MSK Direct with PM&R Specialist Dr. Fred Bagares

Dr. Tea  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. Tea  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. Tea  0:52  

I have a really special guest today Dr. Fred Baris. He is a specialist in sports medicine. And I invited him on to talk about his journey into direct care. And this is going to be a fun one because it's going to be the early stages of direct care. And I know that a lot of Doc's are just hearing about what it's like to practice medicine without insurance, but not really sure what that transition looks like. And I and I'll tell you, it's not been easy for me. So I tell it's not been easy for other folks.

Dr. Fred  1:21  

Yeah, absolutely. Thanks for having me on. I'm in Virginia Beach, Virginia. I know I'm a sports and spine medicine physiatrist. So I trained in EMR. And then I did a fellowship in sports and spine medicine physician, a sports and spine medicine, fellowship. And I started off in private practice that on the west coast, but we moved back to the east coast to be closer to family. But my day to day is I see folks that hit knee, shoulder and spine related disorders, a lot of evaluation with some injections. So steroid injections, hyaluronic acid injections, I also do some interventional spine injections. So one of our first set lumbar epidural steroid injections, and then I also incorporate a lot of EMG as well into my practice. Some I'm fairly, you know, I kind of have a lot of different populations that I've see. But yeah, we've been here on the East Coast or back home on the East Coast since 2016. I finished fellowship in 2000, as well. So I've gone from private practice to academics. I had a went into the military system as a contractor, then back out to private practice, and then now on to direct specialty care. So kind of gone everywhere. So

Dr. Tea  2:55  

Did you so are you currently employed now? 

Dr. Fred  2:58  

I am. Yeah, so it's a minimum multi specialty group. And it's, it's kind of solo slash, it's I'm not, I'm not really a solo practitioner. But I kind of am meaning that I'm like part of a big group. But I carry my own overhead on my own partner, that there's no one else to take in the calls, that sort of thing. But at the same time, it's like, I don't have all the benefits of being a solo practitioner. So it's, it's kind of a it's kind of a unique, unique system, but

Dr. Tea  3:35  

So how did you learn about direct care?

Dr. Fred  3:36  

Um, you know, looking back, I actually looked at direct care when I was trying to write out my, my non compete, so I had a non compete. And so for two years, I was trying to figure out well, you know, what can I do? And at the time, and when I was in the military system, you know, obviously, we don't take any insurance. So I started looking for other models of care. So, actually started a telemedicine business. That's kind of what really kind of gotten into everything. And at that time, you know, there there wasn't really much different direct specialty care, like I was, obviously, I've always been a fan of the DPC model just in general. So, actually started asking a lot of DPC Doc's in my area, just, you know, kind of picking their brain and do they think it would work in a specialty care. And ultimately, the only way that I could not violate my non compete and in start a practice was through a direct orthopedic telemedicine practice, which at the time sounded super crazy. Ironically, you know, like, I kind of pitched my idea to everybody and, of course, everyone said it was a horrible idea. And then COVID happened. So when we're everything that wasn't supposed to happen happen where insurance now cover telemedicine in the world was completely shut down. So So it ironically, everyone that was kind of, you know, kind of the naysayer was asking you for my assistance. But then on the flip side, I was out of network with everyone and I could apply for insurance. So it actually tanked my business. So, so it was kind of an interesting proof of concept. But it was also kind of a lot of the, the basis for kind of what I'm doing now.

Dr. Tea  5:24  

So you just started with a telemedicine type of practice. And now you're looking to have an in house practice. Is that right?

Speaker 1  5:34  

Yes, yeah, exactly. So that was kind of the initial plan was I created this telemedicine practice to eventually feed a brick and mortar practice that was just kind of dipping my toe because this telemedicine practice was it was all cash, you know, or non insurance based. And I was trying to see like, Okay, I'm going to finish up my two year non compete, and then I'll have kind of a patient population, it'll help test out the idea and then eventually feed it into a, into a brick and mortar practice. But, you know, I also saw that the overhead issue, I'm kind of a minimalist kind of a person like, with with kind of the typical traditional medical model, there's just a lot of extra stuff that I never understood why, why we're paying for some of this stuff. So I also wanted to try keep their overhead obviously low, no matter what I ended up doing. So it's, but that's how it all started. It was it was supposed to feed, you know, feed into a brick and mortar practice. But ultimately, I've always just really liked telemedicine and just made a lot of sense to me.

Dr. Tea  6:42  

So with telemedicine, did you have some resistance to patients understanding the services you offered? Or did you find that it just took off as soon as you opened? 

Dr. Fred  6:51  

No, I had a lot of resistance. That that was for sure. It was it was a little bit, you know, it's probably the same thing. You know, no surprise, or one was like, I don't understand why you don't take insurance. And so that was the first barrier. And then on top of that, it was like so you're, you're seeing sports medicine injuries, but not in person, you know, so that that was a second mental barrier for a lot of people, which I completely get. But you know, I've just kind of a law, my practice, then most of the I'm not treating, obviously, like fractures, so that wasn't like the patient population that was looking after is more of a kind of the chronic, the chronic injuries, repetitive injuries, a lot of the folks in my area would eventually see like a bunch of different specialists. So I kind of wanted to be the person to kind of just wrap it all up into one, and then just be this person to kind of help navigate their care. That's kind of how I saw my role, or what I was trying to do in terms of medical practice was, you know, obviously, I'm not doing injections, you know, you know, through telemedicine, but at the same time, if I could at least develop a game plan for this is this is what needs to happen. And like if this, then that, and then they can take that care plan and move forward in their local area. So I was only licensed in Virginia. So I was looking for, for for, you know, even patients all the way, like three to four hours away from me, just so I can kind of help help coordinate care from that standpoint. So it was, yeah, a lot of a lot of resistance. A lot of it was a non starter, the people that I did get, actually, were the folks that were, you know, poorly insured, or, you know, high deductible or uninsured. And a lot of these folks were people that just, they'd seen everyone, and they just needed someone to just look at it, look at the entire picture, which is, at least in the orthopedic world is I mean, you're, you know, you know very well, and sometimes you need someone to look at everything, you know, so that was kind of the, that was kind of my niche. And that's what's going to be my niche with with with this next phase of my career

Dr. Tea  8:59  

that was thinking about how you're phrasing it, you just put all the picture together. And I think a lot of us crave that consistency for our patients, you know, you go to one specialist, they think it's the one thing they go to another it's another thing. And that used to be the role of a primary care physician because they were responsible to gatekeeper but when we're out in direct care, we don't necessarily have the same kind of network and I do find myself included as a specialist still having to streamline what it means to be referred to certain doctors. So it's kind of like, like a general contractor as you're building a house, the person who looks at the big plan, and then they start to sort out exactly the needs for what's going on right now. So I do see a huge benefit to telemedicine in that type of role because again as proceduralist we can't do more than to have these discussions. Right right had already proven to yourself that this model would work with your proof of concept. So how did you decide to go back into the clinic

Speaker 1  10:02  

Part of it was COVID. Meaning that at the time I was I was trying to transition back out before COVID actually hit. And the reason was is that my contract with the military was to only do kind of orthopedic sports-related injuries, so I was no longer doing interventional spine, I was no longer doing EMG they would love for me to have done it, but it wasn't part of my contract. So I didn't want to lose those skills. And the only way I was able to restart that part of my practice is to leave that position. But then obviously, at that point, I was like, Well, you know, I, I wanted to really kind of see how far my practice could go in a private practice model. Because my up until then every I always ran into a lot of barriers actually having a full-blown practice, like, and we're talking like, I was now like, almost five disabused six years into practice, and I never really hit, I never really felt like I hit my stride in the private practice world. And I thought that there was a way that I could make my, my style of medicine work. And I there was only one way to find out. And so that's what kind of drew me out back into private practice, because I started off in private practice, but it was a very specific roles, great practice. But at the same time, I was in a practice where I was only doing spine, I was not seeing hips, knees, you know. And so I felt like there was a whole other part of my practice, straight out of fellowship that that I didn't really get a chance to, to kind of flex those muscles. So brought me back into private practice. 

Dr. Tea  11:44  

You said, you hit some resistance about people not understanding that you don't take insurance. How did you overcome that? Or what were the conversations you had with people about that?

Dr. Fred  11:54  

You know, it's interesting, because, um, I kept a notebook of all my ideas, and I actually went back and I had all these like, kind of phone conversations in my head, like, I was like rehearsing, like, what would I say? So I have like versions of what I used to say. And when I would say now, so you know, a lot of it was like, I was almost trying in 2017 version of myself, I was really just trying to convince people, it's the same, except I don't take insurance. And now I've completely taken a different a different role. It's, it's really different. I'm not trying to sell them the same experience. So kind of my and that's kind of the way I'm approaching it is that like, I'm not trying to give you the same care that you would get over there, I'm trying to give you something completely different. So that's, that's kind of what my I think my evolution has become is that, like, I've been trying to make my practice match what patients have seen. And I realized now that that is completely the wrong approach. In a way, it almost kind of says, like, hey, the standard of care is good. And mine is just as good. But I think anyone in anyone in medicine in general, I think, realizes that the standard of care is not good. You know? And it's, I mean, you ask anyone, you know, even the most successful person that loves where they are, they read, they know that, that the standard of medical, medical care and medical delivery is not great. Anybody would say that. So I've taken the complete opposite. I was like, so that's why I'm doing this is that I'm not trying to provide you with the care with that type of care. I'm trying to give you something different. I think my, I'm not really looking at it as a resistance anymore. Because I think if the way that I'm looking at my pitch now is that if you're happy with your care, perfect, that's good. That's all that I really want. But if you want if you're not happy with your care, and you want something different, then that's where I come into play. So I'm not trying to make insurance, the barrier anymore. I mean, obviously, it's going to be the patient's barrier, but I'm almost trying to not talk about that part of it. In terms of like, is that the only thing we're going to talk about? Because ultimately, I think if if someone is happy with what they're getting, they're not going to be talking to me, you know, so. So I kind of look at it. I'm going to that's how I kind of framed it in my mind. I don't know if patients are going to buy it but but at the same time, I think it changes the conversation. it refocuses it away from the insurance and it really focuses in on what's your what the patient is receiving. Because at that at the end of the day, I just want patients to be happy with their care. If they're happy with what they're getting great. That's all I really that's, that's all that anybody really wants. That's what you want. That's what a physician wants But if you are not happy with your care, or you're looking for a different experience, you know, that's where I come into play.

Dr. Tea  15:06  

Well, I think it goes without saying that a lot of people are unhappy, that they're paying a lot into their insurance. And they're not getting the quality that they thought was there, they thought that they were going to see a doctor who would give them the recommendations. But instead, they're having to fight with insurance on whether or not what the doctor recommends is even covered. And so you hit the nail on the head, we do not offer the same thing as the insurance options are. And unfortunately, patients don't realize that until they are disappointed until they aren't getting what they need. And then they're looking outside of the network for themselves. So they're becoming advocates for themselves, realizing the limitations, and I think my best patients are those who have been through it all. And see how this continuously care is the things that can prevent surgery. It's not covered. Right? That's what people want. So I think the right the niche is a big discussion, the fact that we're not really talking about insurance, is the other big discussion, and we really have to stand out if we're gonna be on the small island of non insurance, we really have to make an appoint that it's not how it's paid, it's what's being given. Right, in our services. what resources did you use to get to the understanding of, you know, how you want to build your business now

Dr. Fred  16:31  

You know, a lot of it was looking at the kind of the DPC Facebook groups. And then also, actually, I don't think that the, the threshold specialty care was even a group when I hadn't initially started. I mean, I'm sure people were out there, but it wasn't really formed. So it's interesting. When I went back, I was like, Oh, these groups weren't here. This would have been nice, you know, the beginning. But, um, I've been looking a lot mainly on on on the Facebook groups and the DPC, the pipe, your podcast, along with some of the other ones have really kind of given me a lot of motivation. In terms of the business side of it. Like, I'm not I, you know, I don't I don't have an MBA, you know, but at the same time I was in the telemedicine business actually gave me at least a structure. So I had an LLC, so I kind of just like, kind of bumped my head along the way and just figure it out. But at the same time, like, I have an accountant, who is actually a tax attorney, as well. So that's also that's also been really helpful in trying to understand how to structure structure, the practice and the business. But let's say for the most part, you know, it's like Facebook, YouTube, you know, all the social media stuff. I think that's really probably the biggest difference between 2017 Me and now is that like, now, I just know that, like, my ideas work, I just know it so 

Dr. Tea  18:04  

yeah, there wasn't a lot of resources. When I started either. I opened my practice in 2018. And same thing, I saw DPC model, I was like, membership. sounds cool. I don't know if I can do it in my specialty, where you're looking at membership services to or you both are fee for service. 

Dr. Fred  18:23  

Yeah. So again, I think in the beginning, I was looking potentially for kind of partly membership, and partly kind of fee for service. And now I'm really focusing on fee for service, at least right now, I haven't really found that something that I feel comfortable charging someone monthly just yet. Initially, I had that I had an idea of trying to market myself towards like, like gyms like CrossFit gyms to just like, you know, basically have me on retainer for a small fee, as a way to kind of like be part of it. But that wasn't really very well received. And especially, I mean, you know, no one kicked me out. But at the same time, like, I'm not a CrossFit guy, like, if anything, I'm really big into jujitsu and the jujitsu community in the CrossFit community are similar in that they all kind of really shy away from any medical care. necessary, so and I just didn't, you know, I think the only way to kind of I think it's still a really good model. I know that there's, I think a DPC doc that has, like a CrossFit is based out of CrossFit or has some sort of profit model, but I'm not part of that community. You know, like, I try that initially looking at opening space, you know, looking for spaces to open a practice in these CrossFit gyms or these local gyms. But you know, at the same time, I just felt like you know, I was really forcing something you know, trying to like I'm just not that guy. You know, I you know, if we do JiuJitsu absolutely, I'll do it all day long, you know, but at the it, it was really kind of kind of challenging to even now to fit a membership model, I'll have to wait and see and see what kind of pans out. I mean, I think that one of the interesting things about being a specialist is like, I haven't a lot of my procedures, I could potentially try to do a membership model, you know, to try and space it out throughout the year. But my inherent my the way practices like I try not to do injections, you know, so it's almost a little counterintuitive like to try and create a membership model where I mean, they can have access to me, but to offer actually a product to them, like, my only product at this point is, you know, my my education, like giving them my education and they're in the procedures. I haven't really gone into like the regenerative medicine, I do retroactive regenerative medicine, but I'm not really in a wellness space and induced other things like that. So I haven't I think for an orthopedic or sports, sports medicine, spine medicine practice, you'd have to kind of offer something along those lines. I'm sure there's other things, but I haven't really found that product that I think a membership model would be would sell. Yeah

Dr. Tea  21:16  

We have a lot of, we have a lot to discuss, because I have some ideas about those, those beliefs. So I do have both options. And the reason why I really love following DPC culture is because when you do find that space that fits a membership, it's recurring revenue. So instead of having to kill people, they leave and you have to continue to regenerate your marketing expenses get higher, you know, when you keep getting new people, just having a slower stream of people turning over. It's not like we're trying to keep them sick. But we're paying attention to people who need long term care, and will give a higher higher level of care because of how deeply our relationship is to people. And so I believe in our spaces, both podiatry and in physiatry, where we're providing a service for people who have pain, who don't want surgery, who want alternative options, there's a potential for it. Not to say that I have the answer for it all. But we can do small packages of membership, we can do a recall campaign where hey, we know that this is a degenerating condition, you know, why don't you come back for follow ups and things like that. So I don't think it's impossible. But I do think we have to explore a lot

Dr. Fred  22:33  

clarify like, I don't think it's an impossible. I think my if you ask me in a year, I'll probably have a different answer. I think, I think meaning that like, I don't know anyone else doing what I'm trying to do. So I don't have anything to compare it to. But I also don't know what my market will bear. And I think that might dictate the first year or two of how I structure how I design the fee structure right now everything is just before service. But I 100% think that there's a population that would benefit from a membership, I just haven't figured out I mean, I have it in my mind. But whether or not that person shows up, that's when I'm still waiting to see I am also the you know, thinking thinking about it a little more. I actually think that the chronic neurologic patients that I that I'm trained on stroke, spinal cord, you know, folks with diabetic neuropathy gait disorders, I think that that is definitely a population for sure that would benefit from membership model that I'm in some I'm actually actually just got off the phone with with someone and I've been having some conversations about how to make that work because it's one of the things that really kind of drives me is like I'm even though I'm a sports, you know, orthopedic kind of person, I've always I'm a physiatrist first so I'm trying to, I see a big gap of, of care in my community for this for these populations. So I'm trying to fill fill that gap with potential, you know, with with a direct care model, I just haven't, you know, I like I said, I think if you asked me about an 18 months, I'll probably have a different answer for you. So I'm sure you know, you know, I'm sure you probably had the same reservations in the beginning. And then in the change once you actually saw

Dr. Tea  24:20  

I was just throwing spaghetti at the wall to see what's what's stuck. And I'm still doing that anything. I think that's a really important lesson to share is that there is no written pathway for our specialties. And there's a lot more specialties that can benefit from this model. And so we are the leading edge we are showing what's possible, but it's not the only way also, when do you plan on opening your brick and mortar

Dr. Fred  24:47  

November 1 this year

Dr. Tea  24:49  

So officially? 

Dr. Fred  24:50  

I mean, quick. Yeah, yeah, that's that's the plan. So I'm trying to finalize a lot of the details. I have a sub lease in hand And, you know, I have the EMR and the phone stuff. So I'm, you know, I'm honestly ready to go, I'm just waiting to get, you know, to finish up with this part of my career and kind of move move on. Because, you know, the thing that was interesting too, you know, if I had, like, my word of advice is like, is, you know, just kind of just do it. At the end of the day, like, I looked at my like, essentially, like my journal of ideas. And I was like, I've had this idea for forever, you know, and one of my big things I always tell my wife was, like, you know, tomorrow can't wait anymore. Like, I just have to go do it, you know, and I just need to figure it out. And it's really what I think has been interesting is that ever since I decided to do it, like, I've had just an explosion of I have different ideas to do, you know, and, you know, not just medicine, like all these ideas outside of medicine. And I think that that is something that I'm sure everybody has experienced that, like, if you're not happy in the traditional medical model, you know, I think it definitely apps, your creativity. And as soon as I decided, it's like, I had a million ideas, like I literally was just like in my journal, and just all sorts of ideas just kind of came out. So now I'm like, trying to organize my ideas, because I have too many of them. But, but yeah, November 1, that the legacy is going to begin.

Dr. Tea  26:28  

So what word of advice do you have for the doctor who's kind of sitting on the fence just observing us versus insurance? What would you advise for them?

Dr. Fred  26:38  

You know, I think I think the best thing to do is, is start to develop an exit strategy, just just for the sake of knowing I think I think in for me, I just didn't see how I could get out. Especially even now, in the current model that I'm in right now. I was I that part was the biggest, one of the things that scared me the most was how if I wanted to leave, how do I do it? You know, and so I started kind of asking questions, talking to lawyers. And, you know, I wasn't trying to like, I basically consulted a lawyer to create an exit strategy for me, like, look at my contract. What does this mean? I don't want any kind of surprises. Because I think most physicians will feel like you're just, you're just stuck, you know, it's too hard to get out. You know, and I think that that's, if you had to start somewhere, just knowing that there were the exit plant where the exit is, and having a plan, I think is the first step. Because I think if you're, you know, it all looks great from the outside, but if you don't know how to get outside, or get, you know, there's just no, there's just no way you're gonna get there. I think that's that's a, that's definitely something that anybody can do. The scary part is is like admitting that you want out, you know, and I think that that is, I think, a different a different animal in and of itself, because I think that I had to figure out that I wasn't happy, you know, with with, I kind of, I kind of knew it, you know, on paper, but like, I came to the realization that I was like, This is not who I want to be, you know, this is not the physician I want to be, you know, this is the father and husband I want to be it was I started to realize that a lot of it served to come home, you know, bringing it home. So I think if you're even looking at them, you're on the Facebook groups, you're poking at it, start at least thinking about an exit strategy. Because as soon as you actually figure it out that that's what you want to do. You're sure you're gonna have to figure out the exit strategy anyway. So you might as well have a plan and not executed or executed. But at least you have a plan. 

Dr. Tea  28:43  

That's really good. I've not heard someone say it that way. Oh, planning for that exit strategy. 

Dr. Fred  28:48  

Yeah. I think it's, it's scary. And you know, it's just like, you know, it's, it's like anything else. It's like, you're admitting to yourself that you want something different. It's easier to say that I can't get out when you when you don't when there's no exit. But the reality is, there always is an exit. And I think that's what I've realized is like, I've been holding myself back, you know, this whole time, you know, and blaming it on the system, but the reality is you sure finances and family and loans and this and that. And I said but at the end of the day is to you. You're the one that has to make the decision. I mean, I fortunately was have been always pretty good with my money and very frugal, paid off my loans ahead ahead of schedule. Because it was part of my exit strategy. To be honest, looking back, I didn't the idea of having a loan and having to, let's say that I wanted to stay get a new job, having to make sure that the next job could pay for my previous loans. I put more pressure on the type of job that I would have to attain. So I kind of explained it to my wife as like, if I just get rid of $2,500 a month, I could take a lower paying job and that feel the stress, you know it versus if I have to constantly Yes, sure, you can hold on to a loan, pay up, you know, low interest rate you're locked in. But if that job does satisfies you, or you end up quitting, or something happens, the next job you get has to match that. And I didn't like that. So I just said, I just paid it all off. And then it kind of just freed me up because, again, I think it was looking back it was, I think, part of my, the exit strategy. I just was like, now you have an exit strategy for my career, but it's just like, What do I don't want something to hold me back, especially since it's like, it's not something tangible, you know, it's, you know, it's not like I was like lugging around like a house with me, it was just this this mental weight of alone, but that mental weight completely affects the kind of jobs I'd be entertaining. You know, like, if I was, you know, throwing out numbers, like if I knew that I entered $1,000, you know, a year to make all my loan payments. But if it's not there, I would entertain a $200,000 job. You know, as long as I've met all my, you know, met everything else, I think that's a little bit hard to accept, because I think as you know, physicians are always looking to make more, but you know, what else like, I've, my wife jokes, me, she says that I'm allergic to money. Because it's like, this is this, by far is like, probably the most lucrative, like position and job that I've ever had. And I'm walking away, because I don't think I've ever been this unhappy. So I think that's, I think that's, that's kind of the way that I've looked at it is like, if you can get rid of your loans, like, I think that's that's a massive weight.

Dr. Tea  31:41  

I hope you're not allergic to money, because that's the we need that to run our business. 

Dr. Fred  31:45  

No, I know, I know. But it's like, you know, because so when I first started mentioning, I think I need to quit. A lot of people said, Well, what's your number? What do you need to retire? Can you just hang in there until you can get that number. And ultimately, like, I just said, I don't think there's enough, there's a number that is going to make this worth it anymore. You know, and I just, I could feel myself burning out. Like I used to tell him I, I have this app on my phone. And it's it's it's a countdown timer countdown timer, to when I'm officially done with medicine, and the fact that it was kind of funny, you know, because I was like, oh, I'll just quit when my, my son is 18 years old. But then now that I'm looking at him, and it was kind of sad, you know, it's like, I was just been waiting, you know, to quit. And so then I just started thinking is like, is the trade off? Or the number worth, you know, another day of unhappiness, another day of not being 100% 150%? of physician? I know it can be? And I think that's, that's a personal answer is like, you know, but I'm not trying to obviously, you know, tell people that their decision is the wrong one. But that's, that was my decision, I just said, I can't be, I can't live like this anymore. It's just like, I know that I'm not burning, I'm burnt out, but I'm pretty damn close. And so I knew at that point, I was like, I have to, I have to have to cut bait, but, you know, I'll kind of share this story, it was kind of, it's what led to me quitting, essentially, or deciding to take charge. So I was so happened that like, I was going on vacation. This is just like a cult, like literally a couple of weeks ago, like we went to, we went on a cruise to Alaska. And I was, you know, on the deck, you know, just looking at enjoying the scenery, and I was I was just flipping through my pictures on my phone. And I literally was like, I don't recognize that person anymore. You know, like, I went back all the way like way, way back, like, you know, high school, college and a high school college all the way through and I was like, I could just see it on my face. I was like, I stopped smiling. You know, my smile on my face look different, like kind of the whole transition. The second thing was my daughter, she's she's 12. And she said, she kept asking me like, are you okay? Are you okay? And she she basically said, like, you don't you don't look good, you know, you look different to me. And that really, that really hit home for me because I was like, I thought I was like, you know, like a duck. Right? You know, just how might you know looking fine on top. But, you know, she could tell and as soon as I as soon as I realized that I you know, I was on the boat and I just I just told him I was like, I'm done. So as soon as we got back I just put in my mind I just get handed in my resignation. So I'm I you know, I think I'm lucky. I saw that, you know, like literally as cheesy as it sounds like looking over the you know, looking at the shoreline just scrolling through an album like then after that. I haven't looked back. It's a very common theme for everybody. It's it's scary, but I mean, I just is like I can't. What's scarier to me? Is living living my life the way? That way? Another day? I just can't do it. All right, I'm not gonna do it, I could do it, but I'm not going to do it.

Dr. Tea  35:12  

Thank you so much for sharing that. It's, you know, first of all, we all need a vacation is what that sounds, we need some perspective. Yeah, I can definitely resonate with that. Burning out, getting toasty and crispy around the edges hating why your family's seeing it as muscling through but in reality, the people who love you see right through you, they know you're hurting, and they're just waiting for you to come back home.

Dr. Fred  35:39  

You know, once I put in my notice, my current employer could have cared less, you know, and obviously, like, you know, like, I think that it's not personal, it's business, I no longer can make them money. So they just need to find someone else to take up my space. And I jokingly said like that, jokingly, it's true, I said, I'm going to tell it to share that they have paid more attention to when am I leaving than when I actually came, there was not as much marketing. In the beginning, I had to pay for all the marketing. And then now that I'm exiting, you know, the, it's like, and it's pretty much they're trying to, I don't want to say they can't wait for me to leave, but they're looking for ways to leverage me leading into an advertising opportunity. And so that was very eye opening. I was like, wow, and I was like, I'm making the right decision. I was like, I can't be part of something. I can't be part of an organization that doesn't that doesn't see the value in me, you know, even quitting. It was there was no, hey, are you okay? You know, what's going on? You know, nothing, it was just like, Okay, well, this is what you need to do. Just a very like, like, Okay, I mean, which, on one side was it was they've been gracious in that sense, like the, you know, just said, Okay, that's it. Um, but then after that, I was like, Okay, that's it. And that's it. There's just that saying, where, like, you know, your work will never love you. Like, it's 100%. True, I would rather much rather spend my time with people that do then that not, you know, so. So that was a good experience for me, because, you know, you hear about it, but I'm like, I'm literally in it right now. It's, I'm just, I'm just, I'm just a cog in the wheel. You know, I've never felt I've never felt that. So even on the days, like, as I'm exiting, I don't know, I don't eat lunch. But I've been leaving. I've been leaving together to get outside. Because I just would rather spend that time like, focusing on you know, building my business and just not being in that kind of energy anymore. It's not worth it so

Dr. Tea  37:49  

I'm so grateful that you're, you're so willing to share what you're going through. I know, it's not been easy. But I'm also really glad that you know, there's something else to look forward to, instead of just working for somebody else who really don't care about the value we bring to the table.

Dr. Fred  38:03  

I think, look, if I could tell my young young physician self coming out, I've always known that I was like, special. And I have really good ideas. And I kind of I always showed my ideas to people say, hey, is this a good idea? And I now and then the telemedicine thing was a real eye opener to me, because I was like, this was an amazing idea that I had, and it only came to fruition when COVID happen. And that's when I was like, Oh, it does work. And the world doesn't want that. So I would say to like that younger self, I was like stop showing people stop asking. If your ideas are good, just do it, you know, on Stop, stop trying to please other people. And I think that maybe that's like the that's just the way I've always been. But that's not the way I'm now I'm like, every time I come up with an idea, I'm like, I'm just doing it. I'm not telling I'm not asking people if it's good. I was like, it's gonna work, it's going to work. It's not it's not. And so, you know, I think anyone on the fence like, it's just, I would just go honestly, I would just exit strategy and start and start planning your idea because especially in the medical field, they're not going to sit back and tell you you have a good idea. And if you have a good idea, they're kind of monetize you first. That's just the way that that's just the business of it. I think more of these conversations need to happen not necessarily like a direct care or direct specialty care model, but it's just like I just think a lot of people need to in medicine just need to hear this conversation whether or not they're happy, you know, happy with it or not because I think it will I think it would really resonate with people so if you're so that's actually one of my my my missions now is like I'm we need to tell the story. I'm going to tell mine I encourage everyone to tell theirs because it's ever since I put in my notice I've had so many of my colleagues say hey, what are you doing? Like oh,

Dr. Tea  39:52  

now you're right. Yeah,

Dr. Fred  39:54  

I mean in and a lot of them are like they're in tough positions like I hear them talk and Just like, yeah, man, like, we gotta we gotta unplug as like that's, that's the only way. 

Dr. Tea  40:05  

Any last words for the listeners today,

Speaker 1  40:08  

Just do it. Just do it exit strategy. I mean, I think honestly, like, even even the employed person that's happy they need an exit strategy like, like how do you retire? Like how do you close a practice? That's literally what I'm still doing right now I think learning how to how to transition and close a practice is like just something we're never trained on, you know, we just kind of assumed that it's always happily ever after. So, you know, I think if you're happy, great, but if you're even thinking about, you know, looking for a different model, have an exit strategy, start developing one.

Dr. Tea  40:43  

Great, thank you so much for your wisdom and your pearls. I look forward to catching up with you one year from now, to see what thanks for your time, Fred, take care. 

Dr. Tea  40:47  

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. Tea  41:14  

And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time.