The Doctor's Agent: Advocating for the Advocates in the Business of Medicine with Ethan Nkana, Principal of the Rocky Mountain Physician Agency

[00:00:00] Welcome to the Chalk Talk Gym Podcast, where we explore insights into healthcare that help

[00:00:08] uncover new opportunities for growth and success.

[00:00:11] I'm your host, Jim Jordan.

[00:00:21] Welcome back to our podcast.

[00:00:24] In an ever-evolving landscape of healthcare, innovation is key to navigating complex challenges.

[00:00:29] And our guests today, Ethan and Kana, is a trailblazer advocating for physicians in the

[00:00:34] business of medicine.

[00:00:36] With a unique background in law and hospital administration, Ethan founded Rocky Mountain

[00:00:40] Physician Agency to empower doctors in contract negotiations.

[00:00:47] As a former hospital executive, Ethan immediately understands the pressures physicians face,

[00:00:51] from burnout to lack of autonomy, and he recognizes that while doctors are exceptional at advocating

[00:00:57] for their patients, they often struggle to advocate for themselves.

[00:01:02] Ethan is on a mission to ensure doctors can focus on providing the best patient care without

[00:01:07] compromising their well-being or fair compensation.

[00:01:11] In this episode, we'll explore the shifting dynamics between physicians and private practices

[00:01:15] and hospital systems, and Ethan will share insights on physician contracts, the impending

[00:01:21] doctor shortage, and how his work is transforming the way physicians navigate their careers.

[00:01:28] So Ethan, welcome, and tell me in the audience a little bit more about yourself and what motivated

[00:01:33] you to become a physician advocate.

[00:01:36] My name is Ethan.

[00:01:37] My last name is Nkana, N-K-A-N-A.

[00:01:41] My journey is, I think, a little bit eclectic in the sense that I'm a lawyer by training,

[00:01:48] but I never practiced, and I never wanted to practice.

[00:01:51] I went to law school to get my law degree, to develop the skills to become a hospital

[00:01:56] CEO.

[00:01:58] And while all of my classmates were taking the bar, I was finishing my MBA at the University

[00:02:05] of Dayton.

[00:02:06] And I wanted all of that to lead into my career as a hospital CEO.

[00:02:14] Little did I know in 2019, I was going to get laid off and really reevaluate what my

[00:02:22] career path is and what my career purpose is.

[00:02:26] Why am I doing what I'm doing?

[00:02:29] And it's led me now into this path of being a talent agent for doctors and advocating

[00:02:34] for doctors in contract negotiations.

[00:02:37] So we were talking earlier, trying to understand is that mostly private practice or people

[00:02:42] that are physician practices that are owned.

[00:02:44] So maybe for the audience, share how physician practices work.

[00:02:48] Some are private, some are owned, just to give people some context.

[00:02:53] Yeah, so you typically have kind of the major dichotomy between private practice and what

[00:02:58] you would call physician employment.

[00:03:00] Now the hypocrisy in that is that you can be an employee in private practice, but for

[00:03:06] the sake of the discussion, we'll just say there's private practice and employed.

[00:03:10] Employed tends to mean large hospitals, health systems, or even community hospitals and clinics

[00:03:17] where the doctor gets a biweekly or bimonthly paycheck that they can rely on no matter how

[00:03:25] busy they are, no matter how much work they do, how many hours they work, they get this

[00:03:29] consistent paycheck.

[00:03:31] In the private practice side, you see a lot more of an entrepreneurial spirit among doctors

[00:03:38] and many doctors are paid on what I call what you heal model.

[00:03:43] So as busy as you are, that's how much earning potential you have as a physician.

[00:03:49] And so that tends to draw physicians who are interested in autonomy and earning potential.

[00:03:56] And at the same time, the business side of medicine, which frankly is daunting to many

[00:04:01] of the doctors I work with.

[00:04:02] Have you noticed there's an age line there in that decision to be employed or not employed?

[00:04:07] Oh, interesting.

[00:04:08] I've never thought about it that way, Jim.

[00:04:11] But when I think about the doctors I serve, I rarely, I can maybe think of one or two

[00:04:18] doctors who go into private practice directly from training.

[00:04:23] That is similar to being a lawyer, leaving law school and putting up your own shingle.

[00:04:28] That's kind of a lost art.

[00:04:30] You don't see that as much in the industry.

[00:04:32] So many doctors come out, go the employed route, work for a few years, realize it's

[00:04:39] a business, and then they decide, you know, I'm going to change pace.

[00:04:44] I want to change direction.

[00:04:45] And maybe they decide to go the private practice route.

[00:04:47] So I do tend to see it more with experienced doctors as they get five, 10, 15 years into

[00:04:53] their career and they decide, I want to control how I practice medicine.

[00:04:59] I spent 15 years as a hospital executive and I was telling doctors, you need to see patients

[00:05:05] faster.

[00:05:07] The budget can't support another medical assistant.

[00:05:09] All of these things that help doctors provide the best care, but yet people with MBAs are

[00:05:14] making those decisions.

[00:05:16] And that just is completely incongruous with the Hippocratic Oath.

[00:05:21] And so it should be doctors who are in charge of how long we need to spend with patients.

[00:05:26] What support clinically do I need to care for my patients?

[00:05:30] Not MBAs and attorneys like myself.

[00:05:33] I think too, that one of the things that's interesting to me as someone who focuses on

[00:05:38] information systems is that I started my career in the manufacturing side and I could tell

[00:05:43] you down to a half penny what something costs.

[00:05:47] And I could also tie that through cost basis analysis to revenue.

[00:05:53] And when I talked to my CFO friends in a hospital system, it's more of a cost bucket that they

[00:05:59] throw it into and you can't see cause and effect.

[00:06:02] So for example, when physician measurement first came out and I was involved in it, you

[00:06:07] would talk to the physicians who get what they call the train wreck cases and say, you

[00:06:12] can't be measuring my performance against someone who's getting the easier cases.

[00:06:18] And so it's a lot more complex than that.

[00:06:20] And the fact of the matter is the MBAs that you're talking about don't actually have the

[00:06:24] tools to be able to do what we would call activity based costing.

[00:06:28] So you get laid off.

[00:06:29] What made you thought of doing what you're doing?

[00:06:33] It really was an epiphany I had and there's a magazine over my left shoulder.

[00:06:40] It's 5280 Magazine.

[00:06:41] I framed that because about a week after I got laid off, I reached out to, she's now

[00:06:49] my wife at the time, she's my girlfriend.

[00:06:52] And she said, Hey, you're stressed, you're frustrated, you need to go get a massage.

[00:06:56] So as I'm sitting in the lobby waiting to go back for my massage, I see that magazine

[00:07:01] on the table there.

[00:07:03] And it got me thinking, did those doctors know how much they should be paid?

[00:07:08] How do doctors know how much they should be paid?

[00:07:10] And the thought that really catalyzed this idea was why don't doctors have agents like

[00:07:17] professional athletes?

[00:07:19] They go through a decade, decade and a half, 20 years of training, put their head in the

[00:07:24] sand to become elite at their craft.

[00:07:27] They come out and make all this money, athlete hire agents, negotiate their deals and doctors,

[00:07:32] I can tell you from experience do it themselves.

[00:07:35] And they leave a tremendous amount of money on the table.

[00:07:39] And that really was the genesis of Rocky Mountain Physician Agency, which is a tower agency,

[00:07:46] not for musicians, movie stars and athletes, but for physicians.

[00:07:50] I love that.

[00:07:51] So how did you find your first client?

[00:07:53] It was networking.

[00:07:54] The only thing I've ever done in my career is working in hospitals.

[00:07:57] So I don't have any shortage of doctors in my role of eds who I worked with or interacted

[00:08:03] with and the initial clients were doctors in the same health system I had worked with

[00:08:09] as an employee who I knew were frustrated.

[00:08:12] And then imagine you can probably relate to this as well, but once you help doctors, doctors

[00:08:19] talk to doctors.

[00:08:21] And when they realize, wow, Ethan has my best interests in mind.

[00:08:25] Ethan has unparalleled experience working in hospitals.

[00:08:29] He knows the business of hospitals.

[00:08:32] And Ethan isn't going to charge me like an attorney by the hour or by the six minute

[00:08:36] increment to talk to me.

[00:08:38] I talked to doctors.

[00:08:39] I've talked to three doctors today already just on questions, who are not clients, just

[00:08:44] on questions they have and situations they're going through.

[00:08:47] So ultimately my job, yes, is as an agent, that's fun and amazing, but I also see a big

[00:08:53] part of my job is as a teacher.

[00:08:55] Oh, that's interesting.

[00:08:56] So when I go through contracts, I actually mind map them, right?

[00:09:00] So you have all the layers and how it all layers out.

[00:09:03] What are the triggers that you learned can help physicians?

[00:09:08] The biggest thing that I think about is the patient.

[00:09:12] I am focused on how can I help my doctor be laser focused on the patient?

[00:09:19] And what are the barriers to that?

[00:09:21] I don't feel as though I do anything but work.

[00:09:24] I'm at the hospital or my practice all the time, or I don't feel as though I have agency

[00:09:30] in making decisions on behalf of my patients.

[00:09:34] One of my clients right now, for many doctors who are listening, you probably are accustomed

[00:09:39] to hearing 15 minute visits.

[00:09:41] All the practice that I'm talking with now, they've been asked for the last six months

[00:09:46] to put on a 10 minute visit.

[00:09:48] And these are OBGYNs, not any other specialists, they're OBGYNs.

[00:09:51] So they're somewhat like specialized in their work.

[00:09:54] And so my job is to support those physicians by advocating for those patients to get adequate

[00:10:03] time with the doctors.

[00:10:05] So when you're dealing with the hospital administration, what gets them to make those

[00:10:12] changes?

[00:10:13] Is it the risk of losing a physician because we have a physician shortage coming up?

[00:10:16] Or is it, we were talking activity based, are you connecting?

[00:10:19] For example, there's clear data that shows the decreased time a physician has lack of

[00:10:24] bedside manner, the increase in malpractice rate.

[00:10:28] And someone could not be as strongly skilled and be charming and they have a better malpractice

[00:10:33] rate when in fact maybe in real life they should have a higher one.

[00:10:37] So that data is there.

[00:10:39] So these are kind of things you bring to the attention of?

[00:10:42] You know, my work, it's almost color by number.

[00:10:46] So when I do education for residency programs, fellowships, physician associations, I give

[00:10:51] doctors the blueprint to go do this for themselves.

[00:10:55] You don't need to hire me to do it.

[00:10:57] I don't do magic.

[00:10:58] I follow a formula.

[00:11:00] So for these doctors, the very first thing that I do when a doctor hires me, and look,

[00:11:05] I'm going to say the hard part first.

[00:11:07] You must be willing to go.

[00:11:09] I'm not saying you have to go, but you must be willing to at least consider it.

[00:11:13] And here's why.

[00:11:14] I worked with a group of six women physicians and they're all OBGYNs.

[00:11:19] They went to their employer, which is a national for-profit health system.

[00:11:23] And they said, we want to be paid fairly for our work.

[00:11:26] The employer predictably said, which I told the doctors, said, we can't pay you another

[00:11:31] dollar or else we're going to end up in prison because of stark law violation.

[00:11:35] So I said, okay, here's how you fail by going to your employer and asking for a salary raise.

[00:11:41] You will fail.

[00:11:42] I don't care if you're a neurosurgeon, family medicine, or anything in between, you will

[00:11:46] fail.

[00:11:47] The way that you give yourself the chance of success, and again, you will stay with

[00:11:51] your current employer, but you must go get a competing offer.

[00:11:53] You must.

[00:11:54] That is an essential and non-negotiable part of the process.

[00:11:58] So I went out and I got three offers for these amazing doctors.

[00:12:02] There were six of them.

[00:12:03] These offers were for more money, better schedules so they could spend time with their

[00:12:06] family and more support in their practices.

[00:12:08] So obviously these doctors were going to go, right?

[00:12:11] It's not that simple.

[00:12:13] Doctors are not motivated by money, generally speaking.

[00:12:16] They're motivated by support for my patients.

[00:12:19] I want to have a seat at the table, a schedule that fulfills my cup.

[00:12:23] And so what we did was after we got those offers, we came back to the employer and said,

[00:12:28] If you're not willing to advocate for these doctors to have adequate time with their patients

[00:12:33] and adequate support, they're going to go somewhere where they can't.

[00:12:37] And then when I said, hey, they have an offer for this much more money, then the tone changes.

[00:12:42] Now we'll hold on.

[00:12:43] Let's, can we have a conversation?

[00:12:46] So the punchline to that is the doctor's got everything they asked for.

[00:12:49] More support, more MAs, MPs, better schedules, didn't have to take as much call.

[00:12:54] Now there's a call pool of locums doctors ready to help back them up.

[00:12:59] But here's the kicker.

[00:13:00] Those doctors did not ask for a single dollar when they met with me.

[00:13:04] But as a result of working together, we got them $180,000 each individual base salary

[00:13:10] increase and then individually, we also got them a $40,000 bonus just to stay with their

[00:13:16] current employer and sign a new contract.

[00:13:19] So less than half of that went to paying my fee because my fee is a percentage of my doctor's

[00:13:24] pay.

[00:13:25] So the doctors know exactly what I'm motivated by and that's to help me make those money.

[00:13:30] Can you explain the Stark Law to people just to make sure they understand it?

[00:13:34] Yeah, there's kind of this pair of laws, Stark and anti-kickback that usually tend to go

[00:13:39] hand in hand.

[00:13:40] The punchline is it is illegal to pay doctors for their services and referrals or volume

[00:13:47] of services and referrals.

[00:13:49] So in the hospital world, the way that typically works is when you talk about a doctor's pay,

[00:13:55] you cannot in any way implicate volume.

[00:13:59] Well, if you send us this many patients, we'll pay you this much, that is considered illegal.

[00:14:04] And I think fundamentally part of the rationale is we want doctors to do what's in the best

[00:14:10] interest of the patient.

[00:14:11] And if there's a financial incentive, now there seems to be a conflict of interest potentially.

[00:14:16] So as I understood that law, it was more about doctors being financially motivated to

[00:14:23] make referrals to have the money come back in their own pockets.

[00:14:26] I think that is the simplest form of that law.

[00:14:29] Exactly.

[00:14:30] Yeah, exactly.

[00:14:31] And it got a little more complex because the law was intended or it came about when most

[00:14:37] people were in private practice or wholly owned physician practices.

[00:14:42] And now that these practices are owned by hospital systems or integrated delivery networks,

[00:14:47] that law might be a little less clear on how to execute it is my sense of it.

[00:14:53] What I tend to see now is, and I did this while I was a hospital executive, but I just use

[00:14:59] it as a shield.

[00:15:00] Hey, doctor, I can't pay you any more money because of Stark and Antek kickback.

[00:15:03] Well, what does that mean?

[00:15:04] Don't worry about it.

[00:15:05] It's bad.

[00:15:06] It's really bad.

[00:15:07] I never actually, even though I studied Stark and Antek kickback deeply when I was in law

[00:15:12] school, I never used it in the legal sense.

[00:15:16] I always used it in the business sense as a way to chill doctors from taking action,

[00:15:23] meaning going somewhere else.

[00:15:25] There's an old saying pinpoint don't label right?

[00:15:27] And labels.

[00:15:28] So it seems to me they're using that law as a label that no one really has agreement on

[00:15:34] the definition of it and its details.

[00:15:36] So when you're working with these physician groups, how are they finding you?

[00:15:42] The biggest thing is education before anything else.

[00:15:46] I'm a teacher.

[00:15:47] I want doctors to know that challenges you're up against in the business of medicine.

[00:15:53] And if a doctor wants me to help give them all the answers to the test so they can do

[00:15:57] it on their own.

[00:15:58] Awesome.

[00:15:59] But ultimately most doctors find us as a result of residency, education, fellowship, education,

[00:16:06] physician associations.

[00:16:07] I was with national medical association a few weeks ago and I'll be with the Iowa association

[00:16:14] of family medicine physicians here next month.

[00:16:16] Again, just helping doctors understand the challenges they're up against and how they

[00:16:21] can advocate for themselves and for their patients in their contracts.

[00:16:25] So I think one of the things that's valuable about using someone like yourself is that

[00:16:30] can happen without physicians having a confrontation with administration, right?

[00:16:36] There's two ways to go.

[00:16:37] We negotiate hard for ourself and break down some relationships or we don't negotiate hard

[00:16:41] for ourselves.

[00:16:43] And I guess you can play that role.

[00:16:45] So as you've grown, what challenges has your organization or you had in servicing your

[00:16:50] clients?

[00:16:51] What have you had to change or adapt to or what do you see as changes that are coming?

[00:16:55] I think the biggest thing that I found so discouraging is most doctors don't believe

[00:17:03] they deserve better.

[00:17:04] I had a doctor call me recently out of New York who she's a rheumatologist.

[00:17:11] She have her salary cut in half, her guaranteed salary.

[00:17:15] Now from a hospital executive, from a mathematical perspective, that seems almost impossible,

[00:17:21] but it happened to her and there were some reasons that she explained were valid at the

[00:17:25] time.

[00:17:26] The reason she called me was because the employer had not fulfilled their promise to make her

[00:17:32] whole after she took that cut.

[00:17:35] And so she hired me to help her resolve that cut in her salary.

[00:17:41] But the challenge is that doctor signed a contract in good faith to cut her salary in

[00:17:48] half.

[00:17:49] She didn't think to say, wait, how is this going to benefit me again?

[00:17:54] She didn't think she deserved better.

[00:17:56] She didn't think she deserved to advocate for herself.

[00:17:58] And I think that's the thing that I'm so deeply saddened by is that more doctors don't believe

[00:18:06] that they deserve to be paid fairly for their work, sacrifice and commitment.

[00:18:10] I think the other piece is there's no place to go to get benchmarks on these numbers.

[00:18:14] Now, I just happened to know, I was showing you earlier and for the audience on my website,

[00:18:19] healthcaredatacenter, instead of .com, it's .center.

[00:18:22] If you go and you type physician, you'll get some of this data.

[00:18:26] But I just happened to know from that report that rheumatologists are one of the poorest

[00:18:30] paid physician groups.

[00:18:31] And part of that reason is there is no chargeable CPT code.

[00:18:35] It's more a visit thing and it's more an outcomes thing.

[00:18:38] And so even though we're trying to move to value-based and away from these individual

[00:18:43] codes, the fact of the matter is that physicians are still predominantly paid through CPT codes.

[00:18:49] So I think that's kind of interesting.

[00:18:51] So as you learn to negotiate and you've developed your techniques, what sort of shifts have

[00:18:56] you made in the past four years since you've been doing this for five years?

[00:19:00] I realized that doctors don't care about money as much as I was hoping they would.

[00:19:06] So my messaging has changed from helping doctors maximize their compensation, which is where

[00:19:13] I started.

[00:19:14] Basically it was the same model as athletes.

[00:19:18] Make a bunch of money, be on the best team, and that's what makes athletes happy.

[00:19:22] But that's not what makes doctors happy.

[00:19:24] Doctors are motivated by their purpose.

[00:19:27] Doctors are motivated by the outcomes of their patients, the relationships with their patients.

[00:19:32] And so I shifted entirely my focus to be more intentional about time with patients, resources

[00:19:41] you need to do your job, feeling as though you're not stuck at work all the time.

[00:19:46] And then the third leg of the tripod is, you do deserve to be paid fairly.

[00:19:50] You don't have to make a million bucks, but you deserve to be paid fairly.

[00:19:53] I think you know this and our audience is more than just physicians, so I'll share this.

[00:19:58] There's a lot of these physicians take that administration home at night and spend weekends

[00:20:03] on that stuff.

[00:20:04] And so recently I just happened to be doing my annual dermatologist visit and I've had

[00:20:10] the same person for a million years, so we know their kids and all that kind of stuff.

[00:20:15] And so we were just chatting and I said, oh, you actually have a scribe with you now.

[00:20:19] And she said, as practice, we sat down and we were all burning out and we're all taking

[00:20:24] away time from our families.

[00:20:26] And we realized that if we just added this incremental spend, how much productivity

[00:20:31] we could get not only in terms of after work hours, but actually open up appointments.

[00:20:37] Dermatology right now is very hard to get people, right?

[00:20:40] There's a shortage.

[00:20:41] We can actually create more access.

[00:20:43] And so I think that's interesting.

[00:20:45] So as these contracts are changing and policies are changing, where do you go to keep track

[00:20:51] of all these changes?

[00:20:53] I love to stay.

[00:20:54] So right now, if you look at my inbox, I've got some fierce health care updates, some

[00:20:58] medscape updates.

[00:21:00] So again, I am going to nerd out on your website because a lot of the things that you highlighted

[00:21:08] in that report, a lot of things you didn't even look at, but things like burnout, that

[00:21:13] is a growing concern for doctors.

[00:21:15] The impending physician shortage are things I think about.

[00:21:19] I also am looking at trends in physician pay around gender, race, things like that.

[00:21:26] So I am always interested in kind of the cutting edge of, I don't so much care about the legal

[00:21:32] side as much as I do about the physician side.

[00:21:37] Are they being paid fairly?

[00:21:38] Are they being supported?

[00:21:39] Are they burning out at work?

[00:21:41] Are they frustrated?

[00:21:42] Those are the things that I'm more interested in so that I can help advocate for them.

[00:21:46] So it's in that report that might be interesting to you and it is a potential shift that maybe

[00:21:50] we can discuss.

[00:21:51] So we're going to have this potentially 130,000 physician shortage, but ironically, nurse practitioners

[00:21:58] and PAs are going to start growing.

[00:22:01] And so for the audience to appreciate this, I can make a nurse or a PA in six years.

[00:22:06] It takes me 15 plus to make a board certified doctor.

[00:22:10] So the ability of things to change rapidly is a challenge.

[00:22:15] And I was looking at the authorities that create the capacity, measure the capacity

[00:22:20] for physicians.

[00:22:21] And before I wrote that report, I was very upset saying, these guys are like a union.

[00:22:25] They're personally keeping the numbers down.

[00:22:27] And then as I got to the end of it, I started plotting when the baby boomers are all dead.

[00:22:32] And you would start realizing if they let it go, they're going to have a whole nother

[00:22:36] problem in 15 or 20 years with way too many physicians.

[00:22:40] So I predict, and I'll be curious what you think about this, that one of the things when

[00:22:46] I interviewed the nurse practitioners and the physician assistants, they all say that

[00:22:51] they don't get to practice to the top of their training.

[00:22:56] And so my thought is what we may be seeing is physicians given, nurse practitioners and

[00:23:02] physician assistants, and they become the oversight, they start leading teams versus

[00:23:08] having to make every decision and they come and manage the more difficult cases.

[00:23:12] What do you think about that process and how would you change your contracts?

[00:23:15] Yeah, that's really interesting.

[00:23:17] I certainly could see that as a path forward.

[00:23:22] I think I would rebut that with the idea that I think many doctors are feeling as though

[00:23:32] their work is being encroached on.

[00:23:34] Yes.

[00:23:35] So I'd be curious, Jim, sorry, do you think that trend is one that is helpful for physicians?

[00:23:43] Is that the right role for physicians being the overseer of care as opposed to the actual

[00:23:49] person who's giving the care?

[00:23:51] You know, I would kind of throw that back and say like, is that trend the right trend?

[00:23:55] So the encroachment piece was very much related to the CPT co pay by piece, right?

[00:24:02] So I think as we move to the value-based system and what people receiving a salary with a

[00:24:07] bonus, it's going to start measuring on outcomes of value.

[00:24:10] And I think that, you know, why do you have certain diseases you'd rather go to the Cleveland

[00:24:16] Clinic versus, you know, Idaho Hospital, which is no disrespect to Idaho Hospital.

[00:24:21] It's that when you think of a distribution, when we were in statistics, when we were

[00:24:24] kids, right?

[00:24:25] The tail of the distribution is when all the madness is.

[00:24:28] And that experience allows them to look at very complex cases and have insight that

[00:24:34] other people don't have.

[00:24:35] So we can have a whole conversation on AI in rural hospitals, and that could change.

[00:24:39] But I think that physicians aren't having time to, you know, when they're working the

[00:24:44] little cases to be able to stay on top of these more complex cases.

[00:24:48] And so I think if they're getting paid for the same and the payment system isn't going

[00:24:52] to be the impediment, I think there's more joy in the job.

[00:24:57] Interesting.

[00:24:58] You know, that would kind of like mirror like anesthesiologists.

[00:25:01] They have nurse anesthetists, CRNAs.

[00:25:04] Yeah, that's a really interesting thought.

[00:25:06] So what would you say is the biggest lesson you've learned thus far in this new journey?

[00:25:11] It's not about the money.

[00:25:13] It's rarely, if ever, about the money for doctors.

[00:25:17] Doctors are tired.

[00:25:18] They just want to be doctors.

[00:25:21] They don't want to be, generally speaking, right?

[00:25:23] I have doctors who are executives, CMOs, CEOs.

[00:25:27] Doctors can be and do anything they want.

[00:25:29] But the overwhelming majority, the 80% in the middle of that bell curve, just want to

[00:25:34] be really good doctors and provide really good care to their patients.

[00:25:38] And the business of medicine is doing everything it can to cut away at that.

[00:25:43] Fewer resources, see more patients, still very heavily in that fee-for-service world that

[00:25:49] we've been in as an American health care system.

[00:25:52] And I think for doctors, it's going to take not just one, not just two, but it's going

[00:25:58] to take a collective to say we deserve better as a profession.

[00:26:03] And if we're going to care for people and keep them healthy through pandemics, then

[00:26:07] we need to be able to be healthy enough to provide that care ourselves.

[00:26:11] I think the thing for me that what's that concern is that when I talk to physician friends,

[00:26:16] because historically you certainly have stories as I interview physicians that their family

[00:26:21] did something completely different and they became a physician.

[00:26:24] But a lot of them are from families of nurses and doctors, and it's been a thing, right?

[00:26:29] And so they're advising their kids not to go into it now.

[00:26:32] And I think that, you know, physicians by the very nature of some of the smartest brains

[00:26:37] that we have in this country, and they can easily apply themselves in other places that

[00:26:42] make a lot more money.

[00:26:43] So I've always agreed with exactly what you say.

[00:26:45] They do it for different motivations.

[00:26:47] They do it to help people.

[00:26:49] And I think we need to figure out how to rectify that.

[00:26:51] And I think, you know, what you're doing here is exceptional and very, very unique.

[00:26:55] Is there a trade union with what you're doing or are you like how many people like you are

[00:27:00] out in the world doing this?

[00:27:02] You know, if you Google physician contract review, you'll see a bunch of companies come

[00:27:06] up what I call like contract review factories where like they'll review it, let's go ahead

[00:27:11] and sign it.

[00:27:12] It's kind of like going to urgent care with a broken leg.

[00:27:14] Like they'll tell you you have a broken leg, but they're not going to repair it.

[00:27:17] I'm the orthopedic surgeon.

[00:27:19] So I repair it.

[00:27:20] So right now, I don't know of anyone else who's being a talent agent for doctors in

[00:27:24] the way that we are.

[00:27:26] And the main differentiator is that the overwhelming majority of our clients are experienced doctors

[00:27:33] who feel stuck.

[00:27:35] They feel as though I'm not able to see my family as much as I like or do things I enjoy

[00:27:40] outside of work.

[00:27:42] I never have consistent support in my practice.

[00:27:46] Those tend to be the doctors we work with.

[00:27:49] They end up staying with their current employer for better circumstances and inevitably more

[00:27:54] money because that's how I get paid.

[00:27:57] So unlike the other kind of like flat fee contract review companies that kind of churn

[00:28:02] and burn, I don't work with every doctor.

[00:28:06] We're not a fit for every doctor.

[00:28:08] So my success is measured on how much more money our doctors making than their competitors

[00:28:14] and their partners and competitors.

[00:28:16] Very interesting.

[00:28:17] Good.

[00:28:19] I think one thing if there are physicians who are feeling stuck, I would say talk to

[00:28:25] your friends.

[00:28:26] Talk to your friends about it.

[00:28:27] Talk to your colleagues, your partners about it because I think a lot of times with doctors,

[00:28:32] the suffering happens in silence or maybe a doctor who gets her salary cut in half will

[00:28:38] call me and she's crying on the phone and that's really unfortunate.

[00:28:42] But through that, I would say if you are struggling, if you're frustrated, stressed, feeling burned

[00:28:49] out, talk with your partners and colleagues about it because someone else is probably

[00:28:53] feeling that too.

[00:28:54] Now, how can people get in touch with you?

[00:28:56] Our Instagram at Physician Agency is popping all the time.

[00:29:02] We just started a YouTube channel at The Doctors Agent and then on LinkedIn, we've started

[00:29:09] to share a ton of education on physician contract negotiation and how doctors can be paid fairly.

[00:29:15] That's just my first name and last name, N-K-A-N-A on LinkedIn.

[00:29:20] Perfect.

[00:29:21] We'll have that in the show notes too.

[00:29:22] Well, thank you for joining us today.

[00:29:24] It's been a delight, Jim.

[00:29:26] Thank you for having me.

[00:29:27] Thanks for tuning into the Chalk Talk Gym podcast.

[00:29:32] For resources, show notes, and ways to get in touch, visit us at ChalkTalkGym.com.