micro-business Archives - NonClinical Physicians

More On The Benefits of a Professional Corporation

John Jurica — Tue, 22 Oct 2024 12:26:08 +0000

Interview with Dr. Tod Stillson – Part 2 – 375

In this podcast episode, Dr. Tod Stillson explains more about the benefits of a professional corporation and the steps to take in forming one.

This week we build upon our previous discussion where he introduced the concept of employment light and shared his journey from traditional employment to independent contracting.

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

Making the Transition Without Rocking the Boat

Our first episode focused on how doctors can win as a micro-corporation and negotiate better contracts. Part 2 reveals practical strategies for a seamless transition and income diversification through professional incorporation.

The beauty of transitioning to a professional corporation lies in its seamlessness. As Dr. Stillson explains you can maintain your regular clinical presence while restructuring your business model behind the scenes. He continued wearing the same lab coat, attending medical executive meetings, and maintaining hospital relationships – but with one significant difference: a $200,000 increase in compensation.

You don't need to shout it from the mountaintops… You just need to ask for it very quietly. – Dr. Tod Stillson

The key is creating a win-win situation where your hospital isn't paying more, but you receive fair market value for their services through a more powerful business structure.

The Power of Professional Negotiation

Here's a crucial piece of advice that every physician should consider: when restructuring your practice, professional legal representation isn't just helpful – it's essential. Under a professional corporation:

Legal fees become a business expense (pre-tax dollars)
Healthcare-specific attorneys can negotiate better contract terms
Non-compete clauses and other contract elements become negotiable
Professional representation levels the playing field with hospital legal teams

Benefits of a Professional Corporation and Income Diversification

The medical landscape is evolving, and with it, new opportunities for income diversification are emerging. Today's physicians are exploring:

“Job stacking” – strategically combining part-time positions
Direct primary care models
Telehealth and “practice without walls” concepts
Multiple revenue streams from different medical services

Dr. Stillson successfully monetized various aspects of his practice, from clinic work to sports medicine coverage, ultimately creating multiple distinct income streams. This approach not only increases financial stability but also provides greater professional autonomy.

Summary

For those ready to dive deeper into professional corporations, you can find Dr. Stillson's comprehensive guide Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy on Amazon. His website offers both free resources and paid courses to help you navigate this transition. As part of his commitment to helping physicians thrive, Dr. Stillson also offers a free eBook titled 20 Reasons Every Resident Should Start a Corporation During Their Residency.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 375

More On The Benefits of a Professional Corporation

- Interview with Dr. Tod Stillson Part 2

Dr. Tod Stillson: And I'll say back in the day when I did this tenure over a decade ago, John, my simple goal was to let everybody in the community, including my own peers, have no idea that it was happening. In other words, I still wore all the same lab coat. I still wore all the branding of the hospital. I still did every bit of work that I was doing. It really looked like no different. I still even went to the medical exec meetings, the staff meetings. I participated. I was very willing to participate. On many levels, it looked like I was doing exactly the same thing.

But behind the scenes, the business model was dramatically different. And that's what was empowering in terms of my autonomy and in terms of my taxes and really the financial side of the equation, as I mentioned. And when I made that transition, I got a $200,000 raise just by making that transition. And so an amazing amount of money. But the point is, is that I wanted to do it seamlessly. And that's how I encourage most doctors to do it.

You don't need to shout it from the mountaintops. You just need to actually to make it the most win-win. You just ask for it very quietly, okay? And for the hospital, they're not paying you more in this system. In other words, you're not asking for a raise. Now, you're listening to me go, wait a second, you said you got paid $200,000 more. Well, I did. And that's because their stupid employee contract was a stupid employee contract that wasn't paying doctors fairly, okay? I just was now getting paid fairly for what I was worth in the marketplace. And it's that simple.

So that's not more, that's just fair, right? And that's important for a hospital. I see it in that way. I have plenty of hospitals that also pay doctors in employment-like contracts on salaries too. It doesn't have to be productivity-based. There's all sorts of PSA structures that a doctor can use that makes sense for them if they prefer that. But the point is make it win-win.

John: Excellent. Now, I don't know if you mentioned this earlier or I heard it somewhere else in hearing about your background in that.

So if you're currently employed and you have a non-compete, does that itself become a barrier in any way? Or do you still have a non-compete under your professional incorporation?

Dr. Tod Stillson: It's all about the negotiation. One of the elements that the hospital wanted to put in place with my new PSA contract when I made that conversion, they wanted to put a non-compete in that basically was non-compete in the essential services the hospital was performing while I was engaged in the contract. It didn't have a one year or a 30 day or 90 day, one year, two year wraparound non-compete around it. It was just literally during while the contract was in place. That was all about negotiation. So the point is, it's all about what you want to negotiate.

So if you convert it over and if they're like we had a one year non-compete when you were an employee. We want to have a one year non-compete in this employment-like contract. If you're okay with that, they're okay with that. But it's also a point in time where as an independent contractor, you might say, well, let's negotiate that down. Okay. Let's take that down to three months, six months, eliminate it altogether.

And as your listeners know, this is something that's a hot topic in medicine anyway, right now that it may get eliminated federally all across the board, or at least get put back into the state's hands. And there's just a whole bunch of stuff going on in that context. But the answer is, this is an opportunity when you reformulate a contract to determine the exact terms of it.

I'll bring this point up again to your audience. This is the point where I did what I would recommend them to do. I hired a lawyer who understand healthcare contracts, who negotiated and worked on my behalf. And that was one of the smartest moves I made. And one of the best return on investments that I ever made when it came to this, because they knew and understood things. And they could speak the language, but the hospital lawyers that they needed to hear and communicate it in a way that was best for me.

So when you try and negotiate it yourself, you're not going to typically beat the hospital layers. Okay. You aren't. No matter how kind they seem to be to you, they-

John: They're smiling all the way.

Dr. Tod Stillson: They are smiling all the way. And that's because they're going to kind of, because of information asymmetry, oftentimes, they're going to list that contract more towards them. That's their job. That's who they represent, then towards you. So don't be afraid to hire a contract review or negotiation lawyer. We have them as SimpliMD people that we work with. And so that's another take home message for your audience.

John: Yeah, I'm glad you brought that up. Because I get that question occasionally, it comes up, do I need an attorney to do this or that? And actually, when I close out each podcast episode, I say, get an attorney, get an accountant, do these things. And it's just, I mean, it's not cheap, but it's worth it. You're going to end up just being in a much better position if you really have someone who knows what they're doing, advising you and maybe even creating the documents.

Dr. Tod Stillson: That's exactly right. And I'll say when you do it like I've done as a micro corporation so my own PC professional corporation, that's a business expense. So it's not even coming out, unlike when you're traditionally employed, all these things come out of your personal pocket, right? So that's post-tax dollars. And it's feels a whole lot better spending on professional services when you're using pre-tax dollars to spend on those professional services.

John: Now, are there some other things I think, because you've written a lot on this topic, other things that you can think of just offhand that using this new model for yourself, that it enabled you to do that did end up, ultimately, basically diversifying your income or assets. Let's put it that way.

Dr. Tod Stillson: Yeah. So what's your question specifically?

John: So when you've switched to this model of interacting and creating your own micro business, there's other things you can do with it.

Dr. Tod Stillson: Oh, I see. Yeah. Got you.

John: Yeah, that are beneficial.

Dr. Tod Stillson: So first of all, it's about diversifying your income channels. And so then anytime you as a professional can diversify your income channels, the better off you're going to be. Now, a traditional employee, professionally, most of their work is being done with that one prime employer, right? So that's one income channel.

And there's doctors that do side work. They can do 1099 side hustles. Like I said, 40%, 50% of doctors will do that. And so you can have those. That's a good example of just professional income diversification, right? In today's world of younger doctors that I talk to all the time, we call this job stacking. The younger doctor, the younger population call that job stacking. And in today's world of job stacking is really cool, John, because Kate, for you and I, we grew up in this mentality of like, you work for one part, one employer, one job, one income. You're kind of, we're all in, in one place.

And that's just how you did it. And there's a lot of loyalty involved in a lot of these things because they are intertwined in that. But younger doctors don't have that same amount of loyalty. They're smartly, they don't have as much loyalty. They think about lifestyle. So what they do, their end point is not just setting down in a community and working a job for 40 years. Okay. Their goal is a certain lifestyle that they're going to then do the backwards math of saying, what number of jobs that I need to take on that will give me the lifestyle that I want to live and the income that I want to have to connect the dots to that process.

So younger doctors are not uncommon for them to not have a 1.0 full-time job with somebody. It's for them to take on a 0.5, a 0.6, a 0.7 full-time equivalent, and then take the extra time they have and stack in other professional income or non-professional income sources. So they can use their time wisely to create income channels that are not reliant on one big source, but reliant on multiple sources. That allows them to then pick and choose the levers moving forward of how they want to increase or decrease when depending on how it's going to still meet the lifestyle they desire.

Okay. So that's called job stacking and younger doctors will get that. And they are doing that more and more. I don't have to remind your listeners this, that more than, it's actually a little bit more than half of doctors now in training are women as opposed to men, and women in medicine, not to say they can't be full-fledged all in. But we see more and more women not wanting to work 1.0 full-time jobs because they've put off having kids and then they're going to start their family. And they do want to sit down in that a little bit more.

So we're seeing a lot more employers offering 0.5, 0.6, 0.7 FTE positions because you have to for the workforce, especially the women, but even for men. So there's a lot of opportunities that exist in the workforce now to do this job stacking. And that all comes back to your concept that you said, multiple income sources.

So now if you roll back to what I did 10 years ago, I developed multiple income sources and income channels out of the work that I had been doing, that was one source. So what I did was I monetized my clinic work. I monetized what I was doing in the hospital. I monetized my call. I monetized my unassigned hospital newborn call, my unassigned obstetrical call, because those are different nuances when you're covering your own practice and when you're covering the hospital's service, so to speak. And so all of those things got monetized.

I monetized my sports medicine work. I've been the local team physician for the high school for years and oversaw athletic trainers. I monetized the nursing homework that I was doing. And then I began to diversify my income channels through things outside of the hospital's control, okay, including real estate, right? So I'm medical office building. Remember you heard me say I started the medical office building and began to receive income related to the medical office building.

And we really just began to diversify other real estate related elements and other income sources that at the end led to about, all said and done, probably 8 to 10 income sources that were all contributing to my household benefit that was beyond just the one that I had when I was traditionally employed. And that diversification is number one, empowering, but number two, it's also a better way to grow your financial footprint and your financial health because you're going to grow more wealth that way.

John: Excellent. Wow. That's a lot.

Dr. Tod Stillson: That's a lot. I know. I know it's a lot. I'm sorry. No, it is.

John: I'm probably going to, we're going to run out of time here in a minute. I do have one more question I want your opinion on, although you may not be an expert because I'm going to ask you about something I don't think you've ever done, but when you do talk to people in one of the options that some physicians have come up with to say, I want to do my practice in a completely different way. So I'm going to do some kind of cash only practice.

I'm going to do a DPC. I'm going to do this, that, do you have an opinion about just the pros and cons of that model versus doing what you're describing? Is there such a thing as a combination? I don't know.

Dr. Tod Stillson: Well, they're kind of, anything's possible nowadays. So I can say that it'd be tough because of the non-compete part to do a combination. But here's what I would say is number one, employment light is hybrid. So it's like having your foot in both doors, like a private practice and a hospital employee altogether. So it's a hybrid model, if you will.

And I found there to be some great strength and benefit for that. I can see though, that there is great, one of my best friends and my former practice partners here in my local community has a direct primary care model in our local community. So when all that went down to over a decade ago, he left, he went to work for basically a bank, became their little contracted family doctor in the bank, big bank. Okay.

John: Corporate medicine, huh?

Dr. Tod Stillson: Yeah. Corporate med. He went and did a little corporate medicine in a different way, but he got away from the thumb of the hospital. And then he eventually came back into the community and started a direct primary care practice. And he's been wildly successful at that. And I know he's a good friend. I talk to him regularly and I support everything he's doing, even though you kind of, in one level, we might be, "competing" with one another. We're not. But I love that model.

I think for patients, it's a tremendous winner. I think for doctors, it's a tremendous winner. I think that there's huge amount of space and opportunity for direct primary care and kind of going, I call it going off the grid medicine where you're just doing cash only. And I think this is a great place for that. It's not going to be the right thing for every doctor, but it fits into this idea of what I, and it's really what I encourage doctors to think about is micro corporations. So back in the day, John, we would think about medicine fit into one or two boxes, A, private practice.

You ran a business, you had HR, employees, lab, building, a lot of things about running a business versus the other end of the spectrum, being an employee where they ran the business and they just gave you a paycheck. I mean, and that was the two models that have existed for about 20 to 30 years, mostly.

Now we're seeing this growing space of cash only practices. Fantastic. Love to see that. Micro corporations, which is what in some regards what I did. I mean, I'm a little small corporation who has, well, two employees, myself, my wife's my bookkeeper. So there's some reasons that we benefit from having her being a bookkeeper in that. But really only person I have to manage is myself. So that's a micro corporation, and really direct primary care is oftentimes similar version of that, right?

A direct primary care clinic might have their own building. But there's usually going to be one doctor, maybe a nurse, maybe a receptionist, it's very lean. It's that almost again, lean versions of private practice is what direct primary care is in some regards. But I'd also say in this world that we're in, John, for doctors, there's also, and this is one of the courses I teach and people can get on my website to check it out. It's called the practice without walls, how to create a practice without walls, because that's the emerging space that a lot of doctors are inspired to do. And that is exactly what I have done.

Incorporate yourself and then contract out your professional services to anywhere in the world who virtually needs your professional services. So telehealth would be a classic example of that. And so, you can be doing telehealth and while you're living in California here in the Midwest, right, you can do that from anywhere you want in the world. And this practice without walls concept is just growing significantly. Think about Hims & Hers and there's doctors behind the scenes who are filling those prescriptions. Has to be a doctor behind the scenes, right?

John: Yes, exactly.

Dr. Tod Stillson: And so those doctors are working virtually somewhat in a telehealth model, doing that, easy money, easy work for them, so to speak. All right. So there are all sorts of ways that doctors can do location independent work. You had mentioned, I think even before we got online here, that you're still an administrator with the urgent care company that you've been working with. So that to a large extent, location independent work, right? So you don't have to be there. You can do that from your home. That's your professional work, both clinical and non-clinical that doctors can do a whole lot of that.

There's legal work, there's administrative work, just a massive amount of things that doctors can do that isn't just in that traditional private practice model. Okay. So the world is our oyster. There's a lot of options and I like to just inspire and encourage doctors to look at all options rather than just blindly following the herd into traditional employment and saying, this is my lot in life. Because quite honestly, that's a miserable lot to be in nowadays.

John: For sure. For sure. Well, I think you mentioned earlier, we're going to end in a minute here, but I think you mentioned your son is in training. Has he figured out what he's going to land in when he's all done?

Dr. Tod Stillson: Oh, I literally just talked to him today and I said, "John, have you figured out yet what you want to do?" And he loves medicine, and he gets that from his dad. I love medicine. In a family medicine, there's just so many options, right? So he's still trying to figure out how he wants to land the plane, whether he wants to do direct primary care, he might do some emergency medicine too. Even today he's like, "Dad, I might just take a year. We might go out to California." Because his wife's from Alabama and they're having their first child. They're going to end up in Alabama. Let me just put it that way. I know that.

But he's like, "We might take a year when it's easy to travel and go out to California, go somewhere we want to be and just work." Again, he's a good example, creating the lifestyle that you want and then working backwards to do whatever work supports that work. And in family medicine, John, you and I know, you can go a thousand different directions when it comes to the work you want to do.

And so he's got options. I don't know where he's going to land and what he's going to do, but I can tell you this much, he's going to be a great doctor. He's a great young man. I love him. I have five children. I love all five of my children, but he's going to be a good young doctor. A lot of the things I teach, I've shared with him one-on-one and he gets it. And so he's well-equipped. He's already started his own corporation. He's using it for moonlighting while he is in residency.

And so he's doing, like I told you, he's doing what I would have told my younger self to do so that he can thrive in the marketplace. And I really have a, in fact, one of the free eBooks that I have online is 20 reasons every resident should start a corporation during their residency. I feel strongly that if a resident can enter the marketplace by saying to the marketplace, I'm a business, I'm a micro corporation, and I want to be identified as a micro corporation, not as a traditional employee, when they enter the marketplace, that's the key spot because once you get started, even 3 to 5 or 10 years in, just because of the forces of physics, it's hard to make a change.

Okay. It's true. But if you can start out at the beginning by understanding and empowering yourself in that way, you'll likely stay in that space and really learn from it.

John: Okay. Well, I think that if your son was already in practice, the advice you just gave would be just as good. And the reason I say that is because listeners, that's your advice. Look at these things and choose an option and check it out and see if you can make things better for yourself. Tell us again, the website, the name of the book, where we can get all that stuff before we let you go.

Dr. Tod Stillson: So simplimd.com, S-I-M-P-L-I-M-D.com. And my book is Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy. You can get that on Amazon. I have lots of free and paid resources on my website. Listen, John, this is my passion project. I retired after 30 years in the clinic and I'm doing this as a passion project, as well as a very novel telehealth business I'm going to be getting off the ground in the next three months that's going to be really cool for doctors.

Think of Hims & Hers in the form of acute infections for the world to be treated in. As a family doctor, we're experts in acute infectious treatment, right? So I'm starting a site to work on that. But I love medicine. I love our tribe in medicine. And my passion and my retirement is semi-retirement, I would call it, my wife would agree, is to help our tribe and help our world be a better place than it currently exists.

And the system is rigged and broken right now. We've got to make changes. And I'm going to keep shouting it from the mountaintops. There are alternatives. There's a better place for us to land. And I want to see us all end up in win-win relationships.

John: Bravo. I'm glad to hear that. And I think if we have more people like you pushing it and sharing and educating, we'll get there eventually. So thanks, Tod, for being here today. I really appreciate it. I've learned a lot. And I think the listeners have too.

Dr. Tod Stillson: And John, thank you for your seven years plus of doing this show and really making a difference in the world. I realize sometimes it feels like, kind of feel like you're in an echo chamber sometime. But the reality is you're making a difference one person at a time. And it's a great effort that you're making. And I appreciate you inviting me to be a part of this. It's a kind of join arms to help people.

John: Yeah. Well, I appreciate that. Thanks a lot. Bye now.

Dr. Tod Stillson: Bye-bye.

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The post More On The Benefits of a Professional Corporation appeared first on NonClinical Physicians.

Now Every Doctor Can Win As a Micro-Corporation

John Jurica — Tue, 15 Oct 2024 11:51:13 +0000

Interview with Dr. Tod Stillson – Part 1 – 374

In this podcast episode, Dr. Tod Stillson describes how to win as a micro-corporation. For the past 10 years, Tod has been working under a professional services contract, rather than as a direct employee, providing him with greater autonomy and income.

Dr. Stillson shares his journey from a traditionally employed physician to an independent contractor. In this revealing interview, Tod introduces the concept of employment light and explains how doctors can negotiate better contracts with their current employers.

Our Sponsor

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

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

For Podcast Listeners

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

The Rise of Corporate Medicine and Its Impact on Physicians

Corporate control of healthcare has led to decreased autonomy and increased burnout among physicians. Tod describes how arbitrary compensation caps and a lack of understanding from administrators have contributed to this problem.

He emphasizes the need for doctors to stand up for themselves and take control of their professional lives. And he describes the simple change he made to accomplish that goal.

Understanding the Employment Light Model

Tod explains the concept that allows physicians to work as independent contractors while maintaining a relationship with their current employer. This model offers increased professional autonomy, significant tax benefits, and an easier way to create multiple income streams. Some of the topics we cover in Part 1 of our conversation are:

Preparing to become an independent contractor,
Negotiating a professional services agreement,
Creating the opportunity for multiple income sources, and,
How to approach your employer about transitioning to this model.

Empowering Physicians to Win as a Micro-Corporation

Recognizing the lack of business education in medical training, Dr. Stillson created SimpliMD, a resource for doctors to improve their business acumen. He emphasizes the importance of understanding:

The true value doctors bring to healthcare systems, including downstream revenue,
How to negotiate fair compensation based on productivity, and,
The power of business knowledge in preserving professional and personal autonomy.