Episode Transcript
Daniel Wrenne: What's up guys? Today I am super excited to be talking with someone very special to me that I've known for quite some time. We've worked with our family in our planning firm for many years now, so I've had the privilege of working alongside this great family through a big part of this journey, and I'm especially proud to see the progress that they've made.
My guest today is Dr. Maggie Abraham. Maggie is a very established and experienced pediatric gynecologist. She's also a mom to four kiddos and a wife to a great husband. So it's safe to say they have a lot going on with that. However, lately they've had even more going on that we're gonna be talking about today.
In particular, Maggie recently made the decision to leave her super safe, financially secure, and very established hospital based position, and this was not something she was really planning on. But nonetheless, she's leaving to venture into a new professional endeavor that's loaded up with all kinds of unknowns that's very unpredictable and comes with a lot of financial risk.
So some might think her decision to leave this comfortable place and go into somewhere or something that's so uncomfortable is maybe a bad one. So, However, based on what I know about what they have going on and what we discussed today and the fact that she has this renewed glow about her, which you'll see from our conversation, I'm extremely confident this is a fantastic decision, and it's one that I don't think she'll ever regret except for maybe regretting she didn't do it sooner.
And I think also agree after listening into our conversation. So without further ado, let's jump into the conversation now.
Daniel Wrenne: Maggie, thanks for chatting with me today.
Maggie Abraham: It's good to be here. Thank you, Daniel.
Daniel Wrenne: For having me. Yeah, I'm, I'm really excited you have, I know you have a lot going on. We've been kind of catching up on things. the really the interesting thing, you're at this unique kind of intersection of life and work and I'm excited particularly to talk about all this stuff you have going on.
so just to kind of give a little bit of a background, Maggie and I have known each other for quite a while. We worked together one-on-one with her family. I was looking back, I didn't realize it had been quite this long, but it's been since 2015 or 2016. Wow. So quite a while. and that was around the time actually where I was in a similar spot in my life where you are today.
cuz it was early in on. That business interest. so Maggie is at this really interesting point. So she was working in the super safe world of established traditional healthcare, we'll call it. and some people would define it as super safe and and secure, but, and I would say from an outsider's view, it was a very successful career.
but now you're at this transition point where you're leaving it and going into this world of like the unknown and the uncomfortable to start your own practice and kind of lean into this big, huge scary change. And despite all these like currents going against maybe starting your own or making this jump, you're doing it anyway.
So I think first of all, that's like you, you deserve lots of congratulations for doing that because that's like a big, scary, courageous thing. And I think most people. Probably get a little bit down the road of where you've gone and then they stop. Cuz there's so many like hurdles and the current is against you.
So it takes a lot of courage and I think it's, it's really important to remind yourself of that, that's a big deal that you've taken it as far as it is. But maybe we could take a step back first. So that's kind of where you're at, is you've got this big transition going on. But like, Did this happen overnight?
Was this like a boom, you're doing it? Or where did, when did this all start brewing?
Maggie Abraham: Well, as you mentioned, I've been working with you since 2016, so obviously all my finances are perfectly tucked away in this great box.
Daniel Wrenne: Yeah. And they are perfect. They're great, you all.
Maggie Abraham: Yeah. I think there's still a lot of work to be done there.
but yeah. you're right when you mentioned that, it's kind of safe, I think I did kind of tuck myself away and academic medicine or working for, a large organization. I graduated residency in 2010, so yeah, I've been doing this a while. but, along the way, my priority shifted a little bit.
I got married, have four kids, And my work's still really important to me. Obviously, you, didn't mention, but I'm a pediatric adolescent gynecologist, so that's a small subspecialty niche within a larger field of obstetrics and gynecology. And so I love working with teenagers, man. and I think when you work with teenagers, they take on risk.
they're not afraid to challenge the status quo, try new things. And I guess, maybe over time, some of those things rubbed off on me. I think one of the things I realized quite early on in medicine was that in medicine I'm replaceable. And so I feel like a. I've always sort of been aware of that piece and also realizing that at home with my family, I'm not quite so replaceable.
And so there's a lot of things you can outsource and, I've had some great people help us with our kids and different things. But over time I think that balance, the tension kind of grew for me. And, there was definitely a lot of professional interests and pursuits that, I put aside at different times just in order to have balance.
And then kinda I would say over the past two years working for a large hospital organization that tension point was kinda coming to the surface again for me. Pediatric adolescent guide is a small field. So, over the years I'd sort of sought out practices where there were multiple providers.
So we had to share the call piece in particular. And at one point in my current practice, in my most recent practice my partner left cuz her husband got a, an another job. And I was in it on my own. One of my biggest fears kind of realized. And when that happened I was on call.
24 7 pretty much. And that was really hard. I think the balance kinda and I started to reevaluate things and then I built up the division and the trade-off, was that at the end of that, once we were recruited more people that, I'd scale back. And so I scaled back to part-time hoping that gonna be able to rebalance kind of my responsibilities on the home front as well as, my professional interests and In going part-time, I thought my call would get prorated accordingly.
And the organization were not, they didn't see it the same way. So they wanted me to continue to take, 50 50 call. So being on call, 50% of the time, and I realized that just wasn't sustainable for me. And so I handed, I said, if that's the way it would ha it is, then, I wouldn't be able to continue in the position.
And I kind had, you know, seen it kind of head in that direction. And so I kind of toyed around in my head with the idea of, what if they require me to take 50% call, what will I do? And, I'd kind of loosely toyed with the idea of, well, I think I'd have to resign and then, I put that thought away because, it's pretty uncomfortable thought because then you're like, well, what if?
And it came to that, so I did actually resign. And then when you're a physician you usually have about three months notice to work through. So that was a tough time. Everything had worked towards, I was kind of letting it go.
Daniel Wrenne: Yeah. Did they try to get, talk you into staying after you're like, no.
Maggie Abraham: It wasn't quite, no, my letter of resignation read like, well, there was a conversation and then followed by a letter of resignation and it said, I can't meet the call requirements, but should they change I'd happily reconsider. And you know, and initially met with 24 hours of crickets.
Hmm. And then, um, they didn't reconsider. Yeah. they did, they circled back a little bit later when they, there, there had been some leadership changes too mm-hmm. Within the organization. So I think that played a role. But yes, they did. Not, yeah, circle back to try and make things work.
But at that point, it was a couple of weeks down the road and I'd already kind of wrapped my head around the idea that. Okay. Like, I am gonna do this differently. And Danielle, it's not just one thing. Mm-hmm. There was the call piece, but there was also a lot of other things that I had just kind of made peace with, you know?
I think, you know, I kind of made things work for me, but the call piece was like, it was just a compromise I wasn't willing to make anymore. And, you know, I kind of knew in my head first, and then it was kind of the surreal experience of walking it out, just knowing that it was the right decision, even though it felt really hard.
And I like, Yeah, I think, you know, when you put so much into something you hold onto it so tightly. And for me, being a doctor is really important. It still is. I love being a doctor, but working for large organizations had those challenges and also some great things.
There's a lot that I'm grateful for, but
Daniel Wrenne: yeah. What were some of the others other reasons? So call, I know is the kind of the straw that broke the Campbell's back. Um,
Maggie Abraham: yeah, the deciding piece. Financially I've always been willing to trade, not always, but, largely willing to trade money for time.
So I was always quite careful in setting targets and different things like that to make sure that I had a little margin in my life. So, practice volumes are high and the pressure that was definitely, sometimes I had. Patients, new patient appointments were three, six months out at times.
And so there's a lot of access issues in our clinic, and that was getting increasingly stressful, just trying to find places to work patients in and just getting through volumes. Volumes.
Daniel Wrenne: Like where you had thousands of patients, I imagine.
Maggie Abraham: Oh, I had a practice of over 5,000 patients.
Yeah.
Daniel Wrenne: I don't know exactly. Obviously I haven't done the job, so I don't know for sure, but I can't, I think my max on like knowing people is like 300 people. I start to like, forget names and like, not know. I don't know how intimate you're to, but like how do you even.
No more than a thousand, much less 5,000. Like,
Maggie Abraham: oh yeah. I mean, shared practice. So, historically the practice was started by a colleague, and so she had built it up and then another physician had joined along the way and she had left after a few years, and then I joined. So kind of had the remnants of their practice too.
And then there was my patients that I built up. So, I mean, you're not touching, you can't, that's not awesome. But, a patient is still considered a patient of the practice, even if they haven't been seen within mm-hmm. Three years I think is, is the cutoff. So Yeah. Large volumes for sure. And, I will say there was a couple of times where I realized that, I was kind of waiting in shallow waters. Like I knew enough to know that if I asked a certain question, it was gonna open a whole other line of conversation and that was gonna derail like you in your
Daniel Wrenne: interactions with patients in your schedule.
Do you think that compromised your ability to provide the best healthcare? Yeah.
Maggie Abraham: I mean, there's no substitute for time, you know, and as efficient as you get, you still can't get around that. You can never be fast enough for administration. Right. But, in order to provide good, good healthcare, you really have to give your patients time.
Mm. because, imparting knowledge is, the easy part, but, partnering with a patient to embark on, good health decision making is a whole other process.
Daniel Wrenne: The art That's like the art of it.
Maggie Abraham: Yeah. It, yeah, it is. And so often, like giving them the education, is the easy part.
Mm-hmm. But then helping them to understand it and then to sorta helping them to incorporate it into their lives. and building, building a relationship. Provide, you know, they share with you, what their limitations are. connecting with your patients is, it's so important, in order to really.
be effective and bring healing to any situation. and so yeah, like there's a lot of different stories, but, you know, my daughter, my five year old who's quite a fit fire, my youngest, she came to work with me one afternoon, some gap in, I don't know, I had to pick her up and sit her in my office for a couple of hours.
And, she turned around to me at the end of it and said, mommy, I thought you were a doctor. And I was like, oh, yeah, am a doctor. And she's like, oh, you're not a computer person. Wow. And I was like, oh yeah, cuz that's really what she saw, obviously I wasn't bringing her into patient rooms with me, but still called my office.
Yeah. And so there was a lot of those moments.
Daniel Wrenne: kids always are great eye openers to things. They're like,
Maggie Abraham: they're really good at observing, not always so great at Interpretat interpretation, right? Yeah, yeah, yeah. But she really did reflect back to me and I was like, yeah, like spending a lot of time charting.
and honestly, there was times when, you know, I'd just go into clinic and I'd be like, today I'm just gonna like, not chart. I had an off, I worked, I scaled back, so I had time to chart, outside of the office. And that made a huge difference. Sometimes I just be like, I'm just gonna interact with my patients fully.
no, multitasking is applauded, but. I think there's give and take there. and so, you know, you can't really make eye contact and type at the same time by sending a prescription or, you know. Yeah. It's not really feasible.
Daniel Wrenne: one of them's gotta go. Yeah.
Maggie Abraham: And, there's so many nonverbal, cues in conversation and you missed them.
And so, I do that from time to time and then I'd sit down and, be like, okay, now I need to package that whole encounter in, into billable visit. And, it was kind of switching gears and I was like, gosh, if I didn't have to document so much, I really feel like I could give more.
And I think the documentation has definitely increased over the, my lifetime in medicine. It's a bit of a killjoy. yeah. And people talk about getting scribes, but it's not feasible for everybody.
Daniel Wrenne: but the other thing is like, what's the purpose of the documentation? Is it, I mean, there's one thing to do, like valuable for the patient's interest, like really important notes are valuable.
But if it's like, Kinda like halfway garbage. You're like, this is just for billing purposes. You're like, I'm just doing the things to check the boxes. That's mind numbing, I think.
Maggie Abraham: And I think honestly, if you have huge volumes of patients, you almost need that documentation because can't remember fall back on.
Yes. So there's that whole piece to it, and then there's important detail, but the time crunch of it all like. Seeing patients, documenting everything. And for me, a lot of my notes are consults too, so they're going back to primary care providers and different things. So, so some of it's of value for sure.
And then it's helpful for me to be able to enter back into the narrative and, know certain things. I'll be honest, I'm not holding that around in my head, but it is exhaustive. There's a lot of it that's redundant for sure. And but it's also there, there is a role for it, but I think, it needs to be rebalanced and if it's important, then we need to be given time to do it, right?
Mm-hmm.
Daniel Wrenne: Yeah. Yeah. So all, so there was multiple fa factors kind of brewing that were causing some stress or like didn't seem right in how your work. Was going. I wouldn't, I mean, I don't know if you'd call it like burnout. I don't know the definition, the burnout thing is all over the place these days. But
Maggie Abraham: you know, I wrestled with that.
I was like, am I burned out? I don't think so. I should emphatically say no. Because I still really loved seeing my patients. Mm-hmm. Um, but I also really felt that, I wanted to show up as a parent too, and I was enjoying those faces. And so I wanted to be able to have both. And, you could have it all, just not all at once.
So I felt like I scaled back, I took a salary cut. and I still wasn't able to balance things. So, I mean, they had to make it, I felt like in the end, like I had to go, I needed to go for myself. There was also a huge part of me that was kind of doing mental gymnastics in my head to try and make my situation work because I was comfortable.
Mm-hmm. In many respects, I've made peace with some of the trade-offs, I talk about them and say like, they're kind of far away from how I envisioned practicing,
Daniel Wrenne: but yeah. Yeah. It reminds me a ton of my experience in so financial side of the, a different industry, but super similar in the, I was working in the traditional world of financial services and there's a lot of problems there that were basically like inhibiting you from being able to provide the best possible advice and help for people and, lots of production focus and a lot of the similar challenges in healthcare.
But I kind of, once I saw that, I basically created, and I just realized this, I created this like, Hurdle that I kind of knew was insurmountable. Like they couldn't jump this hurdle. Like I'm talking about my employer. Mm-hmm. And I created it and I'm like, well, if they can do this one thing that's like gonna allow me to act in my client's best interest, then I'll stay.
And so I'm like, Hey here's this thing. I need you to do it because it's gonna, it's only way I can truly act in my client's best interest. And they're like we just can't do that. Mm-hmm. And I knew going in that they were unable to do it, kind of, but I, it gave me this like, definitive point where when they said We can't do that, I'm like, I guess I'm out.
Like, and that was my point where I'm like 100% out. And it was great to know that, but it's so hard to get to that a hundred percent all in point. Right? Or point, sometimes you have to kinda all out, right. All out on one thing. All in on another thing maybe. But it sounds like yours was similar.
Maggie Abraham: Yeah. Yeah, it had definitely gotten to the point where I was like, I can't compromise anything else. And yeah. And then when they didn't meet me in my ask, I was like, okay, I understand that, you know, they've got an organization to run and this is how they choose to run it. And so, yeah, it was a parting of ways and then it was like, what do I do now?
Oh
Daniel Wrenne: yeah. So at that point, when was that? When that happened when did they say like, eh, I guess we're not gonna be able to compromise?
Maggie Abraham: So I had a thought around December that, hey, this actually happen in the new year. Like they might require me to take X amount of call, which I can't feasibly do. I mean, I can do it, but.
I can't do it. You know what I mean? And then it actually happened in January. And I mean, my husband was, you know, my husband, he was wonderfully supportive. He was like, yeah, he's something else. And honestly, my son had been saying it to me for, I don't know how long, but he's like, mommy, why don't you be your own boss?
And it like repeatedly because, you know, my husband and I had been, talking back and forth about different things and all the kids would hear our conversations, but he was the one who kept saying it. So in January, I think towards the end of January, February know, there was a couple of meetings stacked up for the new year.
You know, nothing happens over Christmas, really. Mm-hmm. and so I was prepared. I think that it might happen, but I really felt like slim chance. But then it was my reality and I didn't have a plan. And, Joel kept saying to me, just take time. you don't need a plan.
and I was like, have you looked at our, our finances? We talked to Daniel Wr. Just kidding. but, I thought about a lot of different things. those three months were really, really hard, like working out my notice, going to clinic every day. And, tucking in, procedures and loose ends.
Mm. but also finding landing places for, you know, my patients and, and then, telling them that, there was like a scheduling issue. So it was kind of like, you know, the practice were like, tell them so patients know they can't reschedule. And, just having to tell them every day and then, Honestly, that was really rough.
I, I feel like I'm probably getting stuck on saying it out loud even now. Mm-hmm. It was heartbreaking in many ways. And it definitely, I'd come home after a day and just be like, gosh, working out this three hard, these three months notice was really hard. just emotionally just stepping away and not knowing what was next.
Like, they would keep, like my patients would say to me all the time, or the parents, where, where are you gonna be? Like, what are you gonna do? And I was like, I dunno. but I kept saying, Google me, you'll find me on Google.
Daniel Wrenne: That's gonna be, which is pretty, pretty good thing to say. I mean, you can find anything on Google.
Maggie Abraham: I know. and then I started to think and then just evaluate things and I like to run. So when I run, I listen to your podcast from time to time. And so you were doing, talking a lot about direct patient care and I started thinking a lot about that and I'd spoken to some colleagues too about starting my own practice and things just started to take shape.
If you feel like I can dive into a little bit about some of the fears mm-hmm. Around
Daniel Wrenne: all of that. Yeah. I mean, that's scary. when was it, what was the scariest point? Like what, at what point were your li what I mean, was it right before that conversation with them about the, breaking point of you're gonna be out or in
Maggie Abraham: Yeah.
The scariest point was definitely letting go, letting go of my current position and stepping into like nothing.
Daniel Wrenne: Yeah. What were you telling yourself? What were all the like, reasons to not do? I mean, that's what usually in my head, I'm like, here's all the reasons not to do it. You know, you're kind of talking to yourself.
What were the conversations like in your head at that point in time?
Maggie Abraham: W well, I already felt I'd compromised a lot, and so to continue to take call like 50% of the time was just compromising my family. I think, people sort of forget that, doctors, you know, you take a, you when you care, when you enter into a caring relationship with a patient, like, it's a weighty thing.
And I think, you know, there's more than just I mean, it's meaningful and wonderful, but you know, my kids would be like, oh mom, are you coming to X, Y, and Z? And they're like, are you on call? Yeah. Are you gonna get called away? And that being a factor 50% of the time, like that's not good.
You know, the other weekend the weekdays were a little bit easier to manage and honestly, I think it just took its toll over time and I just didn't wanna factor anymore, didn't wanna take two cars to places or juggle the kids last minute and, It was really my desire to show up more on a home front that really made it unsustainable for me to, yeah.
Daniel Wrenne: But that's what I would say that's super important that sticks out most about all this is like, well two things I think is that when you were talking about your replaceable at home versus at work, you can be replaced. In other words, like your job as a mom is super important, like very important.
And then the other thing you mentioned about like, the volume and the pressures basically compromising your ability to provide quality healthcare to your patients or was getting to that point. And so it's like, to me those are like major values conflicts. That's the way I would see it. It's like a values conflict.
Like you're getting kind of pushed the direction of a conflicting with what's most important to you. And, but that's, this call thing was kinda like the breaking point. It's like, They're drawing a hard line and it's gonna conflict with your values. And, but in order, when you make a decision, I think when you're able to make a decision that's like, in alignment with your values, which was to say, no, I'm out.
That's like a home run. And the problem is, so finance, going back to like finances and scary and fear and all the things that hold you up. Like those are all, you can figure those out. And the fears are usually overinflated and, but like the values thing, like that's, it's almost like that's a huge win.
And I think usually when you get through those hangups or hurdles, you feel like really this like, breath of fresh air and you feel more yourself and you feel like, like. You've made a good decision, even though it's kind of scary and there's nothing there. But like, I'm curious for you, it seems like this was like a big val, ultimately a values decision.
It was like, about what's most important to you and you made the, to me the right decision cuz it was aligned with your values. And we haven't even talked about what the new alternative is. I'm we're kind of at this point where you're going into nothingness and I'm still saying I think that's a home run decision and I'm a finance guy.
I'm like, not even asking about the numbers at all, but what was your feelings at that point in time?
Maggie Abraham: Yeah, like there was a, there's a lot of scariness about the unknown. Like what next? Like I'd always had something to jump into, but there was like some concrete pieces, like my kids were established in school, we weren't moving anywhere.
Mm. So I knew that whatever was next, I was, I still, being a mom is a full-time job. But for me, like I really also wanted to practice medicine. And, when I was leaving my job, yeah. Like I was also scared that there was a huge gap, what was gonna happen to my patients? Who's gonna take care of them now?
And so, as I sat with many of those things, I started, and, the things that people in my inner circle, my family my friends, the people who really know me, were saying to me were also things to consider. Like, um, what about being my own boss? Like, what would that look like?
And when you're not at work and you don't have to get up and go to work, there's a lot of time to actually think about things and time to be creative and time to sort of unpack what's important. you know, I really realized that I didn't want to work for another organization for a while, even though I'd valued doing that for a really long time.
And I wanna be really clear in saying that, there's so many great things about working for big organizations. There's exciting things that I got to do. And a lot of great things. And I got to work with a lot of really great people too, so it wasn't all bad. This didn't suit me to continue in that position because, my life has evolved, 15 years. Yeah. A lot. And so, and yeah. And I also think that we have been thoughtful over the years about making sure that we have. Margin. And I know maybe my finances could look a whole lot better. Well, they could
Daniel Wrenne: always look better too. That's like, you don't want to go too far down that road.
It's like your finances. Well I'm not gonna get into your finances cuz it's private between you and us, but like, we'll talk, generally speaking, like typically the type of people that work with or are willing to pay for help. Around their finances and stick with it for a long period of time and follow advice.
Your, your finances are gonna look pretty solid. Like you have a lot of flexibility, although they're never perfect, but like your finances are solid in that you're able to make big life moves. The scary part, even if you have millions and millions of dollars and billions of dollars, even like some people that have a ton of money actually have an even harder time making that kind of decision, whether it's like money worship or like fear of loss or whatever.
Like, it's not all the money is just the tool and you just want to kind of use the money to allow you to do the things in life, and that's, You're, I would say you all are more than in a position where you can kind of do the things in life, even if it involves making a big career jump like this.
And that's so, looking at someone that's just really, no margin, lots of debt over committed on their finances, like, or even maybe straight outta training and has student loans on top of it all. And, all that stuff can compound. And really they're, I don't, I'm not trying to say like do anything anytime independently of finances.
The finances are obviously important, but you don't ever want to get to this position where your finances are holding you back. And I think a lot of people are at that spot or maybe they don't even know Yeah. Where they're at with that.
Maggie Abraham: And I guess I just wanted to add to that. Yeah. One thing I really had to wrestle with was like, what is my source? Is my bank account and the finances that I have, is that gonna be the, what the place from which I make my decisions? but I really, a friend had said this to me like a long time ago, and I keep circling back to it, but what is my source in life?
And I know that, and you, you know this about me, but yeah, like, I'm Christian. And so when I will say that, I realized and making some of these scary decisions that, you know, my bank account will never be enough. I'll never have perfect security in it, so yeah, I think, being good stewards, using our money wisely and being generous.
But, I've been broke. Yeah. And I've been okay when I was, I mean, I don't like that place.
Daniel Wrenne: Right. Well, I go fast, but I, but I think the Christian, the call of Christians is actually to embrace un. Discomfort comfort. Yes. You know, comfort is not en endorsed necessarily, but that's a cultural thing more than anything.
Like, we all really work hard to get comfortable.
Maggie Abraham: Right. And I feel like, I was comfortable and I got a little shook up for me. And, there's nothing wrong with being comfortable either, but it just got to the point where it was time for me to make some changes and I felt like it's been really uncomfortable and it's also been let go.
but I can talk a little bit about Yeah. The things that I, that were really scary for me. So once I got past the idea of not having a paycheck, Which my husband was totally fine with. My kids are really great about it though. They were like, well mommy, you're not working now, so, can we still afford to do this activity?
And, they're be willing to kinda, well, maybe we can just take a pause for a
Daniel Wrenne: while. And they probably like loved seeing you around more too. Yes.
Maggie Abraham: And they do. And I've loved being around just picking them up and taking them to places and just seeing who they are in their environments.
Like, I feel like you don't know what you're missing out on until you, I don't know what the end of that is, but we don't know what we're missing. And almost to keep going, sometimes you kinda have to block that out. And I don't regret, I don't regret my life to this point, but I feel like I'm ex I'm glad I made the change that I've made, even though I'm still in a what's next point.
But I was really scared. I think, When I was scared that I wouldn't be able to practice pediatric adolescent gynecology outside of a big organization. Mm-hmm. And I was, you know, looking at different job opportunities and I, I started to realize, gosh, like I really wanna do this my way. And so, that was one thought I had going forward.
I was like, whatever chapter I enter into next, like, I want to practice adolescent guide and I don't wanna do it under the constraints of an organization. I wanna do it differently. I wanna have more time. I wanna feel less time pressured. I want to be able to go a little deeper if the situation calls for it.
And I want to know my patients better. You're right, you can't know of patients well, and some patients don't really need you to know them. I would argue, they're coming to you for a specific reason, but others do. And in order to provide, like Indi Healthcare has to be individualized.
And we have to be able to relate to our patients well in order to, enter into a therapeutic relationship. And that's only possible if there's time to do it. So that was one thing. And I guess one of the other big fears I had was just feeling like putting an idea out there and it not working.
And so when, and the other thing too is, I don't know if you know this about me, but my dad was A veterinarian. So I grew up, with him being on call all the time, constantly. Mm-hmm. Part li his life constantly being interrupted with calls. But I also grew up, going places with him in the car, in the van, and going out to families and I mean I think that impacted me a lot as a child.
But also, he had always said to me like, don't work too hard. And he worked really hard his whole life. And, I think it was rewarding, but I really got to a place in my life where I realized, I don't have to work super hard in order to provide financially for my kids or my family.
And that's definitely a luxury, right? But I also realized that I wanted to balance things a little better, maybe or differently to what he did. Yeah. And so I was always really scared of going into private practice or my own practice, cuz I always felt that that will come with this big burden of call and being available and all of those pieces. Right.
Yeah. And so I think, sometimes the promises we make in childhood right, come back to, to bite us as adults. So I think just unwrapping that a little bit and realizing that, hey, look, you can create it a little differently. The demands and the pressures he had are different to the ones that I have.
Mm. So I can be creative in, in how I engage it. And I wound up being in practice by myself for a year. And so not by choice because I would never have chosen that for myself. But I realized actually no. Like it's okay. And then, the whole idea of direct patient care, like I'm not inventing this, I'm not one of the trailblazers.
It's true. Tried, it's tested and proven to work. So I feel like, for me it's kinda onboarding on something new, like as an early adopter, but there's a lot of security there. And then one other thing I guess I'd like to say is that, yeah, I think we all probably worry that we're gonna fail at something.
And I don't know, like I'm okay with failing if nobody sees me, but I don't really be the poster child for not being successful. Right. But, um, I realized, gosh, I had already was kind of exposed just in my, my inner circle. I'd admit admitted thing. I'd said things out loud like, Hey, I wanna start my own practice.
And then what was stopping me? Just my own unwillingness to step into that and raise failing. And I decided, gosh, I really regret it if I don't try it. And that, I think ultimately was the thing that, that kinda propelled me forward. I was like, I'm gonna do this and see how it all pan out.
Daniel Wrenne: Yeah. Yeah. That getting to that point where you can connect the regret to lack of action. I think the big, the most common regrets people have are like, Not doing the big scary things in life that they know are probably worth trying at least. Whatever, not even professional, like anything.
so just doing it anyway, despite the fact that it's big and scary and, and failures on the table, that's also the going into the uncomfortable thing. And being uncomfortable comes with this whole idea that you might look like a fool. You're putting yourself on the line and people may be like, man, that, or, you know, people are gonna be like, that's not gonna work too.
I don't know if you've had, have you had doubters? No, that's good. You,
Maggie Abraham: I mean, when I spoke a little bit about, To people about starting a private practice. A lot of people were like, oh, you're gonna have to partner with, a group so you can get group rates on things, and that sort of a conversation.
And I was like, oh, I'm actually kind of think doing things a little
Daniel Wrenne: differently. You're like, I'm not doing insurance. And they're like, yes. Whoa, whoa, whoa, whoa.
Maggie Abraham: And maybe I just haven't spoken to enough people, Daniel. Yeah. If I talk to more people, they're gonna like, tell me. I mean, so you I collected out the people that I'm gonna talk to, to all the people we're gonna tell me this is gonna work.
Daniel Wrenne: Just kidding. Yeah. I mean, your influence, your sphere of influence is huge. Is a huge factor in all this. You've already mentioned people, you've kind, family and hearing people's input and that kind of thing can be really good, but it can also be bad. Like, so you have to be careful who you're.
Rolling with, I mean, not that you don't associate with people, but there's definitely Debbie Downers out there all over the place and they're just like, used to the, you know, the types. It's like, eh, that's the way you gotta do it, cuz that's the way it's always been done. Types. And, you know, that's just what they're gonna say and it is what it is and they just can't wrap their head around doing things differently.
It
Maggie Abraham: also depends on how we're gonna measure success here, right? Correct. So, you know, the financial piece is obviously a consideration, but like this is bigger for me. This is about, you know, doing healthcare the way I feel I will do it best without the constraints of, you know, an organization, but also it's about.
The risk, you know? And I think it's about being able to balance showing up in all the places that I care about and all the places that I feel I'm called to be present in. Mm-hmm. So it, it's kind of more, I hope to balance my books well. Like it don't get long.
Daniel Wrenne: Yeah. Well it feels, it also feels like it can feel alone when you make the decision to even though you have people that you can, like, you know, your spouse or your friends, your family or whomever, but like, at the end of the day, it's on you, you know?
So, one of the big decisions I, you know, that I am aware of that you made was to hire help to really help you quarterback the whole startup process like a consulting firm and and that. I think is an expensive thing, like on, you know, it costs money. And a lot of times there's a temptation to be like, oh, I'm already pinched financially and why in the, how in the world could I possibly justify writing another big check when I'm already in this scary financial position to pay somebody?
And then you start kind of nitpicking the thing and then you're like, well, I could do all these things myself. And it's just, you go down the road and it is just difficult to get to that point. And most of the time people end up like, I'm just gonna do it myself. But you made the decision to, hire help and, and you know, be on board, which in some ways is really nice cuz you got a teammate kind of, and you got somebody to help.
but like, what was that like deciding, I think it seems like that was the first big decision after, once you decided, you know, I'm out and then you kind of drifted towards this idea of starting your own practice. Then it seemed like the next progression would be like, well, how am I gonna assemble things?
Maggie Abraham: Right. So I think, you know, there was a couple of steps like saying out loud, I'm gonna do this, and then moving on from that place of how am I gonna do this? Hmm. And again, I had listened to one of your podcasts and I was like, oh, there, there's somebody else who can do this with me. And I can pay them and they'll do it, you know, they'll help me do it.
Right. I, I never, I don't wanna, I didn't wanna overlook anything, you know, from a legal standpoint or from any standpoint, you know, and I wanted the structure and system to be built well. And I, I wanted, you know, to pay somebody to, to help me navigate some of the logistical pieces. Mm.
And again, I guess I had kind of the flexibility in, in the, on the financial side. And so that made it possible. I also really, I. Felt that, and just, I guess I should speak just from an about the flexibility and the financial standpoint. I ha we had plans to do some home renovations, and I had some, we had a HELOC and some money set aside for it, but it was kind of sitting there and then this idea dominated and then we repurposed that money for my business.
So it's not, it's not like it was just sitting there aimlessly. Mm-hmm. You know, you know, there was, there's a opportunity cost, you know, to, to doing it. But on the same note, the money was there and that we could put towards this. And so, you know, there's that piece. So, you know, I'm grateful that we could make it f that is financially feasible for us.
And then the other piece I guess is, you know, I was very much at risk of, okay, I've said it out loud, but doing a U-turn, you know, running the other direction. I know that I can do this, but I come out. Yeah. And so actually, you know, signing on the dotted line and onboarding with another organization.
Because that's what Freedom Health works are, right. To help make this this possible. And you know, I spoke to a couple of other physicians who were doing direct specialty care or or a, a pediatrician who's doing direct primary care and they were wonderfully encouraging. Mm-hmm. They were like, oh yeah, you could do this.
And yeah, you could put all those pieces together. But again, I also kind of thought, is that what I wanna spend my time doing? And I knew that, you know, some things I would rethink unnecessarily and, you know, freedom Health breaks, they'll, like, they'll keep you moving forward. And so, I mean, there's many different ways to do it.
This is the way that I chose, it's also summertime. My kids are off. Goodness. Yeah. Summer, they're not all in camps every single week. And so, you know, I wanted to spend my time. With them. Mm-hmm. And also get my practice going. So, yeah.
Daniel Wrenne: So yeah. So you, I know you, you sent us the proposal from them to kind of look at, and this is, this kind of gives you a taste into the role of like what I am.
And as so funny, if you have a financial planner and you're starting a direct care practice or any business for that matter, we're kind of like the whole pokers typically in that situation. You know, second set of eyes kind of thing. So Maggie sends me the, this proposal and email from the Freedom Health Works people you know, about the practice and the cost and the, all this stuff.
And Yes. You know, we have like a zillion questions. Yeah, I
Maggie Abraham: think I had a handful. And then Daniel, you had a, I was like, they're all excellent questions. Why did I not think of any
Daniel Wrenne: of those? Yeah. And then they, they joke with me about, they're like, you gotta take it easy on us. Oh really? Yeah. I mean, but we're, you know, we just have to play it case by case.
And we wanna really keep people on their toes and make sure all those bases are covered. And and you know, 80% of the time it's favorable cuz you've already done lots of good due diligence and you're doing it for the right reasons. And like you've all, you've explained like it's, it's good for you to do this, but on occasion we'll find some.
Stuff in there that's like, well, maybe, you know, maybe you should look at another. Cuz there's surprisingly, there's a, a handful companies doing this is a, a very evolving field, or I guess, I don't know if I would call it, not field, but like, way of doing a way of practicing medicine. It's a quickly evolving, fast-growing new way of doing medicine.
And so there's all kinds of new companies and players and people getting involved in it, and it's growing really fast. So it's kind of exciting, but it's also, you know, you gotta kind of make sure you're checking all the check boxes and you know Yeah. Aligning with the right people. So that particular company you're working with, they've done it with several hundred practices already.
So it's like, that's kind of nice to, instead of just, you know, doing it your first time. Solo, it's, it's like you can kinda leverage all that.
Maggie Abraham: Yeah. And so again, that kind of speaks to, you know, how Ill-founded many of my fears were, you know, because there's, there's, there are people to partner with to make it happen who have done it before and it's not new to them, even if it's new to you.
And so it's been really helpful for me, um mm-hmm to have that. And I was really grateful, you know, you asked them all the tough questions.
Daniel Wrenne: Yeah. They had pretty good answers. So that helped. They did, right? Yeah. I was like, oh, pretty good.
Maggie Abraham: Yeah. Yeah. And so, and sometimes asking having just the, the correct language, you know, when it comes to something in healthcare, I can, you know, come up with the right language.
But the financial. The financial pieces. You know, it's kind of silly to say you're gonna start your own business and then not even know how to put together a business plan, but yeah, that was me. But you know, the medicine of it, I feel confident I can do the business piece I need some help with
Daniel Wrenne: yeah.
You, well, you got people on your team that can help and that's, and you can, and it allows you to do the medicine piece. More efficiently and focus on it at least more. And that that's a, a big deal too. Well I know we're getting towards the end. I don't want to take too much of your time. I really appreciated you coming on to chat, but I was hoping if we could, if you have a few more minutes, I was hoping if you could share a little bit more about like what it's gonna look like, what the practice, the new practice is gonna look like what sort of services, like how are, and maybe somebody's listening and they're like, I don't even know how she's gonna make any money.
Like, cause we just said you're not taking insurance, so maybe you could give us a little bit of a snippet as to what you, I know that's probably gonna evolve over time, but what you see that looking like.
Maggie Abraham: So I'm hopeful in the next couple of months that we'll actually launch my practice. So it's, we've got a name.
It's called the G y n space. What is it? The g y N space.
Daniel Wrenne: Oh, nice. Yeah.
Maggie Abraham: So it's a gynecology practice for girls. Teenagers, adolescents, young adults. And it's on a virtual platform only. So it's not full scope pd, adolescent guide. There'll be some, you know, limitations there cuz I'm starting off for virtually only.
So hang on a minute. What was the other piece of that, of
Daniel Wrenne: the question? Yeah, I was just curious like, how, how you gonna make money? That's kind of a critical part. I mean, I hope
Maggie Abraham: so. freedom HealthWorks ran the financials and they looked great. Yeah. Whether they're into reality or not, to be determined, you might have to have me back for a part two.
Daniel Wrenne: Well, you're gonna, you're gonna do like a retainer sort of setup and some, maybe some one-off visits for fee for service.
Maggie Abraham: So, Mostly, you know, there will be a membership piece. Yeah. But most of what I'll do will be initial consultation and then if they wanna sign up for ongoing care they can, and play a monthly membership fee.
Mm-hmm. Or if, you know, they just need an initial consultation and then follow up a year from then, then there'll be like a follow up consult fee. Hmm. So it is direct fee for service. Yep. Like patient pay you in the sense that it's transactional and the sense that, you know, transparent fee for service, my pricing will be, yeah.
Daniel Wrenne: Billing is far simplified. Like it's the patient pays you. Yeah. So when you eliminate insurance, billing gets my web,
Maggie Abraham: my website will say, if you have. This, this or this, it will cost this, this, or this to be I still have a little bit of a question mark over you know, it's always been really important to me to see patients of all payer status.
And so, you know, I still have a little catch in my heart about, Hey, is everybody gonna be able to access my services? And I've tried to be thoughtful and, you know, as physicians, I think, you know, we're not all that connected to the finances of medicine when we work for large organizations. Mm. And so setting pricing and things like that is surprisingly hard.
And then trying to set a price that's reasonable that's also been a challenge. And then you know, there are some great practices out there with kind Robinhood models and different things like that, that have me kind of thinking about things. So I do wanna have, you know, different pricing, so a membership or fees, but then also an accessible fee option so that, you know, finances aren't a barrier, but at the same time I'm providing a service, so mm-hmm.
That has to come with a cost if financial Right. At the same time. Yeah. So balancing some of that is still something I'm trying to work out, but yeah.
Daniel Wrenne: Yeah. I'm curious to hear on the backend how people, how the patients respond differently. Because, so I mean, I have worked with, as a patient I'm talking about with the traditional physicians and then also indirect care models and it's dramatically different.
Like, like, like night and day different has been my experience as a patient. And I think, I would imagine that's how most people experience it. And I'm, you know, curious. It depends on a lot of things and specialty and what the services actually are. And but one of, one of the particular changes that I was thinking about is when people start paying for something they start to get a little more like vested in it, which is a un You don't always realize that on the front end when you're doing all this stuff.
So, What I have noticed is typically the more people pay, like, and it, and I'm talking about more in relation to their world. So, and some people don't have as much means as other people, but like more in relation to their world. The more that people tend to pay, the more vesting they have in whatever X y Zs service it is.
And they're gonna kind of show up and ask the hard questions and but that also helps you or, you know, whomever you're working with to, to be in a better, like, they have their, their ears are tuned in really well to what you're saying, as opposed to when it's free or not, you know, free in air quotes, like free in our traditional system.
Like people have the tendency to be like, ah, yeah. You know? Okay.
Maggie Abraham: Yeah. And I will say too that my niche of expertise is. You know, it's an important, it's an important field and there aren't a whole lot of pediatric adolescent gynecologists and so reproductive care for adolescents and, you know, in young adults isn't widely available.
Hmm. My patients come from all over to see me. And so taking away some of those access barriers and taking away, you know, they always worry about if they see me, are they gonna need a pelvic exam? And so when all of that's put on a virtual platform, I feel like it's, it's gonna hopefully be more accessible and more acceptable Yeah.
To them to seek reproductive care. Mm-hmm. And I think their needs that largely go unaddressed. And so I'm hopeful that this sort of a model will meet. Teenagers and young adults where they're at, and give them a service that they value. And I hope the financial part of it all works out well.
Oh, it'll
Daniel Wrenne: work out. You, you'll be just fine. Yeah.
Maggie Abraham: Not welcome. Come up with a
Daniel Wrenne: plan B. Yeah. There's always a plan B. And you mean, you
Maggie Abraham: know, I can't figure it all out at the start. I've gotta step in.
Daniel Wrenne: And then that's the difference in entrepreneurship and practicing medicine. Practicing medicine is you go for excellence and then you start to practice.
I'm kind of, and you know, let's go for like 90 plus percent before, you know, but then you, you, you do it and you strive for perfection or near perfection In entrepreneurship, it's like, let's go for like, eh, decent, like let's do the best we can and then go try it. Not, and then like, it's gonna fail some, and then you tweak it, and then you keep put it out again, and then it's gonna fail, and then you tweak it, and then slowly you're like evolving it based on your experience with the failures.
Right. To make it better so that it caters more to what the need is. Mm-hmm. Yeah. And that it's a different, it's kind of a different mindset, I guess. Yeah.
Maggie Abraham: Yeah. It's definitely a mind shift. Yeah.
Daniel Wrenne: Yeah. Yeah. Embrace the failure. Failing Forward is one of my favorite books. It's a John Maxwell book, but it's, I
Maggie Abraham: might have to read it.
Daniel Wrenne: Yeah. I mean, it's, it's great. It's, helps to get that mindset where you're like, failure is actually a step, step stepping stone to, to the next level of, or evolution of the practice.
Maggie Abraham: Yeah. I think we have to be willing to, to risk, right? Mm-hmm. In order to kinda move forward.
Daniel Wrenne: Yes.
Well, you are definitely taking that risk, and I commend you on that con. Congratulations on making the big jump, and I feel like we have to reconnect to talk about it after. So, you know, maybe a year or something like that, I don't know, give it some time and there'll be a part two and we're gonna talk about all the great things that you have to be continued to be continued.
The conversation will be continued and I look forward to hearing all that good stuff. Thank you Daniel. Yeah, thanks for coming on.
Maggie Abraham: Yeah, it's been great. And yeah, you've been a big part of, our financial journey and yeah, I think, you know, I owe you in no small part. Well
Daniel Wrenne: it's so, it's freedom. It's very rewarding for us.
One of the most rewarding things, I'm like kind of the. In the role of, like, I'm proud of the successes. That's super rewarding for us to see families we work with. And the one of the most rewarding things like that we see is when people take the big jumps that are in alignment with their values and despite the finances.
So that's, that's like a especially proud moment for me. So I'm, I'm very proud.
Maggie Abraham: And I'll also mention that we took a leap on you based on your virtual
Daniel Wrenne: Yes. It was the profile.
Maggie Abraham: Cause we've actually never met in person. I know,
Daniel Wrenne: I know. That's why it's very similar to what's going on with Direct Care in medicine.
It's like, we did that in 2014 in finance and it was, it's, it's a, there's a lot of similarities. So thank you for taking the risk and
Maggie Abraham: a calculated risk. Yeah, calculated. It worked out really well for me. Yeah. Yeah. Yeah. Thank you.
Daniel Wrenne: Thank Maggie.
