The Stages of Opting Out

Dr. T  0:00  
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is the direct care way. 

Dr. T  0:24  
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.

Dr. T  0:50  
In this episode, we're gonna talk to you about what it looks like to opt out. Actually, it's going to parallel the five stages of grief. Because I know when I tell somebody how to opt out and have a direct care practice, it just means to get out of your contracts, right. But I know it's not that simple. For a lot of us, there's a transition phase. And it's very similar to the stages of grief. So I'm going to kind of adopt it and modify it for you to get the whole picture of what we actually go through. When we start to opt out. Doing something different that is healthy for our mental well being requires a leap of faith into the unknown. But to be honest, this is not really unknown. 

Dr. T  1:31  
There's a lot of us who have a direct care practice, who is successfully doing the thing that we want to do. And I'm sharing all those resources with you here on this podcast through interviews and self reflection and sharing my own experiences. So you have the tools here to help you with your direct care practice, you are not alone, and you are deserving of what you want, or what you truly want, not just what the system has to offer you, this is within reach for you. So let's talk about those five stages of grief, which is really the stages of opting out. So let's see if you can find the parallel in the stages, I'll try to help you along the way. 

Dr. T  2:10  
The first stage is denial, you know, we deny that anything is even wrong in our healthcare system. We go about our busy way, we feel like seeing 40 to 60 patients a day is super normal. We are taught that and grinding after hours is just what it is in medicine. That's what it takes to be a really good physician. And now we are charting on the weekends, our personal time starts to get cut into because we have these work obligations, we have these patients to take care of who need these medications who require prior authorization and that is just chipping away at our personal time will start to get really annoyed about the increase in workload that the insurance demands. They are constantly insulting our intellect with questions that could be answered in our chart, which is why we submitted our charts in order to get paid. 

Dr. T  3:00  
This is cyclical This is day in and day out, we are all doing the same thing over and over again thinking that things will suddenly change on its own. Right now stage two is anger. Somewhere along the line, somebody shines a light on a problem that we can now see, we see that the healthcare system is really messed up. Maybe you've experienced it yourself, you needed to see a doctor but it took 15 minutes to get on the phone with somebody, you get a hold of somebody and maybe they're not even a staff member. They're like the on call service, they leave a message for the medical assistant to take to the doctor and then like forever passes by before you even get a hold of your doctor.

Dr. T  3:37  
 And it was a really simple question that you needed answered and you couldn't get any of that even with health insurance, or patients need a thing that you prescribe and they couldn't get the thing like, what the heck right? Were doctors who made the recommendation? What's the holdup, it should have been an easy transaction. Healthcare is a relationship between the patient and the physician but all these people in between, they want to cut in so there you have it, right. So stage two, we get angry, we saw that something was wrong, the pandemic really shine a light on how vulnerable we are as physicians in this type of system. Not only are we getting paid so little, the payments are now continuing to decline. 

Dr. T  4:17  
And then we have to do these peer to peer call with people who are not our peers in the way of specialty. It's like a totally different specialty, or not even a physician, we have to justify why we're ordering stuff regurgitating our notes or having to call for prior authorizations because they need the physician to call. And we just can't seem to help our patients without this type of interference. And it's making us absolutely insane every day so the third stage is bargaining. We try to rationalize or bargain with the system looking for somebody to help us negotiate better rates. We see that their rates are terrible, but we try to find ways around it like joining a super group to help leverage the power physicians in numbers, only to get a few more bucks. But the paperwork, it doesn't stop, we think it might change, but we don't see the change happening. So then we take on some more courses on how to do creative billing, just so that we can optimize our payments, or we succumb to maybe if I just hang out for a few more years, I can finally retire and do something totally different outside of medicine, live my life. Finally, right. 

Dr. T  5:25  
Some of us are adding new products or technology, but still remain on contract. And so we're still on the hamster wheel of having a lot more to do. For patients, even though we said this is our medical recommendation. So let's even look to get employment out of private practice thinking that if we just handed off some of the business management and HR responsibility, then I will be happier, right? If we do this, then we will find happiness. But in both circumstances, whether you're private practice or employed, it's insurance base. And so the same things exist, seeing lots of patients having to do these peer to peer calls, having to know how to code and use the correct modifier to get paid like it's endless. And then the fourth stage is depression, you get to the point where nothing really changes, and you feel kind of hopeless, you're unhappy that you just can't be the doctor, you went off on the person on the other side of that peer to peer call, okay, that was me, I went off on somebody who was actually not my peer with a totally different specialty. 

Dr. T  6:30  
I don't even think they were practicing medicine. But they were asking me why I needed an MRI of both feet. And I said, Because I'm evaluating for X, Y, and Z. And they said, We can't do both. And I just kept getting louder. It was very frustrating. And ultimately, what that doctor said to me was, the insurance doesn't care that you're trying to be efficient, they just want pay for both. So not only am I dealing with the system, I'm dealing with the doctor who is defending the system, it's very frustrating to be in that situation. And I know you've been through the same as well. So it's no wonder that some of us try to leave private practice and to go into an employment situation, it just seems more comfortable. 

Dr. T  7:07  
But if we're still in the insurance based practice, we still have to follow with the rules that they set for physicians, right. And so here we are, the last stage is acceptance, there's actually two things that you could accept, you could accept that this is just the way medicine is that you ride until you retire. Or you burn out, right, this is the roll the dice type of game, you don't really know which direction will win first, whether you retire or burnout. But oftentimes, a lot of us are just burning out first, or the alternative reality is we can accept that there is another way, which is through direct care. So if you choose to sit in the resistance of change, then it's hard to find hope and joy in the practice of medicine, right. But if you choose to move past, and through these stages of grief, of letting go of something that you thought was supposed to be it for you getting a predictable pay from insurance, despite the declining reimbursement rates, knowing that patients will show up because you're in network, you know, there's comfort in that predictability, I get it. 

Dr. T  8:13  
That's what I used to do, but then not having autonomy as well, that is very frustrating, that can feel very restrictive. And if you choose to continue on this trajectory of having a practice that is dependent on insurance, and realizing that you will never have control in your schedule, or even in the way you care for patients, that can definitely burn you out a lot faster. And it's a really dark place to be. I know that because I was there. And I see that with colleagues who call me who share the same pain who are going through the same process. But what I do see is those who are able to see an alternative who I'm helping guide through this process, because I've been through it just recently, you can finally land on a path that gives you the freedom you've been looking for. You might be wondering how I'm sort of sure this? Well, I haven't met a direct care doctor who said they regretted opting out. 

Dr. T  9:06  
That's how I know from the new doctors who I'm currently helping to the ones who have or should have retired. But they continue to choose medicine because they love it so much. And have been doing it cash based for over 40 years, I can see what is possible. Even though I'm only in the early few stages of my practice. I want to have a practice that is going to give me longevity is going to give me joy in the work that I do where I show up. I know exactly what to predict I'm going to get payment for my time, patients are going to get what they want, which is an attentive Doctor Who gives them options and alternatives. We both win in this system. In the insurance based practice who's actually winning it the patients can't get the care that the doctors recommend and the doctors can't give patients the recommendations. All the while the insurance companies are making billion dollars in profit. Like that doesn't seem to make sense right? logically speaking, why would we support a system that doesn't support our patients, and it isn't support the physician either, right? It shouldn't be both, they should support the physician, give them autonomy, it's just support the patients who pay into who pay into the insurance premiums, a whole lot of money. 

Dr. T  10:16  
But in return, they have to wait months to even be seen. That seems kind of silly, right. So as you know, I can go off on a tangent about my distaste for the entire ecosystem of healthcare in the United States. But there is a place where insurance is beneficial. And it's not that I don't think people should have insurance, I just think physicians don't have to work with them. That's all. in private practice, we don't have an abundance of resources versus Academic Center and institutions, right, we're talking about two different entities in private practice, you don't have to work with insurance to have a practice that you love and generates enough revenue for you to have the time freedom back to have a work life balance that really works for you. 

Dr. T  10:54  
You deserve to have a practice that you're proud of the one that works for you, and not where you have to work for it all the time. If you want to practice medicine without having to take on these ridiculous workloads that is typical of insurance requirements, or even putting yourself or your business at risk for an audit or those refund requests, which I just got from Medicare, I think I provided a service over three years ago, and they just mailed me a refund request because they feel that they overpaid me, right. Like I'm so glad I'm out of the system. But anyway, this type of practice direct care, it's within reach, I think it's really important to be totally transparent about what it takes to opt out.

Dr. T  11:33  
It really does take some level of ambition and Audacity and really to dream that you can make this happen to believe that it's possible, which is why I put together the course it's a 12 week course called Launch in 12 weeks, it doesn't mean you have to launch in 12 ways it doesn't mean you have to opt out within 12 weeks. It just gives you the roadmap of what to anticipate as you start to transition out. This is what I wish I had as I was opting out, we can't go back in time, so I'm creating it for you. So you don't have to spend all the time digging up all of different resources. It's just all in one place. Plus, you get the monthly coaching calls with me where I can guide you in your specific journey. 

Dr. T  12:13  
Whatever phase you are at in your practice, whether you are employment and want to have your own practice, or you are in the insurance based practice looking to opt out and you want to know the strategy on how to do that safely. Or if you find yourself in a position where you were employed, and then suddenly let go and you don't have a backup plan, but you find direct care to be really appealing. I would love to help you. This course gives you that framework. This entire podcast series is dedicated to you, my friend, my colleagues who hates insurance, who hates working for other people and want control in their life. 

Dr. T  12:46  
From the bottom of my heart, I want to thank you for reaching out and helping me continue with my mission to let others know about TRICARE. It was only a year ago that I dreamed about bringing all of this together with other like minded specialists. And I'm seeing a lot of you launch your own direct specialty care practice. It's such a beautiful thing to witness my friends and my colleagues chasing their dreams, one that so many other people are easily criticizing us for but you know what? Who cares, it's our life, we get to live it the way we want to. And someday they're going to need us to and we'll be over here ready to help as they go through their own stages of grief. So there you have it, the stages of opting out, which parallels the stages of grief because you are going through a new identity, something that was never taught to us that in medical school not in residency training, not even in in our first couple of jobs. But that dream direct specialty care practice is definitely within reach. 

Dr. T  13:44  
I'm so happy for those of you who've taken the courses and reached out to me, I look forward to expanding my reach and letting more physicians know of another way to practice medicine. Thanks so much. I'll catch you next week.

Dr. T  13:57  
Thank you so much for being here with me. If you enjoyed this episode and want to hear more. Please like, share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect find my info in the show notes and send me your questions. That might be the topic for future episodes. 

Dr. T  14:16  
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time