, Maryland. I practiced with about 20 internists, mostly a few family physicians are sprinkled in there and then some subspecialists. So, we have, I think three or four other subspecialists that work all under our roof. And so, that's mostly what I've been doing essentially full-time.

And then I've had this idea since the beginning of my residency, but really sort of hit the road about a year and a half ago at the tail end of the pandemic when we all had a little more time and some of us had some breathing room. I started this side venture in helping people put together their advanced directives.

John: That's very interesting. What happened that prompted you to do that? Apparently there's a problem that was needed to be solved. And in that, tell me, did you have some special relationship with that whole concept? Do you work for a hospice or any of those kinds of things? Explain that in more detail.

Dr. Eleanor Tanno: Yeah. The idea came really early in residency when I was in the hospital and doing time in the ICU. I'm sure as many physicians have seen end-of-life care in this country, the pendulum has swung. And so, we do a lot of aggressive end-of-life care and find ourselves asking, "Is it worth it for this patient? Are they getting anything out of it? Are we actually solving a problem?" And also I found that a lot of families are completely unprepared to answer the questions about end of life care and next steps.

And if they did ever talk about it with their family members, which most of the time they hadn't, it was in the form of an advanced director that had made with an estate attorney that was often extremely dated by even honestly, decades. And it didn't actually have any practical information for physicians. If I'm in a persistent vegetative state, pull the plug or something. They wouldn't actually say that term, but no heroic measures.

And I just found myself asking why are people making these documents with an attorney and not with a physician? And how can I potentially be the physician who makes that document with them and has these conversations? This idea sort of mulled around in my head for years. And I thought, "Well, one day I would love to help people put their advanced directives together from a clinical perspective."

And then when I got into practice, I just realized during a primary care session, you could briefly go over these things, but there just isn't time to really get into this information. And there's so many misconceptions out there about end of life care that I decided to really dive into this more and create a more robust system.

And I did at one point investigate doing a palliative care fellowship, maybe two years into practice. I thought maybe I should go down that road. But what I found, and I did go as far as actually to shadow a palliative care fellowship program and really see what they do all day. I found a lot of it was symptom management, which was not really a piece I needed.

And a lot of what people need is they just really need the clinical perspective and just really basic misconceptions to be corrected. A lot of people, they think that withdrawing care at the end of life is the same thing as say do not resuscitate. There's a lot of just really basic stuff that really any physician who's been in a hospital could help people with. And so, I thought, "Well, I think I can do what I want to do without the fellowship, and if I need to, I can always go back for it."

I started doing this and getting into it more, and the more I got into it, the more really of a need I realized that there is, and people are thirsty to know about this stuff. It's a little bit of a black box, which as physicians, that's our fault too, but there's just so much light to be shed in this area.

John: No, absolutely. And you mentioned the attorneys. My wife and I did the same thing. We went and did this plan. It was kind of a life plan. It was really more for the financial side. And one of the things that was in there were the documents for advanced directive. And so, we filled out what we did. Luckily, she's a respiratory therapist, I'm a physician. At least I understood pretty well what I was doing.

The other thing that it makes me think about too, when you said about being trained in palliative. The reality is even most of the physicians doing hospice care are not palliative care doctors. There's very few of those. Mostly, it is internists and family physicians like you that are doing it anyway. And you're taking care of patients that are seniors and are older. So, it's something that they all need. So yeah, it makes perfect sense. And I think you're right. The MD, DO, whatever, is plenty to understand how to make something that's a lot more specific and useful. So, that's interesting. What happened? There was a point where you said, "Okay, I'm going to do something about this." Take us down that path. What did you start doing?

Dr. Eleanor Tanno: Well, I started listening to a lot of podcasts, actually. Nonclinical career podcasts. There are so many out there, but a number that really sort of resonated with me. And one of the ones that I found was Marjorie Stiegler's podcast. And she's very practical.

My background is in engineering, and I just felt like she was speaking to me, actually like nuts and bolts how to do it. So, she talked about how to make a website. She even had a whole episode on how to create a podcast down to what kind of a camera and what kind of a mic to get. These little really, really useful nuggets.

And so, at some point I just listened enough and enough and then I felt like I was ready to launch. And I did that and I started writing and I thought, "Well, while I'm getting all my prep work, at least I can be writing down my ideas and creating, so that when I'm ready to hit go, I can." And then I created my website, which I did from scratch myself, which was a whole lesson in everything you can learn on YouTube, which I thought was fantastic.

John: Yeah, YouTube is great.

Dr. Eleanor Tanno: I know. Really, I mean, it's amazing. And that was really great because now I know how to change it and edit it and do things. And just all these little things along the way. When you get into practice after a number of years, I'm sure you hear this a lot from your people, you plateau a little bit, right? I answered the same 100 questions a day, right?

John: Right.

Dr. Eleanor Tanno: And I see the same 50 clinical diagnoses and 10 of those I see, I don't even know, 15 times a day. And so, it was really fun to start to learn something and get out there, and it's almost like you put these breadcrumbs. You leave something and you forget about it, and then a couple weeks later you get an email, "Hey, your article was accepted into wherever." And so, that's what I was doing and reaching out and making connections with senior communities, which is sort of my target audience. Most people who are thinking about advanced directives are generally in their sixties and seventies, but some of them are younger.

John: Now I'm sure that with your individual patients, of course, this was something you were doing all along in terms of trying to get that done. Although, like you said, there's not enough time in a normal visit. But the other thing that occurs to me is there's probably opportunities just to do lectures. Were you doing that before this became an idea to be a business? Or are you doing more of that now?

Dr. Eleanor Tanno: That was sort of like the building. I reached out, I thought who would be interested in this? I live outside of DC. People are very highly educated and then they retire and then they're looking for something to do with their brains. And so, there's a lot of these senior lecturers in communities. And so, I reached out to them, and honestly, they were delighted to have a physician. There aren't that many physicians who have the time or energy or interest in doing something like this or anything in terms of the lectures.

And so, I reached out and I said, "Hey, are you interested?" And I think as I did them, I got more comfortable, I realized what questions people had. I refined things. I get great feedback from my students, and I think it's just nice to have something practical. The lectures were born out of that. And as I go one day I hope to make probably an online course that people can individually take online and just purchase basically like an hour, two hours, whatever ends up being.

John: Yeah, it seems like the progression is okay, do some live events and keep doing them forever if you like. And those are usually in person, then you have the online events, and then eventually you do that so many times you're like, "Okay, well, I could definitely turn this. I can just record the darn thing because I've done it 20, 50 times." And then that's just there for people to purchase or have access to for free or what have you. So, that sounds like the process that you're following.

Dr. Eleanor Tanno: Yeah. And then the other client base that I hadn't considered when I first started was actually working with attorneys. So, I reached out to a local estate attorney, and I had asked her basically if she could see a place where we could essentially partner where she could do the legal part of the advanced directive, and I could help people with the medical part.

And she owns her own practice and she was like, "To heck with meeting one-on-one, I would love for you to come and train my estate attorneys on how to do advanced directives." Because apparently this is their least favorite part of doing the estate planning is the medical part. Because they don't feel comfortable. They don't have the training and any questions they get, they basically say, "Go ask your doctor." And so, that would be a really interesting thing is to go and train attorneys on advanced directives.

John: That's interesting how you can find a new niche that you didn't know existed, but you just get out there and network and reach out to someone that you might know or maybe that somebody refers to you and these things can develop.

One of the things I've noticed in the past is that at first it didn't make sense to me that somebody who was working full-time, who is maybe a little burnt out, just as we all are, or bored. Like you said, you're seeing the same diagnosis so many times a day. Well, let's just add another 10 or 12 hours of work a week to my plate. But it seems like people that do that, either they somehow know how to balance it but they feel they enjoy it so much and actually life seems more fulfilling and really not so much of burnout. So, is that what you've experienced in this process?

Dr. Eleanor Tanno: Yeah. I find this whole process extremely creative. Like I said, creating a website, reaching out to people, creating lectures, trying to find materials that make something that can be extremely complicated, much more user-friendly. For me, it's a lot of fun. And sometimes it's a small thing, like you're sending an email to somebody or something, and so, you might do 10, 15 minutes on that day. And other days I'm sitting down, I'm like, okay, I'm about to give a talk. Next week I have a talk for a hundred people in an advanced directive workshop. I really need to put aside a number of hours to get that done." So, it ebbs and flows, but in terms of how I find the time, it's something I enjoy. Anything you enjoy, you find time for. And I guess part of it also, I have a two and a half year old.

John: That doesn't take any time, does it?

Dr. Eleanor Tanno: No, but when she started going to bed about the same time, I felt like I could breathe. And suddenly it was eight o'clock at night and I thought, "I think she's sleeping for the night." Rather than maybe watch TV for an hour, I was like, "Well, let me write for an hour." And I enjoyed it. So, it didn't seem like that. It doesn't feel like work and it's so creative.

And I think the other thing is, and I tell this a lot of times to my medical students from Georgetown. You get into this job and there's kind of like a limit on what physicians can do in clinical practice, right? Unless you're in a hospital and you move up. Once you're in private practice, and I'm a partner at my office, there's not a whole lot of growth from an employment statement point that could happen there.

But with this side venture, it feels like the sky is the limit. I was listening to this one podcast where they said "You don't need to think outside of the box, just the box is bigger than you think it is." Something to the effect of that. And it just feels like there's so much out there and you just stumble into interesting people and ideas and fields and training the attorneys on the estate planning aspect of it. It's like you almost stumble into these new worlds and you're like, "Wow, there's something here for me to work on." I don't know, it's very open and creative.

John: Well, you said it earlier about how we spend so much time in our education and we're learning constantly. We're just programmed to learn and then you reach a plateau in your practice. And so, okay, well, I'm going to learn something new. For me, over the years, I remember I was three or four years into my practice and we didn't have a retirement plan. And I knew nothing about investing. So I spent the next year learning about investing. It was interesting, it was something different from medicine. I never became a stockbroker or anything, but it was just like, "Yeah, I can just take my attitude towards learning and apply it to this, and then it'll be something else after that."

Now this has been fine though, right? It's meshing with your practice, you're still covering and practicing full-time and doing this. Are there certain aspects of this where you can actually earn income from it that are, I don't know, maybe with this recent conversation with the attorney that opens up a whole different venue? But what part of it do you think it is really? Because we all want to diversify our income, right?

Dr. Eleanor Tanno: Yeah.

John: So, what part does it seem like has the most potential for that for you right now?

Dr. Eleanor Tanno: Right. I think there's a lot of potential. If somebody's going to sit down with a state attorney and pay them, I've heard, easily $5,000, $10,000 to put together their estate documents, why wouldn't they as part of that package or on top of that package, meet with a physician to do their advanced directive? So, that's one place that for sure income can be earned.

A lot of these lectures I give, they are at paid venues. So, assisted livings will pay for speakers. Recently, I have one that a hospital gave a grant to a local senior community to get more advanced directives in the community. And then if I did an online course, which I do want to do hopefully in the nearest future, I imagine people would be very happy to pay a nominal fee for that. As opposed to what it would cost to sit down one-on-one to then to pay for a two hour course or something. And then if I did more speaking, especially at the attorney level, that for sure could be another paid speaking audience essentially.

John: It sounds good. Sounds like a plan. I failed to mention your website or the URL for that. It's called advancedirectivemd.com. Correct?

Dr. Eleanor Tanno: Yes.

John: Yes. And so, if our listeners go to your site, because I think it's good to look at what someone has created in this process of doing a side venture, side gig, whatever. What will they find on the website? Because you created it yourself, and it is a very good website. I definitely looked it over and it's awesome really. It's better than mine. And I'm paying somebody.

Dr. Eleanor Tanno: Well, I did get professional photos, which I think was something that was highly recommended. I took a course through Marjorie Stiegler's online class. And so, that was one thing that she had talked about.

John: I'm going to ring the bell again to hers.

Dr. Eleanor Tanno: I know, I know. She's a common name at my dinner table. My husband asked me if I was secretly sending her money or something. I was like no. In terms of the website, the homepage is basically make an advance directive with a physician. I put out there what I am.

And then really there's articles that I've written that I think are really helpful. And I often when I teach classes say "I can't cover everything in this lecture, read more." And so, I have an entire article on dedicated to do not resuscitate orders. And then I have something in Maryland. I'm in Maryland. And we have the MOLST form.

John: Right.

Dr. Eleanor Tanno: And so, people have a lot of questions about that form because it's confusing. I have stuff on the pitfalls of choosing your medical power of attorney, specifically focused around adult children who are arguing over their parents' advance directives.

John: That's a good article. I got to read that one.

Dr. Eleanor Tanno: I think that was something I saw a lot in the hospital. Maybe they talked to their spouse about their advance directive, but they never talked to their kids about it. I've tried to make the most basic questions people ask, the most user friendly things. And then that's pretty much what my website is there for. And then I have obviously the ways to connect with me and then some of the things I do with speaking.

John: Yeah, I think you list workshops, webinars, speaking events. Not that those are all active at any given day, but I think it's good. It's a good mix. And then from what I'm hearing, \it seems like you're a resource for patients and for physicians and now for attorneys.

Dr. Eleanor Tanno: Well, my target client is patients, people, not physicians. I don't think that there's much I say that most physicians haven't encountered in their lifetime or their training. But really the step-by-step guide of how to make an advanced directive for patients and like I said, the power of attorney. These are questions that I get a lot.

What's interesting is when you start teaching and seeing questions people have, you learn things that you didn't even realize were pain points for other people. I was teaching this course and about a third of my students did not have an obvious medical power of attorney. They were single, they were widows. Their kids had complicated medical problems, whatever the story was. And that for them was the reason they hadn't made an advance directive because they didn't know who they would have as their power of attorney, and therefore they were paralyzed over this. And I found out later that apparently 20% of people are in this case.

So, now when I talk about naming a medical power of attorney, I make sure to say, if you don't have an obvious person, 20% of the population don't feel alone in that. And then I talk about some things that people might do to mitigate that. And so, that's the kind of stuff, that really working with people and patients that I learned along the way that I thought was surprising and interesting.

John: Very nice. Well, we're getting near the end here. We wish you all the best for sure. Another question that I typically ask my guests before they leave is, if you were talking to a physician who's in the middle of their practice, they're kind of burnt out maybe or just frustrated, bored, all the above, what advice would you have for them?

Dr. Eleanor Tanno: Really, the sky is the limit. We're so locked into this idea that we're in clinical medicine and that's all we are doing, but the more people I talk to about this, the more physicians I meet doing things that are out of the box. And so, you just have to find what interests you. I feel in some ways that I'm sort of reinventing the wheel with what I'm doing, but a lot of times there's tons of things outside of clinical medicine that are not as starting from scratch. And so, you just have to find something that excites you. And that's the community that you can then just build.

John: Well, I do surveys of my listeners every once in a while and one question that keeps coming up is "Well, how do I start a side business?" Obviously, listening to our conversation, Eleanor, would be helpful just to see "Okay, how you walk through that?"

I think it's good to look at your website and say, "Okay, this is a website of someone who started something new. It's not rocket science. Here's what you put out there as part of your marketing plan." And so, I would definitely advise people to check out advancedirectivemd.com.

Now, if they happen to be a patient that needs it, also go there for sure. But I think we can learn a lot. And even looking at your LinkedIn profile, which I'll put in our show notes as well. So I appreciate you taking the time and explaining all this to us today. It's been fun.

Dr. Eleanor Tanno: Thank you so much for having me. It's very exciting.

John: We're going to have to swing back in about a year or so and see what's going on. I think it will be very interesting. Again, thanks for being here. And with that, I'll say goodbye.

Dr. Eleanor Tanno: All right, thanks so much. It was great talking to you.

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How to Be the Best Expert Witness Consultant – 262

John Jurica — Tue, 23 Aug 2022 14:45:41 +0000

Interview with Dr. Gretchen Green

In today's podcast, Dr. Gretchen Green returns to explain how to be the best expert witness consultant you can be.

Gretchen has appeared on the podcast before, on Episode 163 in October 2020. She discussed why this is such an exciting side business, and how to get started. She also introduced the new Expert Witness Startup School that she had created.

Dr. Green will soon begin her sixth release of her program, which teaches doctors exactly how to design, deliver, charge for, promote, and grow an expert witness consulting business. And she has improved the training with each new release.

Gretchen is a diagnostic radiologist. She earned her medical degree at Brown University Medical School. She subsequently finished a diagnostic radiology residency at Yale University School of Medicine and a fellowship in women's imaging at Harvard Medical School.

Gretchen started working as an expert witness in 2015 and has already worked on well over 100 cases. Doing so enabled her to switch to part-time clinical employment in 2016. Doing that provided more time for her family and financial independence.

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.

Getting Started

Gretchen's journey started when her attorney praised her performance when she was sued early in her career. After the lawsuit was over, Gretchen decided to offer her services as an expert witness. It stoked her enthusiasm for critical thinking, and she began working as an expert witness in 2016.

According to Gretchen, the fact that physicians have years of education, training, and clinical experience is what qualifies them as experts. Learning what attorneys need, and how to efficiently review cases, prepare documents, and bill and collect for services are the additional skills needed to get started.

Becoming the Best Expert Witness

Dr. Green developed her first course over two years ago. She is preparing to present the sixth version, with new content based on what she has learned working on well over 100 cases to date. One of her goals in the course is to make her students the best expert witness for their clients.

A course like this provides the framework to know how to communicate with lawyers, how to review cases to complete the work, and ultimately how to approach this as a business. And this is an ideal way to generate extra revenue, allowing physicians to reduce practice hours and improve flexibility and control over their lives.

Dr. Gretchen Green's Advice on Independence and Freedom

…when you take action, when you just get started in something that's new, there's no telling what the tangible and intangible benefits are from it. This may be the thing that re-energizes your clinical career… and it's when you take steps to do some different things… The benefits are really just for yours in the taking…

Summary

Expert witness consulting is an ideal side business for practicing physicians. Because the hourly income is so much higher than that of clinical practice, physicians can work fewer hours, earn more income, and free up personal time for family and other interests. Gretchen has taken her experience with over 100 clients to help you become the best expert witness consultant possible.

You can learn more and enroll in the Expert Witness Startup School by clicking here. By using this link, should you enroll, you will also be invited to join one of the Nonclinical Physicians' Monthly Masterminds, where you will be challenged and held accountable as you build your new consulting business.

[Note: the above is an affiliate link, so I will receive a marketing fee if you purchase using it, but the pricing is exactly the same, and you get MY BONUS ONLY if you use this link.]

This enrollment period ENDS on August 29, 2022, at midnight.

CLICK HERE to CHECK OUT AND ENROLL in the EXPERT WITNESS STARTUP SCHOOL

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

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

Links for Today's Episode:

Expert Witness Start-up School [affiliate link that includes one year of monthly Nonclinical Mastermind meetings]
Dr. Gretchen Green's Website
Top Reasons to Become an Expert Witness Now – 163
How to Develop a Side Gig as an Expert Witness with Dr. Peter Steinberg – 053
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 262

How to Be the Best Expert Witness Consultant - Interview with Dr. Gretchen Green

John: About five years ago, I started my podcast and at the time it didn't seem like there were many resources for physicians who were looking to transition either part-time to a side gig or full-time out of clinical medicine and do something they could build on their background, but things have certainly changed. And I was talking to a colleague of mine back then. Well, this was really about three years ago saying we need to get a bunch of physicians who are experts in different areas to create resources like coaching programs and courses to teach them how to do some of these nonclinical activities.

And then about two years ago in 2020, I had the pleasure of interviewing on this podcast, Dr. Gretchen Green, because she had a fantastic program for teaching physicians how to do expert witness consulting, which is a really bonafide excellent side gig that allows you to maybe cut back on your clinical hours and do something on the side, have less call perhaps, and earn some income. So, we're going to talk about all those things today. We did, again, talk to her two years ago. We're not going to repeat everything we did then. So, first let me welcome Dr. Gretchen Green. Thanks for being here today.

Dr. Gretchen Green: Thanks so much for having me back.

John: Yeah, I needed to, because things have changed. We've gone through a pandemic and I can't believe that you're going to be opening the sixth iteration of your expert witness startup school soon. It has opened probably by the time this has been released. So, I guess I got to keep that in mind. So, thanks for coming.

Dr. Gretchen Green: Yeah. It's great to have this opportunity, especially with so much rapid change during this time. We've got more to talk about and how expert witness work has continued to evolve in what has really been a very traditional field. The law field tends to be very traditional and very stable and very stuck in their ways. And yet even lawyers have shown great abilities to evolve just as we have in medicine.

John: Absolutely. Now give us a little background about how you got into this. We talked about it last time, but there are a lot of new listeners here. So, how is it that you became involved in expert witness consulting and then what prompted you to create the course?

Dr. Gretchen Green: Yeah, that's interesting. You and I had a very similar timeframe about five years ago now. It was in a major pivot point in our lives. I had been in private practice in a large radiology group in North Carolina as a partner for 10 years. And the time value, money, life quality equation was due to change. And so, I made a leap.

I had been sued actually very early in my career. And as part of that, my defense attorney said I did such a great job with my own case that I should consider being an expert witness after the conclusion of the case. And I really thought about it. I thought about how it fueled my fire for critical thinking, really energized a lot of my continued knowledge gathering as a radiologist, and it was a great fit. So, I couldn't do that as part of my previous job. And so, as part of other reasons, I then left and struck out on my own, took a part-time position, started doing expert witness work, really intently 2016 going into 2017.

John: And then somehow people were asking you to tell them what it was like and how to prepare. What was it that got you into the courses?

Dr. Gretchen Green: Yeah. And if you had asked me five years ago, what would I do as an entrepreneur after that point? I could never have predicted the different paths. Initially actually there was a middle point where I got into investing in real estate because I was looking for a way to leverage this side gig income, which three to four hours a week, you can make a $100,000 a year as an expert witness, but then it's very painful paying the highest marginal rate on those taxes. So, I actually got into building real estate and active real estate businesses as part of that.

And one thing led to the next, as part of learning that I got exposed to the digital course creation world. So then in the pandemic, it was March of 2020 when I had lawyers calling me who were part of my 8,000 plus lawyer network that I have asking, "Hey, we finally all have time on our hands. We've got these cases, but we're afraid to call you all because we think you're all saving the world from COVID." And I said, "Whoa, nothing could be further from the truth right now, like this horrible reality is we've got doctors, two thirds of whom are getting pay cuts are furloughed. This is what no one ever thought this Black Swan would look like. So, this is the perfect time to bring these two sides together, to help each other out in ways that maybe other people had never thought possible."

John: Oh, that was perfect. Perfect timing. There's been a lot of entrepreneurs who took advantage of the pandemic in a positive way. They had the time, or maybe they just gotten their appeal of to bike and get better shape, but people did use it productively to some extent. So that's cool. Well, we talked last time about the good things about entering this field, but I guess I wanted to ship because I'll put a link in my show notes to that previous episode, and everyone should listen to it if they're interested in this topic. But also, what I want to talk about today a little bit with you is what are those attributes or skills or things about a physician either that are intrinsic or that they learn to help them be the best expert witness they can be? Because it's not something you can just sort of do without thinking about and planning for.

Dr. Gretchen Green: The most important thing that most doctors have to accept in order to do this work is that the title expert witness you've already earned. That physicians by nature of our years of training, education skills, expertise, and clinical experience, that is what makes you an expert. It's your willingness to put those skills to work a little bit differently in the legal field to evaluate cases objectively and educate lawyers about your opinions. That's what takes some additional skills, but we're really good at doing that. We're really good at going into a new hospital system and figuring out electronic medical records or new clinical practice environments. We constantly adapt in medicine, even as we do a lot of our similar clinical skills.

So having a course like this gives you the structure to understand how to approach communications with lawyers, how to structure, how you review cases to do the work, and ultimately how to look at this also as a business, which is something a lot of doctors now who really want to take control of their finances want to do. And this is a perfect microcosm that helps you build some additional income and yet in a very manageable way that you control.

John: Yeah. I often get questions about in my area, like "If I want to go into hospital management or something, do I have to have a certain personality? Do I need to be an introvert or an extrovert or this or that?" And it's like, no, no. I've met people from all backgrounds, all personalities, they can all be good, medical directors, CMOs. You just have to learn those additional skills. Some of which they're transferable, but just some new skills and some new knowledge about how to do that and play to your strengths and you can do it. I'm assuming it's kind of the same with this.

Dr. Gretchen Green: Absolutely. And a lot of physicians, it's amazing to me, people with so much to give to the world, such a high level of skill and expertise would even be saying, "Is there any use for me in this?" Often people will ask me questions that start with phrases like "I'm just a da-da-da. I'm just an internal medicine doctor." And it's like, "Okay, step back a little bit here and think of the sentence you just said. I'd like you to rewind your life. Your entire life has been for this goal and you've given so much personally, professionally. You're not just anything."

And so, this is one of the great benefits of doing this work is you actually get paid what you're worth. And it's very rewarding. It's very intellectually workable. And every specialty pretty much has the opportunity because as long as there's clinical work happening in that specialty, there is a chance of liability from things that have gone wrong potentially. So, every specialty pretty much has the opportunity for this. And in fact, some of the general specialties, internal medicine, and family just by numbers are the most numerous. So, when you're going from a big denominator, you're going to have more work even than some subspecialty cases, neurosurgery, et cetera.

John: It's funny you say the word "just." I'm "just" this or that. I calculate it. Just primary care physicians have at least 15,000 hours of training, maybe 20,000. And when you get into subspecialties, you're over 20,000. That's enormous. And the attorneys need just this little bit of information out of that whole background that you have. I really have felt that this is the ideal side gig. Like I said, if you can cut your hours back clinically, make your life a little easier, work less hours, earn more and come to make up that difference and free up your life to spend time with your family and do other things.

Dr. Gretchen Green: Exactly. That's exactly my course. And I sort of sketched out goals over time. The 5-year, 10-year, 15-year plans. And I rapidly became busier than I could accommodate using my expert witness work and then with real estate and other things that I went back again on my clinical time. I now work two full clinical days a week and a part day, about three weeks a month. I have a total unicorn job. My group is just the best in the planet with these most amazing people who I get to work with and they value the skills that I bring back to the practice from this work. People have a lot of different opinions about is it good or bad? It's like, are you a good witch or a bad witch for doing this work?

But the fact is that the work needs doing. And so, we may as well have people bringing their best skills and understanding how to objectively review cases so that we can have at least positive impacts in the field. But yeah, it's definitely impacted my time. And so now, especially that expert witness work has become even more virtually based with depositions often being on Zoom, even some trials now, it's been more of an opportunity than ever to work in expert witness time into my own schedule, which has become busier and busier with other things.

John: Okay. Yeah. I want to make sure we spend a minute just talking about what else has changed. Maybe that's the main thing that has changed. The big question people often have as well. "If I'm doing this, how much time do I spend reviewing records?" Which sounds pretty straightforward. "How much time do I have to spend in a deposition? How much time do I have to spend testifying in court?" Which should be a pretty rare event. So, has that changed at all in the last three or four years? And tell us more about the remote situation. Can you do 100% remote almost?

Dr. Gretchen Green: It's almost 100%. Now the practical reality has been that a lot of trials were simply just deferred or canceled over the pandemic as courts were closed. Now we're still facing a backlog. We've still faced some ups and downs with variants that have affected different states and different courts, schedules. So, it's still probably slower from a trial standpoint than it has been in the past. But cases are going to trial. Things are catching up.

And just to give you an idea on the percentages. Per week I may spend a handful of hours doing case review. I've been retained in over 150 cases now over five years and yet it's very manageable and it's definitely less than the percentage of my time that I do my clinical work or other things. And that's important from a state compliance standpoint. You don't want to be doing way more expert witness work than you are in your clinical time. There is a balance that states do want but that's not hard to achieve just from the realities of life.

Depositions now, I'm doing as a pretty much a three-hour block. We schedule those at least 30 days in advance. And with the exception of one that has been hybrid, they've all been virtual. So those are all Zoom and it's done in a very confined timeframe for which I'm prepaid because I have to commit to that scheduled time. And that's an opportunity lost for other work of course

Case review is really as flexible as you want in your own time. I have had a couple cases that went to trial, but one of them, they deposed me in advance using a special deposition technique called it Day Bennet Essay deposition, which is just a formal term for we deposed you on Zoom before the trial and then play that deposition at trial instead of me coming to the testimony.

And then in one, we were due to start trial in about a week, but the plaintiff became critically ill. And so, they canceled the trial because if the plaintiff had died in the midst of trial, that would've resulted in a mistrial because I guess the damages in everything changes with the calculus. But otherwise, it's really been the most manageable now that it's ever been. And it's not going to change. Lawyers love doing... It's love-hate, right? We all hate some things about Zoom, but we love much more that I think we hate. And so, I don't see that they're going to just go back to all in person depositions, and now with trials and the opportunities to work with flexibility with schedules, I see that as a continued benefit.

John: Awesome. Wow. Yeah. I would not have known that unless you had been here explaining that to me today. All right. That's awesome. Okay. I want to stop for a second and give everyone your website. It's theexpertresource.com, correct?

Dr. Gretchen Green: Yes. It's www.theexpertresource.com.

John: And everything that anyone wants to learn about you in terms of what you're doing in your courses and so forth are available there. But we're going to go into a little detail here about the course, and then I have a link that might be a little easier for people if they want to go right to signing up for the course. But let's start. Anything different about the course over the last few years, or just give us a quick overview to cover those things.

Dr. Gretchen Green: One of the new benefits we have, and again, really a pandemic related improvement has been that we have a new opportunity for CME eligibility through a company cmefy.com. This is a group of super creative folks who have really improved the access to CME category one credits for digital courses and other little less traditional educational format products.

So now, this means that this course may be eligible to be paid for by your CME money. If you get that through your employer or your hospital. Even without that, it's still typically tax deductible as a business expense, even if you don't have a whole business LLC setup, which I do address in the course. But even without that, it's typically tax deductible. At any rate, the course pays for itself with your first case that you get retained and pays dividends multiplied when you start billing at the right level from the beginning and don't undervalue your time.

John: Yeah, I would think in just broad strokes that if I were taking a course like this, I'd want to learn just the nuts and bolts of being an expert witness, how do I prepare, how do I review things, how do I interact with attorneys? And then the other half has got to be okay, we want to protect ourselves who like any small business. So, I need to kind of set that up. So how should I set it up as a consultant? I'm assuming what I know is that those are definitely covered in depth in the course.

Dr. Gretchen Green: Yes, I have a dedicated module. That's a bonus module for business building. I also have a separate masterclass that's on money and marketing because a lot of doctors need some extra guidance and exposure to other experts who do that. But this is something that's very doable and these skills are very translatable then to doing other projects that you may want to do in your life, or again, just doing expert witness work, but with it being as a business itself.

John: Okay. That's nice because you're right. Anything we do as a side gig, you should have some kind of legal... I hate to just say an LLC, but that's usually what it turns out to be, but some kind of legal structure and understanding how to set things up and how to organize things. So, that's useful in and of itself. But tell me if you can, what the results may have been for some of your students, because you've been doing this long enough. And I haven't heard any kind of feedback on that. I'd love to hear that.

Dr. Gretchen Green: This has been really exciting even though it's only been two years and the average malpractice case can go on for years. I have cases still from 2019. So, three plus years is not unusual for a total lifetime. And even with pandemic delaying so many cases from progressing. I have had students even from the spring course of last year who have completed trials. So, I get to see their pictures in our Facebook group for the expert resource with them, showing themselves in their hotel room, wearing their suit, ready to go to the courthouse. Folks who have been so happy about deposition preparation, who have really felt that they did a great job, became prepared, they were confident.

And probably the most telling are the ones who will message me and just say, "Hey, I can't even tell you how my life has changed having this financially in my life. Having this ability, it has changed my life, being in charge of this and having the opportunity." Again, all this is, is putting your skills to work for money. That's what work is. And it's a great way, a very gratifying way to do it in a way that is needed.

John: Yeah. Your comment about how long cases can take. I've been involved in several malpractices and some were just other things. There are typically five years. There is that long period of time, but there's a lot of need along the way for reviewing things and updating things. And so, I wouldn't be afraid of that. It doesn't really matter to the medical consultant how long it takes. You're there just to provide your expertise, I would imagine.

Boy, if I was younger, I think I'd really look at doing something like this. I was deposed a couple of times and I kind of enjoyed it. You prepare for it and you just answer straightforwardly and you keep your cool, which you should really, you're a professional, so that should be simple. So yeah, I'm glad to hear that you've had great success with the people that have gone through the course and continue to interact with you with the Facebook group and otherwise.

Dr. Gretchen Green: Yeah. People will email me, they'll message me. And I think another benefit that we're probably just beginning to see is that physicians who are well versed in the medical malpractice environment may themselves be less likely to get sued. It may also improve the quality of care when they're practicing. Not defensively. Not defensively ordering exams and overdoing, but from truly a proactive sense of better practice of being informed about consensus statements, white papers, really keeping on top of literature and the best thing that this does at the end of the day is it improves patient care. It makes us better doctors.

John: Oh no, that's absolutely true. Nothing would teach a physician how to document better than being deposed. Because they're just looking at your records, let's say as a defendant. Not now as a consultant, but even as an expert witness, you're going to learn these things that the importance of how you document and when you document and everything else that goes into taking care of a patient and how it can impact on a potential lawsuit. It's eye opening. I would say definitely just going through this course would help that whether you ever serve as an expert witness or not.

Dr. Gretchen Green: True, true. And if you were ever yourself sued, even bet that you're going to put all these skills to work and more, and then you are your own benefit of your own expertise as well.

John: All right. That's absolutely true. Okay. Well, I've been lucky enough. I was able to help support you last time and I'm going to do it again this time. Not just through the podcast, but I'll have some links, which I will mention now. So, if my listeners go to nonclinicalphysicians.com/ewcourse, it will bring you directly to a page. It will explain in detail what the course is like and how to sign up. It's not mandatory. You can go and just check it out. So, I will put that link in my show notes, but if you're not looking at the show notes, again, it's nonclinicalphysicians.com/ewcourse. I'll be mentioning it in some of my emails that most of you get.

All right. Well, let's see, Gretchen. Any last-minute comments or advice for physicians who are maybe in general just looking for a way to find more independence and freedom? They could do this, but in general, what's your experience in dealing with physicians that are kind of burned out, looking for other things to do?

Dr. Gretchen Green: I think this comes to your mission where you're providing information about doing things beyond the scope of typical clinical practice in medicine. When you take action, when you just get started in something that's new, there's no telling what the tangible and intangible benefits are from it. This may be the thing that re-energizes your clinical career, or as you've discussed in some recent podcasts about serving on nonprofit boards, the world is full of opportunities outside the clinical office. And it's when you take some steps to do some different things, where really the entry curve it's not a steep learning curve compared to learning how to do cardiothoracic surgery. It's just not as hard as that. The benefits are really just for yours in the making. So, I thank you so much for your support of the course, and I'm really happy that this link will help support your programs as well. And I'm just glad to be part of this community of physicians helping other physicians.

John: Yeah. You've been a real useful part of it for many physicians. We've learned some things today that we can use probably. And if we want to learn more, then we'll have that link and I'll send people to that. And I really look forward to hearing about how the next course goes. And maybe we'll have you again in a year or two and see what has transpired, because I know you're working on some new things. Well, that'll be our tease for the next time.

Dr. Gretchen Green: That's right. Well, thanks so much for having me.

John: It's been my pleasure. Thanks Gretchen. Bye-bye.

Dr. Gretchen Green: Thank you.

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Boost Well-Being and Align ’Soul to Role’ During Career Selection – 260

John Jurica — Tue, 09 Aug 2022 12:00:17 +0000

Interview with Dr. Joe Sherman

In today's podcast, Dr. Joe Sherman describes how he helps physicians align ‘soul to role' during their career selection process.

By avoiding burnout and broadening possibilities, Dr. Joe Sherman, a physician coach and retreat leader, helps other doctors discover greater joy in their lives.

Joe obtained his medical degree and residency training in pediatrics at the Virginia Commonwealth University School of Medicine. And for more than 30 years, he has provided healthcare to children in the District of Columbia, Tacoma, Seattle, Uganda, Bolivia, and other nations.

He recently served as the Health Services Director at Mary's Place, a refuge for homeless families. At the University of Washington in Seattle, where he currently holds a clinical associate professorship in pediatrics, he has held a number of academic positions.

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.

Align ‘Soul to Role' During Career Selection

The idea in Parker Palmer's book “Let Your Life Speak,” to align your soul and your work (or role), resonated with Joe. Examining past experiences and reflecting on them can help us discover the things that truly make us happy.

Joe was drawn to the Center for Courage & Renewal after reading the book by Palmer, one of the Center's founders. He began coaching physicians and holding retreats for those seeking guidance on how to live more realistically.

Dr. Sherman's Retreat

The Center for Courage & Renewal's traditional concept involves gathering people together for four days to form a community. Participants work on their individual problems in a circle of trust with a set of rules known as touchstones. Much of the work is devoted to career selection.

Joe offers half-day or full-day mini-retreats for inpatient medical teams, or outpatient clinic workers. He creates also provides reflection groups or workshops, along with the traditional retreat, in locations where one can reflect, rest, and revitalize while earning CME credit.

Summary

You can access a free 30-minute consultation on his website: joeshermanmd.com. During that consultation, you will look at your life, and reflect on how it worked or didn't work. Additionally, you can email him at joe@joeshermanmd.com.

Dr. Sherman's next retreat will be held on Whidbey Island, Washington, from September 22 through 25, 2022. In addition to working on aligning your “sole to role,” during career selection, members participate in kayaking and other mountain activities in a stunning setting with the breathtaking Olympic Mountains in the distance.

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 260

Boost Well-Being by Aligning 'Soul to Role' in Career Selection

John: Today's guest is an accomplished pediatrician. In fact, he's done his pediatric practice all over the world from what I can tell, but really that's not why he's here today, because he's transitioned into being a coach, consultant and retreat facilitator, which we're going to learn about today. So, with that, I would just like to welcome Dr. Joe Sherman. Hello.

Dr. Joe Sherman: Hi John. Thanks so much for having me.

John: It's my pleasure. I'm looking forward to talking and hearing about your burnout, how you transcended that or overcame that and what you're doing now. So, it's going to be a very interesting conversation, I'm sure.

Dr. Joe Sherman: Yeah. Thanks so much. I always enjoy talking about this.

John: Excellent. So now we usually start with a little background. Just give us the short version of your background, your education, clinical work, and definitely touch on some of the things you've done that are a little different from the typical pediatrician.

Dr. Joe Sherman: Sure. I'm an east coaster. I was born and raised in Washington, DC in the city and went away for college at Duke University and then went to Richmond, Virginia at Virginia Commonwealth University, Medical college of Virginia. I did both medical school and residency there in pediatrics and then moved from there back to DC and then began my career as a general pediatrician.

And I would say that the majority of my focus in practice was service to underserved populations of children and families. And my passion really lies in the education and teaching of trainees and bringing the community and the academic center together in trying to link them up. And back then in the late 80s, when I was beginning my practice, most training centers were ivory towers and you never left the building. Now it's a little bit more integrated, but at the time it wasn't.

I worked in many outreach projects where we had teams, interdisciplinary teams to reach out to different populations, pediatric mobile clinics and teams that were based in the community and doing house calls and so forth. In addition to that, I've had stints in Uganda as well as in Bolivia. And I love international health and working with organizations in both of those countries, as well as short term trips to some other Latin American countries.

So, that's about a summary of my clinical experience. And as long as I kept doing that variety of things, I found that I was fulfilled in medicine. But I have to say that pretty much the whole time, even at the beginning of my training, in the back of my mind there was always this thought that came up of "Does this have to be in medicine? Could I be doing some of these things outside of medicine?" Because I always enjoyed athletic coaching and counseling and tutoring and mentoring. And so, those are the things that, especially overseas where you have to kind of wear a lot of hats when resources are very low. That's when I found that I really thrived.

John: Nice. You were sort of going back and forth in some of these activities but apparently from our conversation before we got on the call here, is that you at some point had some episodes where you were pretty burnt out, is that right?

Dr. Joe Sherman: Yes. I would say I was. And I think the classic definition of burnout, this emotional exhaustion dissociation, sense of lack of impact and so forth. At times I had that classical syndrome, I would say. At other times I feel like I was just misplaced, perhaps. It was just the wrong job with the wrong time in my life. And during my time in my practice, I went from being single, to being married without kids to later on being married with kids and little kids and then big kids. Life changes, your situation changes. So therefore, what you're attracted to as far as a practice, a job, an activity is concerned, also changes. I had some minor changes and I always kind of switched jobs I think in those situations and moved on. Opportunities were there.

But then the real crash came when I returned from Bolivia after living there for four years with my family and we raised our little kids there. And returned and tried to plug back into academic medicine here in Seattle. And I just started to go downhill and it was confusing to me. I know that what I had experienced in Bolivia was amazing. I was doing a variety of activities and that fit me well. And yet when I was placed in this clinic in an atmosphere and setting that it seemed like logically, cognitively on paper, would've been the perfect fit. I found myself going downhill. It was confusing to me. I became increasingly anxious. I wanted to work harder to try to fix a broken system. I felt responsible for everybody and everything.

And so, at a time where I was really starting to feel uncertain, it was proposed to me that I was doing such a great job. Why don't I become the medical director of the clinic? And so, like many of us physicians do, when we think something's wrong and we're not feeling too well about our situation, we work harder to try to make it better and try to fix it. And so, I did, and that just made me crash even further.

John: After speaking with so many people about this topic, I think there's an expiration date or something sometimes. Sure, there's medical students, residents they're burned out from day one. They stay burned out and they get fried, but most of us go into it, we're excited. It's interesting. We're at the top of our game because we've just finished our training. I don't know. It's almost like a candle. There's a point where the candle is gone. It's disappeared. The wax evaporated, it burned and there's nothing left And for each of us, medicine is such a fast-changing field that it's really easy to get overwhelmed. And you can only keep that level of intensity for so long. So, I don't know. That's kind of what I'm starting to think about after going back and thinking about my burnout.

Dr. Joe Sherman: Yeah. John, I think as I look back during the time of my training and then my medical practice, medicine has changed dramatically during that time. I mean, not just the evolution of the electronic health record, but also other technology and research and the complexity of medicine has changed. And so, the things that I could keep in my little pocket of that handbook that said, "Oh, I'll just look it up in the Harriet Lane Handbook and tell you what to do." Now it's an enormous amount of information.

John: It is. And I think about this all the time. When I was in med school, literally there were probably 10 medications I had to choose from. A couple of antibiotics, Lasix. Tegnect, the first medicine for ulcers. It didn't exist when I started med school. It's just overwhelming now. There's like a bunch of drugs for COVID. It's just blowing my mind. I can't keep up. Anyway, I'll stop beating that horse.

Dr. Joe Sherman: I'll just say there was just one little vignette very quickly, is that when people talk about HIV. HIV now.

John: Oh yes, exactly.

Dr. Joe Sherman: I had one hour lecture on HIV in my entire medical career, in my entire medical training. And it was by a pathologist who just said there's this strange disease seen in San Francisco. Just want to let you guys know and stay tuned for more. That was it.

John: Wow. Well, I think about that and I look back and I had two patients die of HIV, no treatment whatsoever available for it. And now it's like, okay, we've got these multiple drug pills you take once a day, once a week, whatever. And it's completely controlled. So, it's fantastic. But boy was that frustrating back in the day.

Dr. Joe Sherman: My first pediatric patient, it was a baby who died of perinatal transmission of HIV.

John: That's rough. Okay. Now, you kind of did a reassessment and started to think about whatever the next thing you were going to do when you decided, "Well, maybe I've reached that point." So, tell us about that transition and what you did to prepare for it.

Dr. Joe Sherman: Sure. Like I say, I tried to hang on and make things better. And I was in therapy, seen a psychiatrist just because of anxiety, depression, but still would not let go of this job because it was my identity. And finally, I had to. It was kind of like if I wanted to stay in my marriage, in my family, I just had to do something. So, I did. And it was a time where I stopped and just sat back and said "I need to really reassess where I am in my life and how I got here."

And I came across a book written by Parker Palmer called "Let Your Life Speak." And he wrote about this concept of soul to role that somehow we can examine our lives and see the experiences that we've had and from looking at those experiences we can reflect on that and determine what are those things that really bring us joy in life. What are those things that really bring us to life that make us feel like we are excited?

One of the things that I say is what is some activity that while you're doing it, you wish it would never end because you're having so much fun or you're enjoying it so much? Or what is something that you have done that you say, "I can't wait to get back and do that again?" And then extract the elements of what was present in that time and see how that might fit into a career or your next decision or other things in your life.

Reading that book attracted me to the Center for Courage & Renewal, which is a center that he helped found and group retreats for people who were trying to discern how to live their lives more authentically. And so, I went to a couple of those retreats and found them extremely helpful and decided to train to be a facilitator of those retreats. And that's how I got my start with accompanying health professionals on that journey.

John: Okay. Yeah. Tell us about the retreat concept, maybe the way you're doing it now, or how it's evolved for you. I've always found that group activities can be very helpful because people have the shared experience, but yet they have their own perspective and they've learned and they can learn from one another. So, what's that been like for you? How would you do that? Do you get a group of doctors together?

Dr. Joe Sherman: Yeah. The classic model for the Center for Courage & Renewal is this. Go away to a place for like four days and come together and establish community. It's almost parallel reflection, parallel discernment. And so, everyone is working on their own issues, but you're doing it in a circle of trust, a circle that has a certain guideline you call them touchstones.

Well, the problem is healthcare professionals are very busy. It's really hard for them to get away for that much period of time. So, I tried to adapt it a bit to their situations. I started to do mini retreats for medical teams, inpatient teams, such as palliative care teams or outpatient clinic staff and say, "Hey, let's do a half day retreat or all-day retreat." Or the other thing that I did was, for example, with palliative care teams, can I meet with the team for an hour and a half once a month and have this ongoing reflection on their experiences and how it applies to the direction that they want to take. And this builds team unity and also helps people understand each other on the teams.

Those are types of offerings that I have now, which are those short term, either reflection groups or workshops, as well as the classic getaway and do in that model of going to a place where you can reflect, you can relax, you can rejuvenate, and you can also gain some CME credit for it at the same time. So, we also have those available too.

John: Okay. I think you've got one coming up in a month from what I remember, a month or two. Who would be the ideal member or someone who would come to that? In other words, are you bringing a team from one local spot or are you pulling people from the whole country? And what is the thing that is common to all those people where getting together is going to help them?

Dr. Joe Sherman: Yeah. I have a co-facilitator who's a clinical psychologist who specializes, all of her clients are physicians. These retreats that we have, that we co-facilitate together, we have one in the wintertime in February that's in Florida. And then we have one that's in the early fall on Whidbey Island outside of Seattle, Washington. And these retreats are transformational leadership retreats. And they're worth 25 hours of CME credit, category one credit. And it's really a time for any type of physician, nurse practitioner, PA, medical provider, who wants to examine their practice, their lives in the context of a position that they hold. Perhaps it's a leadership position, either formal or informal within their organizations. And the idea is "I want to examine what brings me life and how I can act more authentically and then how I can transform my organization so that I can provide a space and a culture for everyone to be able to do that."

And one of these big AMA surveys that was done during the pandemic concluded that there were two elements that were associated with resilience of medical providers during the pandemic. And those two elements that had to be present in their organization was one that they felt like there was a shared mission that they felt like they were all in this together. And that that was explicit and lived out.

The second was that they felt valued, that they felt like they were valued by their organization as a member of that organization. And that has implications. The implications are that you're engaged in decision making and the direction that things take. So, those are the topics that we deal with during these retreats as to how to get yourself to examine who you are, why you do what you do, and then how you can bring that to your organization.

John: I find that interesting and I have a question for you about that only because most people that I talk to on my podcast here are people that are ending up leaving medicine. But there's been coaches that I was surprised to find out during the interview that like 80%, 90% of the people they work with actually stay in practice. So, it's how they do the coaching or the people that are coming to them, but that's the whole point is they want to continue in practice.

What I'm hearing from you is that if you can become a leader in one of these organizations, you can continue doing what you're doing now. You may be pulled away and spend more time in leadership and less time seeing one on one patients. But is your feeling that most of these people are there to learn how to stay in practice with a group and support one another and continue doing that for patients?

Dr. Joe Sherman: I would say for these retreats, people come with all kinds of ideas because they're at different stages of their careers. Some people are early on, pretty young. Some people are looking at perhaps retiring and maybe they're burned out. Maybe they need some reason to stay in it, or maybe they're looking at a way to make it work. And making it work may be that they transition a little bit out of clinical medicine and more toward administration or more toward program development or something outside of clinical medicine altogether. It's different for every person I would say.

John: Do you get feedback from the participants later? What's your general sense of their ability to make that change?

Dr. Joe Sherman: Yeah. It's so hard because when I talk to physicians and other clinicians, they feel like they're stuck in a system that is intransient. It just will not change.

John: It's a system.

Dr. Joe Sherman: It's a system problem, right?

John: Yeah.

Dr. Joe Sherman: And usually my response to that is you're right. It is unjust to blame you as an individual physician or other provider. It's unjust to say, "It's all your fault. You just have to shape up, do a little meditation and yoga. You'll be better." That is totally unfair. We are in a broken system. Now, as a result of that, what are you going to do about it? If you are someone who is a political activist and you are a leader, and you're going to really put your energy into changing the system, all the power to you, we need more people like that. If you're not, and you really want to concentrate on taking care of patients or concentrate on teaching or research or whatever it is. Well, then what can you do to fortify yourself to make your own experience more fulfilling? And what can you do with the closest sphere of influence around you? Who do you interact with every day? Because those are the people that can make or break your day.

So, we focus on that. And I would say that when people go through our retreats, as well as my individual coaching, that's what I really focus on is really what is it that drives you and how can you bring that out in other people so that you provide a culture that everyone feels supported? They feel like they're valued, and they feel like they're in the same mission.

John: And when I left medicine, I went into administration at a hospital, became a chief medical officer. And so, I was kind of on a dark side in a way. But I think that while I was doing it, I was actually helping the physicians. Even at the base level of saying, "You know what? You're not getting paid enough. We're going to give you a raise" The CFO was not going to volunteer to do that. The CEO wasn't either. And so, I'm always encouraging people to get involved in leadership. If you're frustrated, you can go one of two ways. You can bail on the whole thing, or you can get involved and change it somewhat.

Dr. Joe Sherman: Yeah. I think what they used to say is that the MDs that go to administration went to the dark side and now we don't like them anymore because they're the bad guys. But it's almost like administrators and clinicians live in these two different cultures. And never the twain shall meet or get along, but I've been in situations, especially with smaller organizations where that shared mission is explicit and discussed amongst administrators as well as clinicians. And when you do that, then you want to learn from the other person.

And tell me about your experience. Tell me about the pressures as an administrator that you have to keep the bottom line going. And I'll listen to you as long as you listen to me about the hassles I have to do with trying to check all the boxes you want me to check. And I think if people are able to see each other as humans and move forward in that, then I think they can get along. And I also believe that money is not always the answer and it's turning out I think especially during this pandemic, that time and the quality of how you spend your time is so much more valuable to people.

John: Right. Absolutely. Anecdotally, I think there's evidence that large systems that are actually run by physicians, that understand one another, have more engagement with the other physicians and actually their burnout levels are lower. So, that's why I encourage physicians to get into those leadership positions because yeah, you can improve it even within a broken system.

Dr. Joe Sherman: Yeah. And I think sometimes it's intimidating and it's interesting because when I do individual coaching, individual coaching in the corporate business world is thought to be a perk. It's thought to be, "Wow, I got a coach. This is great."

John: That's right.

Dr. Joe Sherman: But for physicians, it's thought to be a little bit kind of like remedial, like you're behind in your charts, you're causing a problem in the OR, we need to coach you up so that you act better. So, when coaches, even when they get to leadership positions, sometimes they think "Coach? Oh, gosh. I don't want you to, because I just need to learn how to be an administrator. I need to learn business." And it may be true. You need to learn the vocabulary, but you're not in the room. There's plenty of business people in that room. They need people who can tell them this is the implication and the impact of that decision on the clinicians when you make that change.

John: Yeah. So many of them just really have no idea if they've never been a clinician at any level. There's a lot of nurses that run hospitals and that kind of thing. But when you have just the MBA, it's doing it. They really don't understand the physician-patient relationship or what a nurse really truly does. Okay. So now I want to pick your brain a little bit more because you mentioned the book earlier and you mentioned Let Your Life Speak and you mentioned Soul to Role.

Dr. Joe Sherman: Yeah, that's correct.

John: Which you explained, but can you give us a little bit more about how I might be able to figure that out? I'm one of those people like, I don't know how I feel and how am I going to figure out what I really enjoy doing?

Dr. Joe Sherman: Yeah. As physicians, we're very much in our heads all the time. And the strangest thing is that we deal with the body. I mean, that's what we're dealing with. We dissected it. We do study physiology, all that stuff. We're not very in touch with our own bodies. And we're not very much in touch with our emotions, our soul, whatever you want to call it.

A lot of times, I think "What are you talking about this solar role? What is it?" Well, one thing is to say, and what we talked about before is think of an experience that you've had where you've felt those things that I said, "I wish it would never end or I can't wait to do it again." And then you look at it and you say, "Wow, who was involved? What was the setting? What was it? What are the values I was living out? What were the feelings? How did it feel in my body? What were the emotions I felt?"

Now I have to say, for me, you have to be pretty elementary with physicians. They say with myself too. So, I have a list of emotions, a list of feelings, a list of body sensations. Pick something, circle these things on the list. And the reason that I say to do that is that you get to know your own body, your own emotions better because our brains can tell us all kinds of things. In that job where I just went downhill, my brain was telling me, "Work harder, work harder. You can do this. You've done it before." And my body was getting deteriorated and my soul was shrinking, but I wasn't paying attention to that.

I think paying attention to those things and then say, okay, these are the values I was living out. Connection, service, social justice, whatever, compassion. These are the things that I really felt I was living out in that moment. Okay. Now, as I look at my practice, where do I feel those sensations, those physical sensations and those emotions and live out those values? Is it present in my practice? Oh yeah. When I see a mom with a newborn baby and she's in my office and she's in tears and says, "Oh gosh, I feel like a failure as a mom." Now, to me, that hits all my values. So, I sit back and I don't say, "Oh, come on. You were great. You're a great mom. Come on. You do a great job. You'll be fine."

But I sit back and I say, "Wow, tell me about what that feels like. What does it feel like to feel like you're just a failure as a mom?" And then really pay attention and listen. Now that's me. Those are my values. That's the kind of thing. Now, other people may not be like that, but it's important to know what are those things that really make you click? What is your "why" and what are the things associated with that? And then if you can expand the number of experiences in your job where those values are present, and those feelings are present and try to push away those things on the other end of the spectrum which you feel like go against your values and are miserable and you can't stand, then your job satisfaction can increase.

They found with academic physicians, this group one study that was done found that if they can say that 20% of their activities during the course of the week are things that they're passionate about, then they'll deal with the other 80%, no problem. But we don't even have that. We don't have 20% of anything. And then that is what is happening now as more and more physicians are finding that a hundred percent of what they experience is just drudgery.

John: Yeah. I think back when I was burnt out, the way I summed it up was I just started hating my patients because I always said, medicine is fantastic if it wasn't for the patients, which is kind of an oxymoron there, but then you know something is wrong.

Dr. Joe Sherman: Yeah.

John: For sure. I have a pediatrician friend who loves taking care of kids and the families of the kids that have attention deficit disorder. He loves teaching the family. He'll spend an hour if he can do it, it's hard in today's practice. But he's trying to figure out how to do more of that and less of something else. And so far, I think he's been at least a little bit successful. So, that makes sense.

Dr. Joe Sherman: Yeah. Right now, I still do some clinical medicine I fill in for physicians at a clinic where I used to work. And it's a group of physicians that decided to start a nonprofit private practice because they had a mission, a common mission that we all wanted to serve, and we wanted to spend more time with patients. So, we said, okay, we're going to compromise our income a little bit, but we're going to have 45 minutes of child visits. We're going to have 30-minute acute visits and follow ups. We're going to have one hour for every ADHD evaluation.

And then we found that unrecognized autism was a huge issue. And so, we're going to start figuring out how we can be a center of excellence to do autism evaluation. These are things that are possible to do. You have to be a bit creative. You have to really look and say, "How can I look at all possibilities and not just say, oh, I called my friend for residency and it's just as bad for her. So, I'm stuck. I'll just stick it out with the hell?"

John: I spoke with a guest not too long ago, who is seeing a big resurgence of direct contracting, they call DPC and I think it's being driven by the large employers and they're just trying to get rid of the insurance companies and just contract directly with physicians so that they can do the 30-minute, the 45-minute visit. So maybe there's some hope out there. In the meantime, try and focus on what you said in terms of finding those things that most resonate with your vision and your values. So, tell us, you're doing individual coaching too in between the retreats that obviously aren't happening every other weekend or anything.

Dr. Joe Sherman: Yeah. Right.

John: So, give us the whole rundown. What's your website and how does someone contact you if they want to learn more about your coaching or your retreats?

Dr. Joe Sherman: Sure. My website is joeshermanmd.com. Very simple. And if you just plug that in and search it, then you'll find my website. And you can email me directly. It's joe@joeshermanmd.com. And on my website, if you go there, there's an option to schedule a free 30 minutes consultation. And I would say the individual coaching, if somebody is feeling, I mean, there's a variety of things. If you're just feeling like, "Boy, I just want some clarity in trying to make career discernment about what direction to take." That's great. That's a reason for coaching. If you feel like bosh, "I am just burned out completely. I feel like I just don't fit anymore and I don't know what to do. I'm kind of confused." That's a reason for coaching. If I feel like, "Wow, I just transitioned to this new job and I really want to make sure that I get off on the right start and I don't commit to things that I really don't really like doing. And I have that tendency to never say no." That's a good reason for coaching, setting boundaries and so forth. Usually with this consultation, find out a little bit about what the issue is. Talk a little bit about this philosophy of examining your life and then integrating it into your experiences and then coming back and seeing how it worked or didn't work. And decide then whether it makes sense to continue on with individual coaching programs.

John: Sounds good. This episode is probably going to be released sometime in August. And so, I did want to mention that your next retreat is actually going to be held in September. I think the third week of September, something like that. Is that right?

Dr. Joe Sherman: Yes. Correct. It's September 22nd to 25th and it's on Whidbey Island, Washington. It's right off the coast of Seattle. And it's a beautiful, beautiful setting right on the beach with the majestic Olympic mountains in the background, which includes some kayaking and mountain activities.

John: Oh, nice.

Dr. Joe Sherman: Yeah. It's the best time to be in the Pacific Northwest. Everybody hears about the rain in Seattle, but come in September, that's the beautiful time.

John: Excellent. I always think of all those people out in Washington, they seem to be so outdoorsy and fit. I'm in the Midwest where everyone's fat and lazy.

Dr. Joe Sherman: I'm a transplant out here. So, I'm still trying to. My wife is from here, so she's a little bit more focused to the outdoors. I'm doing my best.

John: I would love to be able to just throw a kayak in the lake or the river and hop in and do it. I mean, I've kayaked a couple of times, but when we're living in the Midwest, you got to struggle to get any kind of activity. We live in the cornfield. So, I guess if you want to just jog, you're okay. But you got a lot of options out where you are.

Dr. Joe Sherman: Yeah, there are. Yeah.

John: My listeners, you better try that because it'd be like a vacation. You're going to be gone for two or three days. You actually are going to learn something. You can get CME credit, you're going to have some insights into how to make your life better and then do some sightseeing and get a little exercise all at the same time.

Dr. Joe Sherman: Yeah. And speaking of CME credit, actually, you can get CME credit from individual professional development coaching too. And that's one thing that I tell my clients or potential clients is that they're not category one, but if you look at whatever your state licensing requirements are, you can have a certain number of category two, category three. But for professional development coaching, you can apply CME credit for those for state licensing.

John: Yeah, definitely. It's usually category two and most states will accept that. They don't always require category one for sure. Excellent. Well, this has been fun. I guess we're running out of time. Well, we're over time now, but that's okay. We're having a good time. So, I really appreciate you coming on the show today, Joe. This has been very fun. And I look forward to hearing about what you do over the next few years with this coaching and consulting that you're doing. I appreciate you for being on the podcast today. And with that, I have to say goodbye.

Dr. Joe Sherman: Thanks so much, John. I really appreciate the invitation and chatting with you.

John: It's been my pleasure.

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Find the Fulfillment of a Freelance Remote Yoga and Meditation Teacher – 250

John Jurica — Tue, 31 May 2022 19:30:21 +0000

Interview with Dr. Rachel Beanland

In today's podcast, Dr. Rachel Beanland describes her transition from working for the NHS to becoming a freelance Yoga and Meditation Instructor.

Dr. Rachel Beanland completed her basic medical degree in the United Kingdom at the University of Bristol. A few years later, she completed additional Public Health training at the University of Sheffield.

In 2019 she founded Resilience Yoga. Resilience Yoga creates personalized classes for clients to build their own yoga stories and live more mindfully. In her Yoga practice, she helps women in medicine understand their needs and prioritize their health. She does this using evidence-based approaches, enabling clients to make conscious decisions and live a life they love.

She is now able to do both public health consulting and yoga and meditation practices.

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.

Journey to Public Health Specialist and Yoga and Meditation Instructor

In the UK, you can go begin your medical training at the age of 18. Dr. Beanland did that at the University of Bristol in the Southwest. During her 4th and 5th year, she had the option to spend time either overseas. She went to South Africa to a rural hospital where they were piloting the prevention of mother-to-child HIV transmission and HIV treatment. Subsequently, she returned to the UK to finish her training in adult medicine.

When Rachel finished her training, she decided to move to France and start working with United Nations organizations. For the last 8 years she's been working with the World Health Organization, the Joint United Nations Programme on HIV and AIDS, and academic institutions. And she found that she can work independently doing consulting, which enables her to balance her time between that and teaching meditation and yoga.

Yoga and Meditation

Rachel has been a yoga practitioner for years. In 2008, she developed a much more consistent practice, which led her to complete teacher training in yoga and meditation. Now, she balances freelance consulting work with yoga and meditation instruction.

In Resilience Yoga, she offers one-to-one programs using Zoom on a weekly basis over a three-month period of time. She also offers live teaching using the InsightTimer app. And that enterprise is run as a not-for-profit.

She is also working on a new course which is the Breathwork session. It's a really simple tool to use, to reduce stress and anxiety for healthcare workers in their clinical environment.

The morning's guide to yoga is a really simple practice. It won't take very long and it's based on six movements of the spine. You can do it right in your pajamas next to your bed.

It's the first thing you do when you wake up. And it's just a really nice outline that someone can get started with… That's what I like to try and do with people: just to give really simple things that you can add in.

Summary

You can find Rachel at resilienceyoga.fr or on LinkedIn.

Then check her podcast, “Authentic Tea” where she connects with coaches in medicine who have found their way to balance. She also highlights people who've explored lifestyle medicine, yogis, and people who have stepped out completely of medicine and are now doing other things.

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 250

Find the Fulfillment of a Freelance Remote Yoga and Meditation Teacher

John: Well, today I have another international guest who's originally from the UK, who's living in another country in France. She can tell us about that. So, I'm just happy to be able to expand our reach here to outside of the United States. With that, hello, Dr. Rachel Beanland.

Dr. Rachel Beanland: Hi. Hi, John. Thank you for having me. I'm excited to be here and to chat with you today.

John: Yeah. We just love talking to physicians that have gone through some career changes and have responded to whatever happened in their life that prompted them to reach out and try something new. I think this can be very instructive and inspirational and it can be fun to hear about your background, which is different from my usual guests. So, thanks for coming on.

Dr. Rachel Beanland: You're welcome. Thanks for having me.

John: All right. Like we usually do here, the first part here is we're going to let you introduce yourself a little bit, tell us about your medical education and background. In fact, if you want to expound us a little bit to remind the US listeners how the system is a little different. And what I was trying to get into too is, at what point did you segue from general practice or the training into public health, which is a big part of what you do?

Dr. Rachel Beanland: Yeah, sure. As you said, I'm from the UK originally. I did my training in medicine in the UK. And in the UK, you can go straight in at 18 to do your five-year training. So, I did that. I did that at the University of Bristol in the Southwest, a beautiful part of the UK, if you ever make it over there. I really enjoyed my training. And towards the end of my training, it's usual for us between our fourth and fifth year to usually spend some time either overseas or in a different environment so that people can get an experience of what clinical medicine is like somewhere else. So, I actually spent some time in South Africa then. And I was very fortunate to be in a rural hospital where they were actually piloting prevention of mother to child transmission, HIV treatment.

At that time, ART wasn't routinely available for adults or children in South Africa. And they were just starting to get more medication to people and to trial things. And actually, I think that experience really opened my eyes to a lot of different things, definitely to inequality across the globe, but also to the world of prevention and looking at how we could balance prevention and treatment. And it sparked an interest in me looking at global health as a bigger picture. But I went back to the UK, I finished my medical training and I worked in clinical medicine. So, in the UK, straight out of med school you do a year where you're sort of preregistered, and then you're straight on the wards from that moment, from the first year onwards.

I decided to continue training in adult medicine, which would be in internal medicine in the US system. And I went through various rotations, the normal kind of rotation that you would expect. So, cardiology, hepatology, et cetera. And I really enjoyed it. I really loved it. I loved working in a team. I loved the connection with patients. I didn't love the exams. I was doing more and more exams and it was very difficult to balance the studying and the clinical environment. And I also realized that I was seeing a lot of patients again and again, coming in and starting to realize that there was a limit to what I could do in a treatment capacity. So, I think that was starting to come through in me that I wanted to kind of explore a little bit broader, what could I do that was slightly broader. And at the same time, I also found that environment quite draining in my own energy levels. And I probably wasn't really looking after my own physical or mental health very well. If I now reflect backwards, I can see that I was just on a roller coaster.

John: Right.

Dr. Rachel Beanland: And there was a point where it was quite interesting because the system in the UK changed. So, the training system changed. It used to be that you could continue doing placements whilst you were getting exams, and you could wait till you then moved on to the next specialty. They changed that and they enforced a much stricter rule. So, you had to have a certain amount of years. If you'd gone over those years of practice, but you hadn't finished your exams, you were forced to either stop that specialty or find a different specialty.

And that in a way, I always think threats can be opportunities. At the time it was quite stressful, but it made me reflect a little bit on where I was going with my career. And that was when I decided I would take a clinical research post. So, I step out of the wards, I took a clinical research post in sexual health. I wanted to see really what it was like not being on the wards full time and whether I would miss the physical sort of interaction with people and the clinical contact. And I realized that, yes, there were lots of parts of clinical work that I had enjoyed, but I could see that by focusing more on the more upstream aspect of health and health systems and health policy, that actually I could still feel very fulfilled within my medical career. So, I decided to specialize in public health.

And so, in the UK, the public health training is a five-year program. You do a master's in public health as part of that program. And then you do a rotation around different public health bodies in the UK. So, you spend time at national level, regional level, and then obviously the local level. I was able to do that, and that really gave me an enormous portfolio of skills, really, to look at population health differently. I did to begin with, I hung on to a bit of clinical work. I'd been doing more and more infectious diseases. So, I continued doing a TB screening clinic.

And then I was at a point where I realized I couldn't do both. I had to make a decision because it was hard to dip into clinical medicine and feel confident and up to date with everything. And at the same time, I needed that time and energy to pursue a public health career. I always continued wanting to look at global health, and I think that comes from that very early experience of spending time in South Africa. And I also, during my internal medicine training spent some time in Honduras as well, working in a clinical setting. I think both of those experiences gave me a motivation to want to try and address inequality in health across the globe.

So, when I finished all my training in the UK, I decided I would like to come across to France and start working with some of the UN organizations and explore what that looked like. For the last eight years I've been working largely with UN organizations like WHO, UNAIDS, IMO, those organizations, but sometimes academic institutions as well.

I've kind of found that I can work independently and do contracts and consulting, and it allows me to find the teams and the people that I really enjoy working with and pick up work that I find interesting and that I can use my skills for. So, that's how I found my way to becoming an independent public health specialist as to where I am today.

John: Very nice. You completed the formal training about eight years ago. I don't know if the entire time of these eight years you've been an independent contractor or with some of that with employment. But it's really all the same thing. You're doing that kind of work. And for my listener's benefit, public health, like you said, there's opportunities to actually see patients, but you can do a ton in public health, which doesn't require daily face to face interacting with patients.

And to me, it reminds me of when I was a chief medical officer for a hospital. I was having this impact on thousands of patients, but I didn't actually have to sit down with a patient and deal with an EMR and do those sorts of things. So, I kind of get that you had a similar type of feeling.

Dr. Rachel Beanland: Yeah. And I think now, it took me a while to adjust. I think I was so used to seeing immediate feedback. Someone would either get better or they would. And you knew that very quickly, you'd get the very sick patient come through, acute medic, and then you'd think "Okay, we're going to do the X, X, Y, Z, or this isn't working, now we're going to try this." You would have your protocols. You felt very familiar with it.

And when I stepped into public health, I've realized the impact can be so much bigger, but I probably am never going to see that impact. Maybe somebody else will in my role, or maybe it will take two or three years or longer. And so, you have to kind of be very happy with that level of uncertainty. And I think that comes from having a sense that you know what you're doing. It has the potential to impact the lives of hundreds, thousands, millions of people.

And so, one of the things I was able to work on when I came out here to live in France is working with the WHO on their HIV treatment guidelines. And it made me realize how sort of circular it's been since that medical student that went to South Africa and saw hundreds of people with HIV who were dying at that point because they didn't have any treatment. And so, it's been really interesting for me, in my journey to kind of realize that that experience has probably shaped my passion for wanting to look at what else is going on in the world and to try to do what I can to make an impact on that somehow.

John: Yeah, I think that probably would resonate with a lot of physicians. And I would encourage, we don't talk about public health very much on the podcast, but actually some of the people that I've known that have been "nonclinical" were in public health and it's an area in the US where it gives you a lot of different options in terms of medical writing and you can work in prisons, you can work with public health service. And again, it's at a level where you're dealing more with your measuring outcomes. They are long term, like you said, it's not like a month or a week. It's a year, two years, three years longer, but you're working and you're affecting lots of lives. In fact, that's another good thing that you brought up because one of the things that irritates physicians sometimes is fact it's one patient at a time. And if I leave this clinical thing, I'm not going to have the impact, but the reality is in many nonclinical including this, you have a much bigger impact long term, and more even global, like you're doing.

Dr. Rachel Beanland: Yeah. And the potential to reach a lot of people. I think that is the positivity around it and the options. And I also think public health is incredibly broad, like you say. So, it also has allowed me to explore different aspects of it. And there's parts of public health that really don't suit me very well at all, but it's allowed me to kind of see who I like working with, what I like to work on. And I still maintain all the infectious disease that I was doing in internal medicine. So, most of my focus is on HIV and TB. And obviously COVID has been a big focus for so many physicians over the last two years. I think that's the joy of medicine actually in so many ways. It's so broad that there are so many things we can do with the skills. And what I really like to try and encourage people through some of the work I do now is that we shouldn't be afraid to try and explore it because it's there for us to do that. And there's so much there that you can find something that you feel really passionate about and feel joyful about waking up to do.

John: Yeah. I think a lot of us have tunnel vision because we just have this fantasy of what medicine is. Okay, we're going to become a family doctor, an internist or surgeon, and we're going to be in the hospital doing operations. And we don't even realize that there's so many things that physicians can do and should consider, and just have to spend some time and learn about what those are. And some of those are very close to clinical, like public health and others are completely nonclinical, more of leadership in whatever venue it might be. So, are you doing this pretty much full time right now? Or have you segued into other things?

Dr. Rachel Beanland: Yes. I would say about 50% of the time I do public health. Depending on the contracts that come through, sometimes it can be quite concentrated, other times it can be one or two days a week. But I think what it has allowed me to do is to explore other passions in my life. And one of those things that came into my life at the same time that I stepped out of clinical medicine was yoga and meditation. So, it was quite interesting because it had always been something that I had been interested in exploring, but I never had the time or the energy to do it. I was terrible at canceling classes. I would see people and think, "Oh, I'm not sure that's me."

And I think taking a step out of that tunnel vision, traditional role, allowed me to just try to be myself more. I think, like you say, we kind of go into something and we feel like we have to follow the steps that everybody in front of us is following. And there were times where I really didn't feel like I was being myself. And when I was able to step away and have that moment of reflection, I could start to explore other things.

So, yoga was one of those things for me. And since 2008, I've just really developed a much more consistent practice with it, which led me to do my teacher training, and trained to be a meditation teacher as well. And so, the other half of my working week, if you like, is spent on developing my yoga and meditation business and sharing that with other people. And the majority of the people that I have in my community and my clients are other women in medicine, because I think it's me sharing my experience and understanding the environment that these women come from, allows me to support them to make changes in their lives.

John: Now, is that something that's pretty much 100% remote access, or are you doing anything face to face?

Dr. Rachel Beanland: Yeah, it's all remote. It is sort of mainly because of the pandemic, again, an opportunity but I think the online world is an interesting one. As an individual and with my own wellbeing and my kind of conscious practice, I can see that there can be lots of negative things about the world of online and social media. But I think it's such an amazing way to connect to people. You and I are assisting here in completely different time zones, having a conversation. Without the use of social media and all these different platforms, we wouldn't be able to do that. So, it is amazing to be able to connect to my clients and my community in other countries, to women working in different environments, to other clinical settings and to share my support with them.

It wasn't my intention necessarily when I started my yoga business, but with every business, I think you have to evolve and adapt and see where it takes you. And that's actually something I found interesting. I don't know whether you've had this with any other guess, but when you step out of medicine, particularly out of clinical medicine and you maybe have your own business and you start something, you suddenly have a lot of ability to be really creative. You can make up your own rules, you can decide if something's working or not.

And I think for a lot of medics, that can be quite scary because we're so used to protocols and being very driven by what's the right thing and the evidence driven approach. And it's quite different to suddenly be able to decide which day you want to launch your podcast on, or what your course looks like. And if it doesn't work, you can take it off again, these sorts of things.

John: Yeah. I would think that's definitely true. And also, in medicine, you pretty much have to be perfect in the sense that you want to use protocols. You want to follow the right way to do things, keep people well, don't injure them. And the wrong thing done at the wrong time is you can easily hurt a patient. But in business it's no, you should try different things. And maybe half of them will fail. It doesn't matter. Each failure is just a learning experience and you move forward. So, it is really difficult for many physicians to make that adjustment.

Dr. Rachel Beanland: Yeah. It's a big change. It's a very different thing, but I think one of the real positives that come for me is being able to have that creativity blogging or podcasting, whatever format you choose to express your ideas and your experience to your community. It's a really creative avenue, which I don't have in my public health life. I think that's where I love doing both of them because they allow me to have maybe slightly different parts of my personality in both of my roles. And so, I quite like how they balance each other. I quite like how they kind of sit alongside each other. And I think one without the other probably wouldn't work for me.

John: Yeah. It's nice to have that balance. I wanted to ask you about yoga and meditation, the online remote coaching, and consulting or teaching. So, everyone does it a little differently, I think. I've had a few other guests that are doing some aspect of that. So how does it work for you? What are you actually offering? Maybe you should tell us the website to find all those things, but tell us what you're offering and how does that look? Are you doing video courses, one on one, groups? How does that look?

Dr. Rachel Beanland: Yeah. My brand is called Resilience Yoga. Within that, the majority of the work I really like to do is one to one, because I can really see a greater benefit by working with people individually. And so, what I like to offer is a one-to-one program, which is a coaching relationship over a three-month period of time, whereby we work through whatever the transition is that someone is going through. Sometimes that's a career transition. People thinking about moving outside of clinical medicine into something else. Sometimes it can be a life event, either moving home a bereavement, something has happened, whereas somebody needs that additional support to kind of make those changes that they want to do. So, I really like doing that one-to-one and that's done online. We do Zooms and we connect to each other like that on a weekly basis.

And then the other work I do is through offering live teaching. And I do that through the Insight Timer app, which if anyone has not explored it, I would definitely recommend. It's an amazing app because it has so much content on there. Lots of guided meditations, lots of talks and podcasts. It has some yoga classes. And what it does is it has a free version of the app and a paid version. And the whole model is run as a not-for-profit model. So, it's a really nice space. It's a really safe space. It's a really positive environment. And I offer lives on there.

So, some of the things at the moment that have been really popular is breathwork because I do a breathwork session on there for healthcare workers. And it's a really simple tool to use, to reduce stress and anxiety. And I find that for a lot of healthcare workers it can be an amazing thing just to learn some really simple techniques that they can take into the clinical environment.

And at the moment I'm pulling together a course which will be based on more of those breathwork techniques, but going into it in much more detail. So, I'm hoping to be able to launch that in the next month or so, and share that with my community. Those are my sort of main ways of reaching out to people. And then within the website that I have, you can find my podcast, which I really loved doing because I spoke to lots of other women who are in medicine who have found their way of balance, whatever that looks like to them. So, there are a few people who are coaches, a few people who've explored lifestyle medicine, another couple of yogis, people who have stepped out completely of medicine and are now doing other things. So yeah, that was really fun to do. You can find all of those on my website as well as the other podcasting channels. But like speaking to you today, I really enjoy that interaction one to one. I think it is really nice on a podcast and listening to a podcast. It's a really nice way to hear more about somebody.

John: So, what's the name of the podcast?

Dr. Rachel Beanland: My podcast is called Authentic Tea.

John: Authentic?

Dr. Rachel Beanland: Tea. Like a cup of tea. The idea is we're having a chat, a cup of tea and being our authentic selves. Yeah.

John: All right. They can probably find that on any podcast app, but they go to your website and obviously get access to it as well. Okay, that's good to know. I'll put that in the show notes. So, it sounds like even with the public health side, it is consulting, it's flexible. And so, you kind of match it and if you have to cut back on the meditation and yoga, because you have an intense consultation for a while, that's fine, but then the next one might be a little less intense and then you can ramp up the other. It sounds like you've found a pretty good balance career wise and hopefully in the rest of your life. But in terms of what you're doing to help others, it sounds pretty awesome.

Dr. Rachel Beanland: Thank you. Yeah, it is really nice to have balances. And one of the reasons I was able to do my teacher training was because I've realized that with my public health contracts, there would be sometimes months where I wouldn't have so much coming through just because of the nature of the work. Sometimes it's very busy at the beginning of the year. Anyone who's worked as an external consultant will know that a lot of these consultant roles come through from funding. So, people's funding periods finish and then they don't have any funding anymore.

So, there is a cyclical element to working like that independently and that can be a bit uncertain and can add in a different sense of stability. But what it allowed me to do was to explore something else. It gave me that space to do my yoga teacher training. And like you say now, it gives me that time. If I have less, I do more in my yoga business. If I have more going on in my yoga business and I have more clients coming in, then I don't look for another public health contract until later on in the year. So, I really like the variety of it that it's allowed me to do. And I think maybe that was something I've always really enjoyed. I quite like it if my weeks don't look the same. I'm quite happy with that. Some people aren't, but I quite like that.

John: Yes. All right. Well, in the past I've usually tried to do... Someone's doing a hospital management or UM job or something and I'm like, "Okay, well, how satisfied are you with that?" I'm going to put it to you. Doing everything you're doing now on a scale of 1 to 10, where 10 is Nirvana perfection, and 1 is like living in hell. Where do you feel like you're fitting right now with respect to your life and your work and the integration of all those things?

Dr. Rachel Beanland: Yeah. That's a nice question. I would say nine. It's close to a 10. I think the other thing that working as I do, which has allowed me to do is to explore living in a different way. So, we do live in the mountains here. We have a space outside, which I could call an eco-farm. We have lots of low energy solutions, lots of environmentally friendly things going on outside. We try to live really consciously about everything we're doing. And so, I know that my work and how my work is allows me to live this life here. So, there's not much that could be better about that.

John: It all sounds very intentional. There's a lot of physicians who live lives that they're just going along with it. They're being pushed by some other force. They're not really doing what they want to do. They don't necessarily wake up in the morning actually thinking "I'm looking forward to my day." And as far as the eco-friendly, I think in the US, there's something called homesteading where you sort of grow your own food and you use less energy and it sounds very similar to that. And you're kind of out in the country. Yeah. That I think is healthy and it's good for us. So, this has been very inspirational. I think it's going to be a good message for other physicians who think that, "Well, we don't have control. We can't really decide what we're going to do and how we're going to do it." And so, that's been very instructive. Let's see. I think we spoke before briefly at one point and you have something that you think the listeners might find helpful. It's a guide to... Is it Morning Yoga?

Dr. Rachel Beanland: Yeah. Morning Yoga. Yeah. I think you are right about the intentionality of things. I think in a Yogi world, we talk about being and doing. So, I think in medicine, a lot of the time we're doing, doing, doing, and we can create our lives to be so busy that we have so little time to actually take care of ourselves. And that's what I find with a lot of my clients is that they're often so busy giving to other people that they've stopped actually looking after themselves.

I think when you're trying to add in techniques like yoga meditation, the key thing is to keep them so simple. And that's how I started my practice. I added it in five minutes. Five minutes in the morning. And I always say to my clients, if you can just make that extra five minutes in the morning, it will set your day up to be completely different.

This morning's guide to yoga is a really simple practice. It won't take very long and it's based on six movements of the spine. You can do it right in your pajamas next to your bed. The first thing you do when you wake up. And it's just a really nice outline that someone can get started with. And I think that that's what I like to try and do with people is just to give really simple things that you can add in. And who knows where that may build onto, but I think we have a danger sometimes as medics to want to overperform. And I've definitely done this in the past where I think this week, I'm going to do a two hours yoga class.

John: Yeah. Right.

Dr. Rachel Beanland: But I think actually we have to start small. We have to start small, and add it in. So yeah, this is a really nice outline of a yoga practice. And if you go to my website, you can find the link there, but I'll share that with you as well, John.

John: Okay. Excellent. For those that don't want to listen or go to the show notes or go to your site, just so they know, it's at www.resilienceyoga.fr/guidetomorningyoga. They'll be on your website when they go for that, because it's got that URL in there. But I'll put that in the show notes. And listeners, please send me a note and tell me if you find that useful. Well, I'll look it up myself too. So, I'll make my own distinctions.

Dr. Rachel Beanland: Thank you.

John: All right. Rachel, I think we're pretty much out of time here, at least the goal that we set. So, I really appreciate you for being here and telling us. And again, I think it's been very inspirational. Hopefully people will listen and think "Maybe I can make a change and achieve a life where it's a little more balanced and in keeping with my values and my health." Any last advice for our listeners before I let you go?

Dr. Rachel Beanland: Oh, well, it's been an absolute pleasure speaking to you. And so, I would just say to the listeners out there, I think it is really important to be able to take a little bit of time to think about, like you say, your values and to reflect and to know that you can be yourself. I think that the most important lesson I've learned is that you will find something where you can feel yourself. And if you're not feeling yourself in what you're doing, then that's the moment to take a bit of reflection.

John: Very good. All right, Rachel, thank you very much. And hopefully we'll catch up again sometime down the road. And with that, I'll say goodbye.

Dr. Rachel Beanland: Thank you, John. Thanks everyone. It's been wonderful having you.

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How to Use Consulting and Advising to Find Freedom – 249

John Jurica — Tue, 24 May 2022 10:30:02 +0000

Interview with Dr. Carl Peters

In today's episode, Dr. Carl Peters describes his transition from traditional practice to telemedicine, consulting and advising.

Dr. Carl Peters graduated from the University of Missouri-Columbia Medical School. Then he completed his Family Medicine Residency Program at the University of California, Davis. He is board-certified in Family Medicine and Urgent Care Medicine.

The first stage of the pivot was to learn everything he could about properly establishing a freelance telemedicine practice. Doing so enabled Carl to generate sufficient income working just 6 hours per day, 4 days a week. Once that was established, he focused on nonclinical activities to supplement his income.

A Family and Urgent Care physician with 25 years of experience and over 10,000 telemedicine visits, Carl is now offering his expertise in a variety of ways.

He previously provided direction and expertise as medical director for a network of 12 new urgent care centers. The health system he worked for opened all 12 in about 17 months. He is now the Director of Patient Operations and Lead Physician for Bow Tie Medical. And he continues to provide consulting services and occasional telemedicine visits.

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.

Telemedicine

Dr. Peters set up his telemedicine company as an independent contractor serving several telemedicine companies. These included large telehealth companies like MD Live and Teladoc.

He decided not to do block scheduling because he wanted to be efficient with his time. He generally works 4 days a week. That way, he is able to run errands and explore other employment and consulting opportunities on his off-days.

Here are some of the important steps Carl advises you take when creating a flexible non-employed telemedicine business:

Obtain multiple state licenses (one in each U.S. time zone, if possible).
- Each telehealth company gives you the big population states of California, New York, Texas, and Florida. But you may want to focus on states such as Indiana or Utah, where there is often a greater need.
Do business in a state that's part of the Interstate Medical Licensure Compact.
- That makes it easier to obtain additional licenses. You don't want to do more than four to six states, however. Spread them out geographically.
You will need a decent internet connection with 2 carriers. You can use your phone's hotspot functionality as a third backup.
Set up your connections to optimize your efficiency.
- Carl is generally working on one internet service using four monitors. The center monitor is his working monitor. And he keeps each telehealth company site open on an individual monitor so he can watch and select a patient that comes into a waiting room. He uses his own templates to improve his efficiency, dropping them into his notes as needed.

Preparing in this way allows him to interact with 6 to 8 patients per hour on most days.

Consulting and Advising

Once he felt confident that he could generate sufficient income through telemedicine, Dr. Peters actively sought nonclinical work. He signed on with a company that wanted to develop a new network of urgent care centers. As the medical director, he helped the company open 12 new clinics over a 17-month period in eastern Missouri.

He then looked for opportunities in consulting and advising other organizations. That lead to his role as Director of Member Operations and Lead Physician at Bow Tie Medical. Bow Tie Medical brings telemedicine services to employers to improve care, enhance quality and access, and reduce costs.

Dr. Carl Peters' Advice

When medicine is just not fun, it's frustrating, it's not fulfilling… the biggest thing is to research and learn and network and connect… Second thing, if you're not sure where you want to go, I'd say, keep it diversified a little bit. Maybe don't put all your eggs in one basket.

Summary

It can be more interesting and rewarding to diversify your job situation. By networking, you can find jobs that play to your strengths. Dr. Peters found the best networking opportunities on LinkedIn, Doximity, and Health Tech Nerds (HTN), or talking to old schoolmates, and co-residents.

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

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Transcription PNC Podcast Episode 249

How to Use Consulting and Advising to Find Freedom - Interview with Dr. Carl Peters

John: Today I have a fellow family physician who has responded to his frustrations with the current health system, as many of us have in his own unique way. And I thought you'd find it instructive. Hello, Dr. Carl Peters.

Dr. Carl Peters: Hello, John.

John: Hey, it's great to have you here. We had a chance to talk a little bit. And by the way, I didn't mention that you and I were linked up by Tom Davis. I think a lot of my listeners know who Tom Davis is because he's been on the podcast a few times and people know we partnered together on New Script. I was happy to be introduced and find a fellow physician that went through the process that many have. So, I'm interested in hearing your story.

Dr. Carl Peters: Oh, absolutely.

John: So, what happened? You were plugging along there doing family medicine. Tell us a little bit about your education and what led up to your practice, and then we'll get into what happened towards the end of that long clinical career.

Dr. Carl Peters: Yeah. Like a lot of us in family medicine, you do your residency and look at a career, lifelong career in family practice. And I did that for about 15 years or so, and kind of hooked up with a company in the St. Louis area that I was very pleased with. They were doing a lot of great things, but unfortunately, I joined them just as the ship was taking on water.

Within about 18 months I knew things were in bad shape. And by 24 months I left. By then I was getting a little frazzled with family medicine, just not the actual caring of patients, but just the business, some of the background stuff, the electronic health records, and all the things that get in between you and me as a patient and a doctor. The insurance stuff, all the games we have to play to satisfy that, to get paid the claims and billing, how much is driven by that, really not by actual patient care. So, I started rethinking a little bit. I've always enjoyed doing an occasional urgent care shift, so I was going to just temporarily do urgent care, maybe for a year, and rethink things a little bit. I started my urgent care career, which went on for the last eight years and really did enjoy it.

But then here we go, they started strategic plans that weren't being revealed to the doctor about, "Oh, we're going to start using mid-levels and goodbye doctors." We had targets on our back. I moved to another company and "Oh, yeah. No, no doctors will always be first and foremost." But then a new model starts to come up and it looks like we again have a target on our back. And so, that got a little frustrating too, even though I did enjoy it.

And then, part of the target on the back was an operation that was going to come in and take over these urgent care centers with this health system and they needed a medical director. And it's like, "Well, shoot, let's look at that." I had some management experience, and initially, it was very rewarding. It was something that had a very excellent team initially. And we worked really hard and we built 12 urgent care clincics from zero in 18 months. So, I went from just a handful of providers to 40 under me in that time period. And it was a very aggressive growth schedule, maybe a little bit too much.

John: Let me comment on that. That is really unreal. But it goes along with what I've seen because I've been in urgent care just in recent years. It's kind of a segue into retirement, more or less. You just hear about all these different buyouts and consolidations. So, I think you mentioned maybe two systems you were working for with urgent care. In the last one you became a medical director. Were those both health systems? Those weren't owned by private equity firms?

Dr. Carl Peters: Correct. They were large health systems that owned them, yes.

John: I think it's funny because I'm sure that most health systems lose money in urgent care. If they can break even, they're happy most of the time because they see it as a loss leader to get people into the doors. But there's always that struggle. And then at some point, they reach a point where we got to start making money and that means we're going to start using the mid-level providers and the things you talked about.

Dr. Carl Peters: Yes, yes. In a way, this was a transition into a nonclinical space as a medical director, and I really enjoyed it. But in watching the model over time, it was a very lean model, very lean. The leanest I've ever seen. And you really had to be hiring rock stars for your techs and stuff like that, your MAs and techs, otherwise, it just became apparent that "Ugh, this is pretty lean." And then the business team changed out a little bit to a culture that again, to me is part of the problem in medicine in this country that just looked at physicians as they really didn't care. It just was like, "Just do what we tell you to do, and we're not going to get your opinion on anything." Just the culture changed. And at that point, the job enjoyment really started going down. And actually, most of the leadership team left after this new management took over.

And so, at that point, I became very discouraged about everything. Where do I want to go next? And I ran across Dr. Tom Davis, who actually we've known each other on and off for years. He was, I believe, a resident when I was in medical school. And I was actually searching around looking at podcasts, just like what you have here. I don't know how I came across it, but I came across Dr. Heather Fork's website. And Tom had just done a podcast that she published. And I was like, "Wait a minute. I know that guy." And I just listened to it.

It was a big life-changer for me because I linked up with Tom. We reconnected. We hadn't talked to each other in years. And basically, we started looking at alternatives. And this was just before COVID, the telehealth space was really growing, especially in the acute care market. And so, Tom has done so many interesting things.

It's interesting, the people I've met that I had no idea knew Tom know Tom. As one person said, "All roads lead to Tom." But anyway, he does a lot of many different things outside of clinical medicine and business medicine. He's a very, very knowledgeable guy. So, we hooked up and he kind of showed me a path into the telehealth space and to build my own practice.

And by then I was like I just want to control my own shots. I am tired of answering the corporate needs and business people that are just taking over more and more in medicine. And part of that's our fault over the years, but whatever, I won't get into that. But Tom, we talked for a while and it just became really clear. So, I started a telehealth practice. Tom was my mentor and followed along and helped me build this up. And it was just immensely, I just loved it. I just really loved it.

John: I got to comment on that because you must have been in the right place at the right time. Because you're getting into telemedicine, but it was before the pandemics. You're getting set up. And I know Tom, basically, he's very passionate about taking back control for everybody in medicine that was kind of promised one thing. And even the patients have been promised one thing, which is to get good caring physicians that can spend time and take care of you. And now everybody's unhappy because the physicians can't spend time and the patients don't get the time and everyone's got paperwork. I've heard that telemedicine is a way to really get a little more control, particularly if you set it up I think the way that Tom has done it. So, tell us how you set that up. And what did that turn out to look like over the first year or two of doing telemedicine?

Dr. Carl Peters: Yeah. I think it would've been very successful regardless, but this was like buying Coca-Cola stock in the 1930s and hanging onto it. I've been doing this right before telehealth, it went gangbusters. But basically, I set up as an independent contractor with multiple companies. And there are large telehealth companies like MD Live and stuff out there like Teladoc. And I set up with multiple companies, first of all, to keep diversified, because at this point too, I knew diversification and Tom certainly agreed it was going to be key to my future. Not to have my eggs in one basket, one employer, if you will, whatever.

I contracted with at least four different companies. And then I gathered some extra state licenses. I only had one at the time. And so, it could be a three-month process. I gained some more state licenses and set up my home office, and basically did the onboarding with them, which is much more abbreviated than a standard onboarding with a large system. And also, the EHR programs used by these telehealth companies are much more stripped down and you're not having to put all this inane stuff in that has nothing to do with the clinical need. And then launched and built up from there. So, I would actually work with all four companies on a given day.

And the beauty, I decided not to do block scheduling. You have a couple of options there. You can do it on-demand. So, this is kind of what I call being the Uber in telehealth. Basically, you decide when you want to turn on things. I never set an alarm. Wake up when I wake up, have my coffee, read the news as I want to do, and say, okay, I'm ready. And by 8:00 or 9:00, I'm turning on my computer and I'm starting to see patients.

There was no schedule. I didn't have anything that I had to answer to. And I would just see patients until like, "Okay, it's time for a break, take a break anytime you want to." If I want to have coffee with my elderly mother for an hour or two, perfect, whatever. Go have lunch with my brother. It doesn't matter. You control time. And this was the first time in my career that I could control time. And it was beautiful. And you just decide, "Okay, after a while, I've seen 35, 40 patients" which goes pretty quick in the telehealth space. It's like, okay, I'm done for the day.

And I would just do that maybe four days a week. I'd take a day off just to run errands, chill, and relax. And it was interesting that I was able to make the income needs that I was interested in six-plus hours a day, four days a week. So, 25 hours, 30 maybe tops. And I was making the income that was actually pretty close to, not as a medical director, but as like in the urgent care centers.

John: Yeah. Well, that's not bad.

Dr. Carl Peters: I'm pretty happy with it.

John: You don't have anyone telling you what to do. And your liability. I haven't heard there's a huge liability in telemedicine as compared to other things. And the lifestyle is better. That few dollars cut and overall pay is not much to give up. Now I've heard some stories in the past, and maybe this doesn't happen anymore, but I heard of stories like some of the companies are kind of fly by night. You have a contract and then low and behold, they shut down. They don't pay you. Have you experienced any of that since you've been doing this?

Dr. Carl Peters: No because again, Tom mentored me. Tom has, I believe it's called the Institute of Telemedicine Mastery, ITM. And he mentors you. He's very careful because he understands that landscape really well and not getting hooked up with companies that look like they're just ready to flip from you and sell to some venture capitalists or what have you. And as a matter of fact, to this day, all four companies that I have worked with are still alive and well, and nothing's really changed other than one did sell. They were integrated somewhat, but they did sell to the insurance company Cigna, but there's really no difference in their process or care.

John: Okay. Any tips, tricks, or things to avoid to the listeners if they're thinking about getting into telemedicine?

Dr. Carl Peters: Yeah. The biggest thing is you want to have a certain number of state licenses. There are some folks out there that literally have 50 licenses, but that's a heck of a lot of work to manage and of course, cost and completely unnecessary. So, you do want to have multiple state licenses. Each telehealth company says, "Oh, we really want it. We'll give you the big population states of California, New York, Texas, and Florida." And I found that now there are actually what I call sleeper states that just don't have a lot of telehealth doctors with licenses in them. And you may find you get a lot of action out of Indiana or Utah or something like that. So really you want to query them about where there is more need, we're not interested as much in population but need. They have California well represented, don't waste your time getting a California license.

Also, it makes it really easy if you happen to reside, have a business in or reside in a compact state that's part of the interstate medical license compact. And if that happens, it's very easy to get licenses in other states. There are reciprocal agreements through about 35 states currently. Unfortunately, my state of Missouri is not in the compact and so I don't have that luxury and have to do full applications. But you don't want to do more than four, five, or six states. And that should be enough. Spread them out a little bit. Other than that, your office supply. You want to have at least a five megabytes per second upload and download capability. You got to have some kind of decent internet. I have two phone carriers I could hotspot if I needed to, but I've never had any problems.

I don't have two different services for my internet. You can if you want. Some minimal equipment to purchase. I use three monitors and my center monitor is my working monitor. And I keep all four of the telehealth companies on a separate monitor so I can watch. And if a patient comes into a waiting room on one, bam, I'll play whack-a-mole and grab it. You grab them or something like that. Because the way you get patients is a little different from company to company. But I keep all four tiled on one screen. And in my third screen, I keep and I do recommend this for efficiency reasons, again, the documentation piece is pretty simple, but I have many little templates for common illnesses and stuff. And I just bring them over drag and drop them into my note. So, I'm not typing full-blown notes each time. And that way my throughput is at least six people an hour. So sometimes you get up to eight and stuff by being efficient.

John: How long did it take you to get decently streamlined the way you're talking about? Did that take a few months? Was it pretty quick?

Dr. Carl Peters: Well, again, Tom was helpful and a lot of goals and tips and stuff with that. But really it just took two weeks. I was pretty comfortable. Because you would think, "Oh my goodness, we're all used to mega EHR systems that are built or set up for billing and claims and really not about patient care." So, we're used to Epic and Cerner and all the other ones out there. But the ones are so stripped down here. That was my biggest intimidation. Like, "Oh my God, I got to learn different platforms here." But they're really not. There is simple soap note-type stuff.

John: Okay.

Dr. Carl Peters: So, it's pretty straightforward and you don't have to count all your HPI elements and review system elements, or waste your time doing all that. The eRx modules, the medication ordering is really simple and there are a lot of simplified rules that they're all pretty uniform between the companies. We're not prescribing narcotics. We're not prescribing lifestyle drugs.

John: Yeah.

Dr. Carl Peters: And stuff like that. There's a lot of uniformity between them.

John: It's interesting to me, as you're talking about that, that as family physicians, we went into it because well, we want to do a little bit of everything. But I think we've learned now what the specialists have learned. If you can narrow down what you're doing to just these 20 things or 80 things, whatever that number is, it does get a lot easier and you get faster, you get more efficient. Actually, I just kind of realized that while you were saying that, "Hey, we don't do narcotics. We're not doing (what did you call them) lifestyle drugs?"

Dr. Carl Peters: Yeah. Viagras and everything.

John: Yeah. That's a good point. I have a question. I've never done telemedicine, but there are certain, sometimes peak hours or maybe the opposite of peak hours, times when they can't get physicians. Is it possible to get a little higher payment level by going in at that time?

Dr. Carl Peters: Yes. Now, certainly of course, and they're not all the same, but some of the telemedicine companies will incentivize for after-hours and all that. But you got to understand, some of these companies will have thousands of doctors, but most of them are just doing this as supplemental work and they have a day job.

John: Part-time.

Dr. Carl Peters: I'm probably in a minority. It is a little different right now. But up until this last fall, when I was doing this at full steam, I was doing this as a primary income stream and I was doing a little expert witness. I was doing some minor advisor stuff, some other stuff, whatever. But mostly 90% of my income stream was coming from this and they don't have as many docs doing that.

But it's something that, I hope they're not listening to, the companies, that I wanted banker's hours. And the majority of patients will call between 9:00 to 5:00. Great advice I received is also to have states in different time zones. So here it is. I'm rolling in the Central Time Zone at 9:00 AM and stuff like that, but they're getting up real early on the West Coast and maybe before work, they want. So, I have a Washington state license. And vice versa later in the day, maybe the people out east are starting to get home from work. "I'm starting to have this burning when I urinate and I want to get in touch with somebody or this rash." Let's get this rash addressed. So, I could get some of the East Coast. In reality, I haven't seen a lot of trending where there's a wave across the country as the day goes by. It really just seems to be a hodgepodge. And there's a lot of people that just call from work. They go to a conference room or they go quietly.

John: Like they show you, they have shingles rash on their back.

Dr. Carl Peters: Oh yeah. Or go outside of work, out the back in the smoking zone or something like that. They're talking to you. And so, I never really found much of a trend with that. But by having six states and working through four companies, I pretty much stayed busy because the summers really get quiet. Now COVID of course, busted that, but still the methodology worked out really well to just keep volume. So, I didn't have to sit and twiddle my thumbs for 15 minutes. I just had a steady stream and I could just, "Okay, let me grab this patient, let me grab this patient." And so, it worked out really well.

John: All right. Well, it sounds like you've got that down and everything's done. You're good. You're going to just do that the rest of your life. What else is going on? We talked before that you got involved in some other activities, either to supplement that or just because it's interesting and maybe an opportunity for leadership. So, what happened next?

Dr. Carl Peters: Yeah. Well, this physician recruiter I know in my city, here. She's known me for many years. "Carl, you just want to build stuff. I know your mind. You want to build stuff and all that. I don't think this is going to telehealth or whatever. Yeah. You go do your thing." But I mean, I liked it. I really did. And there was a lot of bread-and-butter stuff you get bored within telehealth, like in the urgent care. You get your calls, UTIs and stuff, but then you get these curveballs coming your way. And it was interesting.

And the other really interesting thing I found about telehealth is if I was to predict before I started how many patients each day out of, let's say, I saw 40 people in a day. How many would I have to send for a hands-on exam? I would've sent over 25%. But in reality, remember they teach us in med school, the history is the most important thing. And by doing a real careful history and all that. And there's actually a lot. You can have a patient self-palpate, do different things or whatever. I really was astonished that I only would send one to two a day. And I still have never been sued. So, it's great news.

John: Nice.

Dr. Carl Peters: But I'm really astonished by doing a careful history. You could really take care of so much in the telehealth space. But then, I started thinking, "Well, God, you're really a family practice doc." And I didn't want my skills to get rusty. I've been doing urgent care all these years in primary care. Diabetes, chronic disease management, things like that. And I've kept my boards up, everything like that. But, again, Tom, linked me to O Thai medical in Cleveland, Ohio. And this is a newer thing building out virtual primary care, not acute care. Acute care has been done. It was going on way before COVID. Of course, COVID blew it up. But of course, there's more and more interest in virtual primary care.

It's like, "Well, wait a minute, we can do this with telehealth in their acute space. What about managing someone's diabetes? What about their hypertension and all these other things? What's the utility of putting our hands on them versus we could take care of a lot of this by ordering the right test, doing this, meeting up with them, and all that."

And so, the answer is actually a lot of it can be done. A lot of it. A lot of people are looking into space. And this is a little bit newer in this country right now. And so, I got linked with these people and started just doing a few consults with them and it was okay. A couple of operational things, nothing big. It's physician-led. This is what is really refreshing. This company is physician-led. We don't have all these business people that just look at doctors as little peons and stuff like that. And the vision of this guy, just matched everything. He and I have been kind of burned out over the years just seeing what's happened to the medicine and the waste that goes on, and the silliness.

Our vision matches on. And he goes, "Well, what do you really want to do?" And I said, "I want to build something." And it was right as this company is really starting to develop this virtual, what they call comprehensive care. Because we work with specialists, we can get second opinions from any specialists and all that. And get back to a model where a family physician should be able to take care of 90% who walk in the door.

And also managing the referrals. They do all this price shopping. They started off just taking care of people who had no insurance, but now they're developing their own insurance model. And so, there's a lot of aggressive price shopping because, heck, an MRI of the need can be $500 at a private facility. Or if you go to a big medical system thing, Cleveland Clinic, they may charge $3,000 for the same test. Blood work. A for-profit company like LabCorp charges $2.50 cents in my market for hemoglobin A1C or a CDC. So, we price shop this for people and get them the best prices. And I said, "Well, this is really cool." But they needed help in developing this so it could be scaled out.

And so, I'm really transitioned now mostly as the director of patient operations and lead physician for this company. And we currently see people across 35 states now doing virtual primary care. And we're building this up to scale into the tens of thousands of patient members. So, it's a really exciting time, with really nice people. The business team, they're not the types of folks I've run into in the past. They're all just really respectful, nice people, and work together. We all get each other's opinions and stuff and problem-solve together. And it's just been a really cool team and just kind of really got me stimulated again as like, "Wow, this is fun. I get to build something. Look at all the failures that we have in healthcare that we've been through all these years, and have a chance to sort of clean slate it and build something different."

And also look at it from the physician perspective too, John, because this intervention between you and the patient, that's slowly been growing, eroding the patient-physician relationship. How do we get that back? In this operation, you don't have to write all these notes. You don't need to count all these elements, anything. Get the meat of it down. Keep it simple. Let's give you tools. You don't need to spend all this time. And also, we're not going to have you do all this little stuff or whatever. We got care coordinators that'll take care of that for you. You are trained for your medical knowledge and that's where we want you just to concentrate on that. And not all the little nit-noid stuff that has nothing to do with patient care. So, it's pretty cool. And that's what I'm currently spending almost all my time doing now.

John: Now what kind of things do you do in that role? You're the lead physician and what is it? Patient care?

Dr. Carl Peters: Well, it's officially Director of Member Operations. They use the word "member" for a patient.

John: Okay. And so, are you supervising people? Are you creating protocols?

Dr. Carl Peters: All of it. Yes. All of it. Well, one part of the job is to supervise the providers, and also the guardian team. What we call guardians? These are the care coordinators that really are the main quarterback if you will. It's not you and me that's a quarterback. These guys are the quarterbacks. Now, they don't do clinical decision-making. They're the central quarterback that is the big patient advocate. And they would do all the heavy lifting for the stuff. But then when we need the clinical piece involved or whatever, then we get involved. And so, we're part of this team. But they're going to have many more visits with the patient than you and I would. And then what I did is develop all these care plans. There's a consultant in Tennessee that I worked with, Dr. Bill Bestermann, an internist down there. Using these current guidelines and cardiology and stuff for developing care plans for chronic disease management.

What are best practices for diabetes, heart failure, and chronic kidney disease, looking at these what we call optimal medical therapy. So, I designed these care plans that are care maps for both the guardians, but also for the providers for these various chronic conditions. And we're actually in the midst of going to start to digitize these, and everything too. So, it's care plans, managing the team, and then also how can we make all the workflows better? Everything's been re-looked at with this company and we've been doing a lot of redesigning. Taking this from a small mom-and-pop operation to something that could be scaled to tens of thousands of patients. So, very stimulating.

John: Now are they members with insurance, but high deductibles that are trying to have this stuff managed less costly way? Is it people without insurance? Is it a combination of that? Is it Medicare? How does that play out?

Dr. Carl Peters: Yeah. And that's right now ongoing, and product development is building out a health plan, basically. So, it started off as a direct primary care virtual. They actually did have in Cleveland, Ohio, an onsite brick and mortar DPC. That evolved and started to go into virtual space last year. And then we're taking that much further.

And so yes, initially there were patients without insurance. But what we're doing now is offering insurance like a captive model to employers. One we talked to recently, they're paying around $20,000 per employee for healthcare. And it's like, well, wait a minute. With our system here, we could come in and we are going to have family practice docs that are going to be practicing the full spectrum of care. They're not going to rein them in, we're going to remove all these barriers. We're going to tightly manage.

We've got a whole second opinion network. I could contact an endocrinologist or orthopedist and have nice feedback in 24 hours on that. Do we need to send that forward or can we manage it? They're just keeping these people out of the hospital as much as they can, following care plans and keeping them frankly away from specialists as much as we can until we really need them, or even co-managing, and we could keep the cost way down. And so, we are going to employers and say, "Well, we will do this for a fraction of what you're paying." This is a new product offering we're just getting into as part of our growth model or business development plan.

John: Now, this all sounds great because a couple of things I would say. Number one, talking about the MRIs, my wife is looking to get an MRI. We had this high deductible and it was going to be $2,000, but I just called around and I finally could get an MRI red, just walk in for $450 to the foot. That was it. It makes no sense to be spending $2,000 and $3,000 for imaging that's going to be one 10th of that.

Dr. Carl Peters: Yeah. And also, that actually can be cheaper than your co-insurance because a lot of advanced imaging like MRI and CT will have a co-insurance. It actually could even be cheaper than a traditional health plan, what your co-insurance one would be if you had to pay 20% of that or something like that.

John: Right. And I just told my wife, let's just get it and pay it out of pocket. Why even go down that route because the insurance is just so awful. And then the other thing you mentioned of course, you know this very well, but it always occurred to me when they're talking about, especially with all the requirements that Medicare was putting in place and the quality metrics and things is like, this stuff just needs someone to hold the patient's hand and figure out how to get them into the place to get what they need. It doesn't require a physician's order most of the time, number one, unless they have to be treated. And why would a physician have to spend 5- or 10-minutes figuring that out during a visit when you could have someone at a much lower skill level, just say, "Guess what? We got to check your blood pressure once a month and we're going to adjust your medication if you need it." That's it. And then the physician is overseeing that indirectly and if they have complications or something.

I mean, it's been out there. I don't know why it really hasn't taken hold yet, but it sounds like you guys are really trying to get on top of this. And the employers, I think they're driving a lot of it anyway. You're going to employers and offering this, but the big employers have already done it. They actually have their own health systems. The GMs and the big companies, they just hire physicians and NPs and put them in their offices and say, "This is our health system, screw the rest of you."

Dr. Carl Peters: Yes, indeed. And then that's precisely too, John, why we're targeting smaller employers.

John: Yeah, because they can't afford to do that.

Dr. Carl Peters: Right, they're paying full dollar if the company has 200, 300 employees.

John: The quicker we can get rid of the insurance companies, I think the better off we'll all be.

Dr. Carl Peters: Yeah. I actually have come to a point where it's sad. I almost see this as a failed model. At least the way business has been done. It's a money grab and there's just so much waste.

John: Yeah. You're just talking about a 15% plus or minus, and these are publicly traded companies and they make billions of dollars in profit and that's just money that's not going to the patients or to the medical provider. All right. Very interesting. We're getting to the end here, but it sounds like you did that telemedicine, it was a partial transition. I think you're probably still able to do telemedicine whenever you like.

Dr. Carl Peters: I'm still doing some. Yes.

John: At least, for now, you're involved in this completely new thing and it's on the cutting edge and hopefully this will continue to expand. There are other companies doing similar things. Yeah, I think it's great to have physicians like you involved and making it work for the patients.

Dr. Carl Peters: Yes. Yes, indeed.

John: Any advice for physicians who were maybe where you were 5, 10 years ago, whatever it was when you were just sort of saying "This is just not fun, it's frustrating. It's not fulfilling." Any words of advice for those listeners?

Dr. Carl Peters: Yeah. Number one, the biggest thing is to research and learn and network and connect. Because I didn't really realize, we get compartmentalized, "Okay, this is medicine. It's how it works. This is how it works in this country. And people jump from employer to employer." It's just something to really understand there are alternatives out there.

What you're doing, John, your site, your podcasts, how I found Dr. Tom Davis, Dr. Heather Fork, there are others out there too, to connect or at least to research, go through these podcasts, look at these things. And you'll see things like, "Oh, wow, I didn't realize we can do that." There are just all kinds of stuff out there that we could apply ourselves too that are even nonclinical. So, you got to research and connect. LinkedIn is a really good source. You want to make sure you have a nice profile built up. And then you don't want to be hesitant to reach out to people that have done alternative things and talk to them. I find most of us, John, are more than happy to talk to people and help them out. And so, reach out. Networking, some research.

The second thing, if you're not sure where you want to go, I'd say, keep it diversified a little bit. Maybe don't put all your eggs in one basket. Do a little of this. Acute telehealth is an easy transition to get into. It could get some income stream going on while you rethink things. Or maybe you want a lifestyle where you're doing 50% telehealth, and then you're doing some other stuff, whether it's medical writing or expert witness, whatever. I like to keep it diversified because you don't have the job security, I would say, that we did many years ago. This is a very evolving profession. But yeah, it's probably the most advice I would have at the moment.

John: Now, that's very good advice. Yeah. Diversification and just having different options to fall back on or just doing different things. We find it more interesting and stimulating. And networking. I used to think networking was going to a meeting and standing around with a drink in my hand, talking to people and as an introvert, it was never going to happen. But just talking to old schoolmates, co-residents, people, you'd be surprised what other people are doing. And if you just reach out, you'll get more ideas. So, I think that's really great advice.

Dr. Carl Peters: Doximity is another thing to get on because you'll search for and find your old classmates. "Oh, hey, I remember this guy, he's doing this. What? No." And you could reach out. So that's not a bad site too. And on LinkedIn, one other thing I would say is that you could create job search functions based on anything. You could say "physician medical writing" and throw that out there. And he'll just automatically send you stuff into your inbox every day and you could just screen through them. And sometimes those lead on a tangent.

I had someone contact me and say, "Hey, we need a medical director for a COVID testing facility." I was like, okay, part of diversification. So, I did that for a little while. And so, you don't know who will contact you. Of course, most of them are just standard recruiters for standard family practice jobs and whatever, but you could tailor your searches to look into alternative things. You could say acute telehealth, you could put in a search for whatever. And then sometimes those will jog your mind. It's like, "Oh, I never thought about this." And even if you don't want to pursue it, you could at least talk to them a little bit and better understand it. So, I found that to be useful.

John: Good ideas, yeah, with the searches out in LinkedIn. I've not done much on Doximity lately, although I've always had a profile there. But I think I need to spend a little more time to see what's going on there based on what you're telling me.

Dr. Carl Peters: And there's another site too. Another site called Health Tech Nerds, HTN. A lot of it will have nonclinicians on there too, but occasionally you'll have physicians on there looking at if you're more into the tech side of things like software development. There are a lot of start-ups out there and occasionally they do need a physician advisor or something. So yeah, once you get the ball rolling, you start just going off in these different tangents and pretty soon you build up some ideas for yourself and where you want to go.

John: Yeah. I always get people asking me, "Well, where do I start?" Well, these sound like some really good places to start. Okay, Carl, we are out of time. I know some of the people will want to get a hold of you, so I think they can find you on LinkedIn for sure. Just put your name in there. Should we put your email address out there or I can put it in the show notes too, but if someone wanted to get a hold of you?

Dr. Carl Peters: Yeah, I'd be more than happy. That's fine. Sure.

John: All right, we'll do that. And just to tease you a little bit, I think it's saya@att.net. So that's kind of cheeky. I like that.

Dr. Carl Peters: say.a@att.net. Don't forget the little dot.

John: Don't forget the dot. We'll put that in the show notes. All right, Carl. This has been a lot of fun. I've learned a lot and I know the listeners have too, so I really am glad to have you here to explain your recent career journey. It's been very interesting.

Dr. Carl Peters: I appreciate it, John. Thank you kindly.

John: You're welcome. Bye-bye

Dr. Carl Peters: Bye.

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How to Do a New Kind of Medical Legal Consulting as a Part Time Gig – 227

John Jurica — Tue, 21 Dec 2021 10:30:26 +0000

Interview with Dr. Armin Feldman

In this interview, Dr. Armin Feldman explains how to use a new kind of medical legal consulting as a lucrative side gig.

Dr. Armin Feldman is a graduate of the University of Wisconsin Medical School. He completed his training in psychiatry at the University of Colorado Health Sciences Center.

He practiced psychiatry and psychoanalysis for over 20 years, and he owned a network of out-patient head injury rehabilitation clinics around the country.

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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.

A New Form of Medical Legal Consulting

Armin describes how he developed a unique kind of medical legal consulting during that time. He sold his clinic network about 14 years ago. And he devoted himself to providing those services full time. After a few years of perfecting his approach, he began teaching other physicians how to adopt what he was doing.

Over the past 12 years, he has trained over 1,600 other physicians through his Medical/Legal Consulting Coaching Program.

Active Medical Practice Not Required

Dr. Feldman’s consulting is pre-litigation and pre-trial in nature. He helps attorneys manage the medical aspects of cases, increasing case value and saving attorney time. He enables them to better negotiate and settle cases and get the appropriate medical care for their clients. And he does not participate in medical malpractice cases.

If you want to learn more, you can check out the home page for his coaching services and watch a short video at mdbizcon.com. And if you’d like to sign up for his biweekly email, just send him a note requesting it at armin@golegaldoc.com

Summary

That was an eye-opening interview. And it seems like a fairly compelling way to leverage your medical knowledge. Following Dr. Feldman's methods, you will be able to provide lucrative pre-trial medical legal consulting services on a part-time basis.

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

Links for Today's Episode:

Medical Legal Consulting Coaching Program
Sign up for Dr. Feldman's Email Newsletter at armin@golegaldoc.com
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 227

How to Do a New Kind of Medical Legal Consulting as a Part-Time Gig

John: I'm excited to bring you today's interview with an expert on a new kind of medical legal consulting. I think you'll find it very appealing. Dr. Armin Feldman, welcome to the PNC podcast.

Dr. Armin Feldman: Hi John. It is a pleasure to be with you.

John: I've really been looking forward to this because I'll just say that I discovered you somehow doing something that I find very intriguing, very appealing. I've always been one to like, although I've never done it myself, medical expert witness sort of work because I think it fits in with physicians as a part-time gig. But I think you've found a way to even improve on that. First, why don't you just tell us a little bit about your background and bring us through your education and so forth and, and then to what you're doing today?

Dr. Armin Feldman: Sure. I grew up in Milwaukee and I went to college at University of Wisconsin. and then I also went there for medical school. After medical school, I did an internship in internal medicine at the University of Colorado. And then stayed at the University of Colorado for my residency in psychiatry.

After I finished my residency in psychiatry, by the way, for the next five years of Friday afternoons and Saturday mornings, I was also a student at the Denver Institute for Psychoanalysis and I am also a graduate of the Denver Institute. For about 20 years, I have practiced psychiatry and psychoanalysis. And an interesting thing happened along the way. When I was still a resident, I met a young personal injury attorney who was doing some work for a friend of mine. We've been friends now for over 30 years. But after I got into practice, he started sending me his injured clients who primarily have head injuries. And that led me into the field of mild traumatic brain injury.

My true specialty in psychiatry turned out to be mild traumatic brain injury. And I wound up owning an outpatient head injury rehabilitation clinic in Denver. I had a treatment program of my own design. I eventually had other psychiatrists, psychologists, neuropsychologists, psychotherapists, biofeedback therapists, and others working at the clinic. And that led me to eventually wind-up owning outpatient head injury rehab clinics all around the country. I was fortunate enough to eventually sell those clinics. And after I sold the clinics, I was thinking about, "Well, what do I want to do next?" I didn't want to retire. I love medicine.

As part of that work, I testified as an expert witness more times than I wanted to remember on behalf of my patients who are either being cut off their medical care or offered some pits of a settlement. And I was quite familiar with our legal system and I thought, "Well, maybe what I could do is just consult attorneys on any kind of medical question that came up in a case and work with them, pretrial pre-litigation".

In other words, in the areas of the law that I started working with attorneys, approximately 9 out of 10 cases settled. And so, that's where I came in. Well, one thing led to another, and I wound up developing what has turned into a whole new subspecialty of forensic medicine that deals with the pretrial pre and aspects of legal cases. And I developed a whole variety of fairly specific services to help the attorneys help their clients to better negotiate and settle cases.

And after doing that for a few years, I realized this probably could be a new field. I started training other physicians how to do this work through a training program and through conferences. And I guess as they say, the rest is history, it's now 14 years later. Through those means I've trained over 1,600 physicians around the country. And so, that brings us up to today.

John: Very interesting. And of course, you've touched on some of the factors that maybe make this a little bit more appealing than some other forms of consulting. But why don't I have you really spell those out for us? When we think of medical expert witnesses for legal reasons, of course, we're talking about reviewing charts, then a certain percentage of those will result in a deposition and then even a smaller percentage will potentially end up in court. It can get a little stressful, a lot of time involved. It sounds like you're doing something a little different that doesn't always involve those aspects. So, tell us about that.

Dr. Armin Feldman: Yeah, that's right. First of all, I should say I don't do any expert witness work and I don't work in medical malpractice cases. I am working in other kinds of legal cases. The work is primarily in personal injury cases and workers' compensation cases with regard to injuries. But I'll tell you any physician in any specialty can learn how to do this kind of consulting. What happens is, the attorney will call me with a case. We will discuss the case. They will send the medical records. After I review the medical records, I'll interview the client of the attorney in every case. Typically, it was by phone, but now it might be by Zoom meeting. Less than 3% of the time I may want to interview the client in the attorney's conference room.

Once I do my review of the records and interview the client, then I'm going to do any medical research that I need to do. And then in many cases, I'm writing a report. Many services don't require a report, but the thing to understand is that I answer and other physicians that do this, we answer any kind of medical question that comes up in a case. And so, the issue may be related to a specific medical question, a specific condition, a specific injury.

By the way, there are about 16, 17 different kinds of services that we offer to these attorneys to help them. And what that means is to better settle the case. It means settling the case for better value with less attorney time. Help the attorney get the appropriate medical care for their clients, and also help the attorney just to negotiate all the medical issues in the case.

I'll give you a couple of examples. The service that is most requested is to provide the attorney with comprehensive medical summary reports, by the way, it's just a term I invented. But comprehensive medical summary reports that they will include in settlement demand letters. Through the negotiation process, at some point, the attorney will file or submit to opposing counsel and to the insurance company a settlement demand letter. And in that letter one of the things that the attorney must put in there, these are fairly standardized state by state, but obviously, they have to put in a description of damages. There are all kinds of damages. Damage to a car, loss of work time, loss of enjoyment of life, which by the way isn't medical damage. Medical damages tend to be the biggest group.

We will give our medical opinions based on all the things that I just told you about regarding every injury in the case. And so, we will write a comprehensive report that includes our medical opinions. And one of the things that makes this viable is in our legal system, physicians are expected to, and are sanctioned to give medical opinions to medical questions.

Now, if it's that 1 out of 10 cases that's going to trial, well, then obviously the attorney is going to need medical experts in every area of injury. But for the purpose of negotiating and settling the case, what the attorney needs are medical opinions, reports, and other services, all backed up by evidence from the medical literature that they can use to settle the case. And this is a completely legitimate thing that any physician can do. These reports will cover everything in the case, every injury in the case, along with a number of other fairly specific things that need to be in this kind of report.

Now, another thing that we do is that we can actually physically sit in and observe independent medical exams that other physicians do, which puts us in a position to write IME rebuttal reports. Now we all know that they're very good doctors that do very good IME. We also know that in every community across the country, there are physicians that are specifically asked to do these by the insurance companies because they have a fairly good idea of what the opinions are going to be. I think I was probably the first physician in the country to actually physically sit in and observe IBS and write rebuttals.

Another thing that we do quite often is we'll answer specific medical questions in cases. And when we do that, what we're doing, for the most part, is we're helping what the attorneys call to prove a particular medical theory for the case. Now sometimes we'll do that and we'll tell the attorney, "This isn't going to fly, don't do this". But most of the time what we're doing is we're helping to prove a particular medical theory for the case.

Let me just digress for a sec and I'll tell you one other thing. When I started doing this, let's say there was some issue in the case related to a rotator cuff injury, and the attorney wanted a report and my opinion on that particular thing. I would write up the report in the manner in which I just told you. My report's going to go to opposing counsel. Our work is not behind the scenes. Our reports are seen by opposing counsel. They're almost always seen by insurance adjusters. They're often seen by judges, treating doctors, IME doctors, and others.

And the opposing counsel gets my report. Well, what's the first thing they're going to do? They're going to look me up. They look me up and they call the attorney that hired me and they say, "Well, I looked Dr. Feldman up. Why should I pay any attention to his report? He is not an expert in rotator cuff injuries". And of course, this doesn't happen to me anymore because people know who I am, but that's what happens with everyone.

But what my attorney's going to say is, "Well, Dr. Feldman acts as a medical consultant for me, by the way, as opposed to a medical expert, but works as a medical consultant for me in all my cases. And if we can't get this issue and negotiate it out in the settlement based on Dr. Feldman's opinions and boards, and I back it up with evidence from the literature so forth, and you forced me to take this case to trial. When I hired my retained orthopedic surgeon, they're going to say exactly what Dr. Feldman said in his report. In fact, they would be both relying on the same literature, so let's get this settled". And that's how it works.

John: Okay. Let me go back a couple of things just to make it crystal clear because these are some of the things I found so fascinating. Number one is you were talking about the IME Independent Medical Exams. And what you're doing when you do them is you're actually observing someone else's IME as a way to kind of keep the whole process valid for your side of the equation for the attorney you're working with. I just want to make that clear. I think you did, but just for the audience to understand. This is like another sort of perspective to the whole process.

Dr. Armin Feldman: Yeah, that's correct. Sometimes it's something as simple as an observation. I did a case. It was a woman that had a head injury. She had

symptoms, there were CNS questions. All the treating doctors were in agreement with this. One IME doctor said, "No, there's nothing wrong with her". So, I went to a different IME and the IME report came back and the report was that Babinski's were negative. Well, one was positive. And I saw it, I observed it. I tested that. I wasn't the only doctor that saw that. Many of the treating doctors saw that.

And so, that was something that came up in that particular IME. But most of the time, it's more of an opinion thing. The person doesn't need revision surgery for the rotator cuff, because there was no dial leakage on her arthrogram. Well, most orthopedic surgeons would say pain and range of motion, degree of functionality. These are the things that would be criteria with regard to whether that revision surgery would be needed or not. And that's what I might talk about in my revision and my rebuttal report.

John: Right. Again, just to point out something you've already said, the fact that you're a psychiatrist really doesn't make any difference. You don't have to be an internist, an orthopedist, or a neurologist. You need really a basic medical background and maybe a little experience and the ability to read the literature and then serve as sort of an interpreter there for your attorney, your attorney's client, that sort of thing.

Dr. Armin Feldman: In fact, John, it's one of the things that's so much fun about this work. Now, some physicians I talk with, they might be interested in doing this. I talk with them and they just want to stay in their lane. They are not interested in this. But if you went to medicine because you found out that you love medicine, and you enjoy learning about all aspects of medicine, then this is just tremendous, it's so much fun.

I'm not in any position to do any orthopedic or neurosurgery, but I put my knowledge base of spine injuries, rotator cuff injuries, complex regional pain syndrome, and other things up against anyone. And I'm such a more well-rounded and better doctor for all of the hundreds of hours of research that I've done over the years.

John: It's interesting. I interviewed someone who is a medical director or a CMO at a life insurance company. And she happened to be a cardiologist. It's like, well, what does a cardiologist know about life insurance? But it was exactly what you're saying. She was asked to interpret. She would do her research. Whether she had to do with pediatrics adult cardiac renal didn't matter. It was all based on the basic background of being a physician that's got a broad sort of training. That's another very interesting perspective. All right. Are there challenges in this thing? It sounds like it's Nirvana, it's fantastic. There's got to be some challenges and probably some pre-work you have to do.

Dr. Armin Feldman: Yeah. Again, I'm not sure this is entirely a challenge, but it's certainly a thing of interest. In my training program, I'm training physicians on two things. I'm training them on the medicine they need to know, but also, I'm training them on how to successfully start-up, but more importantly, how to run a long-term medical legal consulting business. If there's a challenge, it's the issues outside of medicine. How do you get from zero to up and running with your business? How do you market your business? How do you run your operations on a day-to-day basis? How do you do your billing? These kinds of things.

And so, maybe the challenge for physicians is on that side of the equation. Physicians are now just being employees of big corporations or hospital systems. So, what's the biggest trend? Everybody wants their own side gig, right? So many doctors want their own thing. Well, to have your own thing, you have to know something about business and how to run that business. It doesn't run itself. Now for me, of course, this has been part of the fun of it all. But if there's a challenge it's getting used to... And any physician can learn it, but it's getting used to that side.

John: The plus side there it sounds to me is that if someone is unhappy, unfulfilled and is looking for an alternative that if they can just squeeze out some time, they can actually start this on a part-time basis, learn about it, start working on how to get some clients. And then if it really resonates with them, then they can gradually either phase out or quit their other job or get another type of less stressful clinical job let's say.

Dr. Armin Feldman: Yeah, that's right. Now there are physicians that do it full time. There are physicians that do it instead of retiring, but you're right, the largest group are physicians that do this as a part-time side gig.

John: Okay. Now, how does someone get paid doing this? Do you just sort of have a retainer? Do you use an hourly rate? Do you do a case rate? All the above? I think people will have that question.

Dr. Armin Feldman: The way I train the physicians that are doing this is I charge by the hour for everything that I do. One hourly fee. I keep the billing log form along. Attorneys understand hourly billing. Now, of course, in the areas of the law, which I work primarily, it's done by contingency. But I charge by the hour for everything that I do. Just to quick aside. Now I'm not working on contingency. When I send my bill, I expect to be paid in the next 30 days. And in the real world, 90% of the time I'm paid within 30 to 60 days of sending my bill.

But the way that I've advised physicians over the years is to do an informal survey of their colleagues, determine what you think is the average fee per hour for doing medical expert work in your community. Now, obviously, there's a range, right? Not hard to figure the average. So once you get that average, then you want to come in somewhat below what the medical experts are charging doing this acting as a medical consultant, pretrial, pre-litigation.

John: Okay. That's pretty straightforward. And they can get some either from you, if they take your coaching course or elsewhere, they can figure that out. Tell us about your course exactly. What is it? What is it like now? Is it face to face? Is it live? Is it online? Is it recorded? What does it look like?

Dr. Armin Feldman: It's one year and the physician gets all of the business concepts, all the business tools they need, the medical tools, the training, the manual, the how-to on every aspect of the business. They get everything that I use in my business. They get a website, so forth. And it's both on the business side and on the medical side. But the big thing is they get a year of coaching with me. And I've been doing this full-time for 14 years. And so, it's not an absolute necessity. Occasionally somebody joins the coaching program, I don't hear from them much and they're successful. But far and away, far, far and away, the physicians that stay in close touch with me are the most successful. Whatever they need during the launch plan period, I help all of the physicians with some of their marketing. That's how they learn it in the beginning. I'll actually help them to get their first cases in the door. I read tons of drafts of reports before they go out to their attorneys, and really anything I can do from my end that's going to help them to be successful.

John: That sounds like it's fairly comprehensive for those that take advantage of it. Can you give me an example? I'm curious if everyone that learns this from you, do they do exactly what you do or do you see examples where someone might say, "Well, I want to focus on this aspect or that aspect?" Or maybe they just end up doing something slightly different, just because we're all different. Any examples like that?

Dr. Armin Feldman: There's kind of a tried and true way to do this. And not that I haven't learned from coaching members over the years and made adjustments to things, both on the business side and the medical side. But the fact is if you vary too far from the standard approach, it tends not to be as successful.

John: Well, when you've been doing something for 15 years it tends to be a pretty well-oiled machine at that point, I assume.

Dr. Armin Feldman: Yeah. Yeah. And not that I'm not open to hearing what physicians that are training or have trained are doing. But most of them come back around to doing it the way they were trained.

John: Got it. All right. Well, before we go any further, we're getting near the end here, but I want to make sure I mention your website. Actually, it's sort of a page that has this course on it. It's called mdbizcon.com. And I found a video there. It pretty much explains everything. It's again, pretty interesting. That's one of the things that got me interested in getting you on here in the podcast today. So, let's not forget about that. And then I'm also going to put a copy of your email address in the show notes for anyone that would like to get on your email list. Is that doable?

Dr. Armin Feldman: Yeah, that would be great. I do have a newsletter once a month for physicians that are interested in this topic. And then two weeks after the newsletter comes out, I send out a shorter plain text email with tips, advice on various topics as they come up in my day-to-day work. And then I'll talk about it.

John: If you were to be addressing some of my listeners here who are sometimes a little bit burned out or they're just frustrated with medicine in general, what advice might you have for them in terms of thinking about their careers?

Dr. Armin Feldman: I think as physicians, we all want to help people. That's a good portion of the reason we got into it. So, I would say, first and foremost, find something that you can use your medical knowledge to still help people. And this isn't anything profound, I'm sure you've heard it before. But if you're doing something that you really enjoy and find fun, it doesn't seem much like work. If you're going to do something on the side or look for something to cure that burnout, make sure it's something that you really enjoy, that you find fun doing every day. And if you can combine that with helping people, and by the way, making money, what's better than that?

John: Oh, that's absolutely right. Great advice. Yeah, I think if people don't know about these things, then they feel sort of frustrated or resigned that they can't break away from the corporate practice of medicine or something like that. But just in having conversations with people like you, we've seen just dozens and dozens of different opportunities and options for people if they just sort of open their eyes and look around. I appreciate those comments. Anything else you need us to know about this new kind of medical legal consulting?

Dr. Armin Feldman: If you enjoy medicine as a whole, and you got a kick out of being in med school and learning all the things that we know, and you want to put that medical knowledge to work in a nonclinical field that really helps people and is lucrative, this is something that you should look at.

John: Yeah, that's what I thought when I first heard about this. It's intellectually stimulating. It builds on your medical and actual understanding of the healthcare system itself. And you don't have to be in any particular specialty and you don't have to keep practicing to do this ultimately if you decide to do it full-time from what you've said.

Dr. Armin Feldman: Right.

John: All right. Well, thank you very much. This has been very fascinating, Armin. I really appreciate you for coming on today. And I hope a few of my listeners take you up on the email letter and maybe even enroll in your coaching course. With that, I'll have to say bye-bye.

Dr. Armin Feldman: Okay. Thank you, John. It's been my pleasure.

John: It's been great. Thanks. Bye-bye.

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