In this presentation, Matthew Gillogly examines the unique stressors faced by physicians, especially those who own or operate a medical practice. He begins by noting that, despite extensive medical training that teaches doctors to handle high‑pressure situations, the body’s physiological stress response (cortisol release) is the same for everyone, making recovery as crucial as coping. Gillogly outlines the primary sources of stress for doctors: patient care (generally low stress for most encounters), the demands of running a practice, and the financial volatility that can accompany a transition from high‑salary employment to a cash‑based practice. He identifies three major practice‑related stressors: extremely long working hours, the challenge of leading a non‑clinical team in a modern, collaborative manner, and dramatic income drops when shifting to a cash‑only model, which can strain family life. He argues that insurance‑centric practices are the most stressful because they relinquish control over time, pricing, and cash flow, leading to uncertainty and team frustration. To counteract these pressures, Gillogly recommends several concrete strategies: incorporating cash‑based procedures to secure upfront payment, specializing in a niche (e.g., orthobiologics) to become an expert, and establishing strict personal boundaries such as weekly 24‑hour digital disconnects and minimum four‑day vacations to allow physiological and mental detox. He shares a personal anecdote of a near‑heart‑attack episode that prompted him to adopt these boundaries. Finally, he promotes the Business of Orthobiologics (BOB) event, which blends medical science with business training to help physicians launch or transition to cash‑based practices.
Chapters
All right, let's talk about stress, and let's talk about specifically stress with doctors and how doctors deal with stress. Well, most doctors that I know are really good at managing a lot of stress. I mean, that is what your training has taught you how to do, is how to handle a lot of stress. You think about everything that you go through— medical school, residency, fellowships— everything is designed specifically to put you in as many stressful situations as possible. But the reality is, is that your body, no matter how much training you've had around stress, handles stress the exact same way. There is a chemical reaction, which I won't go into the details of it because you're a doctor, you know this better than I do, but there's a cortisol release that happens in everybody's body goes through the same kind of physical manifestations and chemical releases when the body is under stress. Okay. The difference is, is understanding not just how you deal with the stress, but how do you recover from the stress? And that's what I really want to dive into today, because the reality is, is while you may think that you are Superman or Superwoman, most people overlook of how to process the stress and how to get their body to recover from the stress. More so than how to deal with it. All right, so let's talk about these things because not only is there a tremendous amount of stress in treating patients, there's a tremendous amount of stress in running your own practice and having your own business and being an entrepreneur. So let's talk about all of that today. All right, so let's talk about what are some of the common causes of stress in running a medical practice. Well, one, you have the patients. Okay, the patients are probably the least amount of stress because that's where most of your training is. Right? You know how to deal with patient issues. And the fact of the matter is, is most of your patients are not there for life-threatening situations, right? You don't have anybody coding in front of you. So the patients can actually be the lowest stress thing that you deal with on a day-in and day-out basis in the practice. Again, you're not dealing with any life-threatening situations. They're not coming in coding, you know, and if you're running a cash-based practice, you're not really having to deal with the stress of what's gonna be covered by insurance. Okay? But let's take a look at some of the other issues of what is involved with being an entrepreneur. Hey, I'm Matthew Gillogly, and I'm a Maverick. Well, what is a Maverick? A Maverick goes against the grain. We find our own way. And if you're sick and tired of being pushed around by the insurance companies, come join us. We'll show you the way out, and you'll love medicine again. One, a tremendous amount of long working hours. The amount of hours that you put into a startup is a staggering number of hours. I know this because I've been an entrepreneur for 22+ years, and having done 5 startups, the, the amount of hours that you have to put in to be able to get all the things right that you need to have a successful business— culture, values, people, systems, marketing, all of that— in order for that to be in place takes a tremendous amount of time and energy. And so the fact of the matter is you're gonna be working a lot of hours, okay? And you're gonna be working a lot of insane hours. Now, later on, we'll talk about some cures for that, of how you create some boundaries in that. The second thing is the biggest stressor with regards to running a medical practice, especially a startup, is the people. And I'm not talking about the patients. I'm talking about the people on your team. Leading people, leading a team. It's very, very hard, and most people don't have a lot of experience in leading a team, and most people aren't gifted at leading a team. It's something that you have to learn. So when you're leading a team, let's say you're working in the ER on rotations, it's a lot different. You're the doctor, you give a command, people don't care, you're saving a life. Well, when you're running a business, you can't be that authoritative in today's environment. It's just not possible. And so you have to relearn how you lead. Leadership in today's environment is not about command and control. It's about lifting other people up. And so it becomes very stressful because if you're a typical entrepreneur, type A personality, or just like to be in control, you just want to tell people what to do and not have to really worry about a bunch of blowback. Well, that doesn't really happen when you have a staff anymore. You have to be in a situation where you can develop your leadership skills And to create really this cohesive leadership ability. And then the final cause of stress is low income. A lot of doctors, when they start their cash practice, I've had doctors leave $700,000 a year jobs, 7-figure a year jobs like $1.5 million a year to start a practice. And all of a sudden they go from bringing in $700,000 a year in personal income to paying themselves $100,000 a year. And they have, they have this lifestyle that they built up at the $700,000 range. And now they've got to manage it to the $100,000 range. And so this causes a lot of stress. Doesn't necessarily cause stress at the, at the personal level. The stress that that can create is really in the family environment. You have a spouse who maybe they're working, maybe they're not. You have kids that are used to specific things, and young kids generally don't really understand why all of a sudden they can't go out to dinner every single night and get sushi and only eat half of it, right? Like, this is the stuff that you have to deal with. And so These common causes of stress and the low income, by the way, is also driven by the fact that you don't feel like you're seeing enough patients or making enough money, which is kind of the bonus, if you would. I don't like to call it bonus. Let's call it the unintended bonus of running a practice or running any type of business is the stress that comes with having to produce revenue, produce income each and every single All right, so how do you deal with stress? Well, let's talk first and foremost about the stress of owning an insurance-based practice. I believe that having an insurance practice where 100% or 90% of your income is coming from the insurance providers is the most stressful type of business environment that you can create. And the reason why is you don't control your time, you don't control what you charge, you don't control your money or when you get paid. And so this extra level of stress that comes with having an insurance practice where 90% of your income is being paid to you by a third-party payer creates a tremendous amount of stress because you never really quite know when they're gonna send the check or if they're gonna do a clawback. And so it creates all this stress. You create stress with your team. Your team is frustrated and they take out their frustration on you. And usually what happens as an owner, you don't really have anybody that you can share your frustrations with. Right? You can't share it back down the chain of command because then they just think you're being mean. So to be able to manage with the stress, if you are 90+% insurance, you have to add in cash-based procedures. Because when you add in cash procedures, you get paid upfront, you get paid before the procedure is done, you can dictate what you charge, you can dictate when you get paid, and you're able to do the right thing for the patient. So like I said, I'm going to summarize this. I think the most stressful type of business environment that you can have, or business model you can have, is a business model that's dependent upon the third party giving you the money that you earned. And that's the situation that exists in the insurance-based care environment. Okay, so how are some other things that you can do to manage your stress? The second thing that I would recommend is that you be an expert in one particular thing. Okay? The more you can zero in on being an expert, let's say, in the world of orthobiologics, instead of treating every joint, be a specialist in knees or be a specialist in shoulders or be a specialist in lower back or upper back or neck. Get to be known as an expert in one particular area. Okay? How else can you deal with stress? Well, remember early on in this video or one of our videos, we talked about some things that you can use to manage? This next concept is going to be mind-blowing for not only just entrepreneurs, but for doctors. Ready? Here it is. I want you to create specific boundaries in your life and your time. When you are an insurance-based practice, when you are a doctor in the insurance machine, you don't really control your time. If you're on call, you don't get to control your time or when they can call you. You work insane number of hours. You have to go do surgeries when they tell you to do surgeries. And then you have to go see patients because you have to see so many patients in order to make so much money. So you don't really have the ability to create any boundaries. When you own your own practice and it's a cash-based service, you can create the boundaries to your time. One of the best lessons I ever learned was about 15 years ago as an entrepreneur, young startup entrepreneur, and I was running and gunning. I was working 12, 14, 16 hours a day. I would work maybe 8 to 10 hours on a Sunday. I was Same thing on a Saturday. I was working all the time, and I hit the place where I completely basically collapsed and thought I was having a heart attack. Like, my chest was bothering me. I think I was like 33 years old at the time, or whatever it was, or 35 years old at the time, and I thought I was having a heart attack. And so I went to the urgent care, and I walked in, it was like 2 o'clock in the morning. I said, I think I'm having a heart attack. The lady behind the desk looked up at me, she goes, no, you're not. Fill this form out. And so I sat in the waiting room for like 20 minutes. I'm like, I'm having a heart attack. And they bring me back, they put the EKG on, and the doctor looks at me and he goes, how much stress are you on? And so the doctor explained to me I needed to create boundaries. It was the first conversation that I ever had about boundaries. So what I did was I started doing something very simple. I scheduled Friday afternoons for me. I went and got a massage, whatever, just Took my cell phone, put it in the glove compartment, didn't look at it. Today, what that looks like is I have always, every single week, I have at least a 24-hour period, no cell phone, no email, no texting, nothing. I turn it off, I put it in the glove compartment, or I put it in the desk, and I don't check it for 24 hours. It gives me 24 hours of what are called free time. It allows me to decompress. The second thing is when I go on vacation, if I schedule any type of vacation, it has to be a minimum of 4 days. And the reason why is it takes 3 days to completely detox, okay? It takes me 3 days to completely unwind. Now, there's a lot of other things that you can do, but you have to create boundaries. You have to have boundaries in place that these are times that I work in the business, around the business. These are times that I'm focused on the other important things in my life— family, faith, whatever it Okay, so you have to— in order to deal with the stress, the more stressed out I get, the busier I get, the more free time I schedule for myself. I know that's counterintuitive to a lot of people, but I've learned over all these years that to manage that, when I go through very stressful times, I have to create boundaries. And I encourage you to do the same. If you say to yourself, well, gosh, man, I can't afford to take the time off, All the more reason to start more cash services so you can see less patients get paid more. Okay, would you like to get some training on the science of business along with the science of medicine? Would you like to finally learn how to marry everything that you've learned in medical school with what you need to know in the business world to be successful? Well, we have created the Business of Orthobiologics event. You can check it out at the link that you see below or with our button that you see right here. And we affectionately call it the BOB because it's the business of orthobiologics. It's Only event in the world where we spend half of our time talking about the science of medicine and the other half talking about the science of business. It'll give you everything that you need in order for you to start your own cash-based practice, whether you're starting from scratch or you're inserting it into an existing insured practice. Join us. You'll see, it'll take you directly to the site. You can see where our next event is and learn all about it. We look forward to seeing you at the bottom.
