Insights on the Role of Podcasts and Locum Tenens Q&A. #439

I am telling people about what's going on with our taxes , what's going on with our finances , what's going on in the podcast , but like , am I necessarily an expert ?

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 .

Friday this is an opportunity for you guys , as the audience , to ask me or Renee any question that you may have about anything related to locum tenens , what it's like to be a doc , if you want us to do residency role play like we did recently .

But this is an opportunity for me and Renee to connect with y'all and find out what the pulse of the audience is . But things are a little bit different . Renee is sick and we have a stand in , a little bit more than just a stand , and we have the person who keeps the light going . We have the person who keeps me and Renee in check .

We have the person who keeps me accountable . We got Kiara , our business manager , on the show . Alfred , throw in the music . Put on the applause in the background , please , kiara . What's up ? Welcome to Docs Outside the Box . How you doing ?

I wanted you to come on the show even , uh , before renee got sick , because I think sometimes it's nice to have , um , you know , the folks who are in the background to show their face right , and I think sometimes you just need some new energy and I think you know it'd be great to kind of go back and forth with you .

It'd be great for the audience to hear about you and , as a matter of fact , let's just bleed into that . Kiara , why don't you introduce yourself to the audience , tell them what you do , where you from , how much you charge all that stuff ? Alfred , bleep out how much she charges , alright , so I'm going to leave the charging part out .

I kind of keep you recording and on your toes and just kind of keep touch with the team , with the rest of the team , and kind of just make sure everything flows .

So , like , talk to them about all the stuff that goes on behind the scenes in addition to being , you know , to dealing with two people who are clinically you know they're still doctors , you know moms , dads , what's that like ?

You have to make sure that that makes it to the editor and then you have to get with the rest of the team to make sure that they stay on top of the editor , make sure they get the snippet , the snips out so that we can get their social media running . We got to get the newsletter out on time . It's just , it's a lot of moving parts .

How is it overall with schedule wise ? It's sports . Um , how is it overall with schedule wise ? It's I mean , it depends on the on the week the day , because life still happens . Um , you know , some weeks we get things done . Some weeks are a little bit slower because we just got to slow down .

You know , we've got to take care of kids , we've got to take care of just life in general ourselves .

There's a lot of stuff in the news now that normally doesn't make it in the news , right , like non-clinical type stuff . So , from your perspective , what ? How do you like absorb all of this ? What are your thoughts ?

I might come across it on social media , but , like you said , that's because there's something constantly going on .

Like this is like the first podcast election , right . Like you have , like you know , trump going on rogan and that making a big deal , or some people saying that doesn't make a big deal at all . Kamala harris saying that she's not going on the show for some reasons , that we will never know why , and stuff .

And some people saying , well , that's the reason possible reason why she lost , and so forth . But in general , I think it's crazy to see how many people rely on podcasts for their knowledge , for their news . And then you could just lump that in together with social media . Shit's kind of crazy .

Because , as much as I like to talk to people and you know we try to vet information like I don't have a journalism degree , right . Like I I'm just I'm speaking , I'm not shooting from the hip , so to speak , but I'm just a regular .

You know , I'm a doctor and I am telling people about what happens to us on a , you know , on a weekly basis about what's going on with our taxes , what's going on with our finances , what's going on the podcast , and where we see , like business with medicine in general , general .

But like am I necessarily an expert and I think that you know talking to co-workers who you know like , for example , like they are all about , like robert kennedy and what he said on the joe rogan show , and I'm like , but like he's not like an expert , right , like he's not really an expert .

Right , so , like an expert is an expert is an expert . What the hell does that mean really ? Right , so , like an expert is an expert is an expert . What the hell does that mean really ?

So , like , I know people who , like , have made their political decisions of what who are they're going to vote for , based off of a podcast which , to me , is crazy , you know but then again that's kind of the new standard , right , Because yeah , it's what's changing , People are listening to podcasts . now you have to kind of tailor to the demographic .

way older than you like , the only way you can get your news is from what abc , nbc , cbs , you know . When we were growing up , or at least when I'm growing up because I'm way older than you like , the only way you can get your news is from what ABC , nbc , cbs , you know you laughing , but it's the truth , right ? You see this hairline , right ? Right ?

And ? And newspapers , and now like podcasts , are the new version of the of those things , or YouTubers , or bloggers . That a new version of those things is just that they don't necessarily have journalism degrees .

The question , though , is just because you have a journalism degree , does that make you the person who should be the gatekeeper of keeping all that information ? I don't know , but that's the way it is right now , so that's why we're here .

No matter where you are in your career , you've seen patients your age or younger get seriously injured , have a long-term illness or even have a mental health issue that affects their ability to work . Now what if that was you ? No , for real . What if that was you Without disability insurance ? How are you going to replace your paycheck ?

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 now we are eight years in doing docs outside the box and you know we transitioned from just interviewing other doctors to now we talk about what we are interested in and what the audience writes in and so forth , and you've been with us . Now . What three years now ?

And she's been great . And these last six or seven months have been quite tough for me . So I'm just going to , you know , just be a little bit vulnerable .

But when the election , when Kamala Harris was talking about the sandwich generation , like that's me right , like I think a lot of people , you know you see me as a trauma surgeon you think , oh , it's just money bags and all that stuff .

And it's like , no , because you know , like I have my wife and my kids that I'm taking care of , right , that's on one end . And then I have my parents that I'm taking care of and you know I grew up I grew up low middle class , right .

So you know we have to be really miserly with , you know , my parents expenses to figure out how we can best take care of them . Also , at the same time , like I have to take care of my kids , like . So it's a tough balance to figure out .

How do you take care of parents who are elderly , who can't make that many decisions for themselves , who may need a little bit of some financial assistance for normal things like paying for the house or , you know , groceries and stuff ?

So when she was mentioning that they were going to do some things , make some changes to Medicare where it may make it easier for the elderly to get help , right ?

I think a lot of times when people think about the help that you would get for the elderly , a lot of times people think about Medicaid and if anybody knows , if you don't know , I'm going to let you know right now .

Like , if you want to sign up for Medicaid , in essence you have to be in poverty , right , so you may have to sell your parents house , your parents may have to deplete all of their resources . You have to be poor so that the government can take , you know , so the United States government can take care of you . And that's tough , right , that's really tough .

So you know , I was really paying attention to that and in essence that was swaying me a lot and how I voted , but you know , unfortunately I don't think that's going to happen

now , but that's where I'm at . So I just want folks to understand like , yeah , like you know , we talk about finances and we talk about podcasting and doing locums and all that . But we just like any regular you know 40 something couple that has parents that are aging and we got to take care of them .

We got to take care of them and sometimes you struggle with how you're going to get help and how you're going to get assistance and how you're going to finance things and how you're going to split from being on call to finishing on call to go and take care of them .

So I don't know if this is an issue for them , but I think you know folks who look like me , folks who look like you , the demographics you know these are folks who are going to be the breadwinners for their own families , but a lot of times could be the breadwinners for the entire family , right , like the immediate and nuclear family , and that puts a burden .

And then you throw on top of that student loans , right . And then you throw on top of that , like people aren't getting paid the way they want to get paid .

If you're a woman and you're a doctor , or if you're a woman and you're in healthcare , like there's a possibility that you're going to be making like 20 , 30% less than your male counterpart who's doing the same exact job with the same exact experience . So there's a lot of shit out there to to fight against .

If you haven't been raised in an environment where you feel comfortable negotiating what your hourly rate is going to be , if somebody comes back to you and says , hey , dr Kiara , like you are worth $100 to do X job as a family medicine doctor , but then you find out that a male doctor is being paid $120 for the same job in the same experience , you know , if

you don't have the tools , if you weren't raised with the tools to one one , find out that there's a difference in how you get paid . And then , two , you don't know exactly what to do after that .

Right , like , you don't have the lingo , the language , you don't know the , the , the roads that you need to take to find out how you can get yourself from $100 to $120 , right , like , it takes some sense of pocket watching . But , yeah , like , how would you know that right .

So that's why I think me and Renee , like we really talk on the show like yo , like you guys , need to be negotiating . If someone presents to you a locums contract of $100 , then you may want to bump that up by like 20% , right , instead of just accepting $100 , just right off the rip , just say I'll do it for $120 , right , or $130 .

And you got to advocate for yourself and just be prepared that they're going to push back on you . But just because they push back on you is not personal , like all of this stuff too . Like I think that's the other thing too . People think that this is personal and it's not personal , it's just business Bidness , right .

As a college student , I'm not going to talk about my grades to my classmate because they're a potential competitor potential competitor when I get into medical school . I'm not going to talk about how I did on my classes , because , one , I don't want to be judged and two , you know I'm competing with my classmates . I don't want them to know that .

You know , maybe I'm in the B range and I'm trying to get into surgery and I have this perception that everybody who's applying to surgery is getting straight A's and so forth and has killed their board . So if I mentioned that , then I'm going to be judged a certain way . I'm not saying that's the case all the time , but that was my case , right ?

I didn't talk about it .

When folks don't talk and that's kind of been ingrained in you , since we're talking about 10 , 12 years of that same type of behavior yeah , then you get into residency and you're competing against your fellow residents and then , as you become an attending , it's like well , I'm here , I'm happy to be here , I got this job , but you could be at a significant

disadvantage , like I think , renee talks about a story where you know one of her counterparts , um , sorry , one of her co-workers , who's a woman who's like 10 years , 15 years her senior found out that she was getting paid like , I think , like a hundred grand less than someone , a male , who just got the job , who didn't have as much experience as her .

Like a hundred grand . Maybe I'm exaggerating , but it was like it was . Really . It was above 50k . Right so it . But if you don't find out , you multiply that by 10 years , 15 years that's a lot of money you're investing out on yeah . But millions of dollars .

You know , I can see the pressures for women to like yo , I'm having this child and I'm taking as little maternity leave as possible and I'm jumping right back into this you know , but isn't that like the pro , that's the pro , of local tenants , though ?

Then maybe you do something where you work like two and a half weeks in a row and then you have two . You work like two and a half weeks in a row and then you have two and a weeks , two and a half weeks off , so that you can be with the kids and be Dr , dad and all those different things and be , you know , a good spouse and so forth .

Or you know that's one week on , one week off , or it's four days straight and then five days off , like you get to kind of create your type of schedule that works really good for you , and then you know , like , however , like whenever you work is how you get paid .

Right , so if you're going to take time off , you just have to do that that math with yourself . So I think it's a little bit easier . I think if you're locums for lifestyle , whether you're a man or whether you're a woman that's how I look at it , so that's a good question .

So what I mean by that is like we work , I work at a hospital and when the hospital pays , they don't pay me , they don't pay Renee by name , they pay our business . Then our business gives a salary to me and Renee and then that's how we make it work .

But for several years and this was amazing time we actually ran an OB department as locum tenants , like our , like a . We had a contract with a hospital and we provided locum tenants .

We provided about seven OB docs to a department and they worked with , they did their OB stuff with a family medicine program , and that means we created a schedule , which was amazing . That means we did all the time sheets . That means that we , you know , paid the doctors , we did all the things that you need to do from a tax standpoint .

We got out all the 1099s , we did all the negotiations with the hospital and that was great . We did it for about a good three and a half years . It was a lot of work and there was a lot of times where I'm in between cases trying to make it work . But yeah , we did that , but we don't do that , we're not currently doing that right now .

It doesn't mean that we don't want to do it , but we're just not currently doing that right now . So , yes , we've worked with locum tenens docs . We've sent them places . The only thing that we're not doing right now is we're not working with professionals that are not doctors at this point .

But there are a lot of locum tenon companies out there that are working with nurse practitioners , nurse anesthetists . There are even nurse practitioners who've started their own locums companies and are kind of making it happen their way also . So it's a good question .

What I mean by that is like if you have a trauma surgeon and you know like they're only going to be doing trauma surgery or general surgery or OBs are just going to be , you know that doesn't need to be explained , whereas nurse practitioners you can have nurse practitioners who have , who have really extensive training in one specialty , but just say , hey , I just

want to be a nurse practitioner for something else , right . Same thing with physician assistants Right . Physician assistants can go between any type of specialty that they want to . It's just they need to have a doctor who's going to supervise them .

And two , when you work as a locum tenens doc , right , when you work for yourself or when you work as an independent contractor , are you working with a locums company or are you doing it by yourself , right ? So are you contracting directly with the hospital ? That's what I'd like to know , because I think that that plays a big role . That plays .

That's a big difference .

Um , we just got a house and eventually we're going to do an episode on our um . I can't say that , cause this is still under litigation , but eventually we're going to talk about our um , trials and tribulations , getting a house , um , so we have a tenant upstairs . We love it . Um , he's a good guy . Um , and uh , we're making it run like a business .

Um , but there's some things that I think you all will be wanting to be interested at , and just know that the best way I could describe it is you just I can't say it . I just can't talk about it right now . You can't say it .

know we do , we do have .

In my opinion , as I always say , like I could be very extreme about this I think every doctor should be a locum tenens , every doctor , because I think there's a lot of people I go through Twitter and I'm watching all of these people give comments on the UnitedHealthcare issue .

I hear people give comments on , you know , just different issues that they have with healthcare and like the business of healthcare and basically , if you boil it down to what's the main issue , at least from a doctor perspective , is they don't have control .

Right , and I just want to let people know , like you're not going to have control , like once this got corporatized several years ago , decades ago , that's it Right . So you know there's a certain level of wiggle room that you have as a clinician to say that you know hospital X says A and I believe that I'm going to move in direction B .

Or insurance company says they're going to pay for this and I'm going to do it despite that . Like there's only so much room that you can do , particularly when you're employed . That's how I feel about it when you're employed , like , like , you're a company person , that's it . You're wearing the scrubs . It's true , it's 100% true .

Yeah , you're wearing the scrubs , or you're wearing the white coat that has their company's name on it , right ? So , like , yeah , like , that's how it works . But if you want to be on your own , there's certain sacrifices that you're going to give that you may have to take . There may be a little bit of uncertainty , but that's with any business , right ?

If you have an agent who's normally with a big company or a big firm decides yo , I'm going to do things on my own . I feel like I can represent my clients and my athletes better than said firm . There's going to be a little bit of some uncertainty at first , but then eventually you figure it out .

You get your clientele that wants to work with you because they see how you work . It's the same thing with locum tenens .

If you want the control , if you talk about all these different things that I see a lot of y'all talk about on Twitter , then the best way to get that control back , the best way to control your schedule , the best way to make sure that you're getting paid what you think you're getting paid , the best way for you to be at home with your family , as much as

you think you need to be at home with your family . The best way for you to advocate for your patients is to make sure that there's a separation between the hospital , the clinic and then you . To me , being an independent contractor is the first step and the second step that you need to take . That's how I feel and the second step that you need to take .

That's how I feel Like I just feel like there's a lot of people who do a lot of bloviating and talking and say I'm going to do this and all that stuff and it's like but if the hospital says you're fired .

Look at you trying to reel me in because you know I get on my soapbox and be talking yo , yeah , but yeah , we got something that I think , step by step , it'll help you guys understand the concepts and then be able to really finish the course and be able to get a contract on your own or work properly with a locum tenants company and be able to represent

and advocate for yourself and get the money that you want to get and get the control that you need .

I don't understand how that works .

You know , that is a good question I don't know , we just don't go over 24 years , y'all 24 years experience of doing locum tenens , of negotiating , of walking away from contracts , of accepting contracts , Like right now Renee's in negotiations right now , where she's trying to decide she should be locums or should she be per diem , which is different .

Right Per diem is if you are um , you actually are employed , but you still control your schedule , Um , but there's some benefits that you lose . But you know , there's just certain things . We're not all a hundred percent locums all the time .

There's also a phone number in the text message or , excuse me , in the show notes , where you can text us some information about what you or some questions about what you have and go from there .