Moving Away From Toxic Work Environments And Into Physician Friendly Practices with Dr. Lara Hochman

Daniel: Lara, welcome to the podcast. Dr. Lara: Thanks so much for having me here. Daniel: Yeah, I'm really excited about our discussion today. I know it's gonna be super valuable. We were catching up beforehand about some of the things Lara's working on that you guys will learn more about. But I thought before we get started and dig it in, I wanted to read this review to all of you listening. Daniel: We didn't talk about this beforehand, so this is a surprise to Lara. But I found this fantastic review on, I think it was LinkedIn, about Lara and I just wanted to read it. 'Cuz it to me it kinda like encapsulates like what the work you're doing. So Dr. Hochman is the medical matchmaker for a reason. Daniel: She's like no other physician recruiter. She's a physician and a recruiter and exceptional at both. I met Dr. Hochman while exploring physician opportunities in Austin, Texas. I only wish I had met her sooner. Dr. Hochman is an advocate for finding your voice as a physician. She is both brave and bighearted with an infectious energy that comes across in everything she does from her YouTube videos to podcasts and one-on-one coaching. Daniel: I saw that, I'm like, Dang, that's awesome. That's a good, nice work, by the way. That's an awesome review. So it speaks a lot to, I think, what you're doing. And I think it doesn't even cover everything. We were talking about some stuff before. You're doing some stuff kind of on top of that like advocating and the content you're putting out is really great stuff on YouTube about like just educating physicians on the work environment that they're in. Daniel: Whether it's a healthy environment or a toxic work environment. And I think a lot of physicians are in the ladder unfortunately, cuz all these burnout things that are going on and the stats are not looking good. But I think this is gonna be great discussion and you have a lot to offer and so I wanted to cover that first. Daniel: But before we talk about the work that you're doing, maybe a good starting point would be, if you could share, I would love to hear about your story on how did you get to this point? You're kind of at a unique intersection of physician, recruiter, and now kind of like advocating. Daniel: So how did you get there? Dr. Lara: Yeah. you know, those of us that are still practicing realize how, and, even those of us who aren't still practicing realize what's going on in medicine and that it's very broken. And something has to be done. Our bodies that should be advocating for us or not. Dr. Lara: So I really believe it's up to each and every one of us. So, what I'm doing is by helping doctors to find those practices that will treat them well. I, got into this in part because I was kind of doing it anyway. I had been in a been at a point that I was burnt out and kind of very disillusioned with the system. And I left medicine thinking, I thought I loved medicine, but I don't. This is not for me. Dr. Lara: Turns out I don't like being a doctor anymore. So I left and just a few months later, what appeared to be the perfect job fell into my lap. Practicing medicine. And there was a lot of fear around that because I had finally gotten out and was I just going right back to my abuser. You know? But you know, it seemed perfect. Dr. Lara: So I figured, hey, why not? What have I got to lose? Jump back in. Turns out it was and I got to enjoy practicing medicine again. And it really just highlighted for me how much it's not the practice of medicine. It's all the things surrounding the practice of medicine these days. this job, we didn't deal with insurance companies and I had time with patients and all of those things. So, once I saw that, I realized, gosh, it's kind of an easy air quotes, easy solution is we just have to find better places to work. Dr. Lara: I went from, dreading waking up every morning to be excited when I wake up. Yeah. And when I get, from, getting home from work and having no energy for my kids and hating bedtime because, you know, gosh, turns out I hate bedtime. But no, actually I was just burnt out. And when I was working in a better job, I loved bedtime because I was just at a better place emotionally to be able to be there for my kids and therefore myself. Dr. Lara: So in that, I started helping the company I was working for to recruit physicians. And then word spread that I helped practices find physicians. So friends started reaching out to me to help them find doctors. And I did. I spent countless hours on this. And I figured, well, gosh, I'm putting so much time into this and why not just make this a thing? Dr. Lara: Because I can have such, you know, I think I saw the potential in how much change I can make for individuals, for the practices and just medicine as a whole. So I just jumped in and took a big risk and did it. Daniel: Yeah. I love businesses that start like passion kind of project based or not for the money reasons basically. Daniel: A lot of people you know, in our day job, we talk in finance with people all day long. And a lot of people their business ideas kind of originate from a place of like, I want more, you know, I wanna get more money and that kind of thing. But, usually those don't paint out very well. But when you come from like this place of like, there's a big problem in the world that you're really interested in helping to solve. That's a fantastic place to come from when you're starting a business. And, I also love how you paint the picture of the challenges of medicine and being the system and not like the actual practice of medicine. In the moment, like when that was all happening, did you not see that clearly? Daniel: Or like, did you kind of always see that? Or were you just like burnt out? And you're like, I'm out. I don't care what, what's going on. I'm out. I gotta get out. Like what in the moment? Like what, what were you seeing at that point? Dr. Lara: In the moment, you know, I've always loved being with patients and I actually have always loved medicine. But I don't think I was able to see what medicine could be. And so I didn't know about direct primary care. I didn't know about, you know, I hadn't really thought through it enough to know about autonomy and, you know, making your own decisions. A lot of it was just not knowing what's out there. And I just thought, well, medicine is has gone down the toilet. Dr. Lara: Like I didn't realized that there are actually better places out there. And so, I knew that it wasn't medicine itself. I knew that it was everything surrounding medicine. But I, didn't realize that there are actually better places to practice. Daniel: Yeah. That's the awareness thing is important. I think direct primary care is a really great model. And that it kind of aligns you more with actually providing patient care and it removes you from the system or not all of it, but like a lot of it. And, it's, we've actually had several guests on that are, you know, in direct primary care models and it's a fantastic setup. Unfortunately, well, you know, I guess it depends on your opinion. But there's a lot of people listening that are not in direct primary care setup or maybe they're in the hospital setup. Or like, can it, do you still, how do you feel about the system now at this point that you've kind of gone through these experiences? Daniel: Do you feel like there can be like, healthy work environments within like the hospital system? Or is it getting better? Or is it like, you know, you gotta get, get out of it and just kind of create your own path? What are your thoughts at this point? Dr. Lara: At this point, I actually feel pretty optimistic about the future. Dr. Lara: I do think that there are certain things that will continue to get worse before they get better. But there is already a lot that's getting better. So more doctors are leaving to start direct primary care practices. More doctors are just leaving their hospital systems and starting practices themselves. Dr. Lara: And I do think that the hospitals are starting to wake up to what's happening. They're still making people work extra hours for, you know, less pay or you know, all the things that they're doing. But at the same time, you know, they realize and they have these chief wellness officers that can hopefully do something and that can evolve to something else. Dr. Lara: I do think that change is coming. Hopefully it is sooner rather than later. But you know, I see a lot of very positive changes. Doctors who completely burnt out and thought that they were gonna leave medicine entirely and then started a direct primary care and they were happy. Or, you know, started a practice that takes insurance and we're able to learn to run a practice profitably. Dr. Lara: Which, you know, that's a big challenge. And as you know, you're in finance. It's very stressful. I do see, you know, yes, a lot of practices and physicians are being bought up by the hospital systems. But at the same time, there's a lot of doctors leaving and starting their own thing. Dr. Lara: And I do think that eventually, I don't think it'll be the very near future. But I do think that the hospitals will wake up and start treating their physicians better and listening to physicians voices and, you know, doctors coming into leadership positions to help change things. Daniel: Yeah. Daniel: Unfortunately, well, my suspicions it'll take a, it'll be slow. They're slow to move and it'll be because of money. Unfortunately. A lot of times that's what moves the ship. I think entrepreneurship is one of the best tools, you know, you have to kind of help solve problems and you can kind of just create a new path all together. Daniel: I mean, like, there's maybe solutions we don't even know exist. But the more physicians kind of open up to that idea. I see a lot more physician entrepreneurs and that's kind of cool to see. And I think when you see more of those the more our people that are doing that, they're just gonna create new things that maybe we haven't even thought of. And that's gonna kind of accelerate things. Daniel: But for those of us, for those of you all listening, maybe you're in like this job that you're, you're just kind of in the weeds of a just maybe it's unhealthy. But it's like you're not sure. You're feeling some frustration with work. Like if I'm in that position, I'm like, like you were saying, like I come home and I'm like, it takes me days to kind of like check back into like my family and I don't like bedtime. And like if I'm in that situation, how do I know that I'm, Is it the, is there a good way to look for symptoms that it is a crappy job? Like how do I know it's a, unhealthy work environment? Are there signs? Dr. Lara: Yeah, there's a few. I mean, part of it is listening to yourself and part of it is looking at the job. So you know, for one thing, if you're waking up in the morning and you're dreading going to work, that's a huge symptom. That's a big red flag. If you're not able to be present with your family. Or, you know, if you're snappy. Or you know, it gets as bad as things like addiction or feeling suicidal. Or, you know, we have a big problem with mental health in our physicians and a part of it is that we are not very good at recognizing those things in ourself. Dr. Lara: The work itself, I would say if you're saying things and your voice isn't heard, that's probably a pretty bad sign. Or if you are told to do things that maybe don't agree with you. Or see more patients than you can safely see. And you don't have that option of changing it. Or if there's a patient that you feel is dangerous or abusive. Or you just absolutely awful to your office staff and you're not able to fire them. That's a problem. Dr. Lara: So, you know, I think the biggest, you know, one of the biggest reasons people leave a job, they leave people, they don't leave jobs, is looking at leadership and seeing do they listen? Do they truly listen and hear what you have to say and make changes if they're able to or be able to verbalize why they aren't. Dr. Lara: So, you know, all of those things are really important and being able to make the change and have the, have the voice to be able to do things for real in your practice. Yeah. We're smart people, so. Right. Listen. Daniel: Right. Listen to your people. I heard, I was talking with the family they were working with the other day and they were talking about a problem that they had at work. Daniel: And they worked for a, you know, big, bigger hospital system. But they were like so excited about it because they fixed the problem. And that's not common. It's most of the time it's just kinda like, all right, yeah, yeah, we'll put it on the list. And so they were, and I could tell that they were energized by the fact that the hospital helped them solve this little problem. Daniel: I also think of the, one of my favorite examples of doing this right, is have you seen the show Ted Lasso? Dr. Lara: Oh no, I haven't. I don't even have an Apple TV . Daniel: Yeah. You gotta check it out. We binge watched it. We got like the one month free thing and just binge watched the whole show. So, anyway. The one of the things in, I think it's one of the earlier episodes. When he started coaching the soccer team. Daniel: He's like a football. He's kind of like a country southern football coach. Kind of good old guy goes to European League soccer and is coaching this professional team. And early on, like one of the first few days, he has this thing like the suggestion box that he passes around the soccer players, the pro the pros. And you know, they put in their, their suggestions and for, for things to change. Daniel: So, half of them are like not even paying attention. But one, the one that they talk about in the show is like the person says like, the shower pressure is not very good. And so they show in the show, like they go up to the shower and they're like, Ooh, yeah, it is pretty bad And then they fixed it. And it's just like those little things. Daniel: If you show that you're listening and then also, are making an effort to change it, go like a really long way. And it's also a sign if they're not doing that, it causes, it's, it's a sign that it's not gonna be fixed in the future, Which that's kind of like you lose hope in the job. You're like, if they're not gonna listen to me, like, what's the point of trying to improve? Daniel: And that's, that's not a good, place to be in either. Daniel: Exactly. And, if they do make those little changes, they get so much more engagement from their employees. And the employees, you know, the physicians just double down on trying to be awesome physicians. Right. Versus if they don't do it, they're like, eh, you know, there's the new quiet quitting. Daniel: So that, that's where that kind of gets started. Daniel: Yeah. That's an interesting thing. yeah. So I'm curious of your thoughts. There's a lot of kinda like solutions that people are thinking about. Like we've talked a little bit about some of them already. But I know some of the other ones that are kind of like, I think this is probably the more common solution people are talking about in the physician circles or even following through on is some of the things like, buyer, like retire early financial independence or getting like side gigs or passive income. Daniel: They're like very popular. I would call them kinda like movements. And I think the underlying reason that they become such big things is because of this whole frustration with the system. That's my suspicion. I don't, I guess it's hard to verify that. But my suspicion is this, this is kind of like, and I've heard, I guess I've heard one on one people say that. Like, this is the ultimate reason why I'm going after passive income. Or, or wanting to be financially independent and retire early is because this medical system is terrible. Daniel: But I'm curious about your thoughts on like that approach to addressing the problem. Dr. Lara: I would say that's a symptom. You know, if, this wasn't an issue, people were want to retire early because they would love what they do. We're physicians. We love treating patients. And, you know, not all the patients and not all of physicians love treating patients, but I would say that's a huge symptom of what's going on. Dr. Lara: We're all looking for a way out. An escape. Yeah, I mean, I think that having that financial independence does give you the freedom to make the choices that are better for you. So if you don't feel beholden to your $300,000 of student loans and, you know, health insurance and you have to have a certain employer for anything. When you don't have that financial, Dr. Lara: those, the golden handcuffs, essentially, you're able to make decisions that are better for you day to day, and rather than thinking, trying to climb your way out of things. You know, and, and what's sad too, you know, a lot of the side gigs and, you know, all these other things that are coming up, it's because doctors are looking for something more enjoyable. Dr. Lara: I mean mm-hmm. , you know. Real estate investing or, products or social media things. They're fun. Like they're really, they're in a risky way, some of them. But they're very good risk. But they're fun. And so, you know, we don't have that fun in our work anymore. We don't have that satisfaction. So, Yeah. so yeah, I mean, I would say it's more a symptom than a solution. Dr. Lara: I guess it's a solution as well. Daniel: What's interesting is, well with the fire thing, it's interesting to me is that common thing that happens is people get really, it's almost like they work harder and work more hours kind of in the job that's causing them to want to do this in the first place. So they're like almost like subjecting themselves to more pain now and it's can almost like amplify the issue. Daniel: And then with the side gigs and passive income thing. Those are kind of like entrepreneurial type things. Passive income, I don't think, I don't like that word because it doesn't actually exist. I mean, like, you have to work to earn income. But you know, the idea is like they're very entrepreneurial type things. Daniel: And so I see a lot of people that are really gifted physicians and it's like they're starting over almost in this new flavor of profession. But like they could do something of this, like the same sort of entrepreneurial thing within this expertise that they already have and, that might even, and, also help solve some of these problems. Daniel: That to me seems like a home run. But it, it doesn't seem like yet that that's like the popular, I mean, I don't know. It's just, I don't, I haven't heard a lot of people talking about that. Dr. Lara: Yeah. We do see some physicians now starting, starting their own practices. Daniel: Yeah. Dr. Lara: There's a lot of fear over starting their own practice. Dr. Lara: There's a lot of, I should be doing it this way, or I should be doing X, Y, Z. There's that fear of not doing it correctly versus real estate in investing, it's a little, it's it feels less scary. Daniel: Yeah. It is a smaller step. Dr. Lara: Yeah. So yes, I do think, you know, it would be wonderful if doctors use that entrepreneurial side to start their own practices. Dr. Lara: I think, you know, if, if they can't do that, it's overcoming that fear. Or feeling like, you know, we hear all the time about how financially difficult it is to start a practice. Daniel: Yeah. Dr. Lara: So there's a huge fear around that. So, you know, there's solutions to that. There are companies that will help you start your own practice. Dr. Lara: There are companies that will hire you like as their concierge physician and kind of own you in a way. But for the most part, there's a lot of companies that will help you start your own practice and they do an awesome job of doing it. You know, there's a lot. I think that we just need to reach those people and help, help those doctors realize that medicine can be fun. Dr. Lara: Like, you know, there's so many fun parts of medicine. Daniel: Yeah. you know, facing your fears is scary. But like, you know, that's typically like healthy to kind of lean into those things, especially when it's for the right reasons. The other thing I see with passive income and side gigs is it, it, it's kind of like adds to the time component too. Daniel: Like it ends up being more than you sometimes realize. And so, it can kind of like crunch that time. But I mean, I know it's not always about time. I know you had one of your YouTube videos was really good. It was about, the concept of work life balance and how it's not always exactly about time. Can you share that? Dr. Lara: Yeah. Oh my gosh, I love that video. Daniel: It was my family. Dr. Lara: Cause I haven't heard anyone talk about it in the same way. When I think about work life balance, and I've been through all the different iterations of, trying to find that. So I actually went part-time. Pretty much the day I finished residency. Because to me I had thought of work life balance of you balance your time between work and family. And that is a big part of it. Dr. Lara: But now having done all these different things, I realize what work life balance is. Really is being able to do work you love so that you can be fully present in your work. So that when you go home, you can be fully present with your family or your friends when you're at home. And so work becomes a break from home, and home becomes a break from work. And you have this true balance of not just time, but of what you're doing each day where it doesn't get monotonous. You're enjoying what you're doing. You feel satisfaction in what you're doing. And you don't bring home that drudgery from work. Or you don't take the drudgery from home to work and you get to wake up excited to go to work and you leave work excited to go home. Dr. Lara: So that to me is work life balance. Daniel: Yeah, I love that definition. I think that's how a much healthier way to view it. Because like you were saying with the time thing, I mean, that doesn't, a really toxic work environment is gonna like bring baggage home even if you're working. I think of some of our clients that do like the, like a a lot of them are hospitalists still do like the seven days on, or seven days, seven days on, seven days off kind of thing, where they're working like 90 hour weeks. Daniel: And then, you know, they're working zero for the next week. And, but like on the week that they're not working at all, and that like, basically they have plenty of time. They still have, you know, a lot of 'em we work with are still kind of dealing with these like frustrations that they're kind of like bleeding over into their home life. Even though they have like, you know, this open week. Daniel: But yeah, I love that definition. I think it's a, good way to break it down. Do you think that there's, lost hope in the profession? Is that pretty common? I think it sounded like you kind of had a little bit of a flavor of that. Dr. Lara: I think a lot of people feel that way. Yeah. And I've been there too. Dr. Lara: Definitely. I personally feel positively towards the future of medicine. Dr. Lara: But it's because I've seen all these practices doing all these cool innovative things and being financially successful because of how they're innovating. I think in medicine, especially today, you have to innovate to be successful financially. Dr. Lara: And you know, to be able to enjoy the practice as well. Daniel: Yes. Dr. Lara: So, yes, I do think there's a lot of lost hope. I think that contributes to a lot of what we're seeing our colleagues going through. But my hope is that that changes. Daniel: Well, maybe we could paint a little bit more of the brighter side of things, a picture of what like that ideal practice looks like. 'Cuz there's a lot of really fantastic practices or businesses or things going on. Daniel: And, maybe you could talk, if you could talk about some of like what, what that starts to look like? We've kind of already hinted at some of that. But like, you're enjoying your work first of all. Right? Dr. Lara: Yeah. Yeah. Well, why don't I give you some examples of some of the practices I've worked with. Daniel: That's awesome. Dr. Lara: So, you know, I've worked with a couple of direct primary care practices. Dr. Lara: , Dr. Lara: Those ones kind of speak for themselves. You have time with your patients. You know, there's a lot of autonomy over how you want your day to go. So some of them will do in a mix of in person at home visits or just at home or just telemedicine. Dr. Lara: Kind of the sky's the limit with direct primary care. Daniel: Mm-hmm. Dr. Lara: Because you don't take insurance that you're not beholden to. How, how you write your notes? Or where you see your patients? Or how you see your patients? You know? We spend so much time in medicine doing the off to hours work, like the charting and the patient results and all of that. Dr. Lara: And so we feel like we have to bring the patients back to see them. But in direct primary care, you know, no big deal. You have time, you just call him up on the phone to discuss the results. Dr. Lara: Your payment isn't tied to time and how you see them. Daniel: Right. So you can spend time. Dr. Lara: Yeah. So direct primary care is awesome. Daniel: Yeah. I have had, I've, I've brought up direct primary to many clients that we work with. 'Cuz I love the model. I have heard multiple people come back with this objection of this I. They don't want to be tied to the cell phone 24 hours a day. Like they don't want the patients to all have their cell phones. Daniel: I think that doesn't have to be the way. Like, I'm just curious what your thoughts are on that. Dr. Lara: Yeah, I agree completely. For one thing, you train your patients. So if they know that they should not call you off to hours, they will not call you off to hours. And you know, that comes with setting boundaries, which we're not very good at as physicians. Daniel: Yeah. Dr. Lara: So it's a little bit of a learning curve there. The other thing too, as a DPC doc, you have between 2 and 600 patients. That's like nothing. Daniel: So relative to, compared to 2003, whatever. Dr. Lara: Exactly. So you don't have the same volume of patients calling you. So now you have less patients who are well trained. No big deal. Like, no big deal. Dr. Lara: They typically know, like if you say to your patients, This is my cell phone number. I'm a human being. Please don't abuse it. You know, you set up the rules. Fine. You can have on the answering machine, you know, Hey. , you know, med refills are only taken care of off to hours. If this is not urgent, please do not call me. Dr. Lara: If this is something urgent that cannot wait, go ahead and, you know, put you through. And that's fine on the message. But also, you set those boundaries with your patients. Daniel: Yeah. Dr. Lara: And, and I've been on both ends where I did not set good boundaries and I did set good boundaries and it was very life changing. Dr. Lara: Yes, I hear that objection a lot. And I would say that it all depends on the practice. So some of the physicians that I work with that have their DPC, they don't care if the patients call them. So they do. And so yes, that happens. Mm-hmm. Other physicians set very good boundaries, and they're like, No, I get a call maybe once a month. Maybe? Dr. Lara: You know, my husband has his own practice and he gets called twice a year. I mean, he's, he. , it just rings on his cell phone and he gets a patient. Well, what are you doing? Like, it just, it just doesn't happen, you know? Daniel: Yeah. Dr. Lara: And, and that's where I learned about setting boundaries from like, Oh, okay, you set your boundaries. Dr. Lara: Like he told me that, so Daniel: That's cool. Dr. Lara: Yeah, so I, I think a lot of it depends on how you set your boundaries to the patient. So, mm-hmm. If you're a physician looking to join a direct primary care, that's a question you wanna be asking, is about how the after hours works. Because Yeah, that can be awful if you're tied to your phone all day. Dr. Lara: Yeah, future in the olden days, so, Right. Yeah, so some of the other practices I've worked with, so looking at just fee for service, insurance based practices, well, they're very cool. So some of them will offer these other ancillary services that are a great service to their patient and they make good revenue. Dr. Lara: Mm-hmm. So finances, not a big deal. They, they do that very well. A lot of the practices will treat their office staff like gold. And so, you know, the office staff are there forever. They just don't go. They have each other's back. They stick up for each other. You know, that's always amazing. I've had practices that completely support what the physicians are interested in. Dr. Lara: So, you know, I'll have some physicians who are being boarded in obesity or lifestyle medicine. And the practice will, will help them say, Hey, that would be amazing. Why don't we open up an obesity center within our practice? Or, Hey, that would be great. How can we structure this best for you? And so, you know, it's pretty awesome. Dr. Lara: So I definitely see those practices that actually truly care for their physicians. And a lot of, you know, the discussions that I have with them, the practice owners will say, Hey, I want someone who will bring their fresh new ideas to the practice. I want someone who, you know, we've all been in practice 15 years or more, so things have changed. Dr. Lara: We want someone to come bring ideas to us. Mm-hmm. . So, it's very cool. I see a lot of things. You know, doctors are happier when I speak with the practice owners that I'm working with and I tell them you know, the big challenge that I hit with most of the physicians is salary. They're like, Oh, I'm not taking that. Dr. Lara: No. I'll go to this, you know, abusive hospital system instead, . And it's, and it's, you know, they just don't know better. But you know, when I see that the practice owners are flabbergasted. They're like, why would anyone do that? I used to work for a hospital and I started this because now I have autonomy. Dr. Lara: I can make my own decisions. Yeah. I get to have the flexibility. So it's interesting hearing the differences of opinions, and, and viewpoints because the private practice owners are like, Oh my gosh, this is amazing. Why would anyone go to the hospitals? Daniel: Well, you can't put a price on being present with your kids. Dr. Lara: Right. Exactly. I mean, they're little for so short. Dr. Lara: Yeah. Daniel: That's like a, but that's not always what you first think of when you're comparing job, age, job be usually the first thing is like salary. And some, of the things people a lot of times don't even think about like maybe one is like, 40 hours and the other is 60 or like, or, Or even if you're 40 and 40, like what's the stress load of the 40 here and what's the stress load of the 40 there And like higher stress has a big price. Daniel: You're all physicians, like, you know that stress is unhealthy. Mm-hmm. , Daniel: you know, Dr. Lara: And the other thing, if it's 40 hours and 40 hours, how much time are you spending after hours charting? Daniel: Oh, yeah, yeah, yeah. Dr. Lara: So, and, and that's something I see a lot. So some of the practices I work with have scribes or they've worked out templates so that when you leave, at the end of the day you're done. Dr. Lara: So, So you have physicians comparing 40 hour weeks with one system that you will then spend two or three hours after hours working. And another where you'll spend maybe 30 minutes, maybe an hour? So it's also comparing, is it really 40 hours? Daniel: Yeah. Right. I know primary care, I know has a lot of, challenges within that particular subset of medicine and, a lot of burnout and a lot of, pressure. And they, and, you know, general practice, you can kind of do the direct, direct primary care setup. But I have also, I've heard from, we work with, you know, plenty of specialized physicians and a lot of times when the whole career thing comes up, some, it's like a lot of times they feel kind of handcuffed to the hospital system because they're so specialized. Daniel: Are there like alternatives yet, or good alternatives that you see coming up in the more specialized world of medicine? Dr. Lara: That gets more challenging. Daniel: Yeah. Dr. Lara: You know, with the super specialists, like there's not gonna be an ICU that's not attached to a, to a hospital. So what do you do at that point? Dr. Lara: You know, you can have independent groups that the hospital contracts with. So, Daniel: Right. Dr. Lara: You know, that's one potential solution. But some of the specialties, it does become harder. Like ICU, ER, certain surgeons. So, some of them you have to be academic and you know, there are some physicians, there's one I know who there's just a handful of them in the whole country and she's gone often open to her own practice and it was terrifying. Dr. Lara: And she's just killing it. She's doing amazingly well. Daniel: Yeah, Daniel: I mean, on the flip side, if I'm like playing devil's advocate with that whole idea, the fact that like, it's difficult and nobody's doing it because you're so kind of tied to the hospital, that means there's also like zero competition for someone that does come up with a new way to do it, or less competition. Daniel: And I know it's complicated and scary and, but I would not necessarily say that's a reason to not even look into it, you know? And people can come up with fantastic new ideas that none of us ever even thought was a possibility. Dr. Lara: It's an untapped opportunity. Exactly. Daniel: Yeah. I mean, that's another way to, that's a mindset thing. Daniel: And I know mindset is half of this stuff, right? Dr. Lara: Oh yeah, . Daniel: That's probably, We could do a whole separate podcast on, on mindset. Dr. Lara: Yes, we could. Daniel: Do you have any other examples you'd like to share of a, you know, more of the ideal work setups? Dr. Lara: Yeah. I think, you know, the biggest thing just I don't know that I would say it's an example, but of a thing to know is, yeah, is the listening, You know, does your leadership listen to you? Dr. Lara: Are they gonna hear what you say? I think that's probably the most important thing by far. Daniel: If I'm talking to different places, like if I'm in that midst of this kind of like either looking for a first job or like maybe looking at new opportunities, how. Identify if my potential opportunity is healthy versus unhealthy? Daniel: What are some of the things to kinda, either questions to ask or symptoms you can kind of look for? Dr. Lara: Yeah, so you wanna speak with, you'll probably be interviewing with some sort of medical director. Daniel: Mm-hmm. Dr. Lara: So you can ask them a whole bunch of questions, but don't forget to also speak with the other physicians that work in the practice. Dr. Lara: Or even the office staff. You can say, How long have you been here? You know, you can ask about turnover. Turnover is probably the biggest thing to look for. You wanna know why the job position is available? If it's available because they keep losing doctors. Well, goodness gracious. Mm. It is time to run from that one. Daniel: That's not good. Dr. Lara: But if they're growing, that's a great thing. You wanna ask about what happens if you find something to change. So, you know, if, if I were to ask that question, it would be something along the lines of if I find something that could be done more efficiently in a different way, what would be the process for getting that done? Daniel: Mm-hmm. Dr. Lara: And, I would listen to what they say. But then I would also go to another physician in the practice and say, Well, hey, how does this work? If you know, you feel like you don't wanna be double booked or whatever it is, do they listen to you? Do they hear you? Or have they listened to you? Or can you give me an example of, you know, that's always the best thing because if they have no examples, well. Dr. Lara: Oops Daniel: It's not good. Dr. Lara: Yeah. And, and asking, you know, what's one thing you would change if you could about the practice? So that's not saying, do you like it or do you not like it? It's what would you change? Because that can be very telling. Daniel: Right? Yeah. I, I like that looking or, taking that approach. Daniel: A lot of people get hung up on salary and contracts. And that kinda, not that those are bad things, but the contract and the salary really doesn't say anything about like the actual culture and work environment necessarily. I mean, it may be, there can be little hints, but like at the end of the day, you're, it's the people. Dr. Lara: Yes and no. And you know what I do see with contract negotiations is, sorry, Contracts is the negotiations. Daniel: Mm-hmm. Dr. Lara: So the way that an employer negotiates with you is probably the way they're going to be as an employer. Daniel: Okay. Yeah, that, that's a good point. The actual experience negotiating. Dr. Lara: Mm-hmm. . Dr. Lara: And so, you know, I actually just last night, or yesterday and last night was kind of negotiating a contract for a physician with a practice I'm working with. Dr. Lara: You know, this physician said, Hey, you know, I don't wanna ruffle any feathers, but I was thinking x, y, z and can you just clarify this with me? And the practice came back giving her everything she asked for, cuz they weren't unreasonable. I mean, she was an amazing candidate. And the thing that she was just saying like, Hey, is this standard for private practice? Dr. Lara: Cause the hospitals are offering more. The practice went back and I was like, You know what, I'm gonna give you more. It was PTO. I'm gonna give you more PTO. And in fact all these things you asked for and I'm gonna change our office policy on maternity leave because we haven't really had that come up yet, but it will. Dr. Lara: So we're gonna go ahead and get short-term disability for our office, so that if you were to get pregnant and anyone else in our office gets pregnant, you're not left. stranded Daniel: Yeah. That's, that's good. That's a, that's like a excellent signal that they have a great culture. Dr. Lara: Yeah, exactly. Dr. Lara: Versus, Nope, this is our standard contract. Sign it. Take it or leave it. Daniel: Yep. Daniel: Yeah. That is good. That's a excellent example. Dr. Lara: Yeah. Daniel: Do you have other examples like that? That's a good one. That of things symptoms to look for or one way or the other? It could be negative signs or positive. Dr. Lara: I would listen to what people are not saying in your interview. Daniel: Mm-hmm. Dr. Lara: So, you know, if you, if someone were to ask me what's it like? Or you know, do you like working for a place? Which probably is not the best question cuz you're gonna say yes, obviously. Daniel: Always .Yeah. Dr. Lara: But if it's something like, you know, that and I didn't like it, I'd say I'd probably start to feel awkward. Dr. Lara: And so you wanna read the body language of like, Yeah. You know, it's okay. Like I, you know, it's fine. They, you know, they give us patients and I never have to wash, worry about getting more patients and the EMR is okay and. Versus, oh my gosh, like it's the best. We tell jokes all day and we had a barbecue last week where all the employees came and you know, so a lot of it is listening to what they are not saying. , If everyone's like, Yeah, we have a lot of patience or mm-hmm. . Yep. There's a lot. It's a lot. And they're kind of vague. Daniel: Vague. Dr. Lara: Yeah. Yeah. Dr. Lara: So yeah, that's probably a big one. And just kind of, you know, when I visit practices, I, I'll always ask the office staff, like the receptionists, How long have you been working here? What's it like, blah, blah, blah. And so, you know, obviously I'm doing my market research there and, and they'll tell me things like, Yeah, I've been here for 11 years and it's because I was working somewhere else and that office closed and I was so excited when they offered me the job. You know, all of those sorts of things. Mm-hmm. , I think those are big, but the biggest one that I always tell people is how, how the practice negotiates with you is so, so, so important. Daniel: Mm-hmm. . Daniel: Yeah. And you have to be ready to also act on those signals too. Daniel: I think that's a big thing. I hear, or I see people sometimes see the signals. And then, but acting on them is, is not as, or bound, I guess that gets into like boundaries and like, you know, following through on your values and that kind of thing. It's even if you see the negotiations kind of go in the direction of like, they're not appearing to have a great culture, but like, I kind of need a job and, you know, that's a little bit of a challenging situation. Dr. Lara: A lot of it is not realizing that you have a choice. You can walk away and the world will not fall apart. Daniel: Yep. Do you think that that might play into, I know physicians and everybody, I guess, has kind of a, we have a perfectionist culture, and there's this, fear of failure, I guess. And, I can, I could imagine that making it challenging to work through things like job decisions or, or even starting a business or leaving or saying no to practice or, you know, that kind of thing. Daniel: Curious to your thoughts on that? Dr. Lara: Yeah, I definitely see that a lot where people will sign contracts saying, "But I didn't have a choice". No, they told me this is the standard contract. Or No, I signed it cuz I was told I have to. You don't have to at all. Daniel: Choice. Dr. Lara: Yeah, so choice, knowing that you have that choice. And you know, the ability to know we have a choice is kind of beaten out of us in training. So, that's not unheard of. Dr. Lara: I think our people pleasing tendencies also probably play into that as well. Mm-hmm. , And the big systems know that we're like that and they just totally take advantage. So, you know, when I was, this is before I even thought about starting a business, and it's a big part of why I started it. I was speaking with a hospital system and about working for them and their contract was important. Dr. Lara: It was, I mean, there are no words for how bad this contract was and when I would say things like, you know, but I can't sign that I'd be signing my other business. I had another business at the time that I still have. I'd say, But I'd be signing my business away and giving you ownership of my business. Dr. Lara: And they're like, Well, but this other doctor did it, so you should too. It'll be fine. So I was like, Yeah, that's not a good reason. Like that doesn't, that doesn't make any sense. And he shouldn't have signed that because.. Daniel: That's basically just them saying, just sign it and don't ask questions. I mean. Dr. Lara: Exactly. Dr. Lara: Exactly. So, I did walk away from that one and the world did not fall apart. So. Daniel: Yeah. Learning to, I mean, that's boundaries and saying no, and, you know, choices. We all, I guess any decision we make, we, you know, at the end of the day you could say, no, not the end of the world. Daniel: Well, as we wrap up, I would love it if you could tell us about what you have going on. 'Cuz you gotta, we, I've already talked about the YouTube channel that you have. Daniel: That's fantastic and everyone should check out. Because you have all sorts of great videos and they're very concise. And you just told me before you started recording that you are, you don't have, like, you're not, you know, structured and organized. But they're like concise and organized. Somehow you're doing that off the cuff. So I don't quite understand how you're doing them so concise and organized. But they're, they're, they convey these points, these little points very well, on these topics we've been talking about. So definitely go and check those out. But tell us about your business. Dr. Lara: Yeah, so Happy Day Health, I work as a medical matchmaker. So I prefer not to call it recruiting just because it's so much more than that and so different. Dr. Lara: So I work directly with private practices, physician owned private practices that I have vetted and that I have gotten to know really well and I believe will treat their physicians well. And I help them to find physicians to join them. And then on the flip side, I work with physicians who are looking for practices to join. Dr. Lara: So, I do that. You know, obviously, I love the practices I work with because I have gone through that process with them and I've decided that they will be awesome. So, you know, in that way I can help the doctors hook them up with one of those practices. I also have joined a network of recruiters where something I've learned is that recruiters don't really post their jobs places all the time. Dr. Lara: So it's a matter of finding them. So I do have access to those positions and those range from FQHC to hospital systems, to private practices, to everything. So, you know, while I feel strongly that private practices the answer, not everybody wants to work in a private practice, which is fine. So I have access to those. Dr. Lara: While doing that, I, I will also kind of coach the doctors through the whole process of the interviews and what to look out for. And how to make sure that they get the questions answered that they need. So I do that a lot of coaching through the interview. So we talk before the interview. We talk after the interview. And then when contract negotiations come up, I work with that as well. Dr. Lara: I help out there. And then, you know, if they need a lawyer, I will refer them to a lawyer and all of that. Daniel: Mm-hmm. Dr. Lara: Physician advocacy wise, I do a lot of teaching. So I'll speak at residency programs, trying to teach doctors, you know, what to look out for in a job. So trying to avoid those common mistakes. Dr. Lara: I have my YouTube channel which thank you for those kind words. Daniel: Yeah, I love it. Dr. Lara: That's funny. I never really thought like that they were organized. I was like, I'm gonna not work life balance today. Daniel: The first thing I thought of and, and, and you. I feel like that's the, the, the most obvious thing. Dr. Lara: That's cool. Dr. Lara: Thank you. Dr. Lara: And, you know, so I have my YouTube channel that I do just kind of post stuff that I see either common themes or things that come up with when I'm working. You know, I'd love to post more. I think it's a time management thing. Daniel: Yeah. Dr. Lara: And, I'm on LinkedIn and TikTok is my fun, silly, nice, fun and stupid, which I love. Daniel: TikTok dancing or whatever. Dr. Lara: I don't do the dances. Well, maybe wanted to. And then, yeah, Instagram. I'm on there happy day MD as well. Daniel: Yeah. Nice. Well thanks for coming on. I know there's a ton of stuff here and we, we definitely will have to continue to the discussion. 'Cuz we can, I, I feel like each subject we talked about is like an hour discussion within it. Daniel: So, I think, I think there's a lot behind this. But thank you for coming on and talking with us about it. Dr. Lara: Yeah. Thank you so much for having me.