Speaker 1 00:00:08 What's up, everyone. Welcome to the finance for physicians podcast. I'm your host, Daniel Raimi. Join me as we dig into what it looks like for physicians to begin using their finances as a tool to live better lives. You can learn more about our
[email protected] let's. Jump into today's episode. What's up guys. I'm excited today to share my recent conversation with Dr. Ryan and Katie brown. What's cool about their stories. They're such a great example of people that are really living out their values. So they started in a traditional primary care type of position at a larger hospital. And after a couple of years found that it just really wasn't checking the boxes for them, but instead of kind of weathering it and just working through it, they decided to make some pretty big changes and ultimately decided to start their own concierge medical practice. It's called downtown doctors brown, and it's here in Lexington, Kentucky. And since then, over the past three years, they've been building that practice up and now it's a day. They have a relatively full patient load and have a waiting list even, and are, as you'll tell from our conversation, they're really just happy in their, in their position. So I think you'll definitely enjoy hearing our conversation today. So let's jump into that right now. What's up guys? How's it going? This is, uh, Ryan and Katie brown. I have with me.
Speaker 2 00:01:34 Hi. Good. How are you?
Speaker 1 00:01:37 I'm doing well. So I'm super excited to chat today. We're going to be talking about you guys and your, uh, career career progression. I know you started out in kind of a traditional setup and a life has changed quite a bit from when you got out and the practice. And, uh, now you have a totally different setup. You have your own, uh, concierge practice. And I just look forward to kind of talking through that transition. I think it's, uh, been from what I've seen an excellent, uh, change. So, uh, I appreciate you guys coming on to chat about it.
Speaker 3 00:02:11 Yeah, definitely. We'll talk all day about
Speaker 1 00:02:14 It. Yeah. It's been fun. We've talked a lot about it over the years and um, I guess maybe we could start back. Um, how long has it, we were just talking about it before we started recording, but how long has it been since you, uh, what year did you start in practice? Was it 22,000? And, uh,
Speaker 3 00:02:33 Uh, summer 2015 is when we finished residency and came back to Lexington and then we started our own practice three years ago next month, which would be September, 2018. Okay.
Speaker 1 00:02:51 Yeah. So you started in, so maybe let's start by looking by kind of talking through what was that first job like, just from a high-level standpoint.
Speaker 3 00:02:59 Yeah. So I guess we basically did three years there and then we're almost exactly three years in our own practice. So it is a good comparison time, I guess I just jumped right in. Um, yeah, it was, you know, very much what our only option was when we finished, um, residency, you know, we both did internal medicine and an extra chief year, and that was four years and then four years of med school. So during those eight years, it, it seemed like, I mean, nationally, especially in Lexington, the trend shifted from primary care docs, owning their own practices to all being owned by bigger hospital systems. Um, it might've started earlier in that, but it felt like when I went to med school, there was more options, you know, and the majority of people still own their own smaller practices. And then when we got done and we were looking for jobs, there was like no options, other than going with a bigger employer, you know, in what all these different little primary care offices they had purchased. And some of them were still standing around and changed much. Many of them consolidated in the new buildings. It was, there was a little bit of variety there, but at the end of the day, you were basically going to work with a large employer, um, in a, you know, smaller practice. So that's what we decided. And that was, we decided to come back to Lexington and that was our options. You want to talk about what it was like?
Speaker 2 00:04:23 Yeah. And we kind of have those options pick the one that had been most recently independently owned. The staff had been there a long time. They knew their patients well, and that felt really good about it. We felt like that's the kind of primary care we wanted to practice where people were, you know, invested in their patients and, and in each other. So without a, the hospital owns the practice, but this seems like a good spot. And we started and the staff were great and the patients were great. Um, and you know, we started off with zero patients in the late summer, early fall of 20, what are we saying? 2015. That was, um, and yeah, it started off really well. You get to, you meet your new patients, you start to take care of them. You work with the staff, you, you know, you were finally like practicing for us.
Speaker 2 00:05:15 Primary care is what we had wanted each wanted to do when you're establishing those relationships and taking care of people. And it feels really good. And then at some point, and I don't know what the date was, but there just got to be so many patients that, you know, a year and a half or two years. And we've got, each of us have a couple of thousand people that were taken care of and all of a sudden, um, it doesn't feel as fun. You don't have a relationship with your patient. You're desperately trying to take good care of them. That's why you went into the profession, but you don't have time to do it. You don't have time in the room with a patient. And you've got patients to see reports, to review medicines, to order all kinds of insurance things to do. And you know, you, if you take the time with a patient that they deserve, you get behind, patients are waiting for hours, then they're mad at you.
Speaker 2 00:06:08 Um, you get home late and then you finally get your head on the bed at night and you're stressed about what you missed. And if you took good care of everyone or not, and you get up the next morning to do it again, and you're probably charting before you go to bed at night. So it, you know, pretty quickly went from, oh yeah, this primary care thing is great. This is what we had hoped. It would be to something that felt unenjoyable unsustainable and just, you know, out like, as Brian often says around this fast track to burning out.
Speaker 1 00:06:39 Yeah. That's, that's so interesting. So w early on, though, it was, you kind of had a lower patient load and you, it sounds like maybe you were able to kind of feel that, uh, maybe you can spend more time there wasn't so much pressure to fit everybody in. And, um, but that quickly evaporated to where I think it sounds like a lot of it was just pure that the patient load that you had to kind of take on, right. Or was there other factors beyond just this large amount of, cause I can't imagine dealing with 2000 people in anything that's when, I mean, that's just a lot of people. Was there more to it beyond just the volume
Speaker 3 00:07:22 That's was a good point mentioning like during the ramp up, you know, there was probably a little bit of a honeymoon period where you're out, you actually have a real paycheck, you know, dreamed of doing this primary care thing and you don't go into primary care these days, unless you really want to, you know, majority of people do not go into primary care when they graduated residency, pick a residency, even out of med school, you know, they go to things that are not generalists for the most part. So, you know, we had a passion for it. Um, you know, individually and collectively, I guess. So yeah, it did feel really good, but yeah, at some point the volume just reached, uh, like a critical mass or something and it just, it started to take away, you know, what you're trying to do. Um, and you start what was really killing me was, you know, having to move faster than what I wanted.
Speaker 3 00:08:14 And then also not being able to take workups as far as I wanted them to. And I would have to send them to a specialist or maybe start a medicine, you know, when I would rather discuss other options or whatever. But just to keep up with the pace you just had to kind of move through quicker than what, what the traditional workup would allow, um, that I could do as I was trying to do. So it was like, I wasn't allowed to kind of, or not, I wasn't allowed, but it was kind of keeping me from working at the top of my skillset and faster than what I wanted. So yeah, I don't, I don't remember if it was like when it was with the honeymoon wore off, essentially once you got a certain number, but so essentially we realized a couple of years in like, know this is not sustainable.
Speaker 3 00:08:58 This is not why I sacrificed for as long as I did and built up student loans and took all these years to do this. You know, this is not primary care the way I want to do it. Now there's probably some docs out there who their personality really fits that model. And they may do well in that. It's more of their, you know, nature to work that way. But you can tell like both of us wanted something different out of it. And it was probably one of those early years, early year, 18 months was like,
Speaker 2 00:09:27 Yeah. And I would even say there were probably, there was probably nothing in the beginning that didn't feel great, but probably in this middle portion as we started to get busy, or I think there were other things about being in a hospital on practice that started to become a new sense or become frustrating. And, you know, they maybe seem little at first, but there were certain ways that clinic had to operate how things were ordered, how people scheduled appointments that felt like they were inefficient. But if you made a comment and try to change it, then nothing really happens. So you felt like, especially when like a middle volume of patients that maybe would have been manageable, had the system been more efficient and you're trying to make that happen. And then there are all these layers of administration and it never happens. And they just say, you have a monthly meeting and they say, well, I'll just see more patients then, you know, that became pretty frustrating.
Speaker 2 00:10:25 And then just, I think, um, you know, feeling valued as, um, people and professionals, we, you know, would ha we were only given a certain amount of PTO. And then, you know, one of our kids would have a little program at school that, you know, they're in preschool, it takes 10 minutes and you were required to take a half day of PTO and you only have, you have pretty limited PTO to begin with. And, you know, you would really like to be able to just come in a half an hour late to work that day and not take some of your vacation time. So it felt like you really kind of weren't valued, um, for what you were giving to the practice so much was being asked of you and then you weren't, you know, given much in return.
Speaker 1 00:11:07 Yeah, I know. And I think of in my business and working with people in financial planning and that sort of thing, we, um, have some similar challenges, like there's practices that are like high volume, lots of people they work with. And I used to be in that sort of model and I really didn't get much. Um, it was very rare that you would get like a serious compliment. I mean, like from the clients, like there would be any, you didn't really know them very well, but now in this business, we have kind of a smaller clientele, like a better advisor to client ratio, I guess, is what it translates to. And, uh, we get lots more, uh, you know, the, the, the, the client and you get in there's compliments and there's value kind of exchanged cause the, at the end of the day, you have more time when you have more time or you allow more time to spend with people that's going to just increase that sort of stuff. Has that been your all's experience in terms of the value trade-off with, with, with the patients themselves? Absolutely.
Speaker 2 00:12:09 Without a doubt, I mean, with
Speaker 3 00:12:12 Deeper relationships, you know them better, they know you better, you work harder on these issues together, and then you get the time to actually enjoy the benefits versus just rushing to the next patient, because there's three in the waiting room and you really figured something out, but you know, my laundry forgotten that or whatever, you know? Yeah.
Speaker 2 00:12:33 And I think, you know, I think your line of work and ours are also similar that two of the main things that we do are educate people and reassure them. And those are a huge value to people, but they take time. And so like ordering a lab test or a diagnostic procedure, a medicine, sending them to another doctor, those are what we mostly did at the old practice, like what Ryan was saying, cause you can do them quickly, but really what people usually need and what they're so grateful for. Once you give it to them as reassurance and education, I just need to know that things are okay or they're not, and what's going on. And they really value getting that from us and appreciate it. And the flip side of that is in the old office, people would be so frustrated by how hard it was to get an appointment or the fact that I was running an hour behind, which we spoke about earlier, I'm running an hour behind because I'm trying to take care of the other patients in a way that they deserve.
Speaker 2 00:13:32 So you would hear these frustrations all the time. And then, you know, the patients have this lot or lots of the patients have this kind of misunderstanding that it's, that I have the power or the ability to change how the clinic, you know, to get them an appointment sooner or make it so they don't wait. But then I really, so as a person who, um, you know, prides myself on the quality of care that I'm delivering and having patients be satisfied, it was written Ryan's the same way. It was really hard for my personality to hear this, get this negative feedback and criticism all the time and then feel like it was out of my control to make it any better.
Speaker 1 00:14:11 So what what's also impressive about your story is that you, I think a ton of people probably can empathize or have gone through exactly what you're describing so far, but you all did something like big about it. Mm. And you did it pretty fast, but when did that, do you remember exactly like when that started, the wheels started turning, like I gotta make a huge change and I need to do it fast. Or what was that like? Um, that was all Ryan Good job. So I was more miserable clicker, um, lower pain tolerance.
Speaker 3 00:14:50 Um, and it, it quickens my poles, uh, even back to them because it is extremely anxiety provoking, but I almost feel like, uh, didn't have a choice, you know, which I think helped kind of pull the rip cord and make the change because yeah. Being on that fast track to burnout so fast out of the gate sacrificing for so long, and I'm a little bit older, I didn't go straight through to med school, you know? So it was just like, what in the world put all this effort and time and, you know, went into a passion project with primary care essentially. And this is not sustainable. That was around I think, 18 months, two years. And that was where it was like, okay, we kind of signed an initial three-year contracts.
Speaker 3 00:15:41 No, we weren't like a lock-in, but that was kind of like what it said or whatever. And it was like, okay, well we had kind of an end date with that to renew a contract. So about a year out from that, it was like, um, started looking into other options. Like what can we do here? Because this is not what I want it to be. And to be honest, I did not know anything really about concierge medicine, not heard the term here and there. It certainly wasn't something we were trained about in residency or had any discussions with anybody. But fortunately we were in a position where there was a physician near us physically, um, practicing that with a national group who does concierge. So I could kind of literally see how a different way looked. And that was just lucky on our end to, to not only kind of learn about the concept, but be able to have a physician who was doing it near us and then eventually talked to him and kind of pick his brain about what he was doing.
Speaker 3 00:16:40 So that really opened my eyes. And then our eyes up to, oh, this model could be the antidote, you know, to, to these ills we just talked about. Um, and that we were feeling kind of early on in the practice. And, and I do want to say specifically like the higher ups at that point practice, we're really kind of nice to us. The staff were really was great and we loved him and we were sad to leave. It really was just the model. And it was just that turn and burn high volume model. Like I think the pieces around us were about as good as they could be, but it just, that model was not going to jive with my personality and how I like to take care of patients. You know? So this is one that had to be clear, but so essentially two years and discovered it kind of saw this other doc doing a concierge model with a national group and then being like, whoa, that I think if we could get ourselves in that position, we could practice, well, we want, we could still pay our bills and it would be more at a 20, 25 year career pace, um, versus what I'm on right now, which is like Googling, what do you do with an MD other than something you, I mean, it was like getting to that point.
Speaker 3 00:17:51 So that's when we kind of put our heads together and started exploring.
Speaker 1 00:17:57 So about two years in the wheels started turning and you started and you happen to be close proximity to this person that was actually already doing it right. Except for, they were kind of further down their career path. Right.
Speaker 3 00:18:09 Well, and that's, you're right. It's really early. And in fact, what we did out of the gate was read there's three or four big national companies who kind of partner with docs to help them kind of generally create a concierge practice out of their already full, robust practice. Often in the last five or 10 years, is there a career where this is kind of becoming more common and it's almost like they'll come in and make it turnkey and essentially carve out X number of visions from your huge panel. And that's like, that's the model that was most common three or four years ago. And we were looking into it. So when we first learned about it and reached out to the two or three of these national companies to just to feel them out and learn about it, and Katie can speak more on this because she had a few more in the conversations, but they really didn't have much interest in us because we were too early out. They felt like you needed to be at least eight to 10 years out. So it was kind of funny at first, they didn't when they finally returned calls and stuff, but they weren't interested. They were basically like call us in a few years, but we started doing more research and it was like, hold on a second. This actually, you can do this from scratch. I think, cause that's basically what we were going to have to
Speaker 2 00:19:22 Do. Yeah. I think, um, the humor only comes with hindsight and time. Ryan had this idea. I found any book I could on direct primary care concierge medicine, read them, started contacting these places. And they basically told us, yeah, you know, it is a really great practice model. You need to have a longer established relationship with your patients, for them to be willing to come over to our practice where they pay to see you. You just, you haven't known these people long enough. You know, it's just, this is like what folks do before they transitioned to retirement. That's not what I would want to hear. It was scary and disappointing, but I do think, um, well I was going to say, I think it has often been to our benefit that we've pursued this together because whenever one of us would start to feel too anxious or worried about the reality of making the tradition transition, the other one would say, but look at what we're living right now. Is this sustainable? No, it's not. We kind of go back on course towards transitioning.
Speaker 3 00:20:36 Not only was it an advantage to get us, to make the tough call so early and take the gamble with the huge student loans and all that stuff. It huge to kind of help push us along the way when one of us kind of questioned the change. And then also when we started, I think it helped a lot to have two of us out of the gate to have email like that was beneficial. But when we got those kind of like tepid responses from these national groups, it did kind of almost light a fire under. It was like, I show them, we'll show you and sure enough, a few of them did or they're listening right now.
Speaker 3 00:21:19 I can specifically remember the guy quoting to me the success rate of a new business at three years, which will be next month. And then it was wow. You know, that it was kind of almost a scare tactic because once they realize like, oh, okay, hold on. These guys are serious about it. You know, we kept calling and they looked at the Lexington market. I looked at us as a couple and then realize, okay, hold on. Maybe this, this is not their normal playbook, but it could work well, luckily by then we had done enough research arm to realize like, oh, okay, you don't necessarily have to partner with a national group. I think there's huge advantages to that for sure. And I wouldn't like advise somebody not to do that if that works for them, but it gave us an Essbase to realize like, okay, a lot of these steps or while they're super intimidating can be done. And then we also found a consultant who kind of helps focus on getting you up and running and cutting you loose, you know, almost kind of like the teach a man to fish philosophy versus these other national groups where they just like partner with you step in perpetuity forever.
Speaker 3 00:22:28 And which I think at that, if you're, or in the last 10 years of your career, then sure. Why not? Like, you know, student loans are paid off by then, like, you know, you're, you're kind of in a different phase of life and it's just like, they make it turnkey and they take a cut everything's better than what they were doing. It makes perfect sense. But for us, we're looking literally at a 20 or 25 year career, it was like, no, we'd rather work a little harder upfront. You know, the consultant was huge to help us stay on pace and then, um, cut us loose, you know, we're up and running and that's what we ended up.
Speaker 2 00:23:05 Yeah. Someone's considering this option and thinking about doing it a hundred percent by themselves or with a consultant, independent consultant like we did or going with one of those groups, I would say just put most simply the trade-off is, um, like maybe a little more security and a little less work kind of administrative and set up work upfront, going with one of these groups and what you're trading for that is, you know, autonomy and independence to make the crack exactly how you want it to be. And I'm sure different people would value those things differently. And maybe at different points, probably a little bit of funny.
Speaker 1 00:23:43 Yeah. I'm still, uh, wondering how you got over that big hurdle. It's like you had all the big things. It's like, you have a lot of student loans. They, the big organizations are like, nah, you're too early in your career. Didn't have the patient load. You probably, you know, you are early in your career you're to you two years in, at this point. Like, what was it really that pushed you over that hump? Our
Speaker 3 00:24:07 Second child was born right then and mows the feed. I mean,
Speaker 1 00:24:12 You had a house like you had it. Wasn't like, and you didn't have like a big inheritance and you know, you didn't have like big influx of cash. Like what got you over the hump?
Speaker 3 00:24:25 I think just this real strong desire to, I think, kind of finish or continue to pursue that dream of having the career that I really wanted, you know, the being the primary care doc that gets to practice and help people the way I felt that. And, um, it was, I think once we saw this model and could literally see it in action with one doc and then re read more and more about it. I mean, a lot of the excitement kind of came in and was like, this is like the last gasp here. Like this actually still has a time. I don't have to ride it off and like reinvent or whatever. And then, I mean, I, and I we've talked to other people around the country, other docs who were thinking about doing this and reached out and picked over lines or whatever. And I'm, and I say it almost in, but then I'm like at the end of the conversation with them, I'm like, no, no, no, I'm being serious.
Speaker 3 00:25:15 Katie and I both working with individual therapists at that time. And I do think that really helped. I mean, we had each other to talk about it. We could kind of see hope in the distance and like a better way. And then I think the huge anxiety that came with having to feed the mouse and make the bill payments and all that, I think my week working in therapy, I mean, you know, weekly getting that out, I think it made it to where it was surmountable. Like we could, we kept going forward versus like running into these essentially what often are scary, fearful roadblocks or whatever.
Speaker 2 00:25:52 Yeah. And I think it also helped us to recognize that that bitterness, that resentment, that exhaustion, that terrible feeling you have when you're working that hard every day and you can't enjoy it. And you're not happy with the quality of the work the way that feels it doesn't, it's not worse paying your mortgage or the student loan. It's not like worth any amount of money. So really being focused on we're just, we're trying to have our, our best life here. And that entails enjoying our work, creating a relationship with our patient, delivering high quality, primary care. Like if we can't have those things, I don't, you know, I don't know, well, we'll figure out what to do with the mortgage loan, but it's not worth living a life where those things are secure and accounted for without any question that you're not, you're not content you're not.
Speaker 3 00:26:52 And I think by being in therapy every week, you can't hide from those emotions and then you can't bury him. You can't like put them in the denial bucket, you know, they just kept coming up over and over. So we had to address all of essentially, and then we discovered a model that really did, like I said, it seemed like the antidote. So then it was literally just getting the gumption, you know, kind of like, okay, we're going to get over this. And I'll, and I'll tell people this too often. I think literally the most anxious day of my life was the day we went in to sign for the bank loans, um, to the, on top of our, you know, we each had individual student loans and it was like, literally, like, I mean, it was putting all the eggs into one basket and it's like, we're going to sign for this bank clown. And we don't even have a space yet. And we're going to make this thing happen from scratch. Um, but you know, three years later, you know, I'm thrilled that I walked into the bank that day, but I was very anxious. I'm not going to, yeah,
Speaker 1 00:27:52 Naturally you can take two views of everything. It's like, you can say, everybody's saying, you know, it's never been done this way. Or, you know, young people don't do it this way and you need to have a established patient. You need to be towards retirement and there's no model for this, but, and that can be like a reason not to do it, or it's probably the natural gravitation, but you can also look at it, like that's an excellent reason to do it because that means there's very little competition. Like that's what I remember when it was, cause I was, we were working together then too. And so from an outsider's view, I was completely confident. And you all, either away, I was like, what's the, what's the hang up? Like, let's do this, quit dragging your seat.
Speaker 1 00:28:38 I'd have a lot of people where, um, it's not that way. So it's not always, it's not like it's more common that I'm not competent, I guess is what I'm trying to say. So I was very competent mainly though, because you were following like passion, it was a values-based decision and I knew you would figure it out, but like I was completely confident and you had all the, uh, and I thought it was a good, uh, opportunity. And in, for example, I'm like I would rather work with a physician in that model and there's just not any in our area, but that's just kind of a different view. It seems like you all have kind of gravitated towards that view and it's worked out pretty well for you. Right? I mean,
Speaker 3 00:29:17 Yeah. So, and I think you're right. Like once I realized how, like how much the concierge model made sense to the way general primary care was trending, you know, I think there wasn't part of the impetus or, you know, another thing that helped us get that gumption and to move forward was it seemed to make so much sense. What I didn't want to know is like, or figure out is discovering that, but then not pulling the trigger and then being late to the party when market would be saturated at some point, you know, it was like kind of, as I guys moment for us locally of, there was a few people doing this. There's definitely demand. And I believe in this model and what I don't want to do is wait eight or 10 years. And then all of a sudden, you know, not have the same, you know, demand that exists, what, what seemed to exist at the time.
Speaker 3 00:30:04 So you're right. And I think, yeah, it seemed to just be lining up, even though an Ana at the onset looked like kind of a crazy idea out of the gate. Um, so, and I think having somebody to help us really, you know, the consultant, you know, which we rolled that fee into the bank loans and all that stuff. And that really helped us keep on pace. So we didn't have a huge gap between when you, when we finished that initial three-year contract and when we opened our office one week. Yeah. That was our goal was literally to be out of pocket for only one week because we really needed people to come with us, you know, like where you do need some of those patients and there's limitations about how you can reach out to them and that kind of thing. But now I can tell you that, uh, you know, the majority of our patients are not from our original office.
Speaker 3 00:30:52 You know, we got probably just enough to kind of get the ball rolling. And, you know, we had some runway built in with a working line and all that stuff, but then once we were more established and we had a base, you know, marketing, we did and, and word of mouth referrals really started building. And our, we are essentially a full practice and yeah, which is pretty amazing. We did not expect to be here a year three, but I think the demand is high for this. And, um, in the word of mouth and new patients is ended up what sustained us, you know? So it made sense with the national groups if they didn't want to do it early, because normally they don't have to go out and recruit. A lot of new patients, like carve them out of the current panel. But with us, we really did have to build it, but there was just enough that kind of week. I mean, we, I almost still think them to this day to people who signed on out of the gate with us, because they gave us that space to grow.
Speaker 1 00:31:50 Yeah. So you, we talked about the stress that you guys had in the first job. And I know every job has stress. It's not like perfectly stress-free, but I'm curious what, um, how that has changed and what it's been like, especially in the early days and you know, kind of the transition of, cause I know we talked about the pressure in the prior job, as soon as you started the new business, did you kind of release a lot of that? Was there like this or did it kind of go to a different category? Yeah.
Speaker 2 00:32:26 I mean, that's not still there, but when we're in this phase that we're talking about where we have some patients, but not enough to pay the bills and the businesses, you know, eating alone as we try to get patients on board during that period, it's like, okay, the stress of seeing too many patients not taking good care of them, having someone else tell you how to practice and what to do, that's totally gone, but it want replaced with like all of our eggs are in this basket. It's better, you know, let's not drop, let's not have the bottom fall out. So it's definitely a different kind of stress. And also one that felt surmountable. We just, we just have to get this practice to work. And then this feeling will go away versus the stress and pressure at the old office. There was no, that was it. Wasn't going to go away. That was just gonna stay there.
Speaker 1 00:33:16 You can tweak it to make it better too. You have control.
Speaker 3 00:33:19 Yeah, exactly. Yeah. Have you been convene, able to have your hands on the knobs and adjust how you want it to be done that autonomy is huge and physicians just in general, I think are fairly autonomous personalities, you know, and then training even teaches you to do that more. So stand on your own feet, have the tough conversation, run the code, run the team, you know, make these really tough decisions for families. You know, you don't do that if, if, if you don't believe in yourself and you know, are, are really encouraged to kind of be an independent autonomous person. And then the idea is you go work for these places and they give you the space to doctor how you want. And we take care of the, you know, the printer paper and the insurance filing and, you know, paying the front office staff and you just go doctor, I think in theory it makes sense. But, and for some docs, I think it really, really makes sense. And they do great in that, in the hall. But for a lot that autonomy is what they lost in autonomy is too much, you know, because it doesn't jive with the personality. But I think the new stress was essentially like, and I give Katie credit with this is, I mean, she basically got an MBA on the fly, you know, like becoming a small business owner. It was all these new stressors that we never dealt with or were never trained in.
Speaker 1 00:34:42 It's like I got to set up payroll.
Speaker 4 00:34:46 So,
Speaker 2 00:34:46 And all the types of insurance do you have this insurance?
Speaker 3 00:34:52 Right. So, and then, you know, ordering the couch for the reception room and the equipment with the stethoscopes and the otoscopes, I don't to hire people. So we basically, you know, using consultants, you, you using, you know, different kind of entities to help us with whatever it was. You know, a lot of that actually is settled now. So we should do this again in three years and then, you know, it's really feeling good. Cause I do joke with people still, like at this point I think I still make a little bit less than what I made in the old office and work a little bit harder still, but it's feels way, way better because I'm practicing the way I want I in control of my own destiny. And in three years from now, I don't think that statement will be true anymore. You know? So I think it's, you know, it's a journey and for us in our family, it's made a lot, a lot of sense. Um, but to say it's easy or, um, you know, for everybody would not be true, but we're glad we did it.
Speaker 1 00:36:03 Yeah. That's good. Good. Uh, it's fun to talk about it three years after too. Yeah. Well, if, if you're talking to a, um, earlier career physician or just, I guess in anybody in general, that's in that kind of high pressure environment and, um, is kind of frozen. Maybe, maybe they're frozen. Maybe they're just kinda just early on, on that thought process. Um, any words of wisdom or specific suggestions you would throw out there to kind of help them get through that?
Speaker 3 00:36:37 I'll give my 2 cents. I think I would say to two things, one, you could get some real practical advice and information by that one book that you read and Katie like the concierge startup Bible book. And because I think it is that what it's called. I can't remember the title I called it, but that gives you kind of like nuts and bolts and like, you know, a lot of practical type questions or whatever, and, or, you know, find a physician who's doing it. Be careful you're going to get a lot of that person is not me.
Speaker 2 00:37:15 Um, find somebody
Speaker 3 00:37:16 Locally that, you know, and blah, blah, blah. So that would be like the practical, you know, part of it. And then I think the flip would be honestly, you know, finding a therapist, clergyman, a life coach, executive coach, somebody to like work through your frustrations about your current job and help you focus like your dreams for a future job. Because I think if you ignore that emotional mental kind of health component of it, you know, it's easy to read the practical, but then just like, you know, we were saying kind of get hit roadblocks of like barriers of fear or concern or whatever. Cause you didn't know what your goals are and what you don't like about your current situation. And I think that's really hard. So just figure out when it's between your own years, you know, like having a pro help you work through those, I think clarifies it and then you can have the practice.
Speaker 1 00:38:07 I think if you're a human, you should have a therapist <inaudible> if you're going through a major emotional, you know, because it's be pretty stressful.
Speaker 2 00:38:22 I was trying to find that book, but I would say there's this, you know, it's not the most beautiful website. There's concierge medicine today.org. And that is where I found the title to the book and found some lists of consultants and just like started my search for information about this style of practice. Um, so that could be for someone who's interested in just like starting to read and learn about it. That could be a good place to go. And um, yeah, I would say, I agree with what you two were just saying. I think the most important thing is really learning yourself and your priorities and then figuring out maybe you're in a unique practice where you really can advocate for yourself and set some parameters, you have thoughtful administration and they have some flexibility and you say, these are my priorities and this is how I feel like they can be met. And you know that maybe that it maybe it's that simple. I don't think that's the case most places, but there may be places where that's true. And then, you know, if that can't be, if you're, if you find out where your true values and priorities are and you know, your day-to-day life doesn't line up with them, then it's time to look for another option. Yeah. Don't
Speaker 1 00:39:43 Stay in something that's painful like that, where it's against your overall goals and values. That's just going to be bad for you.
Speaker 2 00:39:53 Yeah. And as physicians, we know that better than anybody we see in our patients all the time, how the stress of their day to day life implicates their not only their emotional and psychological wellbeing, but that legitimately their physical health. And then we also see in our line of work, that things happen that are out of our control with our bodies all the time that you know, it's really not worth trudging along day to day in a life that doesn't feel enjoyable. It's not giving you meaningful relationships and value because you just, you don't know. You only get one. Yeah.
Speaker 1 00:40:34 Awesome. Well, this has been fun. I've enjoyed talking through this and I appreciate you guys sitting down to chat through it with me. Yeah. Thanks. Yeah. Thanks for taking us back. Yeah. It's it was, uh, it was fun to see from mine. I didn't have to sign on the loans. <inaudible>
Speaker 3 00:40:53 Goodness, but it's where it's worked out. All right, guys. I appreciate it. Thanks
Speaker 1 00:41:03 As always. Thank you so much for joining us today. If you found this valuable, please give us a review on iTunes and share with a friend. Also check out our
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