Why Understanding Business is Vital for Today’s Physicians

In this episode of From Print to Pod, we host a discussion based on the article The Second Career Most Physicians Don’t Realize They’re Building.

Physicians often enter private practice believing they are simply continuing their medical careers. However, many realize they are also stepping into the roles of strategists, operators, and leaders. In this blog post, we’ll explore this fascinating transformation through insights shared by a panel of experts, including Dr. Demetrio Aguila, Dr. Silvana Fischman, and Dr. Frank Okosun. Here’s what you need to know about this hidden career shift and its implications.

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Participants:

https://doctorsonsocialmedia.com/frank-okosun-jr-md/

https://doctorsonsocialmedia.com/demetrio-j-aguila-iii-md-facs/

https://doctorsonsocialmedia.com/silvana-fischman-dds-intl-mha-crc/

Takeaways:

• Physicians often transition into business roles without realizing it, affecting their approach to patient care.
• Learning business management skills is essential for navigating the complexities of running a practice.
• Effective delegation and leadership are crucial for maintaining patient-centric care in a business-oriented environment.

Transcript available on our website: https://doctorsonsocialmedia.com/understanding-business-vital/

Doctorsonsocialmedia.com, or SoMeDocs for short, is a healthcare omnimedia platform committed to promoting autonomy for the individuals in healthcare. Subscribe to our newsletter to not miss our new articles, episodes, or events: https://doctorsonsocialmedia.com/subscribe. Contact us anytime, at somedocs@somedocs.com  (please note that we receive many emails and may not respond to all).

Transcript

Dana Corriel: Welcome to From Print to Pod, the SoMeDocs series where we bring our magazine to life through conversation. Think of it as an article club rather than a book club. Each episode, we take a piece that sparked discussion among physicians and our audience, and we explore it more deeply with a panel of experts. I'm Dr. Dana Corriel. I'm the founder of SoMeDocs, and today we're discussing an article that resonated widely. It's called the second career most physicians don't realize they're building.

Many physicians enter private practice thinking that they're simply choosing a different way to practice medicine, but somewhere along the way they realize they've also become operators, strategists, and leaders. So today we're unpacking that transformation. I'm going to introduce the three experts before I start with our first question.

The experts today are Drs. Aguila, Okosun, and Fischman. So do you want to just go around quickly and introduce yourselves in one sentence? Dr. Aguila, you want to go first?

Demetrio Aguila: Sure. So my name is Demetrio Aguila. I am a peripheral nerve surgeon. I run a direct care practice in Omaha, Nebraska.

Dana Corriel: Fantastic. Dr. Fischman.

Silvana Fischman: Hi, I'm Silvana Fischman. I am a trained dentist, but I am a consultant for operations and strategy living in Miami, Florida.

Dana Corriel: Fantastic. Dr. Okosun?

Frank Okosun: Yes, my name is Dr. Frank Okosun. I'm an internal medicine physician in Lake Jackson, Texas, just outside Houston.

Dana Corriel: Fantastic. Welcome to all and thank you for taking the time. Let's start with the following. Something more personal. The article suggests that many physicians don't realize that they're actually building a second career until they're already deep into it. Was there a specific moment when you realized that you weren't just practicing medicine anymore, but you were actually running a business? And then what triggered that realization?

If we want to go with Dr. Fischman if you want to start us off.

Silvana Fischman: Yeah, so.

That's a really good question because I no longer practice dentistry. However, when I did, when I finished my dental school, the first thing that I did was I created a book that was called Administration in the Dental Office. And this is many years ago. And I did realize at that point that while I knew all the dental facts and I understood the clinical side of things, I was missing a big piece. If I wanted my patients to do well, not only the clinical side was important but I had to learn how to manage my office in the right way and that was something that I was not trained for so I had to do a lot of research actually to do learn understand and yeah so you know I'm still learning many many years later.

Dana Corriel: Fantastic, I think that we're all learning. So Dr. Okosun, and I apologize for any mispronunciations of names. It's to you.

Frank Okosun: No, you're fine. So I think it hits you pretty much almost immediately. You think about the idea of opening a practice. When you're an employed physician, your job is just to come in the morning, see patients, make sure they are taken care of, and do your notes, and at the end of the day, you go home.

But when you start to think about opening a practice, then it hits you. You have to look for a location, you gotta get credentialed, you gotta open an LLC or a business name if you don't have one, you gotta hire staff, you might need to go source for a bank loan. So I call it a mini MBA if you don't have one already.

Dana Corriel: Thank you for that. Yeah, I mean, I know that there are some physicians that pursue an MBA after we earn our degree, but a lot of them are not. They are their standard MD, DO, whatever medical degree that they have, and then they open up a private practice and sort of learn the hard way. Dr. Aguila, can you tell us what you think?

Demetrio Aguila: Sure, so I'm glad you asked the question and I think my perspective is probably a little bit different than a lot of other people. I'm sure you find that surprising Dana. But I actually started thinking about running a business when I was 10 years old. As you know, I started working in my dad's office, my dad's a retired physician. I started working in his office when I was 10, emptying trash cans and scrubbing toilets. And basically by the time I graduated from high school, I had done everything there was to do in a doctor's office except actually be the doctor.

And so you know in the back of my mind I was always thinking okay I want to be a business owner I want to run the practice because I realized when I was working for the hospital I had very little control over how things were done and ultimately that hurt my patients and that was really the driving force for me yes I'd like to be my own boss but the reason I wanted to be my own boss is because I felt like I was in the best position to help my patients figure out how to navigate the health care system and the particular needs that I could help them with and giving that control over to somebody else was going to ultimately not be the best result for my patient.

Dana Corriel: Thank you for that, and I will add that you shared some of your background and story in our magazine. You wrote several articles. One is called A Healthcare Nightmare, How Did We Get Here? Another article is called Medicine's Great Resignation, Can History Show Us a Better Way Forward? And that was a two part article, so I appreciate you sharing with us some of your past. Okay, so we're going to push this a little further.

Dana Corriel: Some doctors believe that the moment medicine starts thinking like a business something sacred about the profession gets lost. Others argue the opposite that with strong business thinking good medicine can't survive anymore. Which side of that argument do you fall on and why? Let's vary it up a little let's start with Dr. Okosun.

Frank Okosun: Okay, so it depends what glass you look at it through. I think that physicians need to be running most medical establishments and organizations because then physicians, the way we are trained, we have the best interests at heart just the way like Dr. Aguila was saying. So if you look at it from the point of view from private equity or non medical professionals coming into medicine, I think the patient gets hurt in that process. But when you think about it from doctors actually being doctors and having private practices running hospitals or owning hospitals, I think they are in the best position to rein in the cost and also make sure that patients are taken care of.

Dana Corriel: Okay, gotcha. So becoming our own bosses is more of the solution is what your stance is. Let's move on to Dr. Fischman. What's your take?

Silvana Fischman: Well, so I might come from a different angle as well. I feel that it's not one way or another. I don't think that there's a zero or 100 percent. And I don't think that that's the case for physicians or any other profession. And let me give you an example. My son has one of his best friends and he is a musician. He loves to sing. He loves to produce music. But then he comes out to the real world and he needs to learn how to deal with negotiations, with contracts, with different music labels, et cetera.

Does that make him less of a musician?

Probably not. It just enhances his knowledge because that's something that surrounds the music that he creates. And similarly, I feel that a physician who's a CEO in this case, or who needs to become sort of like a CEO, it's part of what enhances your practice. I don't believe that it removes anything from being a physician. I think that there's also other options.

So for example, yes, you need to learn to, and like Demetrio was saying, I feel like you need to learn to do all the little tasks before, little or big, right? Before you can have other people doing it for you, that way you know what's good and what's not. But at the same time, once you learn and you understand, it doesn't have to be you as a physician who needs to do it. And there's other people that can come in and support as long as you can have delegate and know enough about it. So that's my stance on it. I don't think that it's a common understanding, but I see it very frequently and I set the example of a musician, but there's many other examples of that that we can use.

Dana Corriel: Thank you for that. makes total sense. Dr. Aguila, it's your turn.

Demetrio Aguila: Sure. So thank you both. I really appreciated what both of you had to say. you know, Dr. Fischman, I really appreciated that you used the word delegate because I think that's the key in this conversation because the person that does the delegating is ultimately the person who's in charge, right? So the person who flips burgers at McDonald's isn't the person that delegates to the manager. It's the other way around, right? And so ultimately, regardless of whether or not the physician is the one who's doing all the little nitty gritty things or not, the physician, or in your case, the dentist, would be the person who has the final say. And I think that's a really key component. I spent 22 years in the military, as some of you know, and, you know, one of the things that struck me was that

One of the reasons the military works so well in its military role, you can argue about other aspects, but the reason they're so good at what they do in the military role is because the person that's in charge is the person that best understands the mission, right? So for instance, you have an infantry unit that goes to, you know, to blow stuff up. You're not going to put an attorney who happens to be wearing an army uniform in charge of that infantry unit.

You know, if you have an Air Force fighter squadron that's going to go and shoot down the bad guys, you know, you're not going to put the cook in charge of that fighter squadron. You're going to put the person in charge who understands the big picture, who understands all the moving parts and is in the best position to decide which compromises need to be made. So a great example, I was in the operating room the other day and, you know, we had, we were trying out some, new dressings for, for a case and

And they said, okay, doc, you know, this dressing costs half as much as the other one. And I said, you know what, if you're asking me whether or not I get to make the decision, if I, if I get to make the decision, I don't want to use this dressing because yeah, it may cost half as much, but the reason it costs half as much is because it's half as good, you know? now if we had a system where it was an MBA who's in charge, that MBA, regardless of how good his or her intentions might be, is going to look and say, well, I understand the bottom line and I'm trying to do what's best for the bottom line.

But as the physician, if I educate myself on that bottom line, I'm actually in a better position to make that decision about which compromise, which corners to cut and which ones not to cut in order to get the best result as opposed to somebody else who isn't in the position that I'm in.

Dana Corriel: Yeah, I think it's all about roles and it's interesting because you hear this analogy come up sometimes about the pilots and whether we would feel comfortable having a plane flown by the flight attendant who puts on the pilot uniform and most of us would not feel comfortable and so of course roles are very important. Now the article that we're featuring here in this episode says something interesting and I quote ownership changes posture So I'm curious how that resonates with each of you does becoming an owner actually change the way you think about patients systems or even yourself as a physician Let's vary it up. Dr Okosun, let's start with you.

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Frank Okosun: Yes, definitely, because now as a business owner, the patient is more than a patient to you. It's a fee paying client. And you want to make sure when they come into your establishment, they have a great...

experience because obviously they have options and they could easily go elsewhere. So while you are still focused on the medical part, making sure that they get the best medical care possible, you want to make sure when you walk in the door, is somebody greeting them with a smile? Is somebody attending to them, verifying their insurance? Are they being asked any questions? Do they need water? Do they have any updates on their demographic?

Information so it's a team effort and it has to run like a well-oiled machine So it's not just about the doctor seeing the patient in the room. It's about the the whole experience our patients able to get in contact with the office when they when they need to because at the end of the day you still have to keep the lights on and You have to make payroll and also be able to to pay yourself. So it becomes extra important

to know what the overall patient experience is and if there are anything that you need to work on or things that you need to change, you have to do that to decrease wait time, increase patient satisfaction, maybe have an online portal where they can check in beforehand or an online portal where they can send messages and get clarifications. So it's a constant process of modification and finding what works, what doesn't work and what the pain points are and fixing it.

Dana Corriel: Thank you for that, Dr. Fischman.

Silvana Fischman: Yep. I might be controversial here.

I feel that ownership is something that doesn't only happen when you truly just own fiscally or legally. I think that ownership is something that you have inside. And I can say this because I've owned my own practice, but I've also worked for corporations. And when you're working for a corporation, I think that at the end of the day, the integrity is what determines your ownership or not. And in my case, even though I've worked

for other people. I've always felt that ownership, that sense of responsibility and what Dr. Okusun was mentioning earlier about the patient experience, the satisfaction and how we combine both the clinical and medical side as well as everything else. I think that that needs to be owned by the physician, the CEO, like we're talking about in this article of the clinic, but also

by every single one of the members in the clinic and if they can't own their responsibility and their the results that that causes on the patient then it's probably the wrong team member whether it's the CEO or somebody that we've hired.

Dana Corriel: Thank you for that. Dr. Aguila?

Demetrio Aguila: Well, thank you both again. mean, I think everything you said was very insightful. When I think about ownership, I think as a surgeon, there's no better practice model for a surgeon with very few exceptions than private practice. The reason I say that is because as a surgeon in the operating room, everything that happens in that operating room is my responsibility. In other words, when something goes wrong, it's my fault.

Even if I wasn't in the room, it's still my fault. you know, if the person that's intubating the patient breaks the patient's tooth, who is that patient going to remember? Is that patient going to remember the anesthesiologist or me? Of course, they're going to associate that broken tooth with me. You know, if the patient gets burned by something that the surgical tech left on the patient's thigh, who is the patient going to remember? The patient's going to remember me. So, ultimately, I'm the one that's responsible for all of that. But the difference between being an owner, an owner operator in this case,

versus somebody who is let's say higher up in the organization is that i also have that the whole organization stands or falls on me and so all of the success of the organization is dependent on the decisions that i make and all of the failures that happen within the organization are dependent on the decisions that i make which is not necessarily the case in the situation where i'm employed so for instance when i was employed at the hospital i was the chief of surgery

I was in charge of a whole bunch of different surgeons, right? But if there was a surgical tech that wasn't doing what she was supposed to do, or if there was somebody who wasn't answering the phone properly, I didn't have power to change that. Somebody else, somebody in HR made that decision as to whether or not that person got to stay on the team. And so, you know, some of the successes were my successes, but some of the failures were completely out of my control. Whereas when I am the owner, those failures are my failures.

Because if there's somebody that's not answering the phone properly or to your point, Dr. Okosun, not greeting patients properly when they show up at the door and I don't do something about it, that's not that person's fault anymore. Now it's my fault. But if I'm an employee, I might not be in a position to be able to make that change in order to improve the experience for the patient.

Dana Corriel: Thank you for that. Now looking ahead, do you think private practice physicians will increasingly see themselves as physician entrepreneurs or will consolidation in healthcare make that identity rarer? Let's start with, let's go backwards. Let's start with Dr. Aguila.

Demetrio Aguila: Well, think my perspective on this is somewhat nuanced. And in the interest of time, I'll try to keep it brief. But my feeling is that, first of all, direct care, model in which we don't do anything with insurance, is a growing movement. And how is that relevant to this discussion? There's a collaboration that's going on most of the time implicitly and sometimes explicitly between

the big insurance companies and the big healthcare systems, is driving up medical costs at multiples of the consumer price index, at multiples of inflation, unnecessarily, okay, diverting funds away from people that are actually doing the work and away from the people who are paying for the work. Now, why is that relevant? As that system continues to grow at the rate at which it's growing, what I see in my role as chapter leader in the

Free Market Medical Association is that employers are starting to move farther and farther away from these hospital systems and these insurance systems. And, you know, over 70 % of health insurance in the United States is paid for by employers. So as we see that move away from the hospital systems and away from the insurance systems, what we're going to see is a greater dependence on independent practices, on direct care, on direct contracting. When we hit that tipping point where

you know the majority are no longer working with hospital systems and are moving toward private practices. Then I think what we're going to see is whether people want it or not, they're going to be entrepreneurs because that's where the demand is going to be. And hospitals are going to stop or they're going to significantly decrease the number of physicians that they hire. And so the jobs are going to be out in the private sector.

in the private practice community and so people will, whether they want to or not, will have to learn how to do this. I think ultimately what we're going to do, what we will see is a fostering of a culture of entrepreneurship where we have people like, you know, the four of us who are actually mentoring these younger people and telling them, you don't have to be scared. This is actually a great opportunity. There's a chance here for you to deliver better care, more affordably that treats your patients better and treats you better.

Dana Corriel: Thank you for that. Dr. Fischman.

Silvana Fischman: So it's a very interesting question what you brought up. And I feel that it all depends on what's the ultimate goal for the person in question. And let me tell you what I mean by this. I think that if the ultimate goal for someone is to truly just practice medicine, right? Just see the patients come in, see the patients and leave. There's nothing wrong with that. That does not mean that they are not entrepreneurs. They're entrepreneurs within their own sector of making decisions for the patient. They're entrepreneurs because they need to select the right medication. They're entrepreneurs because they need to select which family members to

involving the care and all those different aspects, right? But there's the ultimate goal of taking care of the patient alone. Then there's other goals. There's a goal of why did I go into medicine? Maybe because I love to engage with other people's families or to have the responsibility of somebody's life in my hands, et cetera. So if that goal is different, then the entrepreneur mind, and our hat comes in and that's what you do. I feel that there are many opportunities and like Dr. Aguila was mentioning earlier, I feel like there's many different ways of being an entrepreneur without necessarily having to be, again going back to my other answer was, necessarily having to be a financial entrepreneur or for somebody that has something brand new. I hope that that made sense.

Dana Corriel: It completely makes sense and I actually love that answer because I am always infusing my discussions with this whole entrepreneurial mindset that I think is lacking in the medical community and it's actually what made us lose our autonomy because we, you know, didn't kind of look at it from a 30,000 foot view as we were giving away our independence and now we are where we are and our peers are burning out. Dr. Okosun.

Frank Okosun: Yes, I love the perspectives that the other presenters have given.

Because at the end of the day, one person doesn't know it all and everybody brings a different idea or opinion to the table. I have to say I agree a lot with what Dr. Aguilar said. We're moving towards systems that rely less on insurance and while there's a lot of consolidation and health insurance companies as well as hospital systems buying out a lot of doctor practices, like he said, it's driving off the cost. And I've noticed a lot of those patients are moving towards my practice as a private practice and physician. And they tell me all the time that they used to love their doctor, they used to see him for 20 years, but as soon as he became employed, everything changed. Their satisfaction with the care and the system just went downhill. And that's why they were changing practices and coming over to my practice. So I think that is where healthcare is going. More into concierge, membership, direct primary care model. Reliance insurance companies, the reimbursements, the prior authorization, the documentation demands are just becoming unrealistic and unattainable. I myself in my practice am moving, I'm currently in the process of a transition towards more of a membership model that focuses more on prevention and wellness instead of the current insurance healthcare system where we have to wait for things to be broken or practice sick care.

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Dana Corriel: Well, congratulations and good luck. I will say that it's a timely insertion here because two of our guests today, Dr. Aguilar and Fishman, are going to be experts in our private practice mastermind that we're debuting in just a few months. So I'm very excited about building a community for folks just like you and others who are not only just starting to come out into private practice, but sometimes even if we're already in it,

We just need more help and we need that community. So we have just a few minutes left. So very succinctly, if a young physician listening today told you that they were considering private practice, would you tell them they're choosing a medical career or an entrepreneurial career that happens to include medicine? And what would you want them to understand before they take that step? So again, just very succinctly, because we have a few minutes, let's start with Dr. Fischman.

Silvana Fischman: both.

Again, I don't believe in extremes. I think that if there's a medical student that wants to become a doctor, they need to understand that this is not just one single thing that they're doing, but neither is anything else. And if you're a mom, you're also a wife, you're also a sister, you're also, again, I'm taking it away from the medicine to give the example. You're always multi-haffinated. And I feel that that is the answer that would suit them the best for people that are not only just as students, but assuming that they're young people going out to the world.

Dana Corriel: Thank you. Analogies for the win. Dr. Okosun.

Frank Okosun: Yes, I will let them know that it requires a lot of hard work. They have to be entrepreneurs. You have to market, you have to understand.

financial reports, you have to understand a little bit about HR. You can't sugarcoat it. You have to let them know it's a lot of hard work. It's literally going to take blood, sweat and tears. There's no easy way out. And at the end of the day, it pays off. I've been able to mentor some...

practice owners now and they see me at the end of it where I kind of have everything down to a science and they think that it's just going to be a walk in the park for them and I let them know that it wasn't this easy at the beginning. You have to put put your work in and you have to be dedicated you have to have the belief that that is what you want to do. If you are not sure about it or if you're 50-50 then the outcome might not work out as you think it would.

Dana Corriel: Thank you for that. And finally, Dr. Aguila.

Demetrio Aguila: Thank you. I'll again try to keep this brief. I agree with everything that everybody said. I would emphasize and I would encourage to the medical student or to the resident who's thinking about doing this. Number one, you know, I know it's scary to think about private practice because you know, most of your colleagues, most of your friends aren't doing it or haven't done it. Most of your mentors haven't done it. But you know, most of the people you went to high school with also didn't go to medical school, right? I mean,

Two out of every three people that apply to medical school don't get in. And you made it, right? You got there. And the odds of you failing in private practice are far lower than the odds of you not getting into medical school. So you're already way ahead of the curve. I would start with that. Number two, medicine, private practice medicine, is relationship based. It's all about the relationships you develop with your patient. And that's one of the challenges in employed medicine is that there are all kinds of barriers and all kinds of

things that prevent you from developing those relationships. You know, we learned in medical school that the number one reason patients sue their doctors is because they don't like them, right? Well, if you have control over the practice, then you have the best, you're in the best position to make sure that your patient does like you, does appreciate you, does have respect for you, and does have the kind of relationship that you need in order to be successful for them, which will then result in success for yourself. So I would encourage those of you that are thinking about this,

You know, yes, you have to be an entrepreneur. Yes, you have to practice medicine. Those are not mutually exclusive. As a matter of fact, I think they go together very nicely.

Dana Corriel: Thank you for that and thank you to all of you for joining us today. Those of you listening you can check out our article in our magazine, doctors on social media.com. You can also check out our mastermind that's coming up. It's under the services tab of our website. And I hope that you tune in for the next episode. So thank you.