Med School Minutes

Med School Minutes- Ep. 42- Maximizing Physician Salaries: Expert Tips from Ethan Nkana

• Kaushik Guha

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Welcome to another episode of the Med School Minutes podcast by Saint James School of Medicine! In this episode, the host Kashik Guha sits down with Ethan Nkana, a specialist in physician contract negotiations, to uncover the secrets to maximizing doctor salaries. Ethan, the founder of Rocky Mountain Physician Agency, shares invaluable insights into the disparities in physician compensation, particularly affecting women and minority doctors.

Learn how Ethan helps rookie and seasoned physicians negotiate better contracts, achieve fair pay, and gain more time with their families and patients. Discover the importance of having multiple job offers and how doctors can use this leverage to secure better deals.

0:00 - Introduction to Med School Minutes
0:35 - Welcoming Ethan Nkana
1:20 - Overview of Physician Contract Negotiation
2:45 - Ethan's Background and Inspiration
3:50 - The Role of a Physician Agent
5:10 - Addressing Misconceptions About Doctor Salaries
7:00 - The Business of Medicine
9:30 - The Importance of Fair Pay for Doctors
11:15 - Ethan's Journey in Hospital Administration
13:00 - Founding Rocky Mountain Physician Agency
15:00 - How Doctors Can Benefit from Contract Negotiations
17:10 - The Power of Multiple Job Offers
19:00 - Helping Rookie Doctors Navigate Job Offers
21:15 - Addressing Salary Inequality Among Physicians
23:20 - Understanding the Market Value for Doctors
26:00 - Strategies for Negotiating Better Contracts
29:45 - Ethan's Unique Approach to Doctor Advocacy
32:30 - The Impact of Fair Compensation on Doctor Well-being
35:00 - Closing Remarks and Contact Information
36:00 - Conclusion and Call to Action

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Speaker 1:

Hello and welcome to another episode of the Med School Minutes podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St James School of Medicine. Here is your host, kaushik Guha.

Speaker 2:

Thank you so much for joining another episode of Med School Minutes where we talk about everything MD related, with the focus on international students, specifically students from the Caribbean. Today we have a very interesting guest, and this podcast is not just pertaining to IMGs or international students. This actually pertains to any physician. We have a very special guest who actually does the negotiation for higher contracts for physicians. This is not residency, mind you, but this is a post-residency negotiation. So a rookie doctor, a seasoned physician, seasoned surgeons this particular person has founded a company that helps physicians maximize their net worth or maximize their salaries, and we're going to have a very interesting conversation with him and I really hope that our viewers, our alumni we have nearly 800 practicing physicians in the US and Canada.

Speaker 2:

I hope you guys tune in and take advantage of this, because this is something that we've talked about internally but again, it's kind of out of our purview because most of our students are gone by then. But once you become a physician, apparently there's a lot of disparity in pay, and this is what Ethan Inkana and his's pay by up to 30 to 40 percent. So, anyway, have a listen and I hope you really find this podcast helpful, ethan. Well, thank you so much for joining us on our podcast, med School Minutes. Podcast Med School Minutes. I just wanted to you know. I saw your background and you're such an interesting person, generally speaking and even in the field that you're working. I think our students and not just our students, but our general audience and medical students absolutely need to know about the kind of work that you do. So can you give us a little bit about yourself and then your company and what it is you actually do?

Speaker 3:

Yeah, first and foremost, thank you for having me. I am delighted to be here. I think the most important thing about my background is that my mom is a doctor.

Speaker 2:

Okay.

Speaker 3:

So this business, to me, is more than just a business. It's my way of honoring her as a physician and, you know, kind of leaving my imprint on medicine in a way that I couldn't intellectually by being a doctor. And so the work that I do most basically is very similar to like a talent agent for a movie star or a professional athlete. I represent doctors in contract negotiations, surgeons, surgical groups, and I help them get more time with their patients, more time with their families, better support in their practices so that they can perform care at the highest level, and then, lastly, fair pay for their work.

Speaker 2:

Okay, and why do you think that that's needed? I mean because you know the general impression is that doctors make buku bucks. Like you know, they graduate from med school. And then the salaries that like at least, if social media is any indicator, you're looking at nearing seven-figure salaries. Why would somebody need you for that?

Speaker 3:

though. That's a fabulous question, and I often have to explain to people outside of medicine that while doctors make buku bucks, they have buku debt right, and so that six figures for most doctors in America. They have six figures of student loan debt that they need to work off or pay down. Or you have other doctors who have other obligations that need to be met after graduating. I have a client right now with a J-1 visa, and so there's certain accommodations that she has to make for her practice. So it's not just that doctors need to be paid more, it's the fact that doctors are not paid fairly, and that's most evident when you get into the pay gaps that are well-pub published between women physicians as well as physicians of color.

Speaker 2:

Okay, so unpack that for me a little bit. What do you mean by doctors are not paid fairly? Because from the standpoint of most average earners, where in the United States, I think, the per capita income is $45,000 or $48,000, something like between less than 50,000. How, why would you say that a doctor making so much money is not paid fairly?

Speaker 3:

For two primary reasons. When I was in hospital administration, one of my jobs was to quantify how valuable a doctor is to our hospital. Okay, and sometimes people will say, well, you work for a for-profit. Nope, I only work for nonprofit, faith-based institutions and I knew down to the dollar how much revenue Dr Smith made for us. Here's where doctors often are not aware of the numbers of the economics of hospitals.

Speaker 3:

As a hospital, I'm going to make $1 million plus minimum off of the effort of a doctor on an annual basis. What I pay the doctor is the expense side of that. So the gap as a business person, person, that gap is what I call my roi, or return on investment. So while doctors get into medicine to care for patients, to do no harm, to cure illnesses, I as a healthcare executive got into medicine for different reasons, for different reasons, and so doctors get caught in the crosshairs of. Medicine is a business and the more money I can make off of a doctor, the more money that goes into my pocket and the more money that goes into our shareholders pocket. So what doctors are often missing is that, yes, you're making 300, 400, 500,000. But what you don't know is how much I'm making as a hospital, off of that effort, which is usually five, six, seven, x what you're being paid. Okay.

Speaker 2:

And do you have internally, from your experience, a particular benchmark? That might be this is fair, or this and above, or this and below is fair. So if it would you say 2x is fair or 3x is fair or, you know, 5x, do you have a certain benchmark or does it vary from region to region, geography to geography?

Speaker 3:

region to region, geography to geography yes, that's a fabulous question and it does vary geographically. But we do use a statistical benchmark which is the gold standard in the United States, which is MGMA, the Medical Group Management Association.

Speaker 3:

So, we rely on that data to tell us what is the 10th all the way up to the 90th percentile of doctors within that certain specialty. And then, of course, you adjust for your care setting. You adjust for how busy you are and maybe you take some leadership responsibilities, but what that does is it helps us get a market value for that doctor's skill set and training. And as you progress as a physician, you become busier, more proficient, which happens really quickly. You should also be paid accordingly, and I think the important thing to call out here is I've talked to doctors who are five, six years into their careers and are still being paid the same as they were their first year. Wow, are your expenses the same?

Speaker 2:

Wow, Are you?

Speaker 3:

still performing at a rookie level six years out. No, you're contributing way more, and it's important that your compensation is commensurate with your efforts and contribution.

Speaker 2:

Okay, so before we dive more into this compensation part, okay, so before we dive more into this compensation part, I really would like our viewers to know exactly how you became an authority in this particular field. So why don't you tell us a little bit about your background and what it is you do, and how do you do what you do?

Speaker 3:

Yeah, that's a great question. This is the only thing I've ever done in my career. So when my mom doing that, I was working on the executive side of hospitals, finance operations, physician contracting. So I was the guy. When Dr Smith comes into the CEO's office and says, hey, ms CEO, I would like to make more money, I was the one next to the CEO saying, well, here's how much Dr Smith makes us and here's how busy they are and all the analytics. So I knew what my CEO would say to a doctor before they even said it. And now I use that to doctor's advantage to say, look, here's what they're going to tell you. It's a standard contract, we don't have the budget, blah, blah, blah. Those are all things that I said. And eventually, because doctors don't have any training or preparation for contracts, they just believe it and they think that we're all in medicine for the same reasons.

Speaker 2:

But what we?

Speaker 3:

don't fully appreciate and embrace is medicine is a business and my revenue has to exceed expenses in order for my business to remain in operation.

Speaker 2:

Okay, and you know. So how many years have you been doing this from the hospital side?

Speaker 3:

So I spent 15 years working as a hospital executive Wow, so it was literally my first job out of college. I was an intern in a hospital HR department, so I was doing all the onboarding of nurses and staff progressively grew in my leadership responsibility. I wanted to be a hospital CEO. That's why I went to law school. I didn't go to law school to become an attorney. I went to law school because I wanted to become a CEO and I felt as though that would be a good skillset to kind of help lead a hospital work with doctors.

Speaker 3:

What I didn't appreciate, speaking of the business of medicine, is I got laid off in 2019. And in that moment of just complete loss professionally, I had this question why don't doctors have agents like professional athletes? And that question spiraled into. Now, four years later, I've represented over 50 doctors in contract negotiations with their employers and spoiler alert, we get them. Like you were saying before, we were recording $50,000, $60,000, $70,000, and even, in some cases, almost $200,000 per year increased compensation, and so it begs the question not well, how good are we that we can do that? How do we do that?

Speaker 3:

That question's ancillary why do hospitals have that money to pay in the first place. If you couldn't give me a pay raise six months ago, why can you now pay me $186,000 more? Because Ethan's in the room? What's the difference now? And so it demonstrates that doctors are so focused and tied to the Hippocratic oath that a lot of times they end up suffering because they don't want to take away from their focus on patients by having to go to another job or ask for a pay raise. So I encourage doctors when you are happy and fulfilled, your patients get the best version of you, and that's what they deserve. Okay.

Speaker 2:

So you, obviously, after undergrad you went to law school and then you got an MBA. So, Ethan, I have to say this I don't think you weren't smart enough to be a doctor. With all those degrees, I genuinely think you're probably just as smart, if not smarter than, any physician I've met and I've dealt with a ton of them. And then after that, you move to Colorado. Is that right?

Speaker 3:

Yeah, so now we're based out of Denver. I lived here with my wife. We got married about six months ago.

Speaker 1:

Oh, congratulations. Yeah, thank you.

Speaker 3:

So we have two old dogs. Usually one of them is in here hanging out with me for a podcast, but not today. But I've lived in Denver for 11 years. We serve doctors nationally, so it just so happens that this weekend I'll be in the mountains doing education for the National Medical Association on how black doctors can be successful in the business of medicine.

Speaker 2:

Awesome and generally speaking, you basically moved and then you started a company. Is that right?

Speaker 3:

You know, it didn't happen quite like that. So I lived here for about six or seven years, got laid off, and that was when I started to have this crisis of conscience like what do I even want to be when I grow up if I'm not going to be a hospital CEO? And then that's when so I'd say probably 2019, about five years ago I had the idea, and then over the last four years, literally, when the pandemic brought us all to working from home, that was about the time was July 2020, where I officially launched, and then three months, four months later, I quit my job and said I'm going to give this thing my full-time effort.

Speaker 2:

Oh, that's amazing. So, um, and what? And it's called. Can you tell us the name?

Speaker 3:

Yeah, it's Rocky mountain physician agency, okay. Yeah, the reason I chose that is because we're based. I have loved denver, right the rocky mountain region of the united states, and I wanted to also bring in this idea of agency, like actors and athletes, which is why included the physician agency piece okay, um, and generally speaking, so.

Speaker 2:

So it's almost a happy coincidence that Denver, if I'm not mistaken, is the healthiest city in the United States, isn't it? We're up there. We're usually more about the hospital or the doctor compensation field. So the reason I ask this is because, as you know, we're a school, we're one of the oldest Caribbean medical schools, we're the largest family-owned Caribbean medical school and we have over 800, or almost 800, practicing physicians right now, and we get this a lot, this question a lot. Hey, compensation, you know, med school? Because we don't. I mean, we don't have a business course, we don't have a negotiations course. What we are recently introducing is a networking course.

Speaker 2:

Not a course, but like a seminar, where students come and we're trying to help them network, because some of our older physicians or older alum have come and said you know what? We met some of your kids and they don't know how to talk.

Speaker 2:

They don't know how to do all of this. So obviously you know, I mean negotiations is obviously a skill. Now, when a student finishes residency, residency is kind of set in stone, right. That's where you won't be able to come and make much of a difference there, because this is coming from the government. Post-residency, I've heard a lot of our physicians come and say you know what? I didn't have any room for negotiation. When would a physician actually engage you? Or when should they engage somebody like you?

Speaker 3:

The moment you are thinking about your job after training is when you should call me Okay. The reason for that is because I can give you the roadmap. I can say you don't have to work with me, but here's exactly what you should expect and how you can prepare yourself for success. You should expect and how you can prepare yourself for success. I think you brought up a really good point where a lot of rookie doctors will go into their first job and say well, I'm making $200,000. That's way more than I made as a resident. How could I say no my first job? I went from making $12 an hour as an intern to $60,000. I didn't negotiate. That was an ungodly amount of money to me.

Speaker 3:

But now that I have a little more skill in this space, I understand that it's not a matter of well. I need to ask for more, to be aggressive. It's the market is a certain number for your skillset and you need to make sure that you're paid fairly for your work. So for rookie doctors, there's one key that will help you get what you deserve in your first contract and it's getting multiple job offers. I don't care if you have J1. I don't care if you have to work for an FQHC underserved. You need to get more than one job offer. That way you have the ability to walk away from the offer, which is a superpower in contract negotiation.

Speaker 3:

But I tell everyone, my clients, even my experienced orthopedic surgeons, who I'm talking to here in about 20 minutes. I tell every one of those clients if you go into your employer and ask for more money, better schedule, more support, you will not get it. I'm just going to spoil it for you. You're not going to get it If you have a competing offer. Now you have leverage. I don't care how good of a doctor you are, I work with the best. None of them can walk into their boss's office and ask for a salary raise and get it without having a competing offer. So for rookie docs, gotta have multiple offers in order to have leverage and make changes so I I'm going to be honest.

Speaker 2:

A lot of our physicians during residency aren't looking for multiple jobs. They're like, okay, I'm finishing residency here, I probably am going to work here, and that's kind of an understanding that they have with their program director. Program director is very happy and again they get one offer. Can you help such rookie docs get multiple offers even?

Speaker 3:

help such rookie docs get multiple offers, even Absolutely. We work with doctors in kind of one of two phases. Some doctors bring us offers and say we want you to help review, analyze and negotiate these for us from behind the scenes or your employer doesn't see us. And then other doctors say so when they call us up front. They say we want your expertise in identifying opportunities that fit in, helping me find job offers, opportunities, create leverage and then in turn negotiate those opportunities for the most value to the doctor. And also it's not just the St James thing. I've talked to the University of Michigan, at Stanford, all of these training programs, and it's not unique to you.

Speaker 3:

Every doctor is coming out of training with this, this feeling of like I'm exhausted. It's, I often say, your contract is like the last 0.2 miles of a marathon. You run the 26 miles and then you're ready to cross through the tape. A lot of doctors just collapse and say I'm not going to go the last 0.2 and cross the tape by getting multiple offers, by negotiating those offers. It is like giving up on the last 0.2 miles to not negotiate your offer and find multiple job offers because you've spent how many years and hundreds of thousands of dollars and hours on your education. And now the last point two you're going to phone it in yeah, wow, you know, I mean you.

Speaker 2:

You bring this up. This is a very interesting point because we've had a couple of residents who, post residency, have matched into big university hospitals in Chicago, you know, there are two massively dominant medical universities and then there's another one that has a huge hospital associated with it and it is funny because these hospitals pay notoriously low amounts, like I'm talking about. As much as you know, a post-MBA 22, 23-year-old will probably make in an entry-level consulting job that low and for that situation, and you know, when we talk to the students, they're like and I was like you know, that's really really low. I mean again students they're like, oh, and I was like you know that's really really low. I mean, again, I don't really study the market like you do, but I have a general idea how much a hospitalist should make because we place students across the globe uh, not just in the united states. We have students who've gone to the caribbean, like the cayman islands even, and they're working there and they're making a lot of money.

Speaker 2:

These other smaller economies are actually paying more than these big university hospitals and these students are like well, or I shouldn't say students, but these physicians are like well, you know? I mean, I don't know, it's a big name I can work there for a couple of years and then I'll just move and probably go somewhere else. What would you say to a physician like that?

Speaker 3:

I don't think it's an either or situation. So a lot of times what happens is doctors suffer in silence.

Speaker 2:

Okay.

Speaker 3:

Doctors may be frustrated and you don't talk to somebody about it. They're fortunate to have you, but a lot of times doctors aren't talking to anyone about the fact that I know I'm underpaid, but I'm underpaid because I love my patients, I love my work, I love this population and I often share that. Doctors sometimes feel tension between doing good doing the good work you do and doing well. Okay, and it's okay to do both. It's okay to do good and do well. So In that situation, lock arms with your fellow doctors. Talk about your salary at work. Someone in the room is going to raise their hand Hopefully it's not you, but someone in the room is going to raise their hand and say wait, that's not fair. Why is everyone else paid that way and I'm not? Lock arms together. It's like when I was a kid growing up, there was the Power Rangers and they would all come together and bring their powers together. That's how it is. When doctors lock arms together, it is impossible I can tell you from experience on the hospital side it is impossible to ignore a group of doctors. That magic number is usually between three and four doctors. When you lock arms together, I guarantee you you can do amazing things.

Speaker 3:

But you come in one-on-one and say hey, ethan, I'm frustrated with my salary. Can I get a salary raise? Oh, dr Smith, you know, it's just not in the budget. Maybe next year. And, by the way, I actually need you to see patients more quickly, so those 15 minute appointments need to be 12.

Speaker 3:

And did you go on vacation last month because it looks like your rvs were a little low? So they're gonna. Not only are you gonna say I deserve more, they're gonna flip it on you and try to make you have even less. So I guarantee you medicine is a business and once you're in it, you understand it. It's the rookie doctors, I think, that have this idealized version of what being a doctor is Not fully understanding the context that you're walking into. So I want you to have all the energy and time to focus on what you do best, which is caring for patients, and my job is to help alleviate the stress of being paid fairly, having a schedule that you enjoy, that honors your lifestyle goals and that allows you to spend time with the people that you care most about.

Speaker 2:

Okay, and so that means, essentially, even rookie doctors have a scope for negotiation, generally speaking, because, I'm going to be honest, most of our rookie doctors don't. I mean, they just don't. They're like oh, I got an offer, look at me, I'm so great, I'm making a lot of money, I'm happy, that's it. But one thing I did want to touch upon was something that you pointed out is that we've also noticed that in the last decade at least, physician salaries haven't changed, at least beginning physician salaries. I mean, is that true or false in your opinion, since you've seen this from the other end, you've seen this from the other?

Speaker 3:

end. The gap between cost of living and physician salaries gets wider and wider and wider, wow.

Speaker 2:

And I know, when we were talking about this, you actually mentioned that there is a lot of disparity and unfairness in doctor's compensation, even within physician groups. Can you elaborate on that a little bit more?

Speaker 3:

This is not my opinion. If you go to Medscape Merritt Hawkins, this data is publicly available. I have distilled it down into what I think are some key highlights. I have distilled it down into what I think are some key highlights, but often when I post some of these findings, people will try to rationalize Well, that's because of irrelevant reasons and my belief is that, for whatever reasons these disparities exist, my role is resolving them. So I often stay out of the academics of like well, why does this exist and what are the rationale?

Speaker 3:

The numbers are generalist positions where women, on average, are going to make about $60,000 less than their male counterparts. So from a percentage perspective, that's about 25%, and that's from Medscape's 2022 report. They just published on their latest report about a week and a half ago. The same goes for doctors of color. So if you are a black doctor speaking of the doctors, I'm going to educate this weekend with the National Medical Association the average salary for all doctors is $339,000. The average salary for white doctors $346,000. So it's above the national average. Now, when you go to black doctors, who are the lowest among all minority groups reported, they make $313,000. So that's about $26,000 less on average than all doctors across the board, wow, wow.

Speaker 3:

Yeah same work, right?

Speaker 2:

So if you and I were in your past life, if you and I were economists, sitting in cubicles next to each other and I was paid less than you for the same work, I would be frustrated by that, yeah, I don't even think a lot of people know that, because when I talk to our students, the light at the end of their tunnel is getting a residency residency and at the residency I don't even think like because I keep hearing this on a regular basis that once I'm into residency it's utopia for us. Like everybody's equal, there are pretty standard salaries across the board, but what I'm hearing from you is that's totally not the case and even after finishing residency for, uh, seasoned professional, there still might be inequalities that exist. That's pretty amazing. So, as you know your services, how much does it cost the physician to hire somebody like you?

Speaker 3:

cost the physician to hire somebody like you. What I started out with when I initially started the business is I wanted for doctors to not have to worry about paying us, and so we've done two things to make the payment completely painless. One instead of charging doctors a flat fee, painless One. Instead of charging doctors a flat fee, our fee is tied to their compensation. Okay, so our fee is a percentage of the doctor's base salary, so that way they know that we're incentivized to help make them more money. Okay. Secondarily, we negotiate our fee into the doctor's contract.

Speaker 3:

So, we just had a general surgeon who signed her first contract. Her salary caused us to have a fee of about $15,000. And then what we did is we negotiated a $50,000 5-0 signing bonus into her contract. She's part of that to pay us, and then the rest of it goes to her and we also make her way more money than those initial offers.

Speaker 3:

So, one, we want to increase your salary and then, two, we get a signing bonus that's nice and big, so it covers our fee, so you don't have to worry about how we get paid.

Speaker 2:

Wow, that's pretty awesome. So one thing I did want to cover is that you know, as you mentioned there's, you should be armed with multiple offers, right, that makes your job easier. That makes the physician a lot more desirable, so to speak, to the employer. However, you know, we've heard about locums. I've heard about locums, but a lot of our students don't have no idea what locums is. Do you think getting a locums offer would constitute a second offer, so to speak, because locums offers are relatively easy to get? Again, I don't know if this is true or not. Maybe you can shed some light on that.

Speaker 3:

Yeah, that's a really interesting question. I tend to think of locums as an alternative or a supplement to a doctor's job full-time job. So mainly the doctors that I've encountered who work with locums are doing one of two things Either they are moonlighting, so I'm doing locums in addition to my full-time gig. So, as an easy example, hospitalists tend to have a seven on, seven off schedule, so I'll have some hospitalists who will use that seven off as some time for locums, so it will supplement their full-time employment.

Speaker 3:

I have others who say I'm burned out of being an employee. I don't like how much control they have. I want an alternative to working full-time for this one conglomerate employer, and so doctors will go work locums because they have more control over their earning potential. They have more control over their schedule, where they work, when they work, and in those situations the primary considerations would be you need to understand your pay, your taxes, your benefits, because you're a contractor. Now there's a few different things to consider, but I often say locums is a good supplement to your main gig as a side hustle, or it's a good alternative for doctors who are just not really enthusiastic about where they are now and maybe want to consider a different opportunity.

Speaker 2:

Okay. So would you consider locums to be another job offer, so to speak? If somebody gets a locums offer, can they go back to their principal employer and say hey, I got locums. If I do this for the stipulated time, or if I were to do this full time, I'm actually making more, so I'm going to leave. Do you think that that's a possibility?

Speaker 3:

I'm going to leave. Do you think that that's a possibility? Absolutely. I think your ability to walk away as a physician really is your power in a contract negotiation. Now here's the nuance that I would include in that statement is I always encourage my doctors if you were going to negotiate, you can only negotiate with offers you would accept.

Speaker 3:

So just as an easy example, I had a neurosurgeon who was looking in California and Texas and then, out of the blue, he had a buddy reach out who had an opportunity in Oklahoma, and he said oh, ethan, can I now use the Oklahoma offer to negotiate against the California offer? And I said unless you would accept the Oklahoma offer, do not include it in your negotiation. The reason for that is because it's this idea that if you bring it into the conversation, you must be willing to accept it, because the employer that you're negotiating with may say, oh, okay, cool, well, good luck, all the best. I think there is this irrational fear that doctor's offers will get pulled. I've never seen that happen. I'm sure it does happen, but it doesn't happen because a doctor is asking for reasonable updates to the employment contract. That's not why offers get pulled, and so I often say if you're going to use a second offer, locums could be that you must be willing to accept that offer in order to use it with leverage.

Speaker 2:

I think that makes complete sense. I mean, you know, if you're making a power play, you need to be able to live with the consequences, so to speak. I think that makes complete sense, all right, well, I mean, I think that you know the services that you're providing. I'm going to be very honest with you I've never heard anybody really provide the services that you're providing. This is a very unique area. I know a lot of people who are working for companies that do like a staffing agency for physicians, that do locums and not just locums but full-time. But what you're doing is completely different. I mean, you know, is this a very competitive field that you're in, or is this a completely niche that you're creating right now?

Speaker 3:

There are a ton of contract attorneys and companies that say we do contract reviews. I think that has done a disservice to physicians, because it's the same as going to the doctor for a diagnosis. You go in, they tell you you've got 16 things wrong with you. Okay, well, how do I fix them? Well, we don't do that. We just point out the things that are wrong. We are really focused on one making sure we identify the things that are wrong, the diagnosis, but also the treatment. So how can we get you paid fairly? How can we get you a schedule that honors your lifestyle goals? And we're not just going to say, well, cool, good luck on those offers, we're going to go get those for you. So I don't believe there's anybody else doing what we do. But I also think that doctors have been so accustomed to these contract review factories that just churn and burn oh, it looks good, dr Smith, nothing illegal, you're good to sign. Now Dr Smith's underpaid by $50,000, and they don't even know it.

Speaker 2:

Wow, I mean, you know, ethan, again, you said this before that you kept saying that you're not smart enough to be a physician. I completely disagree with that. I I mean you, literally single-handedly are creating a brand new industry and I think that's needed because you know doctors, at the end of the day, I want them to be uh, paid, uh, you know fairly, because I want a happy physician looking at me and my family, because, at the end of the day, there are very few professions that is life and death and physicians are definitely that. I always have the notion that there are four major civilization building professions, and it's teachers, it's farmers, it's engineers and it's doctors. Unfortunately, it's not like consultants or lawyers.

Speaker 3:

Lawyers will have something to say about that, that's for sure.

Speaker 2:

Probably, but I'm just saying like if there was a zombie apocalypse, you would be-.

Speaker 3:

I think that's spot on. I think, it's spot on Lawyers, I think often overestimate how important we are.

Speaker 2:

So, but I think that the service that physicians are providing and I do also think that the way you know, the hours, hours are crazy for physicians nowadays because of the rigor, and you know a lot of we keep hearing this again. We're we're a school, right, so we keep talking to students on a regular basis and they said that you know what the juice is really not worth the squeeze. I can get a CPA and make probably just as much as a physician. Probably in one fourth of the time a physician makes Same thing with law. To a certain extent, why would I want to be a physician? And that's why we have this crazy acute shortage of physicians.

Speaker 2:

And you know, the laws aren't changing as quickly as they should and you know, to a certain extent, I hope and I wish physicians get paid competitively so that some of the political scenarios that are playing out in today's world can be averted and prevented, because physicians will have the time and the energy to raise their voice to make sure that we are going in the right direction.

Speaker 2:

And I think the role that you're playing in the big picture of things is amazing and it's remarkable. So you know, thank you for doing what you're doing what I would like to do, ethan, is that, as I said, we have a pretty big alumni base. I'd like to share your information, if that's okay, with our physicians we have in our alumni directory, as well as our current physicians who have just matched into residency. Just stay in touch with you to get some advice and then you know, possibly at some point if you wouldn't mind doing a webinar for some of our alumni and see if they can benefit from your services, because I can tell you this much that they are not getting, in my opinion, competitive salaries that they should be getting. I agree, yeah.

Speaker 3:

First and foremost, let's keep the conversation going about that webinar. I will be more than happy to make myself available, because that education piece is just so important for doctors to know. One that you do deserve better. And two, how do I go get that for myself?

Speaker 2:

I would love to support, right, awesome. But, ethan, again, thank you so much for being on our show. I know you have an appointment in about 10 minutes, if I'm not mistaken. Yeah, it's coming up here. Thank you so much, ethan, for wonderful insights. There were so many things I just really didn't know about the economics of physician compensation and I really appreciate you shedding some light on that. Again, I truly hope that our alumnus or our alumni have found this particular podcast helpful and I hope they reach out to Ethan in Ghana for his services. But again, if you like the content of this podcast, please give us a like, follow and share, download more episodes of our podcast on any of the platforms that you prefer, and remember there's never a shortcut to becoming an MD.

Speaker 1:

Thank you so much for tuning into our show. We hope you enjoyed another episode of Med School Minutes. If you like our content, please follow us and receive notification when a new show is posted. This podcast is brought to you by St James School of Medicine. For a video version of this podcast, please check us out on sjsmorg slash video.