Dr. Shivonne asks about locums and investing. #403

These are communities that look like me trying to explain it to corporate that you know I don't care what your fair market value . You treat me as I compare it to no number you can give me . You have to see my worth .

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

A lot of times we don't get a chance to really interact with folks who are listening or people who just have questions about just what to do with their career , what to do with their lifestyle , and we are always given advice .

So this is a great opportunity for us to kind of talk to a listener , get their opinion or , excuse me , get our opinion on what they want to do with their life and we just kind of take it from there .

So , everybody , we're going to put the , the number that you can text us if you have questions and if you want to be on the show and have a discussion like this . But we have Dr Siobhan Suttles excuse me family medicine doctor who's here to talk about locums , talk about investing and probably a little bit more .

Dr Siobhan , you want to tell us a little bit about yourself , where you're from , tell us what med school you went to and where you're practicing at right now .

That's what I love to do , as well as adolescent and women's health . So those are my focuses , and I'm currently in Akron , ohio , and I went to Neal Yukon , which is now known as Neo Med . It's had a few name changes Since I went there .

I think every president has named it something different , but that's where I went to school and I did my residency at the Ohio State and I am currently , like I said , in Akron Awesome .

To make this kind of money and to keep up with that kind of Workload is getting a little mundane and a little tiresome , that you know . Getting up in the morning is a little bit harder Each and each day .

To go in and face that kind of environment and the turnover of the number of providers that's there in having to reintroduce yourself to new patients every day , even if they have already established with the company themselves .

They're new to you and so instead of having two new patients per session , you're left with 11 new to provider patients because they've had an abundance of physicians leaving to go somewhere else because they need to feed their families . I mean , you can't be mad at people changing every two to three .

Contracts are changed in the middle of a year and then you are left to either stay and accept what they don't give you or find some other alternative , and so I'm in the middle of contract renegotiation and looking for some guidance on , you know , making a different step , such as locums .

And then the dynamics is I see and serve the health equity in the city , so like I see the patients who nobody else really wants to see , you know , whatever , because of the high acuity of the patient , and so it's only me and one person that sees a majority of those patients here and so that's one clinic .

And we're in the underserved area of the city , right across the street from one of the biggest churches in the city , and so we get a lot of care from homeless . You know people out of prison or out of jail . You know they get referred to us , especially since my partner used to be one of the providers at the jail here in the city .

You know they will sometimes come over to our clinic once they were released , so we see a lot of those patients who you know otherwise wouldn't see a doctor .

You know , whatever , I got a higher help to come in and help , and so moving back home was easier because my sister is literally three minutes around the corner for me . And she puts my son on the bus in the morning for me and get some off the bus in the afternoons . And then , you know , those two nights a week I want to go work out or at the gym .

She got to keep them later and I just feel like that's a lot , even though there's family and they don't require you to pay them , thank God . You know it's still a lot and as a mother you got that guilt feeling . You know you feel guilty about not being there for your kid in the morning and you only there at night and so you look like the monster .

You always got to put me to bed and wake me up and fight with me in the morning , but throughout the day we don't have . We have limited hours Monday through Friday .

And then you call me back and say no , dr Suttles , I need you to be the lead over two offices now . And so I'm , like you , trying to restructure your primary care department and in the meantime I'm left out here , naked by myself , you know .

And so there is no room to schedule follow up visits , there's no room to see anybody really acutely , because you're trying to fit in people's patients and I say people's patients , other doctors , patients who you haven't had an established relationship with . You're trying to fit them in on your schedule and still see the patients you established a relationship with .

And so there's nowhere to put these people and you don't want to hire anybody .

I don't know if you guys heard , or it was on front page news here , of course , but our hospital just got Bought by a venture capitalists group . No , from a nonprofit hospital system to a non for profit hospital system , starting in probably January of 2025 . And so you got doctors who still need to pay the student loan debt .

But here we are in the middle negotiations and you trying to decrease your match to my 401k . You trying to remove CME money . You want to pay me less to do more and I'm just like nah , that don't work for me . And also we're in contract . I think we kind of know where this negotiation .

You know you got all these different locum companies out here and some of them be in my email , you know whatever , but I don't know who to go with .

And already , with the restraint of being a single mom , like I had explained earlier , travel is looking like something and I'm going to have to consider , for the simple fact that I looked at your list of the top 10 places that's looking for , you know , family medicine , docs and stuff like that , and the commitment they're looking for is like two to six months ,

I'm like , no , I need something a little bit shorter , shorter but lucrative .

Because I think a lot of people are like bouncing is not an exact , is not an option , right , unless you have a plan Right . So it's either resign with the hospital under the full terms or and you have really good , you being from Akron and you being from Cleveland you got LeBron James there , who knows how to sign a one year contract On the low right .

Excuse me on the right , you'll sign a one year contract , over and over , and over , and over and over again to keep companies to keep the Cleveland Cavaliers making sure that they have talent around them , right , right . So my question to you is one can you just bounce right , just be like I'm out ? Do you have enough in your savings ?

Do you have enough of that to just be like , yeah , I'm not working until I figure out something better ?

And he told me it's pretty much up to me , but you know , you sit at home for six months . That's six months . I'm putting myself backwards . This that afford , but yeah , I could just bounce being short . I mean the answer to that , I could .

One of the things that you could do is you could do the smooth transition right where you work OK , but you do low comes on the side . Now I know , as a single mom , you're already busy . That's going to be tough .

So I guess my question is before we get on to the move and trend you're , before we get into the work in transition , my question is in renegotiating this contract , it sounds like you have a little bit of leverage if people are , you know , chucking the deuces left and right and so while we joke about that one year contract or whatever , the reality is you

probably got a lot of leverage because they probably don't want to lose you . So what , what do you think you could do in order to leverage , kind of , you know , your ability to be able to take advantage of the situation that you have at work and move that into something that you could do , you know , while you transition into low comes ?

So my first couple of years out in practice were in these underserved areas . So I'm dedicated to the patient , you know . Whatever , and it's hard to find people who are invested in those communities , you know , and these are communities that look like me .

And so you know , trying to explain it to corporate , that you know I don't care what your fair market value you bring me , as I compare to no number you can give me , you know whatever . I was comfortable with what you were supplying me before and I'm not looking to make any downward move in my , in my salary , you know whatever .

And that's where we are currently Like you have to see my worth , and I have patients that would stand 10 toes down , like she need to stay , you know whatever , and so who I need to contact ? You know whatever kind of thing . So I think I have some leverage there . And then the fact that they keep adding more responsibilities that come at a price .

You can buy my loyalty for it one year at this fair market price for me , and if that's a no , are you negotiating yourself for ?

it would mean to the hospital with you there and what it would mean to the hospital without you there , without bringing emotion , then , yeah , if you feel comfortable having that type of conversation , go for it .

So for me , I just get a lawyer so I can handle all that stuff , because I , for me , it's just , it's really hard for me to , yeah , like it's hard for me to be transactional about what I do , because what I do on a daily basis is very high intensity you know what I'm saying and for me to kind of just say , hey , like you know , a trauma surgeon is

worth this versus this . There's this . This quantification is hard , you know . So that's often me . I always get a lawyer , because after a while I get bored .

And when I get bored and I start to get frustrated but we're different , we're different , Um , so if you feel like you need a lawyer who can kind of talk about things in a very transactional process and you can't , then go ahead and do that , right , because right now , lawyers who can negotiate for yourself we had one on our show about a year and a half ago

. You know , the average cost , I think realistically , is anywhere between like 500 to maybe like $3,000 , possibly depending on how long it takes Right , but sometimes it doesn't mean that you can't at least get a lawyer to at least review the contract Right . The final yeah , at least give you advice on a contract .

Like , maybe I would ask for a and then I would let B slide so that C can come through and look nicer . You know something like that so that you know that you know in a negotiation you can't get everything Right , but maybe you can get 50% of what you need and go from there .

So if it can be interpreted one way versus another way , you need it to be rock solid , like this thing cannot be interpreted any other way but this way that you want it to be .

So I need a salary , and I need a salary with a floor work RBU that I need to meet , and then I need to know what my payout will be when I see the work RBU you're going to set .

And so now this year is well , hey , Dr Suttles , you didn't meet that measure , so we're going to drop you from a tier four to a tier two no , you're not . Right , because one you can't show me any evidence of a provider who came in this environment and met your current work RBU . You can't even show me how to do it , you know whatever .

And so therefore , it tells me that you hired me knowing that I wouldn't meet that expectation , and so you always plan to pay me less to do more , and so we're going to renegotiate that .

In episode 176 , jamie Fleissner of Cephalife Insurance explains why the best time to buy disability insurance is during your residency .

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 .

So RVU , basically , is a way to quantify .

How much work you do , and it makes sure that the gallbladder that is done in Denver or a gallbladder that is done in Ohio is basically the same price as a gallbladder that is done in Jersey or in Florida .

And what we find out , though , is that if you see a patient who , for example , in family medicine , I'm sure like the RVUs for seeing a patient for a high blood pressure check is not the same as an RVU for a high blood pressure check . It's not the same as an RVU for someone who may have something more complex or a combination of things .

So it really affects your ability to provide a stable income for yourself , because what we end up finding is that RVUs , that relative value unit , really it values procedures more so than clinic visits . Is that safe to say ?

subtles example . It's guaranteed , like they're going to pay you 200K , no matter what , and then in between one of those years , like your second year or third year , they're looking at all the procedures you're doing . They're looking at all the clinic visits that you do .

And then what they do is year four , when you resign with them or whenever it's time to renegotiate or you may not even have to renegotiate that next year is going to be based off of how much you make , is going to be based off of what you did the year before . There's no longer a salary guarantee , right ?

So if let's say , for example , the people don't come to the clinic anymore , you're not getting the referrals that you need anymore , or whatever it may be Patients .

So those who are listening , I hope you're only like why she asked about nope , that happens a lot guys , yeah Well especially when you're doing the work of 10 men .

It's like , you know , at some point they , you know , at some point they have to realize that you do have that leverage , because they don't have the number of providers , and , no matter how much they want to double and triple book you , it is never going to actually equate to the number of patients that they would see if they have the number of providers that

they actually had , which it sounds like they are not really doing a good job at keeping providers .

For me , I think that's actually the leverage that you have is that they don't have the number of providers that they need and that you are providing , you know , a service , especially when you describe that you're seeing a patient population that a lot of doctors might be running from .

If I were you , though , I would never bank on doing a negotiation based on something that they will externally promise ie , we will get more providers . They cannot guarantee you that . That is a big conditional , because it has . It's going to be an if , not necessarily a when .

So when you negotiate on something that you know that you can control , that you can set the boundary on . So I do like the . You know , I want my salary , I want my base salary . Is that your biggest pain point ?

So I'm trying to get my feet wet a little bit , but I can't be pushed into it , you know whatever , and still expect to do this job . And , like you know , one of the biggest things for me is that most of the administrators here are physicians , right , but none of them carry a patient load , not even a half a day a week , right , you know whatever .

So if you want to help the system , you know , instead of sitting behind a desk , see some patients If patients is how we going to get our money you know Right .

Are you here to make it easier for the administrators to understand the plight of doctors , or are you just here to basically be a nice face to the demands of what the C-suite wants doctors to do ? You know what I mean . That's what I get nervous about .

Probably not , because I'm in this big conglomerate . I'm in this . I'm just a cog in a wheel . So I'll do what I can .

But right now , the priority is I got to get my time back and I think that's probably a majority of administrative physicians , you know , and no shade to them because they probably did it because they were burnt out from seeing so many patients and they probably feel like , yeah , I'm not , I'm just a cog in a wheel .

This is not necessarily going to change , but I've got to do something to change my own life for myself and for my children .

You know , like you mentioned , you're a single mom and , yes , you become the monster of wake up when the child doesn't want to wake up in the morning and go to sleep , when he doesn't want to go to sleep , and it's like you know , is that the only interaction that you're going to have with this kid ? Correct you know .

What I was thinking is just maybe considering seeing how far you can get with negotiations and then just deciding .

You know what this is going to be either one year or two year type thing and during that time you're saving up , you're getting your ducks in a row , you're speaking to family and you're just saying , hey , guys like oh , and also you're looking at other options , whether that's going to a competing hospital or considering locums , or maybe considering urgent care If

that's not like restricted from you when you leave your hospital , and so forth . But I , during those telemedicine , telemedicine right , you know those one year to two years . Those are the things that I would be doing to really like get yourself ready to transition out of this situation , because it doesn't seem like it's a situation that's going to end positively .

Because , yes , let's say you do get the salary guarantee and yes , let's say you do get the RVUs that you want , like the things that are also just important to you , ie spending time with your children , not being on call or seeing so many hella patients . I don't know if that's really going to change .

So I mean , one other thing that I wanted to negotiate in that too , was some protected time . I already get a couple of hours of protected time per week , but because you're asking me to take on more administrative role , I need a little bit more protected time . And so that's you know paperwork coming in from four other doctors plus your cell .

You know , that's the part of my job I hate to . Renee , I heard you say I hate the paperwork .

There's opportunities to be locums there . You'd be surprised you leaving . You might be able to do locums at your facility . I was thinking the same thing . It's like you know what y'all can't have me this way . You don't have to have to have me the other way , right ? That's one thing to consider .

Also , don't sleep on like private practices that are in the area that need some coverage on weekends or may need coverage when people take time off Yep , right . And also don't sleep on like other competing hospitals that just need locums coverage , you know , for their practices either during a week or during the weekends and so forth . It just depends on you know .

And obviously you know there's family practice opportunities where you have to travel , right , but that's going to be difficult .

You know , with a six year old , you know that's going to be really difficult and that's why I say it depends on how uncomfortable you want to get , but I think you can do it , maybe not far away , but I do think you can find these local places that are willing to contract with you , maybe even just running an urgent care , you know .

Didn't know anything about me , I didn't know anything about her and I think there was at one point when I quick story , when I came in , I think that evening she set me up in a second room and I got up before her and I went to my rotation and she I come back .

And when I come back she says to me girl , I thought you was crazy , I was like what happened ? She's like I went into the room I didn't see anything . No luggage , no , nothing . She thought I had left , but what actually happened was I had put all my stuff away in a closet .

But she thought I was insane and just like up and left , right and I was like what is going on , but I digress ,

I digress . Those are good times , but you do have a little something on the side that you are doing . So tell us a little bit about that and if that is an option to be able to expand that , to be able to kind of meet the goals that you're trying to meet right now .

Right , because while Locom certainly is an option for you , entrepreneurship Right Looks different ways . Right , so tell us about what you're doing , the name of your company and what it's all about , and like how you envision that growing potentially .

It's pretty much seeing patients who are self-pay , you know , no insurance base or anything like cash based business , who are looking to feel good from the you know , inside out , you know , and outside in you know whatever .

So , just doing that , I did a little bit in North Carolina when I was there , had a nurse that was working alongside with me , and so since I moved here , I'm currently looking to hire like a nurse practitioner to kind of do more of the lead work .

A lot of the time is during the week and I can do some consults maybe two days a week and offer some other services as I roll out stuff . So I'm looking to make that full time . But that's a dream , you know . So trying to work that in some kind of way . So those are where my weekends are currently like stuff like that .

I mean that's one of the things that I think you should certainly consider , especially if locums becomes something that's a little more cumbersome for you .

Right , you know me and I love ourselves some locums , but you know it doesn't necessarily work for everyone , and I think with something like the Lux MD , that's something that you could potentially build out , get clientele . If you listen to episode what is it ? Number two with Dre , number two or three with Dr Dre on Burge ?

He talks about how he built a concierge practice where he literally has I don't know eight patients or something per year and they pay like a premium price to have access to them . Also , brooke Shillay .

Or give my business , the Lux MD , the , the ref , the runway that it needs to really get off its feet . Yeah , because , like I said , if you're , if you just go cold turkey , you know , and you're paying for your re , you're paying for , you know , your home or , excuse me , you're paying for your home or you're paying for all of those different things .

You know you're not going to have the re , the runway , to really do what you want to do with the Lux MD Right , whereas if you're working just for maybe a year . You're giving yourself a finite time . You're bringing in revenue . You got what .

You got what you wanted , which was the salary guarantee , and , yes , they're making you work , but look , they've already making you work and you're already doing this on the weekend . So you give yourself a timeline after a year . You're bouncing , you know .

The question I also had , too is in your current practice style , is the hospital doing a good job with advertising Like is your billboard up there ? Are they still doing that type of stuff or no ?

So a lot of them will just like they'll hold the fork right Because they're like , well , no matter , we still got to bring in a certain type of revenue . So just be prepared for like a really hard negotiations .

If we need another you know Q&A I'm more than happy to come on and tell you what I did , how it worked for me , but I really would love to just like take this money and flip it real fast , you know feel like I want to you know , I'm not a day trader , you know , but I've been put , some put in and some .

You know , whatever I need to do to pay my son's tuition legally .

Yo , alfred , put the text number on there . Let us know if you're Onlyfans , doc Boom , there you go . But Dr Siobhan , dr Siobhan we should have you come back and talk about the investing component , because I think it's really interesting , because if you have a financial planner , do you know what the plan is ? Do you know what you're invested in ?

Do you have access to see it ? Do you know how he or she gets paid ?

Those are things that I think we can work out in another episode , because I'll be really honest with you In terms of flipping quickly and I know you're just joking with how quickly but we are long-term investors , so when we buy , we buy and we hold and we are investing for the long term .

Now , when we get real estate , that's a little bit different , and so forth . But it'll be super interesting to get you on to talk about that and see what your approach is and see what your numbers show and give advice on that when we have you back on the show .

He's done our Loeweums contracts for us and he's really good , very thorough , and loves to call people if he needs to be able to be like , yeah , we're going to do this this way , and so he's very effective . So I will text you his information tonight .

Number two is you're negotiating on your own and you feel comfortable doing that . But no , just like Renee had just mentioned , there are lawyers out there who I think are well worth their weight in gold in terms of being able to give you a different opinion or maybe even kind of take the emotion out of things .

If you feel like you're getting emotional with it , I do . I'm not saying you are , but I would .

And then three is considering fighting for what's really important for you , which is having the salary bottom guaranteed and then having the RVU's be working concurrently , and then realizing that you may not be able to get everything and putting yourself on a timeline , because you can put up with for a life if you give yourself a year or two years , right , like

we've been through it . Right , like you can put up with stuff for like a year or two if you know what the ultimate end goal is .

And then number four , I think , also is considering locums opportunities that are local to you right , local to other hospitals , local with other private practices , or maybe even when you walk away from this hospital , coming back and saying you know what ?

I'll come back and I'll be a locums doctor for you know , for as long as it takes for you to hire fans rate would be , you know , only fans divided by 365 .

Number five is your entrepreneurial endeavor , which you're already in the midst of anyway , is not only just keeping yourself ready to go to do locums at other places , but also using this year or two to kind of give your business the Luxemd , the runway that it needs for you to really just say you know what , for a year , we just going to make it happen and

we're not going to worry about working anywhere else . This is what I do , and give you the time and the opportunity to do the administrative and marketing things that you need to grow the business Right . You got a lot of options . Invest in myself .