Doctors strike in New York hospitals, Locums Q&A and Meet the team. #441

All you have to do is show that your income is increased and you can buy more benefits at that time . No medical questions asked .

So there's a lot of episodes that we recorded either late in November or early in December , and you know , life be lifin' . So I'm here with the entire crew , my entire team that continues to make Docs Outside the Box one of the best podcasts out there , and truly without this team here , we would not be able to do what we're doing .

So I want to give a shout out to what you see . Actually , on my left , if you guys are , I don't know how this is going to edit out , but on my left I have Kiara . What's up ? Welcome to the podcast . I know reluctantly , you come on the show . Below we have Audrey . Audrey is also part of our team . Then we have some straggler .

I don't know who she is , she just hacked her way into this . I got to talk to Zoom Merry New .

. Like , come on , guys , if you know you know right , that's how we doing in 2015 , 2025 . Excuse me , if you know , you know right , that's how we doing in 2015 , 2025 .

So , with that being said , before we jump into some of the things that we've missed from the end of 2024 and things that are going on right now , I just want to preface this by saying guys , I don't know if you have noticed , but over the last several weeks even longer than that , several months it's been really difficult for me to really concentrate on putting

out episodes for the show and really being locked in for the show , and there's so many different things that me and Renee are doing , and I think about when we first started this journey together paying off our debt and then eventually starting the podcast in 2016 . The first beginning was let's try to pay off our debt in 2016, .

The first beginning was let's try to pay off our debt . Then , once we started the podcast , it was okay . Once we finished paying off our debt , then let's really get into this locums world and then once we got into the locums world , it was okay .

We have children , then it's real estate , then let's move back to New Jersey and then you take on a whole bunch of other things . Covid occurs and so forth .

But I think one of the things that I think you know , once you get to like my age group and I'm 46 , and I think a lot of doctors who come from my demographic that we necessarily don't plan for or you just never think is going to hit you is you become part of something called the sandwich generation and what that means , long story short , is you know I'm

a husband , I'm taking care of my children , I got my wife . You know I got responsibilities there . I'm a physician . But the other thing that makes the other part of the sandwich generation is I'm also now having to help take care of my parents . My parents are elderly , my oldest or , excuse me , my dad is 84 and my mom is 77 .

And they've done the yeoman's job of raising me and helping me to become a physician .

But one of the things that you just never quite can prepare for is what happens when you have to take care of them , and that's what's been going on over the last several months is I've been primarily taking care of my parents and trying to juggle , take care of kids and be a good doctor and , you know , be a good business person , and sometimes some things

fall through the cracks . So I wanted to start off the year by being very honest with you all and letting you guys know that , hey , sometimes shit falls to the ground . You can't do everything . So that's kind of .

Where I've been recently is just my mind has been with them and making sure that I'm providing the best environment for them and taking care of them , but also at the same time , you know , being plugged into being a good family man and then also , at the same time , putting out a really quality , quality show .

So you know , if anybody's listening to this show and is going through something similar , come in and write in . You can definitely reach out to us . There's a , if you go to the show notes there show notes there's a text us line .

There's also a phone number there that you can leave us a voicem amount of physicians , healthcare professionals who are going through something similar , and sometimes some people say you kind of like suffer in silence . I don't say I'm suffering or anything like that .

But it's just kind of one of those things that initially I didn't want to share because it's just like ah , this is just part of you know family , you take care of your family and you kind of move on . This is just part of you know family , you take care of your family and you kind of move on .

And I think Kamala Harris , when she was running for office , she mentioned that you know if she got elected unfortunately she didn't , but if she got elected , you know one of the priorities that she would have worked on is transitioning some of that Medicare dollars and even Medicaid dollars to making it easier for people who are working class , who are in the

sandwich generation , you know , to have more options , to have more , you know ability to take care of family members in a way that you know is what's the word I want to use in a decent fashion , without necessarily having to deplete your family's funds to go into Medicaid or having to put them in a nursing home or do something that you just never had to

anticipate . So if you guys are listening and you're going through something similar , yeah , go ahead and write to us and let us know , because I think it's a very important topic that we don't often get a chance to talk about and we definitely don't talk about . We've never talked about here on the show . So that's what's been going on with me .

We have a plan now , you know , between me and my three older sisters we have a plan to provide care for my dad and my mom and stuff . But it's not perfect , but it's just one of those things that we go through . But it's just one of those things that we go through . I remember when I first started working .

I remember my partners who were older than me . They were going through the process of actually burying their parents , but because I was younger , I didn't quite get that and at the time my parents were still .

My dad was driving in the 70s , my dad was driving up until his 80s , but now it's like wait , now I really got to provide a significant amount of time to take care of them . So this is something that I'm definitely new to going through . I've been scouring the internet , the programs that are available . There are a lot of programs but a lot of times .

Based off of um , you know what your parents have in terms of their retirement , what they have in terms of a house , what they have in terms of just any type of financial . Um , you know , if they're not completely broke , a lot of times you don't really qualify for a lot of programs , which can be very frustrating , you know .

So I leave it like this like I remember , like when I was in residency , like I , there was a slew of people who I was taking care of like the last year of my training , who were my dad's age and they had developed like colon cancer , had like had to have emergency surgery and you know , they ended up passing away , unfortunately , and it just finally clicked

to me . I was like , wait , these are my dad's age . They never had a colonoscopy and I never reached out to my dad to say , dad , did you ever get a colonoscopy ? So I called my dad , this is like 2011 . I was like dad , do you ever get a colonoscopy ? So I called my dad , this is like 2011 . I was like dad , do you ever get a colonoscopy ?

He's like no , not that I can think of . And I was like , wow , like dad , you need to get a colonoscopy . And I rushed him and urged him and later on that year he got it .

Basically , what I'm trying to say is that , like , you could be so into like taking care of other people that you're not necessarily taking care of your own family , and I think , now that you know we're going through this and I'm aware of like , do not resuscitate DNRs , dnis , advanced directives , you know , dementia , all these different things that we see on a

daily basis with trauma , when you look back and you're like , wow , like this is actually happening to my family , when you have , you know I take care of patients who fall down and they develop traumatic brain injuries and you know one of the hardest things is deciding should they go back home or should they go to a nursing home or should they go to , you know

, a rehab facility . These are discussions that you know very easily I can have , but when you have to have that with your own family , it makes it very hard , it's very difficult to take the intellectual side out of things and really just focus on the visceral , like emotional , like that's my dad , that's daddy , or that's my mom , that's mommy .

do . The problem is that your family , they're not your patients , and so if you try to intellectualize everything with your family , you're missing a vital part of what they need in order to be cared for . They need you emotionally . They have doctors , but they need you emotionally .

It doesn't mean that you're not looking and you're not aware of what's going on and that if something is not right , that you're not going to say it . But you can't approach your family in the same way that you would approach your patients .

You know , in a lot of cases anyway , you can't approach them the same , because your family relies on you in different ways than your patient relies on you . You know and that's that's kind of a discussion that me and I have had offline , just kind of talking about you know how we care for our parents and you know making plans for them .

And you know , with older people , we know it's very , very difficult for older people to either , you know , lose autonomy , lose their faculties , you know lose their assets , or have someone you know now responsible for taking care of their assets , taking care of them on a daily basis and them not quite always knowing or being in the mix of what's going on ,

because they can't necessarily do that just based on their capabilities . And so when you try to intellectualize certain things , it comes off as being harsh , cold , deceptive , right Like older people are very sensitive to people potentially taking advantage of them , including family members sometimes .

And so when you just approach it as an intellectual , just like knowledge base , like oh , this is what it is , because I know , I've seen it before , this is what it is . It's like base , like oh , this is what it is , because I know , I've seen it before , this is what it is .

It's like you don't really think you don't really look like you care about me . Is what they're thinking ? You don't really look like you care about me . You look like you have an agenda and it's like you might not have an agenda .

But removing some of that , but removing some of that , you know just intellectual , you know facade , if you will removing some of that and replacing it with some emotion actually is not just helpful to your family member , but it's helpful to you too , because , as these things are going on , you're slowly grieving , you're slowly mourning the changes that you're seeing

in your parents , you know , and eventually they'll be gone and then you'll be left to mourn , only to mourn , right .

And so now the question becomes well , when they are gone , are you going to have the regret that you didn't have more of those emotional moments , that you didn't say the things that you really should have or wanted to say , but you were so busy trying to intellectualize things that you know you just kept it moving .

You're just going through the motions , so I think it's harder for those reasons .

Right , and although I tend to be very like , I got to have a plan , you know , to make sure what's the next step , to anticipate . You know , there's some blind spots that I have , so that's the part that is very difficult is kind of being a son as well as kind of helping to like all right , mom , dad , I got this part of the race .

Let me help you get you know to a place that you guys will feel very comfortable .

But also , at the same time , like Renee said , it's like you know , sometimes with dementia you may not know , or they they just you know . They sometimes become very suspicious , you know . So it could be . It's very tough , it's a catch 22 .

That's why I had asked as a doctor , does it make a difference ? Because you have the knowledge ? I don't have the knowledge that you have . I don't have the experience that you have .

Actually , we were just kind of talking previously , you know , before we started the recording , about childbirth right , and childbirth is also a place where it's like , dude , like I need you to be my husband , not the doctor , like I need you to be my husband , not the doctor , right .

Although I always joke with me because his OB rotation in med school was a joke , I think our baby was the first baby he'd ever seen born , admit it .

His wife wasn't an OB , she wasn't in medicine but he was and so it was kind of clear that the baby's heart rate was not doing what it was supposed to be doing .

So the heart rate kept dipping down , dipping down long points of not recovering but then recovering , and then dipping down again where it was like , look , she's so far from 10 centimeters , this baby is eventually just going to conk out . Like the baby's not going to be able to recover much longer from this . This is just way too much stress on the baby .

And so he kept pushing like no , no , no , no , let's just see if she will , you know , continue to dilate . Let's see if she'll continue to dilate . Well , whatever her dilation was , it just wasn't fast enough to be like all right , push and get this baby out . So finally he allows them to , you know , examine her and then go to C-section .

The problem is that he has emotion and intellect attached to this woman , to this process that is about to happen with this baby .

And so between the emotion of I don't want her to undergo C-section and the intellectual piece of because I know , you know , how brutal C-sections can potentially be and I know what complications can happen with C-sections and I know potentially she might be doomed to , you know , repeat C-sections in the future .

It was his first baby Then he didn't , he had that intellect , but also it was like , oh , but this is my wife . Had it been any other patient , he'd be like , yeah , she needs C-section .

Is there a part where you , as the doctor , or your team , was like , because for me , what I am always doing , if I get that situation because we get that a lot where we'll have patients who are taken care of and then we'll have family members who are either doctors or very rarely doctors , but like nurses or other health care professionals and so forth , and

you know , when they start to direct care , a lot of times I'll just center it back to the patient and start talking to the patient . So did you guys talk to the wife and say , okay , this is what's going on , what do you want to do ? Like , how did that go ?

We gonna have a session where we talk about this , because this is amazing . It's an amazing the challenges craze . I think me and you , renee , we need to do that because there's a lot of judging on your part and there's a lot I need to get off my chest . We can't .

Come like , because this is anyway anyway , they take her to the operating room , and now the resident starts trying to scrub . In what ? He's at the scrub sink and the attending finally was like what are you doing ?

But you know , the problem also was that once the baby came out , we do something called cord gases . If the baby especially I should say , if the baby isn't very vigorous when it comes out , if it's not crying , it's kind of floppy or you know , it's just not vigorous .

And the cord gases were lower than normal , which makes you start thinking like , oh , does my baby have , you know , some sort of brain injury or whatever ?

And it's like , see , you don't want to be a part of that outcome , you don't want to be the person who now has to think , man , if I had not delayed that C-section , you know , potentially could I have caused my child harm .

So this is , you know , these are the kinds of things that you have to think about as a physician who also is now the patient or the patient support system that you don't . You know , you want to be there to advocate , but you don't want to overstep and potentially be a part of a bad outcome .

That happens because now you got to think well , what was my role in this bad outcome ?

That example is really extreme , though , because it's like damn it , like you know , if you put that in any other specialty , like that's , like you know , a family member trying , or this doctor trying to scrub into a family member's case , it's like you just can't do that . Get out of here , you know so is there ?

I think we all in the in the specialty , or I think we all in the field , are just like , yeah , we don't want to treat our family members like if it's like minor things , like they have a cold or you know something that's very minor , like yeah , whatever , but like an actual procedure on a family member or , you know , actually guiding them through something

major that they're going through that you're in charge of . That's a lot of pressure and I think there's always this just unsaid rule of never treat your family . You just get somebody else to treat them . That Like I , like if something were to happen to my children , like I would not want to be the person who scrubbed it and taking care of my children .

I would never want to do that .

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Usually you get less healthy over time , so when you're healthy , it's easier to acquire the coverage . Number two it's also less expensive because it's based on your age and your health . You're not getting younger or healthier over time , so you're at the ideal time . The earlier you get it and the younger you are , the less expensive it's going to be .

She's loving the podcast and , renee , she knows a lot of your advice is geared toward younger , pre-med resident type folks . But she says , oh my gosh , I'm like wait , I think I missed that in life and yes , so thank you .

Also , I did locums when I was a general OBGYN and liked it , but I have wondered about doing it as a gynecologist , oncologist Because she did locums .

I guess she gets hounded all the time , but I just wonder about continuity of care and how I would feel if my patients weren't cared for the way I would want them to be cared for while I'm there and just like the personal connection with taking care of patients for years . She wants your thoughts on that so locums , locums , locums , locums , she's done locums .

Because if she's done , if she's done locums as a as ob , it's not that big of a deal you would think .

Audrey , maybe if you want to look up and see if type in locums and put in Gynonc and see what you come up with , because that would be very interesting to me , because gynecologic oncology is something that , yeah , there is a lot of continuity of care in terms of gynec right , because you're seeing patients , you're potentially taking out their tumors by operating

on them , and then you know you are Wait a second .

I thought your gynecologist like if my gynecologist found something in there that could potentially be cancerous tumor or whatever I didn't know that I had to be referred to someone who specialized and I thought she would take care of that .

So there are gynecologic specialties , specialists who do an extra three years , and it's funny because there's a saying that they do three years to learn five operations to learn five operations .

But essentially , gynecologic oncologists are really badass surgeons , like really , really , I mean just amazing surgeons who then involve themselves in the chemotherapy , radiation therapy and follow-up care that patients get after they've gone through a gynecologic cancer .

So , as a gynecologist , if there is locums for gynecological oncologists , I could only imagine that those would be long-term stints .

Actually , when I moved to Idaho , I was in long-term . Why'd you move there ? I was about to ask the same thing . Because who moved to Idaho ? I was in long-term .

I do know the difference like I don't think he's coming out here like giving all this advice . Oh , the polar bear comes , like you know , duck under a car , polar bears , and like shut up , you're from Brooklyn , new York . You're from Brooklyn , new York . Like you ain't learned nothing Like just relax , all right , someone told you something .

So the reason that I say that is because , if it's going to be long-term , it's usually because they need someone in their offices , right In their clinics , actually seeing patients doing the follow-up visits and things like that , as well as operating on those patients clinics actually seeing patients doing the follow-up visits and things like that , as well as operating

on those patients but I don't think that it's ever going to be like a . Well , we just need you for a week .

You're probably just going to be seeing patients who are already in the hospital , whose plan of care is already set out . You just have to continue with that . Plan of care is already set out . You just have to continue with that plan of care and make sure that the patients are stable .

Or you are admitting patients who might have complications from their cancers or from their surgeries or from their chemo and radiation , right ? Not necessarily operating , just kind of keeping everything at bay until the main gynoc comes back and is able to continue on . That's what I would say .

Yeah , locum tenants , uh , dying oncologists yeah yeah , I would just say this like , uh , dr michelle , like it's coming , um , there's just like an overcorrection , and whenever you have , um , one way of doing things that people are really upset about you know , whether it's doctors or other health care providers if there is one way of doing things and they're not

happy with it , there's going to be an overcorrection . And you know , like we do locums and sometimes we can be locums fanatics . I don't think everybody's going to go to locums , but I do think that in some form or fashion , every specialty can can do locums , every specialty can do locums .

And I think , in general , people doctors , professionals they want their independence , they want to be paid well and they want to be in control of how they practice and things that we never considered , like even cardiothoracic surgery , right , like , is this my heart surgeon ? Is it just here for the weekend ? Possibly ? Yes , that might occur .

Right , the way in which things are going , with the way how people want to live their lives and have their careers going , some people want to have a situation where , like , maybe they are doing heart surgery for Monday through Friday and maybe they need weekends off and someone may have to cover and maybe there's a major complication that occurs over the weekend

and that person who's ever there doing low incomes may have to do it . Same thing with gyne . It happens in trauma , it happens in OB , it happens in medicine , it happens in neurosurgery , it happens in all the different types of specialties .

I think the most important thing is just like , what are you going to add and what are you going to bring in to make sure that the patient has really good outcomes ?

And I think for me , because I practice with trauma , because I do trauma and I do it in an independent contracting fashion , but I do it for like a week at a time and then I go is I'm very I try to be very responsible and very realistic about what I can offer a patient .

If I know that a patient needs a major operation and I won't be there to complete it , or I won't be there to , you know , see them to the finish line , then there's two options that I have .

One is you know , I make sure that my partner can at least complete the job right , finish the next surgery if it needs to be done , or at least make sure that my partners can finish the care of this patient if they need that , or I transfer them to a higher level of care , right , because I tend to work at level two trauma centers or smaller hospitals .

So if I need to send them to a larger facility that has way more resources than I have , then I tend to do that also . So I think that it just looks different .

But I think in the realm of Gynoc or surgical oncology or anything that's related to oncology , where you need to have a long term relationship , I think that you're going to see loc healthcare providers with their lifestyle and I think , even just from a , when you have a situation where you have things corporatized , it has to be a situation where , you know , in

the corporatization of healthcare , you have to have a situation where people can be plugged in and plugged out , plugged in and plugged out , which leads us to our next topic . I don't know when we're going to get to that , but , um , you know we're talking about doctors striking and so forth .

When you have , you know , things so corporatized and people get plugged in and plugged out and cogs in the wheel , well , the even doctors who are not normally thought of as cogs in the wheels , they're going to act like a cog in the wheel and they're going to strike like other employees because you treat them like an employee .

So that's what I have to say about that .

there's a . There's a component of having to trust , trust the system to some extent , because even if even in private practice you can't be there 24 seven , you , you , just you can't . There has to be a point at which there's a handoff .

And we know that as much as we like to take care of our patients and make sure that we're doing everything that we can for our patients , you can't do that for 100% of your patients all the time .

So there has to be a handoff and you have to be able to trust your partners to be able to do you know what they think is best Not not always what you think is best , right , but what they think is best because they're not you and trust that that will yield at least a good outcome for the patients , the best outcome possible .

It's just that 0.01 percent that or 0.1 percent that is different and it the difference is so infinitesimal in comparison to the overall care of what you got , like we all think that you need an operation or we all think that you don't need an operation .

Like , and even as physicians , there are things that we do that have no scientific basis whatsoever , but we do it because that's what we were taught in our respective residency program , right ? So , for example , let's say , renee trained at an OB program and I trained at another OB program .

To be honest , the way how we take care of people is going to be exactly the same , but there's going to be like small little minor things that , like she may do , that I may do , but when you look at things overall , it doesn't really make a big difference . Right , it's all the same thing .

It's just that she just does something a little bit different than I do . But overall , we know that this patient needs to be delivered , this patient needs to be C-section . This patient may need antibiotics . Well , where you may see a difference is she may use a different antibiotic than I may use a different antibiotic , right , or she ?

may take her staples out like a day later than I would . For me , that's what I've always seen as the biggest difference you'd see nothing major .

Like , yeah , we just do things differently , but I think that there's also the element of one your personal preferences , your biases , your knowledge base right , because if Dr is taking care of me and Dr is up on the latest X , y and Z , but Dr X is old school and does stuff the really old school way , in ways that you know , haven't proven to be up with

the times and have actually , you know , is just really antiquated in the way that Dr X practices which might prove to have worse outcomes than more modern stuff , then , yeah , I think that that actually does make a difference , right ?

So , you know , even when let's talk about , like , appendicitis , right , there are now guidelines that suggest that , for certain patients , antibiotics would be appropriate If a person is not a great candidate for surgery or just doesn't want surgery for whatever reason , and they are a good candidate for antibiotics , but Dr X is like nope .

When I trained , everybody got a surgery right , everybody got surgery for appendicitis . Well , that's a huge difference . The other thing that I would say also is your approach right to patients . How do you speak to patients ? How do you educate patients ? Are you capable of educating patients ? Because there are doctors who are not capable of educating patients .

They come at patients with all these scientific well , there are two schools of thought . You know , blah , blah , blah . It's like nobody want to hear that . People want to hear what is wrong with me , what's going to happen ? What are you going to do ? How are you going to fix this ? That's what people want to know .

You know they want to know that you're , you're compassionate . There are doctors who are not compassionate , they are very cold , intellectual and they just tell you what they got to say oh , I'm sorry , you got three days to live , bye , bye , and then that's it , and it's like I want to hear that .

So I think that you know that small percentage is where the meat is at , like that . That's where it is . You know all that 99% stuff is great , because the 99% , if all of that is the same , that's not the thing that's going to , you know , change your outcome .

It's that small 1% that's the thing that's going to change your outcome and unfortunately , you know when you switch doctors if Dr Nee goes off and you know somebody else is coming on and Nee knows this , that he's seen that that 1% it makes a difference .

listen to your show . I'm like , oh shit , really , when did I sign out ?

But while I was there I delivered her . But while I was there I delivered her and I told her I'll deliver you , but I had to go away that weekend . So I ended up delivering her on a Friday evening and by Saturday I had to go . So I had to hand her off .

Now , before I left , I knew that the colleague I was handing her off to was that 1% difference was in the way . He was going to speak to her about birth control .

So I spoke to her about birth control and then we would continue the conversation when she came back for her you know , for her visit and I said to my colleague you don't have to talk to her about birth control because I already talked to her about birth control . We got a plan . It's okay , don't talk to her about birth control .

Heart , lungs , uterus , legs those are the things you need to examine . Do not talk to her about birth control . So what does he do ? He goes in , he talks to her about birth control in the most asinine , paternalistic way that you could ever imagine a 50 something year old , very traditional man coming to talk to a 16 year old girl about birth control .

And that was the letter that I found that she that she wrote it was a complaint . But that 1% , right there , right Cause he didn't do anything different . He discharged her to home on day two , didn't do anything different for her , but that 1% , that was the difference .

Her comment was um , she's been following since med school , she completed residency in 2022 and has only been doing locums as an attending , and so she found that you guys provide extremely valuable advice as she's still learning and navigating this territory .

Thank you for your continued dedication to educating the community in a transparent fashion , and thank you for exposing us to the many possibilities that exist out there . For those of us that in medicine who want to do the unconventional Bless up .

But he's older than me , he's , you know , maybe 20 years older than me and he does locums for urology . So he's we're chatting about you know what it's like to do locums for urology . So we're chatting about what it's like to do locums for urology and speaking of having a long-term relationship with patients and so forth .

He covers the ER and he doesn't cover clinic . He just covers the emergencies that occur with urology . So we're just chatting and he's like , yeah , you're fairly young , how long have you been doing locums ? I was like I've been doing locums since I finished training and I done it throughout . You know , even being employed , I would do locums on the side .

And now I'm a hundred percent locums and I'll be very honest with you , I would not go back , right . And he's like man , like he's like it's , he told me he's like it's really amazing to see that you are very young and you've already come to that .

You know analysis , you know he said like I'm in my sixties and I just started doing locums two years ago and the way how it occurred was I was trying to . I got to a certain age and according to that age , according to the bylaws of the hospital that I used to work at , I don't have to take call anymore .

Well , he said , well , after you know , covid occurred and left . Well , he said , well , after you know , covid occurred and left . Like they kind of changed the bylaws where it wasn't always just purely based on age . Now it's they have to , like the medical staff has to vote , to see that you just let me not take call anymore .

Well , they put it to a vote and one person said , yeah , you know , he lost by one vote and he's like I don't care , I'm not taking call . And it just became this back and forth thing where eventually he ended up signing a letter of resignation and he left .

But he says look at that , I'm a guy in my early 60s , I left practice , I left New York , you know , and now I'm doing locums . But my wife says I'm happier , you know , we make just as much and I'm home more . And I'll be honest with you , I'm less , you know , irritable , you know , and I don't have to be in clinic all the time and stuff .

Now , I'm not saying that , you know , doing locums is the panacea , but I think it's just really fascinating to . You know , we're recording this episode and you know we get that comment . And then I had that conversation late last night , you know , with a urologist . But it be's like that , you know it be's like that .

And I was telling him the same thing that , hey , like you know , when you have docs in a certain position , or if you have people who are in a certain position and they don't like it , they're going to overcorrect Right position and they don't like it , they're going to overcorrect right .

You see that in college sports , you see that in music , you see that in you know a whole bunch of different industries , where people just say , look , I'm going to go completely to the other side and until we're able to meet in the middle , you know this is the way it's going to be . So , very interesting conversation .

But Viadals , I think I actually know who that person is now . I think they've written to us before . Is it v-i-a-d-o-l-l-z ? Yes , yeah , I think they've written to us before . But shout out to you and we're glad that you enjoy the show and we're glad that you're continuing to do locums and , as we always say we do locums until it doesn't work for us .

And there's something called I think it's called New York City Hospital , health and Hospitals or something like that which is a contractor for the public hospitals that employ the doctors who then work in these public hospitals . Right , because if they were public employees , they actually would not be allowed to strike .

So what's going on is that the doctors , of course , are burnt out , they feel like they are underpaid , they feel like their underpayment is not allowing for recruitment and retention of quality doctors . So there's probably a lot of turnover ongoing , so that the doctors that remain end up having to work longer hours .

So they are striking so that they can get better compensated , they can get better benefits , I'm sure you know , with compensation , or with better compensation and better benefits , their thought process is well , you'll be able to attract more quality doctors and have doctors stay in this very high cost of living area called New York City .

Right , because I mean , that's the point , right ? If you don't have enough money , then how can you really say that you're going to stay at the job that you're at . So that's what's going on , and they're planning on striking unless there is a deal made .

I think that you know , I haven't read what they're saying , but if what you're telling me is true , like these are reasons to fight for , whether it means strike or whatever it may be but these are issues that we see at a lot of different places where you don't have enough staff because you have a facility that doesn't want to pay the staff or they don't want

to pay for help and so forth , and , as a result , you get a lot of turnover . People are like look , I can only work here for a certain period of time and then I get burnt out . I got to go someplace else and then the people who are stuck there if you can't recruit anymore , the patients are still coming .

So now you're doing more with less , and this is an issue . But I think when you have docs or professionals who are , when you treat them like employees , this is what employees do they strike , and I think that we all in general I think the public in general is going to have to learn to accept this , as this is going to be the reality .

It's going to happen more and more , and this is just the way , how it is , and I wish the doctors good luck . You know , because I think that you know , when you have this big of a , when you have this big of a strike , more than likely the state is going to get involved , like the governor is going to get involved .

We just saw a doctor strike what last year ?

And so we're seeing even more doctors unions pop up , which is probably why we're also starting to see more strikes , because people are feeling like I'm a blue collared worker as a physician . Now to your question Kiara , as a locums , right , you wouldn't have this problem .

Because the reality is , as a locums , you've kind of set the example for those employed physicians to be like . If you don't want these problems , here's a solution . It may not be the only solution , but here's a solution .

If you were all really concerned about all of this , instead of striking , what you would all do is quit and say rehire me as an independent contractor . Now , that job might get shot for that one , but but if you really want to strike like , that's how you actually strike right .

That , okay , we have to always maintain a positive relationship with this group , and that positive relationship may either be making sure that they have you know , we help to decrease the turnover or help them with whatever they may need , because if they bounce and we can't force them to stay , we up Schitt's Creek , basically . So is that what you're saying ?

I like my little job , I like my little benefits , I like knowing that I don't have to pay for my health insurance out of pocket and go on to the healthcare marketplace and I just like all my benefits . Okay , that's fine . You don't need all thousand doctors to do that .

What you need is some measure of a tipping point for even if it were 400 doctors less than half of the thousand to say we out unless you give us an independently contracted relationship , Because New York City will be hard pressed to find 400 doctors all at once to come in and do locums right , Like on their own .

act blue collar .

Right , let's say , you know the situation is shitty , you're working there , and a lot of times what happens folks is locums come in and they can handle shitty situations because they know they don't have to be there forever . They're like look , I'll work my two weeks and then I'm out . Or I'll work a week and then I'm in and I'm out . See y'all later .

And you come back in and it's like , okay , I can handle this , but it's only for a short period of time .

But then what happens when you're there , for example , dr Renee , let's say you work in there at this facility and you're like your colleagues who happen to be employed are like listen , we on , like January 13th , we striking you know we , we doing this , we doing our Nat Turner thing , what you doing , are you coming with us ? What you ?

I'm here because of the same reasons that you want to strike , especially if I've been here for a long period of time . Guess what ? That only says to me that your only option right now is to strike , because they're never going to fix this problem . They're just going to keep calling me in . So yeah , go out and strike . I encourage it . I encourage it .

Go out and strike .

You get there , you find out that , um yeah , like the , the doctors are burnt out , they don't have assistance , blah , blah , blah . But ultimately you see that patients are , care is at risk . What would you do in that situation ? Do you still work there or would you leave ?

I was new to this hospital and it took me like two times going there two or three times going there to realize something's not really right here and I felt like I would have a lot of liability . So the answer is actually no . I'm not going to put my livelihood on the line for a hospital whose system is going to bite me in the butt .

Right , I see , because it's the system that's going to bite me in the butt , but I'm the one whose butt is going to get bitten because that hospital is going to keep standing . My license might not .

I'd be like because y'all crazy and you want to put your livelihood on the line .

I do think that , as if you are locums , like this is a situation where listen , like if you don't like it there or if it's a shitty conditions , you can always just be like I'm not going to work here anymore , I'm going to leave . If you decide to continue to work there , then you know it's temporary , you get in , you get out and go from there .

So for me , I would continue working there , even if they were striking but my deal breaker , and then it's time for me to go . Or it's just a place I just don't want to be at anymore . It's time for me to go . But I applaud them . I applaud them for fighting for what's very important , which is their sanity , as well as the patient care and so forth .

And yo , if you guys don't know medicine , I feel like there's a demarcation line Once you cross over the Hudson Riverson river . Like medicine in new york is different than medicine and anywhere else where else .

You guys don't like people don't understand like that , like , just like the concept of like getting a patient out to go to rehab , like where are you taking them ? Like , right , like this brooklyn is or , excuse me , new york is just so like inundated , like you could be at a shopping , like at a bodega , and right next to it is a rehab facility .

Everything in New York is just different , right ? Let me get a big thing of cheese ?

But in addition to what the current fees are , if you are going into New York below the 60th Street , between what five in the morning and like nine at night below 60th Street , so we're talking about like . We're talking about like , from the Holland Tunnel , you know , all the way up to like , Midtown , right ?

If you're going from New York to New Jersey , from New Jersey into there , or if you're just traveling into that area , they're going to be those little scanners that are scanning you , looking at your , your license plate and sending you $9 to come in . And that's crazy . And from a hospital standpoint , it's crazy .

Think about everybody from New Jersey who needs to go to a hospital . They get their healthcare in New York , New Jersey . Who needs to go to a hospital ? They get their health care in New York , right ? People who live in Fort Lee or who live right across the river and they had to go get their health care below 60 , they're going to get taxed , crazy .

You , if you can live in New York , you can afford $4,000 a month rent or you have , like a high raise that you own , and there's not going to be a go between anymore , right ? So you're really rich or you're really poor , and people are already moving to Jersey for that . People are already moving to Connecticut and other places .

So the thing that's crazy , though , is the news and the narratives really drive the public sentiment on this too , because the whole point is to drive people to start using public transportation .

But if you guys have been paying attention with what's been going on in new york and public transportation like we're talking about , like what , earlier last week or late last week , a gentleman got pushed in front of a train , right , and then a week before that , or two weeks before that , a woman was sleeping on the train and she got set on fire , so it's

just like there's a lot of stuff going on . I mean New York .

Like you walk down the street and you you see like seven crazies aren't in a block . You never know what you're gonna get that day , but it's the norm . Like it's like oh shit , she's on fire . And then it's like okay , and then you go on about today .

I think right and um , I don't know that that part is is is a very difficult one , because I think you know that's an extreme one , right like you don't really see people get put on fire there . But you see , you know you'll see like scuffles or I mean you have millions .

the flames . So you also have to think at this point , it's about preservation . It's about preservation . Yeah , so if I go put her out in my next , wait , you're talking about the guy who did it . Yeah , the guy who did it . He was fanning her , yeah , he was fanning her claims To make it worse .

I would have thought you were crazy , because I'm like I'm going to New York , I'm going to Jersey , I'm going to practice there and that's where I'm from , and I would have never thought that I'd be practicing , doing what I'm doing , you know , in different parts of the country , mainly because I don't want to practice in New York .

Nope , I don't want to practice in New York City . You know , I don't want to live in . That was an opportunity to do .

You know , as a physician , it definitely doesn't Do you ever feel like you abandoned your neighborhood ?

It's not sustainable for the people who live there . It's going to be sustainable for me , it's not . So how am I going to bring quality care ? This is why the people are striking . This is why the doctors are striking , because they want to take care of those neighborhoods , but they can't . They literally can't .

The doctors are suffering , the patients are suffering , the community is suffering , everybody's suffering .

On my part , I'll be honest with you . I struggle with that . I struggle with that . I'm like man , like you know , like the hospital in my neighborhood . It closed and now everybody goes to Newark , beth Israel .

But there was a hospital in Irvington that you know treated my grandmother when she came from Ghana and treated , you know , I , when I broke my finger , you know I went there . That was the nice local hospital , beautiful local hospital that they just shut down and then shifted everybody to Newark .

But you know , sometimes I feel like man , like did I , you know , did I ? Did I abandon this neighborhood Because you know it's tough , it's a tough thing . So I .

How much more can I actually put , how much more frustration can I put up with ? That's different , though .

The country in general has invested in that person . So there's a certain level of responsibility or there's a certain level of they have to pay back that stuff and then when they leave , it's like it really is a big deal in these countries , right , it's it comes down to .

We talk about this I don't know if you guys have heard about this Audrey and Kiara of in the United States , what's really taking care of patients ? Is it the system or is it an individual doctor , right ? Whereas if you go to like , you know certain places that are- .

So in this situation where , like you have like an entire country that's putting significant amount of investment into individual providers , when they leave , that leaves a huge hole , particularly if you have a doctor that's taking care of maybe you know 10,000 , you know 20,000 , 50,000 people and stuff .

sustainable situation for them . Whereas in the United States you probably will never see a medical mission in Brooklyn , New York , right , Because there is . I don't want to say there is no shortage , because there's always a shortage in New York , but not to the extent of , you know , a shortage of where you would do an international medical mission .

Right , there are places that people can go , whether it be 45 minutes away , 20 minutes away , there are places that people can go and you are most definitely going to find a doctor there .

So , even if you brought every single doctor in the United States to all of the underserved areas you know that there are , like it's you're not going to have that same level of , I guess , abandonment in , you know , in another country as you are , you know , in the United States . I just I don't know .

Because if you do a procedure on a patient in these medical missions and they have a complication , who's going to follow up with these patients ?

So that is a big deal , that if you're starting a medical mission even more so than just like , how do we start a medical mission it's like , okay , if we start a medical mission , who's going to even follow up on these patients ? Like that's the first thought If we do this , who's going to follow up with these patients ?

So I think that can be a big problem . So it really boils down to , like you always have to make sure that , like you are having the community buy in and you're also having the buy in . Well then , when you leave , like those physicians need to know how to handle the complications of that esoteric surgery also .

So that requires , like , a really good working relationship . It requires trust . You know , it requires time . Say , what did you say Willingness , willingness and stuff and meeting people in the middle and that's one of the hardest parts . That's the case with our medical missions .

But , like Nhi said , it depends on the organization that you go with , and that's why you have to determine exactly how much care are you going to give to a patient , because in trying to decrease someone's suffering , you could actually increase it upon your exit .

If someone has a complication , it's like well , you know they were suffering before , but now they're suffering in a very different way and no one can take care of them .

But you know , when you are for me , yeah , when , when , like I had to really let it be known guys , like in the beginning of the year , in August , which is seven months , eight months from now , I need two weeks off to go and do X , Y and Z .

So , like sometimes in July , you know , when August comes out , it's like , guys , I told you like I need two weeks in a row off so I can go to Ghana . Like this happened a couple of times , like I don't know why , like I told you this , you know , and luckily my partners were very like , oh yeah , we got to make sure that that occurs .

But you know that could be a problem . You know , getting two weeks off in a row as an employed doc could be tough , I think .

It'll send you kind of our freebie about , you know , it'll tell you something very interesting about locums , but it will also allow us to have your email , your information , to be able to send out to you so that once we are taking individuals for the course and seats are going to be limited that you will be the first to know .

So go ahead and click that link , give us your information , get that freebie and be on the list to be able to get info on the course .

So in the course you're going to learn kind of some of the things that we've been talking about , you know , over the course of the podcast , of getting your first locums gig or optimizing if you're already doing locums , optimizing how you can get the gigs that really work for you , negotiating those gigs for yourself , setting your schedule and really just kind of

building , I guess building a portfolio of assignments that will allow you to kind of live the life that you want without burnout , without having to worry about your schedule , like we just talked about , and just knowing what your deal breakers are .

Right , we all have deal breakers and sometimes we kind of try to push past those and with locums you don't have to . Something's a deal breaker , you check the deuces and you keep it moving until you find a gig that you want .

But I think the locums course is going to be a nice way for those of you who haven't done locums before to really understand the nooks and crannies , the meat and potatoes of doing locums , especially if you want to do locums as a full-time gig .

But even if you want to do locums kind of part-time or on the side , just to dip your little pinky toe in the locums pool . This course is a great way to be able to do that .

They stick their head in the sand . This course will help uncover all of that stuff for you , so that you can really get started even doing this part-time on the side , which is what we did and then eventually , if you want to , you can always transition , with the knowledge that you'll learn in this course , to transition to doing locums on your own also .

So I think it's a really great course . We put a lot of work into it and , yeah , we've been doing this for locums for over 12 years , so we know what we're talking about Real quick . Before we end this episode , guys , I just want to very quickly , in five minutes or less .

Guys , I just really want to know you know what is the outlook for you guys for 2025 ? I have my outlook , so I'll give you guys an opportunity to say what is it . What is the New Year's resolution ? What is the theme or 2025 for you guys individually , so why don't we start with Kiara ? What's your theme for 2025 ?

I actually decided not to do any resolutions this year .

So last year I actually lost 20 pounds , from beginning to end , I know , and I feel a lot better . But I didn't do it with the intention of , like I need to reach this by the end of the year . It was more like oh , I want to start working out more consistently and whatever I lose , I lose .

Whatever I don't , I don't just to feel better this year , I would like to keep that up and maybe read more , but I'm not setting like a number to that , if that makes sense . Like I'm not like I want to read 50 books by the end of the year , because if I don't meet 50 , I'm like , well , you know , you kind of suck .

So that's my only reservation you already know what you need to do , but why are you not actionizing it ? Why are you not doing it ? So I plan on answering that question throughout the year . So go ahead and do it and also travel . Kiara , we're on the same .

I just wanna be intentional with many things in my life , including like romantic relationships . I just want to be intentional with so many things because , yeah , so I look forward to like answering the question . You already know what you want for yourself to be a better person . So why not ? Why are you not doing it ? So I'll keep doing things to you know .

Answer the question . So , yeah , that's me for 2025 .

You know where our kids were younger and they destroyed everything . Not that they don't still destroy things , but they're older . I'd like to kind of be more intentional about the spaces that we create in the house , so that I can just feel better .

There's a lot of things that I just want to just cut out so I could be hyper-focused on what I do really good at , and I think that over the years as I started in the beginning of the show , over the years we've just kind of taken on more and more things that we want to do as fun and I think we've become a jack of trades and I think it's time to

become masters of certain types of activities that we do , whether that's real estate , podcasting or whatever that

may be . So my goal this year is to cut the frivolous stuff out , really focus on even with the podcast , like quantity excuse me , quality as opposed to quantity and really focus on putting out great episodes and really focus on , you know , getting Docs Outside the Box back to being the best podcast out there for medical professionals .

All of the stuff to get in touch with us on our socials , as well as to text us or send us messages , is below in the show descriptions or in the show notes on your podcast app , whatever you're listening to . All right , we'll catch you guys on the next episode . Y'all , peace , peace .