041 - Do This ONE Thing and Live Powerfully In Medical Practice - Lessons from a Successful PCP Brunel Joseph, MD

In this episode, Coach JPMD shares the value of being persistent in the face of his podcast recording journey after a couple of failed attempts at interviewing Brunel Joseph, MD.  Dr. Joseph joined Dr Pierre eight years ago and has since taken over his Tampa practice and transformed it into a highly successful office.  Listen to the end to hear Dr. Joseph share what he thinks is the ONE thing that newer physicians should do in order to have a thriving practice.

Our mission is to help populations live long by increasing physician awareness of spiritual, mental and physical health globally.

Show Notes

 Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans. 

Transcript

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Intro  0:00  
Welcome to the practice impossible podcast. Where your host, Jude Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now, here's your host, Coach JPMD. 

Coach JPMD  0:24  
Welcome to the practice impossible podcast with your host Coach JPMD. And today we have the honor of having a good friend and colleague, Dr. Brunel Joseph on the podcast, but it's been a long time coming. We had two failed attempts. And it's been an impossible mission. Trying to get to Dr Joseph on. The first time, we actually recorded from your office right?

Brunel Joseph, MD  0:48  
Yes 

Coach JPMD  0:48  
And you know, I feel like I'm getting old. I'm telling stories now. So I'm going to tell this story. So we recorded in your office, we had a great conversation, I thought it was great. And you hung up, I hung up, and I tried to play it and it was gone. There was no audio. And that was almost a year ago. 

Brunel Joseph, MD  1:06  
Yes, yes. 

Coach JPMD  1:08  
I was embarrassed. And I think Dr. Joseph would be the only person that I could actually had mustered the courage to say, hey, can we do it again? So we can't, he came to my house, we were in a rental. And I said, You know what, we're gonna do it live. And we'll, we'll record it, then. Well, we recorded it. You had a very good episode. And it was garbage again. So for those podcasters out there, for those who they're trying to do something different. Let me tell you, it was hard for me to ask Dr. Joseph to come back. But he did. And here he is. Dr. Brunel Joseph, thank you for coming on the practice impossible podcast and we're so happy to have you. And, you know, why don't you tell us a little about yourself, or maybe even catch up with life, because you know, I haven't seen you in a couple of weeks and months. So what's been going on?

Brunel Joseph, MD  1:57  
Yes, yes. Thank you so much. Thanks for having me. I appreciate the opportunity to be here. Well, it's been busy. You know, what we do? It's, we aren't working every day. But between now with family, you know, when we started this, it was just me a single guy, you know, working every day, but now, family's growing.

Coach JPMD  2:19  
Yeah? So you say family, I know you got married. So tell us about marriage. How marriage life is and it's been your past the honeymoon stage. Right? Because you're already past a year, right?

Brunel Joseph, MD  2:29  
Oh, my goodness. Yes. Well, past the year two kids now. Daughters, three and a half my son is two and a half.

Coach JPMD  2:37  
Are you kidding me? Two and a Half already it's been two and a half years?

Brunel Joseph, MD  2:39  
Yes. Yeah. Wow. Time flies, time flies.

Coach JPMD  2:42  
And your wife is she working? Or is she...

Brunel Joseph, MD  2:46  
So my wife has actually been home since to the pandemic. And with the kids being so young. At this stage, she's starting to, she wants to go back. I mean, she's been itching, to get back to work. And she's starting to get to do some coverages and things like that to just to start to kind of fill it out and then see how much she wants to do. But

Coach JPMD  3:08  
What did she do again? So we can tell the audience.

Unknown Speaker  3:12  
She's a chiropractor and she has her own practice, which she closed that down with, on the pandemic, it and at the time, we also just pregnant. So the pandemic and baby came early. Also, that's really needed to super early. So we kind of needed to close things down. And now we're in the process of thinking of going again, open again. 

Coach JPMD  3:37  
Okay. Now when you say open again, open to have another baby or open another practice?

Unknown Speaker  3:42  
Oh no. The baby thing is done. We have two beautiful kids, a boy and a girl. We have the complete the perfect set. So we are done. No more babies.

Coach JPMD  3:55  
So why don't you tell your audience what do you do? How you ended up in Spring Hill and your background?

Unknown Speaker  4:01  
Yes, yes. Primary Care Physician with sports medicine background sports fellowship, sports medicine fellowship trend. Currently we practice this clear 100% Managed Care almost 100% Managed Care. I came to Spring Hill. I was in my residency in Illinois, at the time originally from Haiti, tropical guy. And moved to the US ended up in Illinois doing residency. I wanted to get back to Florida. That's where most of my family is at a time my mother was in South Florida. And she was older and I wanted to come being in Florida too, so I can be closer, spend more time with family and I interviewed with Access Healthcare. And at the time, I was supposed to take a position in South Florida and Port St. Lucie and they told me to come and see most of the operation is up in Hernando County, and they told me Hey, I wanted to meet this young, smart doctor, I want you to work with and the rest is history. And, and it's been over 10 years now.

Coach JPMD  5:09  
Yeah. So so that I'm not sure why you said young. But that Doc was me. And I was not that young but we were looking to expand the practice. And we definitely enjoyed having Dr. Dr. Brunel Joseph in our practice in Spring Hill, but then, you know, life happened to me and having to give up the Tampa office. Right. So you took over the Tampa office. But even before we get that, that aspect, you said you're from Haiti. Were you born in Haiti or

Unknown Speaker  5:38  
Born and raised in Haiti moved to the US as a teenager. I was 19 when I moved here. 

Coach JPMD  5:43  
Okay. So you you did? Because Cinco de Yes. In French.

Unknown Speaker  5:48  
Yes. French. Yes. Yes. And moved here went to UF to my undergraduate degree and, and end up staying in Florida, and ended up again, moving back. So I mean, I've been around which I moved back to the islands for a few years, moved to England did some of medical training there, and an England go to Illinois for my residency and fellowship, and came back to Florida.

Coach JPMD  6:15  
You know, I'm not sure if I knew that about you. But the England part what, what do you think is the biggest difference that you saw in British medicine in Europe versus medicine here? What was the biggest difference?

Unknown Speaker  6:26  
Well, the biggest difference obviously, is that Payor right here, you have one payor, mostly in England, you have the National Health Service, the NHS, funded by the government, and only a few selected few people can afford to get a private insurance on the site, if they do not want to wait on the NHS. Like we all know, if it's owned by the government, it's slower. If you need something done, if it's urgent is gonna get done if it's urgent is gonna get done. Okay. But it was the slower pace and the National Health Service. I'll give you an example. Okay. And England, if you need a knee replacement, for example, definitely elective surgery, it might be important, but it's not emergent, then that might you might have to wait on line for a few months. 

Coach JPMD  7:06  
Few months. 

Brunel Joseph, MD  7:07  
Yeah, maybe? Could be even six months. 

Coach JPMD  7:09  
Okay. So you see the physician, they schedule you? Is it because the scheduling is so far out? Or because they don't have enough physicians?

Unknown Speaker  7:17  
Well, it's a combination of things. So the way the National Health Service works is that we go to med school, when you're done, you have to spend some time working for the National Health, the NHS, but this is those same physicians, particular surgeons, they also have their private practices that they run. Right. So an example, if you come to me, as an orthopaedic surgeon, an NHS service is gonna take you longer things a little slower there. But I can go next week, to my private practice, and, and do it for you privately. So that kind of, again, this is an saying the negative part of it. So the positives are, it's yes, you pay more taxes, but you are covered under insurance for emergencies or for medical care. It's all covered that way. But it's not you're not going to get the service the way I mean, it's not a fast service like it is here in the US.

Coach JPMD  8:16  
So sorry, sorry, we distracted from that, because I was always interested in finding out what your personal experience was because you've done both. Yes. So you did your residency and fellowship in Illinois, and you decided to do sports medicine. 

Brunel Joseph, MD  8:30  
Correct. 

Coach JPMD  8:30  
So I know that I remember having a conversation with you and saying, you want to do sports medicine here. You were thinking about joining being a team physicians. Did you ever do that I can't remember. 

Unknown Speaker  8:39  
Yeah I did some coverages. I covered some teams, college and high schools. When I came back to Florida, what I really wanted to do is a mix I want to do practice, which I can do my general managed care practice. And I had that vision of having like sports medicine, and doing sports injuries and concussions and things like that on the side. But I kind of suddenly realize that managed care really demands your full attention, and terms of the things that you need to do to be there for your patients. And we'll talk more about that in terms of it's not you come in I take care of your headaches and bye bye, Right? You responsible for the comprehensive care of that patient. And so that requires a lot more. So then I decided to focus more on managed care and that that was a good decision on my part.

Coach JPMD  9:31  
Yeah. So when did it click for you? That managed care was a good decision. I know that you know, some physicians, so are practicing fee for service. They're doing a lot of injury medicine, or I should say auto accidents and things like that. When did you feel it? It kind of clicked for you?

Unknown Speaker  9:50  
Well, when I really kind of realize in managed care, the preventative care piece is very important, right? So we need to do more prevention. And I mean, I saw a crow difficult prevent if we could eat better and exercise you can prevent 70% of the, of the diseases and the money that we spend on health care in this country, right? So it clicked for me, when I realized that I didn't have to see 30 patients in a day, I'd have to see 35 patients in a day, I could see 10 patients a day, and to spend time with those patients do good preventative care. And in terms of the financial reward is probably better. Some, I feel better, because I'm taking better care of that patient, I spend more time with my patient. And also the financial reward was also better. So it kind of clicked for me there.

Coach JPMD  10:45  
So what do you say your colleagues are doing do you talk to your colleagues about what you do and or your former residency training colleagues?

Unknown Speaker  10:53  
Most of my colleagues that I went to school with are still doing fee for service, some of them my sports medicine, guys, some of them chose to do 100 percent sports medicine, and some do family care, but not sports, but not managed care eiher. So it's mostly fee for service. And they most of mine, the grind, they are seeing 30 patients 25-30 patients a day. I mean, if I remember correctly, you have to take like to break even, then you have to see at least 17 patients or 20 patients a day. And to make a profit, you have to be in the 20s - 30s. So in terms of fee for service, so it takes..

Coach JPMD  11:27  
So are they seeing younger patients, because I couldn't see myself. I mean, at this point during this 20 years now, I couldn't see myself seeing 20 patients, if I see 15 patients a day, I'm like, Oh, that's a lot. Because you do so much for your patients, how are they able to manage that? How are they able to do everything for the patients with chronic conditions?

Brunel Joseph, MD  11:46  
Correct. So what's happening is, most of these guys, they were they're not doing a comprehensive visit for that patient every time, right? If you have to see 30 patients, obviously, I'm going to check your blood pressure gives you the medication so that they might have to come back for.

Coach JPMD  12:03  
So you're you're you're turning them, but you're also having them have to come back come back to manage other problems. So it's one problem at a time. Yeah. So you've been doing this? How many years now? 10 years? 

Brunel Joseph, MD  12:17  
10 years.

Coach JPMD  12:18  
 10 years? 

Brunel Joseph, MD  12:18  
10 years. 

Coach JPMD  12:20  
What would you say are three things that you really like about managed care? I think you mentioned one, but maybe two more things.

Unknown Speaker  12:24  
The preventative care piece is very important to me, because I think the fact that we are responsible for the overall health of the patient, then you take your time to do a lot of preventative care. And if we prevent it, if I make sure that the colonoscopy is done, I make sure that mammograms are done, then you can prevent colon cancer, we can catch the breast cancer early, then you're going to the patient doesn't have to go through as much we will not to spend as much. So I like that managed care's really preventative care focus. That's one. Again, I mentioned the fact that you financial, the financial reward is better, for sure. And you build a better raport with your patient as well, right? Because the patient knows, you will make sure the patient knows that you're there for them. You're there for them. Weekends, days 24/7 and my patient they know to call me. It's my job. They know that I'm okay. They call me on Saturday because they have a burning question about something. Because of that you build a better relationship with your patients, they will open up to you more. So I think those are the things that I really liked the most about minus 

Coach JPMD  12:25  
Yeah, I agree with you, 100%. And it's building those reports. And I think I mentioned in the last episode, you know, five things, five reasons to embrace managed care is because if you see a 65 year old patient, that 65 year old may live another 15-20 years, if you have a good rapport with them, you prevent care, and you do what you need to do to manage their care. They're never going to leave you. So that's guaranteed income. Correct. And even if they do leave, I had one patient who left and he came back, you know, with this he was embarrassed to come back because he thought I was gonna yell at him. And I said, No, no, I just want to know, why did you leave? Well, it was close to my house. It was 15 minutes from my house. But Doc, that other doctor was just yelling at me and pointing his finger in my face and telling me I have to do certain things. And I just felt horrible. I'll never leave you again. So I'm sure you've had those experiences. 

Unknown Speaker  13:39  
I have similar experience. I've been most recent one patient I've been seeing for a long time as well. And there's a group that came to town where they provided a lot of the things including transportation and that was the drive for her. They can take pick me up from home take me to the office. They do the X rays in the office. They do everything there and she called me to tell me, sorry I have to leave. That's okay, that's going to work better for you. But she came back because then she realized that they pick her up and they have to go pick up 15 other people, she's in she's in a van for most of her day, and when she gets there, it's like, she's, she's a number. 

Coach JPMD  15:16  
Yeah. 

Brunel Joseph, MD  15:17  
And you know me I can I can, is that that's something I can not because you know me and...

Coach JPMD  15:23  
Yeah it's all about the relationship. 

Brunel Joseph, MD  15:25  
Yeah, yeah.

Coach JPMD  15:26  
Yeah. So what are three things that you would change things that you like, Man, this, this really sucks.

Unknown Speaker  15:32  
Things to change is the perception of managed care by other specialists and even some primary care doc don't really get managed care. So there are some people you will meet in our profession, you say, Hey, I do managed care they like, ah, for some reason there is a negative connotation that some people have about managed care. And I think it's because the primary care doc control, they feel like there's control too much of the care. And the other things. And if there's something I want to change is just like, because it's managed care. It's more detail this more involved you are responsible for. It's a big responsibility, so to speak, right? You have a fee for service patient, they come in, let's see, do the bare minimum, they leave two days later, something happened they end up in the ER as a fee for service doctor. It's not I mean, yes, my patient I care wish didn't happen, however, you're not on the hook, so to speak, or whatever happened to that patient outside of? So as a managed care person, the hospital call me they text and say, Hey, I have your patient here. Can you see him tomorrow because I'm thinking about discharging. But if you can't see him that I'm going to keep them here, I will see them. So it's like he always your responsibility for that patient continues, right. So what else I would change about my industry. Maybe on the patient side, some patient also don't recognize what managed care is. I still have some patients and it's hard as physician you don't know what you can teach the patient what you cannot. I've had a patient come to me, blood pressure was kind of elevated, I wanted to come back in a couple of days. Oh doc I feel bad. I don't want to, to abuse the system. But if they come back to see me again, next week, then I'm going to be to billing the insurance. So there is an education part, both for physician needs to be educated more about managed care and the general population as well. But it's like what's the how do you do that? Are we supposed to do that there's that grey area of what you're supposed to tell the patient or not?

Coach JPMD  17:38  
Yeah. And I think one of the things I I find really difficult to, for me to even accept is some of the HEDIS measures. I don't know if you... 

Brunel Joseph, MD  17:47  
Yes.

Coach JPMD  17:47  
There's a HEDIS measures that were there all over us. And if a patient has cardiovascular disease, or even diabetes, they need to be on a statin drug. Yes. Sometimes the patients are intolerant to it, sometimes they're their cholesterol is a normal. So I haven't found a good study that tells me that if a cholesterol is normal, we still need to prescribe the a statin, long term studies. I mean, I'm talking 20, 30, 40 years or so. And there's no way for us to get rid of that measure. So I find a little annoying, because even as a physician, we should have the ability to say, Hey, we should exclude this patient out of this criteria so that we can meet that measure. But you know, they want 85% 90% compliance, which I think is a little crazy,

Unknown Speaker  18:33  
Correct. And the other part is like the patient if that goes along with the patient's responsibility to patient that blood pressure medication isn't the person is not compliant. But sometimes the pharmacy sent it too early, or the patient cannot tolerate it. And so you have all those measures that you're supposed to meet that can be challenging. 

Coach JPMD  18:53  
Absolutely. So what's the one thing you would tell a younger physician such that by doing that one thing, it would make their lives much easier?

Unknown Speaker  19:02  
I would say being open to learn, right? Being afraid to learn and not just and we both know, we don't get trained in medical school for any of this, in terms of the financial side appears out of training, I did not know the difference between fee for service and managed care. I heard about it and I wanted to acquire more on it to learn and I felt like this, this was the way of the future. So I was willing to do that. Just like I said, some outside of even other physicians so don't know about managed care, look at a certain way outside of people come in out of training sometimes and not even some of them are not even willing to learn because they they've heard that managed certain things about managed care. So I think what I would, I would say is to be open to learning about different theories open to learning about different insurances. Obviously open to learning more about medicine because obviously, you have so much more to learn. As you finish training. Those are really the things I would maybe get a mentor, that that's something I've thought about, I should have done early, get a mentor, because sometimes a lot of us are in our own little bubble. You don't know what the next primary care guys doing if there's some questions you don't want to ask.. you know how it is.

Coach JPMD  20:19  
It's a competitive landscape. I mean, if you ask this question or if you know what this guy is doing, he's gonna take patients away from you and cry. And there's so many patients out there this so much, you don't need to think that way. But it was a great point.

Brunel Joseph, MD  20:33  
But even financially, so that's a big taboo also within our field, you can't talk finances.

Coach JPMD  20:42  
And that's one of the biggest things we should be talking about. Yeah, because we're coming out of debt. And I saw out of I was on a Facebook group, a physician, community Facebook group, and one of the questions from a physician, and I guess this is public knowledge, because it's on Facebook, so I can say it. But he had three kids, and he just came out of residency making $250,000 a year, and they living in a 2000 square foot home. They have debt, they owe people money, and he wants to buy a house. Should he buy a house? And I know you know the answer to this. The answer is 

Brunel Joseph, MD  21:17  
No 

Coach JPMD  21:18  
Exactly. 

Brunel Joseph, MD  21:19  
No 

Coach JPMD  21:20  
No. But you know, the old me 20 years ago would have said, Oh, yeah, bud you make enough money. And yeah, you should you know, get out of the rent. No, no, no. Pay off your debt.

Unknown Speaker  21:30  
Oh, yeah. I mean, that's another thing when you said, what else? You thought to go back? Financial education. Oh, my goodness, in terms of it. If I know then what I know now the much better position today. 

Coach JPMD  21:46  
Yeah. 

Brunel Joseph, MD  21:47  
Right. Within the first three years of finishing our responsibilities were not much. I was a single guy making good amount of money. If you go back and think, Okay, I was making good amount of money. 

Coach JPMD  22:03  
Yeah, yeah. 

Brunel Joseph, MD  22:04  
And it was just me.

Coach JPMD  22:06  
So I, you know, I'll tell you what I was doing. I was flipping houses with student loan debt. What business did I have doing that? That's just nuts. But I did it. And you know, we learned from mistakes, and we try, we're trying to at the practice impossible keep people from doctors from doing this, this type of stuff. So I think I think people are getting it. It's just takes a little bit longer. And we need guys like you who can come on and share your experiences and tell us what we should do and what we shouldn't do. I so thank you for coming on for a third time, but this one is actually recorded. And I see the levels on this machine going up and things are recorded. So I think we're good.

Brunel Joseph, MD  22:49  
Thank you, I'm happy to do it.

Coach JPMD  22:51  
Thank you so much Dr Joseph and we'll see you soon. 

Brunel Joseph, MD  22:54  
See you soon.