Dr. Pamela Wible, MD- How to Break Free of the Machine and Run an Incredible, Profitable, & Prosperous Practice

This podcast features an interview with Dr. Pamela Wible.

I’ve been working on networking with other authors and experts who can speak to the issues that physicians face every day.

For example, what can physicians do to become financially free and truly enjoy their job? How can they look forward to going to work every day? 

That’s why I thought I’d bring a special guest to the podcast, Dr. Pamela Wible.

Pamela Wible, MD, is a family physician and pioneer in the ideal medical care movement. In 2004, Dr. Wible left assembly-line medicine and held town hall meetings where she invited citizens to design their own ideal clinic. Open since 2005,  Dr. Wible’s innovative practice has inspired physicians to create ideal clinics nationwide.

This interview reveals the following:

– How she started up & maintains a simple, yet highly profitable (90%!) margin practice

– The secrets to systematizing & automating a practice (Including revealing the billing tool she uses)

– What critical skills doctors miss in their training (Hint: they do this every day)

– How much money doctors should spend on advertising when they own their own practice

– When physicians should go to counseling to maintain their sanity & inner peace (and who they shouldn’t go to)

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Podcast with Pamela Wible

 

Dave:             My name is Dave Denniston. Welcome to my latest episode on The Freedom Formula for Physicians Podcast.

I’ve been working on networking with other authors and experts who can speak to the issues that physicians face every day.

That’s why I thought I’d bring a special guest to the podcast, Dr. Pamela Wible (WHY-BOWL), MD.

Pamela Wible, M.D., is a family physician and pioneer in the ideal medical care movement. In 2004, Dr. Wible left assembly-line medicine and held town hall meetings where she invited citizens to design their own ideal clinic. Open since 2005, Wible’s innovative practice has inspired physicians to create ideal clinics nationwide.

 

Her model is now taught in medical schools and undergraduate medical humanities courses and is featured in the Harvard School of Public Health’s newest edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration, a textbook examining major trends with the potential to change the dynamics of health care.

 

Dr. Wible is author of Amazon’s top-rated Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. She is also coauthor of two award-winning anthologies.

 

When not treating patients in her community clinic, Dr. Wible devotes her time to medical student and physician suicide prevention. Her articles on physician suicide have been picked up by major news outlets such as The Washington Post and her pioneering work on ideal medical care and physician suicide aired on a special 2014 primetime segment on America Tonight.

 

Dr. Wible has been interviewed by CNN, ABC, CBS, and she is a frequent guest on NPR. An inspiring leader and educator of the next generation of physicians, Dr. Wible has been awarded the 2015 Women Leaders in Medicine Award from the American Medical Student Association.

 

Welcome Dr. Wible!

 

Dr. Wible:      Wow thank you, what an introduction.

 

Dave:             You’ve done a lot and gosh what a journey, right? You’ve been through a lot and really rethought healthcare, so just tell us about the beginning. What inspired you to be a physician? What did that journey looked like?

 

Dr. Wible:      Well both of my parents are physicians, so they’re workaholics which is kind of a classic trait of physicians so they were not home much and in fact we don’t even have a family photo that has ever been taken of my brother, myself and my parents until I was fully five years old, can you believe that?

 

Dave:             Oh my gosh.

 

Dr. Wible:      I mean they’re so workaholic they’re not doing, you know, we’re not doing like the usual family things like going to church or basketball games, anything like that, I mean they are at work and so I used to go to work with them because I did not have reliable child care probably because I was one of those stubborn oldest child, children. I was going to do it my own way and so I think I scared off most of my baby sitters and so I ended up at work with them and I was essentially raised you know a lot of the time with my dad in a hospital setting and he’s a pathologist and worked in the morgue and so I spent a lot of time in the morgue and watching autopsy and things that children should probably never be doing and that CPS would probably intervene in today’s world that I was allowed to be this kind of, he introduced me as a child doctor. He actually introduced me as a doctor in training to his live patients because he also had jobs at a Macedon clinics and the police station before Breathalyzer they have to have a doctor on site. So essentially I saw all the parts of society that children are not supposed to see really early on.

 

Dave:             And you still became a physician despite all that.

 

Dr. Wible:      Yes, I just thought it was super fun. I just thought wow how amazing is this to meet people during like this incredibly transformative moments of their life, when they’re in a hospital or right after they’ve died or they just got checked into prison or you know at their crisis moments. I thought it was beautiful because you can really change somebody’s life when you’re there for them at that moment and so I just thought there was a lot of potential for healing in the social, psychological realm and also it had the academics stimulation of just the science. So the whole thing was like an amazing package.

 

Dave:             So did your parents own clinics until these times, like they were employees?

 

Dr. Wible:      No my dad was an employee and had lots of little side jobs like I’ve described in and my mom had her own practice, she’s a psychiatrist so she’s a really amazing self-employed psychiatrist, now retired but she opened her own practice during a time in the 70’s in Dallas when all her colleagues said you would never make it. She end up making like twice as much as any other doctor in time in psychiatry. She basically just wanted to, I guess they wanted to take the safe route and just feel like they were in the big machine but you know a result of being I guess in one of these large organizations is you don’t have any control over your destiny and you can’t earn more money, you can’t do creative things, I mean you kind of locked down into a one size fits all assembly line.

 

Dave:             And they’re telling you Medicare reimbursements might be going down, we’re not sure if we will be able to give you pay raises or anything like that. So when you get into practice were you part of a hospital or did you start your own clinic?

 

Dr. Wible:      Yes I spent ten years as an employee, as an unsatisfied employee and I just thought at the beginning well maybe it’s this one job and so I poked around and tried like six different jobs in ten years, my resume looks like I’m very unstable, it’s in the years of 1996 and 2004 or so because you know I tried everything hospital based clinics, I tried small physician on practices, part-time,  full-time, community health centers, migrant, farmers clinics, I mean I just kind of wandered around to get the feel of the landscape you know to hopefully to find that ideal clinic that I have always been dreaming of, that I wrote on my personal statement when I applied to medical school and guess what it’s not out there. There’s no like kind of flight in job that you could just take on salary that I could find that I thought was anywhere near ideal. So I had a revelation that if I was going to work in an ideal clinic and be the doctor that I always imagined I better do it on my own.

 

Dave:             We’re you moving around quite a bit?

 

Dr. Wible:      Just Oregon and Washington pretty much.

 

Dave:             Well that’s big enough of an area that you get to.

 

Dr. Wible:      Yes.

 

Dave:             So you got to this point where you wanted to start your own clinic and did you immediately opened one up or did you do the town hall meetings that I mentioned in the introduction bio, you know what was that process like?

 

Dr. Wible:      Well I just had an opinion that you know I’m pretty miserable working for these ridiculous production line clinics and it doesn’t look like the patients are very happy either and so whilst the patients aren’t happy, the doctors aren’t happy why not we get together and create a new model that will really work for us? And so I decided to lead a series of town hall meetings and invite my entire community to design the first ideal clinic in the United States and they are designed completely by patients and it’s kind of going out of a limb to tell people that in a month I’m going to open a clinic that’s designed completely by you guys, what do you want? I’ll do anything you want. I got a hundred pages of written testimony and what people wanted was just so simple, putting the end user in charge of designing the services that they want is a pretty smart move.

 

Dave:             And so do you think in terms of, what kind of things were they asking for? Was it, do they want more than one doctor available for example? Do they expect to have a practice with multiple docs? Do they want to have, were they talking about aesthetics? Were they talking about cost? What kind of things were they helping to design?

 

Dr. Wible:      Well the number one thing is they want it to be just all delivered on human scale, I mean a small room with a person that they know. There’s one person described well I want to feel like I’m at my friend’s house, sitting with my best friend who happens to be my doctor. So that sort of like close family feeling which is you know family medicine, you’re supposed to be the doctor for the whole family and they know you over generations and that’s always what I wanted to do and so it was really cool when they said and this was the consent theme that they want a small space that is human scale with one person. They don’t want multiple doctors, they don’t want multiple staffs, people they just want their doctor and to have that sacred relationship back between the physician and the patient. So that like financially is fantastic because I end up getting a two hundred and eight square foot office space because when you think about it there’s two type of doctors, you’re either a cognitive specialist or procedurist and even do I do procedures like global skin surgeries and such, you know you don’t need a lot of square footage to provide cognitive services,, you’re using your brain. Its already like housed in your head, you could sit in a small square footage room with somebody else and provide healthcare in probably fifty square feet if you wanted too. I have a big expanse of two hundred and eighty square foot of office right, that only cost two hundred and eighty dollars a month to rent and now it’s gone up to four twenty five over ten years, but still that’s pretty cheap for a medical office space right?

 

Dave:             Right, oh yes. I mean that’s nothing really.

 

Dr. Wible:      Yes and I have no staff, so that’s like usually the biggest expense in the medical offices all like thirteen people running around for physician and they’re kind of like a human shield that like prevents the doctor from having to have patients cling to them and you know just to create this weird adversarial relationship when you have so many staff buffering you from your patients with what they really, it’s kind of like if you have thirteen staff at home buffering you from your own children, they probably act out and get really disturbed when they couldn’t get alone time with you and that’s what patients want, it’s that sacred relationship back, so when you remove all those third parties and mediaries not only is your overhead really, really low and you make a lot more money per calories spent during the day. But you finally get back that vision that you always had when you apply to medical school of what you thought you would be doing in the future and then your patients finally get a real doctor and answers to their problems because there’s nobody interrupting and no staff buzzing and phone lines beeping. I do all my administrative stuff at home, at my little home office which is like about a mile from my clinic that when I’m looking at my patients in the clinics there’s literally no possibility of any interruptions, it’s just the two of us.

 

Dave:             So you don’t have a receptionist for example?

 

Dr. Wible:      No.

 

Dave:             Nothing like that? So what happens if you’re running behind you know people just know to wait or?

 

Dr. Wible:      I’m pretty much never running behind, there will be these people really well and my appointments are thirty to sixty minutes so I kind of know who’s anxious and needs a little bit more time and I schedule everyone myself so it’s not like walking in to a room and being surprised by suddenly seeing somebody I’ve never met before who has a whole new set of problems that I have no clue about, you know its vey predictable. It’s by chance I happen to run late maybe by ten minutes of so, I do have a gift basket by the door and everyone gets a free gift if I run late as a way of saying I’m sorry and showing that I value their time and they are just as valuable as I am. You know I don’t stuck people up for two hour late from a waiting room for a ten minute office visit which is disrespectful and not at all a definition of healthcare.

 

Dave:             Right that’s probably a frustration with a lot of people. What about billing? There’s so many different codes and insurance companies and different things that you have to deal with as practitioner.

 

Dr. Wible:      Its actually really simple, it’s very, very simple that the problem is in medical school we were never taught business skills so you basically get launched into a career and assembly line medicine with no business skills, so you’re easy prey for all these third parties to take advantage of that. So if you go in your own practice it’s very easy to understand these codes and basically people with GEDs from high school become coders and billers, it can’t be that hard, right? I made it to medical school. I tell doctor that he can understand the Kreb Cycle, you can run your own practice, it’s not any harder than simple math, you know what I mean? So the thing is what you need to do is you just cut out the abusive third parties and deal with the third parties that are actually enhancing the patient-physician relationship. So I still take insurance but I only take insurance with companies that treat me and my patients well. I have not find up to take government insurance. I mean I did for a year, I took Medicare and I did not appreciate the way I was treated and the amount of administrative hoops they want me to jump through was ridiculous and I will say as an aside I don’t try to run anyone away for a lack of money, so anyone who wants to see me can see me and we work out a fee that works but I will and no way shape perform deal with anyone who abuses me whether it’s a patient or a third party that wants me to sign a contract with them. I will just not sign it. I would encourage other people to behave the same way because then if we don’t take abuse and bullying in our careers and in our lives we have a better world.

 

Dave:             So it sounds like something where you’re in control of who you want to work with, who you don’t want to work with and you’re not just necessarily taking on, you could take out any patient but perhaps you have work around rather than dealing with some of the administrative hassles that can come with dealing with certain companies or the government.

 

Dr. Wible:      Yes there are certain companies that will deny our first claims, sow hay would we deal with them if they will make me resubmit all these claims and treat me like crap, you know what I mean? I deal with companies that like give me a five page contract that says you’ll be the doctor, we’ll be the insurance company. You see the patient, send us the bill and we’ll pay you, you know that sort of thing. Like a pretty straightforward five page contract. I mean I’ve had insurance companies try to give me like fifty page contact but they wouldn’t give me the contract until they have somebody come into my office and the woman drove all the way from Portland like two hours and she wanted to measure the space between the toilet and the wall to make sure, I mean before you even give me the contract once I passed this weird exam of my office space which was like so detail oriented and ridiculous and then they sent me this fifty page contract and I was like: well I’m not going to sign that contact. There was a line in the contract that said: If we decide that you did something wrong you’ll be responsible for our legal cost. I mean it’s like you got to be an idiot to sign a contract that has a line like that.

 

Dave:             Wow. Would you have outsourced anything? Is there anything you would outsource? You don’t have any employee at the clinic, is there something that you would outsource outside?

 

 

Dr. Wible:      I don’t think I can personally with my OCD personality, I definitely some mentors that I’ve had, I received instruction never to outsource anything having to do with money, you just open yourself up not to mention other sorts of things. I’ve also been told never to outsource marketing which I actually enjoy, you know that peace and it’s not like I need to market more because I have so many patients and I don’t know what to do and I’m trying to rehome some of them, but with HEPO, laws, patient confidentially this is not like an auto repair shop or something where there’s not all the laws related to confidentially you know, so I would find it hard to outsource anything, that’s just me and my personality. Other people you know there are definitely things they can outsource their billings, if they don’t like billings there’s billing services that will take like seven or eight person and will make do all of your billing or something like that. You could have virtual systems, I mean there’s lots of different little things, I mean the whole fact that you can put your whole medical record all in your laptop and you could do online scheduling where the patients fill out their own appointment times, there’s lots of things that you can do and automate and systems you can create like just with technology that will take the burden off of the physician.

 

Dave:             Do you have anyone that if anyone is listening that they might be good for them to check out, a couple of tool you will throw out there that you think would be good for people?

 

Dr. Wible:      I personally use Office Ally which is a free clearing house for bill, for claim submission and I’ve been using them since 2006 and I have hadn’t no problems at all and I usually get paid in like two weeks from the insurance companies, so they get my claims immediately after I see the patient, they store all the demographics of the patient in their system and they need just kind of update it with the code for the day and the date and press enter, it’s pretty easy. So there’s no reason why doctors cant submit their own claims and if you’re seeing fifty patients a day you don’t probably want to do it but I feel like at the most ever eleven patients for half day but more like six to eight which is very easy and a lot of my patients are uninsured so they pay cash which is very easy and you don’t have to deal with any of that.

 

Dave:             That sounds a lot easier that you’re not seeing people in fifteen minutes intervals, right? I mean you spend thirty minutes with them.

 

Dr. Wible:      Yes and that’s enough time to solve people’s problem, imagine that.

 

Dave:             Well enough to say it’s running your own practice and thank you for giving some of these great suggestions.  Besides running your own practice, you coach other docs on how they can change their practice. What do you think needs to be revolutionized in medicine and how can physicians go about doing that?

 

Dr. Wible:      Well I lead retreats and it’s just called Live Your Dream, it’s a teleseminar that’s like you know several months long and then at the end we have a live retreat for five days in Oregon, off the grid, in the woods, on a hundred and fifty acres of the hot springs, that’s incredible so you have to turn your cellphone off for five days, does not sound painful and just see and relaxing beautiful absolutely gorgeous natural setting with you know I have fifty or some doctors coming to this next retreat in May and so I think the issue for some doctors is that in medical school they have, when they apply they have this wonderful vision of what they want to do afterwards but medical school only provides one of the three skills sets that you need to be successful as a physician. They provide the technical skills and that’s in the realm of Western Medicine, you know enough to fill up like the technical skills of other holistic sorts of medicine but you do let’s just say probably graduate with the skills to know which drug to give for Strep throat and you know kind of the Western medical model skills but you’re not given any of the human skills, like a human skill set that is missing which is in the realm of you know, how do you tell somebody their wife died in a car accident? What do you do when the three year old child died and how do you talk to the parents and how do you deal with grief yourself and you know the whole human side of being in a profession that’s basically steep in suffering and pain. Like the bad news stories outweighs the good news stories in medicine I would say you know. There’s more unexpected trauma than like unexpected joy and in a regular day in a medical practice unless you’re just delivering babes and they’re all healthy right? So you know you can relate what I’m saying.

 

Dave:             Yes I can relate with my little kiddo.

 

Dr. Wible:      Yes, we don’t get any training in that so we just like have to go in a room and wing it and say “I’m sorry your child died” you know like kind of a big deal delivering news like that to have no training, you know? We also have no training on like what is patient’s satisfaction. We’re getting patient satisfaction scores that they’re posting online and they are like marring the reputations of physicians by grading them online for everyone to see but we never had a course on what is good service and what is patient satisfaction. That’s like how can you be graded on something that’s never been taught? How do you be a doctor, the human part of it? Totally absent from our training.

 

Dave:             How do you train that in? How can that be?

 

Dr. Wible:      They were kind of basically move into medicine a pretty loving compassionate people to begin with so we just kind of wing it and learn overtime on our own and sort of watch people around us and see what they are doing but there’s no formal structure that I’ve ever received on how to be with people Its because I was with my dad and been seeing patients from age four and I kind of learned on the job by watching other doctors but I think there should be a little bit more form on that, everyone has the best human relationship skills by nature. Some people need a little more help in that area. And so the other piece that is missing is the business skills which I eluded to earlier like we’re just given no business skills so then were basically easy prey when we graduate and we are graduating as these little automaton robots and some of them do assembly line medicine which is a completely unsatisfactory thing to spend your life which was what leads to physician suicides. So what these retreats are is a way of reclaiming the two skill sets that were missing, the human skill set and the business skill set that these physicians need to thrive in their own practices. And I don’t claim that I have the be all and all model I’m just demonstrating how one physician is living here dreams, right? And so I give them this kind of my whole process and how you know if they learn something along the way that they want to integrate that makes sense to them, I’m not suggesting everyone go out and do town hall meetings, some doctors are completely freaked out by public speaking, but you know the whole idea of why don’t you ask your patient what they want? Even on an online survey or ask your friends or there’s a different way of designing a medical practice and our field is just so stale and lacks so many, just lacks the entrepreneurial kind of mind set and initiation that we need.

 

Dave:             So let’s say someone opened up their practice? What do you thing the first thing is that they should do in terms of marketing and in terms of spreading the word, what’s the first thing they should do?

 

Dr. Wible:      Well they should first make sure they are in the right location with enough people that really want, I mean if you’re going to provide bariatric medicine so you’re dealing with obesity and you’re in an area full of housemates that don’t really have problems of weight, you know it’s like you have to put yourself in the right location, you have to really understand where are you putting, what are you delivering because physicians graduate as kind of like you go to family practice residency program you graduate as a family practice doctor and like one is interchangeable with the next they don’t really help you differentiate what your special skills are and I think physicians need to understand what their special interests and skills are and then message this clearly and locate themselves in an area where there’s patients that really need what they’re offering. So physicians just don’t, they don’t have a handle on this, they don’t quite, they haven’t quite found themselves yet and they haven’t figured it out because they have PTSD Depression and some of them are having suicidal thoughts, it’s hard to like have enough time for self-reflection to figure out who you wanted to be when you started medical school when you’re in the midst of all the pain and suffering and the debt load and all of that of the student loans which I’m sure you hear about.

 

Dave:             Oh my gosh, yes. We talked about it a lot and ways to reduce and eliminate them and I guess just talk about the financial transition here, what does that look like for docs? Do they have to have a significant amount of money on the side do you think to sustain lifestyle and have enough to because I’m sure the second you opened up a clinic there’s not a thousand of people ready to walk in, right? And make a payment that takes, sometimes they ramped up, what does that look like?

 

Dr. Wible:      Just depends again on the physician, I don’t have it on one size, it’s all modeling, I encourage people to think about like what they want out of life. Me I’ very happy in a  nine hundred square foot log cabin type house in the woods and I don’t really need anything and I have no debt and I have no kids, so it’s not like I have like big economic pressure. If you’re somebody that has five hundred thousand dollars of debt between you and your husband that both went to medical school and you want to live the high life then you have to do a different calculation than what I’m doing and so you just need to make the numbers match but I want to encourage people to think about the big difference between having what I have which was a seventy four percent overhead at my big factory job and a ten percent overhead at my own practice, that means that if you see somebody for a hundred bucks for bronchitis or whatever they come in with, there’s a big difference between keeping ninety dollars and keeping twenty six after an appointment, that adds up. So people do not understand these overhead calculations and they get talked into this what beautiful jobs, these salaries that sound really great and the mountain top skiing and beautiful school in the woods that if you’re exhausted and burned out from seeing thirty patients a day in a practice that is unsatisfying for you, you won’t enjoy the scenery that you just bought into because you’ll be exhausted. And physicians need to have a satisfying life and be able to see real doctors and they cannot do that for the most part on assembly line you know.

 

Dave:             What you and I were chatting earlier was I think the future is coming where hospitals have been gobbling u small practices and larger practices all over the place and as people step on the assembly line they’re getting less and less, it seems to me able to negotiate its kind of like you’re a worker and you should be happy with what you have and financially it seems to me that with dealing with Medicare and the ACA and some of these other situations it’s going to become less profitable to work in a hospital setting as opposed to being a sole practitioner where maybe you could own the building back.

 

Dr. Wible:      Oh yes right I mean the whole thing is they’ve created so much bureaucracy around this and made this so complicated that you need like a gazillion staff, people just to handle the Medicare. You know the Medicare guidelines I think they’re twice as long as the US tax code, I think the US tax code like you know all the regulations related to US taxes, like seventy five thousand pages and last I heard like Medicare regulations are a hundred and fifty thousand pages. Like who could be responsible for all the little thing? I mean gosh, I had enough reading when I do a five page contract with Regents Blue Cross Shield, I don’t want to read a hundred and fifty thousand pages from Medicare, I mean its daunting, right? And hospitals are notoriously very bad at managing primary care clinics, they shouldn’t be dealing that at all. They should just deal with their own problems there in section rates and the issue that they need to get under control in the hospital, it makes no sense for them to manage like neighborhood medical clinics.

 

Dave:             So what do you think about the marketing aspect of the practice? Are there resources that you would point people towards to get this financial education, a business education? Where could people go to learn more about how to run a practice?

 

Dr. Wible:      Well the marketing aspect, you basically don’t really need that if you have a good methods and you are in the right location because you will be, you should have a waiting list you know in six to twelve months and be completely packed. If what you’re delivering is anything that people want and everyone is desperate for a good doctor, so if you’re a good doctor and your personable and you put yourself in an area where people have the problem that you’re solving you should have a line around the block and should not have any, doctor should never pay money on advertising because it’s all word of mouth, over deliver to the first ten, twenty people you see and who will tell everyone in town and call their relatives and you should be like you know packed. And if you’re not you’re doing something wrong, either your personality is not warm and friendly or you’re not providing a service that people really need I that area or people don’t know you exist because you know it’s just you don’t generally need, I mean the reason why I’m doing marketing like I discussed before is I’m trying to market the idea that physicians can go into solo practice but as far as each individual physician in their practice they should be packed with patients just from word of mouth. Financial stuff, I mean there’s a lot of doctors online that give like financial advice to other doctors but keep your overhead low is the main thing and the lower your overhead is the sooner you can get out of the economic news that is like hanging you from the ceiling and so it just frees you up to do anything you want, you know if you want to go on vacation a month out of the year, if you have a low overhead, my previous practice my overhead was three hundred and seventy thousand dollars a year which means I started every month like thirty thousand dollars like on essentially if you book that like thirty thousand dollars on a master card starting very month and you have to pay that off each month. My overhead now is something like the ten percent overhead, I mean I was thinking the same salary like my overhead is so high. Let’s see my overhead now it’s like a thousand dollars a month or something, I mean it’s really, really low which means you can do whatever you want, you’re literally free.

 

Dave:             That’s beautiful.

 

Dr. Wible:      Yes and I mean there’s a lot of financial advisors and of course like what to do when you have extra money if you’re ever the physician who have extra money to do something but like just get your overhead down and pay off your student loans, like that would be number one. And then business skills, I think you should look out and find other physicians who are in direct patient care, actually practicing medicine the way you would like to and ask them to mentor you. The thing that really is disturbing is there’s a lot of physicians who put themselves out there as guru, healers, who can help other physicians and these physicians have left direct patient care, they no longer touch patients because they couldn’t figure out how to make it work and they were miserable as doctors. So now what do they write books? And they speak on how to be a doctor but they couldn’t do it themselves. If you couldn’t make it or do this yourself don’t put yourself out there as a solution for other doctors, do you know what I mean?

 

Dave:             Absolutely.

 

Dr. Wible:      It is so annoying because some doctors fall for that, pay twenty five thousand dollars to do a special course with some celebrity doctor who claims to have the answer to their burn out and it’s like well what’s the history of that doctor? They left medicine because they were burned out, so how do they have the answer? If everyone left medicine because they’re burned out we don’t have no more doctors. So obviously we need doctors who are practicing medicine, who aren’t burned out, who can show people how fun it is to be a doctor. Like a real doctor that sees and touches patients, so mentors.

 

Dave:             It sounds like your advice it’s like I’d wrap it up in two phrases, it would be keep it simple, you know don’t worry about having the biggest, largest office, you know keep it small, keep it intimate, it will help your overhead and in that way you can work on your student loans and some of these other things that may happen and it sounds like secondly is just be in a community with other physicians. Get some mentors, get people around you that you can rely on and lean on and ask advice from. Does that sound fair?

 

Dr. Wible:      Yes like just have a mentor that you know is running, if you want to run an ideal practice and work part-time as a pediatrician, find another pediatrician who is really happy working part time in a financially you know fall into practice that looks to be like succeeding, right? And pick their brain you know. So it’s an apprenticeship profession so we need mentors and a lot of medical students and physicians tell me is that what they’ve been exposed to is anti-mentorship. They’re exposed to a lot of doctors they’d never want to become. That’s a horrible way to train doctors.

 

Dave:             Yes totally.

 

Dr. Wible:      We don’t need an anti-mentorship medical education model, we need actually these physicians who were showcasing successful models, who are really happy to be teaching in medical schools, not kind of the ivory tower tenured group that has no idea what’s going on outside of the medical school, who tell people “oh you can’t go on solo practice, it’s impossible”. Well they haven’t left the medical school in a while, their life, you know what I mean the ivory tower folks?

 

Dave:             Yes, they’re in the university, they’re doing some great stuff but they haven’t ever done anything outside of that.

I’d like to bring it full circle and talk again about your books. You’ve written quite a few! I think it’s really cool that you are doing all of this. What advice would you give to other doctors who are considering writing their own books or looking to get on the speaking circuit? What tools would you tell them to use?

 

Dr. Wible:      I think just find out what their passion is and stick with that because it would give them so much energy and it’s hard to, I wouldn’t try to figure out like start from the place of how could I make a lot of money by writing a book and then write for the audience, I would write from your heart and from the place that gives you the most passion and then put yourself in an authentic way out into the word and you’ll be much better received than you kind of you know, some people get really hang up on how much money they can make by doing things and if you start with that and work backwards then the soul and heart disappears, you know. So I think start with your heart and soul, do what you love in the world, contribute something you know, I mean say something new, don’t just repeat some other things that other people are saying. Do something really innovative, creative and if you’re successful at it start sharing it with the world which is what I did. I mean I was like really? I can make this much more money working this many less hours, I think many doctors would be interested in knowing this, right? So I wrote about it and put the information to the world and then lo and behold people start picking up on it, so I think it all starts with your passion and your hear and you know why you think you were born and to really be the healer that you were always supposed to be. And healing can come in many forms, direct patient care, one on one touching patients or writing articles that can change people’s perception of what healthcare is and what a doctor should be, you know doing other sorts of and hence inspiring these doctors who are really, really burned out and looking for some leadership, you know. So that’s what, I hope that helps.

 

Dave:             Yes totally I think it’s this process of first figure out what you want to talk about and how you want to change the world per se or change your profession or change the community and that’s what you want to write about.

 

Dr. Wible:      Yes, I mean you can even look at it as like if you were somebody told you you could do a Ted Talk tomorrow, what’s your one big idea that’s going to change the world? Like what is it? Like write your Ted Talk now even though you haven’t been invited yet, right? What’s your one big idea? If you don’t know what it is then start dealing inside yourself to find it, don’t look outside yourself and grasp at straws, go inside and remember who you are as a healer.

 

Dave:             And once you do that and it’s out there do you think for you, you having those articles, having those books does that help kind of feed into the system of finding more patients and connecting with other physicians? What does that look like for you?

 

Dr. Wible:      Well I’m not looking for more patients because I’m just completely packed but it does I have physicians constantly emailing me and writing me because they’re inspired by things that I’ve done, that I’ve written about, so it’s kind of cool to have like big cyber footprint out there of articles that are inspiring people, so yes it’s great, it’s really great. A lot of physicians have contacted me and then like the wonderful thing writing about suicide is that I have all this suicidal people contacting me and just validating them and their experience, like they feel so much better and they’ve told me I saved their lives and who knew just by writing about a taboo topic that you could save so many people’s lives.

 

Dave:             It helps you to feel great and probably fires you up like that.

 

Dr. Wible:      It does, yes it’s great.

 

Dave:             And for me I mean writing is a release partially to, that’s part of the reason. I like to write or speak, I mean for me it can be hard to communicate sometimes as a guy, most ladies tend to talk and enjoy chatting it up with many people and guys tend to keep it inside, so I find that it can be a great release for e personally just to.

 

Dr. Wible:      Yes its therapeutic, it’s like emotionally cleansing. It’s good to process all the stuff, keep it inside. So I would encourage every physician to be writing, I would also encourage every physician to go to therapy at least once or twice a month because it is really important that you have psychological support and not your spouse. You will burn your spouse out real fast if you start talking about the things that you see at work, there’s a reason why they didn’t go into medicine and you know they’re a librarian. They’re looking for something completely different, they’re fueled by something very different than working in the ER. So you got to you know and there was even this medical student who emailed me this morning telling me that he was very inspired by the things I’ve written and in order to, you know when he exercises, he’s an athlete, he runs, he’s in a very good physical shape and he’s decided that he is going to get a therapist that he can see all the way through medical school which is really smart. That as smart as brushing your teeth and exercising, having mental health care because this is not any sort of a cake walk through medical school. You know you’re going to see deaf, you’re going to be with patients with families who are wailing and suffering and you better have an outlet for that and a way to process it and unfortunately medical schools have not become progressive enough to have an infrastructure to allow that to easily happen on the school campus. So if you need to go off campus to a social worker or a shaman or sit in a TP, whatever you have to do to start processing your emotions and I really do recommend that you do it with somebody else. I mean writing is good but it’s good to bounce it off with somebody else and to cry with somebody else and to share what it feels like to be in a room when the baby died, the miscarriage, you know you really need some support for what you see in medical school and beyond. So all doctors should be in therapy as far as I’m concerned. They have to check that little checkbox on their board license renewal that says if they’ve been in therapy or if they’ve have mental health issues so I always recommend go to somebody that’s not keeping chart notes, that you don’t have to claim as like an official psychiatry visit. There’s a lot of different people out there, even massage therapist who will sit during your massage and talk to you about how you’re feeling. So you can get therapy with any number of people. I just wouldn’t rely on your family and your friends as much, I would try to get it to somebody who have some professional expertise in the area of mental wellness.

 

Dave:             Absolutely, that’s great, great advice and we have to wrap up.

Thanks so much for being with us! If people have more questions, maybe they are curious about starting their own practice or they want to find how they can get out of the machine over time- or maybe they want to follow your blog or pick up a copy of your book- how can they get in contact with you?

 

Dr. Wible:      Just go to idealmedicalcare.org and very thing is there that you can possibly want on anything that I’ve spoken about today.

 

Dave:             Okay, any other closing thoughts? Things you want to share with folks?

 

Dr. Wible:      If there’s any physicians listening I really want to drive home the point that you can’t be a victim and a healer at the same time, so please choose one and if you choose to be a victim it would be good to get out of medicine because you’re a disservice to yourself and your patients. And if you choose not to be a victim and you want to be a real healer there’s a whole heck of a lot of ways you can innovate and deliver health care today besides what looks obvious to you in this assembly line practices. So I encourage people to stand up and be real doctors because patients are dying for you to do that.

 

Dave:             Awesome, awesome. Thanks again for joining us Dr. Wible! I’ll look forward to reading your next post and your next book.

 

If you are a physician wanting to tell your story, grapple with these tough issues, and get on the soapbox for a few minutes, I’d love to share it too in the next Freedom Formula for Physicians Podcast. Make sure to contact me at dave@daviddenniston.com or on my website daviddenniston.com/physicians.

 

For the Freedom Formula for Physicians podcast, this is Dave Denniston. Thanks so much for joining us and make sure to subscribe and check in again soon! Have a good one.