Ask Me MD: Medical School for the real world
Ask Me MD: Medical School for the real world
Women in Medicine - Running a Private Practice Roundtable
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Dr. Verret is joined by Dr. Neha Dhudshia, Dr. Sejal Mehta, and Dr. Sherine Reno on the challenges of running your own practice and being a woman in medicine.
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Ask Me MD, medical school for the real world with the MD Dr. D.J. Verret.
D.J. Verret, MD, FACS :Greetings and welcome to another episode of Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret, and today I'm joined by three of my colleagues to discuss women in medicine and running your own private practice. Dr. Sejal Mehta, Dr. Sherine Reno and Dr. Neha Dudshia will join me right after this quick break. Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret and today we have a great roundtable discussion with three female physicians all in private practice Dr. Neha Dudshia, internal medicine doctor, Sejal Mehta of psychiatry and Dr. Sherine Reno, physical medicine and rehabilitation. Doctors. Thanks for joining me.
Sherine Reno, MD :Thanks for having us.
Neha Dudshia, MD :Thank you for having me.
D.J. Verret, MD, FACS :I, you know, this is it's a great, it's a great topic. And it combines kind of two things that that is always of interest to physicians, how you kind of go out on your own and start private practices or participate in really small groups, and some of the challenges that women face in medicine, so I'm excited to talk about it. Let's let's kind of start by going around the table. And if each of you could kind of tell us about yourself and your current practice situation, that'd be great. And terrain, I'll pick on you first.
Sherine Reno, MD :Ah, okay, my name is Dr. Sherine Reno. My specialty is physical medicine and rehabilitation. And I specialize in sports medicine. My practice is at the corner of alpha and Preston actually in Dallas. My performed mine in the name of my company is Performance Sports Medicine. I basically do mostly sports injuries, and a few other musculoskeletal injuries that come along as well. I have a wonderful private practice, I'm so low, do all the wear all the hats. But because of that I get to do exactly what I want. And I'll tell you more about that later.
D.J. Verret, MD, FACS :Sejal, give us the psychiatry bent on where you are and what you're doing.
Sejal Mehta, MD :Definitely, DJ, thank you so much for this opportunity in just chit chatting with my colleagues, physician colleagues. I am a psychiatrist. I have board certification in children and adolescent adult and Addiction Medicine. I'm in a private practice. My company name is Socratic medical associates. And it's in West Plano. And I have been president of that group for about 13 years now. And slowly and steadily adding another speciality like internal medicine, or another psychologist to the group. So slow expansion is on the horizon.
Unknown Speaker :And last but certainly not least, Dr. Neha. If you can give us your background and where you are, that would be great.
Neha Dudshia, MD :Great, great. Thank you for asking me to join. So yes, I'm Neha Dudhsia and I practice internal medicine private practice in West Plano. I have a really nice practice. I think it's this nice low volume practice, where I get to be very hands on I don't use any nurses or any physician extenders, the entirety of the patient visit is with me. So I get to spend a lot of time with my patients and get to know them really well. And this is how I've practiced from the get go. So basically, when I finished up residency training and stuff, within a month I started my practice so I just moved and you know, took boards and all that stuff and you know, was able to start off my practice that way. And next month Actually, I'll be hitting 25 years in practice.
D.J. Verret, MD, FACS :Congratulations. That's awesome.
Neha Dudshia, MD :Yeah. Thanks.Plano is actually my hometown. So it was sort of like a moving back, you know, to your hometown, it was sort of, you know, idealic in my mind to move back, hang up a shingle, start your practice. And, you know, do all of that. And my practice is across the street from Presbyterian Plano. And so, you know, over the years had no chance to have some involvement there. I was actually the first general female internist on staff at presby. Plano. And in 2003, I was the first female general internist to be chairman of the Medicine Department.
D.J. Verret, MD, FACS :So with, obviously, that that's quite an experience in practice, why did you decide to come out and actually start your own practice? You mentioned coming back home, but starting your own practice is a whole different idea than just practicing in your hometown.
Neha Dudshia, MD :Correct? Well, some of it is knowing one's own personality, I think. And I knew that I was somebody that wanted more control. And I wanted to create a less stressful environment than what I saw in a lot of large practices or employed settings. And being a control freak, you know, I wanted to, you know, make my schedule the way that I wanted it with enough time and making adjustments and, you know, I was able to already see kind of what some of those intangible benefits were to being in charge of your own practice
Unknown Speaker :And Sejal, can you maybe also speak to why you started your own practice? And you mentioned something in the introduction, that you were looking at bringing on other specialist into the group maybe also included a little little thought on, on why you decided to start doing that as well?
Sejal Mehta, MD :Absolutely. So my situation is a little bit different. As you know, I have done my medical school in India. Then I came over here did my boards, and my residency and fellowship in Union at University of Kansas. And I started after that. I was married, I had two little children when I was done with my training. So I actually just took a part time job up in Kansas City. And no weekends, just being a mother making sure that being a child psychiatrist, I am giving my children what they need, so they don't have to find another child psychiatrist down the road. So I did that for about four years. And then my husband decided that we want to go back to Texas because he loves Texas, we have family in here. And initially, he he's also a physician. And after his residency, he had started practice in Kaufman, Texas in 92 1992. So 919 92 to 1995, I had actually worked as his office manager, and learn so much in setting up a private practice at that time. Then I went and finished my training, came back to Texas in 2004. I still have little, young kids who needed all this activity and Mama time. So I pick up a job, which was more than a part time it was more than full time, actually, I was working a lot of hours, but still making sure that I'm attending all my kids activities and driving them around and taking care of elderly sets of both sides of the parent in the home. And of course, having a physician husband is also something that we have to make sure that we are working things out between us because our both of our schedules are really very demanding. So what happened was in that work period from 2004, to 2007, the group that I was part of started fizzling out. There were some disagreements there were the president of the group decided that he is going to be moving out of the state doing something else. And then it was like, okay, who is gonna take care of this, all this? Six, Seven doctors and employees and who's going to do it? So it happened that it was it's just fell into my lap, that it was my responsibility. I took it and taught myself a little bit more. And it was not scared thank God because from 2005 to 2007, I also went out and got my MBA. So I understood the business aspect of The medicine and have been able to start the practice, get the leadership role, continuing to self teach several different things and a lot of experience a lot of mistakes. I have made some mistakes too. But it's a learning step I have learned from my mistakes. And probably I'm a wiser person today, because of those mistakes that I have made. But overall, now, after 1213 years, and about 40 years ago, I asked my husband, who is an internist, that why don't you just join my practice, instead of working for some other hospital or company? You are a great physician, and you are a primary care physician internal medicine, I am a psychiatrist. It's a natural combination of the speciality. Why don't we work together, and he says, okay, maybe we can do that. And that's what we did. So I have an internal medicine physician as a part of my practice right now. I also have no practitioners. And I'm actually looking for a couple of more psychiatrists, because there is so much work.
D.J. Verret, MD, FACS :And Sherine, obviously, definitely want to hear about starting your practice. But I'm also interested, I noticed, all three of our physicians on the panel and I as a fourth, have used a different name for our practice than our personal names. So I'm interested to hear your thoughts on on how you came about selecting the name of your practice.
Sherine Reno, MD :Question, um, basically, I came from a different background than a lot of people who go into medicine, I actually was a professional dancer went through the theater and arts programming, before I ever determined that I was going to go back to school and go back for medicine. And one of the things that was always the most important is what do you need to do to perform well, and I originally did a lot of training of athletes, gymnast, dancers, stunt people, etc. And so that word always kind of stuck in my head. So when I actually went out to actually, you know what, this was actually the second company, I started this one in 2010. But because I had worked with so many people in the sports arenas, performance was always the most important element. So that became part of the name. I originally started out as natural corrections, because I wanted to do the most natural thing that would help. But then I got a lot of people who thought I was actually a chiropractor. So we did change to the performance sports medicine.
D.J. Verret, MD, FACS :It's interesting, you bring up that point in, I think part of it, when you're coming up with the name of the practice, it's also important to know who your clientele is going to be and what your vision for the practice is. Would you agree with that?
Sherine Reno, MD :Absolutely. And that's, you know, there's a lot of really interesting things. And I think women who are going to have a private practice need to take into account you do like Nihad just said, You need to know your own personality. And you need to know what makes you really happy. You need to find your niche or the things that you do better than other people. And then you need to find a way how do you reach those people. And to be honest, I had kind of a journey that helped me learn all those elements. And I'm in a really good place even despite COVID right now, because of that,
D.J. Verret, MD, FACS :well you bring up I heard say Joel and you both mentioned learning and making mistakes along the way so that the next question I'm going to pose to the panel is what was your biggest challenge in starting a practice? And and how what did you learn from it? And how did you overcome it, and I'll throw that into shareen first.
Sherine Reno, MD :I actually did. When I first came out of residency, I went work for a large spine surgery group got about one sports medicine patient a month and I knew I wanted to do more. At some point in time, I just said this is what I really truly want to do what I'm truly the best at and so I went and talked to consultants to say well how would I start a practice and they basically said, Well, you know, you need about 1500 square foot for your for your therapy gym, you know, you need your procedure room because I do procedures as well and you need your office visit rooms and you need a medical records room and a you know, you know just basically lots of space and they told me Okay, it's gonna take you about $500,000 alone to get started. You know, have you a little bit of operating capital he through the first six months and I kind of felt I said, I don't know enough about business to know that I could pay off that loan. So I started, you know, coming from creative background, came up with creative problem solving skills. I looked and said, Where can I find enough space for working out and you know, therapy and still have enough to do the other elements, I went down the street found a very low volume, fitness gym. And basically, they had rooms that I could rent for office visit procedure and a combined medical records and staff, you know, like presearch, etc, with a phone in it. And so basically, I, I paid probably about $3,000 a month for that. So it was great thing, you know, just my employee expenses, and my rent expenses were incredibly low. And so just being able to solve that space of you know, do you have to have your own Can you sublease, other spaces, you know, there, you have put on your your creative thinking hat, I also had problems with marketing. And with other support staff, I didn't have money for $5,000 a month marketing. But what I found was really effective was being medical at the athletic events, your names in the program, the coaches know who you are, the parents know who you are. And that kind of spreads by itself. So find things where you can talk to the community without spending a ton of money first. So and then, the last thing is, you know, all of the other doctors know too, is I needed expert in finance, and accounting, because I knew I had an ex husband, who is IRS agent, and knew I didn't want to come up crosswise and not doing everything perfectly. So I had to find an accountant who had time to talk to me and made sure that I categorized everything correctly. And I did find one that was very good and good at medicine. And my last little thing is make sure you get good medical legal advice. Don't get into any contracts that can get you into trouble. I actually have a son who just finished his law school and passed his bar and all that other stuff. And he kept me from getting into a couple of, you know, really scary things were like one was Forest Park where they said, well, we're going to only do out of network procedures. And if you send us somebody will send you, you know, a referral fee. And I'm going to sound kind of funny, but then when I talk to Jamison, if I'm in contract with that those companies even though it's not Medicare or Medicaid, it's still not allowed. So if you do need to not be afraid, you know, get somebody good that you can talk to, that can keep you out of trouble. And to be honest, I would never change it. I love what I do. And I love having the decision making process that allows me to do what I think is necessary without going through 15 different committees and steps. And for our listeners out there who may not know Forest Park was a huge issue in the Dallas Fort Worth area. Several of the physicians are now serving prison time for the illegal kickbacks that occurred at the hospital.
Unknown Speaker :Now have your biggest challenges. You in listening to your story? I think one of the sounds like you had a lot of first as a woman physician in the Plano area. So I'm sure that probably plays a part of the story into some of your biggest challenges as well.
Neha Dudshia, MD :Oh, yes and no, in the sense that I mean, I had all the typical challenges in the sense that I didn't know how to run a practice, I really have no business background, nothing was taught to us in residency in terms of running a practice or even familiar familiarity with billing and coding and such. But, you know, none of this stuff is hard. It was just new. I mean, and, you know, it's it's stuff that you can that you can pick up, you know, fairly quickly. And yes, there's a learning curve, you're gonna make some, you know, mistakes and such. But, you know, it, it all works out in the long run is that's just in the short term. I don't really think it was an issue in terms of being a female in practice. In fact, honestly, I see it as an advantage because at that time, there really weren't a lot and there were a lot of patients who wanted a female internist. And so I would say that, you know, for myself, it wasn't, you know, necessarily a negative, it was really almost sort of a positive. And I do understand people in in other settings have maybe had some challenges, but fortunately, I really didn't come across that.
Unknown Speaker :Did you see it being an internist? Obviously, on the income spectrum, internist are on the lower end? Did you see that as being a really daunting possibility when thinking about taking on the debt that would be needed to actually start your own practice?
Neha Dudshia, MD :Yes, that was probably the other challenge, I would say is that, you know, you're starting a practice and maybe haven't even finished paying off your medical school loans. And so, you know, that was a, that was a little bit of a concern. But, you know, fortunately, you know, there are ways that you can do that I was able to pay some of it off, even while doing some moonlighting as a resident, and even when I was starting my practice, and, you know, certainly that helped. And, you know, really, it took only six months before it was a breakeven and so, you know, paying that off, paying off loans was not really that bad. You just have to think small, if you want to have a certain practice in a certain way, you know, you don't overly staff it, you start with one employee, and, you know, a small space so that you're keeping your overhead down as much as you can.
Unknown Speaker :And Sejal, you know, a common theme I'm hearing with our other panelist is start small and grow as you need. You obviously had a little bit different scenario where you were in a couple of different practice settings, before you fully went out on your own and started, was there a challenge when you were actually running the ship? Being the doctor and the administrator now that that that you didn't expect, even with your previous experience?
Sejal Mehta, MD :Yes, yes. So when I took over, as a president, I actually had to sit down with for hours with the lawyer, and an accountant that was already there for the company, to understand the structure, the way it was set up, because it was not straightforward. So it took me a little bit of time to understand that, and then set things up, I everything was in place 401k, and all other benefits, and everything was there. But I just had to understand how it is and clean it up, basically. So it was a little bit different. And then the model has changed for me over the years. And of course, it's getting better and better. And as Neha and Sharon Seine. Being on our own gives us a lot of command on our own schedule. And another advantage and this is for all women physician is the Another advantage is that while we all know this is a fact that in our workforce, women are paid less about 15 to 20%, less at face value, compared to men colleague, even in medicine. But when one is in a private practice, the insurance company reimbursement all the rate that you set is not there is no bias or discrimination there. So I think that it's an advantage of being on your own and having your own practice. So you are getting paid what you are worth, or what you value yourself at.
D.J. Verret, MD, FACS :And I know you kind of touched on it before, but what do you see is the biggest advantages to your current practice model. It seems like everybody has kind of settled on the at least smaller, independent private practice. What do you see is as kind of the biggest advantage there.
Sejal Mehta, MD :Um, I wouldn't consider my practice small right now. Pretty nice. I have about three or four nurse practitioners that are extremely busy, keep me busy, keeps me on my toe because I'm very hands on with supervision. And I'm also just like all this, all of you. I also like to be active in community and do something my for my physician, colleague and community. So I have to figure out to a lot the time for all that. kids growing up has helped in that scenario. And when you ask about growth or staying small, of course, I do have an ambition of growing the practice adding Two or three more psychiatrist, and taking on some of more challenges. When I'm challenged, I get motivated. And, and my problem solving skills kick in. And I enjoy solving the problem that other people would just like, deal with it for days and days and days. And I can kind of untangle that in just a few minutes, two hours, I love it. So that's the driving force, and adding and growing in this environment, and digit Why? Because here is the one thing that I think all of you will agree that physicians have difficulty getting on one book one platform, physicians are, by nature and by training, more independent and more egoistic and not able to work with each other as smoothly, they will. In my experience, I have seen physician trusting corporate America more than their physician colleague. And It baffles me why that is the case. But I really am hoping to cultivate that relationship with other physician and other psychiatrists that we gotta be helping each other out, pulling each other up. Corporate America, in general. Now there is it also depends on individual person who we are dealing with. But in general, corporate America is all about bottom line. And as a physician, patient care, and quality is our bottom line.
Unknown Speaker :I think that's a really good point. And definitely a sentiment I would second. Sherine, was there a challenge you faced as a woman in medicine, starting your own practice or running your own practice that your male counterparts just aren't facing?
Sherine Reno, MD :It's just the same one that everybody faces as a female is, you know, at the time I was a single mom and had kids and in middle middle school and one in high school. Without any support at home, you just had to make decisions to say, you know, how can I juggle both jobs, and I can, I chose to juggle both things. And that didn't make a difference in what I chose to do. I was encouraged to do surgical specialties, but I knew that I didn't want to be gone all the nights, I didn't want to have all the calls. So I just chose what I did that allowed me to do most everything that I wanted to do. I don't begrudge the man. And I'm To be honest, I'm sure there's some single bad physicians that have made similar choices to me. So I don't think it's anything bad. It's just, you know, we're all given different challenges to face in this life. And it's all our job to figure out the best, you know, compromise that we can.
Unknown Speaker :And Neha, how you kind of talked a little bit about that same question earlier, and how, in some ways being a female physician in your practice situation was actually beneficial. But is there a challenge that that you think you faced as well, in practice, and maybe also address one of the thoughts, Sejal made about reimbursement differences in private practice? Are you seeing some kind of a difference in the reimbursement you would get versus your male counterparts?
Neha Dudshia, MD :So, um, so I think in terms of, you know, the challenges and such, it's, you know, I think, you know, the reimbursement is always going to be the same from urine, the insurance companies based on whatever your IPA has negotiated. So that's really not, you know, the issue when you're in private practice, and I do see that, you know, potentially as an advantage to being in private practice. But I know that that can be an issue for, you know, for others that are maybe in other settings, like academics or in a large group or such. And I think, you know, finding the, I think the challenge that I would say and that I hear from all of my female colleagues is life work balance, and, you know, with a private practice, you're able to have better control of that, but it is still a challenge and, and I think really, the best thing there is to just be able to have a way that But you can achieve it as best possible and make adjustments during times of your life when you're busier. And other times when you're able to work more you can do so it is really key to make sure you find a really good person to be your call coverage. If, you know, if you're so low, then you will certainly need that. I am fortunate in that I was able to find a very like minded physician. And we sort of have an arrangement where we're both solo practices. But we have an office and expense sharing arrangement. And that just works out so perfectly. So if one wants to be off or needs to be off or whatever, it's just very easy.
D.J. Verret, MD, FACS :And actually, that's a that's a really good point there when I think when a lot of physicians who aren't exposed to private practice, maybe if you're in residency or in a employed large group, I don't think they always realize you can actually work with another physician, but not be employed and not be completely financially tied to that other person.
Neha Dudshia, MD :Yes, and that works out very good. Because, you know, people have very different goals for their life, financial goals, personal goals, you know, and so, in order to avoid, you know, misunderstandings, you know, problems and resentment and things like that, I think it is a very nice arrangement.
Unknown Speaker :And I think we're approaching the end of our half hour here, and this has been great. I'm going to pose one more, one more question to the panelists here. And, and we've, we've talked about it a little bit, but maybe in a broader sense. What is the biggest challenge that you see, in general, for women in medicine, and how do you think we can address it to overcome what's going on? And Neha I'll start with you.
Unknown Speaker :Yeah, I think, you know, that is a that is a difficult question. And, you know, like Brian mentioned, I think there are a lot of my colleagues who are still facing a lot of issues there. I was going to mention that there is going to be a really great talk about this that the TMA is having through the women's physician section, it's going to be on Saturday, September 12, at noon, and you can register for that, or if you're not able to do it, then you can watch it later. But it's a nationally known speaker, Jan, excuse me, Jane van dies. And she's going to be speaking about the equity equation. And she is sort of an expert on that she was the CEO and founder of that organization, also a co founder of time's up healthcare.
Unknown Speaker :Sejal, I'll pose the same question to you, but maybe even a little broader. Obviously, you come from India and and, and have immigrated to the US. Is there something you see for women in medicine being a challenge or even for immigrants in the US healthcare system? And how do you think we can address it to make things better?
Sejal Mehta, MD :Oh, my God, this is a can of worms.
D.J. Verret, MD, FACS :We're approaching the end of our half hour. So big, big picture.
Sejal Mehta, MD :Big Picture. Right now we have about 35 40% of us physicians, our immigrant physician, so majority of Americans, I mean, not majority, but almost half of American population is being cared for by immigrants. And I know so many immigrants that immigrated or migrated, lawfully migrated physicians sitting on a sideline and not being in a practice of medicine. That is a huge issue, we can actually leverage that. I would say that being a woman being a woman of color being actually born in another country. I do experience not only glass ceiling, also glass walls, but then and it is up to me to decide that I'm going to shatter those things and I'm in if there is a price to pay, I have to be ready to pay the price for shattering this ceiling or shattering that wall. Now, there is an implicit bias there is no denying that but there is so many opportunities as well that this country has given to me and my other immigrant, other physicians. For the most part, if we are doing the right thing, we are following the lead legal, ethical, moral, bad, we will succeed. And that is the great thing about setup in our country, that it allows an individual who is willing to work hard a success and have the ambition fulfilled that or have the achievement made. So the journey is hard, but it's beautiful. I have enjoyed each and every minute of it, and I continue to enjoy it. So yes, it is a little bit difficult. I mean, I would love to see immigrant women physician in some leadership positions, which is happening slowly and steadily, but it's happening. And I would encourage our younger physicians who are right now in residency, fellowship, medical school or in practice, in a very new practice, is find a mentor, especially for women find a mentor who has been through, like, collectively, three of us help more than 50 years of experience in running medical practice, become a brain, we can help, we can help you to avoid the mistakes that we have made. Because we were not aware and we didn't have a mentor or coach. I'm willing to take someone under my being and help them out. And I know Neha and Sharon would do the same. So find a mentor, find, you don't have to just work eight to five or eight to three, work for someone else, and then be unhappy at the end of the day. If it is if it is making you happy. Ultimately, it's about your state of mind if it's if it's making you happy, fine, but no need to keep complaining and still staying in their job. That is a way to do private practice. We do control things way to be self sufficient and be happy.
Unknown Speaker :I think that's that's some great advice, especially about finding a mentor. And I know coming out it was difficult, kind of getting up the courage to call people but but now being on the other side, I know that those people that you would think about calling are happy to talk. And, and I can, I can definitely say you've left a lot of glass shards behind from all the class you broke, or broken. I think all I think all of you guys have left a lot of glass shards behind it. I definitely applaud you in what you've done. And Sherine, I will pose it to you, I think you come with a an interesting, an interesting background as well, obviously not as much, definitely not in the business realm more of an art background. And being a single mom, a lot of a lot of different characteristics than you would think would be needed to run a business, but you've ended up very successful. So what do you see is kind of the biggest challenges for women out there. And how do you overcome those?
Sherine Reno, MD :I think just you need to think creatively, you need to follow your dreams and follow your heart. Mostly, I think Sega had a wonderful piece of advice. If you're not happy, then you need to look elsewhere. The other thing that I think and it's just something I'm keeping in mind right now is you do need to follow the politics because those will affect all of our ability to practice in the ways that we want to have Plan A and have Plan B. I'm moving more toward a concierge practice over time, but I think that I need to make sure that that's not going to be made untenable by the changes that we may face. So you know, I'm hoping I'm very hopeful that you know, the United States is always going to do a wonderful job and keeping our medical community intact and providing the wonderful care that we do. But just you know, make sure that you follow things and if there's things that are especially prominent are important to your field that you let your legislators know so that they can take everything into account. I think we all are bright people and we can make our way through whatever we need to.
Unknown Speaker :And I would I would definitely second that doctor, Dr. Sherine Reno, Dr. Sejal Mehta and Dr. Neha Dudshia. Thanks for joining me today. It has been quite fun and a lot of really good information. Thanks again for coming.
Sejal Mehta, MD :Thank you all.
Sherine Reno, MD :Thank you.
Neha Dudshia, MD :Thank you, Dr. Verret.
Unknown Speaker :You've been listening to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. Thanks for joining us. Until next time, make it an awesome week.
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