In today's episode, Dr. Lara Hochman returns to the podcast to share her insights on finding joy when seeking a new practice.

Through Dr. Hochman's company, Happy Day Health, she matches physicians with private practices that prioritize their well-being and financial stability.

Our Sponsor

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

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

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

For Podcast Listeners

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

Your Guide to a Stress-Free Medical Career

Dr. Lara Hochman introduces the Stress-Free Physician Career Guide, a free email course designed to help physicians navigate the job market with confidence. This resource covers essential topics such as vetting potential practices based on personal values, choosing the right employer, and negotiating salaries. By providing this guide, Lara aims to equip physicians with the knowledge they need to make informed career decisions and find positions that align with their aspirations and values.

Avoiding Common Pitfalls in Job Selection

One of the most common mistakes physicians make when choosing an employer is focusing solely on salary. Dr. Lara Hochman warns against this approach, advising physicians to consider factors like work-life balance, practice culture, and support systems. She emphasizes the importance of thoroughly vetting potential practices by speaking with current physicians and staff. By understanding what truly matters to them and asking the right questions, physicians can avoid pitfalls and find fulfilling positions that offer more than just a paycheck.

Dr. Lara Hochman's Advice on The Importance of Knowing What You Want

Knowing what you're looking for first, and then just going out and finding that… It's very cool to see when I work with physicians who know exactly what they want, and I find them that and they land the job and they're happy.

Summary

By thoroughly vetting practices and asking the right questions, physicians can find fulfilling positions that enhance their work-life balance and overall happiness. For more resources and information, visit Happy Day Health and connect with Dr. Hochman on LinkedIn or Instagram.

Links for Today's Episode:

• Dr. Lara Hochman's Website at Happy Day Health
• Dr. Lara Hochman's LinkedIn Page
• The Stress-Free Physicians Career Guide

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 363

Avoid These Mistakes When Seeking a New Practice

- Interview with Dr. Lara Hochman

John: As I've mentioned in previous episodes of the show, I'm becoming more and more convinced that we as physicians can find happiness in medical practice. I focus a lot on nonclinical careers, but I'm seeing more and more about practices that are really fun to be a part of. My guest today was here a couple of years ago, and she was talking about those situations because she matches physicians with practices. And so, I thought I'd have her come back to kind of complete that conversation. With that, I want to just say that I'm happy to have Dr. Lara Hochman here on the podcast again. Hi, Lara.

Dr. Lara Hochman: Hi, thank you so much for having me back. I'm so excited.

John: Well, good. You've been continuing to do what you were doing back then, in terms of connecting physicians with practices. I've talked to a lot of people, but I don't actually do the connecting and I never have a chance to really follow up with people necessarily if they've been on the podcast. I'm really looking for some of your advice and wisdom on this. But tell us a little bit about where things have gone, let's say in the last year and a half or two years since we spoke in terms of Happy Day Health and what you're doing, and remind our listeners as to what exactly we're talking about.

Dr. Lara Hochman: Sure. As the medical matchmaker, I created Happy Day Health as a company that really helps to match physicians with physician owned private practices. And these are practices that I have vetted, that I believe treat their physicians well, that are financially viable, and that are great places to work.

And I do this because I think it's important for us before deciding to make that leap into nonclinical medicine or to make that leap into all the dire things that we as physicians, look at what the other options are out there because there's some awesome places to work. And that's by having more physicians in private practice, this is how we really regain our voice as a physician community.

John: I agree a hundred percent. And so, I think it's going to be very useful for us to learn from you what we should really be looking at to optimize that situation. I have my ideas, but I'm not even going to get into that. And one of the things I noticed when I was looking at your website again, and reviewing some of your videos and that is that you created a new resource that I hadn't seen before called the Stress-Free Physician Career Guide. So why don't you tell us about that? Because I think our listeners, many will be interested in accessing that.

Dr. Lara Hochman: Yeah, this is an email course, it's completely free. And it runs through a little bit about vetting those practices for yourself. If you're looking for a job and trying to figure out what does that job even look like? Or how do you vet a practice according to your values? Because what's an ideal practice for me is not going to be the ideal practice for you. So using what you know about your values and what your dream job looks like, how do you use that to vet the practice and see if it's correct for you? And then how do you select your ideal employer? How do you negotiate your salary? So, it's just a very nice, easy, free resource for physicians to help answer a lot of the questions that I get repeatedly. And that are so important to know how to do.

John: Yeah, I talked to a lot of coaches by virtue of doing the podcast. And for many of them, the first step is always about identifying what your passion is, or what your goals are, or what your principles are, or vision, those kinds of things, you're starting a new business. And so it sounds like you start there, and then you just go even beyond that is to dig into exactly what you might be looking for.

One of the things that I used to advise people that were looking for a job in the hospital setting was the same thing was, make a list of everything you do, let's say in a day or a week, and separate them by what you love doing and what you hate doing, and then try and find a career that will optimize what you love and get rid of all of what you hate. So where do we find the career guide? I don't want to forget about sending people to the right place.

Dr. Lara Hochman: If you head to my website, which is www.happydayhealth.co, there's a tab at the top, the stress-free physician career guide, go ahead, and it'll be right there.

John: Just start filling it out and using it. Okay, cool. One of the ways I like to look at some things sometimes when people are thinking about their career, and it's kind of like clickbait when you look at the internet, but it's like mistakes to avoid. That's why I'm going to ask you questions about mistakes that we can avoid. So, let's start with, I'm assuming that you're dealing mostly with physicians who are coming from practice, maybe they're coming fresh out of residency or fellowship, but they're probably going to start as an employee. They may not end up that way, and I guess I'll ask you about that in a minute, but what's the biggest mistake when choosing an employer? Should we just go with the one that pays us the most? Or how do we find out for sure that we're going to like being at, working with some group, assuming mostly it's going to be a physician group?

Dr. Lara Hochman: That's funny, that would probably be the biggest mistake that I see is just going with the one that pays the most. And I totally get it. Yeah, it's not even desperate. It's the loans and I want to get paid my worth and I want to feel well compensated. And those are all very valid. But in doing that, there's a lot of other things that get overlooked a lot.

Maybe besides compensation, and I was speaking with a financial advisor once who said the best paying job is probably your red flag. That's the red flag is if it pays really well. You can think of it that way. But, yeah, it's definitely interesting how pay structure works. And especially in the insurance model and how insurance companies pay hospitals versus FQHCs versus private practice. That's all important to take into account.

But I would say the other biggest mistake, oh, gosh, it's so hard to narrow it down to one. One of the ones is interviewing too many places, which sounds silly, almost, but what I tend to see is that then you go into analysis paralysis, so you don't know what you're looking for beforehand. Then you're interviewing at multiple practices, you get multiple offers, they're all a little bit different from each other. What ends up happening is you just shut down. When you have too many tabs open in your brain, and these are big tabs. This is a big life decision. And then it often people just end up picking the highest paying one.

So, knowing what you're looking for first, and then just going out and finding that. It's very cool to see when I work with physicians who know exactly what they want, and I find them that and they land the job and they're happy, like, easy peasy versus the ones and typically those are the younger new grads or anything don't really know what they want yet. And they just look everywhere. And then sometimes they'll lose opportunities because they take too long. And that may have been this incredible opportunity that they've lost. So, that would be a big one. And one that I think would be pretty unexpected.

Another one is not vetting the practice appropriately. You hear a lot of times, even in physician owned practices of a bait and switch they promised me this, but then I got that. And it's actually pretty easy to avoid that situation just by speaking with physicians that are already in the practice saying, well, an example is a physician I recently placed in this pretty cool practice. She came from a bait and switch situation where she was a high producer. She wanted to see a lot of patients. She was promised a lot of patients and she was paid purely on production, which is great potentially, but turns out they couldn't even fill her schedule more than five patients a day. That's something that could have been avoided. So, not vetting the practice appropriately is really important. So you don't get into the bait and switch situation.

John: Yeah. I was chatting with a physician recently that I know very well and he's fresh out of residency a year or so ago. And he had that exact situation. It looked like a good practice. It was actually physician run and owned have been around a long time, but his volume was nowhere near what they said it would be. They practically guaranteed it, although not in the contract of course. And he wasn't making anywhere near because the productivity kicked in at the end of the first year and he was still in the process of building his practice. So that was rough for sure. And he's gone somewhere else now, which is very disruptive.

Dr. Lara Hochman: Yeah. It's so important to know what you're getting yourself into. And on the flip side, the practices that are hiring, it's expensive to hire doctors and you don't want to tell them the wrong thing and then have them arrive and realize it's something different and leave. Because then you've lost many tens of thousands of hundreds of thousands of dollars by hiring someone unnecessarily. So, practices need to be honest as well. It's really a two way street.

John: And I think we talked about this last time that maybe physicians don't have deep pockets. If they're a small group, three, five, 10, whatever, even a group of 20, they don't have the resources of a large hospital system. So focusing on the pay is probably, the cultures of those two situations are completely different. Again, it gets back to what you said before about focusing on the, just the pay.

Dr. Lara Hochman: Yeah. There's so much more to that. And especially with how much we want a good quality of life as we should, those are really important things to look at. What's your work-life balance going to be like, what what's the culture of the practice going to be like, will you have a voice? Will you have autonomy? Will admin listen to you? Do you have support? There's so many things that are going to be important to avoid burnout. That's really should not be overlooked. It's really important.

John: What about to switch gears a little bit, just in terms of negotiating everyone, maybe you find the ideal practice, looks like it would be ideal, but you do have to go through that process. So maybe mistakes you might see related to negotiating the contract once it gets to that point.

Dr. Lara Hochman: The big things are around transparency. I don't really see negotiating as I'm going to say what I want and you say what you want and it's buttheads until someone has to give in. Negotiating really is coming to an agreement on what works on both sides. And really working towards that together, I think is so important.

If you're just closed mind and you're like, I want X, Y, Z, and this is it, or else you're probably not going to get anywhere. You're not going to get what you want and versus using the example of tail malpractice insurance, I went tail, the practice doesn't want to provide tail. Well, maybe you can meet in the middle and see how it'll work for both. Obviously, tail is going to be less expensive for something like pediatrics than it would for OB-GYN or neurosurgery. But if I stay three years, perhaps you can pay 50%. If I stay, stay five years, you'll pay 100%, whatever it is, but trying to find something that works for both ends. Because if you're going to ask a new an OBGYN practice to pay your $100,000 tail, if you leave off to one year, that's probably not fair. Seeing it from both sides really is important, when it comes to negotiating for sure.

John: When I was CMO of a hospital, I used to do a lot of contract negotiations. And when I came away with, once I left was yeah, a small practice is not going to be able to put all that money out after one year of work and you just leave. But if you're working for a large hospital system, I put my foot down and say, look, this is the cost of doing business in that situation. But when it comes to, you got to give your physician partners a little bit of a break. If you're talking about tail for a very high cost specialty, that makes perfect sense. Anything else in the contracts that you've found maybe have been stumbling blocks that maybe unnecessarily prevented someone from accepting a relatively good or very good position?

Dr. Lara Hochman: Yeah, actually recently I had a physician, wonderful physician with an incredible practice who she had her dollar amount that she wanted to earn and just wasn't realistic. She didn't want to see a whole bunch of patients. So, unfortunately the math didn't work. But she was coming from a big hospital system that could blow money and was burnt out seeing 20 patients a day coming to a small private practice who had scribes admin support. When you're done, you're done. Awesome culture. This practice is just exemplary, really, really good practice, good morals, good ethics. But they see far more patients a day than this physician was used to.

And what it ended up coming down to was the practice said, we love this physician. We would love to have her join our team. However, she'd be seeing half the amount of patients we are and getting paid more. And we can't justify it. We can't that she's not even bringing in the revenue to be able to justify her salary.

I think knowing what it is that you're asking is so important. And that comes back down to the win-win situation that we were talking about earlier, but understanding what it is you're asking for before asking for it, and then truly actually listening to what the practice is saying back, because you may lose the job opportunity of your lifetime. And you may have been willing to take that lower salary, but because you didn't quite play ball, so to speak not take part in that two-way conversation, you may lose something that could be really cool.

John: Yeah, because every practice is totally different. And if one is very efficient, it has a lot of support like you said, they had scribes. That gets rid of a lot of work. Oh boy, that's probably based on just, again, she was fixated on one thing, and that was the most important, and she wasn't going to listen to any kind of alternatives.

Well, again, that gets back to the vetting. When I think about vetting like hospital systems, there's a lot of data out there publicly, probably not so much for physicians, but give us a few examples. Who should they talk to if they're trying to vet a practice? I can imagine there's be dozens of different approaches to trying to get information, including maybe talking to some of the patients, but what do most of your clients do to try and learn as much as they can about an opportunity?

Dr. Lara Hochman: The first step is in the interview. Really, there are almost no wrong questions. There's wrong ways to ask certain questions. But if there's something that you're afraid to ask, it probably means it's one of the most important things to ask. So, I'll have doctors who say this is really important to me, but I'm afraid to ask it. I really want to be a partner, but I don't want to scare them away, but if that's something that's really important to you, you definitely want to ask. It goes back to knowing your values and knowing what's important to you, and that's where that starts. Ask the hard questions. Definitely not just ask them, but ask them in a nice way. How would you want to be asked certain questions? Speak with other physicians that are already in the practice. If you're interviewing with a practice that only has one physician or one clinician, speak to the office manager. Speak to the medical assistants. Look at the turnover rate.

So, if the practice is turning over their office managers or billing people, that's potentially a red flag. So, look at that. If there's no one to speak to, well, that's not really very good. And then you want to ask those people about things that are important to you. You can ask around in the community. What I like to do when I'm interviewing for jobs or I actually went to a practice as a patient who now ended up being a repeat client of mine, but when I was in the waiting room, I was speaking with the receptionist and asking her what's it like working for this practice? She didn't know who I was. She didn't even know that I was evaluating if I wanted to work with them as help them find a doctor. But speaking with as many people as you can is one of the most important things. And if there are more than one physician in the practice, those are the people you want to speak to.

John: Okay. This is a question I think that my listeners will have. So, you've connected these physicians with practices. It's mostly physician run practices. Do the majority of those, are they looking for eventual partnership? Are some of them looking just to remain an employee, if it suits them? What's your experience been with that sort of goal?

Dr. Lara Hochman: It's about 50-50, I would say. The practices that are looking for partners, part of how I vet it is are they actually looking for a partner or are they just saying you're a partner so that they'll draw you in? Yeah, the practices that I work with that are looking for a partner are looking for a true partner. They want someone to bounce business ideas off of. They want someone to help them grow their practice. They want someone to be a part of the business, and typically they will start teaching you that before you become partners so that at the time of partnership, you can hit the ground running.

John: Okay. Another question that might come up, I'm thinking for my listeners. We've heard a lot about physicians going into practice that they love. And one of the options that some of the solo people have done that I've talked to have gone into a DPC. And I think I saw that one of your listings had specifically mentioned that. So, where does that fall in this? Are many of your practices that you're working with, are they DPCs? Are more going that way? What's your feedback on that whole situation?

Dr. Lara Hochman: There's definitely more DPCs opening up for sure. There's no question about that. As more people learn about it, it's such an attractive option. Some of my practices are direct primary care, direct specialty care or concierge. I wouldn't say the majority yet. I imagine that will change as more and more practices open, but it's an incredible option. It's really great.

John: Okay. All right. I'm trying to think of other questions that I've been asked personally, or that I have. Those are the top things that I was interested in learning about. And I mean, it sounds very hopeful to me. I think I'm going to have to get some more guests running DPCs and things like that. Tell us your website again, where can we find you and where can we look for the Stress-Free Physician Career Guide?

Dr. Lara Hochman: My website is www.happytohealth.co. Please check it out. That's where I have all of my jobs posted that I'm currently helping. You can sign up if there's something you don't see that you want, you can sign up and I'll let you know when something does come up for that. The Stress-Free Physician Career Guide is on there. There's a link to a course that I ran on opening your own practice. Anything is on there. I'm on social media, LinkedIn, Laura Hockman MD is where I'm the most active. I am on Instagram, Happy Day MD, I think. I don't even know.

John: I forget where my social media is. But yes, definitely. I saw the YouTube videos. So they're definitely going to be found there. You've been on another podcast, I'm sure, where you address this issue. So we can look for you there. All right. I guess I'm going to let you go in a minute here. But I'm just thinking, okay, if you're currently an employed physician, you're in a practice or working for a large corporation, you're probably doing the usual insurance company driven healthcare and you're getting miserable, any other advice you have just in general for how these people should think about the rest of their careers while they're feeling miserable?

Dr. Lara Hochman: Yeah, we got one life, we have to enjoy it. There'll be no job that's going to be good 100% of the time. But if you're miserable, why wait? What are you waiting for? If you're so unhappy, there's going to be something better, whether it's nonclinical, and that's where your podcast really can come in handy, or something clinical is out there that you enjoy, I would say, open up your mind. There's a lot of where we feel like we need to be practicing one way or we need to do it one way or another.

What have you got to lose? Take a job that sees less patients, take a job that if you want to stay clinical, think about what it is you actually don't like about your job. And most of what I hear is not clinical part, it's the admin part. So there's jobs available out there where you can still see patients and still do good in the world, and not have to deal with all the admin stuff. So you got this, it's just a matter of finding what you want, but knowing what you want first, so that you can go out and find it.

John: Yeah, so many physicians obviously want to be taking care of patients. And like you said earlier, there may be that practice not that far away that just has scribes, and you don't have to deal with the EMR as much as you do now, or whatever that issue might be. I think things are starting to turn for the better. I really appreciate you doing what you do and sharing these updates with us from time to time so that we keep the faith. Thanks again for being here today, Lara.

Dr. Lara Hochman: Yeah, thanks so much for having me. I really appreciate it.

John: You're welcome. I'll hopefully talk to you again next year or two.

Dr. Lara Hochman: Great.

John: Bye-bye.

Dr. Lara Hochman: Bye.

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The post Avoid These Mistakes When Seeking a New Practice appeared first on NonClinical Physicians.

I’ve invited a former guest from 2020 to show us how he created the private practice of the future while simultaneously growing a business start-up.

Dr. Phil Boucher has been in private practice since 2014. He is known for integrating cutting-edge technologies into his practice, and for helping other physicians communicate better with patients, improve productivity, and understand marketing. 

Our Sponsor

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

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

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

For Podcast Listeners

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

Dr. Phil Boucher Creates the Private Practice of the Future

Dr. Phil Boucher is revolutionizing private medical practices with his innovative tools, OpenSpot and Practice Leads. OpenSpot fills last-minute appointment cancellations via automated text messaging, easing the administrative burden and maximizing capacity. Practice Leads offers a HIPAA-compliant CRM that centralizes patient communications, ensuring no potential patient is overlooked and automating follow-ups.

Dr. Boucher’s approach combines technology with personalized care, advocating for physicians to embrace private practice for greater autonomy and job satisfaction. By providing tools to streamline operations and nurture patient relationships, he helps physicians create thriving, independent practices that deliver exceptional care. His vision for the future of private practice blends efficiency with a personal touch, benefiting both physicians and patients.

Revolutionizing Appointment Management with OpenSpot

Dr. Phil Boucher highlights how OpenSpot addresses the common issue of last-minute cancellations in medical practices. By leveraging text messaging, OpenSpot fills scheduling gaps without burdening administrative staff with endless phone calls. The platform integrates seamlessly with existing systems like email, Slack, or Teams, ensuring real-time updates on filled slots. Available nationwide, OpenSpot can be set up within a week, offering a streamlined solution that enhances efficiency and patient satisfaction.

Empowering Physicians to Embrace Autonomy and Fun in Practice

I think physicians are often afraid because they feel like business is too hard… There's a way to figure out how to go into business for yourself and to practice medicine or to serve the people that you feel called to serve… It can be really fun and… profitable and you can really enjoy your life more.

Summary

To learn more, book a demo, or connect with Dr. Boucher, visit findopenspot.com and getpracticeleads.com. Additionally, Dr. Boucher is accessible via text for direct communication and support. His commitment to improving private practice is evident in his willingness to engage and assist fellow physicians in optimizing their practice management and patient care.

Links for Today's Episode:

• Frontier Pediatric Care
• Phil Boucher's LinkedIn Profile
• OpenSpot SMS Platform for Replacing Cancellations Quickly.
• Practice Leads – Manage Your Leads In One Place
• Who Can Help When Private Practice Matters? – 174
• How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256
• Text QUESTIONS for Phil Boucher to 402-741-4494.

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 360

Building the Private Practice of the Future with Technology

- Interview with Dr. Phil Boucher

John: Today's guest has always been an innovator when it comes to adopting new technologies to make his medical practice more efficient, more accessible, and more fun for everybody. And even back in 2020 when we first met, he was developing new ways to improve the patient experience and the physician's experience with practice. And so, with that, I want to welcome today's guest, Dr. Phil Boucher. Welcome.

Dr. Phil Boucher: Thank you so much. I can't believe it's been since December 2020. What a difference, it feels like a decade makes in the past four years. Oh my gosh.

John: Went through one pandemic, there could have been two in there, I suppose, but one was enough.

Dr. Phil Boucher: No one would have noticed if there were two probably at that point.

John: Well, no. I was doing purposely, I was looking back at old guests to see what they were up to today. And then I came across what you're doing. And it's almost overwhelming to me, just jumping back in years later and go, "Whoa, what's Phil up to?"

Dr. Phil Boucher: Right.

John: Give us a brief version of what's happened since we last spoke in 2020.

Dr. Phil Boucher: Background for me, if you've missed the episode back in 2020 is I'm a pediatrician in Lincoln, Nebraska. I graduated from residency like 10 years ago now, and was in private practice partner for about eight years, left that partnership two and a half years ago to start a pediatric direct primary care practice. Also in that time came up with this software concept that we'll talk about, I'm sure.

I built a software company and have been wearing those two hats to help physicians, help my patients. So it's kind of been a mix of things that I've been up to in the big picture of things. The two biggest things on my plate have been my DPC practice and my software company.

I also do a lot of marketing help for physicians, especially private practice physicians is kind of my people. And so helping private practice owners and physicians in private practice to better market themselves to their local patient populations. Those are kind of the big picture of things. We also built a new house. We have six kids now. I don't remember how many we had back in then. I won't try to remember.

John: Four, maybe.

Dr. Phil Boucher: But we probably had four of that and we have six now and we got two more dogs in the meantime too. So a lot has happened, I guess since we last spoke.

John: Yes, that is a lot. I got to pile on a little bit because I don't know if I've mentioned this in the podcast before listeners, but as of December of this past year, I didn't have any grandkids. I have five kids between my wife and I have a family and had no grandkids. And now we have three.

Dr. Phil Boucher: Your Christmas just got a lot more expensive there this year.

John: Yeah, exactly. I don't know, but six kids now that's good. I'm from a family of 10. I'm the oldest, but I can't even imagine in today's day and age to get six or more kids.

Dr. Phil Boucher: Oh gosh. I'm sure similar to back then, once you reach a certain threshold, another mouth to feed is, you just kind of divide the plates up a little bit differently and the cost and the time does diminish after you get to a certain number. I don't know what that number is.

John: Yeah. Well, congratulations. You've done a lot here and keep moving forward in all areas of your life, which is awesome. So let's get to the business of today. The really thing that kind of interested me is when I saw that you weredoing these sort of side gig businesses with software and that kind of thing. But I do want you to just briefly tell us about the DPC because that's also a very interesting topic.

Dr. Phil Boucher: I got pulled towards DPC kind of in 2021, listening to podcasts about DPC, to be honest with you. And hearing about the way that they were able to help families and help their parent practice to really thrive. It made me really excited for, well, I see so many different ways that patients and as a pediatrician, it's mostly the parents that we're talking about here, that they're struggling regardless of the pandemic, just the way that they connect with the way that they feel herded in and out of the office, the wait times, all of those things really weighed on my heart, seeing the ways that we weren't able to care for the patients the way that I wanted to, which led me to DPC and then realizing that there's so many ways to reduce the hassle for families and for me as the clinician to really drew me to direct primary care.

We have in our state, Nebraska, several family practice, direct primary care practices that have been thriving, but ours was the first and remains the first and only pediatric direct primary care. Luckily, around the country, though, there are a number of thriving pediatric direct primary care practices and really a network of pediatricians supporting each other in direct primary care.

There's a couple specific in the DPC realm things about pediatrics, and one of the biggest is the vaccines. And so, that was one of the hard hurdles to climb. And I've been working to help other pediatricians climb that hurdle now that I'm on the other side of that and have a good setup for vaccines. But as you know, vaccines are extremely expensive and often become a huge source of cash flow issue for practices in general. And when you're talking about pediatric DPC, where the volume is smaller, all of those things that really magnifies the cash flow issues that go along with vaccines. That was a big hurdle to climb over.

And then the other thing for pediatrics is almost all parents have insurance. They either have commercial or private insurance or Medicaid. And so, most kids are insured. So there's a little bit of a different angle when it comes to the value offer that we put to prospective patients that are considering joining our practice that isn't as required as strongly, I feel like, in the family practice realm.

It's not zero, but there is a different value offer when it comes to positioning yourself to grow your pediatric direct primary care practice from a marketing standpoint and from a way that we sell. We do the sales for patients joining our practice. So those have been kind of two of the really interesting challenges when it comes to pediatric DPC. And then just being a business owner and owning a practice, all of those sorts of things that kind of go along with starting a practice from scratch.

John: Nice. Well, that could be a whole separate episode. I think I'm going to do a series maybe two or three of you who are doing this family medicine internist, others, and maybe we can have you back on the podcast, go into that. But the bottom line is though you're charging or you have a monthly fee that people pay and they have almost unlimited access to you one way or the other.

Dr. Phil Boucher: Yes. That's how we frame it is instead of all of the copays and deductibles and you know, calling and pressing three and waiting 17 minutes to talk to a nurse, to get told to schedule an appointment. People just text us for the most part. And millennials and Gen Z who are most of our parents that are joining love texting, hate being on the phone, hate taking that time out of their day. They love the convenience factor of it. And honestly, we do too, because it's so much easier than getting voicemails and playing phone tag and all those things to just communicate in the means that works best for us and for parents. The monthly membership fee, they can pay with their HSA. It covers everything. So there's no outside expenses. If you want your kids ears pierced, that's separate, but otherwise we really don't have any other line items that people pay for.

The thing that I think I've loved probably as much as the way that I'm able to have those relationships with families with longer visits and getting to know them more and just coming to know that my patients are going to see me or one of our team members when they come into the office is that we're able to try new things at a much faster clip because we don't have 17 layers of meetings and committees and proven concepts. If we want to try something new, we can with relative ease. We fail at a fair number of the things that we try. They just don't work. But then we have successes that we're able to really jump on quickly.

One thing that we did shortly after starting our DPC practice, we were in the midst of the pandemic. We had a ton of N95 masks. We set it up so that teachers could get those. A couple of months later, we had the formula shortage. Instead of having 17 rounds of committees, we just said, well, what if we have a formula bank and we can just get people that have formula on their shelves at home. Their baby has outgrown the formula. They haven't used it yet. Bring it to the office. We can distribute it to other families that are in need.

Same thing with COVID vaccines. We're able to just really jump quickly on the things in the community that are important and respond to those by figuring things out and just having a really, we can figure this out attitude as a team. It's made a huge difference for me, just enjoying being able to practice medicine, but also to respond to parents' needs and community needs in a much more quick way where things don't have to go to vote after vote after vote and nitpicking all the details. We say we want to do this, and then we do it.

A couple of weeks ago, or no, maybe a month or two ago, we thought, okay, there's a lot of teenagers that need to learn CPR for babysitting because they have younger siblings and all those sorts of things. So we're like, well, let's just do CPR and first aid for teens.

A month after deciding this is something that we should do, we just had one yesterday where we had like 10 teenagers that came in and did CPR training and learned first aid. Just the ability to do things like that when we think of them and when we hear from our parents that this is what they need, and to be able to jump on that has been so rewarding for me.

John: That's impressive. It sounds really to be involved in that. It's fun. It's rewarding. On the parent side, it's probably fantastic as well, just to be able to access that. You mentioned texting and people's use of texting. I think that brings us to the one topic I definitely wanted to talk to you about, which was you developed and are selling a product, I think now, and it's kind of a side gig. Just tell us all about it. It's called OpenSpot, I believe.

Dr. Phil Boucher: OpenSpot. This was not on my bingo card, but a couple months after opening my DPC, an eye surgeon who works in the parking lot across the street from my practice had sent me a message on Instagram actually saying, "Hey, here's the problem I'm facing. I know that you are kind of a techie guy. Do you have any ideas?" His problem was he's booked out several months for new patients, but has a lot of last minute cancellations. Timmy's sick. We don't have transportation. We got a better offer. We're not coming in for our appointment tomorrow. He would be twiddling his thumbs not having patients to see despite being booked out three months because his staff couldn't get a hold of patients. They didn't have the bandwidth to just call and leave all these voicemails and play phone tag to try and fill tomorrow at 11:30, an opening that just popped up. He was asking, Do you have any sort of solutions?

I couldn't really find anything that did that, but had enough experience and willingness to try that I was like, I think we can create something. And so we put a MVP, a minimum viable product together where essentially they could keep a waitlist. And then when an opening arose, they could start texting their waitlist. These people are booked out two months. Hey, tomorrow we have an opening at 11:30. Does that work for you? Reply yes, if so, and it's yours or reply pass, and we'll move on to the next person.

And so, that was the concept. And it kind of took off because you could do the math of how much money that and revenue that can generate if you're filling those gaps in the appointment slots. And so what we did was we had that minimum viable product, and we tried it in some local practices. And in the process, I learned a lot about software as a service, which I was completely unfamiliar with before that, but was able to figure out, okay, here's how it works. Here's what we can offer. Here's the limitations that we have not being integrated with an EMR, which I was like, well, no one's going to want to use this. People don't really mind having two windows open. They probably use multiple software products throughout the course of their day anyways.

And so it's okay if it's not integrated, if it gets those appointment spots filled and practice managers actually like filling appointment spots, even if it creates a little bit of a headache for their staff and not having to call people on the phone really reduces that headache that could exist of, you need to get this spot filled. Well, what if we could just text people?

And so I got a little bit of some energy from the initial traction of OpenSpot and went to a couple of local venture capitalist firms and said, hey, this is what we're doing. And they were interested and invested. I went and did it's called Founder University. It was by Jason Calacanis, who's an investor, Silicon Valley guy, early stage in Uber and lots of money and interest in supporting others. And got in a cohort of his and did a pitch contest at the end, won that. So won $25,000 from him for that. And then locally, we had a startup week, Omaha startup week, did my pitch competition at that and actually won that and got another $25,000 from that.

There's a lot of money out there for people that have an idea and can spark interest and tell a good story that there's a lot of people that want to invest in those sorts of things. And then the biggest one was our Nebraska State Department of Economic Development wants to support and grow local businesses. So we got a grant for $100,000 from them to further our product development. And essentially they were paying to have it developed locally. And what that did is it allowed us to start developing the product, taking it from what I made, which was the minimum viable product, which was really the minimum viable product into something that was actually like fancy and pretty and used real code and all those sorts of things.

And so that's kind of been the journey of OpenSpot. The biggest thing that we added now, one of the functionalities, aside from like building the whole product from scratch, was if somebody if you text and say, Hey, John, does tomorrow at 11z;30 work to see Dr. Smith? No. Perfect. We'll keep you on the list. And then it just automatically goes to the next person. Hey, Mary, does tomorrow at 11:30 work? Yes. Perfect. It's your spot or no. Perfect. We'll go to the next person on the list. So really automating that for practices so that once they start and they say, Dr. Smith has an opening tomorrow at 11:30, it will just keep asking people until it finds somebody that will take the spot.

And so functionality like that has really made it easier for practices to get on board with. This is kind of like a set it and forget it. And it's going to keep asking and putting people asking for the next person in line over and over again until it finds somebody for that spot so the staff are really hands off.

John: So how does it get the list of people that are on the list? Does it integrate with the EMR now or with some scheduling?

Dr. Phil Boucher: It either integrates with the EMR or the schedulers just add them to the list for people that want to be on the list. Most practices nowadays will have a very rudimentary wait list functionality. It's often like a three ring binder or a notebook in a drawer. And so we elevate that by just having them have a place where they can put in the relevant information. This patient needs in with Dr. Smith. This patient doesn't care. They'll see whoever's available. This is how much time they need for their appointment, whatever the relevant details are that the schedulers used to make those appointments. We get them to capture that information. They sit on the list and then they can start just pinging and going down the list when they tell us that there's an opening available.

John: Very nice. It reminds me this whole idea of queuing theory people lining up. Family medicine for a while was really pushing for basically an open schedule with no appointments. In other words, you have to call within a day or two of your appointment because the longer your list is, the more you'll have no shows. It's just a correlation. So it sounds like you've solved the problem, get the best of both worlds, have a decent list of people out there. So you're sure you're going to use your resources and then show up. So was this you had to like start a separate business, an LLC or something and you just hire a bunch of software programmers or what?

Dr. Phil Boucher: I really started leaning with this, which was developing it myself and sitting at the computer until I figured out and practiced and made it work. That's part of the nice thing about being in DPC is I see fewer patients per day, which means I have more time for all of these other side things for good and for bad. We had to start a separate LLC, then we had to convert it to a Delaware C-Corp because what I learned is that VC firms want you to have a Delaware C-Corp something. I don't know the specifics, but that's a thing. Like if you think you're ever going to take investors money, then start with a Delaware C-Corp and you'll save yourself a fair amount of lawyer fees and hassles in that regard.

But yeah, those were the biggest things and just all the business stuff behind that, which is pretty typical and people set up businesses all the time. So, there's not anything that a doctor can't learn to do or hire somebody to help them do. But from there, then just figuring out how to market it and get in front of the right people. That's been a lot of trial and error is like who the decision makers are, who are the ones that are actually going to implement this, who's going to maintain it.

And it has mostly come down to the people that we need to talk to, maybe to get initial interests or physicians that say, yeah, this is a problem. I do have a lot of gaps in my schedule that I would like to fill because I don't really want to work more days and I don't really want to just pile more patients in. What if I could just be more efficient in the time that I have, which is filling those gaps in the schedule that creep up.

Because honestly, I think people are less enthusiastic about going to the doctor than in years past. Like you do see a lot more no-shows or last minute cancellations because I think the weight of going to the doctor has less meaning than it used to. And so people are more likely to skip or bail or take a better offer or cancel at the last minute.

And so, if we can get those people to make sure that they tell us within 24 hours, at least 24 hours notice, then we can usually fill those gap spots without having to spend hours on the phone and playing phone tag and all those sorts of things.

John: Well, one of the things that's probably threatening the most physicians is marketing, advertising, promoting, that sort of thing. So just to learn about that, why don't you just market your product to us right now? Tell us, I have physicians that are practicing here. So what are you doing to market it? But just tell us about the website and what we'll see if we go to the website and what we can expect from the product and that kind of thing.

Dr. Phil Boucher: Yeah, essentially for most physicians, it's something that you're going to tell your office administrator, "Hey, we're really busy. We have a waiting list out the door, but we have a lot of unfilled appointment spots at the end of the day because of last minute cancellations." And what OpenSpot does is it allows you to fill those holes in the schedule without having your staff overburdened with trying to make phone calls and play phone tag. And it meets patients where they are, which is text messaging. And it just makes it easy for them.

Most physicians task their administrator of looking into it and taking those next steps when it comes to, is it the right fit for us and does it work with our practice workflow? And then the schedulers are the ones that are using it on the day-to-day basis. And so we try and make it make sense for schedulers to see the value of filling those spots, which makes everybody happy. And also not adding to their burden of making phone calls or who's talking to this one, or did somebody already offer this appointment? It just streamlines that entire process so that you know that there's something and it's not a person that could be doing other important work that's working to fill those spots.

John: Is this available nationally? Right now I can call you or go to your website?

Dr. Phil Boucher: Absolutely. Yes, findopenspot.com.

John: findopenspot.com. That's the website. Okay. And how long does it take to implement?

Dr. Phil Boucher: Less than a week. We do all the training and everything along those lines. Once people get set up, we find out what types of appointments they need and what types they have. Because one of the things that I've learned, being a pediatrician, I don't know how everybody else's scheduling flows work. Learning that dermatologists need more time for fillers than Botox seems like something that's intuitive to dermatologists, but it wasn't intuitive to me. And so, learning about the practice and the way that appointments are scheduled, which is just a quick Zoom with your scheduling team to figure out what that looks like, what the relevant information is, because it's all very specific for practices.

Some practices have really wide open schedules, some have very regimented schedules. And so, we're able to work with all of those, but it just takes a quick understanding from your schedulers, how they schedule, what they need to know to make a good appointment, what they don't care about when it comes to scheduling appointments, and then fine-tuning the system so that it gets the relevant information and can make good matches.

John: And let's see, it seems like in the old days, some software would sit on someone's server at their office, but I assume this is actually an app that gets integrated.

Dr. Phil Boucher: Yes. It's all browser-based. Chrome browser, Safari browser, whatever browser you're using, it's just a different tab that you would have open that you would switch back and forth to. We've also set it up because it's working in the background. You don't want to have to kind of like tend to it. And so whatever system your practice uses, whether it be email or Slack or Teams, it integrates with those too. So it can say, hey, we filled the spot at 11:30 tomorrow and let this practice know so that they know that that booking has been made when it gets made.

John: And are you doing something actively to promote this besides, I don't know, just talking about it? How do you actually get the word out short of going person to person and calling them and say, hey, do you want this?

Dr. Phil Boucher: That's been the biggest challenge is figuring out the best way to get in front of the decision makers. Some of it's on LinkedIn, some of it's on podcasts and video. Some of it is trade shows. We've done some trade shows where you're talking at the Medical Group Management Association and those sorts of things. Those are all different routes of getting it out there, but it's kind of the approach which I've learned as a pediatrician and marketing my practice. You have to connect. You have to have a lot of touch points before people make that next step. It's not something where they just see it and they go and they sign up.

I'm kind of that way. I'm like an early adopter. I got the first Apple Watch and I'm still going strong with Apple Watches when I first heard about them. I don't have the Apple Vision Pro thing yet, but I think most people need a lot of touch points before they realize, hey, this is something that I need to look into.

I know that like the people that are listening to this, it's probably unlikely that they're going to go and just put in their credit card information and sign up. But if they hear from me and they see me on a bunch of different channels on a regular basis, then that probably is going to nudge them and eventually they're going to be like, hey, let me forward this to my office administrator. We should look into this because I frequently have all of these gaps in my schedule and I know the schedulers are too busy to be calling patients. And that's what it's going to take to actually get that first phone call and that discussion rolling.

I think that's something that I intuitively knew and was reminded of over and over again, is that it takes a lot of touch points for people to do something about it. And also when there's a little bit of change involved, that it's going to take a lot of time from a change management perspective.

John: And if they go to findopenspot.com, is there a contact form or do they sign up to do a call with you or how does that work?

Dr. Phil Boucher: Usually people just book a demo. We chat through and figure out if it's a good fit even, and then from there decide how to integrate it into their workflows if that's something that they're looking for. But the easiest way is just to book a demo that's free and you just book it straight from there and it's a Zoom call where we can talk through what they're looking for.

John: And you told me as we were organizing this meeting that, oh, you thought you'd create some other software, another tool. So why don't you quickly give us a rundown on where you are with that, what it does. Are you in the same business or is this now another business?

Dr. Phil Boucher: I'd say this is just a spinoff of OpenSpot, in terms of lie the hierarchy of businesses. OpenSpot is great for busy practices that are full and they've got a wait list of at least four weeks and they're really trying to fill those gaps. They're trying to increase efficiency.

As a DPC pediatrician, I get to talk with a lot of DPC doctors, both in family medicine and internal medicine and in pediatrics and specialty care. And one of the things that they need, they don't have full practices and long wait lists. I don't have a wait list. We don't use OpenSpot in my practice. If you need an appointment today, John, you would just text and say, hey, my son fell and I think he needs stitches. And we would just text back and say, come on over. There's not a wait in that capacity for DPC.

But what they need to do is they need to really have a lot of touch points with prospective patients to get them to say, okay, this is the practice for me, or I understand how this works and how it'd be beneficial. And so, what we created then for that side of practices, small practices, growing practices, startup practices, is essentially a HIPAA compliant CRM. CRM is Client Relationship Manager in business speak. But essentially it's a way to manage the relationship and manage the outreach and touch points with potential customers, potential patients in a way that helps them stay organized, know who's reached out, know where people are at in the pipeline of their customer journey of initial reach out, learning more, book a meet and greet, join the practice, loss to follow up, those sorts of things.

And so, what practice leads does is it allows for small practices to manage those leads as they come in and nurture them along to the point where then they're taking that next step. Because what I found was a lot of practices are really good at the first touch points or meeting patients at the baby expo or the health convention or whatever it might be, but then they were losing them to follow up because they just weren't making enough touch points with them to stay top of mind.

Because most people today aren't looking for a new doctor and you really have to convince them that there's something better for them. But over time, you can do that if you have enough touch points, enough nurture points, if you're able to talk to them on a regular enough basis to say, hey, maybe there is a better way, or maybe we offer something that your regular practice doesn't, or maybe we have a special evaluation that we do that we need to explain in a little bit more depth to you how we do it and what we do.

And so, what Practice Leads does is it allows you to track those leads as they come in, nurture them along, have one place, one inbox that has text message, email, contact us forms, Instagram, Facebook, all of that in one continuous stream of information so that you're not looking in seven different places to remember where somebody contacted you and how they reached you and what their deal is. That's what Practice Leads is. It's a HIPAA compliant CRM for small and growing practices.

John: Very nice. So that is up and running now and accessible to the practicing physicians?

Dr. Phil Boucher: Yes. And the thing that I love about it, one, is that it's HIPAA compliant, and two, is that it lets you do it all in one place, and three, is it's completely customizable. And so, the way that we use that in my practice is we've been doing a lot of ADHD evaluations. Before somebody books an ADHD evaluation with me, they probably want to know that I know what I'm talking about and that I'm not just going to push medicines on them because most people these days want to try things other than medicines.

The way that we work that is they start with a webinar that's free and on demand, and it's about how food impacts our child's behavior and attention and focus. And then from there, they get a series of emails and text messages that share more about our process and what we do and how we do it and what an evaluation looks like and what it doesn't look like and who it's good for and who doesn't really need it. And here's some other strategies that you can implement before you get to an evaluation.

And over time, we build trust, we build rapport, we build that trust factor that really is important before somebody decides, I'm going to book an evaluation. And so, what Practice Leads does is allows us to monitor those parents, as they're going through the process of watching the webinar, opening emails, reading blog posts, reading news articles that we send them. It allows you to automate that process so you know where they're at in that funnel that you've created to get them to eventually, over enough touch points, decide they're the right practice for me. I want to get an ADHD evaluation. This is timely because school is starting sooner. We're really struggling with this and that or the other thing. You build that relationship and you're the one that they turn to then when they actually need something.

John: Excellent. Well, what's the website for that?

Dr. Phil Boucher: GetPracticeLeads.com.

John: GetPracticeLeads.com. Okay, obviously, I'll put that in the show notes along with the OpenSpot link as well. And actually, the link to your practice because I think people will find it interesting just to see what you look like online when people are thinking about joining your practice.

Well, this is very interesting. I'm definitely going to follow up with you down the road here and see how things are going. Any last advice? I guess I'm going to stop there. Any last advice though about, I don't know, it seems like things are exciting with what you're doing. Just practicing in the US, is it possible to make it fun and profitable at the same time for physicians?

Dr. Phil Boucher: I think it is, but I don't think that you're going to find as much fun stuck in an organization or a large institution. And I think more physicians are getting really hip to that. This that we've been sold, the large employer, they often trade autonomy and care for more RVUs. And what that means for physicians often is that they feel like they're not anywhere near the top of the food chain. And they're often feel very replaceable and just like a cog in the wheel. And I think that you can have a lot more fun and enjoy medicine and practice medicine the way that you want when you have more control over the way that you practice it. And I think physicians are often afraid because they feel like business is too hard.

Because I graduated from medical school 15 years ago, 16 years ago, something like that. We got no business training at all. And it feels like maybe it was intentional because they want to grow academics and they want to grow large institutional employees. And so, why would we tell you about business? Business is hard. How are you going to figure out your books? How are you going to do bookkeeping and taxes? Those things sound hard. Let's just keep you at the academic center or at the large organization and you'll be miserable. But at least you won't have to do those things.

But then I talked to physicians and there's a million new small businesses that open in the US every single year. Most of the small business people that are opening these businesses don't have the training, don't have the cash flow, don't have the connections that every physician in the country has.

And so, I always encourage people there's a way to figure out how to go into business for yourself and to practice medicine or to serve the people that you feel called to serve, which for me, I love taking care of parents and families locally. I love helping other physicians to grow their practices. I love helping thriving practices to thrive even more or to get physicians their time back so that they can do with it what they like, whether it's being more efficient in their day to day, whether it's growing their practice with marketing, whatever it might be to give them more autonomy and more freedom to do what's really important to them and to focus on those sorts of things.

There's a way to figure all those things out. But it does take a little bit of risk, but you've done risky things before. It does take a little bit of learning, but you've learned for decades now. You can do all these things if you just feel like, okay, maybe there's another way to do it because there's a lot of people out there that are really unhappy in their practices. I can't spend that much time on the physician Facebook groups anymore because there's so much negativity and it's not their fault. It's the system that they're a part of and that they're forced to work within that's really causing a lot of that burnout and a lot of that cynicism that you see in a lot of the Facebook groups.

But there's another way and it can be really fun and it can be really profitable and you can really enjoy your life more. I wake up and I am ready to go and I have these long lists of things to do. I wish I could do all the things that are on my list every day, but I have a really good team that helps me to hone down what I actually need to do and then they do the other things that help me to thrive. It's just such a fun way to practice and it's such a fun career of helping everybody that I can help.

John: Fantastic. Very inspirational. You rock, man. I love what you're saying. I agree with it. If I was 20 years younger, I might jump in myself, but I can at least get the word out and you've been very helpful in getting that word out today, Phil. Please do.

Dr. Phil Boucher: Please do. I know I give you my cell phone number. You can put that in the show notes and just tell anybody that wants to. I'm decent in email. I'm getting better at email, but the best way to reach me is to text because it's hard for me to ignore when my little green box on the thing says one or 12 or whatever. Text me. Anyone out there, any physician out there can absolutely text me to chat and figure out how to help them.

It's not to get you to join OpenSpot or Practice Leads or anything like that. It's just I love helping and I love brainstorming for physicians. I think that there are very few specialties where you can't do something outside the box of what you're doing right now. I don't know how heart surgeons can work outside of a large center, but everyone else that doesn't require a cardiopulmonary bypass can figure out something outside of the hospital if they're sick of being an employed physician and want to do something else.

John: I'll definitely put that in the show notes. You listeners look in there and they have the number. You can text Phil or reach out and check this out however way you want to. I will do that. All right, Phil. With that, I am going to say goodbye and let you go. I hope to talk to you again in the near future.

Dr. Phil Boucher: Yeah, let's not have four years pass between our next chat.

John: Okay, bye now.

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The post Building the Private Practice of the Future with Technology appeared first on NonClinical Physicians.

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

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

Solving the Burnout Problem

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

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

Happy Day Health Services

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

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

Building the Medical Matchmaker Business

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

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

Challenges for Physicians Going ‘Private'

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

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

Dr. Hochman's Advice

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

Summary

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

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

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

Links for Today's Episode:

• Happy Day Health
• Dr. Lara Hochman's LinkedIn Page
• How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256
• Who Can Help When Private Practice Matters? – 174
• NewScr!pt

Download This Episode:

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

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 273

How the Medical Matchmaker Provides a Solution to Burnout

- Interview with Dr. Lara Hochman

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

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

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

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

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

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

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

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

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

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

John: Oh, really?

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

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

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

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

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

John: Nice.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Lara Hochman: Yeah.

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

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

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

Dr. Lara Hochman: Bye.

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The post How the Medical Matchmaker Provides a Solution to Burnout – 273 appeared first on NonClinical Physicians.

In today's podcast, Ron Barshop explains how to save healthcare, satisfy patients, and fix physician burnout.

Our Sponsor

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

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

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

What is DPC?

Direct Primary Care is a subscription-based program for connecting patients with physicians. It allows for immediate and continuous access to care. Most people might know it as concierge or “VIP” care. However, it has evolved to include a more grass-roots, scalable method for accessing care.

It enables doctors to provide medical coverage to a panel of 600 to 800 patients. And, instead of offering a six-to-eight-minute interaction with patients, DPC physicians spend 30 minutes or more with them during face-to-face visits. With DPC, coding and billing are no longer a concern. 

Support for Independent Practitioners

Ron described four companies that support physicians in developing their DPC practices that have been featured on the Primary Care Cures Podcast. They are helping independent doctors start their own practices wherever they live.

1. Episode 165 – Chris Habig, Freedom Healthworks. Doctors don't need to become entrepreneurs overnight. The company handles money, marketing, and all the backend work, and hiring is very much turnkey.
   
   
2. Episode 21 and Episode 42 – Dr. Josh and Kirk Umbehr, Atlas MD. More than half of the independent DPCs in the nation were started with Atlas MD. 
   
   
3. Episode 25 – Dr. Paul Thomas, Plum Health.  Paul Thomas established his own practice right after finishing his residency. He will shortly be launching his third practice. He explains how to launch swiftly using social media, and introduces other tools to help DPC start-ups.
   
   
4. Episode 59 – Dr. Brian Forrest, Access Healthcare Direct. He has helped launch more than a hundred distinct DPCs.

Summary

Physicians who feel burned out should look into direct payment models. There is consulting support for starting up an independent practice.  And there are large companies that will add you to their DPC networks. You can leam more about this growing phenomenon by listening to the Primary Care Cures Podcast. A list of all of the episodes can be found here: primarycarecures.com/podcast-episodes/

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:

• Ron Barshop's Website
• Primary Care Cures Podcast
• Achieve Beautiful Balance as Medical Director and Concierge Physician – 234

Companies Mentioned in This Episode:

• Freedom Works – 165
• Atlas MD – 21
• Atlas MD – 22
• Plum Health – 25
• Access H/C Direct – 59
• First Stop Health – 130
• Proactive MD – 138
• Next Level Urgent Care – 126
• Nice Healthcare – 113
• Marathon Health – 164
• Medici – 118
• Medici – 58
• 98point6 – 62
• Crossover Health – 111
• Premise Health – 110
• Everside Health – 106

Value-based Care ACO Companies: 

• ChenMed – 64
• Village MD – 84
• Catalyst Healthcare 45
• Nextera Healthcare – 28
• Redirect Health – 121
• Redirect Health – 29
• Redirect Health 6

• NewScr!pt

Download This Episode:

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

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 256

How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout

Interview with Ron Barshop>

John: Today's guest is not a physician, but honestly, it took me two or three of his podcast episodes to figure that out. So, why would that be? Well, because he so clearly describes the problems with our current system, most of which are driving physicians out of the system that I thought he had to be a physician. But no, he's not. He's awesome. He has a great podcast, he's written books. And the thing is he goes a step further. He offers solutions. And the solutions he describes if implemented, I think will fix healthcare as he claims. So, we're going to hear about that. With that, let me introduce Ron Barhop. Thanks for coming.

Ron Barhop: Thank you for inviting me. I'm looking forward to this.

John: Yeah, there's so much I'm trying to understand what you're talking about on your podcast and in your books. But before we get into that, why don't we just have you tell us a little bit about your background education and how you started to get this interest in direct contracted primary care?

Ron Barhop: Well, when I was an angel investor and I had an angel network, a gentleman came to me with a really interesting healthcare company, but it wasn't really fundable by early stage. But he and I became partners later in a business that helped physical medicine find its way into the exam rooms of primary care physicians and helped them add ancillary income.

He and I split up and he formed an allergy company and I formed an allergy testing and treatment C company. And it would turn out to be, I thought the solution for primary care to cure it, because it was broken clearly, was ancillary income. 15 years ago, is when I started the primary care supplement income company. But I started a podcast four years ago to "Sherlock" the crime scene. And the crime scene is "Why are we between Slovenia and Costa Rica in our outcomes with care nations?" And that's basically the GDP of Milwaukee.

John: Right.

Ron Barhop: And we're spending almost double Switzerland, our second closest competitor in spent. And then another question was "How come if the Fed is right, 51% of people are making under $20 an hour and 80% of workers are making under $30 an hour?" We have this backbone of hourly workers. And so, we have this Wealthcare-Poorcare system for them versus the others.

Basically, we have unfunctional uninsured about half of all workers. They have these high deductible plans they can't even use. They don't have enough money in the bank to access it. And then over half the PCPs are burned out. So, I've got this 51% under $20 an hour, 50% of doctors are unhappy in their jobs and they're supposed to be taking care of my health and my kids' health and my family's health. And I knew that if we had a cure for primary care, then we could cure overall healthcare because that's sort of the mouth of the river, if you will.

John: I guess I would just say, can you give us just kind of an overview of the best situation for what is DPC and what's the ideal situation for that way of providing care?

Ron Barhop: Well, most people might know it as concierge or VIP care, but it's not that anymore. It's scaling and there's sort of two flavors of direct primary care that I discovered on my show. Again, I was just like Sherlock Holmes, just trying to get my magnifying glass out and figure out what's the solution. And initially, I got what I call the Mount Everest, or maybe I should say the Mount Rushmore of the four DPC doctors that are the thought leaders on my show.

I thought that was the answer as independent mom and pop Kool-Aid stands that are taking care of locals. And that doesn't solve the jumbo employer problem, which is a whole different flavor of DPC that is cropped up as private equity's been funding at the last really five to 10 years. And so, I suddenly discovered, "Wait a minute, you can have a jumbo solution and a mini solution all in the same model."

Just to take a step back, DPC - Direct Primary Care is a subscription base monthly payment per member per month. And what it allows for is an employer to access immediate care, but also let's take it from the doctor's perspective, because that's your listener. From a doctor's perspective, their panel is now 600 to 800 as opposed to triple or no quadruple that. It allows them to have instead of a six-to-eight-minute interaction with half that time typing. Now they can toss the EHR Bible out the window and not have to code and not have to bill, which is a massive regime of pre-authorizations and all the headaches that every listener knows. And it allows them to have a longer visit with a member. And the member now gets 30 minutes, 45 minutes on a second or third interview. They get an hour on the first exam, but more importantly, they have access with virtual care. So, they have an app that allows them to text synchronously tight with the doc at the same time or talk by chat or video.

Telehealth got this big boom in the pandemic to 40% utilization jump and DPCs had it all along. It's been part of it since 1998. It allows the physician to now have their calling come back into their life again, why they chose the calling. So, it's an amazing thing. This scaling has allowed an employer that has people in three or five or 10 states or three or five, 10 metros, or even in foreign countries to now have access to a primary care physician, which is really important for chronic care because that's 80% to 95% of their cost. And now they can get those folks in front of a primary care physician and head off in the past. So, they're not using that expensive downstream utilization of hospitals and ER and urgent care that are so costly and too late, frankly, for the chronic patient that needs lots of love and lots of attention now.

John: I sense that the devils in the details, to some extent. It's just hard to get my mind around "Okay, I'm going, I'm using an EMR. I'm working with insurance companies. Of course, I'm in my staff, I have to staff up like three or four employees just to handle the insurance and the rebuilding and so on and so forth." So, how is it that works where you're not having to code?

Ron Barhop: The problem with American healthcare that's unique and special about us, we're going to call it special in the short best sense of the word, is that we don't have access to inexpensive, immediately accessible primary care in America. And most primary care physicians would die to have three or four employees doing their billing and coding. But if you do the math, it's closer to eight or nine administrative types.

John: Okay.

Ron Barhop: These medical assistants aren't even giving to touch the patient. They're dealing with pre-ops and they're dealing with check in, putting stuff into a computer. They're dealing with the billing collecting, all of that regime. And when you have DPC, it's a monthly subscription. You're getting anywhere as low as 20 with one company as high as 120 or 150 depending on the services the employer wants. Now increasingly primary care is stretching like a rubber band to include behavioral health because that's what employers need. They need their people healthy and back at work. And generally, it's free. The ROI for DPC is one out of one year one, and it's as high as three or four on one year, two or three or four because of the downstream utilization that drops.

And the exciting thing about it is you only need maybe one assistant at the front to check people in. You're not coding anymore and you're not billing because there's no insurance company involved. So, we get these bloated expensive middles like PBMs out of the picture. We get these bloated insurance companies. 90% of the profits for insurance companies, core units have been federal. They're not seeing private employers anymore because they've fled long ago because they know that the incentives are maligned.

So, if you're a DPC doc and you're with a large scalable firm, they do all the backend for you. And there's three people that I'll introduce to this show that are helping independent doctors that want to start their own practice wherever they live, meet the patients, wherever they are. Again, as I said, there are two flavors. I'll try to carefully parse those out as we have this talk today.

John: I understand that there are, and I've heard either on your podcast or others, let's say talking to the really small company physician practice, and they just opt out of the whole system. They somehow have a tool or mechanism to receive the monthly payment. They have to deal with the high-cost items. I don't know if that's through reinsurance or some other method for the patients, not for them obviously. And then there's the other iterations that I think that you're going to get into, but if I was just finishing residency or early in my career decided to do this, how would I actually get started by doing it on my own or other companies I can reach out to, to help me?

Ron Barhop: Yes. I'll give you the names of three people that are helping people do exactly that. I just interviewed on my show number 165 Chris Habig, Freedom Healthworks. He basically does finances, does the marketing, does all the backend, does the hiring pretty much turnkey because doctors don't need to become entrepreneurs overnight when you have somebody like Chris that helps you get started.

There's another company. Dr. Josh and Kirk Umbehr with Atlas MD have launched over half of all the DPCs that are independent in the country today. That's episodes 21 and 42. And Josh the doctor, and Kirk the brother, are helping them get started in the practice with all the millions of questions and FAQs they've got to get it launched immediately.

I had another guest who is part of my Mount Rushmore, Paul Thomas. Dr. Paul Thomas has Plum Health and he's episode 25. He consults now with doctors that need to get started. And he came straight out of medical school, straight out of his residency and started his own practice and is now opening his third practice soon, where he lives. So, he will tell you how to rapidly start with social media and using all the obvious tools that are clear to a guy who's just getting started, how to launch quickly.

And then there's a gentleman named Dr. Brian Forrest, Access Healthcare, which is show 59. And he has launched probably over a hundred different DPC. And all of these gentlemen that I'm talking about have basically a hundred percent success. There are very few fallouts when you go there, if you want to go independent. If you want to go on a scalable, we'll talk about those a little bit later, but if you want to go scalable and go to work for somebody, these are the happiest doctors in America. They don't go to a convention and drink a lot of wine. They drink a lot of fresh water and they're happy. They're joyful because they don't have the burnout of the regime anymore of the insurance companies lording over them like a hot sweater in July.

John: All right. I'm definitely going to put those in the show notes. I'll make sure to put those podcast episodes in the show notes and the names and so forth. That's very helpful. I guess I wanted to comment too, as you're talking about this, I look at it from the perspective of the physicians being unhappy, but the other half of the equation is the patients are miserable because like you said earlier spending five minutes with a patient, spending 10 minutes documenting and trying to solve a problem. And now you're having them come back over and over, because you really only have time for one problem. You're not doing a comprehensive visit. Again, my audience, we kind of focus on the physician's side of this, but of course we all know that it's just making the patients as miserable as we are. So, if we can break that pattern, then this is going to be fantastic.

Ron Barhop: Well, the jumbo employers are using this to get free healthcare. So, when you take away the friction of finance, the friction of time, the friction of "Do I even have a doctor that cares about me or has information on me? I have to start all over again" goes away when you deal with these nationally scalable models that are now growing in all 50 states. Also, it's good to measure. If you're going to go work for one of those, what is their turnover with the employers? Most of them have 98% to 99% retention with their client, which is the employer who's paying the bill on that per monthly basis I was telling you about. And if you're measuring metrics, and doctors love metrics, what does that turnover and what is the employee satisfaction?

And there's two ways you can parse that out also. You can look at the NPS, the net promoter scores of most of these firms, and they're in the high 80s and low 90s. And some of them are in the high 90s. That means the patient is incredibly happy. And some of them will publish their Google ratings. I don't know why they don't, because that's a big question mark. For me, why wouldn't you be proud? But many of them have them in the mid four's, tons of fives and a few fours and obvious one or two. But Google ratings will tell you that the ultimate consumer, the patient is very happy. So, you don't have to guess when you go to work for these companies and you can look at the Glassdoor ratings. But Glassdoor is kind of like Twitter. If Elon Musk is finding out, it can be loaded with fake reviews in there.

I've seen companies that are at a two or a three instead of a five. And suddenly employees start jumping in, that are, I think, fake employees that are saying how wonderful it is to work there when all the rest previously were saying the truth of what it is like to work there. So, if you look at the Glassdoor of a hospital, a typical big system, it's not going to be very pretty. But if you look at the Glassdoor of a lot of these PCPs that are now getting, and by the way, most of these companies I'm about to talk about are all run by doctors. So that's a plus, right? But they're much, much higher rated, and I don't think they need to fake anything in there because the customer, the consumer, the member is genuinely happy.

John: No, that's the ultimate test, I think. Especially if all the stakeholders are really doing well and benefiting from it. Let's see, we're going to talk a little bit more about some of those businesses or the corporate side of things. To me, it sounds like that's kind of where this came from to some extent, because the big employers just decided, "Look, we're tired of number one, wasting our money. Number two, the insurance company is just billing, charging us to manage this thing and it's ridiculous." And so, they just took it over and started hiring doctors and putting clinics together, and that kind of thing, I imagine.

Ron Barhop: I'll talk about the small guys first that are regional and growing and maybe they'll be acquired by some of the larger ones, but we're talking about 20 million members. We're talking about 20,000 PCPs. And it's not just broad scope PCPs, although that's best, if you're a family doctor or DO or an internist and you have lots of scope in your practice. That's better than a gerontologist or a pediatrician, but there's plenty of those folks in this model too. But the gerontologists are getting snapped up by the Medicare advantage capitated plans. And I'll talk about those too, if you'd like, but I've had these guests on my show. Do you want me to just run through the list? Because it's about 10 or 15 companies.

John: Yeah, sure.

Ron Barhop: Okay. Small to bigs, First Stop Health. You'll hear the Patrick Spain interview on episode 130. Proactive, John Collier episode 138. Dr. Juliet Breeze is expanding big time in Texas. Next Level Urgent Care, that's episode 126. Nice Healthcare. I joked around. I can't believe that a name was still available a few years ago, but Nice Healthcare is Thompson Aderinkomi. He is the first guy I'm going to mention that's not a doctor. That's episode 113.

And now we're getting into the bigger voice here and it is the Dr. Jeff Wells with Marathon Health, episode 164 was just on our show. They're the most transparent I was able to find in terms of just getting all the metrics if you're a doctor and you want to go work there. But it's all on my show if you want to save the time.

Dr. Clinton Phillips, episode 118 and 58 with Medici healthcare is one of the largest virtual primary cares. But now that everybody's jumping in, basically Teledoc jumped in a few months ago. They have 11 fortune one hundreds. Medici has a third of the fortune one hundreds.

Brad Younggren with 98point6, episode 62. 98point6 is helping Walmart to do the virtual. And then Scott Shreeve with Crossover. It'd be hard to name a Silicon Valley big that's not using them, but that's episode 111. And so, Crossover is in all the Amazon fulfillment centers and they're expanding in LinkedIn and into it. The list goes on and on. Facebook.

Dr. Jami Doucette with Premise Health is the largest. They have 3 million members and that's episode 110. Premise Health, again, helps hundreds of employees, almost 800 employers across the country that are jumbos. And the one that I found first was Everside. Dr. Gaurov Dayal is their president. And Everside, not only helped the state of New Jersey save billions between primary care and pharmaceutical spend, which is the biggest amount ever by a state or county or anything. We had Chris Deacon on our show. Chris was the state treasurer. She was in charge of the program for that in pensions back before she left.

But Everside also helps the state of Colorado and big school districts all over the country. So, they're the second largest, probably over a million members. These are companies that I would probably look to. And I have not had on my show yet one medical, but they're a public company that does, with the purchase of IRA health, both the Medicare population and the employer population.Cityblock, I haven't had on my show yet, but they're doing a lot in the Northeast. Famhealth is a feminine female only business consumer. And then Firefly. There are a ton of them that are going after either employers or members directly that are worthy of looking at with this screen, I was giving you from a doctor's perspective.

John: With these companies, from the perspective of the physician, are they contracting with them? Are they employed by them? What's that relationship between the physician and their providing that service to the employers?

Ron Barhop: Yeah, they work for Crossover, get their paycheck from Premise. They get their benefits from Everside. They're not going out on their own. If you want to go out on your own, I would talk to those first four guests that can help you launch. But if you want to go, and it's not more stable, it's just different. But most of them will still give you a panel. You'll have your members that are coming to you, physically, because they're spread out all over the country. So, if you Google onsite or near site clinics, a lot of these companies will pop up. And they're either in the headquarters or near major employment manufacturing, or they're nearby. They're in the neighborhoods where the people live.

John: It's a little overwhelming, although it's been kind of bubbling in the background for a long time, it sounds like. And you have mentioned on the podcast that they've been very successful. Like you said, the dollars look good. The physicians are happy. The patients remain with the physicians, the old model of the primary care doing most of the initial management and being that, not just really a gatekeeper, but really that one-on-one physician and managing things. It seems to be almost Nirvana. So, what have we missed now? Are there some other types of companies that are doing this, that we haven't discussed so far?

Ron Barhop: Well, it's an ecosystem. Again, if you're helping an employer, they need access to wholesale pharmacy. A lot of them are contracting either direct with a pharmacy, sometimes the gross is in that town, and they're negotiating rock bottom prices, or there are wholesale mail order firms. I had ScriptCo on the show, their average fill is 4 cents per pill. You don't need a PBM if you got 4 cents per pill. So, they're in 47 states now. I just had Zach Zeller back on the show. You'll see him pop up in last week's episode. And it's not just pharmacy. It's got to be, how do you contract with surgery, labor and delivery being the biggest one?

Well, the Surgery Center of Oklahoma was the OG, the original gangster that started back in 1993. And there's now 60 independent free market surgery centers that are owned by surgeons and doctors that are in pretty much every state. So, if you're willing to travel just a little bit, surgery is 60% to 80% less. And then there's 1,700 independent imaging centers with green imaging. Kristen Dickerson was on one of our shows. And those imaging centers are, again, 20% to 40% of the cost of imaging centers owned by the bigs that had these facility fees and these outrageous prices built into a simple X-ray or MRI or ultrasound. And furthermore, it's not just pharmacy, it's not just surgery, but you've got to access sometimes a hospital. You got to do a deal, sometimes you just got to go there. As much as we don't want them to, and they don't need to, hospitals are going to be contracted within those cities as well, independently through the third-party administrator.

Now you mentioned stop-loss. On a contractor basis with jumbos, they have stop-loss built into these plans by the plan designer, the benefit designer. But if you're independent and you're going to find these docs on your own, in your own town, in your neighborhood, you will buy a company called Sedera Health or Zion Health. And they have these, I guess, they're sort of like stop-loss, but they are low deduct. They can't call them insurance because they're religious plans, but they are allowing people to take care of that scary cancer car accident or cardio incident that could bankrupt them. And those companies pick that up.

And then there's another company that just came into the market from Austin that's called Crowd Health. And I had Andy Schoonover on my show. It's kind of the same idea, but it's just crowdsourced funding of your large healthcare expenses.

I've had it for four years. I had Sedera for four years. I had Redirect Health handle my primary care. Anywhere I want to go, I would show QR code and I would get out no cash. I'd just pay them a monthly fee to access. And it's not their doctors. It's any doctor I want to use. Any labs free, any physical medicine free as part of my monthly. But now Redirect Health is now offering a stop-loss, if you will, with $2,000 deductible in any hospital spend. So, they haven't built into their model too. So now I'm using them fully, not some of these other religious.

John: This is something that I think my listeners would like to dig into a lot more because it's an option if they're really feeling frustrated and burned out. You have a book called "Healthcare is Fixed." Is that out? Is that available for pre-order? Because it goes into these details from what I know. I've not seen the book. So, tell us about that.

Ron Barhop: I wrote it in 2019. I recorded it right after that and I've been sitting on it. And John, I don't know why. I don't know what I'm afraid of. I hope to pick with Healthcare is Fixed and you can go to healthcareisfixed.com, but I hope to go pick a company every year and identify what I think are the best. So, I'm going to write another book about hopefully the new ecosystem in Alaska, which is doing amazing things at half the price in primary care for the Alaskan native population.

I hope to write a book about RosenCare, but I think Mr. Rosen and his daughter or granddaughter are going to write a book. But RosenCare again, for less than half the cost, is delivering healthcare so much so that they have no debt on 6,000 room hotel resorts around our Orlando convention center. And they're funding a school district that used to be crime ridden and drug ridden. Now they're paying for all the college for any student that graduates high school. Community college, vocational school, full boat, PhD level college. Medical school, whatever they want to go to. And some of the doctors that started out as students there 20 years ago are now serving their population of their employees.

John: Nice.

Ron Barhop: There's amazing companies out there doing incredible things that are literally eliminating crime in neighborhoods. There are no gangs in this school district and they just adopted a bigger one. The best way to measure is who wins in this model? And if the employers are winning, because they now have a ROI of one on one or two on one or three on one. And if the consumer, we don't call them patients in this world, we call them members. But if the consumer's winning, if the doctors and nurses are winning, they have low turnover rates. If the shareholders of those companies are all winning, if the communities are winning, like the Orlando community has gotten rid of crime and these giant school districts, if costs are dropping 20% to 60%, and if outcomes are rising measurably, we don't have a triple aim problem or quadruple aim problem anymore. We have an octupole aim and then we're accomplishing them all eight. Those are passe to talk about quadruple aim. You can have three out of four, but not all four. No, that doesn't work anymore. We have direct contracting with a large ecosystem with primary care as the foundation, John, is the answer.

John: Well, I could get behind that 100% for sure. For my listeners. This is going to be overwhelming. So, you want to go to primarycarecareers.com because you can find out about the podcast and start listing the episodes. And then you can go to healthcareisfixed.com where actually there's a lot of information that you've described. And that book when it's available is going to be there for us. So, we'll look for that. Any other big points, as we want to get to before I start to wrap up our interview here? Did we hit the high points?

Ron Barhop: Yeah. The system is clearly broken. We don't need to talk about that. You do a lot of that on your show. But there are happy doctors out there that have opted out. And this is the most important point that there is a downside. You have to opt out of anything federal. You can't no longer take Medicare, Medicaid. You can't take TRICARE defense health. So, you can't go moonlight at the VA on the weekends and you can't be a medical director if you will, for a company that takes Medicare Medicaid. So, you have to step out and that's again, a glitch in the law that allows the bigs to sort of lord over this model. But once you opt out, it doesn't mean you can't opt in again, but you just no longer are participating in things.

And if you think about it, it is kind of logical. CMS does not want to write a check to Dr X and then write her another check. So, you get another check from her employer at Eversite or Premise or Medici. It makes sense a little bit, but the opt out is there's no reason folks shouldn't be able to consult on the weekends and help out other folks that are in need with this giant shortage that's looming.

John: Maybe at some point they'll figure out how to make that work. So, what's the best way for listeners to find you? Just one of those two that I mentioned?

Ron Barhop: Yeah. You and I found each other on LinkedIn and I'm easy to get to and I am happy to respond and talk to anybody and send them in the right direction. But if they listen to these 12 or 15 shows, they'll get to meet the CEOs that are making the changes. They'll get to talk to or hear the metrics of what drives these models. And they'll start hearing the same thing over and over again, which is, this is really healthcare fixed. This is really primary care cured. And that's why I named the show "Primary Care Cures." And that's why I named the book "Healthcare is Fixed."

John: If we can just get that to be adopted across the board, it'll be in great shape.

Ron Barhop: It's going to grow no matter what happens, it's an unstoppable movement.

John: All right. Now is the time to jump on the bandwagon. This has been very interesting, Ron. I really appreciate you coming and explaining this to us and describing this. This has been really an eyeopener. Even though I promote a lot of the nonclinical careers for people that are burned out, I would definitely encourage you if you want to continue to practice, you definitely have to look at these direct payment models and DPC and some of these companies that are supporting this. It's fantastic. All right, with that, I guess it's time to say goodbye. Thanks Ron. Bye.

Ron Barhop: Thanks John for inviting me. I appreciate it.

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The post How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256 appeared first on NonClinical Physicians.

On this week’s episode of the PNC podcast, Dr. Uchenna Umeh, also known as “Dr. Lulu” and the “Momatrician,” describes how you can find a career that you really love.

Uchenna spent the early part of her career in a traditional pediatric practice. When she decided she needed a change of pace, she enlisted in the Air Force. She completed her time there, and entered traditional practice. But she was struck by the extent of the mental health issues in her patients and experienced a harsh wake-up call when a young patient of hers attempted suicide.

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

Direct Primary Care

Several colleagues and a relative of Uchenna's also attempted to end their lives. She felt she was being called to a higher purpose. After seeing the positive response she received when speaking on the topic at her son’s school, she left “penicillin pediatrics” and focused her efforts on helping troubled teens.

Your best legacy might very well be the one that you haven't even looked into.

She honed her message, and started speaking regularly on the topics of bullying, depression and mental health issues in children and teens. She provided telemedicine services to make ends meet between speaking engagements. And she realized that she also wanted help to individual patients. So, she opened her direct primary care (DPC) practice to families with struggling teenagers.

Depression vs. Mental Anguish

During our conversation, Uchenna makes an important distinction between depression and mental anguish, using an example from her personal life. Depression, she says, is misconstrued as the primary cause of suicide, when mental anguish is often the underlying trigger. Much of it is situational, rather than biochemical. Hence, the question shouldn’t be “Why do you want to end your life?” but rather, “What happened?”

By sharing stories and asking the right questions, Uchenna’s patients find they can overcome such challenges.

We're united by our storylines. We are connected by our storylines. What if you talk about yours, I talk about mine, and we also are talking about ours?

Design a Career That You Really Love, Too

Uchenna has a small but significant practice working exclusively with troubled children. Her patients make appointments with her as they need, and call her cell phone in a crisis. She sees patients three days a week, leaving two days for her writing, traveling and podcasting. She believes that you can follow her example to find a career that you really love, too.

Summary

Uchenna continues seeing patients and is expanding her writing and speaking. She started her podcast, Suicide Pages, to shed light on these issues. There, she interviews guests who have faced and overcome their struggles.

“Dr. Lulu” has also written two books, How to Raise Well-Rounded Children (Dr. Lulu's “How To” Series Book 1) and A Teen's Life: Looking at Teen's Lives Through Their Daily Struggles. The former is about raising children using eager and open communication. The latter is a look into the lives of struggling teens.

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The post Be Creative and Design the Career That You Really Love – 139 appeared first on NonClinical Physicians.