telemedicine Archives - NonClinical Physicians

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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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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The post How Does a Consultant Start a New Telemedicine Service? appeared first on NonClinical Physicians.

How to Find Fulfillment and Flexibility in Your Nontraditional Job

John Jurica — Wed, 27 Dec 2023 15:35:21 +0000

Interview with Dr. David Feig – Episode 332

In today's episode, John interviews a podcast listener who describes his search for fulfillment and flexibility in a nontraditional job.

Dr. Feig completed his medical degree and his Master’s Degree in Public Health at Emory University. Then he completed a Family Medicine Residency at the University of Michigan and a Sports Medicine Fellowship at Rush University Medical Center.

Our Show Sponsor

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

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

Find Fulfillment and Flexibility

He worked for 4 years before branching out into chart reviews, and part-time medical director roles in various settings. He also tried locums and telemedicine along the way. David also explains why he decided to move away from full-time clinical practice to find fulfillment and flexibility in his work.

David has faced the challenges that many listeners face. He described how his attitudes and feelings about each new job can shift from enthusiasm to burnout or indifference. We heard the rationale behind the choices he made as he moved from traditional clinical practice to locums and telemedicine to his current nonclinical job.

Fully Nonclinical Position

In his most recent job, he reviews claims as a Medicare contractor. During our conversation, he describes his thoughts on the different jobs he has tried since leaving clinical medicine. And he explains how working as a Medicare claims reviewer is different from the usual utilization management positions.

Summary

If you have any follow-up questions about any part of his journey, you can reach out to Dr. Feig on LinkedIn by searching for David Feig, MD. A link to his LinkedIn profile and other related content can be found in the show notes below.

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 332

How to Find Fulfillment and Flexibility in Your Nontraditional Job

- Interview with Dr. David Fieg

John: I invited today's guest because I think he represents many of you. He practiced medicine for a while, decided to try some other things part-time and full-time. And he tried locums, he tried telemedicine, and recently he's been performing claim reviews for Medicare. I'm really interested in hearing what he has learned from all these jobs he's done and what advice he has to share with me and with you. So, welcome and hello, Dr. David Fieg.

Dr. David Fieg: Hello, John. Thank you for having me today.

John: I'm really glad you agreed to do this because, again, so many of us reached a point where we thought, "Well, maybe I should do something else", or for whatever reason, we maybe get into your reasons today. And then we just look around and try different things. Sometimes part-time, sometimes full-time. And so, I think it's just going to be really interesting to hear what motivated you and what you learned along the way. So thanks for being here.

Dr. David Fieg: Oh, again, my pleasure. I was a listener before I became a guest.

John: Yes. And that's a good way to go for me because then it's so relevant to the other listeners to hear your perspective. But tell us a little bit about your early education and your clinical career before you started thinking about making a change.

Dr. David Fieg: I had a little bit of an atypical path to medicine in the sense that I went to college. I was pre-med. I thought, "Oh, I'm always going to be a doctor." Growing up I had a very gifted pediatrician who took very good care of me and my brothers. And he was definitely an inspiration. Just as an aside, I guess he was trained clinically as a neurosurgeon but apparently, he had some issue operating. Back in the day, I guess the way they did lighting and the ORs, it gave him sneezing attacks. And obviously during brain surgery, that's a big problem. And he had to retrain essentially in pediatrics because he couldn't operate. But that level of skill translated into his pediatrics because he was quite brilliant. And he always had a moment to answer my questions. And he was very much a great role model for me.

I went off to college, and was in the pre-med track. And I tried to distinguish myself by trying not to be as cutthroat as the stereotypical pre-med students. And I had some moments. I already had notions of taking a year off. I was going to take a year off. My mistake was looking back on it was, what was I going to do in that year off? Because if you're looking for a job, a lot of places are like, you're going to go in a year and start school, and not a lot of places are excited to hire you in those scenarios. So I was able to get some work and I did apply to medicine.

And I think for my first application cycle, I was very ill prepared in terms of where I applied. I applied to a bunch of very selective schools. Maybe I was a little over confident, who knows? I think I got two interviews and one wait list and it didn't work out. And then I'm like, "Oh, this is terrible. I didn't get in. What am I going to do?" And I applied one more time. This time I was a lot more broad in where I applied. I'm remembering, but I'm pretty sure I was on seven wait lists. And I thought "Seven wait lists?" This has got to be made and I'll get in somewhere. And seven became six and five and four and three, then two. And then I was like, "Oh dear."

I went back and got a master's in public health with the notion that either I was going to get a job in healthcare if I couldn't be a doctor or it would be enough to hopefully get me over the hump and an acceptance somewhere. I did that and I applied one last time. And after some trials and tribulations with two more wait lists, I got offers in both places and everything started. And it was quite the shock when I finally got accepted.

John: Well, we have more in common than I knew about even from talking to you before. I was not accepted. I was out for two years. What I did was I took a micro course because I think that was the area I was weakest in. And lo and behold, when I applied two or three years later, I got in. But who knew? And we both have master's in public health. So, keep going. Tell us more now. You've made it through med school. You went into family medicine, but then you did a fellowship after that, from what I know.

Dr. David Fieg: Yeah. Medical school was definitely really hard for me. And I think it's hard for a lot of people. Coming from probably very academically talented and most people that go on to medical school have great academic credentials that they wouldn't have gotten in. The one footnote maybe to this story that I do get a kick out of later on was at times, I think I caught the ire of some of my professors because of my yawning. I would yawn a lot on rounds, and it got enough that it was noticed and I really couldn't put my finger on it. But it definitely didn't make things simple, I guess what I would say. But I persevered, get to Michigan, get a fellowship, and then sort of go on from there. That was sort of everything. That's sort of why I gravitated a bit towards family because of the connection to sports.

John: How was that program?

Dr. David Fieg: Oh, that was a breath of fresh air. In medical school, depending on the size of your class, it could be 50 people, it could be 100 people. I'm sure there are some schools that have even larger classes. But it was a breath of fresh air and a lot of struggles that I had in medical school, really I think were different in residency. And then the funny thing is, after getting some concern, that I was on call and I was snoring so loud on call, in the call rooms, people would pick me up physically and move me to the outside of the call room and kind of lay me by the door. Other people began to notice and then the thought was "You also kind of stopped breathing when you're sleeping. Maybe you should get that sleep study." And I was like, "Oh, get out of town. That can't possibly be. I've been doing this since I was in medical school." And it's like, "Oh, okay, go get it."

I got a sleep study and they did diagnose me with very bad sleep apnea. Very bad. And I was the resident that when I was on call, I would carry my CPAP machine with me to the hospital in case I got a chance to lay down for a while. I would put my CPAP on because that way if I slept, I actually could get restorative sleep for a change. It was definitely a wake up call. And then everything got a lot easier after that, shockingly. I was doing better. My in service exams got much better, my performance on rotations got better.

I did finish up with my family medicine training and I went off to do a sports medicine fellowship. And that was eye-opening just in the sense of the nature of the practice and how you want to maximize how much you're getting out of that one year to get the skills you need to sort of build forward.

And I think at times it was a struggle because it is one year, it's only really one year to acclimate in some cases to a new city or a new environment. But all the while you kind of have to be on your toes in terms of dealing with a new system in some cases, and then also your professors, the athletes you're taking care of. So, it was a very busy year, and it definitely was a long year as well.

And after finishing up, basically decided I had enough for the winter being in the Midwest for a few years. That's when I was looking for jobs on the West coast to get away from snow at least for a little while. And lo and behold, I did find something and I was off to the west coast to try to hopefully escape the Midwest winters that I had gotten used to over a couple of years.

John: What did you find? Was it something that was geared mostly in sports medicine or was it family medicine too or something else?

Dr. David Fieg: Oh, definitely family medicine. And that was maybe the strange thing as I was going through my fellowship. I had realized that I still enjoy the practice of all spectrums of medicine. Maybe not as much obstetrics, but certainly the primary care component was what I think called to me the most. But I still enjoyed the musculoskeletal part two. Instead of trying to do sports med only, I had gravitated to more traditional practice.

In that particular group, it was me who had the sports background and then we had an orthopedist who had decided to stop operating. He was really doing non-operative stuff. So we sort of had a nice relationship, a synergistic relationship that we would sometimes see each other's patients and I'd ask him questions and vice versa. Although mostly I asked him questions when I was starting out. And he had to go out and about and he had patients that needed say synvisc injections on their knees or something. I'd be happy to jump in and help out with that. So, that was a great initial experience as my first job out fellowship.

John: Nice. Well, how long did you continue doing that and what caused you to make a change?

Dr. David Fieg: It was about four years. And I think I come to the realization that they say your first job out of training is going to be the job where you figure out what you want your job to be. And as with everything, there are some always some really good stuff. And then there's stuff that's not so good. And ultimately working in a big system carries a lot of benefits in the sense that there's a billing department, there are other departments that can support you, there's a credentialing department. All these things that you can take advantage of. They are often CME that they'll pay for and other benefits that you get from working in a large system. But you also have to realize that you also work in a large system with your other doctors and your other coworkers, nurse practitioners, PAs. Everyone that kind of forms the team. You definitely have to be part of that system.

And if you say have an entrepreneurial spirit or you want to maybe spread your wings or if you're like me and you're also very technical and you get very frustrated by maybe the electronic medical records that you use, and most physicians have strong opinions about it obviously, you're not really in a position where you can get them to give you your own system, you're going to use what they have. And you can do the best you can within it but flexibility is not something you get necessarily in those environments. You get the security of working for a larger system. The large system is going to pay your salary, whereas if you have your own practice, you've got to get a bookkeeper and make sure you get your bills sent out to get paid usually from the insurance companies, otherwise you don't necessarily have an income.

Having a more explicit understanding of that kind of trade off, I think after four years it became a little more clear just in the sense that you have to find a niche, I guess. And I do very much say that when you're out of training, finding what you want to do can be tricky. Definitely I wanted to point out systems and technology and how we use it to be more efficient, but also realizing doing that in a large system, I think change is never easy. And I think change in a large hospital system or any healthcare system is challenging. If we look at how our hospital systems have changed over the years, or even how they changed from COVID, we can kind of realize that kind of change is atypical. Usually it takes a crisis like COVID to get things to change. And that was maybe a big thing we'll talk about in a bit is how much telemedicine changed in that timeframe out of necessity. That it hadn't really changed a lot before that until there was like, okay, people need this care and we have to find a way to do it, and these are the places that are set up to provide that.

At any rate, all those things go on my mind and I realized that I did want to make a change and I had pursued some other opportunities and I found a job working more partly clinical, partly as an area medical director for an urgent care system. It was based out of Portland that had opened up some places in Seattle. I guess you could say it was my first official administrative role.

The funny thing is, and it's the other thing I learned the hard way, when you're a physician working in a clinic, whether you want to be management or not, you are one of the doctors there, you are a provider, which means that other staff will definitely notice when you say or do things. You have to be careful what you say, and you also have to realize that you might not necessarily... You want to just show up and take care of patients and go home, but I think it's rarely ever that simple.

I certainly learned that you have to be mindful of that when you're in your job. Now, I was in this new job and I was actually officially management in my title at least. I got to see patients also help oversee some nurse practitioners and some physician assistants to run the clinics and kind of keep things running smooth. And I was doing a lot of chart review and just being available for clinical support for the team, and practicing in a different way. Seeing how they figure out the account I think was a valuable insight that I hadn't had a chance to really experience before.

John: Now, was it at that location that you started getting into the telemedicine, or did that come later?

Dr. David Fieg: That actually came later. As much as I enjoyed the opportunities working in urgent care, I had this thought in my brain that launched the having relationship with your patients and having that longitudinal care was actually a good thing. And it is a good thing. Although, looking back on it, I think there are caveats you have to be mindful of too.

I wanted to get into a situation where there was more of a panel of patients that I'd be taking care of. Maybe shift from the acute stuff to more of the continuity of care that I enjoyed. I made one more shift to a startup that was doing more work in that field, more based out of employer healthcare model in which employers actually can have their own clinics that are managed generally, contracted by this third party, so that the patients, the employees can go thinking that they are not necessarily going to the company doctor. It's the company that the company hired to help provide some extra care.

And there are creative ways you can manage the finances such that you can provide services, the company can cover it. If it helps with utilization of your primary insurance spending, then it can often pay for itself. There's some interesting ways around it. I think the market has changed a bit over the years, but that was what it was when I came into that profession.

John: What was that situation like? Was it one or two of you in a pod or was it a large group? Was it centralized where employees were coming from all over?

Dr. David Fieg: It started out pretty small with only two locations. And over time it expanded to multiple locations around the Pacific Northwest. And then it kept expanding from there. The growth of the company was pretty huge. And it did go on to do some big things from what I understand. I learned a lot again. And I was hired to work there, as one of the docs. And there were some changes. And then I had the opportunity to get more involved in leadership again, which was nice. And I did do a lot more on the technical side, kind of working with the EMR system, got to see the nuts and bolts of it, and that was sort of exciting and also overwhelming.

The more you dive into it, the more you realize that it's pretty complicated. And it's sort of why hospital systems have entire departments of people trying to wrangle this because it oftentimes has that level of detail because humans are complicated, medicine is complicated. And to translate some of that stuff to the non-physician, but to the developer that's writing the program, these are complicated things that we don't often think about. I learned a lot from the other perspective about that. That was definitely a great experience and also very much overwhelming in the grand scheme of things.

John: Then what? You were about to segue either into another move or thinking about something else. What was the next step for you?

Dr. David Fieg: I think it was at a professional low point in terms of my health that I think the stress of keeping up with medicine is something that all physicians have to deal with. And actually almost anyone in a professional setting, whether it's a nurse, a lawyer, a doctor, a nurse practitioner, a physician assistant, I think you all experienced some level of burnout. And I think over the course of my career, I certainly had burnout several times. I should give it a little shout out to Dike Drummond who I did connect with at different points over my career. That was really one of the first people to talk about burnout amongst physicians and then other health professions in a really solid and very focused way that really tried to define it.

I had left that particular job and that's when I sort of did more telemedicine. I also started to do a lot more locums in the area. More opportunities came up where I had never really done locums before. The opportunity to leverage some connections I had, I built up over the years to help cover some clinics, to help cover some maternity leave for some larger hospital systems, but also still going back and then sometimes then doing a couple hour shift in telemedicine was an experience. And it went well enough that I kept doing the telemedicine for a while. And that's when I got to experience both, you can say, doing coverage physically in a clinic, and then also doing telemedicine from home.

And I learned a lot. This was actually still pre pandemic. It was just before the pandemic and that was where things got really crazy, I guess you could say. Only in the sense that I was doing a little bit of both. I was still sort of looking, experimenting, do I want to open my own practice? Should I open up my own telemedicine practice? How can I manage this? And that's sort of when I just focused a lot on telemedicine for a period of time. And that's sort of when my locums assignments had run out and I decided not to sign up for anymore for a while so I could run more with the telemedicine component. And then I was doing that for a while.

The one thing I learned is that when you're in primary care and you have a patient coming in for a visit, the first few minutes of the visit can be incredibly nerve wracking because you don't know how sick the patient really is. And then when you see them on the camera, if you can, that's when you get an idea, "Do I feel good about this? Do I not feel good about this?" And maybe the major thing I learned was if you have concerns that the patient maybe is too sick for telemedicine, you have to be very explicit about that. And no, they'll never be happy to hear that. But if you're firm and you communicate your concerns, vast majority of patients that I explained my concerns to were willing to go into an emergency room and get care, which was good. And I think you have to be very cognizant of that if you're doing telemedicine because it's not the same as in-person care.

And maybe that's the biggest difference. At least in-person care, you can see the EMS take the patient to the hospital, but in telemedicine, you have to trust that they're going to follow through. And that was always a point of concern.

John: People I've talked to, they seem to indicate that's the skill you need to know to recognize when they're sick, and then to be able to quickly and effectively communicate, okay, this is not a telemedicine visit. You need to see somebody and whether it's emergent or in the next six hours or what have you.

We're going to run out of time pretty soon. So I really want to hear about what you're doing now and how you feel that fits in with your long-term plans and do you enjoy it? I'd like to see what you think about it. I don't know that many people are doing the job that you're doing now.

Dr. David Fieg: Right. I'd say I'm from New York, so we talk a lot. It goes with the territory. As I was doing telemedicine, I did have some friends that were involved in doing more utilization management work. I was able to pick up some extra work on the side. I cut to halftime telemedicine, halftime doing utilization management. This is more the traditional nonclinical job in which you're usually reviewing advanced imaging and trying to make decisions about whether the MRI or the CAT scan should be approved. I did that for a while.

And that experience, particularly working with different insurances and how to interpret rules and regulations, did give me the skills to connect with where I'm working now, which is more about reviewing Medicare claims as a qualified independent contractor. Working from one of the companies that reviews claims, it's quite complicated, much more complicated than I ever realized.

But what it boils down to is that Medicare rules and regulations are quite complicated. And even though I've worked in big hospital systems, even though I've worked in small startups, even though I've worked in many places, I did take quite a few Medicare paying patients. The physician's knowledge of the intricacies of some of the regulations is maybe not what we thought. And then you kind of realize, well, everything's on the website, so if you really have a question about how to bill for X, Y, Z, you can go to their website and look up rules and regulations. And maybe that's sort of the takeaway for me was I learned a lot through practice, although I did mainly outpatient, so I was probably more in part B than inpatient part A.

But you learn a lot by practice, and since we have separate billers and coders, maybe you don't get into the same level of detail that you do when you're actually reviewing the cases. And you see how it was coded, you see how the documentation was, and then you compare what you have to, what the regulations for Medicare are, and you try to make sense of why it was denied, what the rationale is. You do an independent review. You basically start from scratch to sort of see what your concerns are. But it certainly makes you realize just that obviously billing and coding for medical care is very complicated. And know physicians really focus for obvious reasons on the clinical side.

But looking back on how Medicare does their guidelines, how they do national coverage determinations, how they do local coverage determinations, all that information is out there. And if you do have patients you're taking care of, it's really important to be aware of how you do your documentation. That's probably why clinical documentation improvement specialist or clinical documentation review is also becoming a hot field because if we all had time, we could probably document better. If our computer system was better, we would document better. But you have to be the most efficient and the tools you have at hand.

John: Now I have a question. The review of Medicare, was there much of an orientation or training? They just throw you some manuals? How did that work out?

Dr. David Fieg: Oh, no, I got some great doctors to work with. We actually did it virtually because I had started the job right when COVID hit for real in March of 2020. That was when Seattle had its first few cases right before. People finally realized that it finally had reached to the states. And certainly things changed a lot after that fact, changes in telemedicine and then changes with remote work. This was always a remote position interestingly enough. I was able to virtually sit, and of course, now we have the technology to do this. Sit and talk by phone, by video, by real time sharing screens, going over cases, going over the information, trying to read through the major case types, understanding the types of cases you'll see in different parts of Medicare, whether it's part A or part B. Understanding one's more inpatient, one's more outpatient. Certain drugs are considered the B of A, so they fall under more of the part A side. Getting a lot of minutiae of detail, and just understanding how the cases go.

But a lot of really good doctors that have been doing this for a while and have a lot of experience, were really helpful in getting me trained to pick up all these details. And then a lot of it, honestly, is also reading a lot of cases, reading the decisions and going back to the case and just looking through it back and forth and understanding seeing the patterns arise. Why was this denied? Well, they didn't document X, Y, Z. Well, why was this approved? Well, they did document X, Y, Z. Sometimes it can come down to that, sometimes it can be more of a judgment call. But document, document, document is what they say.

You want to be careful on what you put in the chart in the sense of just for certain conditions, you just need to be very explicit as to what you saw and document it. It also comes back maybe strangely to the systems that we use. And if your EMR, as you said, whether it's due to time, energy and money is more out of the box, maybe it's not as customized as it could be for your particular style or your clinic. And that could affect your reimbursement if it's not configured correctly to capture all the key things that you need.

It's funny how that's kind of a strange circle and that we don't have time so we run through with our computer systems to document what we need, but maybe we don't spend enough time making sure it's documenting enough of the things we need, whether it's private insurance or commercial insurance or is it Medicaid, Medicare. Because they do have requirements that are available for review. And we do want to be mindful of them because getting paid is important and not getting paid for even the large health system can be quite onerous.

John: Yeah. It catches up with you if there's too much of that going on. Well, we are going to be out of time here in about a minute. So, just looking back, maybe advice you have for other people that are at the beginning of the journey that you've made so far where you're trying to find the right clinical thing to do, or maybe they want to do two different things or maybe they don't want to do clinical. What advice would you have for people that just find themselves early in that process?

Dr. David Fieg: I think you do want to get at least some clinical basis. And when you're out of training, you want to practice for at least a few years. A lot of the best nonclinical work does often require anywhere from three to five years of actual practice experience. For a lot of people you might close some doors if you don't finish your residency, if you don't do some clinical practice for a few years.

But once you get through that point, that's a great time to reassess. And as I said, there's more and more opportunities, whether it's telemedicine, whether it's utilization management, whether it's clinical documentation improvement, whether it is doing case or claim review, whether it's legal consulting. There's a tremendous variety of things available. One of the struggles I think is just connecting to figure out what's out there because it seems to change all the time. A lot of people didn't know about the work I'm doing now in terms of review for Medicare claims. More were familiar with utilization management. I think more are getting familiar with certainly the legal consulting component, and also getting more familiar with the clinical documentation improvement.

That's maybe the flip side to what I do, is that they're working with the docs to make sure they understand if they're seeing case X all day long, that they know what the requirements are for documentation, if they're billing a lot of Medicare claims. So that everything is set up to set them up for success rather than confusion in a lot of physician queries. I see that they send a query to the physician, the coder sends a query to the physician. What was this? And I remember getting them when I was practicing more in a traditional practice and it's like, "What is this? Why am I filling this out?" It's like, no, fill it out and try to actually think about what you're going to write because it's really important and it may actually affect whether you get paid or not.

John: Yeah, absolutely. I think some people might have lingering questions, you've covered a lot of material here today. It's okay I assume maybe if they can just find you on LinkedIn?

Dr. David Fieg: Oh yeah, absolutely. I'm kind of an open book. David B. Fieg. There aren't too many Fiegs on LinkedIn. So, if you see the doctor, that probably is me.

John: Well, I will put that link in the show notes too. If anyone is really struggling to find you, they can go to the show notes for this episode.

Dr. David Fieg: Yeah. And if you see the one that went to Michigan for a residency, that's probably me. So go Blue. Hopefully, we'll bring home the big one for the playoffs this year.

John: All right. All of you out there, I hope you are Michigan fans. All right, David, this has been really good. I appreciate it. We might have to have you come back in a few years and see if you're still doing this or have done something else, but we have a lot to think about. I really enjoyed hearing your story today.

Dr. David Fieg: Sure.

John: With that, I will say goodbye.

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The 5 Most Popular Home Based and Remote Careers – 291

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

This List Keeps Growing

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

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

Our Sponsor

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

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

Benefits of a Remote or Home Based Job

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

flexibility
convenience
lower costs for transportation
availability for family members

Categories of home based and remote careers:

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

Summary

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

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 291

5 Most Popular Home Based and Remote Careers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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Today's PNC Podcast Transcript

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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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The post Create a Life with Freedom of Time, Place and Means – 266 appeared first on NonClinical Physicians.

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

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Today's PNC Podcast Transcript

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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:

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Podcast Editing & Production Services are provided by Oscar Hamilton

Disclaimers:

Many of the links that I refer you to, and that you’ll find in the show notes, 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, that I have personally used or am very familiar with.

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

What Is the Latest Telemedicine-Supported Specialty? – 173

John Jurica — Tue, 08 Dec 2020 11:15:37 +0000

Interview with Dr. Christopher Leonard and John Sory

The latest telemedicine-supported specialty, wound care, is becoming more popular. Today we hear from two leaders from a company that helped integrate telemedicine with this growing medical field.

Vohra Wound Physicians is the largest physician wound management group in the US, delivering over a million patient encounters per year.

For today's interview, I bring two guests to the podcast to discuss this important topic. They are Dr. Christopher Leonard, the Chief Information Officer for Vohra, and John Sory, its President.

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, unlike other programs, this program only takes a year to complete. Economist Magazine recently ranked the UT Haslam Business School #1 in the world as the Most Relevant Executive MBA.

By joining the University of Tennessee 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.

We met Dr. Christopher Leonard when he was first interviewed for the podcast over a year ago. Chris talked about his career journey and informatics over two episodes: No. 91 and 92.

Background

Chris is a general surgeon who became interested in wound care many years ago. He joined Vohra in 2009 as a physician in the field, and became Director of Informatics in 2010, and Chief Information Officer in 2015. Dr. Leonard is responsible for the strategic design of the company’s healthcare technology. He brings his creative vision to support Vohra’s mission in the continuous improvement of its novel healthcare delivery model.

The President of the company, John Sory, is also on today’s show. He provides background and encourages you to consider applying to work with the company because it is expanding and recruiting physicians.

John has been an integral part of Vohra since March 2018 and brings 25 years of extensive expertise in healthcare management. Today, he is responsible for managing Vohra’s core operations and key strategic initiatives as he promotes wound care as the latest telemedicine-supported specialty.

Formerly, he served as the Chief Executive, UHealth Regional Alliance for the University of Miami Health System. Prior to that role, he led Pfizer Health Solutions (PHS), a wholly-owned, global subsidiary of Pfizer Inc. PHS developed and sold health information technologies, designed employer-based health services, and operated risk-based population health programs across the U.S. and Europe.

Latest Telemedicine-Supported Specialty

Chris and John described how Vohra has expanded and continuously improved its wound care services.

They explained how wound care physicians work and how telemedicine supports what they do. They also shared why taking on such a role can be very rewarding. And as an organization with extensive physician leadership, Vohra is more responsive to the doctors' needs than other employers might be.

In reality, we're really on the cutting edge.. and we're doing something no one has done before… it's definitely rewarding in that way. A lot of the clincians end up doing a lot of things they never thought they would get a chance to do. – Dr. Christopher Leonard

Vohra physicians are wound care experts: each completes an extensive wound care fellowship. And each contributes to the company’s interdisciplinary approach to advancing the science of wound care. By working with Vohra, long-term care facilities, and home health agencies benefit from a team of professionals striving to provide improved outcomes at the utmost value.

Summary

Vohra is an interesting company that identified a problem and developed a solution marrying capable physicians with technology. It is currently in a growth phase and needs more physicians to join its team. Its services have helped to make wound care the latest telemedicine-supported specialty that became essential during the COVID pandemic.

And It offers physicians a nontraditional clinical career with more freedom and a better lifestyle. In a future episode, I hope to highlight another telemedicine-supported specialty similar to wound care.

Links for Today's Episode:

Download This Episode:

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The Nonclinical Career Academy Membership Program recently added a new Course!

I've created 19 courses and placed them all in an exclusive, low-cost membership program. The program provides an introduction to dozens of nontraditional careers, with in-depth lessons on several of them. It even includes my full MSL Course. There is a money-back guarantee, so there is no risk to signing up. And I'll add more courses each month.

Learn more about the Academy at nonclinicalphysicians.com/joinnca. It will be closing to new members on December 11, 2020, so start the new year right by signing-up and beginning YOUR career journey now! It's a great gift to give yourself.

Thanks to our sponsor…

Thanks to the UT Physician Executive MBA program for sponsoring the show. It’s an outstanding, highly rated, MBA program designed for working physicians. It is just what you need to prepare for that fulfilling, well-paying career. You can find out more at nonclinicalphysicians.com/physicianmba.

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 information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.

The post What Is the Latest Telemedicine-Supported Specialty? – 173 appeared first on NonClinical Physicians.

Is One of These Popular Home Based Careers for You? – 142

John Jurica — Mon, 11 May 2020 10:00:26 +0000

Eliminate Your Commute

On this week’s episode of the PNC podcast, John runs through the most popular home based careers for physicians. He starts by explaining why home based careers are so attractive.

Then he describes the benefits and challenges of each one.

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, with over 650 graduates. And, unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. Recently, Economist Magazine ranked the business school #1 in the world for the Most Relevant Executive MBA.

While in the program, you'll participate in a company project, thereby contributing to your organization. As a result, University of Tennessee PEMBA students bring exceptional value to their organizations.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

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

Reminder – Leverage and Growth Virtual SUMMIT is Live May 11 through May 22, 2020.

I'm a contributor and affiliate partner for Peter Kim's Leverage and Growth Virtual Summit. With over 50 expert faculty, it is incredible that you can access all of the sessions for FREE. It is designed to build freedom into your life through passive and active income streams, and help secure your family's future in these uncertain times.

My session is on May 19, so be sure to view it. All of the sessions with be released over the next 2 weeks, starting the day this podcast episode is released on May 11, 2020. Each week's sessions will also be posted again on the respective weekend, at absolutely NO COST. And you can pick and choose each day which sessions to view.

At any point, including the final days of the SUMMIT, you can choose to purchase access to all of the videos if you find them to be helpful. In any case, whether you choose to enroll in the free access or buy the video bundle, please USE THIS LINK. It is the only way that I get credit for sharing this SUMMIT with my listeners and readers. And doing so has no effect on the price if you elect to purchase the videos.

Exciting News

We are so proud here at the Physician Nonclinical Careers Podcast to have been recently named a Top 20 Physicians Podcasts You Must Follow in 2020. I'll have more to say about this on next week's podcast.

Why Work from Home?

There are three main benefits to choosing a home-based career:

1. Convenience

When you work from home, you’re able to handle household responsibilities. And navigating childcare or adult caretaking responsibilities may make this type of career a necessity.

2. Cost Savings

Eliminating your commute means you’ll save time, and reduce gasoline and auto maintenance costs, saving you thousands of dollars each year. And the time not spent commuting can be spent working and enhancing your income.

3. Flexibility

Home based careers offer the most flexibility. Though some require working 8-hour days, most will allow you to choose your hours. And you might be able to work from anywhere in the world, even while traveling. Or at odd hours, if you prefer.

Popular Home-based Careers

Here are the factors to consider when seeking one of these popular home based careers:

Chart Review: Performing chart reviews can be done for utilization management, disability and worker’s compensation assessments, expert witness consulting, clinical documentation, and quality improvement. You can work anywhere that has access to the Internet and phone service. Some jobs require work during regular business hours.
Medical writing: As a freelancer, you must set up your own business, and find work, initially. But once you develop relationships with several editors, you should be able to generate regular income, working from anywhere in the world. You must have the self-discipline to meet regular deadlines.
Telemedicine: This is an especially flexible career. You must ensure that you are working with a reputable company. You can start by supplementing your income by moonlighting. And you need to take the necessary steps to manage your liability exposure. You can boost your income by working when other physicians are not working, such as during weekends and holidays.
Consulting: If you're a consultant working from home, you will likely be freelancing, rather than working for a large consulting firm. You may have to do some traveling and speaking to build your authority and market yourself. But once you get started, most of your business can be done from home.
Coaching: Coaching is similar to consulting. But the term is usually used with life, health, wellness, and business coaching of individuals or small groups. It can be face-to-face, but remote coaching is much more common. You must choose a coaching field based on your personal expertise, or obtain formal training, and possibly certification.

Summary

Home based careers offer a great deal of flexibility. And there are several attractive options to consider. The income levels might start out at the lower end of a clinical salary. But busy coaches, consultants, writers, chart reviewers, and telemedicine providers will enjoy improving revenues as they streamline their businesses and increase their customer or patient base. If you haven't already done so, you can listen using the player above, or through iTunes and other players.

Thanks for listening today. I appreciate your support. Be sure to join me next week on the PNC Podcast when I present my interview with Drs. Letizia Alto and Kenji Asakura, who have perfected their approach to generating cash flow through real estate investing, and now produce a course to teach others how to do the same.

Special Offer

Two weeks ago, I presented my interview with Dr. Andrew Wilner on the topic of locum tenens. You can find an extended version of our conversation on the Nonclinical Career Academy. You still have until May 15, 2020, to receive a Free Copy of The Locum Life: A Physician's Guide to Locum Tenens, Kindle Version, if you join the Academy (using any of the links on this page, including this one).

Links for Today's Episode

Leverage and Growth Summit (May 11 – 22, 2020)
Top 20 Physicians Podcast
Nonclinical Career Academy

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Nontraditional Careers: Locum tenens, Telemedicine, Cash-only Practice
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The post Is One of These Popular Home Based Careers for You? – 142 appeared first on NonClinical Physicians.

What Is the Best New Alternative to Physician Employment? – 106

John Jurica — Tue, 10 Sep 2019 11:00:02 +0000

Interview with Dr. Tom Davis

This week on the PNC Podcast Dr. Tom Davis is presenting his take on the best new alternative to physician employment: telemedicine.

I wanted to learn more about this new approach to providing care. So I invited him back for a conversation on telemedicine. And Tom doesn't disappoint. He shares his wealth of experience, advice, and a perspective on telemedicine that is different than most others!

Background

Tom started out his career in medicine as a board-certified family physician. He worked with a group of family doctors at a practice in Missouri. The group developed a network to provide Medicare Advantage services. After 25 successful years, the group decided to sell the network to a competing healthcare system.

Tom cashed out, but remained working under a personal service agreement. After the term of his PSA ended, however, he was eager to get out and start a new chapter in his career.

The only problem was, he had no idea what that next chapter would be. “It was this pit in my stomach and I had no idea what I was going to do.” After receiving his final paycheck, the realization set in that he had no other revenue stream coming in.

“It was this pit in my stomach and I had no idea what I was going to do.”
Dr. Tom Davis

After a month of “recovering” from the burdens of employment, Tom stumbled upon a telemedicine opportunity. And he quickly realized the potential for telemedicine to provide the flexibility he desired. So, he put all of his efforts into establishing a working telemedicine practice.

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

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country, with over 650 graduates. Unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. And Economist Magazine recently ranked the business school #1 in the world for the Most Relevant Executive MBA.

University of Tennessee PEMBA students bring exceptional value to their organizations. While in the program, you'll participate in a company project, thereby contributing to your organization.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

By joining the University of Tennessee physician executive MBA, you will develop the business and management skills you need to advance your career. To find out more, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or go to vitalpe.net/physicianmba.

He Wrote the Book on It

After gaining extensive experience caring for patients with telemedicine, Tom realized that patients need to understand its limitations and pitfalls. So he wrote a book directed at them, which he published in 2018, called Telemedicine Confidential.

Guiding Physicians to the Best New Alternative to Physician Employment

In his telemedicine practice, he found that it enabled him to earn more and work less. It also provides the flexibility to take encounters from beaches and other exotic locations. That flexibility, however, depends on building a solid foundation of sound business practices and appropriate planning.

After establishing his own such practice, Tom also wanted to share what he had discovered with his peers and colleagues. He recognized the value that telemedicine can offer clinicians who were desperately seeking a career with more freedom.

While he was excited to share the benefits of telemedicine, Tom also recognized that there are a number of pitfalls in getting a telemedicine practice set up. And wanted to get the word out to his colleagues.

So Tom developed an online resource for physicians that walks them through the process of developing a telemedicine practice the right way. It's called the Institute for Telemedicine Mastery. It's a place for you to begin an accelerated learning process based on Tom's testing and identifying the best approach to this new way of practicing.

Different Paths

Tom shared important considerations about practicing telemedicine, depending on your specialty and training.

Primary Care

Find and contract with several reputable, stable telemedicine companies providing cross-coverage services.
Sign up as an independent contractor, through an LLC.
Go for the most favorable contracts and leave any company that does not pay promptly.
Learn to practice efficiently and safely, delivering quality care remotely, while minimizing malpractice liability.

Non-procedural Specialists

Expand your practice and offer services to underserved rural hospitals that lack in-house coverage for your expertise (e.g., infectious disease).
Market across large geographic regions to ensure an adequate level of patient volume, if necessary.

Procedure-heavy Specialists and Surgeons

Reduce the costs for care involving bundled payments by using telemedicine for low risk follow-up visits.
For surgeons, telemedicine becomes more about lowering costs than providing new revenue sources.

NPs/PAs

They provide the same type of services as “Primes” but generally need a collaborating physician (another source of revenue for you).
They will need to push back on telemedicine companies demanding too much of they're time.

Treat Yourself like a Business

Tom stresses the importance of approaching telemedicine from an intentional business standpoint. For him, it can't just be a thing that you decide to try on a whim. You'll fail if you begin patient interactions before you've properly prepared yourself.

“If you just jump in, you are never going to successfully live the life I just described.”
Dr. Tom Davis

In the interview, Tom outlines three essential steps that aspiring telemedicine physicians should take. These will help to protect them from liability and ensure that they can maximize their earning potential.

Get an attorney to guide you through the process.
Establish an LLC to protect your personal assets.
Get an accountant to limit your admin time and take advantage of tax benefits.

“Do something. Don’t stay trapped, because the world is a beautiful place and your skills are of incredible value.”
Dr. Tom Davis

On top of those steps, however, it is also important to recognize that you are entering a new mode of care delivery. It's easy for seasoned clinicians to assume that they can transfer their skills and knowledge to telemedicine. But delivering quality care remotely is a new skill.

Summary

Telemedicine can be a hugely rewarding way to supplement your existing clinical work or start a new career. It offers unparalleled flexibility, excellent earning potential, and significantly less stress than in-person clinical medicine.

With that being said, telemedicine comes with its own unique challenges. And it's easy to make an ill-prepared attempt and become disheartened because of poor results. However, by addressing skill gaps, and taking the time to set yourself up for success, it can be a great way to revitalize your career.

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Thanks to our sponsor…

Thanks to the UT Physician Executive MBA program for sponsoring the show. It’s an outstanding, highly rated, MBA program designed for working physicians. It might be just what you need to prepare for that joyful, well-paying career. You can find out more at vitalpe.net/physicianmba.

I hope to see you next time on the PNC Podcast.

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Podcast Editing & Production Services are provided by Oscar Hamilton.

Disclaimers:

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career.

Rig ht click here and “Save As” to download this podcast episode to your computer.

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vitalpe.net/itunes or vitalpe.net/stitcher

The post What Is the Best New Alternative to Physician Employment? – 106 appeared first on NonClinical Physicians.

telemedicine Archives - NonClinical Physicians

How Does a Consultant Start a New Telemedicine Service?

Interview with Dr. Luissa Kiprono – Episode 334

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How to Find Fulfillment and Flexibility in Your Nontraditional Job

Interview with Dr. David Feig – Episode 332

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The 5 Most Popular Home Based and Remote Careers – 291

This List Keeps Growing

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Categories of home based and remote careers:

Chart reviews

Medical writing

Telemedicine

Consulting

Coaching

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

Interview with Dr. Cherisa Sandrow

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Dr. Cherisa Sandrow's Advice

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

Interview with Dr. Cherisa Sandrow

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What Is the Best Way to Leverage Telemedicine? – 181

Interview with Sam Lippolis

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What Is the Latest Telemedicine-Supported Specialty? – 173

Interview with Dr. Christopher Leonard and John Sory

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Latest Telemedicine-Supported Specialty

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Is One of These Popular Home Based Careers for You? – 142