038 - 7 Things You Should NOT Do as a PCP In Medical Practice - Money Tree Series #9

PCPs play a pivotal role in managing Medicare Advantage panels.  Creating healthy personal and business habits that surround your practice can be the difference between retiring early with financial freedom or working until you can’t physically and emotionally work anymore.  Don’t let the stress of your medical practice tear you down.  Learn how to squash old habits now so you can create a prosperous and stress free practice.  Download the money tree diagram here to visualize the role PCPs play.

Don’t forget that Coach JPMD helps physicians go from overwhelmed to confident while increasing their income in 90 days or less. Book a call using this link to learn how you can decrease your stress and earn more. My goal is to help you to understand the business of medicine so you can Practice Impossible.

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

Coach JPMD  0:00  
I used to think, hey, you know what, I'm not gonna see this doctor in the community because he's my competitor, or he may be taking patients from me. But I learned early on by Dr. Singh actually, who was in our episode on real estate, he taught me a valuable lesson. And that was meeting other primary care doctors in the community and talking to them, gave me an opportunity to learn from them, see what they were doing right, see what they were doing wrong. Sometimes they needed coverage, sometimes they wanted to relate with certain things that I was doing in the practice or in the hospitals. So it's always good to remain relational, especially with your colleagues. Hello out there. Thank you for listening to the Practice Impossible Podcast with your host, Coach JPMD. And that's me. And this week's episode, as promised is on the money tree. And if you've been following, I've been releasing the money tree series every couple of weeks on things that you can do in your Medicare Advantage practice, to generate funds, decrease expenses, and earn a good living while taking care of your patient population. And this week's episode is on seven things that you should not do as a PCP or a primary care provider. So you may have already downloaded the money tree diagram at www.coachjpmd.com/moneytree. But if you haven't do so now, so that you can understand how the primary care provider or the PCP is really centered to what happens in the managed care or Medicare Advantage world. 

So these are the seven things that you should not do as a PCP. So after I've listed out the seven things, I'm going to give you some stories that are pertinent to the seven things as well as things that I wish I could have done differently as well. So number one, don't limit the insurances that you take. Number two, don't refuse to meet other primary care providers in the community. Number three, don't demand the highest salary coming out of residency. Number four, don't act like you know everything. And number five, do your best to not be tempted to buy that fancy car coming out of residency. Number six, do not plan to pay off your student loans in 25 years. And number seven, don't think that there is not enough patients for you to earn a good living with. So that's the seven things. So what do I mean by limiting yourself in the first thing for limiting your insurances that you take when you first start, when I came to this area, I came on an income guarantee. And I needed to make a certain amount of money in order to pay off or at least not accept as much money coming from the hospital system. And so in order to do that, I need to see a lot of patients. But if you need to see a lot of patients, that means that you probably need to market the heck out of your practice, or you need to accept all the insurances that are offered in the area so that you have the biggest opportunity to see a large panel of patients. 

So I accepted all insurances, even insurances that many physicians may not think are lucrative I did that. Also, because I wanted the experience, I wanted to be able to see as many patients as possible. And I remember one doctor, actually Dr. Ran, who was seeing a lot of TRICARE patients, I think TRICARE Prime was the insurance and at the time, and not many providers accepted Tricare prime. So that was an opportunity for me to accept a group of patients that did not have a primary care doctors that accepted that insurance. And it turned out to be really lucrative for me. And I don't want to say lucrative, but it was good for the practice. We may not have made a lot of money on TRICARE Prime, but those patients stuck with me for a long time. And they ended up becoming patients that had Medicare or converted to Medicare Advantage plan. So I say, Take as many insurances as you can, especially when you start off. And then you know, as you get more comfortable as you see more patients as you grow your practice, you may be able to cut back on the interest that you accept, if that's something that you want to do, but initially, don't limit yourself. Number two, don't refuse to see other primary care doctors in the community. I used to think, hey, you know what, I'm not going to see this doctor in the community because he's my competitor or he may be taking patients from me but I learned early on by Dr. Singh actually, who was in our episode on real estate. He taught me a valuable lesson. And that was meeting other primary care doctors in the community and talking to them, giving me an opportunity to learn from them, see what they were doing right see what they were doing wrong.

Sometimes they needed coverage. Sometimes they wanted to relate with certain things that I was doing the in the practice or in the hospitals. So So it's always good to remain relational, especially with your colleagues. I remember, you know, passing some physicians by in the hospital lobbyists, and they wouldn't even say hi to me starting off, and I thought, you know, Hey, what did I do to them, but I really didn't do anything because those physicians weren't relational. But there are other PCPs that I developed very good relationships with, initially in the practice, and many of them that who did not accept certain insurances would send patients to me. And knowing that I was relational I was conversation with them, and I wasn't afraid to meet them, and relate with them. So I think one of the things that you should not do is number two is refuse to meet other primary care providers and, and remain relational with them. Number three, don't demand the highest salary. Now, I know that some physicians out there saying well, I deserve it, I have all these student loans, I need to make as much money as possible. But as a primary care provider in a especially in a managed care setting, you may not see that those funds are that the revenue coming into your practice until you've grown the practice, until you've learned things that you need to learn, especially in managed care, your panels may start off very small. And so you don't want to keep yourself in a deficit or keep yourself in a situation where you're having to see more patients to be able to make the salary that you're making. I say, if I were to do it, again, I would probably take a lower salary, but a pretty hefty bonus structure, I would negotiate a higher bonus structure so that if I do well, then I will take a higher bonus, which would and could actually earn you even more money than if you were to take a high salary, where a practice may have to carry you until you get to a point where you're you're making enough revenue to cover your salary and your overhead. Now, one of the things that is kind of tied into that as if you take a lower salary or you you're not earning as much initially, but you make yourself valuable to the practice, if there's an extra call that you can take if there's an extra overnight call that you can take, if there's a nursing home that you can round in to help the practice, if there's an extra walk in slot or a Saturday walk in clinics is what I used to do. 

And when we first started the practice 20 years ago, you make yourself valuable to the practice, then when you when it's time to negotiate a higher salary. As you grow your practice, it's going to be much easier for your employer to say, hey, you know what, you know, you may not be seeing as many patients but you're providing a value to the practice. And that in turn will help you generate more money than if you want to ask for high salary and not be as valuable to the practice. Now, if any of you have been practicing for more than five seconds, the practice of medicine is a challenging practice. We come out of residency thinking that we know everything, and we really don't know anything, especially on the business of medicine, unless you had an MBA or unless you had a family member that was practicing medicine. So we have to teach our colleagues coming out that they don't know everything. And it's important to be humble. I think that's one of the things that I think physicians need to, to consider is to learn from others and to put others ahead of themselves so that they can not only be better practitioners, I think, but it also invites other people to help you if you come out thinking that you know everything and why would if another physician want to help you. So don't act like you know, everything is number four. Number five, and this may may be controversial, but I'm gonna say don't buy that fancy car when you just come out of residency. You got to avoid that. Unfortunately, I did it. I don't know if ever you guys know the the movie The St. With Val Kilmer. And in that movie, I can't remember where that movie came out. I may put it in the show notes so I can remember it. But if outcome one was driving a Volvo C 72 door, there was a two door hardtop I think it was. And after seeing that movie, I think I was in third or fourth year residency, I said I need that car when I graduate. And I end up getting that car. And now I was somewhat smart and I bought it used but it was still expensive and I had a payment on it. And it was just something I should not have done knowing that I owed over 150,000 $200,000 in medical school debt. Buying a Volvo C 70 and Val Kilmer drove was not the smartest idea. And I know that many do it. I know that many people buy even more expensive cars. But I I really strongly recommend that. 

Wait, wait three years don't have Doctor it is where you feel like you're you deserve to have that fancy car or that beautiful house and because if I were to If I would have paid off my debt within three to five years, which is number six, then I would have had the opportunity to buy to see seven days. Not that I think I would want to see seven days. But it's just something that I think physicians need to be encouraged that they can have and will have the opportunity to buy just about anything that they want, based on the income that can be generated from their practice, especially during any Medicare Advantage, practice. So number five, don't buy that fancy car when you come out of residency. That's just something that you shouldn't do as a PCP. But anyway, number six, don't plan to pay off your student loans in 25 years, that was something else I did, it took me over 20 years to pay off my student loans, all the while buying housing houses and flipping them in the early 2000s. And thinking that I was going to be a real estate mogul. So I said, I don't need to pay off those student loans. Because you know, I can I can make 10-20% interest on on investments. So my suggestion is that we don't hold on to those debts for 25 years, get them paid off as quickly as you can, so that you have the freedom and the ability to do more with your income and invest more and really live Freer without debt. And so number seven, the number seven thing that you should not do is think that there is not enough patients to go around. Now, what do I mean by that? Well, I remember Dr. Singh once told me that there is no dearth of patients, that you don't need to have 3000 patients on an insurance panel or in your practice battle. Because I can show you and I have shown you in the Llama course that you can make a fairly good income with about 400 patients 400, Medicare, Medicare Advantage lives, that will be more than enough for you. 

So yes, could you do more with 3000? Sure. But then you have to understand what your lifestyle is going to look like, you have to understand the overhead that's going to cost to manage those three 3000 patients. And knowing how I grew my practice, knowing how I was able to manage the panel of patients that I've had, and that I continue to have. If you do a good job in a community, and you partner with your PCPs. And you, you're humble and you do some of these other things that that I suggested in this in this episode, then you will have enough patience, I promise you that. And I don't like promising because you can't really promise but but if you do certain things. And if you understand the business of medicine, and if you understand how to, to relate with your patients and relate with other colleagues, then those 400 patient population is really nothing for you to have. And the beauty of managed care in this day and age is that if you manage it, well, you can also sell your practice in 5-10 years from now, for a very good sum of money. I know a primary care doctor in the in the recent past that I believe sold their practice for 10, time multiple. So whatever their revenue was, they sold it for 10 times more than what that revenue per year was. And there are different formulas of selling your practice. But managed care practices are being bought up by private equity firms. Not to say that that's what we're going to do, or that's what I'm suggesting. But that is a that is a way of practicing impossible, alright, because if you want to build a practice and you want to do it, well, you want to manage your patient population well, and you keep your patients out of the hospital, then you have the opportunity of caring for a population of patients that will be loyal to you that will stick with you and will follow your direction. And you have the opportunity to sell the practice if you want to sell the practice in the future. And then this is different than a fee for service practice, because most fee for service practices cannot command such a high multiple, and an exit strategy. So that's it. So those are the seven things that I don't want any of you guys out there doing. I want you guys to practice impossible. And just to recap some of these things. I'm gonna go through my notes here real quick and say, number one, don't limit the insurances that you take. Number two, don't refuse to meet other primary care providers. 

In other words, be relational. Talk to them, learn from them. Number three, don't demand the highest salary coming out. Show your value show your worth. Make more in bonuses. That's I think the way to go. Number four, don't act like you know everything. Be humble. Number five, as tempting as it is making double, triple what you make In residency and fellowship, don't buy that fancy car, wait, pay off your debt as quickly as possible, at least number six, of course, don't plan to pay your student loans off over 20 years for 25 years. And last but not least, there is enough patience for you out there. Especially if you can manage them. Well, you can do so very well with 400 Managed Care lives. And I can show you that book a call with me, there will be links at the bottom of the show notes, as well as you know, take the course, the llama course learn about Medicare advantage.com is the website. And I think you'll learn lots of information there. So leave some feedback, share this episode with your friends. And hopefully, you won't do these things that some of which I did early on in my career and it will accelerate your growth and help you practice impossible. Thanks for listening. Thanks for sharing. I'll see you in two weeks.

Transcribed by https://otter.ai