nonclinical jobs Archives - NonClinical Physicians

Find Your Great First Nonclinical MSL Job

John Jurica — Tue, 14 May 2024 11:57:14 +0000

Presentation by Dr. Maria Abunto – 352

Today's episode presents an excerpt from Dr. Maria Abunto's masterclass on securing your first nonclinical MSL job from the 2023 Nonclinical Career Summit.

Dr. Maria Abunto, a senior manager of medical science liaisons (MSLs) at Exact Sciences, shares her journey and insights into the MSL role. Dr. Abunto's insights focus on relationship-building, continuous learning, and strategic networking. Whether you are considering a career change or seeking to understand the MSL role better, this post offers valuable guidance and inspiration.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.” If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat. Or check out her website at allthingswriting.com/resilience-coaching.

From Academia to Industry: Dr. Maria Abunto's Journey

Dr. Maria Abunto transitioned from academia to industry, bringing experience from the NIH, Stryker, and now Exact Sciences. Her journey began with a master's degree in public health, where she developed a passion for public service. Driven to make a broader impact, she ventured into the world of medical science liaisons (MSLs).

Dr. Abunto shares her personal story, highlighting the importance of investing in oneself and continuously seeking opportunities to learn and grow. Her transition underscores the value of networking and finding mentors who can guide and support one's career path.

The MSL Role: Responsibilities and Rewards

The MSL role established over 50 years ago is vital in the biopharma industry. MSLs are responsible for building relationships with key opinion leaders (KOLs) and educating them on the science and advancements in treatment related to a company's product. This communication-focused role requires a strong scientific background, typically a doctorate, and excellent interpersonal skills.

Dr. Abunto explains that MSLs work remotely, managing their schedules and traveling to meet with KOLs. The role offers significant rewards, including high compensation, flexible work arrangements, and the opportunity to make a meaningful impact in healthcare.

Finding Your First Nonclinical MSL Job: Tips and Strategies

Breaking into the MSL role can be challenging but achievable with the right preparation and strategy. Dr. Abunto advises aspiring MSLs to focus on matching their skills and experiences with specific therapeutic areas and companies.

Networking is crucial. Attending industry conferences, joining professional organizations like the MSL Society, and connecting with key MSL leaders can open doors to opportunities. Additionally, enrolling in relevant training programs can enhance one's qualifications. Dr. Abunto also emphasizes the importance of building quality professional contacts and researching target companies to stand out in the competitive MSL job market.

Summary

To learn more you should explore the MSL Society website, which offers information and training opportunities for aspiring Medical Science Liaisons. To connect with Maria check out her profile on LinkedIn, where she is likely active and engaging with the medical and scientific community. For detailed presentations and insights from the 2023 Nonclinical Careers Summit, including Dr. Abunto's complete talk, visit the 2023 Summit’s Official Page.

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

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Transcription PNC Podcast Episode 352

Find Your Great First Nonclinical MSL Job

- Interview with Dr. Maria Abunto

John: Dr. Maria Abunto is the senior manager of medical science liaisons at ExactSciences, a molecular diagnostics company specializing in the detection of early-stage cancers. Before she worked there, she was global medical science liaison for Stryker. And she previously worked as an epidemiologist and investigator for the NIH and as a medical scientific expert on the IRB at a large children's hospital. She holds a master's degree in public health from the University of Pittsburgh and she completed a medical degree at the University of the East in Manila, Philippines. All right.

Today's podcast episode is the first half of her presentation from the 2023 Non-Clinical Career Summit in which she describes the MSL biopharma role, why it is a popular non-clinical career, and how to land your first MSL job. So let's jump in as she describes how she landed her first role as an MSL.

Dr. Maria Bunto: I'm Maria Bunto and I'll give a talk about coming from academia to industry or going from the ivory tower to the dark side. So the purpose of my presentation is to educate you on what is a medical science liaison or MSL. And if there's one thing I'd like for you to remember about being an MSL, it's not really bad at all. In fact, it's quite the opposite. It's one of the best jobs in the world and I'm fortunate to have transitioned to a non-clinical career that I love. And hopefully my talk will resonate with some of you.

So this is my disclaimer and the views and opinions are my own and do not reflect that of exact sciences, my employer, and I have no financial relationships to disclose.

So here's an outline of what I'll be talking about today. I'll start with a background about myself and my journey of how I transitioned. Then I'll talk about the MSL role, who MSLs are, and what compensation looks like, and then highlight the pros and cons of being an MSL. Then I'll take a deeper dive into how to become an MSL and briefly talk about the different career paths. I'll provide some information about the MSL society, their training and other resources.

So I'm just gonna go ahead and go into my why. This is my story and I'd like to spend just a few minutes and take you through my journey. Everyone has their unique experiences. So I think it's really important to connect with all of you, the audience out there who's interested and just figuring out what your why is. and why you want to transition. So as a physician, I have had previous experiences as a medical director, supervising operations for a busy family medicine practice. And during that time, I saw countless health disparities and underserved populations without any support or insurance. And so chronic disease is being passed down from generation to generation. And it's just one day that I just had an epiphany at a health fair and we were conducting where I realized I didn't wanna do this anymore, but rather just really focusing on understanding really what's going on here and what's happening upstream in a lot of these marginalized populations and how can we prevent that domino effect downstream?

So I always knew that I wanted to be more than just a medical director. I really wanted to affect populations on a greater level and really make that difference on even a more broader impact. while continuing to develop myself professionally. So identified public health problems, but I also realized the solution really starts with me. So the decision, this became my why. But how I was going to do this was the big question is how was I going to reinvent myself? So I knew my strengths were in public service and building connections and relationships. But I also realized during the soul searching that in order to do this, I needed to up my game and invest in myself. So my journey really begins in 2016 when I went back to graduate school and obtained my master in public health at the University of Pittsburgh. So this was a really great decision and wise investment because I needed to focus and reinvent myself. So I really worked hard to increase my knowledge and skillset, and I discovered that I absolutely loved learning as an adult student, but I didn't know what I would be doing after graduation, but I kept going and I didn't stop and I kept looking for opportunities.

It's in academia where I found an opportunity to expand my network. build my meaningful connections and relationships. So at the bottom right of the corner of the screen here, I'm pictured at graduation with my program director and long time mentor, Dr. David Feingold and the former Dean of Public Health, Dr. Donald Burke. And like I mentioned, I knew my strengths were not only in relationship building, but in public service. So at the top right is where I immersed myself in the Center for Health Equity Initiatives, such as Take the Health Professional to the People Day. So that's where I would conduct blood pressure screenings at barbershops and salons and inner cities around Pittsburgh. And you see, after all these years, I'm still volunteering in a community and giving back. It's been about a decade now. And these are opportunities like creating these long-term relationships with mentors. I also had an awesome mentor during grad school, who after graduation, I joined him at his lab at the National Institutes of Health and Population Sciences is at the NIH. And that's me pictured there on the left-hand corner. at the NIH Clinical Center in Bethesda, Maryland. That's really how I got into research because not only my connections, but my public health experience.

So it was at the NIH where I said, I mentioned that I conducted colorectal cancer research and that I became an epidemiologist there, attended all conferences and network like crazy. And I think that's where in 2017, I joined the MSL Society and became really active. And I attended the three-day live MSL communication and presentation skills training. There I learned as much as I could about being an MSL because I didn't really know I've heard about it, but it was really when I learned more about it that it appealed to me. And it was at the MSL Society Women's Conference in 2018 where I met a physician MSL. She introduced me to her career coach. And I immediately consulted that coach. So I wanted to realize that coach was also a physician. I wanted to really understand, is this a good fit for me? How hard is it to break into the role? She really helped me after 10 months. I landed my first job in industry. It was because of a connection she had, another physician who was hiring at a medical device company. And I know that after working there my first week, I just knew that I loved it and it was such a good fit. So in a nutshell, That was my career path and I'd have to say, I continue to solidify these relationships in the roles with MSLs and MSL leaders who continuously inspire me.

So now let's talk about the MSL role. The MSL was first established in 1967 by the Upjohn company and has existed for more than 50 years. And it continues to evolve in line with the changing diseases, treatment landscapes and healthcare trends. So MSLs were created in response to the need for a professionally trained staff to build rapport with influential physicians known in the pharma industry as key opinion leaders or KOLs and then thought leaders in various therapeutic areas of research. So MSLs became a part of medical affairs department where their activities revolve around building relationships with KOLs, but it's important to note that in the US the MSL is not a commercial role. or a promotional one. It's also not a science role, but rather a communication role through science, where discussions revolve around the research and the data behind the drug or product. So in the past, an advanced clinical degree was not required. However, in the late 1980s and 90s, a number of companies began to require MSLs to hold a doctorate degree, such as an MD, PharmD, or PhD, and now even Doctorate of Nursing, or DNP. As the MSL role grew over the years, the doctorate degrees became the new standard. Many companies require these credentials because MSLs are often viewed as more credible and it helps really establish those peer-to-peer relationships with doctors who you will be working with. And it's a growing field, which is a good sign. It's growing at a rate of about 10% a year with at least one out of four MSLs being hired without previous MSL experience. So over the years, companies have used various titles for the role and Medical Science Liaison or MSL is not the only name, it is called, for example, Pfizer calls MSL's field medical directors or FMDs and Amgen refers to them as regional leaders. So I'd also like to point out that obtaining a master degree may not likely make you a better applicant unless that degree really strengthens your match to the specific MSL role. But we have seen, and also on our team, we've had people that had master degrees and go on to also get a PhD while they're working for an industry company. So what is the purpose of the MSO role? The primary purpose is to be a scientific or disease state expert in the therapeutic area of the company product or pipeline.

So what is an MSL? Well, an MSL is one who holds a clinical degree in the life sciences with extensive experience in clinical medicine and or research. A doctor degree is preferred, but I've seen, as I mentioned, MSLs with master degree break into the role. There are more PhDs and PharmDs or MDs. And lately we've seen a lot of DERS practitioners and also physician assistants transitioning to become MSLs. So an MSL is employed by a pharma, biotech or medical device company. And He or she is a subject matter expert in a particular therapeutic area, such as oncology, hematology, and immunology. Now oncology and immunology, they lead the way with growth rates of about 31% and 28% respectively. And MSL's primary function is to educate on the science and advances in the treatment of the drug or product in a fair and balanced manner.

So it's a remote job where one works from home, one has a home office, and arranges meetings with KOLs or healthcare providers, either in person or virtually. So this diagram is event diagram and really illustrates what the role of the MSL encompasses. So the circle on the left contains all of the people with the science degrees, which is the PharmD, MD, PhDs. And these are people like yourself who have the proven science skills and have spent hours and hours conducting research or practicing science. Now the circle on the right This contains the people with communication relationship driven skills. So these are the soft skills. And that includes emotional intelligence and self-awareness. The circle on the left is necessary but not sufficient to land an MSL role. However, the circle on the right is full of people you want to be with, but is no good without the technical science skills found on the left. The silver middle, the sliver in the middle is where the two circles intersect and that's why the MSL talent is so hard to come by. However, as mastering the science and having degree is found in every candidate, what's often overlooked are the soft skills and the communication skills, as I mentioned, which actually may even be more important here. So MSLs are excellent communicators and this quality is really what is what makes one stand out. It's one thing to know the science and it's quite another to communicate the science. And if you think of the communication rolled through science, that's what makes an awesome MSL.

What are some of the responsibilities of an MSL? The primary responsibility is to establish and maintain relationships with KOLs who are influential doctors or healthcare providers. So since MSLs are subject matter experts of the science behind the products, engagements with KOLs involve discussions about the disease state and can involve education through presentations. An MSL first starts by KOL mapping in their territory and identifying who the key influencers are. and who are important players to get in front of as they begin strategizing and building relationships. A typical day involves proactively reaching out to a list of KOLs, and the MSL will introduce himself or herself through an email or a phone call. And then introductions can also happen at conferences or through your commercial sales force. The goal is to be able to schedule a one-on-one meeting, engage in conversation, and begin to build those relationships. And then from these conversations, may find that the KOL is interested in conducting a clinical trial that aligns with the pharma company or the KOL may request more education on the pivotal study about a company product recently launched. And whatever the outcome, collecting insights are important information to bring back to the company because insights are considered currency to the overall business, especially competitive intelligence insights. And sometimes these meetings are in-person and require travel. And so travel days are an average about two to three days per week. and are structured around the KOL schedule. But you can also modify your schedule, really makes sense to you. If you think according to the metrics of the company or of your team, if you can actually meet those metrics in two to three meetings, half virtual, half in person, minimal travel, that can be accomplished too. So it's really about you being the CEO or you managing and being the manager of your territory.

So here's a survey that was conducted by the MSL Society in 2020 and showing the many different activities that MSLs participate in and can be found on the website, which is free for all members. And also, I think there's also free resources for non-members. And as you can see, majority of the MSLs, over 98%, they manage KOL relationships. And approximately 90% of MSL surveyed said that they attend medical conferences and also provide education through scientific presentations. MSLs focus on meetings with those who are experts and thought leaders because they are influencing how others practice or conduct research using the product or the drug treatment. And an MSL would do that through a peer-to-peer scientific exchange. And the scientific exchange has two aspects to it. The first aspect of the role is a therapeutic area subject matter expert. So disease state awareness and the knowledge of the competitive landscape and the company specific products and pipeline. The second aspect is bringing value that the KOL wants. And sometimes they don't need the MSL scientific acumen. So sometimes what they want are opportunities. For instance, opportunities like a grant for an investigator led study or clinical trial. And sometimes KOLs are not looking for that scientific information, but looking to the MSL to be that conduit to the company's resources to help their career or institutions like being on an advisory board or speaker on podium or an author of a publication. So as an MSL, you will have to know the KOL very well to find out what it is that you can bring value to them. Is it the scientific presentations or is it the career opportunities? And the key is to meet the KOLs where they're at. So now let's shift a little bit and talk about who MSLs are and what compensation looks like. I think this is a really nice set of slides from the MSL Society data that shows an infograph of the makeup of the MSL surveyed by the MSL Society in 2020. 2023 results are very similar. So they surveyed over 2000 MSL professionals and the results in the US showed there was an overwhelming number of women MSLs compared to men, more than half were women and about 41% were men. 31% of MSLs work in the oncology space while 15% of MSLs work in Majority of MSL surveyed were white who had a PhD degree at 39%, followed by 27% for PharmDs. So only 8% of MSLs had a medical degree. The top three places where MSLs work are in large, medium, and small pharma or biotech companies. And then the survey also breaks it down by years of experience.

So MSL-based salaries can vary significantly depending on the therapeutic area, geographic region, years of experience. educational background, and then size of the company, as well as a company's product and pipeline life cycle. So this is a comparison of the average base salary of MSLs from around the globe. The MSL Society hired an external research firm to collect and analyze the data from over 2000 participants from 60 countries around the world. So this is 2022 data. And keep in mind that the MSL role may be defined differently around the world. They may take on other responsibilities similar to commercial sales or marketing. So from those that participated in the 2021 salary survey, the majority of managers or directors of MSLs based in the US use the report as their primary salary benchmark data. I know we use this for our, not only just the MSL society data, but other data that we use as benchmark for our hire for this year. And so as you can see, there is a wide range of salaries and the MSL pay trends on the higher side in the US and then it increases annually, about 3%.

This is a snapshot of the 2022 average base salary of MSLs in the US according to years of experience. And as you can see on the left, the average starting salary is about 160,000. That's not including benefits, which makes it a very attractive compensation, even with less than one year of experience. The salary increases about 3% every year, as I mentioned. However, this is underestimating how much MSLs make because it doesn't include the long-term benefits which could be another 30 to $50,000. For example, some of those benefits are health insurance, 401k, stock options, a company car, and an expense account, which are added on top of your base salary. Now on the right is the average starting salary for an MSL manager or director. It usually starts above $200,000, but varies according to the years of experience. So if you see though that the difference here from managers compared to the MSL's salary is that it varies and it doesn't necessarily mean a trend up as one gains more experience. The years of experience of being a manager or director doesn't always translate to higher pay. And sometimes they do take a pay cut to move up into a company.

So when I was doing my research and deciding on whether the MSL job was right for me, I thought it was important to write down the pros and cons of being an MSL. And I... And I suggest you do the same transitioning, if you're transitioning from clinical to non-clinical. So please note that this is not a comprehensive list and it's very subjective. So for the pros, I showed on the previous slide that MSLs in the US are well compensated with a high base salary. Remote work is a plus, especially during the pandemic when I started. But working from home may not be suitable for some people. Having a flexible schedule includes making your own work schedule, arranging your own meetings and then. healthcare providers, meetings, as well as booking work travel. And there is at least 50% within your region or territory. And travel may be a deal breaker for some, but for me, it suits my lifestyle. And also there are great benefits that I explained. Some of the cons. So for industry is highly regulated and there is a lot of compliance and rules to follow. There is some loss of autonomy there. It's a transition from being a discoverer, for instance, like in academia, to being a knower. You know, you will not have a lot of patient interaction if you were a clinician and moving into becoming an MSL. And will certainly not be a scientist, but rather more of a communicator of science. And then you're going to be part of a larger team that is metrics driven and performance driven. So for example, you're measured on the number of healthcare provider. Outreach and interactions, insights and presentations, those are part of your metrics. Access to healthcare providers and scheduling face-to-face meetings. They were very difficult during the pandemic. But then we made it work through a hybrid kind of meetings where we had virtual and also in-person once they started opening up to vendors and to industry. So it's about really finding creative ways of gaining access.

The MSL role is very competitive. You will be competing against experienced MSLs for every single role you apply for. Breaking in is not easy, but it's not impossible. And most companies will require having MSL experience. It does take a lot of hard work and the right match to find that ideal job. And now I just, I'm going to pause here for a minute and just talk about one thing that I did not touch on. And that is that negative impression or that bias about working in industry. And you know, I came from academia came from practice as well. And I specifically titled my talk, going from academia to the dark side to illustrate this bias. But as someone who has worked on both sides, I believe education and having an open mind are key in tackling these biases and assumptions when considering transitioning to industry. And this section is going to be talking about how to become an MSL. I can be whole another presentation and discussion, but I'll just take a few minutes to talk about some steps and strategies that has worked for me and others. And the bottom line is preparation is key.

So remember that there are no general MSL roles. There are all disease state or therapeutic area focus. The first step is to really identify your therapeutic area or TA. For example, you could be conducting research in Alzheimer's and your disease state focuses neurology or neuroscience. or if you are conducting sickle cell anemia research, your TA will be hematology. If you want to exponentially increase your chances of breaking into your first MSL role, I'd say the three most important things are really to match, match. Match and find those target companies, target roles, and only apply to those once you have done your research and preparation. Next, research the role in the company you'd like to work for. I'd say do that now, follow the company on social media or even on Twitter, on LinkedIn, know everything you can about the company because when it does come time to interview, what I did is I told the company, I said, I've been following you for years, which is, it's a good sign that you actually are very knowledgeable about them. It also allows you more opportunities that help you get in front of people as you network and then get your foot in the door. There are also, for example, internships or fellowships offered because these can count as experience. translatable experience. And so too, you wanna look at and see if there's companies that have internships and apply for those opportunities. Attend industry-wide conferences and events and really build your network. Let them know you, your face and really introduce yourself and be proactive. A focus on quality professional contacts that are directly related to the MSL community. and identify key MSL leaders in medical affairs at companies that are of interest to you. So this is the most effective and easiest way to connect with a hiring manager and other key decision-makers. So the more relevant connections you make, the greater chance you will be successful in breaking in. So become an active member of MSL relevant groups, like the MSL Society, and there's others out there, cheeky scientists. This will allow you to really increase the network your circle of influence with those MSLs in industry, but also in the companies that you are interested in. It's really challenging to achieve on your own your circle of influence without the help of your network. So I highly encourage you to expand your reach and get out of your comfort zone and connect with others.

It's also really challenging to achieve becoming an MSL on your own without proper preparation and guidance. You will need to really stand apart from the competition. So there's also MSL trainings offered for aspiring MSLs, especially if you have no MSL experience. That's a great way to upscale, build your skills. If you lack industry experience or research experience, you know, we wanna keep pace with the changing demands of the profession. And if you need to enroll in online courses to learn about clinical trials or regulatory compliance, I'll provide a list of resources too with websites at the end of this talk.

John: Physicians are uniquely positioned to enter the biopharma industry. They obviously use the products produced by biopharma and are very comfortable discussing the research, development, and deployment of new pharmaceuticals, diagnostic tests, and medical devices. In today's presentation, Maria provided a nice review of the pros and cons of the MSL job, the likely salary to expect, and sound advice to help you transition into the role. If you'd like to hear the rest of our presentation and the other 11 topics presented at the 2023 Non-Clinical Careers Summit, you can check that out at nonc forward slash two zero two three summit. That's nonc forward slash twenty three summit. That's all one word, no hyphens.

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The post Find Your Great First Nonclinical MSL Job appeared first on NonClinical Physicians.

Explore What Matters Most and Design Your Professional Career

John Jurica — Tue, 07 May 2024 11:30:43 +0000

Interview with Dr. Sharon Hull – 351

In today's episode, Dr. Sharon Hull explains why exploring what matters most is critical to designing your career.

From her early experiences in small-town medicine to her role as a pioneering leader in physician coaching, Dr. Hull's story resonates with professionals seeking greater fulfillment and meaning in their work lives. Today, she empowers listeners to embark on their personal journeys of self-discovery and intentional career design.

Our Show Sponsor

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

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

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

Our Episode Sponsor

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

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

Navigating Leadership in Medicine

As a seasoned coach and mentor, Dr. Hull recognizes the importance of leadership development for physicians and other professionals. She discusses the unique challenges physicians face in leadership roles, from communication barriers to institutional politics. Drawing from her coaching experience, Dr. Hull offers practical advice on cultivating essential leadership skills, including effective communication, time management, and strategic decision-making.

Professional Careers by Design

Dr. Hull's forthcoming book, Professional Careers by Design: A Handbook for the Bespoke Life, serves as a roadmap for professionals seeking to design their careers with intentionality and purpose. Through a blend of practical strategies and thought-provoking exercises, the book guides readers through self-discovery and career planning. Dr. Hull emphasizes the importance of aligning career choices with personal values and aspirations, encouraging readers to embrace change and pursue meaningful work that reflects their authentic selves.

Dr. Sharon Hull's Mantra

Start with what matters and then figure out how you can get more of that in your life.

Summary

To connect with Dr. Sharon Hull and explore her insights further, you can visit her website at www.mettasolutions.com. You'll find valuable resources there, including her blog and information about her book, Professional Careers by Design: A Handbook for the Bespoke Life. Additionally, you can follow Dr. Hull on LinkedIn for updates and insights into career transformation and intentional career planning. Whether you're seeking guidance on navigating career transitions or crafting a purpose-driven career path, Dr. Hull's expertise and resources offer invaluable support on your professional journey.

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

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

Links for Today's Episode:

Download This Episode:

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

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

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 351

Explore What Matters Most and Design Your Professional Career

- Interview with Dr. Sharon Hull

John: One of the things that comes up very often when I'm speaking with physicians who are looking for what to do with the next chapter of their life because they're unfulfilled or unhappy is they have this question, "How do I figure out what I should be doing or find out what my passion is?"

Anyway, they've never done that introspection before and that's why I'm so happy to have today's guest, Dr. Sharon Hull with me today. She's written a book, she's been doing coaching for years and she's addressed this particular problem many times with her clients over the years. With that, let me welcome Dr. Sharon Hull.

Dr. Sharon Hull: Thank you, John. It's a delight to be here. I've been following your work for several years and happy to talk to your audience of people who are trying to figure out how to make peace with this career choice.

John: Yes, and how to make the best of it maybe and continue it, maybe get rid of the bad parts of the particular situation and keep the good parts. Tell us about your background, what you've been up to and then we'll get into my questions and about what you've been doing. So tell us about your journey.

Dr. Sharon Hull: I'm delighted to tell you a bit of my story. I'm a family physician. I tell people by initial training and by my DNA. It was my natural fit when I went through medical school and had a wonderful 30-plus year career in family medicine, most of it in academic medicine but I did start in solo rural private practice near my hometown which was its own wild ride of an experience. People that were my second parents, my best friend and my babysitter as a child helped me paint the trim on my office the night before we opened. That's a classic small town family medicine story.

I had a great career as a physician and I realized that my life was going to need to make some shifts along the way to deal with family needs and for that reason I entered early a career of coaching kind of as a side gig with medicine. Everybody in my medical world and my academic world knew that I was doing it and I figured I would go full-time into it when I retired in my mid-60s. That was my mental plan.

And life happened and in my early 50s I got the opportunity to become a full-time coach within an academic center and build a program for coaching physicians and scientists in that center and had a wonderful time doing it but I found myself in my encore career about a decade before I expected to and I haven't looked back. No regrets about medicine and no regrets about an early transition to an encore. So, that's the short version of my story. I'll answer any questions you have.

John: That was very interesting and listeners, I recommend you look at Sharon's LinkedIn profile because you'll get a fuller picture in some ways. It's not the full story obviously but it just shows the number of transitions that Sharon has navigated. Before we get into my other questions, Sharon, can you just tell me the name of your hometown in Southern Illinois?

Dr. Sharon Hull: I grew up in a little town called Ridgeway which was the popcorn capital of the world as it claimed itself. There were 1,200 people in town and 23 people in my high school graduating class. It was a classic small town experience.

John: Do you have any idea how far away that is from Metropolis? Have you ever heard of that town?

Dr. Sharon Hull: I do. I know exactly where Metropolis is. Are you from Metropolis by the way?

John: I'm not but my wife's family is from there and some of them still live in that area.

Dr. Sharon Hull: I grew up probably about 60 miles from Metropolis, just a little bit north.

John: That's definitely Southern Illinois. It's almost Kentucky.

Dr. Sharon Hull: People think that Illinois is all Chicago and there's a whole bunch of the state left.

John: All right, let's get back to the interview. One of the things I wanted to comment on is it looked like because you're involved with academics and you're doing it with coaching, it looked to me a lot like it was leadership coaching and I think that the part they don't necessarily teach in med school and residency, you have to be some type of leader when you're a physician but it's not always the right type of leader. Any comment on that observation?

Dr. Sharon Hull: I have some comments about it. I don't think we get taught how to be leaders and I think leadership is a profession in and of itself that has a certain skill set that you might have if you're a physician and you might not have. I worked with a lot of physicians who found themselves in leadership roles because of their clinical expertise or their scientific expertise and they didn't know what to do with humans in a nonclinical setting.

Usually I wasn't working with people who were in trouble. I was working with people who were new to leadership roles and trying to build the skills. We focused a lot on communication skills, on time and energy management as a new leader and what I sort of jokingly call the institutional perspective or the politics of the whole thing. That's where I spent most of my time in leadership coaching. It's that perspective taking and communication skills.

John: Yes, as you know physicians are often put in leadership role for a team or a committee but if we work in a corporate environment, it's different, or any kind of big hierarchy. It's a whole different way of interacting with people. A lot of people are focusing more on servant leadership for the last 10 or 20 years and so that means it's not like the military approach, the way medicine used to be. That's an important thing. And you must have been contributing heavily to your organization. I don't think there are that many that were doing that kind of coaching at the time.

Dr. Sharon Hull: We were one of the early institutions. I won't say we were the first but we were among the first to really put in place a program that wasn't about people being in trouble. It was really an investment in mid-career talented people who were rising up the ladder and helping them be successful. It was a lot of fun.

John: Sounds like it would be fun. That was a thing that brought me to you when we connected on LinkedIn a month or two ago. And at the time I was setting this interview up with you I didn't actually realize you were on the verge of releasing your book and it addresses all these issues around leadership and designing one's career. I thought this was definitely something we have to talk about. So tell us what's the name of the book and why did you write it?

Dr. Sharon Hull: I'm happy to do that. The title of the book is Professional Careers by Design: A Handbook for the Bespoke Life. This book is kind of a distillation of about a dozen years of coaching professionals about how to help them make their career what they want and need it to be at that moment. Helping them realize that their needs and wants change over the course of a lifetime and that's okay. It's really kind of a guidebook to a lifelong process of being intentional about your career.

I came to write it because I kept coaching people who were asking these questions. How do I know what I want? What do I do? I've trained to do one thing and I can't imagine not doing it but I can't imagine keeping on this path. And I kept looking for the book that I could have them read and I couldn't find the book that covered what I was covering. And after about eight or nine years I decided I probably was going to just have to write it. And that sounds arrogant and I don't mean it to but I couldn't find anybody who was talking about it the way I was coaching people. So I decided to put that in print and maybe leave it as a guidebook.

John: I'm glad you did and the thing is the book hasn't been released yet as we're recording this but it's coming out very soon.

Dr. Sharon Hull: Launch day is tomorrow, John. April 30th. By the time your podcast goes live it will be live and released. We're going to do a big launch event tomorrow where I'm doing interviews of people about their career journey and we're going to have a lot of fun. By the time your listeners hear this it will be available to the public.

John: Okay, we'll get to how to get the book in a minute but it struck me as I was looking at the index for the book there's so many different areas they think are right on in terms of what we need to learn about it. Probably any professional in a similar situation. I don't know if you'd agree but there's a big group that's a lot like us physicians and that's professional athletes. They work really, really hard for a long time. They get burned out and they face things even more in a compressed way because their careers are usually shorter.

That's what I'm going to ask you about today. Some of the things in the book and you can educate me and our listeners and then go off in any direction you want but just to get things started you know what I hear a lot is that physicians say they're just unhappy. I can't really keep this kind of pace up forever. I'm just overwhelmed. I've experienced the same thing myself and that even if you enjoy medicine there's a certain point as you get older you just can't keep up that pace. You can't be on call and work long hours forever. And so, the question is always what do I do next? How do I find out or figure out what I should go towards rather than running away from something?

Dr. Sharon Hull: I'll respond to that first by saying it is good to go towards something rather than just run away. I think that's a hallmark of the early conversations when I meet with somebody who wants to think about changing careers.

The next things I do because I'm a family physician by training is I try to assess the degree of burnout and the degree of mental health compromise and assuming that people are stable and not in urgency about those things. Then we have a conversation about what matters to you. I remember asking one man in his early 50s that question and said "What matters to you right now?" And this was a kind of a classic stoic man who looked at me and just started crying and it surprised the heck out of him that he cried but when he was able to gather his thoughts he said nobody's asked me what I wanted in 40 years. And I think as professionals, it's not just men it's men and women, and it's not just physicians but as professionals we don't ask ourselves what matters very often.

And so, at the beginning of my book the front section is about discernment and it starts with that question, "What matters most to you at this season of your life?" I think that list changes over our seasons. It changes when you're early in your career when you have young children if you have children, when you have caregiving responsibilities or health issues. That's what I mean when I talk about the seasons of people's lives.

When I give them this exercise and it's the first exercise in the book, make your top 10 list of the things that matter. And I tell people, I quote a dear friend and mentor who's recognized in the book, personal and professional, it's all one life. You have a finite amount of energy. What you do with it's up to you. And so, that's kind of the ground state for the book and then I ask them to make that list of what matters and I tell them the only rule is you have to have some personal and some professional things. And there's no right ratio, just make your list. You can't be wrong it's your list.

I bring people back to talk about that and I ask them what they learned and what surprised them. And almost invariably what surprises them is the top five to seven things are personal they're not professional. For all of us, it's kind of near universal human experience with the exception of people who are very early in their careers or at a very high competitive time in their career. I have a professor who's trying to get tenure and trying to get their grants written or somebody who's trying to get through residency or fellowship. Those people it's mostly professional at the top. But for most of us once we're through that, it's about person and nobody gives us permission to do that conversation in our own heads. I feel like I'm preaching to the choir here, let me be quiet and let you do any follow-up if you want to.

John: Well, I think it's ironic sometimes when I talk to people, for example, someone who's working 60 hours a week they're trying to generate a lot of money so they can donate it or contribute it to some venture to be able to share the income to get access to and support that other thing that probably is what's important to them. And to me it's like "Well, why don't you just do something that somehow brings these together if that's really what matters to you?" And like you said life and the career aren't necessarily separate. So that's just an observation that I've made and I'm sure you've seen different versions of that same kind of thing.

Dr. Sharon Hull: Well, you do too. You reach a lot of people and you've talked to a lot of people. I have seen some of the online conversations you've had and these are common questions and you're seeing the same variations on a theme that I see. I will say they extend beyond just the profession of medicine and I tried to write the book or any professional however they define themselves but particularly people who have studied for a long time to enter a profession and have a set of expectations that they'll stay with it from society or from their family or from income needs or whatever. That's who the book is written for is the people who feel like they might be stuck.

John: I'd like to go back to something that you mentioned earlier and it's this whole idea of a life and a career by design. Maybe that's something everyone should be taught either in high school or college about actually taking time to try to design your career, design your life and maybe go back to it from time to time. Growing up I was good at math, I was good in science, I got good grades, so I guess I was going to be a physician. So, how should we really look at that? How should we conceptualize that?

Dr. Sharon Hull: I devote some time in the very beginning of the book to talking about the idea of design thinking, kind of the idea that you make the best first choice you can make and you keep tinkering. And it's people who design furniture or design machine parts do that. Thomas Edison did that when he invented the light bulb. He had 1,500 ways he failed and he said "I didn't fail, I had 1,500 ways not to do it." Sometimes I meet people that feel that way about their careers. And so, the idea that we're designing always gives people that sense of agency to reassess.

And my real unstated goal, I guess I'm stating it here so it will be out of the bag is to get this book in the hands of young trainees as early in their careers possible. I actually think that people younger than you and me have handle on this that we didn't have and they're going to reiterate their careers multiple times. This is just a guidebook to how to do it.

John: Well, I have to agree with you. I have seen some examples that I thought "Wow, they had so much insight in an early age and they were really thinking two or three steps further than I ever thought." Again we're such old school I think, we're from a different era but I couldn't see past that horizon so I just kind of plugged along and did my thing until maybe I felt like it just wasn't the right thing anymore.

Again, I mentioned this earlier but if people look at your LinkedIn profile I think it was a good example yourself and again it might not have all been by design at the beginning but it does demonstrate that you can make significant changes, you can evolve, you can shift from you know patient care to some non-patient care position but still doing what you love and maybe like you said what matters.

Dr. Sharon Hull: It doesn't have to be static but people do have constraints on their decisions. And we talk about that in the book. Perhaps when you're young you have fewer constraints. And we enter a time in our late 20s early 30s to maybe our 40s mid 40s where there are a lot of personal constraints. They might be financial, they might be child rearing, they might be geographic. There are lots of reasons people feel stuck in that period. But if they can see light at the end of the tunnel or see that they do have choice, they can come through burnout a little differently, I think. At least that's my hypothesis, we'll see.

John: I think that's right on at least from what I observed. You mentioned the term "agency" a minute ago. We don't use that term very often. Maybe in a corporate environment I might have heard it once in a while it's a bit of jargon but has a certain really applicable meaning to what we're talking about. So, can you explain what that means to you?

Dr. Sharon Hull: I will. I will first say that as a young family physician I was taught the term self-efficacy, the ability to believe I could do something about a problem I was facing. And to me agency is maybe a just a different term, maybe it's more corporate speak, maybe it's more ethical psychological speak. We are the agents of our own lives and we don't talk about that much. That doesn't make us selfish. It does make us responsible for the choices. I have a coffee mug on my desk over here that says "Never complain about what you permit." And when I first saw that quote it hit me right between the eyes. It's like yeah, if you don't like something, figure out how to change it without just creating chaos around you. And the book is about how not to create chaos but to do it intentionally.

John: Yes, it's odd to me that we feel that in spite of being part of one of the most educated professions on the planet we don't feel we have any options and we don't have any control over life once we get locked in and we've finished residency or fellowship, whatever it is. And you kind of feel like "I have to do this, I've invested so much into this role." And that whole thought process holds us back. But we're not actually obligated to do anything.

Dr. Sharon Hull: I actually have two things I'd like to say about that if I could. The first is that I spent a number of years as the dean of students for a medical school. And my job was to run orientation for the first year students and it was about three weeks long. And at the end of three weeks I would meet with them in small groups and I would say "If in the last three weeks you've figured out that this is not the place for you, and this is not the profession for you, could you say that?" And in eight years six or eight years of doing that job no one ever said yes. Three weeks in people felt stuck.

Now the second thing I want to say about that is our friends in law will tell you my law degree teaches me how to think but it doesn't mean I have to be in the courtroom. They see the skills as a doorway to do all kinds of things. And for a long time I was envious of my law colleagues and then I thought "Well, I have some skills that could open some doors for me too. I just need to think about it differently." So, I got fascinated talking to my law friends.

John: When you were just talking about that question you asked your students as a dean, I always kind of looked at it as a conspiracy. I can't imagine any of my instructors professors or other teachers would tell me "Oh, yeah, after you get into this or maybe eventually you want to do something else outside of medicine or something that applies medicine in a different way where you're not subject to being stuck with dealing with insurance companies and all the regulations and the long hours doing in the EMR."

It seems like they're part of that system and they want to continue this system. They don't want to let anybody out of the system and that might be overly cynical I'll admit. And at least you were there asking that question. I personally have never talked to anyone who's had a positive response to a physician in training who was thinking about leaving medicine. They'll usually do whatever they can to keep them there for a lot of practical reasons too.

Dr. Sharon Hull: Some of the earliest informal coaching I did was with medical students who really did figure out the answer to that question that they really didn't want to do clinical medicine. And much to the chagrin sometimes of my superiors I became a safe place for them to talk. And that may have been where I kind of learned my pathway was going to have a place here.

John: As I suspected your superiors weren't necessarily real enthusiastic about that.

Dr. Sharon Hull: There's this whole mentality of societies investing in your training and you owe society back. They've invested in you and this is a calling. There are lots of parts of that myth and it's not entirely mythical you have to decide what part of it applies to you.

John: It shouldn't be a surprise though when you consider that most of us made a decision to go into health care when we were children.

Dr. Sharon Hull: That's where the term agency comes in. I'm the agent of my own career. And sometimes the choices before us aren't great but we make the best one we can in the moment and get really intentional about what's next.

John: Well, there's more about that in the book, and I am going to ask you one more question before you go. But first let's talk about where they can find the book and then tell us the title and the easiest way to get the book when it comes out.

Dr. Sharon Hull: They can find out more about me obviously through LinkedIn and I'm assuming you'll put my LinkedIn in the show notes. But my website is www.mettasolutions.com. Metta, that's the name of my company, Metta Solutions. And on that website they'll find my blog, they'll also find a page devoted to the book which is titled Professional Careers by Design: A Handbook for the Bespoke Life. On the book page are several options for buying it. You can also find it in the common places like Amazon or Barnes & Noble or Goodreads. But that book page on my website collects all of those in one place.

John: Okay, excellent. Well, we are going to run out of time pretty soon now so I'll put those links to everything you mentioned in the show notes, of course. In thinking about your kind of typical clients or my listeners, any last words for any professional who might just be frustrated or unhappy in their career and how to maybe be better at designing it.

Dr. Sharon Hull: Start with what matters. That is my mantra. Start with what matters to you and then figure out how you can get more of that in your life systematically every day and let the list change as your life changes. That sounds like airy fairy kind of stuff but it's really not. It's common sense. My grandmother would understand it. Just start with what matters and the rest does come. The book can be a guide to the technical parts about what you need to deal with.

John: Yes, that's very helpful. Let's start with what matters. Maybe just sit down and start writing your list.

Dr. Sharon Hull: Top ten list.

John: And if you need help you can start by getting the book. All right, Sharon, this has been fun.

Dr. Sharon Hull: It has been fun, John. Thank you.

John: Thanks again for coming. Bye-bye.

Dr. Sharon Hull: Bye-bye.

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The post Explore What Matters Most and Design Your Professional Career appeared first on NonClinical Physicians.

How to Apply the Visibility Formula to Become Known

John Jurica — Tue, 30 Apr 2024 11:45:14 +0000

Interview with Dr. Nneka Unachukwu – 350

In today's episode, Dr. Una returns to the podcast to teach us how to use her visibility formula and to tell us about her new book.

Two years ago, Dr. Una introduced us to the transformative power of entrepreneurship for physicians. Now, she shares the strategies that have propelled her clients to success, with practical advice for physicians ready to embark on their entrepreneurial journey.

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The Visibility Formula: Unlocking Business Success for Physicians

Dr. Una explains the core principles of her latest book, The Visibility Formula. The book aims to empower physicians to overcome challenges in marketing and branding their businesses. From redefining introversion in entrepreneurship to practical strategies for increasing visibility, she offers valuable insights into building a thriving medical practice.

Practical Strategies for Physician Entrepreneurs

Dr. Una shares actionable tips and strategies for physicians venturing into entrepreneurship. She provides concrete steps for building a sustainable and successful medical practice or business, from identifying target audiences to leveraging social media. Drawing from her own experiences and those of her clients, Dr. Una offers valuable insights into overcoming common challenges and achieving long-term business success.

Summary

From homeschooling her children to leading The EntreMD Business School, Dr. Una's journey is filled with insights for physicians seeking to navigate the entrepreneurial world.

In her latest book, “The Visibility Formula,” Dr. Una unlocks the secrets to business success for physicians, offering practical strategies to overcome introversion, master visibility, and build thriving practices.

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 350

How to Apply the Visibility Formula to Become Known

- Interview with Dr. Nneka Unachukwu

John: I found that one of the best ways for physicians to thrive in today's healthcare environment is to opt out of the traditional corporate employment. That just doesn't do it for most of us. And as an alternative, build your own practice or a healthcare-related business. And to do that, of course, you need business knowledge and marketing knowledge. And that's why I brought on today's guest because she is an expert in both. Maybe we'll get she's taught so many people how to start a business, run a business, optimize a business, market a business. And so, I want to welcome back to the podcast, Dr. Nneka Unuchukwu.

Dr. Nneka Unachukwu: Hi, John. Thank you so much for having me back. This is a treat.

John: Yeah. And of course, you are being a presenter at the summit, which starts a week from now, but it's actually in the past by the time this is posted. I do want to mention it though, because people can still buy the videos after the fact. You are our kickoff speaker next Tuesday. I'm very thankful that you're going to be doing that for us.

Dr. Nneka Unachukwu: Yeah. And I think it's a gift to the physician community really, because we really do need all hands on deck and for people to see examples of what is possible. And you really gathered a really great group of speakers who are speaking on so many different things and everybody should be able to find something that resonates with them. And then hopefully just change the trajectory of their lives really.

John: Yeah. And not the least of which is just get to know some of these speakers who maybe they've never met before or seen and just say, "Wow, I didn't know there was someone doing that, that I could emulate or I could reach out to." Because pretty much all of us, if we're doing this for mentors or coaches or something along those lines too.

All right. Let's see, you were last here about two years ago. Of course, I can never go back and remember where things were two years ago, but just give us an update on maybe how your life has changed and some of the newer things you've been doing since we last spoke back in, I think 2022.

Dr. Nneka Unachukwu: Yeah. A lot has changed since then, but on a personal note, I started homeschooling my older two kids, which has been so good because they get a full education. They get the academic piece. I'm teaching them business, leadership, real estate, character development, and they get a lot of hands-on because I have them hands-on in the business. They're 16 and 14. It's been so rewarding. And some of the things we're going to talk about today are the things that made that possible because I was able to create that space so I could do that. That's been really good.

From a business perspective, I've done a lot, but really focused. As you know we have The EntreMD Business School, which is really about helping doctors build six, seven, multiple seven figure businesses. And for the last two years, I could have started many, many other programs, but I really poured a lot of energy into that. How can I help the doctors get bigger results? How can I help them get results faster? How can I help them see as many examples as possible of what is possible?

And really over the last two years watching them, we're talking docs, building multiple seven figure businesses, taking vacations once a quarter. Their marriages are better. Their relationships with their kids are better. Their health is better. Everything is better because they're back in control. They're back in control. And so just watching that has been so great. I'm really glad. The school is almost four years old now. Just the sheer amount of focus that I've put on that.

And then I really took to writing. I figured we didn't get a business education and everybody's not going to come into the business school, but I did really want physicians to have all these blueprints of how they can change their businesses, how they can grow really great brands and things like that.

This year I was like, "I'm going to do a book a quarter and we see how that goes." For the last two years, I've done a book a year. But then this year I was like, "I'll do one a quarter." That's my tall order for my own self.

John: That sounds like a challenge. It's hard. The way through that and with everything else you're doing, but it's a good challenge.

Dr. Nneka Unachukwu: Yeah, I'm up for it. I committed for a year, so we see what happens after that.

John: Yeah. Well, maybe by then you'll have written everything that needs to be known by anybody. So that'll be good. But that's why we're here. We want to talk about your latest book. You wrote The Visibility Formula recently, and published it. I've had a chance to look through it, but why did you write that and what aspect is it focused on?

Dr. Nneka Unachukwu: Yeah. I started off in entrepreneurship as a socially awkward, super shy introverted introvert. And I think many physicians are introverts and all of that. The problem with that is if we adopt the traditional sense of an introvert, it's almost impossible to make a business work because then the introvert will say, "Well, I can't go out and ask for referrals because I'm shy and I can't speak on stages because I'm shy. I can't ask for reviews because I'm shy." And it goes on and on and on. And I had treated that like a handicap, but being able to show up and promote your business and promote your brand and all of that, it's not really a personality type. It's like a skillset. It's a skillset. And I found so many physician owned businesses struggling, not because they don't have a great service because we lead with service. We have amazing services, but the thing is nobody knows about them. Obscurity is the big problem.

And so, I wanted to create one book where you can go end to end and discover how to build a business that is like a household name where people start saying you're everywhere, where all the people you want to serve can find you because there are so many people who have the problems that our businesses fix, but again, they don't know we exist and if they don't know we exist, they can't say yes to working with us. And so I wanted every doctor to be able to lay their hands on something that they can follow, their team can follow, and it will take them over the course of time from obscure to household name.

And then once we get to that place, we're in a position where we can help the people we're called to serve and we can create financial freedom at the same time. So that's kind of what drove me to write the book.

John: Oh yeah, I think most physicians, it's not something they're aware of or exposed to the idea of marketing or sales or, I don't know, branding even, that kind of thing. Maybe you can walk us through the components of the book or of the visibility formula. Obviously we should all go by the book if we want the details, but you can at least give us a high level overview of at least two or three, or maybe all.

Dr. Nneka Unachukwu: Yeah. The starting point of all things visibility is really recognizing how powerful it is. And when I talk to people about them, if your brand is visible, you get to attract more people that you can work with, which is what you want to do. You get to attract more people who refer people to you, because again, there are people looking to refer to people just like you. They just don't know you exist. You'll get to attract people who will come work for you.

I have so many doctors in The EntreMD Business School who now have one of them over the last three months has had six doctors from different states reach out and say, "You're the person I want to work with. I will move my family cross country to come work with you." Visibility does that.

And then one of my favorite things is that the visibility formula will do for you is it sets the stage for what I call the unknown. There's so many opportunities that can fall in our lap. That could be investments, that could be partnerships, that could be so many things, but they're not things that are on a vision boards and not things that are goals, but they can fall in our lap if people can find us. And so, if we understand how valuable visibility is, we'll be willing to embrace some of our discomfort to be visible. And so, that's the starting point.

Then the second thing, especially for physicians, because when I started out as an entrepreneur, I thought sales marketing, all those things are sleazy things, that used car salesmen did, not professionals like me. But redefining what that is. For instance, I could see selling as something you do to manipulate people to take their money, which is not what selling is. Selling or even being visible is really putting yourself out there loud enough and long enough so the people who have a pain that your business solves can find you. And so, the truth of the matter is putting ourselves out there is sometimes some of the best service we'll do to the people we're called to serve, because they have real problems.

Dr. John, if you think about it, there are problems in maybe your life, your business and things that you're thinking, "If I could just find somebody who does this, I'm willing to pay them whatever. Whatever they want, I'm willing to pay them. I just need the person." But there's somebody else who has a business who solves that. The reason why you're not working with them is because you don't know they exist. And it's the same thing for us.

If that person were to come to you and the person tells you, this is what I do, you're not going to say, "Oh my goodness, this person is sleazy and manipulative." You can even almost hug them and say "I've been looking for somebody like you." And so, being visible is not a slimy thing at all. It's a good thing. It's you serving your people. And if we can just reframe the way we think about it, everything becomes better. These are almost like prerequisites. Once these two are here, it makes embracing the formula, it makes it much easier.

As far as the actual formula, the starting point is who do I serve? Who do I serve? Who is the person? And a lot of times people will tell me, "Well, I can't choose. What I do will help everybody." And I'm like, "They're 8 billion people. You're not going to help everybody." And they're like, "No, but I really can't choose." I'm like, "Yeah, but you're an OB-GYN. You're not a pediatrician, you're not a dermatologist, you're not a heart surgeon. You chose a specialty so you can choose."

Really identifying who is the person my business serves, because when we talk to everybody, we're talking to nobody. And that's the rule of the game. You want it so that this way, everything you're doing is strategic. You're talking to your person at all times. That's the first part of the formula.

The second part of the formula is the person you serve already exists. They're not going to be born. This is someone who's going to swipe a credit card or swipe a card to work with you. They already exist. And so, they're out there in communities and groups and tribes where they've been gathered.

The second part of the formula is identifying where they are already gathered and going to them. For instance, Dr. John, I'm on your podcast and there are people who are listening now who have never heard of me, but they hear of me because I'm here. And the same thing, if you go on somebody else's podcast, there are people who've never heard of you, but they're gathered and you show up there and they're like, "Oh, now I've met Dr. John. Let me go find his podcast. Let me go attend his conference."

And so, we go show up where our audience already is. Because a lot of times what people do, they start a business, they open a social media account and they're talking there all day, every day, but nobody knows them. You have to go find the people. The second stage is going to find the people.

The third stage is then creating what we call a headquarters where people can come and binge on your stuff. Think about Netflix for business. If we use this example, Dr. John, I'm here on your podcast. Some may listen to this and be like "I find what she's saying is really fascinating." They could come to my podcast. My podcast has 414 episodes at this point. So they can binge away. They can see, "Oh, this is what it's like when people work with her." They can see, "Oh, this is what she's about." These are the principles to stand for. "Oh, she showed me this. I can go apply it in my business now and get wins and all that." Everybody kind of wants to own that so people can come home, if you will. They come to the headquarters and really experience you.

And done right, your podcast, YouTube, blog, those are the three main types of headquarters. They really can be a full-time employee in your business because while you're asleep, Dr. John, someone just listened to you talk about the conference. So someone's like, "Yeah, I heard you say the conference has passed, but I'm going to buy the replays and stuff like that." This could be happening at 02:00 A.M. You're asleep where your podcast is working like a full-time employee. Identify who you want to serve, go out there, go find them, build an HQ for them.

And then the fourth stage is really around "How do I set this up in a way that it doesn't take over my life?" I don't want to spend all day every day doing the podcast, creating, pitching where I'm going to go, all of that. Because sometimes people hear about this, they're like, "It's too much. It's a lot of stuff." And that's why we talk about things like repurposing, batching, getting a team, delegation, all of those things.

You can do it because I've had a whole month period where I didn't record a single podcast episode because I wanted to take a break. But I batched and I created six episodes, which is for six weeks. So of course I can take a break. My podcast didn't take a break, but I took a break. So there are ways to do all of these things and it will look like you're everywhere doing all the things at all times, but not really. That's not what's really happening because you've learned to leverage all these other things.

And the truth of the matter is we put ourselves out there long enough, loud enough, and we're strategic with inviting people to work with us and all of that. We will just build a brand. We will build a business where we can serve all the people we want to serve and really create massive change, which is what we really want to do. That's a long answer to your question, but that's kind of the formula.

John: That's a good overview of the formula. Now I'm going to get into the specifics of a couple of questions. One of the things I've become more interested in is instead of pulling people into just these nonclinical jobs, working for UM or an insurance company or something, but going back and saying, "Look, just start your own practice. Maybe do a cash only business of some sort or concierge or whatever you want to call it."

I just want to know when your experience, when you're working with those people, are there certain techniques that they use? Looking for patients geographically around them, do they go out on LinkedIn on social media or do they just do ads in newspapers or what?

Dr. Nneka Unachukwu: That's a great question. There's a lot of things they can do, but I'll tell you almost in order of importance, if you will. I'll give you some. When you have a brick and mortar and you're going to be serving people locally. When we talk about going out to where the people are, a lot of times they're local referral sources.

I'll give you an example. I'm a pediatrician and a great referral source for me would be an OB-GYN because we serve the same person in different ways. The OB-GYN will take care of the mom. I will take care of the mom's kid. And so, there's no competition there because we do completely different things.

Now, if I were to have build a relationship with six OB-GYNs and they're all preferentially referring to me, I'm busy, the end. The end. Because their moms are going to keep having babies and they're going to keep sending them to me. So I just have this constant stream of new people who are coming in.

I will give you an example of one of the docs in The EntreMD Business School, she does weight loss, brick and mortar, and she had been courting this orthopedic surgery group. Because they would need for their patients to have some weight loss to qualify for certain surgeries and stuff like that. And it took her a minute, it took her about 11 months of following up with them and all of that, but it's a big group. And so, the day they said, "Oh, come do a lunch and learn from us. We want to learn more about what you do." She ended up with 42 new referral sources, 42. If they sent you one patient a month, that is 42 new patients a month from one referral source. You see what I mean? And so for brick and mortar, that right there, it's so powerful, it's super powerful. That's number one.

Number two, because private practices tend to be high volume for the most part, except they're concierge like DPC, they tend to be larger volume than say a coach would have. Unleashing your current patients is so powerful. Many of them will refer, but they don't refer because they don't know you're accepting new referrals. Case in point, I was taking care of a patient one day and she said, Dr. Una, are you accepting new patients? Because I had this friend, she has three kids. She asked me who my doctor was and I was like telling her how you were amazing and all of that, but you're busy, I'm sure you don't take new patients. Here she is thinking she's doing me a favor by not referring patients. Meanwhile, I'm actively recruiting and accepting new patients. If we don't tell them, they won't refer. Now sometimes they will, but we won't experience the real magic of it if we're not telling them.

It's as simple as maybe I see 12 patients a day and I decide every day I'm going to ask four people to refer people to me. Especially when they're like, "You're the best thing since sliced bread." What they're literally telling you is ask me for something. Ask me for something. When they tell you that, oh, that's so amazing, that we're looking to build this practice up with patients just like you. Do you have any friends or family who you think deserve to be in a practice like this? And then they're like, of course, yes. And there they go. Because again, one person may give you five people. One person may be someone who's very influential, leads an organization, may give you 20 people. But if we don't ask, that's not happening.

Now people can do ads, but for me, I usually say ads is like gasoline on the fire. You want to make sure there's a fire. You want to make sure there's something already happening and you're doing the ads. I usually put that as last. And social media is also really powerful. Even if you're not getting a whole lot of engagement, do not be confused by it. People are watching, people are referring, people are sharing the video because they're like, oh yeah, this is my doctor and stuff like that. It's so powerful.

I've had clients who they're like, "I'm not getting a whole lot of engagement", but they keep hearing their patients say, "Oh, I see you. I see you online all the time and I shared your video with somebody else." They've gotten paid speaking gigs from that. They've had speaking gigs where they were in front of their ideal audience. They went to speak somewhere and got 20 new patients from one Facebook video that 25 people watched. It's really powerful. If they do the referrals, internal and external, and they do the social media, it's amazing what can happen.

John: All right. Well, let me shift gears to another. As you were talking, I thought, "Well, this whole idea of automating is a good one, because otherwise we just get overwhelmed." Do you have like a one or two of the things that you found that really just made a huge difference in any aspect of your business or your practice?

Dr. Nneka Unachukwu: Yeah. For me, delegation is one that's made the biggest difference. And I like to talk about it because I struggled so much. Because I'm good at a lot of things like most physicians are. And so, I'm like, yeah, I can do it. It'd take too much time to train somebody else to do it. But the problem is that one is too small a number for greatness. There's no way to build a great company with one person. And if you do the opportunity cost is pretty high.

And so, if you can always ask yourself this question, "Is this the best use of my time?" Either as a physician working clinically, or if you're working as a CEO in your business, you are the most expensive person on your team. The question is, would I pay somebody else what I will have to pay me to do this task? I had a client who loved to play on Canva. And if she listens to this, she'll laugh, she knows herself. Loves to play on Canva, loves to create graphics and do all this stuff. I'm like, "Look, if your hourly rate is $350 an hour, and you spent two hours creating this graphic, that's a $700 flyer. Would you ever in this lifetime pay somebody $700 to do that?" And she's like, absolutely not. I'm like, "So stop it. Find somebody else who you can pay appropriately to do that. It's too expensive."

Delegation is it, but one of the struggles with delegation is then we don't want to train the person to do it. They should come, they should know what to do, and they should read my mind and all of those things. The rules that make delegation work are really around you have to be very clear on what you want them to do. You have to be very intentional about training them to do it. You have to be willing to do some hand-holding in the beginning so you can set them free. And it's kind of like you're free for a really long time.

I'll give you an example. The last time I onboarded an executive assistant, I knew she was going to have a lot of tasks to do for me and all of that. I did a 30-day bootcamp with her. 30 days. 30 days, I met with her. I'm like, "This is how you do this. This is why we do this. This is my thinking about this." I did that every day for the first 30 days.

Now, after the first 30 days, she has been able to take so much off my plate. I kid you not, I probably have 12 hours a week back. But the cost for her to be able to do that, do it so efficiently, I represent the brand so perfectly, is a 30-day bootcamp.

John: Yeah. I appreciate what you're saying because I hired a podcast coordinator/assistant. And one of the things she said, "Hey, do you want me to do some of those images, those graphics for your social media and for your podcast?" I'm like, sure. Of course, she does them 10 times better than I ever would. And it actually takes her less time than I was spending doing them. And so, yeah, it's just amazing. You can't get away from having that human person that replaces what you do in spite of all the automated tools we have these days. Ciara, if you're listening to this, helping me with my podcast, then I'm giving you a shout out right now.

Dr. Nneka Unachukwu: That's awesome.

John: Okay. I want to hear more about everything that you do, starting with the book, so we know where is the best place to get the book and so forth.

Dr. Nneka Unachukwu: Yeah. To get the book, it's really simple. You can go to entremd.com/visibilitybook. And you can get the book there. We have other books that we've written, The EntreMD Method, and then Made for More, which is a compilation book from 40 doctors from the EntreMD Business School came together to tell their stories and stuff like that. So, that would be the place to get the book.

John, the way we like to look at this is we call the EntreMD podcast the free MBA for physicians. We deliver a lot of high value talking about business principles, how to scale, what you need to do to take your practice, for instance, to the seven figure mark, how to build a formidable team, all those kinds of things. We talk about all of that there. And it costs nothing. You're on a podcast platform already, just pop in entremd.com and go there.

The second thing we call our $15 MBA, and that will be our books. The Visibility Formula, Made for More, The EntreMD Method, and all the other ones I'm going to write this year. And then the third thing really is for the doctor who is committed to building a six, seven, multiple seven figure business. They're committed to their goals, but they're like, I need some mentorship. I want to be in a community of people who are doing the same things. I don't feel like I'm a unicorn doing something that nobody else has ever done and I can be inspired by people who are doing that. I need accountability because I'm not always motivated and nobody is.

And so, that would be the EntreMD Business School. That's our year-long program. It is a place where it's an alternate reality in medicine really, because you'll see people from starting up to all the way to eight and a half million in revenue, people who are monetizing their personal brand. So, they're working jobs, but they're building their personal brand as their business to private practice, DPC, DSC, speakers, event hosts, people with products, all kinds of businesses in there. The results that they're going on to create are just unbelievable, because you know what I think. Doctors, we make some of the best entrepreneurs, but all in one community creating those results. And so, all of these you can find on the website entremd.com, but these are the ways we support physicians. Those are the three MBAs.

John: Excellent. I think that's fantastic. We know what we know clinically, we're all well-trained. I think there's a big fear of venturing into the practice environment, but I think that's going to be our only saving really. Yeah, there's some good organizations that treat their physicians well, but you don't have the autonomy. Someone is telling you what to do, and you have this 15-page contract, and it's like, who wants to live like that? I would definitely take advantage of this if I was starting my practice, just to learn those business and marketing and promotional things, and just the common sense things that people that have already run a business know about.

Dr. Nneka Unachukwu: Yeah, you talk about fear, but I think that we should be afraid if we don't evolve. Because with the way it is, the burnout is at an all-time high, loss of autonomy is there, and there's no way to explore your full potential, which is one of the things that entrepreneurship allows you to do. There's no financial stability, let's not fool ourselves, because anybody could be fired any day. And so, yes, there may be a fear to venturing out, but you never know. That could absolutely work, and there's so many evidences of people it's worked for, but this other one is a guaranteed fear. We know this is not working. Choose your heart, choose your fear.

John: Yeah, think of a strategy. Maybe you're coming out of residency or fellowship, and you think, "Okay, let me be employed for a while, but make sure that I can get out of that in two or three years, and in the meantime, learn all these other things I need to know, so I can create the perfect situation for myself." But I tell you, I never thought about things that way back in the day, but maybe it's an option for some of the newer grads to consider.

Dr. Nneka Unachukwu: Yeah, very different times. We've had a lot of new grads in recent times, fresh out of fellowship, fresh out of residency, and watching them thrive in private practice, now that's been something. We have what it takes. I always joke, and I say, if we could learn the Krebs cycle, we can learn business.

John: Exactly. All right. Well, I think we're going to be out of time here momentarily. Any last bit of advice, just because you know my audience, it's a lot of physicians, some of whom are unhappy, some are frustrated, some are just looking for fulfillment. But what's your advice for my audience these days?

Dr. Nneka Unachukwu: Yeah, I think the best thing I could say now is with the way the healthcare space is now, the requirement for our evolution, it's a mandatory requirement. We have to change, and we have the capacity to. We're not fixed, we're not stuck. The way it is, it's not the way it always has to be. We can change. We can learn business skills, we can learn speaking skills, we can learn how to monetize brands. The things we're uncomfortable with, we can become comfortable with them. But I want to invite everybody to embrace becoming different, becoming an upgraded version. If you would like 2.0 because the healthcare space and you having autonomy, living without burnout, having financial freedom, having time, freedom to do what you really want to do requires that you evolve. The old model is not working, it's not going to get better. We have to change.

John: Very good, wise words. All right, Dr. Una, thank you for being here today and we'll get you back on in a couple of years again, if I'm still around. But I'm looking forward to hearing your first presentation at the summit and on a future podcast I will definitely give everybody a review of how things went. So I thank you for being here again today.

Dr. Nneka Unachukwu: Thank you so much for having me. And thank you so much for what you do for physicians everywhere. We appreciate you.

John: Thank you for that. All right, with that I'll say goodbye.

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The post How to Apply the Visibility Formula to Become Known appeared first on NonClinical Physicians.

The Best Biopharma Positions For Motivated Practicing Physicians

John Jurica — Tue, 23 Apr 2024 11:14:09 +0000

Presentation by Dr. Nerissa Kreher – 349

In today's episode, we present an excerpt from Dr. Nerissa Kreher's masterclass on securing the best biopharma positions from the 2023 Nonclinical Career Summit.

Dr. Nerissa Kreher is a pediatric endocrinologist and the Chief Medical Officer at a biotech company. She received her medical degree from East Carolina University. She then completed a pediatric residency and pediatric endocrinology fellowship at Indiana University School of Medicine.

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Unveiling New Horizons: Career Transitions in the Biopharma Industry

Dr. Kreher's journey inspires physicians to contemplate career transitions beyond traditional clinical practice. With over 17 years of experience in the biopharma industry, she offers invaluable insights into the diverse pathways available to medical professionals seeking new challenges and opportunities.

Through her narrative, Dr. Kreher illuminates how to leverage clinical expertise in roles ranging from clinical development to patient safety and medical affairs.

Decoding the Biopharma Realm: Contrasts and Considerations

Nerissa highlights the contrasting dynamics between clinical practice and the biopharma industry. She explores the differing hierarchies, teamwork dynamics, and work flexibility, offering her insights for physicians contemplating a career transition to the pharma industry.

These insights will help listeners prepare for their transition from a frustrated clinician to a fulfilling biopharma career.

Summary

Dr. Nerissa Kreher describes how to navigate from clinical medicine to the biopharma industry effectively. Gain insights into diverse career pathways beyond traditional clinical practice, from clinical development to patient safety and medical affairs. Explore new horizons with invaluable guidance from Dr. Kreher.

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 349

The Best Biopharma Positions For Motivated Practicing Physicians

- Lecture by Dr. Nerissa Kreher

Dr. Nerissa Kreher: I'm really excited to be here, John and Tom, thank you so much for this amazing forum. I've enjoyed participating over the last couple of nights and looking forward to tomorrow night as well. Thanks for the opportunity. I'll be speaking today about career opportunities for physicians in the biopharma industry. And I'll get to a little bit of lingo in just a second.

A little bit of background on me. I have a business called The Pharma IndustryMDCoach, and I help physicians explore and ultimately find a fulfilling career in the biopharma industry and use a step-by-step guide of taking you through the process of a resume, LinkedIn, interviewing, negotiating.

But in addition, I'm a certified life coach. And so I also apply the principles of life coaching to help people dispel imposter phenomenon, lack of confidence, self-doubt. And I'll raise some of those things throughout our conversation tonight.

John asked us to start by giving a little bit of our background. I thought it would be fun to share my story because people often ask, "How did I end up transitioning?" And I have to tell you that it was a bit fortuitous actually, but I'm very grateful that it happened. And I'm 17 years now in the biotech industry.

Of course, medical school, residency, fellowship, I'm a pediatric endocrinologist by training. I got married during medical school, had kids during residency and fellowship. And my husband, he was a year behind me, med-peds, and had practiced, but then decided he wanted to go back and do a sports medicine fellowship. We found ourselves in the situation of this is a match for sports medicine, and I was looking for a real job. And so, we ended up looking in three different cities, obviously ones with large academic centers where I could have a pediatric endocrine job.

I was on a clinical research path. I got my master's in clinical research during my fellowship and really enjoyed seeing my clinical research patients, but I never really enjoyed being in clinic day in and day out. I really was on that clinical research track and that's where my passion was.

Through this, I thought I had a job waiting for me at Mass General Hospital in clinical research. When my husband matched in sports medicine there, I called the program director, division director, and the first words out of her mouth were, "Oh no." That obviously was a bit stressful. They offered me a job, ultimately a job seeing patients 80% of the time.

I'm very grateful that I at least knew that's really not what I wanted and didn't just take the job out of feeling helpless and hopeless. I interviewed around the East Coast as far as Rhode Island and Dartmouth, New Hampshire, still didn't find what I was looking for. And a sales representative from Serono asked if I would give her my resume so she could share it at her company. And some of you may know or not, Serono has a recombinant human growth hormone, which obviously is a pedendo I'm very familiar with.

That landed me my first role in the biotech industry as the medical director in medical affairs. And I truly loved it from day one. I think it really pulled from that forever learner phenotype that many physicians have. I was exposed to so many new things, but also I was an expert in pediatric endocrinology. And so I was able to teach people, but I was also learning from others at the same time.

I'm now 17 years in, I've worked at seven different companies, medical affairs, as well as clinical development. I'm in my third chief medical officer role. I've had the opportunity of doing two public offerings, taking private companies public, and I serve on the board of director of a public biotech company as well.

COVID hit us, I felt like very, very dire straits in the early parts of COVID. I couldn't go and do a shift in an ER. And so my way of helping was to try to start helping some of my colleagues that needed to transition. And that's where the IndustryMDCoach was born from. So, that's my story. You can probably tell I have a lot of energy about our industry and really enjoy helping people understand it. I look forward to any questions at the end of the talk.

I like to compare and contrast a little bit between clinical and the biotech and pharma industry. Before I do that, I will use biotech and pharma and biopharma very interchangeably. It used to be that biotech technically meant something that we made in cells. For example, recombinant human growth hormone is manufactured in live cells. And pharma meant things that are synthetically made.

It's a big mishmash now. So many, many companies are biopharma companies because they do both. Some people actually now sort of refer to pharma as bigger companies and biotech as smaller companies. I think biopharma encapsules our whole industry. But if I use one or the other, I probably really mean biopharma.

In the clinical setting, and I fully admit there are some generalities here, but the physician is pretty high on the totem pole from a decision-making standpoint. I recognize insurance, admin, things also have an impact on that decision-making, but they are relatively high on the totem pole.

In the biotech and pharma industry, the physician may not be the ultimate decision-maker. Even as the chief medical officer, meaning I'm like the top medical officer at the company, I'm very rarely making decisions in a vacuum. I have my CEO, I have my chief operating officer, my chief financial officer. And so, decisions are being made in cross-functional teams all the time. That's one big difference that I think a physician really has to think about as they consider, "Is biotech and pharma the right thing for me?"

Obviously, clinical individual patient care, biopharma, we're caring for groups of patients. Now I actually don't even have an active medical license anymore. So I'm not caring for them, meaning making medical decisions for them, but I'm doing things that impact their medical journey overall. And I work in the rare disease space and I'm also understanding that medical journey and learning from patients. I do have the opportunity to be at patient meetings, have patients come to our office and speak to us, but I'm not doing that day-to-day medical care.

I mentioned cross-functional teamwork. Clearly physicians are working cross-functionally every day, with nurses, with physical therapists, with occupational therapists, we can name lots of them, pharmacists. But they all are generally healthcare providers, or at least in that healthcare provider universe. Whereas the cross-functional teamwork we do in the biopharma industry is much more highly varied. And so, for example, a program team might have a person from manufacturing, a person from regulatory, a person from clinical, an operations person, a program lead who's in charge of timelines, deliverables, a finance person.

And so, we're really working with people who speak very different languages than us. And one of the things you have to learn when you come into the industry are some of these languages so that you can actually communicate effectively with one another. But again, as I said, that was one of the things that I found to be really fun because I wanted to learn new things.

In clinical, the day can be very highly structured. As many of you know, there may be a patient waiting for you tomorrow at 08:30 and you know that they're supposed to be in the room. For those of us in the biopharma industry, I don't have a patient waiting for me. I may very well have an 08:30 in the morning meeting, but if my child is sick and vomiting, that meeting is a very different pressure than the patient waiting in the room. And so, there is more flexibility overall in the biopharma industry.

Now, lots of caveats. You could have a manager that was a dictator-style manager and your flexibility is out the window. But just in generalities, not having sort of that scheduled patient waiting for you makes that very different.

We have key indicators of success. Obviously, we're trying to make bonuses. We're trying to hit our timelines and our goals. Our key indicators of success vary with the function and with seniority. And so typically, the company sets their goals and they filter down through the organization. Whereas in clinical, maybe if you're in academics, it's related to grants or publications, then obviously RVUs are a major measure as well.

Funding pressures might be high. That, of course, might apply more towards the academic group. But in biopharma, we don't have funding pressures. I don't need to get a grant to do the research. The company has a budget to support that.

Those are some compare and contrasts. One, not better than the other, but I like to share them with people so that if they're thinking about a transition, they can start to think about, "Would I like that? Would that be concerning to me? Does that sound really exciting to me?"

I mentioned learning a new language. So I'll move past that one. But I really do encourage people to think about what kinds of learners are they? Do they enjoy new challenges? Do they enjoy or maybe even, sometimes I feel like I get bored if I'm doing the same thing day in and day out. And so this ability to interact with different people helps with that issue of not getting bored.

Again, you're typically not going to be the decision maker. And so when I'm working with a physician that wants to transition, there's this balance of humility and confidence that you have to strike during the interview process. People have stereotypes about doctors. And I think many of us would laugh at the stereotype because we know that for most of us it's not true, but people do think that doctors are know-it-alls. And so when you're looking at being on a cross-functional team, people don't want to work with know-it-alls. So you're balancing that in the interview process, but you also have to balance being confident and showing that you can do this job.

I think it's a lot of fun. One of the perks in my mind, I love to travel and I've had the chance to literally see the world. I've been to Japan, to the country of Georgia, Australia, Europe. Now, some people would say I have no interest in travel, and that's fine too, because there are roles in the pharma industry that have very little travel for physicians too. But for me, this opportunity to really see the world has been great.

I have amazing colleagues. I'm still in touch with people from that first Serono job. I was just at a networking event tonight. And the six degrees of separation, it's way less than that. This industry, people move roles, move companies. And so, you really have an opportunity to meet some really cool people.

And it can be really stressful. We still have timelines. We still have expectations. There are weekends that I'm working because I'm at a conference. There are evenings that I'm working because maybe I'm running a clinical trial in Australia and the times are different. I had a boss one time who said, people think we sit around and drink coffee and eat bonbons. It's not drinking coffee and eating bonbons. But the stress is something in my mind, I have more control over when I do the work. I still have to do the work, but the "when" there's not sort of it waiting for me in a patient room.

So, what are the main roles for physicians in the pharma industry? I break it down into three. These are the three entry level roles. Now, once you get in, really the sky's the limit. Physicians can be CEOs. Physicians can lead business development functions. There are all kinds of opportunities, but those are rare until you get your foot in the door, unless you have some kind of other specialty training like if you were maybe went through a MBA program and came right out into pharma, there might be some other opportunities.

But tonight we'll focus on the three main ones, clinical development, patient safety or pharmacovigilance. And at some companies, they call this drug safety. A lot of names for the same thing. And medical affairs.

In clinical development, the main roles that you're thinking about as you're looking for jobs, clinical scientists and clinical development physician, which is the director level or senior director level. And it goes up from there. Most physicians that are entering are entering in the associate director or director level. That's where I'm pointing most people, and then you can rise from there.

Pharmacovigilance, drug safety, patient safety. Same thing. You're sort of director level in pharmacovigilance. And then medical affairs, again, same thing for the physicians, medical affairs director. And then there's also another thing that many of you have heard of called a medical science liaison. I'm not going to spend much time on that tonight because we have another person that's going to spend a whole lecture on MSLs and she's the right person to do it because she's been an MSL. I've never been an MSL. And so I'm really looking forward to her talk as well.

As we move through those, I'll talk about clinical development first. Clinical development involves all aspects of studying an investigational drug product in humans. So we refer to early phase trials as phase one and phase two and late phase trials as phase three and phase four.

So if you think way, way, way back sometime, probably in medical school, you might've learned about this in one of your courses, but phase one trials are the initial safety trials. These are the first time we're putting drugs into humans. It usually in larger drug populations is in healthy volunteers. In the rare disease world in oncology, it's often patients that we're doing these safety studies in.

Phase two is early proof of concept. So you're still looking at safety. We're always looking at safety, but you're starting to look at proof of concept efficacy. Phase three studies typically are the large phase three. They're randomized double-blind placebo controlled studies that we use for registration or approval of a drug with regulatory agencies.

And then phase four typically is post-marketing. After a drug is approved, companies still are running trials to either follow long-term efficacy or follow long-term safety. And we refer to those as phase four.

That gives you a sense of the sort of large bucket of what clinical development is, but that doesn't really answer your questions, I'm guessing. So, let's dive a little deeper. The clinical development physician at the, again, associate director, director level, when they're coming into pharma, they're going to be involved in clinical development strategy and planning.

We're thinking about not just what does one trial look like, but what does it take to develop the drug all the way from putting it into the first human to getting it approved, whether it's with FDA or EMA, which is the European FDA or the Japanese or the Chinese or whatever it might be, whatever regulatory agency. You're thinking about the whole program.

More detailed responsibilities might include protocol design, where we're focused as the physicians on what are the appropriate inclusion, exclusion criteria, endpoints, safety monitoring. Maybe there's been a safety signal in the tox studies, you need to pull that into the protocol so you can monitor it in humans.

Another big regulatory document called the investigator's brochure, the physician's going to have a lot to say about what's in that document. And then of course, as you generate data, you've got data analysis, presenting data at scientific conferences, highly engaged in regulatory conversations. Going and talking to FDA, going and talking to MHRA in the UK.

Engaging with thought leaders or key opinion leaders, KOLs, to get their input. So I'm a pediatric endocrinologist and I work in the area of neuromuscular disease right now. So I don't know everything about neuromuscular. I need to go and ask the people that do. And so those are my thought leaders or KOLs.

And then I'm interacting with people like clinical operations. Those are the people that actually execute the trials. Regulatory, patient safety, patient advocacy. Again, those cross-functional team members.

I mentioned some of the titles already. Some of the transferable skills would be clinical experience, clinical trial experience. But here it doesn't have to be that you were the PI on a phase three pharma-sponsored randomized double-blind placebo-controlled study. It can be that you participated in research and that can be retrospective as well. Data analysis, publications.

Without clinical research experience, I typically would say to people, clinical development will be the hardest place to enter. But if you have research experience, which many of you do, then there are opportunities to come in through clinical development.

Moving to pharmacovigilance, again, drug or patient safety. This involves all things safety data. Those physicians are really not thinking about the efficacy of the drug. They are focused on safety and they have to understand the whole safety package around the drug from when it was first put into cells and into animals all the way through.

They're focusing on understanding all the available data and trying to assign whether or not there's relatability to a side effect to the drug, but maybe it's related just to the disease that we're trying to treat. And that's where the clinical knowledge comes into the patient safety role.

They have significant interactions with clinical development, with regulatory. I think I had no idea coming into the industry how much safety data we have to send to agencies like the FDA every, not even just year, but there are reports that are required by law that go in and these safety physicians are highly involved in those.

Some of the titles, associate medical director, medical director. And transferable skills here, your clinical experience. You're the one that understands pharmacology. You're the one that understands the actual clinical disease and that understanding is what you bring to the table for a safety role.

Clinical trial experience is a plus, but not a necessity. And if you have any experience as a principal investigator, that's PI or sub investigator where you've had to report safety data, again, that's a plus as well, because you understand the reporting process, but that's something that you can learn in the job. It's really that clinical experience that comes as the transferable skill.

And then moving to medical affairs. I actually find medical affairs to be the more difficult of all three to explain to people, because if I talk to you about a clinical trial protocol, most people can get that safety, but medical affairs is a bit nebulous. The definition is the external scientific medical arm that takes clinical or medical information from the company to external stakeholders, such as those key opinion leaders and patient groups, even more importantly these days. They share that information and they bring information back into the company for us to integrate into our development.

Medical affairs is engaged in the scientific exchange of information with external stakeholders. Those stakeholders might be, as I've said, thought leaders, but healthcare providers generally. It doesn't have to be Professor Smith, who's the best neuromuscular doctor in the whole of the United States. Yes, Dr. Smith is probably important, but the doctors who are treating the neuromuscular patients day in and day out are also very important to me. And I'm using neuromuscular as an example, it could be endocrine, it could be cardiovascular. But getting that information, what do they need from drugs? What is an unmet need? What is not being met appropriately? And again, patients and patient family input as well.

They're sharing that scientific and clinical knowledge and they're gathering that scientific and clinical knowledge. They also are very engaged in teaching. Oftentimes, I'm asked to give a lecture to a group of laboratory colleagues who they understand what they're doing at the bench, but they might not understand the disease they're actually working on and helping them understand it and talking to them about what happens to the patient helps them really understand why they come to work every day. So there's a lot of teaching involved in med affairs.

And you're interacting with a lot of people, clinical, but here may be more commercial colleagues and also regulatory because we are a highly regulated industry and anything we take outside, we have to get approval to do so. Regulatory is an important part as well.

Similar titles, again, I'm going to leave medical science liaisons for tomorrow night, but associate medical director, medical director and transferable skills here, again, that clinical experience. And if you have experience with data analysis, with publications, that can be a really nice addition as well, but again, not absolutely necessary.

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Make Your Clinical Practice Great or Move On

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

The Second Annual Summit is Here – 348

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

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

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

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

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

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

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

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

Trends in Addressing Physician Burnout

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

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

Highlights of the NonClinical Career Summit

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

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

Summary

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

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

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Today's PNC Podcast Transcript

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Episode 348 Transcript

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Priceless Advice for the New Expert Witness

John Jurica — Tue, 09 Apr 2024 10:31:38 +0000

Interview with Dr. Joe McMenamin – 347

In today's episode, Dr. Joe McMenamin provides priceless advice for the new expert witness.

Dr. McMenamin, an attorney with an extraordinary blend of medical and legal expertise, shares his compelling journey from medical school to the courtroom. He describes the convergence of these two disciplines, offering insights into the integration of medical and legal expertise.

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Exploring Expert Witness Work: A Physician's Perspective

Joe delves into the need for expert witnesses, emphasizing their role in educating lay jurors on complex matters. He discusses the distinction between fact and expert witnesses. He also outlines the demands on the expert witness, including the need for clarity and credibility in communication.

Considering Expert Witness Work: Opportunities and Considerations

Benefits and Opportunities

John and Joe explore the potential benefits of engaging in expert witness work for physicians. They discuss financial rewards, intellectual challenges, and educational opportunities associated with this role. Joe highlights the satisfaction of contributing to the legal system and assisting jurors in reaching informed decisions.

Challenges and Considerations

Despite its advantages, Joe cautions physicians considering expert witness work about its potential challenges. He discusses the time-consuming nature of reviewing medical records and the necessity of navigating cross-examinations. Joe also addresses the importance of maintaining credibility and the risks associated with advertising one's services as an expert witness.

Exploring the Intersection of Medicine and Law: Career Considerations

Joe shares advice for physicians contemplating a transition to law, addressing common frustrations within the medical field, and the allure of pursuing a legal career. He highlights the significant commitment required to attend law school and cautions against making impulsive decisions driven solely by dissatisfaction with medical practice.

Summary

Joe McMenamin offers valuable insights into legal careers, particularly in expert testimony. He mentions his law firm, Christian and Barton, and encourages interested individuals to contact him for more information. Moreover, he extends an invitation to connect via email for discussions on career transition or legal inquiries.

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How to Be the Best Expert Witness Consultant – 262
Top Reasons to Become an Expert Witness Now – 163
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Today's PNC Podcast Transcript

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Priceless Advice for the New Expert Witness

John

I've always been interested in expert witness work as an attractive side gig. You know, it's interesting, it's intellectually stimulating, it pays well. And in fact, I've had a couple of physicians here on the podcast before, but I've never had an attorney who actually engages or hires or whatever you want to call it, expert witnesses for their cases.

So I'm really happy to have today's guest here. Welcome to the podcast, Joe McMenamin. Thank you, John.

I'm happy to be here. I appreciate the opportunity. I have to just say that it's hard for me not to call you Dr. Joe, because as Joe was going to explain, he does have both the MD and the JD, so he's going to get into why and how that happened. But again, his work has been, you know, as the attorney engaging the physicians to help him out on cases. So that's the perspective we really want to get today. So why don't you go ahead and tell us a little bit about your background and education, how you ended up where you are these days.

Joe

Sure, John. Yes, I went to med school. I'm not a young whippersnapper.

I went to med school between 74 and 78 at Penn, and then did internal medicine at Emory from 78 through 81. And towards the end of that residency, I applied to law school. It was a concept that I had been thinking about on and off since boyhood, and never really made up my mind for sure until pretty late in the game.

In fact, I was applying to nephrology fellowships at the same time that I was applying to law school. Decided on the latter and went to Penn once again, finishing in 85. It took me four years because halfway through the first year, I had to take a year off when we discovered we were pregnant and I had to put a few dollars together.

So I was a moonlight ER doc for a while. And then finishing law school in 85, I went to practice at a large international firm, was there for a good many years. And then about 10, well, in 2013, I did solo stint for about a year, which was, sorry, 10 years, which was quite a change.

And now I'm at a firm called Christian & Barton in downtown Richmond. Curiously enough, in the very same building where I began my career, but with a different firm. And health law is the main focus of what I do for what I assume are obvious reasons.

John

Very nice. Yeah, that must've been an interesting few years there. Have to jump back and forth, you know, in your education, work again clinically.

How did that year go?

Joe

Well, actually it was longer than a year. I mean, I began my ER moonlighting career as a resident, as a JAR and an SAR. Kept it up during law school, all the way through law school, which is entirely doable.

Law school's curriculum is a very different animal from medical school. The one year that was full-time was occasioned, as I say, by the impending birth of our firstborn and the need to put a few dollars together.

John

Since that time, when you took that first, I think full-time job as an attorney, you never then went back to clinical work part-time or moonlighting or anything?

Joe

No, no, I haven't touched a patient since, good Lord, 1985. And so as I tell lay people, if your back hurts or something, I am not the guy you want to talk to. I mean, Rusty doesn't even begin to cover me.

On the other hand, everything I do benefits from and utilizes in some fashion and to some degree, my education and training in medicine. And I've been fortunate to be able to develop a legal practice that capitalizes upon that stage in my education. And I'm grateful for it to this day.

Excellent.

John

Well, the first question I have relative to this, the reason you're here today to understand this work as an expert witness is really to get to your side of the story, your take on it as someone who's engaged physician. So why don't, let's see, why don't we just start by saying, telling us about, you know, why is there a need for expert witnesses? Why this should potentially be an interesting thing to do on the side for physicians, most of whom will still be practicing when they do this, although I understand not always.

And just kind of tell us about your perspective on those topics.

Joe

Well, the reason that expert witnesses exist and not just in medicine, but a great many other fields is that in US law, pardon me, which was stolen in large measure from the British, a lot of decisions are made by juries. And, you know, people wax eloquent about the wonders of the jury system. And indeed it does have a lot to recommend it.

But jurors are by definition lay people. They're chosen from the ranks of registered voters or from drivers or what have you. And it's not impossible theoretically that the next jury that comes along might have a Nobel Laureate in physics on it.

But the probability of that is pretty remote. And even if you did, that doesn't mean that this very bright, very capable person knows anything about how to work up an acute abdomen or what have you. So the idea is to bring in people who by virtue of their knowledge, skill, training and experience are able to enlighten the jury about the menace, about what is expected and whether in a given instance, the defendant, the person being sued did or did not comply with what we refer to as the standard of care.

And because we recognize that however intelligent, somebody with no medical training or background is not going to have any knowledge or at least probably has no knowledge or if he does, he has precious little about medical topics, we bring in physicians to serve as experts. Now, if the case involves, let's say toxicology, we might not want a physician, we might want a toxicologist or it involves a totally different field. I mean, there's all sorts of experts in all sorts of fields that limited only by your imagination but an accountant could be an expert witness potential or a geologist could be an expert witness depending upon what the nature of the claim is.

I focus of course, on healthcare matters. So naturally, the vast majority of the doctors, sorry, of the experts I've hired have been physicians.

John

Okay. Now, what is your understanding of why this might be interesting to do for a physician? I'm sure some of the people come in and do it maybe with some misconceptions but why would you think it'd be something that would be of benefit for a physician to pursue?

Joe

Well, I'll start by suggesting that it is not for everybody. You could be the best doctor on planet earth and perhaps not be a very effective witness. Reverse is also true.

You could be an extraordinarily talented witness but not necessarily a great doc. They're entirely different skill sets, at least as I see things. It may be useful to have a little background in evidence law to preface what my remarks on this.

There's a distinction in the law of evidence between fact witnesses and expert witnesses. A fact witness is just that, somebody who, for whatever reason, has knowledge of facts pertinent to the case. So I leave work this afternoon and I happen to see the Chevy hit the Ford in the intersection.

I don't know the driver of either one. I don't know what either one was doing. I frankly don't even want to be involved but I happened to be there at the time.

I saw what I saw. In the event a lawsuit ensues from that situation, then whichever side thinks my testimony would be useful to its version of the case, can require me if necessary, or can certainly ask me, and if need be, back it up by law, and require me to come to court to testify to whatever I saw. And this proponent, the side that has asked me to come, can ask me a series of questions designed to elicit from me whatever knowledge I have of this situation.

After that, the other side, the side representing whoever the defendant is, if I'm on the plaintiff's side of it, will cross-examine me, ask me a series of questions intended to suggest to the jury that maybe I'm not such a reliable witness. Maybe I didn't see things very clearly. Maybe it was a cloudy day and my vision was hazy because, I don't know, I'm not wearing my glasses.

Or maybe I'm not reliable. Or maybe I'm friendly with the driver of the other car. Whatever, all of that is perfectly kosher, perfectly legitimate.

And, you know, if I do well on cross-examination, the side that asked me to appear will be pleased, and if I don't, then the side that did the cross-examination will be pleased. But the point is that all I can testify to is what I saw or heard or what I know. I cannot offer an opinion.

I cannot say, I think the driver of the Chevy was at fault, even if I really do believe that, and even if, in fact, there's good basis to say that that's true. That's an opinion I cannot offer. Moreover, I don't get paid for my time.

It's expected of me as a citizen to show up when I need to and to testify. An expert witness is a different animal. An expert witness, first of all, is a volunteer.

Nobody can force you to be an expert. You have to willingly accept the opportunity if it is given to you. Second, you do get to charge for your time.

The law recognizes that every moment that you spend horsing around with some lawyer some place is a moment that you cannot be seeing patients or whatever it is you normally do, and as a result, you're losing money in this proposition unless you can bill for it, and so you can. And third is, yes, indeed, you can give opinions. That's the whole point, in fact.

The reason that whatever makes you an expert is that you have knowledge that most people don't, and therefore your views on a particular technical or scientific or medical or otherwise complicated subject are intended to be, and we hope are, useful to this jury of laypeople who have no prior exposure to these concepts, have very little understanding of them, and the biggest job that the expert has is to be a teacher, at least as I see things. You're there to teach the jury what the facts are. Now, even that's a bit of an oversimplification because although I think the distinctions I just drew between fact witnesses and expert witnesses are correct, there are also two types of experts.

There are so-called consulting experts, and then there are testifying experts. A consulting expert, as the name suggests, serves as a consultant to a lawyer, or maybe a group of lawyers, and is chosen presumably because of his knowledge, whatever his expertise may be in the judgment of those hiring him, is highly valuable, highly relevant to whatever is at issue. But that person does not appear in court, does not testify, and the side hiring him is under no obligation to identify him to the other side, nor to tell the other side, even that he exists, much less what his credentials are, or what his opinions might be, or what the basis for those opinions might be.

He's purely behind the scenes. The testifying expert, on the other hand, is the one that Hollywood will make a movie about, or at least feature an expert in a movie about a trial. This is the person who, yes, will indeed have educated the lawyer ahead of time, presumably, but will also be there in court, will take an oath to tell the truth, will then testify in response to questions posed to him by the sponsoring lawyer, and will respond in turn to the cross-examination questions offered by the sponsoring lawyer's opponent.

Now, both the plaintiff, that's the person bringing the suit, and the defendant, the person being sued, have the right to call an expert, or sometimes multiple experts, depending upon the nature of the case and its complexity. It's not unusual, for example, to have at least two experts on both sides. Why?

Well, because the malpractice theory proceeds on the basis of ordinary negligence law, which has four components, classically, duty, breach, causation, damages. Nothing novel here. I'd be disappointed in any first-year tort student who couldn't rattle that list off just as well as I can.

Duty. If you're my doctor, I'm your patient, you owe me a duty. It's pretty much that simple.

It's usually straightforward, not so much. If I'm an accident victim on the side of the road, and you are driving past, and you see me there, and you're able to help, and you decide to help, or you decide not to help, that's duty. Generally, that's not contested in these cases.

It's pretty clear that you do or you don't own a duty. Breach is, in contrast, highly contested. That's the heart and soul of the case.

Did you or did you not breach the standard of care at the relevant time caring for this particular patient? The plaintiff's expert's job on standard of care is to say the standard of care requires A, B, and C. Doctor so-and-so, the defendant failed to do, did do A and B, but he didn't do C.

That's a breach of the standard of care. The second expert that that plaintiff may call is a causation expert, because that's the third element of the story. Again, it's duty, breach, causation, damage.

It's causation is the so what question. I don't know. I'm a general internist, and you come into me with a history of a bad cough.

It seems to be getting worse. You're coughing up blood. You've lost a bunch of weight.

You've got some chest pain. Oh, and by the way, you've got a 100-pack year smoking history. And on examination, I discover that you have a hard mass in your left supraclavicular fossa.

And then on X-ray, there's a mass demonstrated in the left upper lobe, but somehow, I don't put two and two together, and I say, well, sorry, you've got the cough, nothing serious. Probably go away in a few weeks. I'll see you again next year for your annual physical.

But after that appointment, you leave my office, you cross the street, and you're run over by a bus, and boom, you're dead right on the spot. Is there a cause of action against me for medical malpractice for failing to diagnose what I hope was a reasonably clear case of lung cancer? The answer is no.

Why? I might have reached a standard of care in not being able to make that diagnosis, but I didn't kill you. My mistake didn't kill you.

The bus killed you. So maybe there's a claim against the bus company or the driver or both. Maybe there's a claim against the city for not putting a stop sign there.

I don't know. Use your imagination. But there's no claim against me as the doc because I had nothing to do with your death.

There are a class of experts who testify to causation, which is, from a medical point of view, often the most complicated and also the most interesting part of a malpractice case. Why did so-and-so develop condition X? Or why did he die at the age of whatever when he should have lived another 10 years or so it could be argued?

Now, one doctor could serve as both the standard of care expert and the causation expert, but it's not unusual to have one of each or, for that matter, more than one. And then just as the plaintiff gets to call experts to testify to these matters, the defendant can too, and the defendant will if he, as it descends, at least in my view, and you find somebody that you think is highly qualified, testify contradicting what the other side's experts said. Now, at the end of the day, who gets to decide the answer?

The jury. Now, philosophically, you may think that's smart or dumb. I'll leave that to you.

But we've been doing it this way. I'm using we in a grand collective sense, tracing it all the way back to England shortly after the Norman invasion in 1066, William the Conqueror and all that, for nearly 1,000 years. And that's how we decide these cases.

So for better or worse, the lay people sitting in the box are the ones who decide what the standard of care is and whether on a particular occasion, Dr. Smith did or did not comply with that standard. Now, I finally get around to your question was why would you want to do this? Well, you've already pointed out a couple of things, John.

First, you do make money doing this. You know, your time is valuable as a physician. And, you know, it's not at all unusual.

In fact, it would be unusual not to have an expert charge less than let's say $300 an hour. 400 is not unusual. 500 is not unusual.

600 is maybe pushing it a little bit, but not all that much. You know, the sky's the limit. There is a downside.

If your fee is so high as to put you out of reach, you may not get hired because you're simply too expensive. Or the lawyer is willing to bear the freight for whatever that fee happens to be and it warrants into many thousands, but the other side gets to find out what your fees are and can cross-examine you. And a skilled examiner will have no trouble suggesting that because you're $20,000 richer or having got involved with this lawsuit that you're a hired gun and therefore your credibility is out the window.

Now, the jury will not necessarily reject your testimony because of the 20,000 or 40,000 or whatever it is, but it might. So bear that in mind. But there is a source of revenue here and it's not trivial.

There are people who push this really hard. I had a, I mean, one of the most enjoyable aspects of malpractice defense work is cross-examining the other side's expert, at least when you've got some goods on. I mean, I had an expert who testified against me many years ago that I remember vividly.

He maintained a private airplane. The better to go from deposition to deposition to courthouse to courthouse all across the United States and made a handsome living doing this and simply didn't bother seeing patients. Well, it wasn't that hard to cross-examine this guy.

Maintaining airplanes is an expensive proposition. You have to earn a lot of money to be able to do that. And he did, he did it by testifying.

He would testify all over the country all the time and he didn't bother seeing patients because he was too busy testifying. Now here in Virginia, he would not qualify because there's a rule here that says that if you don't have an active clinical practice or at least have had one within two years of the relevant day, then you're no longer qualified. However learned you might've been 20 or five years ago, you're out of business.

Not every state has that rule. So more elaboration perhaps than was necessary, but income. The other thing is it will help you develop a better understanding of the legal system.

Doctors have extensive educations going for years and years and years as I don't need to tell this audience, but seldom do they get much exposure to or experience with the legal system. This is one way to learn about. As you pointed out, John, this is an intellectual challenge.

It is clearly an intellectual exercise here. When you're talking to a jury, remember these folks have no relevant education or training. The wisdom in the field is to suggest that you ought to assume that these folks have a seventh grade education.

Not to disparage anybody, not to put them down, but just because they really don't have much to go. So you've got to take concepts that you and other really smart people have spent a lifetime studying, understanding, agonizing over, and reduce it, translate it in a manner that lay people can understand. Got to keep it simple enough that John Q.

Public, listening carefully, can follow it. So teaching lay folks about complicated subjects is not necessarily an easy thing to do. It is definitely a challenge.

And then when you get cross-examined, if you weren't challenged before, unless the cross-examiner is really lousy, which is possible, then you're truly about to be challenged. I mean, that's the whole game. The game with cross-examination is to try to discredit this witness by whatever means you can come up with short of breaking the law.

And there are a lot of ways to do that. So you need to be on your toes if you're going to survive cross-examination. And if you don't survive it, your chances of being hired again are diminished a little bit.

On the other hand, if you come through it like a champ, the same guy that hired you last time is going to be interested next time if there is an opportunity. Or there isn't, but there's a network among lawyers on both sides of the V, as we call it, the plaintiff's bar and the defense bar. If I need an expert on some topic where I've never had to hire an expert before, I might call up one of my buddies on the defense side and say, hey, Charlie, I had a case coming up.

I need a pediatric neurosurgeon. Can you help me? Yeah, do you have any experience?

And he'll say, no, I'm sorry, I don't either. But he might say, but talk to Mary Smith down the street. I think she hired somebody like that.

And I call Mary up and Mary may be able to say, well, talk to Dr. X at Mecca University. Guy's terrific. And I do that.

Well, we talk to each other and we know about these things. You're also, and this might sound corny, you're also making a meaningful contribution to the justice system. Remember, the jurors, I'm convinced, truly do want to do the right thing.

They want to be fair, they want to be just, and they struggle to do this correctly. And if you're able to help them reach a logical, sound conclusion, not only will they be grateful, but you have genuinely contributed to our country, at least as I see things. And of course, if you testify on the defense side, and I never did and never will do plaintiff's work, you're helping your fellow docs.

Now, I don't know, John, have I, should I go over to the negatives or should I stop?

John

Good question. Well, I guess, yeah, why not? It's kind of addresses this issue.

If someone was thinking about pursuing this work, there's probably certain things you'd want them to know about it, what they should expect, the good, the bad, the ugly. So yeah, why don't you take that on now?

Joe

Well, I've already dwelled at some length on the cross-examination phenomenon. Cross-examination is tough, at least if your examiner is worth his pay. I mean, if he's any good, he'll do a good job.

And that means you've got to be very, very alert. It's time-consuming. If you're going to do a good job, you've got to review the medical records.

Many times in malpractice cases, the medical records are extensive. And the days when we relied upon paper, you know, you got two feet worth of documents to plow through. And granted, doctors read charts all day, every day, and they know how to do it.

But something that doctors, frankly, don't often do is they may not necessarily read the nurse's notes, or the PT's notes, or the OT's notes, or never mind the NA's notes in a nursing home case. You know who does? Plaintiff's lawyers.

So to be aware of what's in potentially damaging information in the nurse's note written at two in the morning, you probably need to read that. Even if in your actual work in clinical practice, you want to see what your consultant had to say in his note. You want to maybe see the progress notes from your colleagues who wrote a note in the chart yesterday.

And you're not necessarily going to pay so much attention to what the occupational therapist had to say. But in litigation, what the OT said might very well be important. So it takes a lot of time.

You're also going to spend a lot of time with lawyers. Some people would consider that cruel and unusual punishment. Depends on your point of view, but if you don't particularly like lawyers, and if you don't, you are not unique in the medical profession, factor in that you're going to spend a lot of time with people that you may not necessarily like.

Now, on the other hand, if I'm hiring you, one of the things that I will do my best to do is to make you happy, since I want you to cooperate with me, work hard with me, do a good job for my client. So I'm going to do my best to keep you happy, but I can't change the fact that I'm employed. Now, and of course, if you do plaintiff's work, you will run the risk of antagonizing your colleagues.

Now, flip side of that. Just as I can portray the guy with the private airplane as a prostitute, if you did nothing but defense work all day, every day, well, I'd be grateful, I would kiss your feet, but you wouldn't be vulnerable to cross by a plaintiff's lawyer who would point out that in the last 16 cases you've reviewed, all of them were for defense counsel. And you refused 17 opportunities to represent, not to represent, but to testify on behalf of plaintiffs, if that were true.

So factor that in as you're thinking about these things. So it can be enjoyable, but it also has its downsides. And one thing I would caution you about is you want to be careful about advertising.

Some docs are eager to do this kind of thing, make that very clear. When I was a baby lawyer a long time ago, I received a letter from a doc in the Central Virginia area addressed to me at my law firm and inviting me to hire him as an expert. No, I'm sorry, I got my story mixed up.

That's not quite correct. Instead, it didn't go to me directly, it went to a guy down the hall, one of my colleagues, one of my fellow lawyers in the firm, whose field was construction law, didn't do malpractice work at all. But he wandered down the hall, he said, Joe, take a look at this, I don't know if this guy's any good or if you're interested, can't help me, but maybe he can help you.

Well, I didn't hire him. And frankly, one reason was because I try to avoid hiring people who advertise. Why?

Because of the very thing that happened when the guy came to trial, by chance, a year or two later. At the right point, when my opportunity to question him came, I said, Dr. So-and-so, who is Ron Eimer? And he said, I have no idea.

I said, well, you write letters to Ron, don't you? I'm sorry, I'm not familiar with this person. I said, all right, well, let me show you Exhibit A.

And I show a copy, of course, to opposing counsel, and I show a copy to the court. Take a look at Exhibit A, if you would. Do you recognize your signature at the bottom of that letter?

Yes, I do. Is that your signature? Yes, it is.

Okay, and Ron Eimer is the person to whom this was addressed, is he not? Yes, and it says Ron Eimer Esquires. He's a lawyer, is he not?

Yeah, and beneath that, it says McGuire Woods and Battle, which was the name of the firm at the time. That's a law firm, is it not? Yes, it is.

So you were ready to Mr. Eimer to get the opportunity to testify, weren't you? And of course, you're getting well-paid for your time this afternoon, are you not? So your advertising really paid off pretty well, didn't Mr. Plaintiff's lawyer?

You know, I can be an SOB when I need to be. So think about that. Doesn't mean you never advertise, or you shouldn't.

Maybe you have to, but be careful because you're creating potential cross-examination equipment and believe me, I won't hesitate to use it if I think it's going to help my client prevail in the case. Also, be careful if you testify too much, as I indicated earlier, you undercut your credibility. Even if there isn't any rule that says you're out if you don't have an active clinical practice, as there is in Virginia, if I can portray you as somebody who testifies for a living, doesn't really take care of patients, then I have severely harmed your credibility because the jury wants to hear, almost always.

They want to hear from docs who actually care for folks who are sick or who are injured, not from people who don't do that for a living. It's too easy for opposing counsel to paint you as incredible, not worthy of belief. Also be careful of organizations that group experts together.

There are companies in the business, there are companies that will advertise to lawyers and say, look, we've got a whole stable of experts in every subject from A to Z, and they really do. They've got from anthropology to zoology or whatever. You need an expert in whatever field, we can help you out.

And they can't. And I won't mind admitting that at times I have relied upon organizations such as that, but be careful because if you get in bed with those guys, you'll have a contract with them. The contract will likely be discoverable.

Contract may very well have language in it that people like me will be able to use to hit you over the head on cost of examination. Think about proof sources. They're important.

You know, it's not an obvious thing. And I had to try a few cases before I began to understand really how important these paper trails may be. So, you know, think about these negatives as well as the positives.

I'm not trying to talk you out of doing this in the least. I've had some, I'm deeply grateful, and I mean that with the most profound sincerity to experts who helped me out and helped me get a doctor's chestnuts out of the fire in a way that was convincing to the court, convincing to the jury more important. And I'm indebted to those folks and I would help them any way I could.

And on the other hand, if you testify against me, I'm going to try and crush you if I possibly can. You may crush me, but that's the name of the game.

John

I do have two or three other little questions before I let you go. One is, you know, people always ask, okay, well, how much am I going to have to do with that massive chart review? How much am I going to have to do for prep and writing report?

And then, oh, do I have to, you know, go to a deposition, prepare for deposition? And what about how often will I end up in court? What's your experience been with that?

Joe

The amount of reading and preparation is largely a function of the complexity of the case and the scope of the medical record. If the chart is comparatively skinny and the facts are simple, well, frankly, there's a pretty good chance of mine I go to court, but if it does, then your prep will be comparatively painless. Now, you will have to spend time with the lawyer that hired you.

That's important. He needs to understand how you're going to answer a particular question, and you need to understand the rules of the road, and the lawyer's job is to acquaint you with them. The lawyer is not there to tell you to answer a certain question a certain way, but the lawyer can try to anticipate what some of the questions will be and can discuss with you various ways to handle them. In the end, it's your opinion, not the lawyer's.

You're the expert, not the lawyer, so you have to answer it as you see fit, but the lawyer can point out that, I don't know, if I look at my wall over there, there are probably six or eight adjectives I could use to describe its color, none of which would be incorrect or untrue, but one might provide in the mind of the listener a different image, maybe a better image, than choice number six, perhaps, and there's nothing wrong with discussing those possibilities.

As far as depositions, that's a matter of state law. All of this stuff is governed by, nearly all of it, is governed by state law. Some states do not make provision for depositions, and it's a matter of choice.

It's a matter of grace and agreement between the lawyers, but you can't force a deposition of the opposing expert in some states. In other states, you can. It's a matter of right.

You get to do it. You can count on the deposition taking probably a good two, three hours and another one or two before that for prep time. Remember, that's all billable.

You get to bill for all of it. I take the position that the prep time, you bill to the lawyer that hired you. The deposition time, you bill to the other lawyer because he's the one who determines how long that deposition goes.

Now, some depositions are endless. I mean, I've had them go for two days, but that's rare. That's unusual.

I've had them be 35 minutes. That's equally rare and unusual, but a couple of three hours, maybe four, that's not unusual. That's fairly typical.

Trial work, you may be on the stand for a relatively short period of time. Often, that's not the case. We'll get to that in a second.

What you may not realize, though, is you have to be available on call. The lawyer does not control the pace of the trial, at least not completely. The judge has the most control over that.

The judge is going to be sensitive to when the jury needs to get up and get a bite to eat or to go to the john or whatever it might be. Things happen. You've got a game plan before the trial.

You have six witnesses. You want to call them in this order. You think you're going to need an hour for this one, 30 minutes for that one, two hours for that one, and so on.

You make all those plans, but while the planning is a good idea, very often you can't stick with that plan. You think that you're going to call your expert at roughly two o'clock on the second day of trial. Well, you can tell him that and he can plan around it, but it might not be until the third day of trial, or it might be 10 o'clock that morning, or it might be some other time.

For a practicing clinician running an office or a hospital practice too, for that matter, that's really difficult to deal with. Yet, the lawyer needs you to have that kind of flexibility because he just doesn't have control over the point in time at which you're going to be needed. When he needs you, he needs you.

No joke. If you're somehow unable to put an expert on, chances are you lose that case. It's very, very difficult to prevail without your expert.

When you sign up, recognize that you're making a commitment and it may be very inconvenient to you. If that's not acceptable, I fully understand and respect that, but don't sign up. Now, discuss it, of course, with a hiring lawyer.

There are circumstances when the degree of control is a little better than I've suggested, and maybe it won't be so difficult. But do realize that trials are unpredictable animals, and things happen at a rate, at a pace that you may not be able to predict.

John

The other sort of short question I have is what's the demand like now, and is it related more to specialty and expertise, or is there an ongoing demand, or is the demand already kind of flooded with expert witness? What's that about?

Joe

Well, this is the United States, and it's 2024. We live in the litigation capital of the known universe, and our enthusiasm for litigation, we as Americans, does not seem to have abated at all during the course of my career. If anything, it may have increased.

And the national pastime is not baseball. The national pastime is litigation. Now, of the physicians out there, and what are they?

A million doctors, maybe, in the whole United States? There's a certain number of them, a fairly high fraction. You want nothing to do with any of this.

They flat will turn you down. And that's their right. They have every right to refuse.

There's no duty to do this. And that means that your pool to choose from is narrow. Of those willing to testify, there are some that I wouldn't hire because it's too easy for them to be cross-examined.

Of those that I am willing to hire, it could be that my number one draft choice is going to be on vacation on the day of trial. And so I'm out of luck. I can't use that guy.

And so for a whole variety of reasons, the chances are good, I would think, that the demand will be there. And there is a market for these services. If it is of interest to you, and you don't want to advertise, you can quietly over lunch or a game of golf or whatever floats your boat, mention it to Dr. So-and-so. Or maybe mention it to, if you happen to know a guy working for, a person working for a malpractice insurance company, who after all will be the ones to pay your freight at the end of the day. Say, you know, I'm curious about this. Tell me about it.

And you don't put anything in writing because that's too easy to find. But a little conversation like that could pave the way to opportunities. So you want to be discreet about it.

And I wouldn't go beating the drum, but let the word get out in subtle and not too obvious manner. And you might get some opportunities. You might find that you really like it.

Then again, you might hate it. So go to school on whatever opportunities you do get and judge whether to keep up with this sort of thing based on your initial experiences.

John

I do have one more question. And this is a tangent that we kind of discussed a little bit during a prep meeting that we did a while back. And it was this idea that as a physician, I get really frustrated.

I'm tired of people telling me what to do. And, you know, the heck with it. I'm going to go to law school and somehow take this out on somebody else.

What's your advice? Or have you heard that comment before? I have heard that comment before.

Joe

I get phone, not every day by any means, but I get from time to time, I get a phone call from Dr. So-and-so from out of the blue, somebody I've never heard of, probably will never speak to again. But somehow, he got hold of my name. And he says, tell me about law school.

Tell me about being a lawyer and all that. And I've developed, I'd like to think, a fairly accurate set of antennae for telling whether the inquiry results from a sincere curiosity about how you combine these fields and whether it would be of interest versus the kind of physician you just described, John, who's thoroughly hacked off because some person somewhere who doesn't have anywhere near his credentials or his training or his knowledge or his experience or the pressure or the responsibility of caring for a patient has just told him, well, no, we're not going to provide prior authorization for whatever it is you want to do.

Well, I understand why you would be very angry about that. If I were subjected to that, I'd be furious. And I don't mind admitting that, however, is not, repeat not, a reason to go to law school.

Law school is a three-year investment. Nowadays, you're looking well at six figures. It's a time when, yes, you can work part-time as I did, but you're not going to be able to earn the fees that you could in full-time practice in medicine.

And, you know, it's not as hard as medical school, in my opinion, but it's not a walk in the park either. There's a lot of reading to do. Some of it is fairly difficult sledding.

Some of the professors you'll like, and frankly, if your experience is anything like mine, some of them you won't. And, of course, you'll be in there with a bunch of young leper snappers, quite possibly. Now, not so much as years ago, but still, you'll be older than most, probably.

Those factors may not necessarily be to your liking, or maybe they will be, but it is a major commitment. It's not just something you decide to do on the odd Thursday for no particular reason. So, if you're angry about the way medicine is being practiced, I understand that.

React to it in some way that makes sense, but don't, on that basis and that basis alone, go to law school. One of the reasons, one of many, that I went to law school, quite honestly, is that I saw a lawsuit wreck the life, and I'm not exaggerating here, I think that's not an exaggeration, wreck the life of a young doctor who was a year ahead of me in training, a fellow that I truly looked up to, a fellow I consciously tried to emulate, because I thought he's the ideal resident by the time this happened, he was a fellow.

I'd like to be just like Dick. And something happened, and he got sued, and he just wasn't the same person. And frankly, I don't think his patients got, at least for a length of time, got quite the same service that they did before.

And I thought, this is wrong. Somebody ought to do something about that. But this was after having thought about it for, I don't know, however long it is from seventh grade to senior residency, a long time, on and off, and weighing many variables and asking people about it, talking to people who are in the field, etc.

You don't do it on the spur of the moment. You don't do it because you're ticked off, however justified your anger may be. You do it because you want to be a lawyer and practice law.

Otherwise, don't bother.

John

I tell you, looking back though, it does sound very interesting. I'm way past that hill. But anyway, okay, so last thing, how do we get a hold of you?

Joe

The best bet, frankly, is to either call me or send me an email, and we'll set up a time to chat. The firm's name is Christian and Barton, B-A-R-T-O-N. And if you Google McMenamin, Christian and Barton, you won't have any trouble.

You might not have any trouble with Joseph P. McMenamin. There aren't that many of us, even in Ireland, and it's still an unusual name.

John

And I'm more than happy to talk to you. All right, well, with that, I want to thank you so much for spending this more than half an hour here today talking about this very interesting topic. So, Joe, with that, I guess it's time to say goodbye.

Joe

Well, thanks very much for the opportunity, John. I enjoyed it, and I hope it's of interest to your audience.

John

You know, one thing that we forgot to mention, so I will throw it here at the end, is that we're going to be seeing you at the Summit, which is going to be in place, is going to be going on within a week or two of the release of this. So, I think my listeners know, because I've mentioned it in other podcasts, but Joe's going to be speaking on a different area of his expertise, having to do with the structure of corporations and starting a small business, those kinds of things. And that'll be running the 16th through the 18th of April of this year in the second annual Summit.

And, boy, we really look forward to hearing from you there, Joe. That'll be fantastic. Thank you, John.

Looking forward to it myself. All right. Bye-bye.

Bye now.

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The post Priceless Advice for the New Expert Witness appeared first on NonClinical Physicians.

Why an Infusion Lounge May Be the Best New Thing

John Jurica — Tue, 02 Apr 2024 11:31:35 +0000

Interview with Dr. Jennifer Allen and Kimberly Lowe – 346

In today's episode, Dr. Jennifer Allen and Kimberly Lowe describe how they grew their Infusion Lounge business together.

Dr. Allen and Kim Lowe were both fed up with conventional approaches to patient care. And they found that they shared a vision for a more upbeat joyful atmosphere. They describe their innovative approach to healthcare delivery, combining facets of direct primary care (DPC) and integrative medicine. Together, they discuss the evolution of their Infusion Center, The Well, highlighting its diverse services, including IV infusions, hormone therapy, and aesthetic procedures.

Our Show Sponsor

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

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

In only 2 weeks from today, the second annual Nonclinical Career Summit will be starting. It’s not entirely nonclinical in its scope, however. We have several presentations about starting and running a private practice free of insurance companies.

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

To learn more check it out at nonclinicalcareersummit.com. Remember that there is NO cost to attend the live event. And if you can’t attend all or part of the Summit, you can purchase the All Access Pass videos for only $39.

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

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

Dr. Jennifer Allen's Journey to Direct Primary Care

Dr. Jennifer Allen shares her unique career trajectory, from nurse to family physician and eventually transitioning to direct primary care (DPC). She recounts the challenges of traditional healthcare and the liberating experience of offering membership-based primary care outside the constraints of insurance.

In her candid discussion, Dr. Allen highlights the pivotal moments that led her to embrace DPC, emphasizing the benefits of alternative healthcare models for physicians and patients.

The Evolution of The Well: A Nurse-Physician Partnership

Kim and Jennifer discuss the inception and growth of The Well, an integrative health practice offering services like IV infusions, hormone therapy, and aesthetic procedures. They detail the journey from conception to expansion, reflecting on the challenges and rewards of their collaboration.

The duo shares insights into their holistic approach to healthcare delivery, emphasizing personalized care, patient education, and the impact of integrative medicine on their rural community.

Navigating Challenges in an Infusion Lounge

Our guests discuss the challenges they faced in establishing The Well, reflecting on legal considerations, business aspects, and the treatments available through integrative medicine. They share their strategies for fostering growth, emphasizing the importance of flexibility and focusing on patient-centered care.

Summary

Dr. Jennifer Allen and Kim Lowe shed light on their innovative approach to healthcare. For those intrigued by their integrative healthcare services, they direct readers to The Well's website. This platform showcases their range of offerings, including IV infusions, hormone therapy, and aesthetic procedures.

Additionally, for individuals seeking an example of a DPC practice, Dr. Allen points to New Freedom Family Medicine's website. Listeners are encouraged to reach out to 636-629-8444 for inquiries about The Well and 573-271-2927 for New Freedom Family Medicine.

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

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Today's PNC Podcast Transcript

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Episode 346 Transcript

Why an Infusion Lounge May Be the Best New Thing

Interview with Dr. Jennifer Allen and Kim Lowe

JOHN: Today's guests have not been on the podcast before, but they are both speakers at the upcoming summit that I mentioned at the introduction of this episode today. And I thought it would be helpful to bring them on, introduce them to you and hear about what they're up to, give you a little groundwork for the summit. And especially I'm really happy to have them here because I've been fascinated by healthcare professionals who have found new ways to deliver care or deliver healthcare in new ways that does not involve insurance companies.

So there are different ways of doing that. We're going to learn a bit about that today. So with that, I would like to welcome Dr. Jennifer Allen and Ms. Kimberly Lowe. Welcome to the podcast.

DR. ALLEN: Hi, thanks for having us.

JOHN: This is going to be fun. I'm going to learn a lot because this is one area where I think I've had one guest that talked about DPC about two years ago and other associated sort of cash-based practices. So we're going to learn a lot today.

So the first thing I'll ask you both is to take turns and tell us about each of your backgrounds, your training, and maybe a little bit about your work history, and then we'll get into how you got together.

DR. ALLEN: Okay. Well, I'll go first. So I'm Jennifer Allen.

I'm a family physician board certified. I started as a nurse back in the early nineties. Life sort of intervened.

I was going to wash you with the idea of going to medical school, and I sort of had a midlife crisis at 20 and was like, no, I don't want to do that. So I left school for a year, did a few things. When I was ready to come back, I just, I graduated with my degree and I didn't know what I wanted to do.

So I did medical research. Then I was cooling my heels and was bored and still didn't want to go to medical school at that time. So I became a nurse and that was great.

I was a nurse for about nine years and then I became a nurse practitioner. I did that for nine years. And then an amazing thing happened that would be a topic, I guess, for another time.

I was given a gift to go to medical school. And so a patient of mine really wanted me to be a doctor. And she said, if I would go back, she would pay for it.

So, so I did. And, and then I did my residency at Mercy Family Medicine in St. Louis and went back into hospital-based practice after that. I hated it.

I just, I could, I love my patients, but I couldn't deal with the mess that that is. And so I had learned about direct primary care along the way, which is, membership-based practice. We don't bill any insurance.

Our patients join our practice as members and pay a monthly membership fee and get basically all the primary care I can give them. Kind of like Netflix, you know, you pay your bill, you rent movies and, you know, you don't have to pay at the time of service. So that experience got me out of the system.

There's a lot of healthcare knowledge that we are not exposed to when we are in the box of traditional Western healthcare that is controlled by the powers that be. And so in that knowledge gathering, I, I learned about other things like IV nutrition and hormone therapy and things like that. And then I met Kim and we had some similar ideas.

And so we joined a partnership and that's where the well came from.

KIM LOWE: So mine's not nearly as exciting. I was a nurse. I've been an RN now for, I guess, oh, going on 16 years.

I graduated first with my associate's degree in nursing, went straight into the workforce at the hospital. I started out in labor and delivery, newborn care, had worked at some big hospitals. I worked at smaller hospitals.

I decided to go back and get my bachelor's degree in nursing in 2015. I too, like I said, have the whole experience, the hospital experience. I love my job.

I love my patients, but the bureaucracy of it all is just a little too much. So I ended up going to work for an integrative medical physician down in St. Louis. And it was a fantastic time in my life because I learned so much.

And he also, he wasn't necessarily direct primary care but he had the same fashion of ideas of how we do things here. So we do the IVs and the hormones and also the direct primary care portion of it, where you come in for regular clinical visits. So I learned a lot there and just, you know, it's an hour commute back and forth.

And I got tired of that life. I did, during COVID, work for a very short amount of time just prior to COVID, I should say, starting. I worked for the insurance company as a case manager because I thought that would be a great way to work at home and to help raise my kids and things as they got older.

Not ideal. So the company was great. I mean, they cared for me as an employee, the benefits were great, but it was just very difficult with the position that I was put in, knowing the things that I knew with integrative care and there was a different world out there.

I started seeing Dr. Allen, I think it was actually in COVID, probably 2020, as a patient of hers. And I wanted to get out of the world of doing insurance and case management and all of that stuff. And I came to her with this idea and I said, hey, I have all this unused, untapped potential and skill.

How would you feel about opening up an infusion lounge? Let's do IVs. Let's do some things.

Let's, you know, get this kind of show on the road for this side, which has been great. I mean, we've gotten some major expansion, I think here, and we've just grown together kind of as business partners, like learning new things. I help her out in the clinic sometimes when she needs, she helps over here.

Like we just kind of scratch each other's back. So it works really well for us all, but that's my background. Not as exciting, but it's just a lot.

JOHN: No, it's good. I mean, it's, you know, we all have different stories. And so, so you were both, you know, working in different ways.

And so it sounds like, Kim, you kind of were the one that said, well, maybe we could do something together where we can expand and both benefit from that. So what was it, was it complicated creating this at the beginning, even from just a legal standpoint? I assume, you know, that your partners in this, in a business sense, as well as in, you know, just socially and so forth.

DR. ALLEN: Yeah. So we actually, I was looking into IV infusion. One of my nurses in our Herman location was talking about doing some IV infusions in our Herman office, and I knew it was a great idea, but I didn't have the, the free time, essentially, to be able to build that by myself.

And it wasn't, I mean, it was literally like a month later, Kim came to me and I was like, you know, we've been considering this. So, so she really was the physical energy that was able to come in and, you know, put the paperwork together and, you know, the literal physical plant, if you will, of it. We just formed an LLC 50-50 partnership and pretty easy, opened our doors.

KIM LOWE: So the moon, the sun, and the stars aligned like all at the right time for this to happen, because it just, it was meant to be, it just was a meant to be practice and things just worked out how they were supposed to.

JOHN: All right. Well, one of the questions, you know, I, I'm kind of, when we were talking and, and even in the summit, you know, I keep throwing this term around, you know, infusion lounge, infusion center. And I understand that you're, the well does a lot of different things and maybe even shouldn't be pigeonholed.

And I understand things like, you know, aesthetic services and med spa type services. I mean, a lot of these clinics have different mixes of what they do. So tell us like what you do, what the technical definition of an infusion lounge is and anything else you want to tell me about the actual business and how, how you take care of people.

KIM LOWE: So I think it's, it's kind of sprouted more from the initial idea was of course the IVs, right? And so as time went on, you know, you start getting to know more things, you see more things, you research more things. Integrative medicine is one of those things that's forever expanding and there's always new things out there that's better and more healthier.

And we actually after, I would say, probably a year of doing IVs and things like that, we were approached by a rep for hormone therapy replacement. And at first we weren't necessarily cool on the idea. I'm like, I don't know, this is somewhat new.

I had heard of it before. I'd never actually done the pellets myself, but at the integrated medical center where I worked, they did those. And I really kind of pushed.

I was like, I think we should, you know, maybe look at this, right? So we got some books, we got ideas. They offered to do pellets for us and give us the information and send us to all these locations to go to watch these things and talk to the actual patients that have gotten them placed before.

And the more we knew about it, the more research we ended up landing on, it probably took, I don't know, three or four months before we were really like, yeah, let's do this.

DR. ALLEN: And so go ahead. Sorry. That's okay.

I mean, again, I, in my separate journey as the DPC doctor, I was looking for new ways to help my patients be healthier. I'm not a box checker. I don't, I don't like a lot of big pharma kind of medications.

And so I was coming on this information on my own in my other practice with nutrition and hormone replacement therapy. And so I was already learning about it. And literally the rep came in the door one day and was like, Hey, what do you think about pellets?

And so the, you know, you either love pellets or you don't, there's a, we live in a very, um, delineated, you know, culture and hormones are not bad. And, but unfortunately the last generation of us as healthcare providers have been educated that they are bad because of bad science and bad research. And that, that stuff gets perpetuated.

And until you delve in on your own and start learning about these things, we just don't know, you know, we're, we have these preconceived notions. And so I was gaining this knowledge. And again, Marla walked through the door and I was like, you know, let me look at this because it's, it's just a different vehicle for the same kind of hormone replacement as patches, creams, and pills that everybody is okay with.

So once, once I realized that it was just a different vehicle and it's not scary and there is a lot of good science behind it. Um, I was like, yeah, let's try this.

KIM LOWE: And so I would say it's, it's probably a different topic for another day, but, and maybe even in the summit, we can talk about this, but hormones are one of those things that I think are absolutely life changing for people. I mean, it is, it literally been a life changing thing in our practice. And, you know, just to see people come in and actually tell you that they feel better.

We're able to get people off of medications that they've been on for years for anxiety and statins and all of these things that have all these eroding side effects to your body later on in life, all in place of a bio-identical hormone pellet. And so to me, it gives you some really warm and fuzzy feelings that we're actually doing good for people out there.

JOHN: Can you give me a one example, just a type of person, client, patient, if you call them in terms of with the implants that what would be like their, the problem that they have, you identify it, how do you identify it? And then, um, what was the impact of, you know, using the implants?

DR. ALLEN: Well, so for a lot of women who are going through menopause, I see it as a continuum. You'll have people who have symptoms early on with the, the loss of testosterone that, that starts actually in our early thirties, women have testosterone. That's the first thing.

Oh, really? Yes. Women have testosterone and it's a very important hormone for us.

And when, when you're coming into your forties, you start to, you start to get the brain fog, you start to get anxiety, you start to get depression and, you know, nobody has a, um, venlafaxine deficiency. Nobody has a Prozac deficiency, right? So, um, when you start looking at those things and how people are interacting in their interpersonal relationships, they're tired, they have no libido, sex doesn't feel good anymore, things like that.

That patient, if you could get somebody to open up, they come in and they just say, I don't feel well. And so you have to sort of peel off the layers and figure out what's going on. And then you approach the subject of hormone replacement.

And I've had women tell me, you gave me my life back and tears streaming down their face. So it's so rewarding to see that.

JOHN: All right. Well, the next question is just kind of a follow-up on sort of the business aspects and just the lifestyle. It's just, you've been doing this, I think three or four years.

And so just kind of, other than that story, which is a very positive one, like, just give me a, what your sense is you're feeling about how it's been going. And do you really think looking back now that it's definitely been something that you're glad you got into?

KIM LOWE: Yeah, absolutely. I mean, I think we laugh now because we were at another location last year, roughly about this time, and it was an 800 square foot clinic. It was tiny.

We were on top of each other. The amount of people that we were seeing was steadily climbing, you know, every day we were seeing more and more. And so we had expanded now to our new location, which is fantastic.

It's 3000 square feet. The regenerative medicine side, the well side is on one side. And then we have the primary clinic on the other side with a conjoined waiting room.

So our patients feel like they have access to both places. The amount of awareness I think has really skyrocketed. And to be honest, you know, the best way that we get patients is word of mouth.

People are really happy with our services. We're a small town, I would say we're rural still. We're not a big town.

We're, you know, we have, we don't have a Chick-fil-A if that tells you anything. So we're not that big. We would still have a rural population and our Hermann office is very rural.

But I would say our, our clientele is just continually going uphill because people are so happy with the services. They come out, they feel better. They don't feel like every time they walk in here, they're just wrote another prescription.

JOHN: Now you've expanded the services even beyond what you've mentioned so far, right? I mean, it seems like there's new things. They probably aren't maybe, you know, 30% of your activities, but what, what other things are you doing besides what we've already talked about?

DR. ALLEN: So we have some radio frequency devices. We do aesthetic procedures like wrinkle reduction, skin tightening, body contouring. We have a cryotherapy machine.

Stress incontinence. That's huge for women.

JOHN: So now if I think about like what would be checking my boxes, it'd be something that, you know, I enjoy doing making a decent income. My patients are happy and I don't, I might be busy, but I'm, you know, I'm happy to do the work because it's, it's part of a mission. So that's what I'm kind of hearing from you that it's kind of checking all those boxes.

DR. ALLEN: Yeah. From, from my point of view, because I have both responsibilities, I mean, I, I work more than the average person who's probably watching this podcast would like to work, but from on the well side of it, it's not something that I have to do on Saturdays and Sundays or at night. And, and that's really, you know, that's really nice.

Now on the direct primary care side, I work a lot, but some of that is me. I'm kind of a workaholic, but I am getting better at boundaries. And if you just teach people, you know, Hey, I am a human being and I deserve my Saturday and Sunday, then they're okay with that.

And if they're not, then they can find somebody else. So.

JOHN: Yeah. And that reminds me when we, when we're finished and when I post this, I'll put links to everything, you know, about the well as of course, but then I'll also put links about your practice, you know, just, you never know. It might be some physicians that maybe don't even live too far from you that might want to look at, you know, what you're doing and maybe call with a few questions or send some patients over.

But, uh, you know, I, I, I've found that even physicians who are busy, if they're doing things, they love, they actually don't have burnout. I mean, they might be tired, but they're not fried the way, you know, it was back in, you know, the corporate style of medicine that most of us physicians and nurses at least learned in our training and, and dealt with. So it sounds like you'd agree with that.

DR. ALLEN: Absolutely. Yeah. Everything about it is different.

KIM LOWE: Yeah.

DR. ALLEN: The documentation is different. The requirements, the environment's just different.

KIM LOWE: The interaction with patients. I mean, just the, the doctor nurse, everything about it is completely different than an intense setting where you feel like you're constantly under a pressure cooker to do more, excel more, be better, take more patients, like all of these things where you don't, you don't have time to actually sit and talk and get to know your patient and build a rapport with your patient. And in the end, that's how you start to peel back the layers is to, to have them feel comfortable enough to talk to you because they are feeling better.

Then you really start getting to the core of a lot of the problems. Right.

JOHN: And the model that you're using with a, you know, a partnership between a physician and nurse that seems to be working out well also. Right. Because a lot of the delivery requires, you know, someone in nursing, obviously that really knows what they're doing and, you know, the physician can deal with the things that require that license.

But it makes sense to me that that would, that partnership would work out.

DR. ALLEN: Yeah, we do things. I mean, a lot of what she does in the clinic is delegated by protocol. You know, so there's established steps, but you know, she's a bachelor's prepared nurse with a lot of experience, so she can use her clinical judgment and problem solve.

And she knows her limitations and she calls me if she needs recommendations or advice.

JOHN: Yeah. Excellent. Well, go ahead and give us the links, the URL or the phone numbers, anything you want to share with anyone who might want to contact you about The Well.

KIM LOWE: So the website is thewelliv.com. And then our phone number is 636-629-8444. And we're responsive to either call or text, so we welcome either.

JOHN: All right. And so some of my listeners might want to see, you know, an example of direct primary care. So what's the website for your practice?

DR. ALLEN: It's newfreedomfamilymed.com. And our phone number is 573-271-2927.

JOHN: Okay, great. Well, we're going to get into a lot more detail during the summit. In fact, I've split this couple up for the summit, Tom Davis and I, because we want to get the perspective, you know, individually from the nurse and the physician, you know, but I think there's just so much interest in doing things like this that are novel and not your run of the mill type of practice.

And, you know, a lot of us are saying we need more individual, you know, family physicians and internists and others who are going into practice outside of the big corporate style of medicine and healthcare. So this is a really good example. So I'm really happy you were able to join me today as guests.

DR. ALLEN: Thank you. Well, thanks for having us. We, I'm very passionate about it.

And I really think that direct primary care could save our healthcare system and keep practicing physicians practicing instead of retiring early, you know, because they can't do it anymore.

JOHN: I think I have to, I might put you on the spot right now and tell you that I'm going to definitely invite you to come back and just talk about that topic sometime as someone who's been living it. And so I just throw that out there. So listeners keep that in mind.

If you want to learn about that, we'll get Dr. Allen back here sometime to talk about her practice in more detail. All right. Any last words of advice for our listeners who might be frustrated, upset, burned out, any of the above, and they're just thinking about maybe just leaving medicine completely or nursing for that matter.

Any advice?

KIM LOWE: I mean, I was there once. I mean, I thought for sure. I'm like, I'm going to go be a veterinarian or something.

But I was there. All I can say is I, I prayed on it. I thought about it.

I, I found somebody who I knew I could trust. I mean, I think, I mean, kind of the same thing. You just see the burnout was high enough.

We just, we wanted something different. We wanted more.

DR. ALLEN: I think you keep it simple. You think of an idea of something, you know, that makes sense to you and then just put one foot in front of the other and see if you can make it happen. It's scary when you keep it in here, right?

Down, look around other people.

KIM LOWE: I mean, we are more, I have people all the time that ask me, how do you do this? And I'm like, well, it's, it's simple. It's really not that hard, but if you ever want help by all means, let me know.

I don't mind giving you a hand up on something information you need to get started, or you have the idea, you have the practice, but you're looking to expand on stuff. And we do that quite a bit. I think we have a couple of practitioners that come to us and Hey, we're trying to start IVs.

Can you help us like figure out where we need to go and what we need to do? So, I mean, I just one physician, one nurse helping each other, I think is fantastic. It works out really well.

Just be willing to help.

JOHN: Yeah. I think when you're in it, you can't even see the light, you know, that there's an option. And then once you actually break through that and you start doing it, it's amazing.

It's not like easy. It's kind of simple in a sense, there's just steps you have to do and it takes work, but I think you're a good example of that making it work. Okay.

Well, thank you so much. I, with that, I am going to say goodbye and thanks again for being here.

DR. ALLEN: John, thanks for having us.

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How To Secure Your First Utilization Management Job

John Jurica — Tue, 26 Mar 2024 13:44:59 +0000

Interview with Dr. Jonathan Vitale – 345

In today's episode, we present Dr. Jonathan Vitale's inspirational masterclass on securing your first utilization management job from the 2023 Nonclinical Career Summit.

Dr. Vitale shares his journey, emphasizing the appeal of UM's remote nature, stable hours, and reduced stress compared to traditional clinical practice.

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

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Dr. Jonathan Vitale's First Utilization Management Job

Dr. Vitale shares his journey from traditional family medicine to becoming a manager of utilization management physicians, highlighting the pivotal moments in this nonclinical career path. He discusses how his early exposure to utilization management, driven by family experiences with insurance rejections, sparked his curiosity and ultimately guided his transition from clinical practice to a leadership role in UM.

Through anecdotes and reflections on his career trajectory, Dr. Vitale provides a compelling narrative that inspires physicians to explore alternative paths.

Navigating Utilization Management: Roles, Compensation, and Application Process

Delving into utilization management (UM) careers, Jonathan provides a comprehensive overview of its definition, functions, and significance within healthcare organizations. He lists the primary goals of UM, emphasizing its role in ensuring the appropriateness, efficiency, and cost-effectiveness of healthcare services while minimizing potential harm to patients.

By delineating the three main categories of UM companies and elucidating the key responsibilities associated with each, Dr. Vitale equips aspiring UM professionals with a foundational understanding essential for navigating this dynamic field.

Jonathan's Advice on Overcoming Fear of Rejection

Apply, apply, apply. The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, ‘My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened.' And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance.

Summary

In his insightful discussion, Dr. Jonathan Vitale shared his journey from family medicine to managing UM physicians, highlighting the appeal of remote work, balanced hours, and reduced stress in UM roles. Dr. Vitale also offered practical advice on gaining UM experience, building CVs, and navigating the application process.

You can contact him through his email drjonathan@drjonathan.com, or check his website drjonathan.com. He also encouraged joining the supportive community of Remote Careers for Physicians on Facebook.

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 345

How to Secure Your First Utilization Management Job

- Presentation by Dr. Jonathan Vitale

Dr. Jonathan Vitale: I'm going to talk about myself a little bit and how I got to what I do today, and then I'm going to talk about what is UM or utilization management. I'll talk about the types of UM, the day-to-day of a UM doctor, then the compensation, which everybody is very interested in, the application process, how to get experience so that you can apply, how to build your CV, how to get appropriate coaching if you need that. And then I'm happy to answer any questions.

Again, I'm Dr. Jonathan Vitale. I am a board certified family physician. I had a pretty traditional journey to being a family physician, and today I'm a manager of utilization management physicians at one of the top health insurance companies in the country.

I'll tell you a little bit about my journey and how I got there. I had a pretty typical path to becoming a family doctor, except I picked up a master's in counseling before medical school. And after medical school I did residency in Chicago and family medicine, and then I moved to New York City where I live now for my first attending job at kind of a concierge clinic that I thought I would enjoy because I really did not like the traditional doctor's schedule, the traditional working nights and weekends, working a lot.

And after doing that for really just a few years, I decided that I needed to transition. I was very fortunate and one of the very fortunate people to have heard about UM very early on. I actually knew about it when I was in high school because my brother has type one diabetes, and my parents would always be getting rejections from the insurance companies. And I always wondered why, and I would ask my mother, and she would tell me that they had doctors working at insurance companies making decisions.

I'm one of the very lucky people who knew about UM, and was intrigued by it very early on, although that's probably only about 1% of UM docs who knew what it was before they became burnt out.

But another thing I wanted to say is welcome to everybody to this amazing community. The community of nonclinical, or as I call us non-traditional physicians. It is a very, very warm community. It's a very welcoming community, and it's a community of people who really want to help you transition into a job that you love.

What I've kind of came to the realization of early in my medical career was that doctors in general, from day one of saying you're a pre-med, day one of deciding your pre-med, you are overworked, you are underappreciated, you are underpaid. And that continues for the 10 or 15 years it takes you from day one of pre-med to becoming an attending. And I think that what happens is a lot of people just become very used to being treated that way. That's why so many doctors do so much extra work for free. Name another profession where you work extra hours and aren't paid for it, or you're doing your charts at night, not paid for it, or on weekends not paid for it or taking call nights and weekends, not paid for it.

And I never understood that, and it always bothered me immensely because I think physicians are amazing. We have so much to offer and we should be fairly compensated and respected for that. And that was one of the things that got me into wanting to transition. And also my background as a counselor is really what got me interested in and after I got there coaching other physicians on how they too can get there.

What I do today in addition to my utilization management job is I also coach physicians. Specifically I help people get remote careers, mostly in UM, but I do know about other fields as well. You can always reach me at drjonathan.com or email me at drjonathan@drjonathan.com, or please, as John mentioned, join our Facebook group of Remote Careers for Physicians, which is a wonderful community of physicians helping out physicians who are interested in remote careers.

I always joke that I was into remote careers before being in a remote career was cool. I started that remote careers Facebook group in 2018, and since the pandemic, it's exploded. Nowadays everybody wants a remote career, it seems like, and I think it's as best of a time as any to transition into this field. But I'm especially going to be talking about tonight utilization management.

So, what is utilization management? It's also called utilization review. But for tonight, we're going to call it UM or utilization management. The best definition I could find is it's a systematic approach used by healthcare organizations, insurance companies, and other stakeholders to evaluate and manage the appropriateness, efficiency and cost effectiveness of healthcare services.

The primary goal of UM is to ensure that patients receive the right care at the right time in the right setting, while minimizing unnecessary treatment costs and potential harm. Another way I think about it is we reduce fraud, waste, and abuse. Probably mostly waste. Probably 80% of what we deal with are waste, wasteful orders, or wasteful requests, et cetera, which we'll talk more about later.

There's really three main buckets of UM companies, and I always like to be very general about how I describe this. And then we'll move down into some specifics. There's private UM companies. These are those third party companies that I always talk about, which are good companies to try to get experience with. Those are superfluous. Many of them are listed in nairo.org, which we'll talk about later. Then there's healthcare systems or hospital systems, which also hire UM nurses and UM doctors.

And then probably the most common for full-time docs would be insurance companies. Insurance companies also hire their own UM nurses, their own UM doctors, their own UM physical therapists, pharmacists, et cetera. And these are the big names you've all heard of. This is your Aetnas, your Humanas, your Uniteds, your Anthems, your Kaisers. They all hire their own UM clinicians to work for them.

And what you do in UM is usually one of three things. There's prior authorizations. Everybody has heard about a prior auth. Everybody knows what a prior auth is. There's certainly a lot of attention in the news nowadays around prior auths and reducing the paperwork associated with prior authorizations. But there's a lot of UM that goes along with that.

A physician orders a test, a study, a medication, a home health service, which I'm involved with. And the prior auth physician determines whether or not that meets certain criteria, and most importantly, whether or not it is medically necessary. That's prior auth. And there's also concurrent reviews. This is very common in the hospital setting. When we're talking about bed days and how long a patient can stay in a hospital, how is this patient doing day to day? They're checking in to see if they can extend and give them more days or if they're suitable to go home or go to rehab or go to a different level of care. That's called concurrent reviews.

And then the final one is probably the smallest, and those are retrospective reviews. Those are done when the service has already been provided, already been rendered, and now they're reviewing it on the backend to see if it was medically necessary and if it fit the guidelines.

The reason why a lot of people go into UM is really primarily I would say what attracts people is the lifestyle, meaning it's typically remote. It's typically 40 hours a week when you're in a full-time gig. It's a typically salaried position. Typically, not always. Also, you have very low liability. Basically, you're not practicing medicine. You don't need malpractice insurance, you carry errors in emissions insurance. It's interesting work. It's a very comfortable pace and you're not patient facing. It's a much lower, lower stress job. And you have typically, generally speaking, nights and weekends off and holidays off.

In terms of compensation, and this is a very hot topic. I'm asked this all the time. There's really not good national average data. I will tell you what I see because I look at hundreds of positions for UM all the time. And I would say there's a very big range. I'm sorry I can't be more specific, but generally if you're a full-time UM physician and you're in one of the primary care areas, you're typically talking about the lower to mid $200,000 range as a W2 base salary. I've seen it all the way up to $300,000, maybe a little bit more for people like an oncologist or people with very, very high demand skills.

But keep in mind, in addition to that, first of all, that's 40 hours a week, but in addition to that base salary, we're also talking about merit increases, which typically happen every year on the order of usually around 2% to 3%, but it can be more than that. In addition to that, you're talking about quarterly or annual bonuses, and you're also talking about usually a stock gift if you work at a large insurance company as I do.

There's a lot of additional compensation that's also very attractive. So, always keep that in mind. I always like people to keep that in mind when they're saying, "Hey, but I make all so much more money than that." I say, "Yeah, but you probably work 80 hours a week and are a hundred times more stressed." So, keep that in mind.

Some other things I wanted to talk about is basically the process of what your typical day looks like when you're doing most UM. And I'm going to talk about full-time jobs, and then we'll talk about the gigs. The full-time jobs, which are kind of the cream of the crop of UM, which are those very, very highly desired 40 hour a week full-time jobs, which are very competitive, is you typically have a set number of cases that you're reviewing per day. You're not chained to your desk. It's not like it is in most clinical practices where every second of your time is scheduled and monitored and you need to be patient facing in order to bill. No, you typically have a set number of cases that you're attempting to get through. Sometimes there's peer-to-peers involved as well. And sometimes you have a few meetings and things like that when you're at the basic medical director level. Medical director is entry level for utilization management.

And then there are also opportunities to grow, kind of like Marie was talking about at MSL. There's some opportunities to grow into more of a team lead and manage a team. And then there's opportunities for being a manager and managing a larger team, which that's what I do. I manage a large team of UM physicians and I also hire them and interview them.

And then there is also the opportunity to branch out into other fields in health insurance companies, which other people are talking about in their lectures tonight. I won't get too much into that.

Something I do want to talk about is some of the other gigs in utilization management. There are small companies, usually these third party companies that exist and they do certain reviews. They may be doing reviews for a certain procedure, they may be doing reviews for a certain medication. And what they'll do is they'll have a panel of doctors of 1099 or independent contractor physicians who they will reach out to and say, "Hey, we have this request for this medication. Can you review it for us? And we'll pay you X number of dollars." It's usually very low, by the way. It's usually like $20, $30. And those companies exist and they are superfluous.

And a lot of physicians look at that and say, "I'm not doing that." And I say, "You don't understand. You have to do that. You do that to get experience. You don't do that to make money. You do it as a side gig while you're still in your other clinical job so that you can get some experience under your belt in doing UM so that you can put that on your CV." And that's why you do those roles for six to 12 months so that you can actually have some experience to talk about when you apply for those big full-time positions.

Now, how do you get these gigs? It's pretty simple. I talk about it all the time on Remote Careers. You just go to nairo.org, the National Association of Independent Review Organization. You click on members, again, you don't become a member, you click on members and you scroll all the way down and it lists the logos of 20 or 30 of these companies.

You go to every one of those individual company websites and you navigate the website and you click on apply to be on the physician panel, and you submit your CV to every one of them. And I guarantee you, at least two or three of them will contact you within the week and put you on their panel. And that means you are now getting UM experience. That's a great way to get you UM experience. Yes, it does take a lot of time to sign up for all of them. I never said it would be easy. And it's a great way to get your first step in the door.

I always say this. My specialty is helping doctors who have no other experience, no outside experience. Normal, average doctors. I guess no doctor is average. We're all awesome. But I would say regular doctors into the world of UM who have no prior or outside experience. No connections, nothing else. That's what I help people to do because that's how I got involved.

After you have that, the next thing that you need to do after you've done that for six or 12 months, that's when you're able to actually apply to these full-time UM gigs that most people want. Like every other non-traditional job, especially nowadays, it is very competitive. However, what I can say, and I think this is really, really important, that it's not that it's super, super competitive, which it is, but it's more so the fact that doctors are used to it being ridiculously easy to get a job. If you're a regular traditional outpatient family doctor, been working at your clinic for 10 years, and now you want to move to a different city next week, and you want a job there, all you have to do is send out an email with your CV to a couple people, and you'll probably get a hundred job offers the same week.

That's how it is for clinical doctors. We're very spoiled. But that is not how it is when you make the transition. And that's something that you really have to psychologically get behind and understand that for many people it's going to take a year, sometimes two years, to actually make that transition to get enough applications in to get rejected enough. As you always hear me on Facebook, for those who follow me, I always say to people, you haven't been rejected enough yet. That's your main problem. It takes a lot of rejection, a lot of getting ghosted before you get your position. But you will get there. Don't worry, you will get there. It's just a process.

The thing that you also want to do is you want to work on your CV, and there's lots of coaches to help you with this. I'm one of them, but there's certainly many other coaches who can help you with this, many of whom you're hearing about these past three nights. And you also want to work very hard on your interview skills, and coaches can help you with that. I can certainly help as can all the other coaches.

And what you want to do is you want to make it your job to every day apply and send in your CV to openings for utilization management. These are typically listed. I like to keep things simple. They're typically listed on Indeed, on LinkedIn and also on the private insurance company's websites.

What I encourage people to do who are interested in a life of UM is every single day, it only probably takes about an hour out of your day, you want to be visiting every one of those websites, and you want to be searching, you want to save this in search, you want to be searching for medical director utilization review, utilization management, utilization review, physician, physician reviewer, MD reviewer. All those synonymous terms that a lot of companies use. And then you want to be looking for those positions and you want to be submitting your CV.

Yes, absolutely. Networking is great. If you can do that, if you have any contacts, if you network through LinkedIn, if you network through one of these conferences through a SEEK conference for anything like that, that's wonderful. But what I can tell you is that in the UM world, things move very quickly and that works both in your favor and against your favor.

Let me be more specific about timing. I always talk about when I first got into UM about how I applied for a year and got rejected probably over a thousand times. At least hundreds and hundreds of times I was rejected or ghosted. And what I've learned now that I'm a hiring manager for UM is that timing is everything.

Let me be more specific on that. Many times these UM companies, especially the insurance companies, which are the largest employer of UM docs, are always trying to get more business. They're always trying to get more contracts. They're always trying to expand their geography. They're always trying to do UM for another network, for another geographic location. They have business folks who that's all they do is try to broaden their business.

And as you guys know, anybody who's worked in business, business is a tough field. Things move very fast and sometimes very unexpected. You can literally be at a job or I can literally be in a position and I can literally hear one day, "Hey, you know what? We finally got that contract we've been after for eight months or 12 months. Now we have a need for five other doctors on your team, as we call them FTEs, full-time equivalents, five FTEs on your team. And you need to get them up and trained and ready to go as soon as humanly possible because we're going to start getting UM cases from that network in three months. And we got to be ready to go."

This is the kind of thing that happens. So, what am I doing? We're posting it on our website. And the first good CV I get who is board certified, who's got some decent experience, I am scheduling them for an interview. But let me tell you what though. That same candidate, if they applied two weeks before, they probably would've gotten either ghosted or rejected. Again, I don't write the rules, ladies and gentlemen, I'm just telling you what they are.

The HR oasis for these big companies is don't assume that they're going to put your CV on hold. Don't assume that every job listed currently is available. That's another one. Don't assume that you're going to even hear back. That's why my best advice is it's a numbers game. When the new positions come up, is why you have to be checking every single day. You need to be applying for that new position, because that happens all the time in UM. And which is good news for people like us, because it means there are definitely jobs that open up and that need good folks.

But the flip side of that though is let's say that you have 20 years of UM experience, 20 years of clinical experience, and you're the most competent UM doc in the world, and you reach out to me and send me your CV today. I'd say "I can't do anything with this but thank you." Because we don't have any openings, I'd say just keep monitoring our website. That's how it works at a lot of the large health insurance companies. Yes, there's other things that happen at smaller companies where they may keep things on hold, but I'm just telling you how it works at the large health insurance companies. That's why I always say to people, and you see me say this on Facebook and everywhere else. Apply, apply, apply.

The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, "My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened." And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance. And these jobs, especially UM jobs, as Marie was talking about MSL jobs, they're very competitive. There's more docs than ever that are looking to make a transition. The other thing is doctors are looking to make a transition earlier and earlier in their careers.

My team, I would say on a whole, at this point, we have about 25 docs on my team. And we are all stages of our career. There's people who are in their early career, mid-career, late career. There's people who are post-retirement who just do this for fun. If that tells you anything about the job as well.

So, it is difficult to get a position, but it's definitely not impossible. It just takes persistence and there's so many people who are there to help you.

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Integrating the Best of Traditional and Functional Medicine

John Jurica — Tue, 19 Mar 2024 20:46:53 +0000

Interview with Dr. Lara Salyer – 344

In today's episode, Dr. Lara Salyer explains how she integrates the best of traditional and functional medicine in her practice. In the process, she takes listeners on a journey of career reinvention and personal empowerment.

Dr. Salyer shares valuable insights and practical advice for practitioners seeking fulfillment and career balance. From the transformative power of creativity to the importance of storytelling and self-expression, listeners are inspired to try something new.

Our Show Sponsor

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

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

Annual Nonclinical Career Summit Coming Soon!

It's time for the Second Annual Nonclinical Career Summit. It’s called Clinical Practice: Make It Great or Move On. We have 12 top-notch speakers such as Dr. Dike Drummond, Dr. Nneka Una, Dr. Gretchen Green, and Dr. Tom Davis.

We'll learn about creating a cash-based practice, MedSpa, Infusion Center, or other business, protecting yourself legally, and learning a lucrative side gig or investing in real estate.

Admission to the live event is free. If you prefer, you can purchase the recordings and bonuses for a small fee. Please join us on the evenings of April 16 through 18.

Go to nonclinicalcareersummit.com to learn more and reserve your spot today.

Our Episode Sponsor

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

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

Reimagining Healthcare and Integrating the Best Parts

In this engaging podcast episode, Dr. Lara Salyer reflects on her transition from burnout in family practice to discovering functional medicine. During our interview, she emphasized the importance of aligning one's career with personal passions and values. Dr. Salyer highlights the transformative power of creativity and innovation in revitalizing professional and personal fulfillment.

Empowering Practitioners and Cultivating Her Speaking Engagements

Lara describes her new role as a mentor, guiding practitioners through strategies for reclaiming joy and autonomy in their careers. She shares practical tips for crafting impactful speeches and navigating the speaking circuit, emphasizing the value of storytelling and authenticity. Additionally, she explores the significance of boundaries, self-expression, and embracing “messy” progress.

Dr. Lara Salyer's Advice on Career Fulfillment

Find your path to fulfillment with WARM: If I'm feeling stuck, overwhelmed, unhappy, I start with “W.” Whose voice is in my head right now making me feel bad?… then Aim low with tiny steps, Remember your ‘why', and “M” is “Messy moves the needle,” you don't have to be perfect.

Summary

Through engaging anecdotes and actionable tips, Dr. Salyer offers a roadmap for reclaiming passion and purpose. Whether you're navigating burnout or seeking to reignite your professional spark, Lara provides hope and guidance, reminding us that it's never too late to design a career that aligns with our deepest values and aspirations. To get in touch with Dr. Salyer you can find more information and contact her directly on her website drlarasalyer.com.

And if you wish to access any of her programs, you can use the Coupon Code “CATALYST” for a $50.00 discount off the usual price.

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Transcription PNC Podcast Episode 344

Integrating the Best of Traditional and Functional Medicine

- Interview with Dr. Lara Salyer

John: Sometimes when rebooting your practice, it's helpful to speak with someone who has a lot of imagination, and that describes today's guest to a T. She first appeared in the podcast in December of 2019, and she was about two years into reimagining herself, at least her approach to patient care. And she's continued to innovate since then, and she's now mentoring clinicians, more than she was at that time. I think that she's a great one to talk to today about remastering, recreating your life and your career. Dr. Lara Salyer, hello and welcome to the podcast.

Dr. Lara Salyer: It's a pleasure, John. I was so excited to receive your email invitation again, and mind blown that it's been four years. I feel like it was just yesterday. We were talking about innovation and transforming healthcare, and look, it continues. I'm happy to talk to your listeners about reimagining healthcare.

John: Yeah, I couldn't believe it either, because I just made a point a few months ago to say, well, I got to go back to my old guests and see what they're up to. And in my mind, your name just stands out. It isn't like something I had to dredge up. It's like, yeah, Laura, she's in the Midwest, she's been doing all these things in Wisconsin. Four years. That is crazy.

Dr. Lara Salyer: It's crazy. We're practically neighbors. But see, this is the beauty of what we've all been through in this global pandemic in the last four years, the world is made larger and smaller. I feel like it's really exploded our ability to connect across the seas and virtually. With the advent of telemedicine laws changing, there's so much cool things and innovations and AI that it's really inspired me. And yeah, I'd love to dive in and just talk about all the changes. Where should we start?

John: Well, let's see. We don't have to redo everything we did last time. I will have a link to the previous episode that has a lot of the information and how you found functional medicine and got involved in that, which I think has escalated exponentially. But anyway, start from there maybe and where we were then. And just touch on some of the things that are new about you and your practice and what you're doing with patients and other physicians.

Dr. Lara Salyer: Sure. Well, this is sort of the example of creating your own career that is a self-expressive vote of the future you'd like to see. And that's really what I embody and I try to use this as my compass as my mantra every day. Just in a one sentence nutshell, I was a burned out family practice doctor, realized I was burned out, not sure if I wanted to stay in medicine, but then fell in love with functional medicine on my last CME and decided that's what I wanted to do. I opened up my practice and we had our interview in 2019 and I talked about what that entailed being an entrepreneur in this space and learning those ropes.

Well, since 2019, I've really enjoyed embracing this creativity of educating patients with online courses and having online group visits every week that provides an ecosystem of support for my patients and really exploring this sandbox of tools that we have right at our disposal to make medicine fun again. And it's naturally been sort of an attracting beacon to other practitioners looking to innovate and to explore some of these options.

I've really amped up my mentoring, not just in the functional and integrative space. I help those practitioners grow and scale a membership practice in their own community using a lot of AI and tech. But I also mentor colleagues in burnout, those that want to tap back into creativity. I graduated from the flow research collective in their high flow leadership, so I can coach how to get that flow acquisition, which for those that don't know, flow is the only time your brain produces all five neurochemicals of happiness. The more you learn how to make your day flow channeled, the happier you are, the more easeful life feels.

And so, I'm enjoying this renaissance of my own personal career, helping practitioners learn how to become and embody their ideal self. And then that naturally just extends into my international speaking career. I had the honor of being invited to the center stage in London last year, last summer, on the largest European medical conference and was able to stand beside some greats that I was honored to have shoulder to shoulder. It just keeps expanding and it's just fun. And like I tell my teens when it stops being fun, now that's the time you need to think of making a shift. But I'm still having a blast.

John: That's a lot to talk about and to consider, but it sounds very positive. I don't know if we're going to get into the flow thing a lot, but maybe we will. But maybe just for our purposes, is that flow state, whether you're working or at home doing something, I'm assuming that's the same thing that in general we talk about when you're in that zone.

Dr. Lara Salyer: Yeah, in the zone. Yes. Just simple. Mihaly Csikszentmihalyi coined the term and it's anything from being in a sport or you're doing Tetris or you're balancing your books. It's just being in deep work.

John: Okay. Cool. I wanted to talk about the speaking a little bit because a lot of my listeners ask me about how to get into that. It seems to be kind of a black box. They don't know how to start. And just some tips on becoming a recognized speaker and getting some of the big types of engagements that you've talked about already today.

Dr. Lara Salyer: I've got lots of tips, John. I think I'm a shameless kind of person who is open to feedback all the time. So, be prepared to speak and make mistakes and fumble and keep getting up and trying again. But the key to establishing your own speaking career is finding your story. You have to have a story and everybody has a story. And once you find the story that is underlying this anchoring mission of why you feel compelled to speak, what are you speaking about? For me, it's speaking about healthcare burnout and the intersection of creativity and how we've lost that piece in healthcare.

And I really believe that physicians, if we could be allowed more autonomy to be self-expressive in the way we deliver medicine, we wouldn't have as much burnout. Of course, it's not that simple. If you look at my message, anybody could look at it and go, "Well, that's not the cure to burnout." No, I'm not saying it is. But it gives me the platform to tell my story, to offer things that I've learned that have helped people. I work with residencies and medical schools and I travel and do workshops. I'm able to craft this around my central story, which is I'm a physician who burned out and found a second career. Or third or fourth, however many you want to count. For anybody listening who's thinking, "How can I develop my speaking career?" start looking at your story. What's your story say? What are you passionate about? If anybody stopped you on the street and said, "You have 40 minutes to tell me something that you're passionate about without any slides, without any prep." That is what you need to talk about.

And so, right there, getting the topic and then second, crafting your PowerPoint, working with a mentor. I had my own public speaking coach, and I believe firmly in coaching. And that's part of the underlying result of my mission with working with so many residencies in medical schools and in my mission that I want to make coaching a part of medical school. That every medical student has a coach assigned. Everybody's got somebody there because we are not above needing that kind of executive help.

And so, when you work with a coach, like a public speaking coach, it can help save time and unlock some of the things that you didn't know you were doing and fidgeting. It makes such a difference. I would start there with knowing your story. What does that say about your mission and your vision in the world? And then working with a coach to help you craft that narrative and really make it professional.

John: I think that's awesome. Because when I think about things that successfully communicate, whether it's a book or a presentation, it always includes a story. Either the speaker's story, the writer's story, or somebody else's story, but it always ties back. That gives that great example of the point you're trying to make and it pulls people in, and they want to hear how the story ends. So, that's cool.

Dr. Lara Salyer: Yes. At least for me, I hated being in, and this is just my preference. Whenever I would be in a lecture or in some kind of presentation and listening to the speaker, it always felt empty to me when there wasn't some kind of transformative takeaway. And so, I like having all of my talks have something at the end that the listener gets, whether it's something that they can download or something that they can walk away with and remember you by. If you're looking to make a speaking career, develop that signature talk. Have some kind of takeaway. Like something downloadable. And if you don't have any of the fancy things like a CRM or an autoresponder, if those words don't resonate with you, you can simply just ask them to give you their email and you can send them something. You can be very old school about it. You don't have to be super polished and professional.

John: I think there are other people that think, "Okay, I'd love to have a speaking career." I don't think they're necessarily as committed because they're a little nervous to have a little stage fright. So, how do you get ready? That UK presentation, that was a big deal.

Dr. Lara Salyer: That was a huge deal. Oh my gosh.

John: How did you prep yourself for that?

Dr. Lara Salyer: Oh goodness. Well, it's that fine line of delusional almost OCD prepping and then trusting the universe that it'll be okay. I love the books. TED Talks, Chris Anderson, or Talk Like TED. Those are the two favorite books I have. I also like Rule the Room is another book, that's a resource. And I often listen to a podcast by Grant Baldwin called Speakers Lab. And believe it or not, that has taught me more than anything because he goes into the business of speaking of how to invite people or pitch to people and follow up and all those kinds of things.

I've learned a lot about the business, but when you're coming down to the wire and you're practicing, it's a combination of I would look at my slides because I was allowed to have some slides, but it was a TED style talk. I had 20 minutes to give my one message. And so, I would practice with the slides and then I would go on a walk and I would listen to myself because I recorded myself and I would listen and imagine the slides on my walk. And then I would try to see if I could anticipate the next sentence. I'd pause the recording and see if I could anticipate the next sentence, not so that it was rote memorization because a lot of public speaking coaches would say, "That's awful. You do not want to memorize your talk." You want it to feel like a conversation. And you want to allow for inflection and for moments of improv in a way.

What I would do is divide my talk into four segments of main points and I would try to anticipate, "Oh yeah, there's that next point. I'm going to talk about this." And that's all it was, was a summer of walks with my dog and just really memorizing the next point that was going to happen until I became comfortable that I felt like I could do it without any help.

John: No, that's awesome. Because you can tell, I watched a lot of TED talks in some of the smaller venues. You can tell the speaker is glancing at a monitor or screen or something to remind them of what they're doing. It doesn't really flow and it's okay, the message is good, but when you have a really good speaker, it flows and it's engaging and it goes by like in two minutes.

Dr. Lara Salyer: Yes. And don't be afraid to practice. Before that UK talk, I had other opportunities where people said, "Could you just give a 20 minute? - Oh yes, absolutely." And I remember in Toronto, I was asked to speak at a very large event for naturopathic doctors, and it was going to be broadcasted and I had no teleprompter, nothing, no slides. I thought, "This is even harder than UK. I am on it. Let's do this. This is going to be gritty test time." And I did it. And guess what? There were interruptions. Somebody walked in front of the feed when it was being recorded. There was a person that interrupted the door and I got put off. I didn't remember my next line, but guess what I did? It just took a moment. And that's the thing is when you face that kind of awkwardness and you realize you're not going to evaporate into ashes, it's okay. And you chuckle and you learn how to sidestep.

Everybody wants you to succeed. Nobody is sitting in the audience waiting for you to mess up and going, "There it is. I'm glad she's messing up." They want you to have a great time. So if you fake it till you make it in that moment and be like, "Okay, here we go", that's when you get to be that elevated speaker that people want to hear from because you're relatable.

John: That's great. That's awesome. I love that. And a lot of resources, I wrote those down and we'll put those in the show notes so people that are really interested can take advantage of those.

Okay. We're going to move into helping other clinicians, but I think before we get into that and how you're doing that, I think our listeners need to understand exactly what does your practice look like now? Functional medicine, not everybody even know what the functional medicine is and kind of tied to that. I think you still call what I would call clients patients but there's a distinction that some people make. And I think it's easier in functional medicine than let's say in doing something like yoga. You're not going to call them. If you can capture all of that in the opening of this next section here on how you help physicians.

Dr. Lara Salyer: Sure. Real quick, I do have a license to practice medicine in Wisconsin and Illinois. I have my attorney that comes in and teaches inside my mentorship for practitioners. I stay very, very close to the law. I don't want to call my patients clients. I'm still a physician, so I have a physician patient relationship. But my practice is very tiny. I call it very cozy. And I keep it that way because I have a lot of other hats I wear. Last year I was invited to be the director of practitioner activation for the School of Applied Functional Medicine. Basically I am the mentor for their school. And so, that is a job that I do part-time, but I also have my own mentorship, the Catalyst studio.

And these are practitioners that come in for 12 months and they're with me and they have a bunch of resources online. And we work one-on-one, and we also have weekly masterminding. We call it studio time. And the reason I've created this artistic metaphor is because I want physicians to create their masterpiece, their work-life masterpiece. I don't believe in work-life balance. I don't think that is something we can achieve. I believe it's a masterpiece. It's an integration of work and life. And so, they're with me for 12 months. And then in addition to that, I have one off session.

People that aren't even in functional medicine, they don't even care about integrative medicine. They might be a medical student, a resident, or just an attending who's like, "Hey, I need some inspiration on how can I pedal through some of these emotions, this burnout." I use solutions focused, positive psychology, a little bit of acceptance commitment techniques that help them tap back into flow. And I give ideas and resources and really get them back into what are they doing here. And helping them with decisions. It can be making a decision on the next step for their career or just how to play again as an adult. We forget that and kids are so good at that. I love being almost that little inspirational fairy that can help my colleagues get back into that childlike wonder.

John: Can you give me an example? And it could be even amalgam of many people, but what is the type of person that shows up at the beginning, either for the one-off mentoring or the 12 month? And then how does it look different at the end of that period? I'm just trying to get that so the listener can say, "Hey, that sounds like it's right up my alley."

Dr. Lara Salyer: Yes. That's great. I like to call this the average practitioner. They are frantic, they're rushed, they're stressed. They're feeling almost hopeless and wondering why they chose this career. But they feel stuck like "I have to be in this track." They don't see many options. They've probably not played or had their hobby dusted off the shelf for years. They probably look at you with blank eyes when you said, "When was the last time you did something fun?" They don't even know. They don't have free time. They really are a victim of their calendar. They're really reactive in their calendar planning instead of proactive. That's the typical practitioner.

And then at the end of my programs, I call them the catalysts. The catalysts, they are expansive, open-minded. They're innovative. They are very much in control of their calendar. They're very autonomous. They see those elements in their calendar and time and space and energy. They're boundaried. They're able to really keep and protect that energy and spend it on things that give them joy. They are more tapped into gratitude and creativity. And these catalysts are such a joy.

And so, I can take people through this journey. In fact, I have a 10 hour CME course that people can take online. Completely self-driven. And it helps them kind of walk through the standards that I've found have worked really well for my clients. I call those clients, my mentees, my catalyst. And it helps walk them through some of the basic foundations of finding your flow and finding your anchoring down into your "why" and how to use that throughout your day to bring joy back into focus.

John: On average, is that group of people employed at a large organization where a corporatization of medicine has kind of driven most of them crazy? Or are they in a practice and they're just overwhelmed? They may own it, but it's out of control because they're trying to handle everything.

Dr. Lara Salyer: That's great. For the functional integrative physicians and practitioners inside my 12 month mentorship, those people usually are solopreneurs. They might be employed, they might have a hybrid practice of insurance and cash pay. And these people are really looking how to strategically move that business. How to make it more streamlined and flow channeled. The one-off catalyst advantage, those are the people that sign up for just one or two or three sessions.

I have bundles of packages where they can meet with me one-on-one, and there's nothing to do with business. It's more about personal development. And those come from all walks of life. I have discounts for students and residents because I remember those days, you can't really afford much. And then it can be attendings, it can be nurse practitioners, people that are just curious about personally developing themselves. And they come from all walks of life as well. They could be independent, most of them employed.

My grand goal in my future, my five to 10 goal is I would love to be a chief wellness officer at a large organization because I've enjoyed working in this high level systemic change and seeing the results of what some of these modalities can do for practitioners is really life affirming for me. So, it's just been a wonderful journey.

John: Now as a secret in some of those to really focus on doing what you love and where the flow can occur potentially, and getting rid of the stuff that just drives you crazy. And does that require delegation? Does that require, or can it enable one to say, "Look, I'm a family physician, but I'm not going to do 100% of what a family physician could do. I'm going to focus on something that I like to do and I'm going to get rid of the rest."

Dr. Lara Salyer: Yes. Oh, I love this. It is getting comfortable disappointing other people. I think as physicians, especially family physicians, we are the bottom of the totem pole. We get everything dumped on us and we just get used to serving our patients, saying yes, doing it all. And it's time to push back. And it's okay to have boundaries. This is where I help people with those boundaries in saying, "Listen, if you are literally burning up and you are a miserable shell of a human, you're going to work, you're coming home from work and you are just not happy at all, something's got to change."

Now you can't change overnight the whole system. The system is slowly changing. But we are at a dawn of a new healthcare with AI helping. I love freed.ai. It's a wonderful program that is a charting program where all it does is listen to you and your patient and creates a beautiful SOAP note. I actually interviewed the founders. It's a resident and her husband who's a computer guy, they founded this company. It's phenomenal. And it's things like this that are going to help us fall back in love with medicine and do what we do best, which is being a healer. We are right now data entry clerks and we're not able to delegate because a lot of hospitals are saying, "No, you have to enter in those lab results. No, you have to do it all." And it's crumbling.

I really believe if we hang on, we are almost through the dark ages of medicine and we're about to enter the dawn of where AI can help us and it's suddenly going to be so much fun. It's like driving a Tesla. It's just, "Wow, everything's done for me." And so, hanging on, I think that's my role in this whole structure is helping our colleagues just to hang on and let's find a way through this that can help you stay human while we wait for AI to help. And it might mean take a day off every week and you go to your administrator saying, "I need to be different RVU. I need to back it down." Because we want to want to save you before you go out with the ship.

John: What was that link again to that AI tool?

Dr. Lara Salyer: Yeah, it's freed.ai. And what I love about them is they give you 10 free visits to try them out. You don't even have to put a credit card in. The proof is in there, amazing algorithms and AI. And then when you do, it's really affordable. You can get an industry, your whole institution can get a license, or you can get your own. If you use the code CATALYST, you get $50 off. I'll just give that out there so people can get a discount if they want it.

John: Excellent. I'll tell you and our listeners here why I am so interested in this is because my thing in the past has been "What other options can you do if you're a burned out physician?" But really, 15, 20 years ago, there wasn't a lot of focus on fixing within your own practice or something like your practice. Now I'm trying to get more people like you to say, let's go back to the beginning and take all the good things that you wanted to be when you went through med school and residency. And let's try and get rid of the other crap that doesn't help.

Dr. Lara Salyer: Yes.

John: That's just holding you down. And as we push this, I think we're going to see more of it. So, I appreciate what you're saying.

Dr. Lara Salyer: I'm glad that you've recognized that. I think there is an exodus of people. Their pendulum swung where people were leaving. Sadly, we lose a lot of people to suicide, a whole medical school class worth every year. And there's a lot of physicians that are just retiring early. But I think the pendulum is going to swing back the other way. Like you said, I want to save the career of medicine. I want to make the career of medicine something that still honors the joy and the creativity and the self-expression. Nobody wants to go see a robotic doctor. And so, I really think that we're almost there. We just got to hang on a bit and keep working at it.

John: The thing is not only are physicians frustrated and upset, the patients aren't happy. They're not happy with a five minute visit for something it takes 20 minutes normally and the doctor spends all their time documenting and sending notes in and blah, blah, blah. The whole thing has to change for patients as much as for physicians.

All right. Why don't you spend a couple minutes telling us about your website and what's on your website and how to get ahold of you and all that kind of stuff?

Dr. Lara Salyer: Oh, sure. Absolutely. We'll start to different things. If you're a patient in Wisconsin or Illinois, you can find me on my website, drlarasalyer.com. But I do keep a very, very long waiting list because I devote a lot of my time and passion to our colleagues. So, if you're a physician, a nurse practitioner, and you're curious about what creativity and flow can do to enhance your happiness and joy, again, go to my website, drlarasalyer.com and you'll be prompted through a series of buttons. It'll ask "What are you here for?" And it will direct you to the practitioner page.

And I would encourage you to take the Catalyst Archetype quiz. It's a free quiz. You'll be matched to one of the four archetypes. Are you a fervent flame, a resolute rock, a wise wind, a reflective river? And then it matches you to a two-page plan that will give you suggestions on adult play activities, things that you could do to enhance your hobbies and self-expression.

And also on that page, you'll find opportunities to do a sample session with me, a real one-on-one working session where we can just dive in and start getting you aligned with your best self. And all my stuff is there. If you need a speaker for your next conference, you need a keynote, again, I have a speaking page on my website. I love speaking. I'd love to connect with you. And there's an application form there as well.

John: Excellent. Well, listeners, I think you should take advantage of that, even if you have to skip the next few weeks of podcast listening. Spend that time checking out Lara's website and make a plan to change your life if you're not happy.

All right, Lara, we're going to run out of time here. So, just some more advice, some last minute advice before we go to our listeners who might be unhappy, out of balance, just frustrated and not enjoying their careers in particular. What advice do you have before we go?

Dr. Lara Salyer: I love little acronyms. I'm going to give you an acronym that I use when I'm feeling stuck, when I'm feeling unmotivated or overwhelmed. It's WARM and it goes like this. If I'm feeling stuck, overwhelmed, unhappy, I start with "W" and I ask, "Who's talking? Whose voice is in my head?" Is it the administrators saying, "You need to see more?" Whose voice is in my head right now making me feel bad? Is it my family of origin? Maybe it's an auntie or a grandma or something. Who's talking right now? Am I listening to my own voice or is it someone else?

The next is "A", which is aim low, not aim high. Aim low. Use Tiny Atomic Habits. James Clear is famous for that book. Atomic Habits. Do one tiny thing. Aim Low. What can you do in the next moment, even if it's just your next breath? Aim low. You're looking for tiny evidences of progress that you can find your way out of this mess.

Then "R" which is reason. What is your reason? What is your reason for medicine? Anchor yourself back into your "why." Why are you doing this? And there's many reasons. And it can shift, it could be stability. I wanted a predictable career. I wanted travel, whatever. But look at your reason because it may have shifted and maybe you're aiming towards the wrong North Star. But just look at that reason.

And lastly, "M" which is messy moves the needle. You don't have to be perfect, you don't have to have the answers all right now. You don't have to figure it out, but you can be messy and show up messy in this spot. When you're feeling overwhelmed, stressed, just remember WARM. Who's talking, aim low, find that reason, and then just be messy and give it another day. It's always going to be better.

John: Thanks for that. I'm going to write that down and see if I can apply it to something I'm doing today.

Dr. Lara Salyer: Perfect. It works every time for me.

John: It sounds like it does. I like the last one too. You're saying in there messy moves, avoid perfection. Don't let perfection drive you so much. Just do something in the right direction. I like that.

All right, Lara, this has been fantastic. We're going to have to get together again, probably in less than four years, if I'm still podcasting.

Dr. Lara Salyer: Another leap year.

John: Oh yeah. No, that's not good. All right. I want to really thank you for being here, and I'll put all those links in the show notes and share it. And with that, I'll say goodbye.

Dr. Lara Salyer: Thank you, John. Bye.

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The Extraordinary Life of the Physician Digital Nomad

John Jurica — Tue, 12 Mar 2024 11:57:09 +0000

Interview with Dr. Chelsea Turgeon – 343

In today's episode, Dr. Chelsea Turgeon describes her unique career as a coach and digital nomad. This episode is an excerpt from Chelsea's popular lecture from the 2023 Nonclinical Career Summit hosted by John Jurica and Tom Davis.

The narrative explores the internal conflicts, moments of self-discovery, and the decision to step off the conventional path. The blog provides a nuanced view of the highs and lows of the digital nomad experience, dispelling myths while offering practical advice.

Our Show Sponsor

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

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

Our Episode Sponsor

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

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

Dr. Chelsea Turgeon's Journey

Dr. Turgeon recounts the challenges she faced during her medical education, exploring the mismatch between her interests and the demands of hospital-based rotations. As she grappled with the internal conflict of wanting more freedom, she took a leave of absence to focus on her next steps.

Her journey took an unexpected turn as she resigned from residency, eventually finding herself teaching English in South Korea.

Embracing the Digital Nomad Lifestyle

Chelsea shares her experiences with the digital nomad lifestyle, both the invigorating aspects and the challenges. She emphasizes the importance of intentional routines to maintain stability despite the transient nature of her lifestyle.

She shares her observations on nurturing relationships while traveling. And she provides insights into earning an income remotely, with examples of healthcare professionals thriving in unconventional roles from telehealth to health tech consultancy.

Navigating the Road to Financial Freedom and Fulfillment

Dr. Turgeon provides valuable insights into financial strategies for sustaining a digital nomad lifestyle. She discusses fellow healthcare professionals who have successfully transitioned into remote roles, such as speech-language pathologists conducting virtual patient sessions and veterinarians specializing in remote image analysis. Additionally, she explores alternative career paths demonstrating that lucrative remote opportunities exist outside the traditional medical sphere.

Summary

Dr. Turgeon recounts her transformative path, from teaching English in South Korea to embracing the life of a Digital Nomad, building her own successful business, and achieving a six-figure income across 20 different countries. Her presentation concludes with insights into how she and others discovered meaningful work, creating a life that is both fascinating and deeply fulfilling.

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 343

The Extraordinary Life of the Physician Digital Nomad

- Presentation by Dr. Chelsea Turgeon

John: This is Dr. Chelsea Turgeon. Chelsea, is it true that you're coming to us from Bulgaria today?

Dr. Chelsea Turgeon: It is true.

John: Oh, my gosh. Well, the wonders of technology make this all possible, so I'm going to be really interested in hearing what you have to say. And so with that, I'll just turn it over to you for the next 30 minutes or so.

Dr. Chelsea Turgeon: Yeah, absolutely. Thank you so much for having me. I'm so happy to be here. I'm going to just go through and talk about my story and how it is that I got to be having this conversation with you guys from Sophia, Bulgaria, where I have been learning to ski for the past few weeks, which is something I'm totally new at. I literally had never put those on my feet before. And just a quick doctor reference that people will get. When I first put the skis on and started to ski, it literally felt like laparoscopic surgery with my feet. Because in laparoscopic surgery the instruments are these extensions of your hands that are really clumsy and it's hard to figure out how to navigate them. And you have to figure out if you move it this way, it goes up, and if you move it this way, it goes down. And it literally felt like having laparoscopic instruments on my feet until I learned how to navigate it better. That's just something I thought that I told some of my surgeon clients that and they were like, "Yeah, we totally appreciate that."

My story. I initially started out, I grew up in Alabama, born and raised there. I always have been interested in psychology. I was somebody who was quite a nerd growing up. I would have my parents drop me off at Barnes & Noble and I would say I was going to study. And I would study, but then I would go to the self-help aisle and just browse the aisles, looking at all of the books on happiness and how to deal with rejection and overcoming depression. And I was just so interested in that whole world. I was interested in how the mind work, how to become happier, how to live better. And that was an interest that I always took with me. In college I majored in psychology and I was trying to decide my career path going forward.

And I did what most people do when they're trying to figure out their career path, which is I pulled the audience. I pulled anyone and everyone around me, which is how a lot of us are taught to approach our careers, is looking outside of us for approval, for advice, for other people's ideas of what we should do with our own lives.

I would tell people, "Okay, I'm majoring in psychology. I think I'm either going to be pre-med and become a psychiatrist, or go to grad school and become a clinical psychologist." And every time I presented those options to people, I would get met with this insane amount of validation around the idea of going to med school, becoming a doctor. "Oh, you must be so smart. What a noble profession." I just slowly started to lean towards that as my career path.

I didn't totally know this at the time, but I was very much craving this external validation and basing a lot of my career decisions from this place of what is going to impress other people and what is going to make me feel important and significant. And so, I was making my career decisions from that place, which is so common. A lot of people do that. I wasn't really going into myself and asking, "What would I really love to be doing?" And I also think from a young age, we're taught to look at what do college admissions want to see on their application? What kind of test scores are you supposed to have? What sort of extra curriculars are you supposed to have? We're just used to basing everything we do on these external metrics that other people are putting on us and then we conform to those metrics.

And so, that's what I was doing and that's what I did for years. I went through medical school. I actually didn't mind my first two years. I do really like learning and studying and I liked that there was a lot more kind of location independence in med school actually. We didn't have to go to classes. We only had to go to 20% or maybe 50%. We had this small percentage where we actually had to be in class. We could actually do a lot of it on our own time, watch the recordings of classes.

I actually spent a lot of time in cafes and being on my own schedule. Like I could go to the gym in the mornings and I only had to be present for a few things. And I actually did really enjoy that flexibility. That was in first and second year. And so, I think having that sort of lifestyle was enough for me at that point to get through the hard parts of the rigorous curriculum, the long hours of studying and all of that.

But then I got to third and fourth year, and the way my med school was structured third and fourth year are very hospital based. You're on rotations, you have a set schedule. You're there for very long hours, 12 hours at a time in the hospital sometimes. They expect you to work weekends even as medical students.

And so, that was the first time I really started to feel this sense of rigidity and like I'm being boxed in. And I couldn't wait until I got off every day. Every day, as soon as my attending said I could go home, I would just feel this huge weight off my shoulders, this relief, just excessively happy to be leaving. And I was starting to question it at that point, "Do I want to be working in a job where all I'm doing is looking forward to the moment I can leave every day?" And there were things I liked about interacting with the patients, but I didn't really love the hospital setting as a whole. I had a hard time with the hours. I require so much sleep. I sleep eight hours a night at least. And then I take a nap during the day. And so, just having that sleep deprivation, I know it's challenging for so many people, but I was really struggling with not getting enough sleep, with just the rigidity of the schedule.

And I started to realize I'm not really that interested in all of the evidence-based medicine and all of the science and the studies and the research. Going and having to learn about the research and the evidence just felt like such a difficult thing to do. It was something I didn't want to learn about. What I was more interested in were things like motivational interviewing to help patients with smoking cessation. I was much more interested in the psychological aspect and the behavioral change. But again, these are things I noticed after the fact and not things that I was paying attention to as much at the time.

I kept going on, I carried on through, I went to residency. I decided to do OB-GYN residency and I made it through my first year. And after the first year, I was really having these big doubts around if medicine is the right career path for me. I was able to push off the nagging thought for a while. I had this thought, "Maybe medicine is not right for me." I was starting to have all these other ideas of what I wanted to do. I started to listen to podcasts about people who are traveling the world and making money online. And I was like, "Wait, this is a thing."

I learned about the world of coaching. My sister actually introduced me to the world of coaching. She got a life coach. And when I was making the transition from med school to residency, I was feeling a lot of anxiety, a lot of imposter syndrome, a lot of just fear, uncertainty. I felt like I was on this conveyor belt that was going and it was like there was no exit of the conveyor belt and I was just stuck on it. And I was leaning back and it was just moving forward. And I was going into this factory, or into this whatever, that's going to crush me. That's how I was feeling as I was going into residency. And I was like, "I think I need some help, but I don't know if it's therapy."

My sister referred me to her life coach and I started working with a coach myself and remember feeling so jealous of her. Because at one point she was emailing me from Rome and I was like, "Wait, you're in Rome and you're working and you're just traveling there for fun." And so, all these little moments of me sort of noticing, this is one thing I tell my clients all the time, is to pay attention to your jealousy. Because while we experience it as an uncomfortable emotion, it is actually a very powerful indication of what we want. It doesn't always mean we want the exact thing that we're jealous of, but within that we can dig in and say, "What does this mean about what I want?"

And for this, I was like, "I think this means that I want more freedom. I love the idea of being able to travel. It feels expansive." And so, all of this is happening as I'm starting residency. And I was like, well, I'm just going to try residency anyways. I'm going to give it a proper try. I'm going to see if the reason I didn't like being in the hospital in the first place was because as a med student, you don't really have many responsibilities. You're just kind of there shadowing and you don't really know where you fit in.

And I was like, "Maybe I just feel awkward and I feel like I don't know what to do. And so, maybe when it's my actual job and I have a role, I'll feel useful, I'll feel helpful." You just really give it a try and see if it's truly that I don't like medicine or if I just don't like this awkward role of med student. I did my first year of residency and it was pretty clear to me by the end that this was not something I wanted to do. However, I kept meeting with my program director to try to tell her, "I don't like this. I think I want to leave medicine." And they kept convincing me, "Just try this next rotation. Just try this next thing." And so, I did these two rotations in a row that just kind of broke me in a sense. Because if you're already on the fence about something, your heart's not fully in it at that point anymore. And then you go through this rigorous schedule and hours. I did OB nights rotation, which is I did seven emergency C-sections in one 24 hour shift at one point. You're just going and going and it's really rigorous. And then I did gyn onc. There's some really sick patients on gyn onc and it's pretty emotionally devastating. That was a really hard rotation to be on as well.

And by the end of that rotation, I was just fried. My program director, we met because she knew I was already on the fence and already struggling. We met and she suggested I take a five week leave of absence from the hospital. And so, I took five weeks off, was able to catch up on sleep finally, journal a lot, connect with my intuition. I went on a camper van road trip around Utah. And during that whole time, what really came to me is I just want to be out in the world. And it didn't make sense. There wasn't a super logical plan around this, but I just had this feeling, this connection from my intuition that was just telling me I just want to be out in the world. I want to be outside, I want to travel. And I didn't have a great idea of what that was going to look like, but I had a very clear sense of knowing that I didn't want to go back. And so, I made the decision that I was going to leave residency and I was going to give this traveling thing a try.

And also I just want to share I was not a traveler before this. I wasn't the friend who took the summers off and went to Europe. I had never really traveled. I went to Nicaragua once for a week on a medical service learning trip in undergrad, but I wasn't a big traveler. And so, it was very strange that I was having this draw to travel the world. And so, I decided to follow it and I turned in my resignation letter and decided to get a job teaching English in South Korea, which sounds a little bit weird, why would I do that?

The way that it kind of came to me was I wanted to travel. I already made that clear. I also wanted a source of income while traveling. I'm a resident, I wasn't stuck in the savings. I didn't really have a lot of leeway where I could just take a sabbatical or anything. I needed to be able to make money. I wanted to travel.

And so, I came upon the concept that you can get this online certification and start teaching English in abroad. And there's a very high need in Asian countries, but you can also do that in Spain and other European places, Latin America, anywhere. I got this online certification, I got a job teaching English in South Korea. I don't know why South Korea to be honest. I don't know if I just wanted to get as far away as possible, but that's just sort of what ended up happening. And I spent a year there teaching English.

And during the time I also went to basically Google Academy or Podcast Academy. I listened to every single podcast I could about building an online business, learning about marketing and strategy, SEO, websites, blogging, all of that. And I initially thought I was going to be a travel blogger. I made my first website and I called it the turquoisetraveler.com and I was like "I'm going to become a travel blogger. I'm going to build a six figure business travel blogging, and that's just what I'm going to do and it's going to take some time to build up the income. So, in the meantime I'm going to teach English." It just felt like, "This is it, this is the plan."

But I realized pretty quickly that I didn't really like writing about travel. I love writing itself, I love traveling. I don't like them sort of being intertwined. I really liked writing about my journey and personal growth and spirituality and so then the idea of life coaching sort of came back into my life. I just had this email that popped into my inbox that was like, "Do this free 30 day life coaching bootcamp and then see if you want to become a coach." And so, I signed up for that. I ended up doing a yearlong life coaching certification program.

I decided to shift from travel blogging more into life coaching and started doing that as my business. After a year of teaching English, I made $2,000 the first year in my business. I was teaching full-time, had the full-time job and I was charging people $60 a session, super casual.

But it was a start. I was getting started. And so, I made $2,000 that first year and then decided I wanted to be fully location independent. And so, I started teaching English online, and was able to make $24 an hour doing that, which was not terrible. I was living in Vietnam at the time. I decided to go to Vietnam. This is when the pandemic happened. I ended up getting stuck in Vietnam during the pandemic and was teaching English online and also starting my coaching business. And so, from there, transitioning from doing these online side gigs and coaching part-time to making coaching my full-time source of income.

And as I've been doing that, I just celebrated my four year travel bursary as I've been traveling the world. I've lived and worked in 24 different countries on five different continents. And I have now successfully built a six figure coaching business where that is my full-time thing and I'm able to really support myself and not just in the backpacker way, where I'm really struggling and staying in hostels, which is where I was initially. And I love that phase of my journey. It was so special to me and I'm really glad I had that time. And now I'm able to really focus more on growing a full business and supporting people in a bigger way, and I get to do all of that while traveling the world.

Let's talk about what does that actually look like? Because that's a big question that I get asked from people is, what does it look like to be a digital nomad? It does seem really glamorous and there are so many good parts of it there. Overall, it's a lifestyle that I love and I wouldn't trade it. However, I think it is important to talk about some of the realities of it because it's easy to look on Instagram at somebody living this lifestyle and think it's all just sunset photos and hikes and all these glamorous things. But there can be difficult parts of travel.

And I don't say any of this to complain. I say this because I know that can be annoying. Like, "Oh, what a sad life that you have. You have to deal with traveling and all of these things." I totally understand that it's such a privileged lifestyle and I'm so grateful for it.

And I think it's important to just be super honest and clear about what it actually entails because it can take a toll on your mental health if you're not being super careful about, because it can be disorienting. You're flying all over the world, you're changing locations all of the time. Really having to be intentional about the routines that you do to ground yourself is so important because there's times where I was in five different countries in two weeks and trying to run a business at the same time. And that is really hard.

And so, being a digital nomad, it's different. You're not traveling. You're not a backpacker, you're not on vacation. Having to figure out how you balance your work and then your self-care, the things you need to do to just maintain your sanity. And then also the fun stuff, the sight-seeing and the tours, there's all of that too. There can be a lot of pressure and I think it just really comes internally, but when I'm in a location, I'll feel pressure of, "Oh, I need to go to this museum and see this site and do this thing and check all these things off." But sometimes I just want to lay in bed and watch Netflix because when you're traveling long term, as I have been, I've been traveling for four years now, you're not always going to want to see things in the same way. You're not going to want to do the same things.

Now as I'm planning my travels, I don't really look at a list of top 10 things to do in this destination because you just get a little bit burnt out and jaded from going to the newest waterfalls and seeing all the churches and the mosques. I know all of this can sound very privileged to say these things but what I'm trying to get at is it's important to really, again, not fall into this external pressure of, "I'm in this location, this is what I should be doing." But really just checking in with yourself and seeing, "What do I want to be doing here? What is going to be nurturing for me?" And giving yourself time to just live your normal life and be a person and know that it doesn't always have to be adventure and travel all the time.

Actually, just to share a little bit more about that for me personally, next week I'm actually sort of moving to Albania. And I say "moving" loosely because I have a suitcase. It's not really moving anything except for myself. But I'm really looking forward to doing several months and potentially even getting a yearlong lease in Albania and having some heads downtime, having a bit of a home base and having more stability because there is that aspect of all the transient, all the variety that it is important to just check in with yourself as you're doing this and set up a routine that works for you.

Some people, we call them slowmads, they travel slower. They go for three months, six months in a location. But I have not been slowmading at all. I've been fast, fast, fast. I've been doing one month in each country and just going around. It's been great and it's what I needed. But yeah, part of that is really just planning out and checking in with what works for you.

Those would be I would say the main cons that I can think of. You're designing your whole life. And so, there's no 09:00 to 05:00 structure. There's nothing set up externally. You really have to do what you think is going to be best for you. The pros are endless. It's such a satisfying, fulfilling lifestyle.

I'm open to being wrong about this. Maybe one day I'll change my mind. As of right now, as I look at my future, I don't think I'll ever be somebody who permanently lives in one location. I imagine myself having multiple home bases around the world because it's a very expansive lifestyle. To me it feels like I'm living to the fullest in the biggest way. I'm seeing the world, I'm doing things that people only dream of doing. I don't even have a bucket list because the moment I want to do something, I can just go do it. The list doesn't build up, I just get to go do the things that I want to do. And so, there is so much freedom, there is so much expansion.

I've just met so many people and you grow and you change and there's so many experiences I've had that wouldn't have been possible if I was still in a hospital tied to a mortgage and having to commute to work every day and just sort of living in this structured routine. It's really shaken me up in a lot of ways. I've grown, I've learned a lot of things about myself. I've changed a lot of patterns.

Some people can digital nomad within the US and that's great too. But for me, being outside of the US has really introduced me to other ways of living and shown me a lot of the conditioning that can happen in the US and allowed me to just step outside of the box and really start to formulate my own ideas about things, which I don't know if that level of independent thinking would've been as possible if I was surrounded by people who were all thinking the exact same way, which can happen in the states more often. My mind is expanding, my heart is expanding in a big way. It's just a very expansive lifestyle.

I would say another con that is just coming to me as well is relationships. Community, romantic relationships, friendships, all of those things are very possible as a digital nomad. There's lots of hubs around the world of big digital nomad communities. And there's a lot of transient nature within all of those. And so, when it comes to cultivating community and meaningful relationships, there has to be a high level of intentionality around that. For a while I was just a free wheel and solo traveler and then I realized, "I need friends. This is something I really need." The cool thing about being a digital nomad though is many people that you meet and who are living a similar lifestyle, they also really need friends. So, they're really open.

In the US I think we can get into some of these really established patterns of no new friends because we have my group, it's kind of a closed situation. As you travel, I meet a lot of people and they're all very open to connecting and you're able to make these deeper connections because everybody that you meet has a leaving home story too. So, that's another cool thing. Every time you meet someone and they're not from around here and they're just traveling the world, it's like, "What got you out here?" That's always really cool because you can go deep pretty quickly. Because people don't just leave everything they know and start traveling the world for no reason. There's usually a deep motivator or some sort of wake up moment they had. That's really powerful to connect with people like that and meeting people from all over the world too. I can recognize the subtleties of different South African city accents because I've just met so many people from so many places. And so, that's a cool thing too.

I think one thing a lot of people want to know is, "How do you make money? How do you support yourself while doing this?" I think a lot of people, especially within medicine, they worry like "I don't have any skill sets that are transferrable to this. I don't know how I can make money remotely doing healthcare." I just want to talk through some of the other healthcare professionals I've met out here, because there's other ones out here and that's so fun.

What I want to share is there's ways to make money potentially using already the skills that you have as a healthcare professional or you can do what I did and come up with a totally different way to make money. I'll just talk through some of the main roles and jobs that I see people doing so that you guys can have some ideas of where to start.

As I've been traveling, I've met a speech language pathologist who was actually an independent contractor and she was seeing her patients virtually. She was doing patient work, was seeing patients virtually and billing. She said she's in a gray area and isn't sure if it's 100% kosher, but she has been doing this as an independent contractor working with patients in the California area. And she took it on the road and is doing it virtually.

I've met a veterinarian. She does consultations, she looks at radiology images and she reads the images and that's her full-time job. You walk by her computer and she's just looking at images of animal insides all day. And so, she's doing that. She's able to take that skill working for a company that just reads the images and is makes her living that way.

I've met several nurses and I don't remember exactly what they were doing, but some sort of patient care role that they were able to do remotely as well. And then I have a friend right now who I've actually been traveling with and she's not medical, but she works at a health tech company called Cerebral. And within that, she's said they have a whole clinical team full of people who are clinicians who consult on the operations and consult on different aspects and they're all remote as well. And so, there's lots of opportunities within health tech, doing either clinical things like telehealth or even just working on the consultant side.

So, that's some of the medical areas that I've seen. Obviously there's another route like I did. I just created my own business. There's a lot you can do in the online space, and especially like physicians, other clinicians, having something like a coaching business or a consulting business and just having any sort of face-to-face interactions with people, I just want to see more physicians making their own businesses and being able to help people on their own terms because they're just such bright, incredible people. And having that ability to just help people in the way you want to, is really powerful. I think it's a really natural transition for physicians to become coaches if that's something they're interested in. And there's a lot of resources to that. Obviously, for me, it was a longer trajectory. I wasn't able to support myself with that right away, but totally worth it.

Other potential income sources that you could quickly learn and master. There's ways to do things like coding bootcamps, which you can do. I just want to go into things that are good ways to make good money that don't require you going all the way back to school. You could do a six month coding bootcamp if you're somebody who's into computers and or into coding in that way. And you can get a six figure job pretty much right out of that six month coding bootcamp. And the bootcamps are a couple thousand dollars. But if that is something that you're interested in doing, it's a really reasonable way to get yourself into a remote position.

Another thing that's similar to that is UX/UI, which is user experience, user interface. It's a little bit like website design, but you're consulting, you don't have to know the coding behind it, but you create what apps look like. When you look at an app and you see what it looks like, the appearance, all the images and the way that it's all laid out, that's UX/UI. That's another thing where you can do a short bootcamp and get a six-figure job pretty quickly after that. I have another friend who's doing that. Those are just some ideas.

I think as we're in medicine, we get this tunnel vision and we think that in order to have these high salaries, we're going to have to go all the way back to school again. If we wanted to change and to do something totally different, we think we'd have to go all the way back to school and it'd be this rigorous process. But I wanted to share with you some of the people I've met who are doing things that they didn't actually go to school for and they're able to find a way to make good income as they're traveling as well.

And that's just the start. I think there's a whole Facebook group for remote careers for physicians. Especially with after the pandemic and the way telehealth has blown up now, there's so many ways to support yourself financially through the internet. It's actually really incredible.

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The post The Extraordinary Life of the Physician Digital Nomad appeared first on NonClinical Physicians.