telehealth Archives - NonClinical Physicians

Introducing a Fearless Medical Entrepreneur

John Jurica — Tue, 10 Dec 2024 12:32:05 +0000

Interview with TJ Oshun – 382

In this podcast episode, John interviews TJ Oshun, founder of CallonDoc, who shares his remarkable journey from practicing medicine to fearless medical entrepreneur.

Starting with a simple solution to help patients access care outside regular clinic hours, TJ transformed a basic telephone consultation service into a comprehensive telehealth platform now serving all 50 states.

TJ's transition from healthcare provider to tech company CEO offers valuable insights for medical professionals interested in entrepreneurship and digital healthcare innovation.

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From Medical Practice to Tech Innovation: Building a Telehealth Empire

TJ's entrepreneurial journey began with a failing clinic in Texas, where he discovered patients struggled to access care during regular business hours. By starting with simple phone consultations and gradually developing a custom technology platform, he built CallonDoc into a comprehensive digital health solution.

The company now offers telehealth services, lab testing, white-label solutions for medical practices, and software licensing – demonstrating how healthcare entrepreneurs can scale beyond traditional medical services into technology-driven solutions.

Keys to Being a Fearless Medical Entrepreneur

Success in healthcare entrepreneurship requires both medical expertise and business acumen. TJ emphasizes the importance of gaining clinical confidence through experience before venturing into independent practice or entrepreneurship.

He advocates for continuous learning through audiobooks, coaching, and formal mentorship programs. He also recommends building strong partnerships and maintaining a focus on the patient experience and satisfaction.

Summary

TJ can be reached via LinkedIn for professional inquiries and networking opportunities, particularly from medical professionals interested in telehealth or healthcare entrepreneurship. You can explore opportunities through CallonDoc by visiting their partnerships page or contacting their business development team.

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Transcription PNC Podcast Episode 382

Introducing a Fearless Medical Entrepreneur

- Interview with TJ Oshun

John: Sometimes I find myself really in awe of the healthcare professionals who, they recognize a problem in medicine or with patients or something, and then they just run full speed into trying to solve that problem. I'm talking about entrepreneurs, of course. So today's guest was one of those people that recognized a problem well before the pandemic that patients didn't have the kind of access that they needed to their medical providers. And so in spite of maybe not having a background in IT, I don't think he did, we'll talk about it, but he jumped in and started working on telehealth and telemedicine. So let's welcome TJ Oshun to the podcast. Hi, TJ.

TJ Oshun: Hello, John. How's it going today? Thanks for having me.

John: It's going well. It's a nice quiet day before Thanksgiving. For those that are listening, of course, that'll be two weeks ago, but we're still going to have fun on this otherwise relatively slow day.

TJ Oshun: Well, I wish I could say the same. It's actually quite busy on my end of town as we wind down and ready for the holiday. Usually we telemedicine around the holiday season when the clinics are closed, that's when we get our spikes. It's been a hectic week to say the least.

John: Yeah, that makes sense. While we're all trying to cool things down and go home, the people covering those off hours and those emergencies are getting busier. So it's good to have you backing us up, you know?

TJ Oshun: Yeah, absolutely.

John: All right. So you're an entrepreneur. I'm going to have you tell us a little bit about your story, but the reason I wanted you to come on today, for several reasons, you run a company that could be of value to physicians, you sometimes hire physicians, but you also support them. And as an entrepreneur, we can learn from you about that aspect because a lot of my guests, I mean, a lot of my followers really and listeners are interested in doing other things besides direct patient care. So why don't you start by just telling us what you're famous for?

TJ Oshun: Yes, absolutely. So what I'm generally, I guess, popular for, the company is popular for is the company cell, which is CallonDoc, a telehealth platform. I think we've actually grown beyond a telehealth company to more of a digital holistic medical platform, right? In the sense that we not only offer the direct patient care, we offer lab services, we offer software as a service where we're licensing our products to other doctors, we're providing provider services to all the telehealth companies. So we do a wide range of things to facilitate healthcare delivery virtually, right?

And at this point, I actually consider myself as a tech company versus a medical company. I spent 70% of my time in marketing and technology versus the medical side of things. So we position more on the technology and patient optimization component of it. But that's essentially what we do, a digital company that is out there to optimize access to healthcare in every way we can, from partnerships to optimizing technology and offering quick access to medical care.

John: Very good. Why don't you tell us a little bit about your story because I know that you started out, well, you immigrated, you started out in healthcare, going to being a PA and then going to med school. And at some point, this urge and this interest in doing what you just described started. So what prompted that? How did you start looking at even starting such a company?

TJ Oshun: Yeah, absolutely. As Will mentioned, it started when I was a hospital in a Texas hospital, UT Southwest. And so I worked there for two years. That was one of the best experience I've had, gave me all the confidence in the world to feel like I could practice independently. So I was there for a couple of years. Then I saw this failing clinic. I have a thing for buying into failing practices. It started even when I was in college where I bought a failing barbershop where I used to get my hair cut. It was closing out and I bought it and I revamped it and turned into a profitable company before I exited.

But the same concept happened. I wanted to start a practice, but then I found this local clinic in Irving, Texas that was failing. Partnered with a couple of my colleagues back then, invested and we turned it around and became profitable within a year. Because I knew what wanted it to happen was just optimizing again, the patient experience, looking for the pinpoints that patient needed and grow from there. But anyway, there were a couple of roadblocks as you can imagine, but we were able to stabilize and became profitable by year two. So as the clinic grew, and I wanted to expand, I couldn't expand past the four walls of the clinic as you can imagine.

So that's one of the things I've learned also as I grew a company, that when you start now, with a brick and mortar, you're limited to the ZIP Code, right? No one is going to travel 20, 30 miles to your clinic, even if you are the best doctor in the world, right? So to scale that, I thought, okay, it had to be something virtual. It had to have some element of technology because if you want to scale, you need to have technology involved and virtual. So it started with a phone call. I surveyed my patient at that time.

And as you can imagine, clinics open 9:00 to 5:00 and I knew there were a lot of no-shows and I started surveying my patients and figuring out why they were absent for their diabetes follow-up visit. And the primary, number one reason they gave me was that you guys open 9:00 to 5:00 when I get out of work. So I had to think outside the box.

How can I see my patient outside of the hours? I started extending hours, but obviously there were limitations to that. You can't open 24/7 at a primary care clinic. So the only way I could do that was actually reaching out to them and seeing them at home. The first thing that came to mind was a phone call because obviously technology wasn't available for telemedicine back then. So I called the medical board, Texas Medical Board of, I'm like, "Is it okay to see a patient virtually over the phone?"

They were like, "There's nothing like that. I can't really tell you what to do as long as you're establishing medical necessity and documenting that you're actually helping and documenting it." So we started that way and we just offered it to the self-pay patient only because there weren't any reimbursement for insurance at that time. So we didn't go that route. So it was only for patients that actually needed the medical service that could not make it and we can establish medical necessity for a phone visit.

And it were always the follow-ups, the patient that compliant with their medication that just needed refills, right? But couldn't make it because of office hours. So we started that way. And I remember telling the medical board on that time to email me so I can have it as an insurance in case something happened.

So I still have that email now in my inbox saying it was okay to treat patient virtually. So it started as a phone call, but I needed to do more. So I created, I went on GoDaddy, developed a website where, because -- and the reason why, yeah, let me just go back a little bit and I hate to dwell on this, but I think it's important, is even the phone call, I had to stay on the call for a long time getting the medical history.

So now the medical intake itself is about 15 minutes. So I'm like, why don't you just create a website where I can actually get all the information at hand. So the actual visit will be discussing the intake, right? And it will be sort of addressing the pain point. So create the website, collecting the data so I didn't have to need, I didn't have to involve a medical assistant. So I collected information on the website.

Then the phone visit would just be addressing those problems or areas and providing solution and refills in labs if I needed to. So that's how it started. Then we started scaling to other parts of urban Texas and Houston and other parts of Texas. And we're able to scale to neighboring states as well, providing telehealth. And this is now more from just a phone visit to more of a digital and video conferencing in some part. And COVID hit, but because we were prepared for that, we were able to scale rapidly to all 50 states within a couple of months of COVID.

And we were able to offer, I think, about 350,000 visits for a couple of months during the height of COVID in all 50 states. So that was how we were able to establish the credibility. And because I also made sure patient experience and satisfaction was the forefront of what I did, we were able to scale even faster. We retained our patient and grew from there.

John: Oh, boy. There's a lot I can ask you about in that whole journey there. So many businesses went out of business during the pandemic. You're one of the few, and I guess the other telehealth and telemedicine companies that actually exploded during the pandemic. But I would say there are a lot of physicians that have an idea and think, oh, I could do that. I'm going to solve this problem, whatever it might be. It could be recruiting, it could be patient care, whatever.

But there's always, if there's a tech component, they usually, they get stuck. Either they've got to invest a lot of money. How did you overcome that? How did you go from being a telephone and a website, which is pretty basic? I mean, now I know you've got these visits there. You can choose from the visits. You can populate the information. You can then talk to whoever you need to talk to. How did you get through that hoop?

TJ Oshun: I think the biggest thing for me, which was painful in the beginning, was actually investing in a homegrown technology. I think most people tend to license a software that may not be customizable or scalable and limiting, right? So we were able to invest in a homegrown technology that scaled with us.

So I was able to figure out what my patient wanted, the pain points, reiterate, customize it, take that out, optimize it. And I listened to the patients, right? I know exactly what they wanted, how they want it. And I gave them options, right? On how to see their doctors, right? So listening to a patient, optimizing the technology. Again, a homegrown technology will allow you to do that versus a legacy or a company that you only had what it offered you.

So that helped us a lot. And I quickly brought in, because I understand I quickly brought in, again, I see myself as a technology company more than a medical, right? So I could handle the medical side. So I was able to quickly bring in software engineers from the beginning, hire a team to power it from the beginning. So my medical, my technology team actually grew faster than my medical team.

So we were able to power that through and customize and optimize based off of that. And obviously we can analyze patient journey, optimize accordingly and go from there.

John: Now, before we got on the call, we were talking about how your company is continuing to expand and diversify and becoming more of a tech company and even supplying the infrastructure, I think, for some practices. But I guess if someone who has like an issue, whether it's an app or thinking about technology, is there any advice on where to find software engineers or where to find the tech people you might need to create something like that?

TJ Oshun: It's always a challenge. I have to go through a series of engineers, companies. There were a lot of politics that went behind that also. I had terrible experience. It wasn't always fun, by the way. One of the first technology company I actually partnered with actually sold my technology to a different telehealth company. Right, right.

So it's challenging, don't get me wrong. The good thing is I was cautious about what sort of information I revealed to them. So what they sold was actually the entry level, the MVP of my ideas. So that saved me there. So which I think the other company got stuck with that product because I was already ready to move to the next level. But it's difficult, right? It's difficult. It's about finding the right company that best fits you and has your best interests at heart. And as you can know, it's partnership.

You have to let them understand that this is a partnership. I'm with you if you guys have my back and compensate them accordingly so they can grow with you, right? If they know as you go, because the company I've been with, I've been with them for six years now and they power all my software engineers.

So I don't have to deal with the hiring process of scouting and recruiting the technology. So they do all of that for me. But as I grow, they grow also. They won multiple awards based on the growth that we've had. So they're growing with me and we continue to grow, right?

John: That's awesome.

TJ Oshun: So yeah, it's about finding the right partnership and someone that can actually grow with you, yeah.

John: I want to get your opinion on another thing because along the way you have hired physicians who actually work and do the telemedicine or answer, and maybe it's PAs and NPs as well. What's your advice for someone who's maybe just coming out of PA school or medical school residency, and they're thinking, I don't know if I want to be employed by a big hospital. Maybe I want to just do telehealth, telemedicine. It seems more flexible. What advice do you have about that for them?

TJ Oshun: Yeah, absolutely. It's always a good thing to try to be independent, but it has to be something that you want to do because starting a business is still at the end of the day a business, right? So you may be a provider, but if you don't have the knack for the entrepreneurial spirit or the ups and downs that comes, resiliency that comes with that, it may be challenging.

There are times where I've hit roadblocks and it would seem like we need to pack the things and go home, but you just have to persevere, right? So that's really, really important. That perseverance is very, very key. And if you don't have the bandwidth to be able to power through that, it may be challenging. So that's number one. It's still at the end of the day, it needs to be perceived as a business that needs to grow and be profitable.

So that's number one. Number two, I think having the medical confidence to be able to run an independent clinic is also important. So like I said, I said, I worked at UT Southwest and that gave me the confidence to be able to practice independently. So getting out of school and starting a company is definitely not advisable. Make sure you have that medical chops where you can confidently treat patients. And it could be just whatever you're comfortable with.

It could just be diabetes, but you have to be comfortable managing those patients independently. So the combination of your medical background, be confident in that, and also the medical chops of being able to run a company because you will do everything. You do everything from marketing, accounting, software development. You are going to be the first couple of years, the guy or person that will drive the force before you start bringing a team that will support you. So you have to have a thing for being an entrepreneur as well.

John: Yeah, and I think you made a good point that if you're going to be on your own and really being primarily responsible for, even if it's "during the off hours" or whatever by telemedicine, maybe it's best to do two or three years, make sure you're really comfortable practicing and then jump full-time into the remote type of telehealth.

TJ Oshun: Absolutely, because it's an isolated world there. You're by yourself, right? There's no one to call sometimes. So you have to be able to navigate independently, right?

John: I want to remind people again, the website where they could at least take a look at what it looks like when someone signs in is callondoc.com, right? C-A-L-L-O-N-D-O-C.com?

TJ Oshun: Correct, callondoc.com. Yes.

John: It's pretty interesting. And so it just gives them an idea of what you've built. But I didn't want to wait to just to the end to do that because sometimes people don't listen to the very end. All right. I want to ask you about some other things. So we've touched on this business and the entrepreneurial part of it. I know somehow, because I think you were in a podcast where you were actually being interviewed by, I think you would call this person a mentor, a coach.

She was through a very well-known company I recognize. So I just wanted your opinion as you've been going through this process. I don't know how long you've been involved with that particular, you might even call it a mastermind or coaching. What's your opinion of that? Why do you do that? And what advice do you have for other potential entrepreneurs or physicians that want to grow in there, even in their practice about that particular aspect?

TJ Oshun: Right. So being a CEO and founder of a company is isolating, you're up there by yourself. You sometimes feel like you're not getting genuine feedback or you may be doing something incorrectly and you just need that sort of reinforcement and reassurance. So even though as a company we were growing, it just felt like I was by myself.

I felt isolated. I felt that I needed to do more and reach out to like-minded thinkers like me. So I found V-Stage online for some reason and I was assigned to this amazing coach. Her name is Margaret. We meet once a month, one-on-one. And I had meet with my group once a month as well where we just talk about each other's problems and give honest feedback and how to address it.

And she takes time to dive deep into my business and try to figure out how we can resolve things, right? One of the things she asks me is, what can I do for you? What do you want to talk about today? So she's like my therapist really, where I can actually, more on the business side, but I can actually let her talk about things, right? Whether I'm struggling with an employee or try to hire someone. So it's just someone to sort of bounce ideas.

And when you talk through things, it actually gives a different perspective. And one of the things actually she gave me, advice she gave me, which actually has worked is I have a lot of ideas in my head, but I never write it down. She's like, "TJ, you have to write it down."

John: Or they just disappear. They float away for a while.

TJ Oshun: Absolutely, right. It just disappears, or you're not as organized as you think you will be. But when you start writing things down, putting things in perspective and assigning timeline and resources to things, it gives you a lot more structure. I say that to say this, that you need the support system, which you may not get from employees, right? I don't have a strong executive team like [inaudible 00:21:07]. When I say strong, it's more of, I'm the CEO and sometimes act as a COO sometimes.

So I don't have, so like a maid that can bounce ideas or an independent thinker. I think that's the best way to think. Someone independent with no vested interest in the company. So she gave me that honest opinion without bias.

John: Well, I'll tell you why I was so interested. First I was a CMO for a hospital and our CEO took advantage of the same company and we had a coach. And so he would meet with that coach and then he would meet with a group every month. And then at some point he found it so helpful that he actually brought that same coach into the organization for the senior executive team. So we were meeting as an entire group, the senior hospital team with this coach or whatever mentor. And then individually, we had the opportunity to do the same thing.

And I've always, I have addressed this on the podcast several times and the advantage or the benefits of having a coach, having a mentor, and even participating in basically what's like a mastermind where you get in a group with your peers from other organizations. So I think that's fantastic.

TJ Oshun: Absolutely, absolutely. And it highlights your strength and weaknesses. It's someone looking in and just giving you their honest opinion. So always, always helpful.

John: Yeah, I think it was that question that you mentioned and sometimes the way my mentor would put it is, what's the thing today that you really don't want to talk about that you should be talking about? And there are a lot of those. All right. So let's shift gears again, because I think what my listeners want sometimes is motivation and encouragement, which they've gotten just kind of hearing your story.

They want to learn some practical things, but some of them might need your services, not as a patient. So we were talking earlier and you have expanded your services. So explain what that's about in terms of how you can partner with individual doctors, individual practices to help cover some of their downtime.

TJ Oshun: Yeah, absolutely. And I'm happy to answer that question. I wanted to throw this in before I forget. So one of the things I do a lot of is read books. I didn't go to business school, right? I learned as I go, but to fast track that I've read a lot of books from people have gone through this already, and I just sort of like, it's like a cheat sheet in a way, right?

But I read a lot of books and I'm not the type that reads hardcore. I just listen to the audio books as I drive or walk down the street of New York. That's one of the things I do when I first wake up in the morning, take like an hour walk in New York, listening to e-book and you get a lot from there. By the time you get back, you have all these things and action plans so that you can go implement that practicable, right?

So I encourage people to actually, your audience listening to read a lot more of this sort of self-development book. And depending on your weaknesses, where I have, if I want to learn more about marketing, I pick up a book about marketing. If I need to scale or hire someone, I pick HR or HR related books. So I think that's very, very helpful. And in terms of how my software can actually help doctors.

So we have a lot of doctors willing to join our team. So I think hiring more doctors is not the way to go now. But what we do is again, we're a tech company. We're licensing our services to clinics. So we've been powering clinics throughout the U.S. Like I mentioned, you're about to retire or a clinic that is closing at six, eight o'clock. We can actually power them after hours if you need to go on vacation and you just need to keep your practice open.

We can come in, white label our platforms so your patients still have the experience as if the way we are cleaning. But it will be powered by our medical providers. You can still do the billing. We negotiate the rate, but we will power those clinics and medical practices. And we've had practices on telehealth companies, actually, that are local, but want to expand to all 50 states, but don't want to have to deal with the headache of hiring doctors in all 50 states. So we power them.

They do all the marketing. We see the patients and deliver the care for those patients, but they still own the business and practice, but it's all powered by CallonDoc. And by the way, most of the partnerships that we've actually been having are all the telehealth companies, which inherently are competition, but we negotiate rates that are not competitive, but we do all the software and medical services in the back end.

John: Nice, nice. So that's another entrepreneurial thing to do, expand really what you're offering outside of the initial services. So that's good. So how would someone that's in that situation that is looking to get someone to cover, and yet, like you said, white label or coordinate with their practice, how would they get ahold of you?

TJ Oshun: So absolutely. So just go on the website, callondoc.com. There's a tab in the menu at the top called our partnerships, our business, fill out a questionnaire, and someone from my business development will reach out to schedule an intake. The questionnaire is just learning about your practice and what sort of partnerships you want, and the right person in our BD will contact you to set you up. Very quick entry. We've done this multiple times. We can launch a platform within a day or a couple of weeks, depending on how demanding the interface is, but it's something we can quickly do just by filling out an intake form.

John: Okay, excellent. That's going to be helpful. All right. Well, I think we're getting close to running out of time here. So, well, we've covered a lot today. So before I let you go, is there any other places that you typically would, if someone had a follow-up question could they maybe send that to LinkedIn, something like that?

TJ Oshun: Yes, they can send that to LinkedIn. I'm active on LinkedIn, but that's the only social media platform I'm really active on.

John: That's cool. As long as they have a question, at least with LinkedIn you can do a little screening, make sure it's appropriate, instead of like, oh, just give us your home phone number. How about that? All right. No, we're going to let you go in a minute. So I guess the question I usually end with is if the physicians in my audience they have different things going on, some want to get out of medicine, some want to do -- they want to change, they want to do cash only, there's lots of options.

What advice do you have maybe for these physicians who are maybe a little frustrated with corporate style medicine, or they don't have the control, whether it be your advice for telemedicine, telehealth, or just doing something entrepreneurial, just any advice you might have for those people who are frustrated and don't know where to go?

TJ Oshun: Sure, absolutely. I think with healthcare, there's tremendous ways you can actually optimize or improve patient care, or even the healthcare as a whole, not necessarily just patient, just healthcare as a whole. I think it's just identifying a problem, and not necessarily try to follow what everyone is doing.

Identifying a problem, that's what I did, identify what the problem was, and solving it. Just in your own space find what the pinpoint is, whether it's a problem with a hospital system, or the clinic system, or a patient, right? Identify a problem and try to solve for that problem. If you can solve, you would definitely create a business out of that. And it will be organic. It will be an organic process because you're actually addressing a problem that no one wants to address and not necessarily be trying to be competitive with a hospital system, or I want to change the whole hospital system. No.

Well, how can you optimize whatever deficiencies they have and they will pay for that? Figure out a problem. Your patient will pay, the hospital system will pay, the clinic will pay. How can I help with a deficiency. Like I said, an example is, we know clinics open 9:00 to 5:00. How can I help the clinic after hours rather than competing with them? So that's what I try to do. Find a problem, help them, and be successful at it organically.

John: Nice. Well, that's good advice. And there's so many, I mean, people are getting frustrated because of the insurance payments and so forth, which you have to deal with that I guess in most situations, however, so a lot of cash pay, a lot of people have savings, health savings accounts and other ways that they can pay for the things. And so there's a lot of new ways to solve the problems, as you said.

TJ Oshun: Absolutely. And actually we don't accept insurance for that reason. One of the things that we try to do is offer a quick, easy access to healthcare. Once you introduce insurance, then you have to go through verification, eligibility check. That takes hours sometimes. But we want our patients to be seen quickly within minutes and done. So our constitution fee is average of $40, which is about your copay anyway. So we've never been incentivized to accept insurance. Our patients can still pay for their medication at their pharmacy with insurance, though. They can pay for labs with insurance. But the medical service itself is self-pay.

John: Yeah, good point. You're right. A lot of the urgent care visits, the people pay out of pocket even if they have insurance. Because you're right, they don't meet their deductible and they're going to have to go through so many hoops and we're going to have to go through so many hoops. We both say, you know what, let's just do that $99 visit and move on.

TJ Oshun: Move on. Absolutely. Absolutely. And it works out. Yeah.

John: Yep. And people get taken care of much more timely. All right, TJ, this has been great. I appreciate you coming onto the podcast. We'll have to catch up with you again down the road and see if you've dominated the entire landscape by two or three years from now.

TJ Oshun: That's the goal. That's the goal. That's the mission one patient at a time. Thank you so much, John, for having me. This was fun. I enjoyed the interaction.

John: Me too. You've been a good, great guest. So with that, I'll say goodbye.

TJ Oshun: Bye-bye, John.

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How Does a Consultant Start a New Telemedicine Service?

John Jurica — Tue, 09 Jan 2024 13:31:49 +0000

Interview with Dr. Luissa Kiprono – Episode 334

In today's episode, we explore the entrepreneurial journey of Dr. Luissa Kiprono who recently decided to start a new telemedicine service. She is a maternal-fetal medicine specialist who transitioned her traditional practice into telemedicine with the creation of TeleMed MFM.

The interview delves into the pivotal moments, challenges, and strategic decisions that led to the establishment of this innovative healthcare model. During our conversation, Luissa describes the importance of self-discipline and adaptability when making such a significant commitment.

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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.

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Evolution of TeleMed MFM: Dr. Luissa Kiprono's Entrepreneurial Journey

Dr. Luissa Kiprono faced challenges when her previous practice closed unexpectedly, leading her to choose the less-traveled path of starting TeleMed MFM. Motivated by a desire for independence and the vision to extend high-risk pregnancy care globally, she committed to a telemedicine-centric approach.

Her strategic decisions included establishing TeleMed MFM as the first to integrate telemedicine into maternal-fetal medicine services so completely. The practice adopted a hybrid model, combining consulting and procedures. Dr. Kiprono started by partnering exclusively with a prominent organization in Kansas City.

Push, Then Breathe: Dr. Luissa Kiprono's Memoir and Thought Empowerment Platform

Dr. Kiprono also described the other major project she has been working on for the past few years, her memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,“ revealing her experiences from the time she was a 19-year-old immigrant to becoming a successful American doctor.

Summary

To connect with Dr. Luissa Kiprono and learn more about TeleMed MFM and her upcoming memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,” you can reach out to her at (210)-660-9906 or via email at DrK@TeleMedMFM.com.

Visit the TeleMed MFM for information on the practice. For updates and insights, explore Dr. Luissa Kiprono's thought empowerment platform at drluissak.com and sign up for her newsletter by emailing hello@drluissak.com. Stay tuned for the release of her memoir on February 13, 2024, available in hard copy, audiobook, and Kindle formats through major retailers in the United States.

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 334

- Interview with Dr. Luissa Kiprono

John: Today's guest first appeared on the podcast in July of 2021, and since then a lot of things have changed. She's a maternal fetal medicine specialist who's now providing care using telemedicine. I definitely wanted to hear about that. She's a University of Tennessee physician executive MBA graduate and holder. I just remind you of that because that's one of our sponsors. And she's also the author with a soon to be released memoir. This should be fun and interesting. Welcome back to the podcast, Dr. Luissa Kiprono.

Dr. Luissa Kiprono: Good morning, John. I'm very excited to be here. Thank you for inviting me back to your podcast, Physician NonClinical Careers.

John: Yeah. I think it was very inspirational last time, what you were doing then. And now some new things have happened, which I find extremely interesting and again, inspirational. Let's just get right into it. For the listeners, if you go back to episode, I think it was 204, you can learn more details of Dr. Kiprono's background and so forth. But to get us started, just go through a little bit of a list of what's happened since we talked back in 2021, if you would.

Dr. Luissa Kiprono: Okay. In August, 2022, right at the conclusion of the COVID pandemic, my organization pediatrics decided to shut doors of the practice I was leading at the time, Texas Perinatal Group. That came as a surprise, I have to say. And at that time, I really came at a crossroads, whether to sign another agreement with another organization or to take a different road, that less travel road, and that is to open my own practice. And really I realized how exhausting has been to invest in someone else's dream and in someone else's endeavor. I said I might as well just start investing in my own. So that is how TeleMed MFM was born.

John: Now, was that from the very get go going to be heavily involving or solely involving telemedicine type of interactions?

Dr. Luissa Kiprono: It was started a hundred percent with a vision to become telemedicine. I have to say that I had plenty of experience in the matter due to the way COVID kind of pushed us with medicine and medical practices. But also I was the first practice in both CompHealth agency, which is the Locum Tenants Agency, and in pediatrics medical group that as a maternal lymph fetal medicine practice would hire and maintain telemedicine in their services. Not only during the pandemic, but also up to the day that the practice closed in August, 2022.

I did have experience in the matter, and I think that's where it kind of started. I was like "I know what to do, I know how to handle it, and it works." But it was scary. I have to tell you, it was exciting and it was scary, to both start a new practice in my fifties and also to start not only just any practice, telemedicine in maternal fetal medicine.

John: Yeah, anytime you make a change like that, it's both. You've got all the business aspects of it, and then also like, "Okay, how am I going to deliver care? What's the best way to do it?" And in telemedicine, I have zero familiarity with. That's like how in that environment you deliver your services. You're to be commended for that and I think when you do that, while it's very stressful, and it probably takes some time and some money, as you mentioned, you have more freedom and independence. So, it's a trade off.

Dr. Luissa Kiprono: Yes, it is. You are your own boss. You also are doing telemedicine, you practice medicine from the comfort of your private office, home office. But I always give award to the wisest, to the newly grads, and the newly grads are excited. Let me tell you. This generation is like, "Oh, yes, this is so exciting, we're going to do telemedicine" and so forth. It does take a lot of self-discipline, and it does take a lot of fortitude to not cut corners because it's easy. Just think about what used to happen during COVID. When Zoom meetings start, you're like, "Oh, I got all this freedom. I can also check an email. Oh, I can also do this. I can also do that." So here you are at the end of the meeting, you're like, "What exactly the meeting was all about?" Those same dangers come when you do telehealth. But it comes with a price.

So you do have to be self-disciplined, you have to say "How it would be if I am the patient and the physician that can renders care on the other side, doesn't pay attention, and they don't give me the best care that is because they do it through telemedicine or they miss something?" You do have to have respect, and also you be yourself like your watchdog, "Hey, I got to do it, this is my job." It's only the place that's different. The care, the connection with the patient, the services render for the patient. They should always be there just like I would be physically in the same office with them.

John: One of the things that attracted me to want to talk to you about this, that prompted me is that I get questions all the time from I'll just say specialists. Some of them are surgeons, some are medical subspecialists. And in their minds they're like, "Well, yeah, primary care, urgent care, that's fine. Telemedicine is very common. People have low risk, colds and respiratory, and they can get treated over the phone or the telemedicine service for a UTI or something."

But it's a different type of telemedicine when you're a consultant. And I've seen surgeons and other specialists do this, but never have I talked to a perinatologist that has done this. And so, my question is, tell me a little bit more about what the interactions are like. Since you have really a close relationship normally with the obstetricians as well as the patient, are you interacting with both and do you do some consults with an obstetrician in which you don't actually talk to the patient? Or are they always involving the patient directly?

Dr. Luissa Kiprono: It is very involved. Communication is the key, at least when it comes from me. My advice is always, always communicate. I'm an over communicator. I speak with my obstetrician, that if I make any changes to the care and we switch gears, I call my referring OB provider, and I say, "Hey, this has come up. This is how I recommend." Then I speak with my patients after I discuss it with the obstetrician. Just imagine everything the same like you would go in a doctor's office. The only difference is through the screen. We are talking live here doing a podcast. Same thing I'm talking live with my patient. Patient comes in, whether it is a video consult from the comfort of their home, or it's a telehealth consultation that is in the practice in the hospital or in the MFM practice where the patient is scheduled to come.

The patient gets an ultrasound. I read the ultrasound, and then we have a consultation. And I conveyed the findings to the patient. We discuss just like you would talk face-to-face with the physician. Medical history, go through the entire finding of the ultrasound, counseling, render an assessment and discuss the plan. And then I finish a consultation through the EMR and sign it. And that's it. It's very, very doable. It goes very seamless. There will be things. Think about it when you are in the office. Does your computer need an update? Sure. Is your computer maybe going to crash and you need to reboot? Yes. Do you have EMR when you go and work in a brick and mortar office? Yes. Or in the hospital? Yes.

All those are happening. The only difference is I am not physically with the patient in the room but my sonographer are by my nurses. If I need to send the patient to the hospital, I call the nurse, let her know. I call the obstetrician and the nurse calls the hospital and the patient shows up just like that.

There are a couple of procedures that obviously I cannot do like amniocentesis, DBS. Those are for prenatal diagnosis of congenital or genetic abnormalities. But that is when the physician who is physically in the office comes into place. And that brings me to my next point, hybrid practice. The hybrid medical practices of healthcare are here to stay because you have to have the hybrid. Think about if you have a team that some of them do just consulting, but some of them do also procedures. People who do procedures have to be during the procedure in that room, in the operating room, or if I have an amniocentesis, the physician, the MFM that is in the office that day, they will go ahead and they take care of that for us.

John: Ah, okay. I've talked to people that are doing telemedicine as primary care. They're constrained by where they're licensed, states they have to be licensed in multiple states, although I know some of that during the pandemic was a little loosened up a little bit. It was a little easier to get. Do you focus on certain locations? Is it kind of local, even though it's telemed or is it countrywide? How does that work?

Dr. Luissa Kiprono: I am licensed in multiple states. Every state has its own slight differences. Now we have Compact. Compact made it easier and more streamlined to be able to be licensed faster in different states. I personally hold multiple licenses, but right now, as a matter of fact, my practice has signed an agreement, an exclusive agreement with a very well-known large organization in Kansas City, Missouri. TeleMed MFM is providing maternal fetal medicine services virtually for their patients.

John: Okay. Yeah, that kind of segues into my question I had about how do you get the word out and where do you find business? And so, it sounds like at least one way is to identify a particular organization, work directly with them. Tell me a little bit more about that.

Dr. Luissa Kiprono: We did a lot of marketing, but when I say marketing, it's not like you've got to put an ad in the paper or an ad in YouTube. That doesn't work that way. A lot has to do with your expertise. Maternal fetal medicine, it's a very close knit environment. The MFM subspecialty really was formed 50 years ago. 50 years ago next year. It is a relatively new specialty. And there are about 1,300 of us, but only about 900 to 1,000 that practice full-time. Now, if you take that to 340 million United States citizens and 77 million women between the age 15 and 49, which we consider the fertile age, you can imagine how big the need is, how tiny the group that we are in of specialists.

To go back to your question, when it comes to marketing or advertising, I started working for this organization through an agency, through my company. My company was contracted by the agency to work for this organization, and they learn how I work, they learn my practices. They were very impressed with my ethics and my expertise. They say we just would like to contract directly with you and do partnership between your company and our organization. Without saying, I was extremely excited. And we actually just executed the partnership last month.

John: Nice. Excellent. How does the lifestyle for you doing your practice this way, have you stuck pretty much to the same kind of hours? Or is there more flexibility doing it this way? That's one of the things that attracts certain physicians to telemedicine because they don't have to travel, obviously. It's very much more efficient. Tell me how it's affected your lifestyle.

Dr. Luissa Kiprono: I worked the same hours that I were before. Actually, I worked more. I work more now than I worked before. When you look at any company, any business that you start, I want to make a caveat, you will work a lot more in the beginning to start it. It just has to. It's just thinking about building momentum to have this business going. But I do work the same, if not more, because when I'm done with my clinical duties, then I start working the administrative duties after hours for my practice. And also now with my adventure, you do have to have the electronic capabilities. I do have literally six monitors in my office. And so, I high grade monitors. I have to have a high speed internet, camera video equipment, audio equipment. That is my livelihood. That's my job is to read ultrasound. I just don't have small screen laptops and have large screen monitors because I read ultrasound about 90% of the time with or without consultations.

That are the requirements that have to be in place in order to do this kind of endeavor. Yes, it is more relaxed because I work from my home office, from my private office. But again, going back to that same caveat that I made the beginning of the podcast, be your own watchdog. Stay disciplined. Because it's easy to become relaxed because you are at home. Well now, you're still at work, you are not at home, you are at work. Home is you go to the other room after your work is done.

John: I'm not exactly sure how your practice worked before. This question might be stupid, but I can imagine especially in MFM, maybe you're doing the ultrasound yourself physically, or you have ultra-sonographers that you typically work with. And now I'm assuming that you're actually getting a lot of different ultrasounds that you're reading from different ultrasonographers maybe. How is the quality? I know you've got the technology, I'm just wondering if it's affected your ability to feel the confidence in what you're looking at.

Dr. Luissa Kiprono: It is an excellent question. It is not a silly question. As a maternal fetal medicine physician, we do have highly trained sonographers. They are not radiologists and they are not OB-GYN sonographers. They are sono techs who spend about 18 months to specialize in fetal ultrasounds. When it comes to that, I had other offers prior to this and they said, "Well, you're just going to read the ultrasound, that an OB tech is going to do it." And I said, no, it just doesn't cut it because I am not there to be able to troubleshoot and I need certain images.

What happened is the maternal fetal medicine, sonographers are going by strict guidelines, imposed by AIUM. They are ARDMS certified and fetal echo certified. Think about this. Just like everything else, if you have a radiologist that reads general X-rays or general MRIs, then he'll have a radiologist who specialized in fetal MRIs, and then you go further, radiologists that have specialized in neuro fetal MRIs. That is so important for me to be able to have this at my fingertips, to trust my staff. I have to trust my sonographers because they are my eyes. And let's say they didn't get the image. I would just ask them, "Hey, can you get another image for me?" And they know exactly what I'm looking for.

Otherwise, the learning curve is very steep. Especially if I'm not there, the trust is not there. Just like you said, the liability is very high on my end because if they miss something, then I miss something, then the patient doesn't get the counseling they should have. The follow-up is not the proper follow-up. And then at delivery, the baby doesn't get the care that they should have been anticipated otherwise.

John: Yes, we don't like surprises in medicine and we really don't like surprises in maternal fetal medicine. I happen to have two daughters that are pregnant at the moment. I'm hearing a lot of things third hand. And one thing is not an ultrasound that's not given the right answers. That was very interesting. We're going to run out of time soon and we're not going to run out quickly because I have a whole other topic I want to talk to you about, but I do want you to go ahead and give the website for the telemedicine MFM business just in case there's physicians listening who may need your services or want to learn more or even contact you on LinkedIn if they're starting something similar.

Dr. Luissa Kiprono: Sure. My practice number is (210)-660-9906. My website, you can find me at telemedmfm.com. And my email is DrLuissaK@TelemedMFM.com. If you go to my website, you can always find there the contact info. And please send me an email, ask me a question. I'll be very, very happy to share my knowledge with you and my expertise. Both how to launch a telemedicine practice, and also how to navigate through the intricacies with both medical but also insurance and licensing.

John: Excellent. I will put all those in the show notes, of course, and even in the email that I send out about the episode. We'll have all those links and a few others that we're going to talk about. But in the process that you've described, you've been busy starting this, but in the meantime, you've also had another activity. I guess I wouldn't call it a hobby, something going on, and it's about a book, a memoir. And so, we definitely want to hear about that as well. When did that start to come up as something you wanted to do?

Dr. Luissa Kiprono: Five years ago I embarked on this journey writing my own memoir. This memoir takes the reader on a journey that I have started back in 1987 as a 19-year-old woman immigrant who came to America for two months. I came to America to meet and know my father. And that turned into a lifetime. And without spoiling the drum roll and transferred the book, it's been a journey. It's been a journey of a lifetime. And that journey of 15 years really takes me and it takes the reader all the way to my graduation date in 2002.

And at this time, I'm thrilled to announce the debut of this first nonfiction book. Its name is Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor. At the same time, I'm launching my platform, it's called Dr. Luissa K. And it is a thought empowerment platform in both leadership and overcoming trauma and thriving by achieving one's own potential. Date of release is February 13th, 2024, and it's going to be launched at all the major retailers in the United States in hard copy, audiobook and Kindle format.

John: Nice. Is this like a traditionally published book through a large publisher?

Dr. Luissa Kiprono: It is a hybrid publishing. The publisher is Greenleaf Publishing Group.

John: Now, we always have questions to address with authors and writers. It's not easy, it's not easy to organize. What method did you use to write? Some people will do blocks three or four hours at a time. Other people will maybe work on a weekend. How did you actually sit down to create this book?

Dr. Luissa Kiprono: I started the first chapter of this book 35 years ago in Romania. Then I wrote that first chapter and I put it aside because life got in the way big time. About five years ago, I found myself recording every morning for about half an hour. I was very intent into doing it. And it lasted about two weeks. When you run a practice, at that time as I was running that huge 52 employee practice. And then also you have a family, children. Life, let's call it. I said I really want to write this book, but there is no way I can write this in my lifetime at the pace I'm going. I started looking at ghost writers and I partnered with my book coach and ghost writer. And that is how the book was finally written through both our collaborations.

I want to tell you something that we all physicians and really some non-physicians, but usually type A personalities, we feel that we must write this book like as if I have to physically write it. But what I can tell you is that the thought out there is that it's actually smarter to work with a book coach and a ghost writer than trying to do it yourself.

It's like delegating. Think about if you are in your office and you're trying to do everything. Trying to vitalize somebody, take fetal heart tones, put the patient in the room, do the ultrasound, be the physician, check out the person, and start that again. How long can you last? You won't last. It's not sustainable. Probably you'll last about three days.

Same thing here. Can you be a full-time physician and write the book and be a mom or a dad and do it all perfectly? No, you can't. You have to A) prioritize, B) work smart. It still took us a couple of years. The book was finalized in December, 2022, which was last year. And then in March was accepted for publication by Greenleaf Publishing Group. And it's now in print, the audiobook is on the way. And it's happening. It's really, really close. The hybrid publishing it's very, very convenient. They work very well in many, many ways. It's hybrid. You do have to put your buy-in and you have to do work and also financially you will have an interest in it.

However, they will put all the wills in motion for publishing and marketing the book. You tell them how much or how little you want them to do, and they will do it for you, and you will approve everything along the way. I would be more than happy John to have a separate podcast to just talk about the process. It is an amazing process that I knew nothing about, like literally nothing. It's unnerving. And I can say it's like rapid fire sequencing. We have to do this, we have to do this, we have to do this. Why? It has to be approved by you, the author. Because at the moment, they accept you and then you sign the agreement with them. We'll also sit down and figure out when do you want this book to be released? And now everything starts dominoing backwards because you are on a schedule. And everybody's going to know that your book comes out, in my case February 13th. Well, we don't want to arrive on February 12th and realize there is no book to be presented.

John: Yeah, absolutely. If I'm not mistaken, and I've talked to other authors, some of the benefits of doing the hybrid is you definitely have more control. If you do a big publisher, one of the big three or four, number one, you lose pretty much all control and they're going to tell you what title they want and how the chapters are going to be put. And it takes a lot longer. And in a hybrid, I think you get to reserve a little bit more of the income that comes into. I'd say most of the guests I've had that have written books have gone that route. Now I've got a few that will self-publish, but I think most everybody's going the route you've gone, especially with one of the really good top-notch hybrid publishers. Boy, this sounds fantastic.

Dr. Luissa Kiprono: Well, just to put a little bit of data out there. 80% of people want to write a book. Out of which 1% finish writing the book. Out of which 1% get accepted for publication. Even with all that, there are about a million books coming on the market every year in the United States, and 4 million all comers, meaning 1 million that are accepted for publication and four millions that includes also self-publishing a year. It's crazy. That's just amazing to me how much influx it is.

John: Well, congratulations.

Dr. Luissa Kiprono: Thank you.

John: Here's what we're going to do. You're going to have to remind me about a week or two beforehand so we'll promote that at that time. And we can obviously promote it through this podcast, which it'll probably be the beginning of January when people see this and hear this. But definitely do something special for that February date. That'll be fun. Tell us where to go to look for that.

Dr. Luissa Kiprono: Okay. To learn more about my book and my platform, my website is www.drluissak.com. My email is hello@drluissak.com. If you sign up for my newsletter, you're going to get it in the mail, but also bring up the updates, any news that come out. And also just to put it out there, just in case anyone wants to join me, February 13th, that will be a destination book launch.

John: Okay. You're going to have to send me the specifics on that so I can put that in the show notes.

Dr. Luissa Kiprono: Sure, we can do that.

John: All right. I think we are getting out of time at this point, but this has been a very interesting episode. We learned a lot about how to implement telemedicine, the pros, the cons, some things to keep in mind. Definitely some good advice. And then about a memoir that's coming out... From the time this is posted about a month after this is going to be posted. So, maybe we'll have some people follow you for that as well. Any last words of advice to our listeners about anything that we've talked about today before I let you go?

Dr. Luissa Kiprono: What I would like to say is that my advice regarding personal growth, follow your heart's desire. If there is something that keeps you up at night, an idea or a goal, whether it is opening a practice, starting a business, or just open up a flower shop. And if that is what you really truly want, if when you talk about it, your eyes are sparkling and your heart starts beating faster, do it. Just do it because you'll never regret it. And don't be afraid that you're going to fail because you know what? You are never going to know unless you try something, especially when you really, really are passionate about it.

John: Thank you for that advice. Very inspirational. You've got this book pretty much in the can we would say. Are you thinking of doing another book later? I'm going to ask that question. Or are you going to rest for a while and think about it?

Dr. Luissa Kiprono: I am going to rest for a while. These last few years have been quite eventful, especially last year with the practice and the entire book publishing. So I will take a break and let's just see. I won't smell the roses for a couple before I decide where am I going to move, what's my next steps are in life.

John: Yeah. Okay. Well, I'll be watching from the sidelines and if you do something else really interesting, I'll have you back on the podcast. Thanks a lot for being here today, Luissa. It's been very fun and educational really.

Dr. Luissa Kiprono: Thank you. I really appreciate the time. And thank you for inviting me for this conversation, John. Happy holidays.

John: You too. Bye-Bye.

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How to Go from Surviving to Thriving in a Remote Healthcare Job – 278

John Jurica — Tue, 13 Dec 2022 15:30:44 +0000

Interview with Dr. Frieda Wiley

In today's episode, Dr. Frieda Wiley shares her secrets for thriving in a remote healthcare job.

Frieda is a pharmacist who worked remotely for several years and is the author of Telecommuting Psychosis: From Surviving to Thriving While Working in Your Pajama Pants.

Our Sponsor

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

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

Telecommuting Psychosis?

Telecommuting Psychosis is not a recognized clinical condition. However, Dr. Wiley used it in order to draw attention to the potentially severe consequences that can occur from the isolation and lack of direct human contact that results from working remotely.

Frieda wrote the book to shed light on this issue, and to share techniques for preventing and reversing the adverse effects. Simple self-care measures that are described in the book can greatly help to eliminate these effects.

Effects of Working Remotely

The drawbacks of working remotely in healthcare vary depending on your field and industry. But some of the more common psychological effects include:

depression,
feelings of isolation,
trouble unplugging from the online world,
lack of external stimulation, and
feeling invisible

There are direct medical effects resulting from long hours spent working remotely, such as elevated lipid levels, heart disease, low vitamin D levels, and weight gain. And there is the frequently encountered reduction in career advancement due to less direct interaction with supervisors and others in the workplace hierarchy.

Dr. Frieda Wiley's Advice

Just know that you have to be your own advocate for your work environment and for your health and that there's no shame in seeking help.

Thriving in a Remote Healthcare Job

Dr. Wiley has several suggestions for thriving in a remote job. To maintain mental health be sure to manage your social health, use an accountability partner, create a social calendar to enhance human interactions, develop a daily mindfulness practice, and “become a tourist in your own town.”

To improve your physical health you should first check the ergonomics of your remote working environment, schedule physical activity and formal exercise, supplement Vitamin D if needed, and take breaks every 20 minutes to address eye strain and dryness.

Properly integrate childcare into your workday, if necessary. Keep workspace separate from other areas. And set boundaries with friends and people who live with you.

Summary

Dr. Wiley addresses these topics and others in much more detail in her book. Go to her website to order it. If you have any questions regarding any of these subjects or would need coaching on how to identify and deal with the drawbacks of working remotely, you may use the contact form on her website, or send her an email at frieda@friedawiley.com.

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 278

How to Go from Surviving to Thriving in a Remote Healthcare Job

- Interview with Dr. Frieda Wiley

John: When I was thinking about bringing on today's guest, I was really positive about it for a number of reasons. When I was chief medical officer at the hospital I worked at for 14 years, one of the people I worked most closely with was a pharmacist, a PharmD like our guest today who ran the pharmacy department at the hospital, and the whole system for that matter.

I'm also very fond of writers, medical writers in particular. And so, I'm really pleased to be able to have today's guest join us and talk a lot about these different things and about a book that she just recently wrote and published. So, with that, I'll say thanks for joining us today, Dr. Frieda Wiley.

Dr. Frieda Wiley: Thank you for having me.

John: All right. Most of my guests are usually physicians, although anyone dealing with nonclinical careers comes on the podcast that we can get on here to learn something from. Obviously, Frieda is a PharmD not an MD, but like I say, I have a very strong affinity for pharmacists because I worked with so many in the past.

But the thing is, I was not aware of a couple of things. Of course, I knew that there were non-physicians that do medical writing. There are actually people that aren't even clinicians that do medical writing. So, I'm interested to hear about that from Frieda today.

And the other is this whole concept of telecommuting and telemedicine, telehealth. I guess I kind of knew in the back of my mind if pharmacists did that, but I really had no idea the scope and the amount that they did. I'm looking forward to learn about that and about some of the downsides of telecommuting. I guess you would put telehealth in that category. A lot to talk about today. Tell us a little bit about your background, your education, Frieda, and then your early clinical work.

Dr. Frieda Wiley: Sure. As you mentioned, I am a pharmacist by terminal training. I actually had a previous career as a chemist in the aerospace industry. It's a brief career as a break between degrees. So, my undergraduate degrees are in biochemistry and Spanish.

John: Interesting.

Dr. Frieda Wiley: Yeah, I mixed it all in there. And when I went to pharmacy school, I kind of focused more on industry. That was my goal to actually work in the pharmaceutical industry. And that was really my introduction into medical writing. I went into standard or more traditional pharmacy practice I should say when I started.

So, I started as a community pharmacist originally as a floating pharmacist where I was traveling to different pharmacies and leaving other pharmacists who were on vacation or gotten sick. I was working for a small grocery store chain that was based predominantly in East Texas, rural areas. And about three months into that I was approached by management to work in medication therapy management, which ultimately became my introduction into remote work because I became a hybrid worker. Because I was a floating pharmacist who already had experience with different stores in different regions, different pharmacies. It made sense to have me travel to these different pharmacies and meet with patients 101 to review their medications. And because there wasn't a central office and I had a lot of administrative work to take care of phone calls, paperwork and things of that nature, then I worked from home at a regional office one to two days a week.

John: Okay. Yeah. So, you got a little taste of that at that point.

Dr. Frieda Wiley: Right. And then I stayed in that role for about another year and then transitioned into working for a managed care firm where I did the exact same thing but in a completely remote setting. I was hired originally as a Spanish speaking pharmacist, serving the greater New York City population. And originally, I was under the impression I was going to have to move to Hoboken, New Jersey or somewhere in the New York City vicinity for that job and obviously become licensed in that area.

Telemedicine laws, as I'm sure you're aware, can be different, a little bit more flexible when it comes to licensure per state. And so, when the company found out that I had some remote experience already under my belt, they pitched me the idea of being fully remote because they wanted to get a head start and they knew it would take me a while to relocate.

John: Okay. I was just to say that can sound quite attractive. And again, I have to remember that there's probably different roles in let's say pharmacy and pharmacy services versus let's say a physician. But the physicians I talk to, they're like, "Oh yeah, the thing I love about telemedicine is I have more control. I can do it when I want to do it. And I don't have to really worry about getting dressed up and putting on a tie or whatever." But it sounds attractive, I would think to you as well. But I think you then later learned there were some downsides to it.

Dr. Frieda Wiley: Yeah. There are downsides to it. And I think it depends on the industry you're in and the type of work that you do. There are many other areas in which there are pharmacists who are involved in patient care working remotely and using telemedicine. But in my case, I wasn't able to work what I wanted to. In my first pharmacy job, I set my own schedule because I'm scheduling appointments with patients and different things.

Well, in this case, they had the administrative part already taken care of and my entire work day was scheduled from 08:00 to 05:00. It became frustrating when it came to networking and what if I needed to go to the doctor. I would have to take vacation leave in order to do that because I didn't have the flexibility in my schedule that other telecommunicators sometimes enjoy.

John: Yeah. Actually, that reminds me of another example. And I do think there are some physicians who are locked into those kinds of schedules as well and other clinicians. For example, one of my children is a social worker and she ended up wanting to work remotely because she was moving at several different times. And she's starting to do, basically, it was utilization and case management type job remotely.

But you're right, they supplied the computer, she couldn't leave the house when she was working. She had set hours. So actually, it made her life no more flexible or easy to adjust to things than it was when she was driving into work. It's not always what you think. And some of those are definitely locked into a normal 09:00 to 05:00 routine, which can be more than 09:00 to 05:00. In fact, in a lot of these cases, they have a certain number of cases they have to do. And if they don't get it done in their eight hours, they might end up working nine or 10 hours. I don't know if that applied to you or not.

Dr. Frieda Wiley: In some cases, it did because, especially towards the end of the year with that particular company, they had numbers to meet and for some reason they realized that first year that we were way behind on our numbers in September. So, then our working hours were extended and, in some cases, we had to work weekends. So that quality of life that originally attracted me to that position, it went away very quickly.

John: Okay. Now I would like to put a pause on talking about this particular part of your life and how it led to writing the book only because I wanted to get a glimpse into this because you did mention, of course, that you were working at the pharma companies and you've done medical writing. And I'll just tell the listeners and I'm going to bring up your website right now, friedawiley.com. It is a place where you can purchase the book that we're going to be talking about.

But it's a good example for people that are interested in medical writing or maybe they're just getting into medical writing, it's an excellent website. It kind of puts everything out in different pages as an overview of what you do. You've got testimonials, I believe. You've got examples of the kind of writing you do. You've got a tab that says portfolio, for example. So, tell us how you got into medical writing, just a glimpse of some of the writing you've done and who you've done writing for.

Dr. Frieda Wiley: Yeah. As I kind of alluded to earlier, when I was in pharmacy school, I had some rotations in the pharmaceutical industry, and specifically back when they still had a pharmaceutical division before they divested. And even though my internships were mainly in regulatory affairs, there were times where I supported the medical writing team, especially during that second summer, which introduced me to the concept. I'd never heard of it at that point.

And so, when I began practicing, I started freelancing while I was practicing. And it started out with, I remember sitting in a doctor's office one time and I saw this magazine. And at the time it really looked more like a slightly more glorified patient handout. I remember reading the content thinking I could do this. I had already written some pamphlets and things when I was on rotation with Indian Health Services. And I saw that as kind of a translation of that.

And so, I actually reached out to the company and I told them who I was and what I wanted to do. Not really the best approach. I really didn't understand the concept of pitching and things like that, but I didn't really hear anything else from them until a year later. And the editor reached out to me and said, "I'm sorry it took so long to get back to you, but we'd be interested in having you write for us."

And then also with doing the medication therapy management, because I was responsible for creating documents that went to the patient back then, this was before the government had set standards for how the documentation would look and different things like that. So, I had to come up with my own templates. I had to come up with a core messaging and phrasing that I might want to use, and then also customize the information that was included, going to each patient as well as to the prescriber.

That skillset helps me become bilingual, not just Spanish English, but in terms of being able to communicate in plain and scientific language. And I leveraged that as I pursued other writing opportunities.

John: Another example of each one of us has certain skills that we accumulate over time, and your set of skills might be different from mine, but they can all be leveraged in a different way for a particular job or series of jobs. It's just a good example of someone who's been a freelance writer, that's made a good living and enjoyed it and leveraged their clinical background and so forth. That was like I said, one of the reasons I wanted to have you come on and talk about that a little bit. What kind of writing have you done besides what you just described? Just some samples of some of the kind of writing that you've participated in.

Dr. Frieda Wiley: Right, sure. I have written slide decks. I've written needs assessments, advisory board summaries, executive summaries that they require. I have written scripts not only for presentations, but also for e-learning, webinars, different things like that. I have also written patient handouts as well as marketing information that would go to physicians as well as general audiences.

John: Yeah, I think it's easy to say, okay, wait, I can only write, let's say maybe CME manuscripts and maybe something for the public. But there's so many different variations, and I've heard this before, needs assessment, learning needs, slide decks. And you're doing something for the advisory board, is that what you said?

Dr. Frieda Wiley: Yes.

John: Those things are beautiful, awesome presentations. You've got to really have some skills to do that.

Dr. Frieda Wiley: Thank you.

John: Because I've been on the receiving end of some of their presentations and they're almost overwhelming sometimes and the way they're created. There's a lot of information and it's very professional. It kind of ties into what you did later and what we're talking about today is writing your book. Obviously, you're a writer, you know how to write, and so you leveraged that to write something that wasn't in that category of medical writing, per se.

Dr. Frieda Wiley: Yes. I loved writing as a child, and that was sort of a childhood dream. And it's one of those things where as you get older and you find out the whole thing that you can do anything is kind of a myth. I had "writing a book" as one of my goals, especially once I started medical writing. It rehashed that dream. And when I became a fully remote employee, I noticed that I just didn't feel as awesome as I did when I went to the office every day. Every job, every setting has its stressors, but I started to notice that I wasn't going out as much. I wasn't socializing as much. I was depressed. I became depressed. I felt isolated even more so because initially I was the only remote worker on my team, and everybody else was in New Jersey and New York. That didn't help either.

And this was back before most companies had the infrastructure to support different types of engagement. So, all of our meetings, I would dial in via phone, a lot of times the call quality would be bad. And because my voice doesn't carry very well and everybody starts talking, I would get drowned out. I would just kind of sit there twiddling my thumbs until there was a break.

John: Yeah.

Dr. Frieda Wiley: Yeah. That's what prompted me. I started journaling initially because I reached out to people and I was telling people, family, members and trusted friends "Look, something's not right. I don't feel myself." And people, we're dismissive because the thought is "You have the dream job when you work from home."

John: Yeah. Well, let me mention the name of the book now before I forget to do that. "Telecommuting Psychosis: From Surviving to Thriving While Working in Your Pajama Pants." You can get that book if it's intriguing, which it sounds to me. I've looked at it and at friedawiley.com/book. So, if you go to her website, you want to look at all the other information if you want to be a medical writer, but then she also has a page with the book on it where you can order it or you can go directly to Amazon. But that sounds pretty extreme "Telecommuting Psychosis." That's a little more than feeling something wasn't just right. So, how did we get to that point?

Dr. Frieda Wiley: Right. Yes, as an obvious disclaimer that it's not an official clinical term, it doesn't show up in the DSM-5 for whatever. But the reason why I chose that title was to call some attention to the situation. And kind of extrapolating from the concept of postpartum psychosis versus depression.

No, I didn't have thoughts of harming myself or harming someone else, but I did reach a point of just extreme mania where I was frustrated. And a lot of that had to do with the fact that nobody seemed to understand or empathize with what I was going through. And I later came to realize that the telecommuting concept, the mental fallout that occurs with it, is something that oftentimes people sweep under the rug.

At the time when I became an overnight telecommuter, unexpectedly, like many people during the pandemic, I didn't have the luxury of having this open forum where people spoke out about it and supported each other. There were very few studies available at the time that talked about it. The pandemic changed that. So, that was also to finish the book because suddenly I had the data to back up everything that I had been saying.

John: Then you applied the skills as a researcher that you did for your medical writing obviously for this book. I'm trying to think what's the easiest way to go through this in not great detail, but what are some of the common effects, adverse effects, and then later we can talk about ways to counteract them or prevent them. And I know you had the eight or nine myths that you talk about, which maybe also relates to that. So, go ahead and just tell us more about this topic and the potential adverse effects of it.

Dr. Frieda Wiley: It's many of the things that I mentioned earlier. The isolation, the depression. And obviously with depression and having a sedentary job and all of that, then you can also expect to see an increase in poor outcomes, poor biomarkers and different things like that. So, LDL, heart disease and things that fall out from that. The lack of vitamin D because you're not getting outside as much or you're not getting outside during the peak hours in which your body would absorb natural vitamin D that has been linked to heart disease, cancer, mental illnesses. We know that people who live in Scandinavian parts of this world are actually more likely to have heart disease and schizophrenia. And there have been studies to show that there's an association between those conditions and the lack of vitamin D. So, those are just a few of many examples.

John: Since you found the research that people are starting to recognize this, are you and others recommending certain ways to counteract these things? Just take it from there.

Dr. Frieda Wiley: Yeah. A lot of it, unfortunately, has to do with self-management. Acknowledging that you have a problem is the first step, or saying that something's not right. Because mental health still carries a stigma. The pandemic helped to erase some of that, but we have to create a safe space for people to say that they're not okay and to seek help.

So, my goal with the book was to take the guesswork out. Start paying attention. We need to be more self-aware. Are you taking breaks? You need to be taking breaks every 20 minutes or so anyway for your eye health. That's one part of it. And making sure that you're moving, making sure that you are sticking to a plan, make up a plan for yourself where you make sure that you are chunking your time, you're managing your time wisely. And part of that includes the self-care element. Self-care not only in terms of physical health, but mental, because it all works together.

John: It's easy to say of course, but I know for a fact that I should exercise three times a week minimum, probably every day. But it's like you almost have to pick your phone up and put it in there as a scheduled event. And if you can do that, great. And you're talking about the same thing. And if you're at a job that doesn't allow that or doesn't enable you to do that, then you should seriously think about not doing that job and finding an employer that has a little more flexibility and allows you the freedom or a little bit of those breaks. On a 09:00 to 05:00 job, you should have 30 to 60 minutes for lunch, for example.

Dr. Frieda Wiley: Yeah. And you raise a point about putting it in your phone or scheduling it. And I was serious when I said that. Sometimes it's an accountability thing. Having an accountability partner that can be very helpful. One of the things that I did pre pandemic is I used to drop in on teleworking groups. For example, I used to go to one in particular that would meet up in different places in Austin when I was in the Washington DC metropolitan area. It was during the pandemic. And so, the co-working groups had all gone remote if they were still active, but we still had times where we would work together. And sometimes that would include scheduling little mini breaks where we would do meditation exercises or get a move around scheduling into the breaks, all system socializing, because still some type of human interaction is very important. We're not meant to be isolated from each other.

John: Yeah, absolutely. Let me do this. There's so much in the book that you address in terms of recognizing and then trying to take these steps to prevent it. Again, let's talk directly to the listeners here. You're doing some kind of at home remote work similar to what Frieda has described. Because we tend to ignore how we're feeling, we tend to ignore what's happening to us. Again, maybe two or three of the symptoms or two or three physical findings that you think people better get to stop and think about this and get the book and figure out how to overcome it.

Dr. Frieda Wiley: Yeah. One side would be noticing that you're not moving around as much anymore and may start to have weight gain. Maybe your back starts to hurt. That's another thing. You have to be your own ergonomics adjuster. You have to figure all of that out. And so, being mindful of that. And you may also notice that if you're not careful, seriously, a few days may go by without leaving the house. Especially if let's say the kids take the bus home or they're driving, why do you need to leave the house? You can have your groceries delivered.

So, making sure that you're keeping track of that. Have I left the house today? Have I socialized outside of my work socializing and thinking about, "Okay, well before the pandemic or before I went remote, what did my social life look like?" Because it's those little interactions sometimes that really add up. And that's something that I really started to miss. And it applies to people, regardless of whether you're introverted or extroverted. I am very introverted. And so, that's another reason why it really threw me off because I was used to doing my own thing and being okay with it.

John: Yeah. I can imagine, I can think of an example like going to the coffee shop. If I'm at home for a week, I would miss that. I don't go every day, but I know when I do go and I am an introvert, I just like to fool around in a sense verbally with the people behind the counter, whatever's going on, mention something. Not political, not controversial. Just to have that interaction with another human being. It's just kind of fun.

Dr. Frieda Wiley: Yeah. The casual banter. And I even talked about that in the book because I missed that as well. So, then you have to think about, "Okay, yes, this is my new office now, maybe it's not going to be the same experience as what it was when I was driving every day, but how can I recreate some of that or capture some of those elements?"

John: It does remind me a lot about the whole issue of burnout and medical care and healthcare in general. And we can get into a very deep hole, deep in the burnout syndrome before we even realize that we are. And so, this sounds like it's the same thing.

One of the things that I tell my listeners and coaches, mentees and so forth, is that it does make a difference where you work. And some places are awesome to work for and some are terrible because they ignore things like this. Are there any ways to figure out as you're looking? Because a remote job still sounds good. I can be home, maybe I have to be home when my kids get home and or I have an elderly parent I'm helping to take care of. I need to be nearby. Okay, fine. But what can I look for in an employer or let's say if you're a freelancer, it's a little different, but you're still a 1099 employee in a sense. What do I look for?

Dr. Frieda Wiley: Yeah. I actually included a little questionnaire at the back of the book to help readers. So, a lot of it starts with the interview process. You need to be very specific and focused about the questions that you ask, making sure you have a really good understanding of that working environment. So, asking what the level of engagement looks like. How do I interact with other employees?

And this may sound obvious now, but because of my frame of reference, it really wasn't. Find out if you are going to be on a team where there are other remote workers. That's important just because of employee conflict, jealousy, animosity, backlash, things like that. Finding out what sorts of infrastructure they have in place that will support remote workers.

And also, there are different things you can talk about to try to get a full understanding of your work. Sometimes the hiring manager will give clues that they maybe are a micromanager or don't really respect work-life balance. So, what I have found is that sometimes the core messaging and the core values that may show up on a company's website may not necessarily align with the role that you're in. It really depends on who your direct line of management is and how much they are working to support that culture. And then of course, if you're able to talk to people within the company offline, and also reviews. So, the nice thing now is if there are so many company reviews that you can kind of do some research and that will also help guide some of those questions that you want to ask.

John: Yeah, that makes sense. And it's related to looking for any job really, to try and get some honest feedback from maybe people that weren't set up to interview you or for you to meet, but that are just there. Like in a hospital you go talk to just some of the nurses or some of the staff or the maintenance man or whatever. Just because you need some hopefully unbiased feedback before you make a final decision.

All right. Tell us again where the website is and the name of the book and all that, because we don't want to forget about that before we let you go.

Dr. Frieda Wiley: Yeah. The website is friedawiley.com and the book is called "Telecommuting Psychosis: From Surviving to Thriving While Working in Your Pajama Pants."

John: Okay. And they can get it by going directly to Amazon or going to your website.

Dr. Frieda Wiley: Both. Go to my website if you can't remember the title and it will take you straight to the Amazon page.

John: Okay, great. And of course, I'll put links in my show notes. I have a last question. If someone who has maybe not done telehealth or telemedicine or telecommuting or remote job, any last bits of advice for them before they take the plunge?

Dr. Frieda Wiley: Yeah. Don't be afraid of it just because I wrote a book about losing my mind. Just know that you have to be your own advocate for your work environment and for your health and that there's no shame in seeking help.

John: Excellent. Thanks. Thanks for that. That's very useful. And I will also remind you, my listeners here in the nonclinical nation, to go to the website if you're a medical writer or a fledgling medical writer because you'll get a lot of good ideas from what Frieda has done. And yeah, pick up the book while you're there.

All right. Well, thank you very much. I appreciate this Frieda, and hopefully we can keep in touch. Do you have any plans to write a new book anytime in the near future?

Dr. Frieda Wiley: I actually have some children's books in the works, so I'm excited about those.

John: Just let me know. I have no problem sending out a little announcement in the podcast or in my emails if you get those published. So, keep us informed.

Dr. Frieda Wiley: Thank you. And thank you for this opportunity.

John: You're welcome. All right. Bye-bye.

Dr. Frieda Wiley: Bye-bye.

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Create a Life with Freedom of Time, Place and Means – 266

John Jurica — Tue, 20 Sep 2022 12:40:56 +0000

Interview with Dr. Cherisa Sandrow

In today's podcast, Dr. Cherisa Sandrow explains how she created a life with freedom of time, place, and means (money).

In Episode 222, Cherisa offered her expertise in telemedicine. Now, she has created a comprehensive program with didactic lessons, and group and individual coaching to teach doctors how to live lives of purpose using telemedicine as a tool.

Family physician Dr. Cherisa Sandrow spent 15 years practicing traditional family medicine, including obstetrics, after graduating from the Philadelphia College of Osteopathic Medicine.

She made the switch to telemedicine in 2015, leaving her busy office-based practice behind. After completing the Maxwell Leadership Certified Team Coaching, Speaking, Leadership, and Training Development Program, she joined the John Maxwell Team as a speaker and instructor. And she began coaching and teaching other physicians to use telemedicine as a temporary or long-term option to gain more freedom and flexibility.

Our Sponsor

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

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

Life with Freedom of Time, Place and Means

Dr. Cherisa Sandrow will be launching a new course called, “From Here to There – Leveraging Virtual Medicine“. She was inspired after participating in the Empowering Women Physicians Programs.

Sandrow Consulting gives physicians tools to create a life with freedom of time, place, and means by using telehealth to replace income; especially physicians who are exhausted, stressed out, burned out, or who need flexibility and independence for other reasons.

This new course lasts for 10 to 12 weeks and is supported by a dozen other career transition experts.

Dr. Sandrow will assist you with upgrading your résumé, LinkedIn profile, and bio as part of the application process. The program includes instructions on how to set up the telehealth workspace, the medical component of telehealth, what to expect from physical exams, and then how to document properly and efficiently.

Dr. Cherisa Sandrow's Advice

We live in this world of mentorship and colleagues… there are people that have done what you want to do that can guide you… and that's always been my mindset… the other thing is that we all have this incredible resilience…

Summary

Telemedicine is a proven solution. However, it is not necessarily the end goal. With the freedom and flexibility it offers, we can create space to rediscover our passion and sense of purpose in life.

You can learn more about From Here to There: Leveraging Virtual Medicine by going to nonclinicalphysicians.com/freedom/

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

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Transcription PNC Podcast Episode 266

Create a Life with Freedom of Time, Place, and Means

- Interview with Dr. Cherisa Sandrow

John: I'm always looking for new programs, courses, books, other resources that will help physicians find more freedom and satisfaction in their lives and maybe also transition to a newer career that builds on their background in medicine. But anyway, that's why I'm bringing back today's guest who's been here before, and she's going to tell us something more about what we spoke about last time and some new things going on. So, with that, I'd like to welcome Dr. Cherisa Sandrow. Hello, and welcome back.

Dr. Cherisa Sandrow: Hi, it's great to be back. It's great to see you again.

John: What you taught us last time and talked to us about last time was so practical. Now it's been almost a year and you've got a new program coming up. And so, I just wanted to catch up with you and kind of figure out what's going on and how it might benefit you, my listeners out there. So, tell me a little bit about what's happened since we last spoke almost a year ago.

Dr. Cherisa Sandrow: Yeah. Great. The world has opened back up which has been awesome. COVID was such a time of isolation for so many. And so, my family and I moved from the Portland Oregon area to Bend, Oregon, which has been our vacation place. It's been one of our favorite places to visit over the past 10 years.

And so, the move is awesome, but also has been a little challenging in regards to community. Between working from home and moving to a new town and COVID, it's challenging to create community, and I know I'm not alone. I actually just saw a post on a Facebook page about a similar situation. I feel like so many physicians and I can speak more directly to female physicians. So many female physicians just feel isolated and are seeking connection. And I'm sure that's true of everybody.

When I in the fall had decided I wanted to put my curriculum onto video, I had been listening to Sunny Smith coach on a semi-retired MD course that I was taking. And as I was listening to her coach, I decided that I wanted to enroll in her summer EWP, the Empowering Women Physicians coaching course. And so that just wrapped up, and it was such a powerful summer of connection and community.

During that course, actually very early on in the course, I was inspired to create this entirely new direction for my consulting business. And so, I'll be launching a course called From Here to There - Leveraging virtual medicine. And I am just in such a different space going into it. I actually was saying I'm feeling like I am lacking joy and connection in my life. And now I feel like I have this entire community and I feel so much more inspiration in my life. So, that's really where I'm at and my girls are just starting school this week.

John: Nice. A little trivia here for the listeners. I'm going to quiz you on this maybe six months from now, but I actually have been in Bend, Oregon once and I was rock climbing with a coach or a guide. It's the only outdoor climbing I've ever done in my life. I'm not a rock climber per se, but Bend, Oregon is an awesome place. It's just like you are living in constant vacation, aren't you, when you're in that part of the country?

Dr. Cherisa Sandrow: That is why people move here. The people that move here are avid outdoor adventurists and love to be active. Basically, it's a town of people that are wanting to live in that environment. And it's grown so much, especially during COVID. Many people from California have moved here, which I think that Californian have moved everywhere.

John: Well, it's a rock-climbing Mecca from what I understand. So, you and your whole family has to learn how to rock climb if you're not already doing it.

Dr. Cherisa Sandrow: When we moved here, it was almost one of the things, not the highest thing on our list of reasons to move here, but it was on that list. So, my oldest daughter is a little rock-climbing prodigy. And so, when we put her on a rock wall a couple years ago, she just went right to the top and we were like, "Holy cow." And so, she rock climbs regularly. She's on the rock-climbing team.

John: Oh boy. Yeah. You're going to have to send some photos out on LinkedIn or something.

Dr. Cherisa Sandrow: Okay. I'll do that.

John: All right. But let's get back to the matter at hand here. Now you have been going through a lot of different things, but one of which is creating this program and kind of expanding it from what I understand.

Dr. Cherisa Sandrow: I'll start with why me, why would I be the person to teach this? So many physicians are wanting to transition to telehealth in the last couple of years. COVID just brought it to the forefront, but it's challenging to know how to even get started and how to make it lucrative, how to actually replace your income with it. And so, I'm a family practice doctor for the first 10 years of practice. I practiced full spectrum family medicine with OB.

And I started working in telemedicine in 2015. I stayed before it was cool and I was doing a little bit of telehealth on the side. And so, I I did that for a year and a half where I was just working with one company, like moonlighting with them, essentially. And in 2017, I transitioned to telemedicine full-time and I was able to not only replace my income, but essentially double my income and cut my hours that I was working in half. And that's what physicians want to do.

And in 2020, I had a lot of physicians that were reaching out, asking me how I did this. And so, I decided to create a curriculum to teach others and I have been coaching one on one over the past two years with using this curriculum. And so, I've created this freedom and flexibility in my life, and I'm super passionate about teaching other physicians who are burnout and wanting a change, how to reclaim and transform their life.

Sandrow Consulting is the name of my company. We help physicians acquire the skills, the tools and the mindset so they can leave their practice and use telehealth as a vehicle to replace their income and give them more time and freedom to figure out what else they want to do in their life. And so, I will take people through all of the steps in the process to get up and running and actually replacing your income will provide the one one-on-one end group support through that transition.

My husband is actually going to be partnering with me on this next phase of our journey. He's been kind of the silent partner as of now, he's been foundational for me though in creating the success that I have. He also is a recovered burnt-out sports med chiropractic physician. He owned a practice, and he has been in the coaching space for the last eight years. And his focus has been really functional medicine and wellness, and his expertise that he's bringing is this is business ownership mindset productivity and system creation, and creating a sense of wellness. And so, our goal is to help physicians just rediscover our purpose and reignite our passion.

Why we went into medicine? We went into medicine because we're super passionate about serving and helping other people. And there's a deep sense of purpose that got us there because in order to get into medical school, we are the top. We go above and beyond. Then you get there and you just spend more than a decade in training and you sacrifice your life and you put everything else on hold and you go into hundreds of thousands of dollars of debt thinking that after you're done with your training, life will be awesome.

And then we get there and life doesn't feel awesome for a lot of physicians and we feel trapped because what else are we going to do? We have all this money to pay back and how else are we going to make a quarter million dollars a year? And we don't realize how much we actually are capable of doing and how many opportunities are out there in the world, which is why I love everything that you do because you start planting seeds and opening people's eyes.

And so, I had my husband go through a program with Caroline Leaf, who is a neuroscientist. She wrote a book called "Switch On Your Brain" and another book called "Cleaning Up Your Mental Mess." She has this neuro cycle program that helps us change our toxic thoughts and rewire our brain. She's studied neuroplasticity for 35 years. And so, she started a facilitator program this year. The goal for me having my husband go through this training is that cleaning up those toxic thoughts and helping people rewire their brain is foundational in recovering from burnout because we just get stuck in a certain way of thinking. And actually, if somebody were to change from a clinical practice or a hospital practice where they're burnt out and they start doing any other thing, if they don't change the toxic thoughts and the patterns that we've developed that is like this work course, just drop work till you drop sort of mindset, we're just going to do the same thing in another field. And so, along that journey of transition, a huge piece of the transition is changing the way our mind is working. And my husband is going to bring that element.

And then the other piece of it is prior to the transition that we made, we were struggling. I mean, we were so close to divorce and we had two children. And my older daughter has some high needs and special needs. And so, through this transition, we were able to heal our marriage and just redefine our core values and redefine ourselves, our own way of thinking. And we are functioning in the world, we are showing up in the world. And so, we are such a great example for other people who are kind of in the same space.

John: Yeah. That gives me a pretty good idea, I think and the listeners too, what kind of got you here. I will say this, that it's funny. Physicians become so desperate to leave, but it's funny because they feel like they're compelled to do something. And the question I get all the time is "I don't know what to do. I don't know what to do."

And I think by addressing all the issues you mentioned in addition to what to do as far as the actual job, but to have the job included, look, here's an easy... Well, it's not easy. It takes work and it takes learning, but here is a proven solution, telemedicine. You can make the same amount of money unless you're a multimillion-dollar high RVU interventional something or other. And you're going to make good money and you're going to have flexibility and freedom and time if they do it the way you do it.

So, I like it. It's not going to be perfect for everybody, but it's going to get people into something quickly and to still pay their bills and pay back their loans. And then if they even want to shift, it sounds like they could do something a little different later, but they have a solution right now.

Dr. Cherisa Sandrow: Yeah, that's absolutely my vision. Telemedicine is not necessarily the end goal. It's freedom and flexibility in our lives and reigniting our own passion and purpose. And telemedicine is a vehicle that I've used. And so, I can teach other people. But then once you get that time back in your life and you heal a little bit from the burnout, then you have the capacity to explore what else you might want to do.

And truly telehealth, the future of telehealth is way more than what most people realize. The American Medical Association adopted a policy back in 2016 that was aimed to ensure that med students and residents learn how to use telemedicine in their clinical practice. And so, this has been like even before COVID a plan for the future of our healthcare system. And in that, they had said as innovation and care delivery and technology continued to transform healthcare, we must ensure that our current future physicians have the tools and resources they need to provide the best possible care for their patients. And for sure, I think once people get into the telehealth world and they start to realize how many opportunities are available, it starts to become more clear how much telehealth and the virtual medicine world is really going to be able to transform our healthcare system. And so, that's definitely exciting.

John: We're talking about, "Well, you could be burned out, you could just be unhappy." What have you. But I'm assuming in your mind, you have a clear picture of who is this ideally, the program you've already been doing with your coaching and so forth, who is the ideal person that would take advantage? I'm sure it's not someone who just had a thought like, "Oh, I'm just a little unhappy." It's probably someone who's really kind of... They don't necessarily have to be burnt out. Tell us about that. Who would be the ideal person?

Dr. Cherisa Sandrow: Yeah. I feel that it's important for people to be in practice a few years before transitioning to telehealth. And so, I don't know that I will turn somebody away who is straight out of residency, but I'm absolutely going to encourage them to do some in-person practice in addition to telehealth, if they want to start doing telehealth early on. And so, really my work is geared towards helping physicians that have been in practice and are struggling to balance work, family and their own life, their own wellness. I think that's most of us though. But not everybody wants to leave practice actually. There's a lot of people that are not even considering the options.

My client is the person who's tired, stressed, and burnt out, or needing flexibility and freedom for some other reasons. When I first put the course together, it was during COVID. And so, my mindset was maybe they're caring for an elderly and they don't want to be exposing them to COVID or maybe they need to be available for their kids that are homeschooling. But there's always life situations that happen and our typical practice doesn't give us the freedom and flexibility. Maybe it's a single mom, a newly single mom or newly single parent, who just has to have more flexibility than our typical practice allows.

John: Yeah. It seems obvious, when you think about telehealth or telemedicine as opposed to traditional practice, one of the big differences besides being on call and having going to the OR in the middle of the night or something is just usually at 08:00 to 06:00. I wouldn't say 09:00 to 05:00, but there's set hours. Whereas I think in most forms in telemedicine you can choose to have more flexibility. You can be taking calls on the weekends or at night or different time zones. So, that part of it, that's where it sounds like it's very flexible, but you have to be disciplined, I would assume.

Dr. Cherisa Sandrow: Yeah. That's actually very true. Well, we are so used to being so busy with somebody else controlling our schedule that when we transition to probably a lot of remote work, but when we transition to business ownership, we have to create our own schedule. Or we will either end up just doing the same thing, working like never leaving your office or you won't ever get work done, because you'll do laundry and you'll have this appointment and that appointment and you want to work out. And so, it is important to learn how to create a schedule, which is actually something that I teach. I think it's important enough to focus on and learn. We don't learn that.

John: The other question that I come across this fear of the unknown is that the physicians that are looking to make a change, they can't really envision what the steps are. They don't know what they should do. "Should I do a CV? Should I start looking? What do I do?" And I think when they have someone like you that can sort of walk them through the steps, there's certain milestones or things that you'll be looking along the way. So maybe I'm assuming that your program kind of addresses those. Are there some big major milestones that people have to kind of get through in this process?

Dr. Cherisa Sandrow: Yeah. Absolutely. And we do all of that. State licensing, getting licensed in multiple states is the thing that kind of takes the longest. And so, we start that process. We help people start that process really in the very beginning, because that is really the piece that we're going to be waiting for at the end is for those licenses to come through. And then we help people first figure out "What your vision is for your life? What do you want your life to look like? What do you want your practice to look like?" And that helps guide us as to where we're going to go with what companies and what direction we're going to go. And so, we focus in the beginning on rediscovering what our strengths are, what our purpose is, what we're passionate about and how we want to show up in the world.

And then we start identifying what the telehealth business vision is and what our goals are. And then setting up a business foundation is huge. And so, I'm going to have a telemedicine lawyer come in and speak. I have a small business accountant who will come in and speak and a bookkeeper who will come in and speak. I will help people with the things that need to get done. And so, setting up an LLC and talking about business ownership, tax write-offs, that kind of stuff. And then we're exploring the companies and which ones to apply for, which is very overwhelming. There's so many. How to review the contracts with the different companies to make sure that you're aware of what you're committing to.

And non-competes are an issue with a lot of the companies. And it's a reason why I never took a job with any of the telehealth companies, because most of them have these non-competes that make it difficult. If you sign a non-compete in the telehealth world, you can't do anything anywhere in the country. And so, I know that a lot of physicians are struggling with their local non-competes and I think it's really important that if somebody wants to transition to telehealth, then they are looking at taking a job with one of the telehealth companies that they're aware of the implications of the non-competes that they may be signing.

And then as far as the application process I help with updating your resume and updating your LinkedIn profile and creating a bio, and then setting up the telehealth workspace and all of the medicine part of telehealth, what's expected from the physical exams and then how to document. And so, all of those pieces along the way, I'm walking somebody through. And so, yeah, there's actually a lot of pieces in the transition that can become very overwhelming if you're not supported through that transition.

John: I was kind of chuckling a little bit because I had this vision. I have a friend and I think you know this friend I'm talking about. I thought the place where you do this is in a chair on the beach or something.

Dr. Cherisa Sandrow: It could be.

John: It could be.

Dr. Cherisa Sandrow: Actually, if you're not doing video calls, if you're taking phone calls or with asynchronous telemedicine, you can be anywhere. And so, if you're doing video or phone visits, you still want to have a HIPAA compliance sort of space and privacy, it still applies.

John: Okay. Well, it sounds like there's a lot of pieces here and it's probably not all crammed into one week. So I'm just curious how does your program look right now in terms of trying to get through this? And not to get through it, but they have time to digest it, maybe ask questions. So, what kind of a timeframe are we talking about that people would commit to, if they were to pursue this?

Dr. Cherisa Sandrow: It will be 10 to 12 weeks. And I have about a dozen experts that I'm bringing into speak that will help encourage everybody when they're hearing other physicians that have create... It's not just me. There are others that have created this similar success in the telehealth world. And hearing other people's stories and how other people were able to create the success and what their journey looked like is of course encouraging. And then we'll have Q&A time with all of those experts as well.

John: Well, that's 12 weeks, basically, if you're saying to go from A to Z, to go from not even have ever set foot in telemedicine, so to speak. And then at the end to be able to do telemedicine, telehealth, whichever version of the approach you're taking. That's quite a transition in a quarter. But it sounds like there's enough time to really dig into each topic and optimize it and make decisions. Because like you said, I'm getting that there are just so many different versions of telehealth that you can choose from. And I know in our last interview, people should go back, I'll put a link to that, but you explained in detail how to overlap some of these things, or it's not really multitasking, but if there's a downtime in this, you've got this other one you can adjust.

Dr. Cherisa Sandrow: Like how to stack them.

John: Stacking. Exactly. That definitely is something that you want to learn as early as possible, but it does take time I'm sure, once you get going to get that experience and to feel comfortable and to become efficient.

Dr. Cherisa Sandrow: Yeah. I think the important thing though to know is that medicine is still the same. And so, the practice of medicine is still the practice of medicine. And we know that, we've been doing that. The delivery changes. And so, we need to learn, there's a lot of mindset shift and there's a lot of belief that has to happen, but the core skill set, we have that.

For me, the business ownership piece of it is important because we are not trained to be business owners and you can take a job with a telehealth company, but you're not going to have as much freedom and flexibility and ownership of your life and you're not going to be as profitable if you take a job with a company because then you are only able to work in that job. And so, teaching business ownership I think is a huge piece.

John: No, that's absolutely critical, I think, to have that freedom, otherwise you're just kind of back in a rat race to some extent, and you're controlled. And when you were talking about the issue of non-compete, that applies probably to both whether you're employed or even if you do have your own business, if you don't sign the right contract. Because you can get stuck with a non-compete, even if you're an independent contractor.

Dr. Cherisa Sandrow: Yeah. We have to read the contracts and be careful with them, but it can. I think the intention of the telehealth companies with the non-competes is that you're not working with another telehealth company. There is only one company that I've encountered that only required that non-compete of physicians and leadership position. And it was around proprietary information, which makes sense to me. But when a company says you can't work with any other telehealth companies, then if that company is slow, and if you're not busy, then you can't do something else. And then in a lot of them, that non-compete limits you if you decide to leave that company. So, then you can't continue doing telehealth. It's just important to be aware of that.

John: Let's see. Let me refresh the audience's memory here on your site. Your website is sandrowconsulting.com. They can go there and see where things stand. If they want to use a link that I can provide, that's nonclinicalphysicians.com/freedom. And that will take them also to that now. I am helping to promote it. And so, I'll probably come up with some kind of bonus for someone to use that link, but either way they can definitely track it down and I'll put that in the show notes. And yeah, I would love to hear the results of some of your clients, customers four or six months down the road. We'll have to track some of them down and maybe I'll get them on the podcast.

Anything else you want to tell us about the program or any other words of advice or wisdom or encouragement you'd like to give us today?

Dr. Cherisa Sandrow: I just want to encourage physicians to recognize how well trained we are as physicians, but our preparation is to be an employee. And so, we have this really extensive training, but then we end up being put into a job where we're the clinician, we're the practitioner. And that's amazing, but it makes us feel like that's all we can do.

And I want people to understand that there is so much, there are so many opportunities that are available, and there are so many experts that are in these different areas that are available to help guide them. And our whole training model is in this mentorship model. Throughout med school and residency, we're mentored. And even going into practice, we run things by our colleagues all the time. That's how we work. You get another set of eyes to go look at your rash, or you review an X-ray with a colleague or you call the specialist to run something by them.

We live in this world of mentorship and colleagues, but then if we decide to transition out on our own, we think we need to figure it out on our own. So, there's a plethora of information on the internet if we start trying to figure it out on our own, but there are people that have done what you want to do that can guide you. Whether you're wanting to go into pharma or coaching or whatever, real estate, there's these mentors. And I think that's something that I valued always.

And so, when I first started out, I reached out to people and I hired Tom Davis to help me when I first started creating my curriculum because I knew I didn't have some of that business skills. And that's always been my mindset is to hire other people to help me because that's how we're trained, but not everybody realizes the value and importance in that. And so, I think that's really important.

And then the other thing is that we all have this incredible resilience just from going through our training, let alone the rest of life that we've experienced. But as physicians, we are resilient beyond belief. And so, what we have proven in our life that we've already overcome and that we've already have achieved, can get us to whatever that next phase is of our life that we want. And so, I think that it's important for us to recognize that we can do it, whatever it is that we want to do.

John: Yeah, absolutely. We've got the brain power, for sure. We just need a little help and some of these steps to learn things that we're not really aware of or have been exposed to. Physicians are somewhat resistant to coaching in general. They feel like, "Well, that's like asking for help and I'm not supposed to." It doesn't make any sense really. Companies, big hospitals and insurance companies, they've been using business coaches for years and years and they love it. And it's what helps them progress even quicker in their career transition.

So, that's what physicians need to learn. It's that by getting some coaching or training or online courses, or what have you, in a particular field, you could just accelerate your progress so much more. That's why I love bringing out guests like you that have created something that is really valuable and can answer a problem or solve a problem for physicians. So, I really appreciate you coming on today Cherisa and explaining this and dropping a few pearls along the way. That's always useful.

Dr. Cherisa Sandrow: Thanks so much for having me.

John: I encourage everyone to go and listen to the previous episode, because you really gave a good overview of telemedicine and telehealth at that time. This is just a lot of misconceptions about it, for those that haven't done it before. Again, thanks a lot for that. And I will put these links in the show notes and I wish you the best of luck.

Dr. Cherisa Sandrow: And can I just add that you are going to be one of my guest speakers? That is exciting too, I'm really happy about that.

John: I'm looking forward to that because I love talking about this stuff and I'm going to try to dispel some myths from my perspective, as well as give the thumbnail of career transition and how I would approach it briefly. But basically, it just echoes what you've already said here today and that you're teaching in your course. So, I think it'll be fun. It'd be great.

Dr. Cherisa Sandrow: Well, thanks so much. It was great to see you.

John: All right. You take care. Bye-bye.

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How to Save Healthcare, Satisfy Patients, and Fix Physician Burnout – 256

John Jurica — Tue, 12 Jul 2022 12:00:32 +0000

Interview with Ron Barshop

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

Ron Barshop is a serial entrepreneur with several ventures serving primary care physicians. His podcast Primary Care Cures presents thought leaders and CEOs of companies improving primary care and the majority of what's wrong with healthcare. And it has been featured on top healthcare podcast lists.

He has served as chairman of multiple capital campaigns as well as two angel networks. He has run ten marathons and received both local and national leadership accolades. Healthcare is Fixed is one of his books (soon to be released).

Our Sponsor

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

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

What is DPC?

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

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

Support for Independent Practitioners

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

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

Summary

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

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 256

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

Interview with Ron Barshop>

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

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

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

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

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

John: Right.

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

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

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

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

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

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

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

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

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

John: Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John: Yeah, sure.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John: Nice.

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

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

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

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

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

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

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

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

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

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

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How to Use Consulting and Advising to Find Freedom – 249

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

Interview with Dr. Carl Peters

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

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

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

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

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

Our Sponsor

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

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

Telemedicine

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

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

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

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

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

Consulting and Advising

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

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

Dr. Carl Peters' Advice

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

Summary

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

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 249

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

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

Dr. Carl Peters: Hello, John.

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

Dr. Carl Peters: Oh, absolutely.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John: Okay.

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

John: Yeah.

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

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

Dr. Carl Peters: Yeah. Viagras and everything.

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

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

John: Part-time.

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

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

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

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

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

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

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

John: Nice.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Carl Peters: Yes. Yes, indeed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John: You're welcome. Bye-bye

Dr. Carl Peters: Bye.

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How Do I Generate Awesome Income with Telemedicine Services? – 222

John Jurica — Tue, 16 Nov 2021 10:45:58 +0000

Interview with Dr. Cherisa Sandrow

On today’s show, we're taking another look at telemedicine services with Dr. Cherisa Sandrow. She is a board-certified family physician who completed her medical degree at the Philadelphia College of Osteopathic Medicine. She worked for nine years practicing family medicine, with an emphasis on obstetrics.

After practicing medicine as an employee, Dr. Sandrow pivoted out of her busy office-based practice and developed a thriving telemedicine service. Doing so allowed her to earn just as much, but with a better lifestyle.

And she had no idea when she started that it would prepare her for the COVID-19 Pandemic. In addition to practicing, she now shares her knowledge with other physicians who want to enjoy the same work-life balance and freedom that she does.

Our Sponsor

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

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

Telemedicine Services Grow

Cherisa cleared up many misconceptions about telemedicine. With greater adoption of telemedicine as a valid care model and improved technology, its use is expanding greatly. If you’re burned out, or simply tired of corporate-style assembly line practice, telemedicine is a great option to consider.

There are so many opportunities for so many specialties. – Dr. Cherisa Sandrow

As mentioned during the interview, Dr. Sandrow is now offering her expertise to others through two upcoming group coaching and discovery calls. These calls will provide more valuable instruction in telemedicine and give you a chance to join her live training program if you like.

Telemedicine Coaching

If you’re interested in learning from a telemedicine expert, she has two sessions coming up very soon. Cherisa will share what she learned during the past six years optimizing her practice. They're planned for November 28th and December 17th (2021).

To register for the limited number of spots, you must send an email directly to her at DRCSANDROW@SANDROWCONSULTING.COM.

Summary

Telemedicine is a great way to practice if you enjoy working from home, or while traveling. And by adopting the tactics described in today's interview, you can become very productive. This will allow you to generate more income and work fewer hours.

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

Links for Today's Episode:

Sandrow Consulting
What Is the Best Way to Leverage Telemedicine? – 181
What Is the Latest Telemedicine-Supported Specialty? – 173
Dr. Cherisa Sandrow's Email Address to register for group discovery calls: drcsandrow@sandrowconsulting.com

Download This Episode:

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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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Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

The post How Do I Generate Awesome Income with Telemedicine Services? – 222 appeared first on NonClinical Physicians.

What Is the Best Way to Leverage Telemedicine? – 181

John Jurica — Tue, 02 Feb 2021 11:00:52 +0000

Interview with Sam Lippolis

Sam Lippolis teaches physicians and organizations how to leverage telemedicine.

She has been implementing telehealth programs full time for 11 years. She teaches her clients how to plan, implement and grow telehealth services.

Her specialty is finding the path of least resistance to start a telemedicine service. And providing the expertise to get it off the ground.

Our Sponsor

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

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

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

Telehealth Expert

Sam shows physicians how to get paid. She helps them choose the right technology, get patients on board, and incorporate appropriate legal protections.

Telemedicine codes change from time to time. Hence, billing can be tricky. For example, there are specific billing codes that were approved for use during the COVID-19 pandemic. Some of them may no longer be valid once the pandemic recedes.

Leverage Telemedicine

Sam describes a much broader way to look at telemedicine. It’s not just a part- or full-time alternative to conventional face-to-face medical practice. Telehealth is a great way to expand your practice. Implemented properly, physicians can bring back patients they've lost during the pandemic.

It’s a generally more efficient, way to provide clinical care. As such, most clinical practices should consider integrating telemedicine.

During her interview, Sam explained that there are many services that can be provided using telemedicine. And the upside is that it enables a practice owner to reduce overhead, sending more income to the bottom line.

Using telemedicine reduces travel time. Clinicians can provide care from home. And patients like the convenience.

Summary

If you have not integrated telemedicine into your clinical activities, you should spend time learning more about it. And if you need help finding the best way to leverage telemedicine, you should engage an expert like Sam Lippolis to help you.

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

Disclaimers:

The post What Is the Best Way to Leverage Telemedicine? – 181 appeared first on NonClinical Physicians.