Succeeding in Medicine with Dr. Bradley Block

I mean, all surgeons, for the most part, have to spend some time in the office in order to get those cases. But ent, it does seem like there's even more of that. So those surgeons who don't like to talk to people at all, that's probably not a great choice for them.

They should have been anesthesiologists.

Hi, everybody, and welcome to the podcast. This is Generations MD My name is Stephanie, and I'm joined here by my colleague Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Block. Please welcome to the podcast. Welcome.

So much for having me. I'm super excited about this.

Yeah, we're so excited to have you. Do you want to give yourself a quick introduction about who you are?

So I'm a private practice otolaryngologist on Long Island. I'm a partner at ENT and Allergy Associates, which is the biggest ENT practice in the country. We are physician owned and run at this point. There are 200 partners, equal share partners, and 300 physicians total. I'll find out next week whether or not I've been elected to the board of trustees and will be one of the board members that's helping to lead the practice. And so that's the otolaryngologist. I also host the Succeed in Medicine podcast, which is everything that we should have been learning while we were memorizing Krebs cycle. And for your listeners, I'm sure you're in deep in memorizing the Krebs cycle, but then when you're out in practice, like, there is so much that we're not taught that we really should be taught. And that's what really my show is, is all about. And then I am also on top of that because you will learn as you go through your. Your training and such. It will. It is never enough. Right? You're never doing enough. Right? Where are these bottomless pits of achievement? And so I'm also the CEO of the Dr. Podcast Network and we help physicians to podcast.

Well, I love that. And I love that that's where you are now backing up. Let's talk about how you got to that point. So growing up, were you all set on being an ENT or what did growing up look like for you?

You know, I had no idea what I wanted to do. I like, not a clue to the point where I was studying abroad my junior year and still had no idea what direction that I wanted to take in my life.

Wait, junior year of college?

Junior of college.

Wow. Okay. You're the first person who didn't say they wanted to be a doctor since they were like, five years old. Yeah, I still don't know if I.

Want to be a doctor. I mean, I still haven't. I still haven't figured that out. So. No, I just. It's. It's. Yeah, it's the. The least, like, typical story, I think, that people tell. I'm sure a lot of them have this story in their heads, but they don't. They don't say it out loud. It was. I couldn't think of anything else to do. And it was like a clear path where everything was set for me, right? Like, I had no clue what I want to do in my life. Like, I told myself, pharmaceutical sales because I was good at science and they make money. But, like, that was a terrible, terrible reason. But when I studied abroad, I studied abroad in Jerusalem, which is, you know, one of those cities in the world that are like no other. And, you know, it kind of laid bare how superficial those aspirations were, and it made me want to do something with more depth. And my closest friend there, who remains a close friend now, decades later, who. He's an orthopedic surgeon himself, he was going to med school, and that was his plan. I was like, you know what? Maybe I should do that. Like, all these gunners that were in the same classes that I was taking and who were started out as pre med and were dropping out, I was like, I'm still keeping up with those classes. I can do. I can do that. I can do that. All right, I'll just be. And now I don't have to figure anything out because my. My path is laid out for me. Maybe the worst reason to become a doctor. I don't know. What do you think?

Well, I think that that's so valid and so real, and I'm glad that we're getting into this discussion because I think that that's the point that me and a lot of my colleagues are.

My peers are at in our medical education journey, because it's so real. You're like, this is a stable career path. I know I'd be good at this, and I know I'd like it. And you just kind of get on the stairs and you keep climbing, climbing, climbing. But it's really hard when we're at this point to now. We actually have to make decisions about what specialty. And then after that, it's like you have to actually choose a job. And we like to have people on this podcast who are doing different types of things in order to expose students who are in that mindset of, okay, this is the path laid out for me. I just got to do the work to be able to kind of think outside the box a little bit.

So I think we're under this impression that there's, like, one right specialty, and then everything else is the wrong one. And the fact of the matter is, if you're like urology, there are probably some things you're going to like about ophthalmology or anesthesiology or otolaryngology. And, like, once you've picked a specialty within that specialty, there's so much you can do. Like, my life as a private practice general otolaryngologist is dramatically different from, like, a academic otologist. So I'm not sure if your listeners know there are ear doctors. They're not ear, nose, and throat doctors. They just do ears, and they're rhinologists who just do noses. Right. And so, like, their lives are very different from my life in and out of the exam room. And so, you know, once you've chosen the specialty, how you navigate within that specialty can lead you down many paths. So, you know, it's. It's not like you're, like, you make this decision and you're locked into this one life. No, you. It opens up a world of possibilities, and then you figure out where you fit within. And then as your career moves along, people go from academics to private practice. It's very hard to go from private practice to academics because you go from taking care of, like, not such complicated stuff in most situations or many situations to the uber complicated stuff in academia. So it's. It's. It's hard to go in that direction, but it's much. It's much more common to go from academics to private practice, so.

Well, did you understand that as a medical student, when you were deciding your specialty? Yeah. So what did that decision look like? Like, what did you think your life was going to look like, and how did that transition to, like, what it is now?

One of my good friends in medical school, who's now one of my partners and practices, we did residency in very different programs, very different parts of the country, but we ended up in the same practice living, like, 10 miles away from each other. He was like, dude, you should check out this cool specialty. They do cool stuff. And so I checked it out, and I was like, oh, this is pretty cool. But. But, like, when we were in medical school, you had something called specials, right, where you've got your mandatory rotations and Then you had a month where you could do other stuff. And I had to choose, you know, whether I wanted to do urology or laryngology or ophthalmology. And I thought I was going to be a pediatric cardiologist. That was my goal because I thought the congenital cardiac anomalies were such interesting physiology. And they all made sense to me that like. And they did procedures. I thought that was what I wanted to do. But I knew eyeballs grossed me out, so I didn't want to go through my peds rotation having eyes gross me out. So I was going to do my optor rotation to get over that. But I didn't get my first choice. I got my second choice, which was otolaryngology. And I was like, wait a second, what they do here is really cool. And I still remember seeing this like two year old kid who like, couldn't eat because he couldn't breathe out of his nose. Like, he had to hold. He had such severe nasal obstruction that every time he had to eat something, he could chew it for a little while while holding his breath, and then would have to open his mouth and take a couple breaths and then hold his breath to chew again. And he had failure to thrive. And they did the adenoidectomy and he thrived after that. And I was like this little procedure that they did where they recover so quickly and they do. So that was a mate like, like that changed that kid's life. And I was like, this is really cool. I want to do this really cool stuff. The big open surgeries never really appealed to me, although in our training we do a ton of those, right? Like, we do free, like big head and neck cancer surgeries with fleet free flap reconstruction. So for those listeners that don't know what a free flap is, like, you'll remove part of someone's, like, mouth and the mandible bone and then you'll replace that with fibula, right. And some of the surrounding muscle and skin to recreate the mandible. And you'll plug those blood vessels into their neck so that it survives. And now they've got leg in their mouth to replace. Like, it's ridiculous what some of these other, not me, but some of these other otolaryngologists are, are able to do so. Like, but that stuff never appealed to me. It was always like the smaller interventions. And that's, that's what I do now. That's my practice.

Yeah, well, how did you find your niche as you're going through training and trying to Figure out exactly what, what part of this specialty you want to be in. What did that look like?

I never really enjoyed the big long surgeries. Like, I just didn't like being in the operating room for 12 hours. Yeah. And so that was pretty easy. Like I'm not going to do. So then, you know, within otolaryngology there are a couple of subspecialties. Right. There's facial plastics, where you're doing cosmetics and, or reconstructions. So that reconstruction that I was talking about, that would be someone who does, you know, facial plastics. There are some head and neck cancer surgeons that do it and some like, it's, you know, there's some overlap in who's, who's doing what. But like facial plastics is cosmetic and reconstruction. Head and neck cancer is exactly what it sounds like. Big head and neck cancer cases, thyroidctomies, parotectomy, submandibular glands. And a lot of us will do these things afterwards even if we didn't do like a fellowship in them. But not so much. It's very uncommon to do the big complicated stuff like otology. You're drilling out mastoids for cholesteatomas. You're fixing eardrums, you're doing stapedectomies, you're doing cochlear implants, you're taking care of patients with dizziness. There's peds, where you're doing a lot of what I, A lot of my practice is peds. I just like taking care of kids. And so I do a lot of tubes, tonsils and adenoids. But if you did a peds fellowship, now you're taking care of like complex pediatric airway with like subglottic stenosis where you need to put like cartilage into, to open up their subglottis so they can actually breathe without a tracheostomy. Or you'll do more complex ear stuff or sinus stuff, specifically in, in kids. So, you know, you, you see all of this stuff in training. And then rhinology, you're doing complex sinus disease. They also do sub skull based tuners, tumors through the nose. They'll help neurosurgery to get to pituitary adenomas through the nose. Cerebral spinal fluid leaks through the nose. Right. So a lot of these complex nasal stuff. But you know, as a generalist, I do all of these things, but just the less complicated versions of them. And I fortunate to live on Long island where we've got a lot of high level academic institutions around the corner from us. So if I'M not comfortable taking care of it. I can just send it to my friends at the academic institutions.

Yeah, well, as I recall, I remember when my, when we were all trying to decide on various specialties that at that time anyway, people when, when they were choosing ENT that they had to acknowledge that you actually spend a lot more time in clinic, I think than other surgical specialties. So that true.

We have a lot of us that stop operating altogether.

Oh, wow.

Yeah, yeah, yeah. Because there's no medical equivalent. Right. There's no like nephrologist to take care of the kidney stuff. Like we are the ear, nose and throat, whether it's medical or surgical. Right. There's no pulmonologist to take care of the lungs or cardiologist to take care of the heart. It's just us taking care of all this stuff, both the medical and the surgical. And so yes, a lot of us spend four days a week in the office and one day a week in the operating room. But in our training we spent half a day in the office, half a day in lectures and the rest of the time in the operating room or seeing consults in the hospital and you know, all the rest of that stuff. So we spent so much time in the operating room in our training, but in our, in practice we spent a lot more time in the office. A lot of people come to us with non surgical stuff.

Yeah, yeah, well that's a, that's a great point. And you know, when somebody's thinking about choosing that if they only want to. Well, I mean all surgeons for the most part have to spend some time in the office. Office in order to get those cases. But, but ent, you know, it does seem like there's, there's even more of that. So those surgeons who don't like to talk to people at all, that's probably not a great choice for them.

They should have been anesthesiologists. That's really. If you don't like to talk to people, radiology or anesthesiology, pathology, there are plenty of places. But if you're a surgeon, it doesn't matter what type of surgeon you are, you're going to be seeing, you have to see a lot of patients, you have to talk to them preoperatively, you have to talk to them postoperatively and then you're communicating with your team intraoperative. Like. But, but yes, we do see a lot of, of medical problems, but a lot of our problems. You know, everyone's got, every specialty has got this where you've got, like, ophtho, for example. Patient comes in saying that their vision is blurry and everything is normal, and they've got 2010 vision, and you can't figure out why they have the complaint. And then people online are talking about how you're gaslighting them by because you're not believing them. Meanwhile, you've done the everything workup and still can't figure it out. Right. And that happens in us, too. Like, we have a lot of patients that have something called globus where they feel like something stuck in their throat, they feel like there's a ball in their throat, they feel like mucus in their throat, they're clearing their throat all the time, and yet you can't. The exam is normal and they don't have reflux, and they failed. All these things that you've tried. And so, yes, there. And we're the backstop. Right. There's no, like, well, then follow up with your internist. No, no, no. The internist sent you this patient. You've got to figure out what's going on. And so every specialty has those, Those. Those challenging patients that not only are they not surgical, they're like, there are a lot of them that you see in the office, and you've got to be okay with that.

Yeah, that's honestly a really good point. And just talking about. I have a lot of friends who want to go into surgery and not sure exactly what surgery, but I think that's really important to consider. Kind of switching gears a little bit. At the beginning of the podcast, you were talking about how you like the idea that this path was laid out for you for medical training. But then you also mentioned how you're in private practice now. I think, you know, typical path, you could just do medical school, residency and go into academics. What did that shift look like, deciding to go into private practice and be a part of that?

It's interesting because.

I felt like I was a disappointment to my training program because I went into private practice.

Yeah, right.

Yeah. Not only that, but a lot of the surgical skills that they spent tons of time teaching me, I never used. Right. I never used a lot of those skills. And then a lot of the things that they did use initially, like my. The stuff that I take care of got slowly more. I'm now 15 years out of training slowly and slowly less complex over time. Like, I stopped doing thyroids after a while because I just, you know, I. What happened for thyroid specifically is I didn't have that much operating room time, and so I had like a full day of thyroids booked and then, you know, a couple of them didn't show up for their pre op visits. And it was because they had gone to other institutions and gotten their surgery sooner. And so now I had a whole day with nothing to do. And I was like, well, I'm not doing this anymore. And so, you know, and there weren't that many that were walking through my door. So I felt like I was this, this disappointment to, to my institution in choosing to do less complex stuff in private practice. And so when I chose private practice, I knew that I wanted to do that. Right. I knew that the uber complicated stuff was never for me to begin with. And so it made more sense to go into private practice. But I did have to. It was like a bitter pill to swallow. And I carried that around with me for a long time, actually. So we're going to turn this into a little therapy session for me and fast forward. A couple weeks ago, I got an email from my chairman saying, hey, we are. We started doing this, this academic day where we invite an alumnus to come and speak to the, you know, to the department. And I heard you're pretty active with your podcast. We'd love to have you come and talk. So to leave thinking that I'm this disappointment, but only to have them invite me to come back and talk was like a really liberating moment for me and realized that I was a lot of that was all in my head. So to those listeners out there, right. Don't think the way that I was thinking that it's some like, admitting defeat or you're less than for choosing this path that's maybe less complicated than the stuff that you were seeing in your training program. It's okay. You are, as long as you take excellent care of your patients, you are helping them, contributing to your, to the society, and you are a credit to your program.

Well, I think that's true of many different programs. Again, you're training in academia and so the people that are your mentors, that is their path. And so you veer off that path and you feel like, okay, I'm doing something different or, you know, not as good, but it's just something different.

Yeah, exactly. Exactly.

Yeah, I definitely feel that. Again, just talking about how we're not exposed to private practice, I do feel like I'm at a big academic institution and sometimes I do feel like this is there. We're there so that they can turn us out and be a part of the big institution.

So this is what you're supposed to do.

Exactly.

If you do something different, it's not what you're supposed to do.

Yes, yes. Or it's going to be really hard and like that's just, you're not gonna be able to do it. What did those early days going into private practice, did you join a group? Did you. How, what did that look like?

So I joined what was at the time a monster group. I think I'm physician 121 in this practice now it's 300 of us, so significantly larger. But it was already a well oiled machine. Right. It's not like I put out a shingle. I joined what was a well oiled machine. Now when I joined it, it seemed on the outside like a well oiled machine. And there were some things about it that I thought weren't so great. And so one of the benefits of being the way my practice is structured, we have committees, we have, that advise the board and so you can get as involved as you want. And so the things that I thought weren't run so well, I got involved and now I'm helping them to be run better. And so this is, you know, so I didn't, I didn't go through some hardship of having to take out loans and, and find space and buy equipment and hire people. All that was done for me. I really stepped into a fantastic situation. So it was not hard. There was no hardship here. It was easy. I joined, they found me an exams room, exam rooms in an office and you know, hit the ground running.

And they already had like, I mean, obviously they already knew there was enough market share, there's enough business that they were going to be able to get busy, you know, relatively quickly.

So it's interesting, they were like, you know what you need to do, you need to visit the offices in the area, you need to go and you'll bring them lunch and you'll talk to the doctors. And even 15 years ago that was antiquated, like hanging out in the hospital taking calls so you can meet the ER doctors. That wasn't the way to do it then and it's not the way to do it now. I think that's a big waste because they have their referral patterns, they have the people. So unless there's something that you're offering that nobody else is offering. Right. Like, like there was, there was actually no one doing complex sinus cases on Long island when I joined or maybe one person. And so if you were, if you went to a bunch of ENT offices and you Were like, give me all of your skull based tumors. They would have been like, yes, now my patients don't have to drive the city anymore. Great. But unless you're doing something like that, if you're. I'm a general, there are plenty of other ents on Long Island. I didn't have anything special that I was offering that nobody else was. And so I was just some schmo offering them lunch that they didn't care about. I think the way that you get referrals is by creating evangelists is by giving your patients such an amazing experience that they go back and tell their doctor. Dr. Block was amazing. He was the best. He listened to all my concerns, he took care of me. He called me the next day to check up on me and made sure I was actually feeling better. Like, and then you get on the phone with the referring doctor and be like, hey, this is what's going on with your patient. If it's something complicated, right? If you're like, they've got a sinus infection, I put them in a box. Obviously you're not going to call about that. But if you're like, I just diagnosed your patient with throat cancer. This is what's going to happen next. Like, you know, keeping them involved like that, right? The primary care physicians are going to be more inclined to send you patients. If they keep hearing it over and over again that you are the best, right? Then they're going to start saying, oh, I've got the person for you. Right? This is all my patients love this doctor. Right? That's how you build a practice. You build a practice by creating evangelists from the beginning to the end of the visit, from the front desk to them leaving the office to being checked on later, like, that's how you build a practice.

Well, that's funny. You know, I do this concierge medical practice and I'm a family medicine doctor and I do have people come by when they are relatively new in practice. And a lot of times I like that. I like seeing their face, I like talking to them. Because even though I've been practicing here for 23 years, but still, stuff, there's turnover, there's sometimes, I mean, actually one ent that I used to send a lot of people to retired recently. So then you're just like, oh, wait, who was that person. Person that came by? Okay, that's right. I'm going to start sending people over there. And then, yes, when they have my patients have a good experience and then they come back and they're like, oh yeah, you know, that was a good experience. Also love the communication. I think that I drive my specialists crazy because I send them a lot of text messages about, okay, you know, so and so is coming. And they have this. I feel like I'm being helpful, I'm teeing it up for them. But it can, it can probably. I'm probably an over communicator at times, but you know, for some of my specialists, I mean, one of these cardiologists came to see me, I don't know, several years ago and I started sending everybody to him. I have like multi generation families that I send to him, but man, he responds to my texts every single time. He takes great care of my patients. They like him and so. But I never would have known him if he hadn't come by to say hi. So anyway, I've just kind of.

Are you in an area that has a lot of specialists or are you in an area with not so many?

Yeah, I'm in Dallas, Texas. And yeah, I am in the heart of Dallas and there is every specialist within a few miles of me. So yeah, there's, I mean, we have like three major hospital systems all within a few miles of where I am. So it is, there's, there's tons and tons of them, but they don't all take the same personalized care of my patients. And because of the way my practice is, my patients need a little, a little extra handhold, tlc, you know, they're fine. It's not that they're, you know, always high maintenance, but they just, they just need a, you know, a little extra.

So.

Yeah, well, building your practice and then kind of getting involved a little bit more in the business side, were you inclined to do that? It sounds like you, there was issues that you wanted to see change in. What did that look like? Kind of getting more involved in like the business side of your practice. And you like doing that?

Yeah, I mean, it's a different way to use my brain. You guys just had Brittany Bankhead and, and she says like every couple of years you need to find a new challenge. And for some of us that's true. For some of us it's not. But for me it's definitely true. Where I need to, you know, flex a different part of my brain every couple of years. And so getting involved in the management of the practice has allowed me to do that. And they knew that I was interested from the beginning because I would actually go to the board meetings where previously it was like in person. Now we do them over zoom. But I would drive up there and sit in and these meetings that seemed like so opaque and so complicated and you know, making such a high level decisions. And now over time, everything's gotten, you know, it makes more. It's taken 15 years, but it's. Everything makes a whole, whole lot more sense. But my practice, it's. They do that by design. Not making it opaque, but making it open to where you can be involved. And so, you know, some people get involved because they think some part of it's not being done well and they want to help it do better. Others just enjoy the process. Other would just want to get involved somewhere in their practice and others kind of get roped in and they don't necessarily love that part of it, but, you know, we'll reach out and be like, hey, we're starting this committee. We need help with this. You know, could you, could you, could you help us out? But, you know, I think it's. For me, it's that I really enjoy using these other parts of my brain because in practice, everything becomes routine, right? Like, we see the same complaints over and over and over and over and over. And this is part of the reason I started my podcast. So my podcast, it's, you know, the tagline is everything, like I said, everything we should have been learning while we memorize and Krebs cycle. But a lot of the stuff that I cover is communication, doctor Patient communication. Making communication more efficient and effective in the exam room. Because in private practice we see a lot of patients, right? And so, so that every patient becomes an evangelist. Not everyone realistically, but more do. Like, I really tried to optimize my communication style. And so I created the podcast to flex that part of my brain because the medical care many times was not that challenging. The challenging part were the psychosocial aspects of it. And so I wanted to get really good at that. And so I started my show partially so I could get experts in front of me in communication that weren't in healthcare per se, but were expert communicators and then focus their expertise on our specific niche so that I could get better at that. And then, you know, and, and learn from there. And then the topics kind of exploded from there. So I, you know, cover a lot of, A lot of different. But, but I cover a lot on. On communication because it does get mundane. Maybe mundane's a little harsh, but yes, yes.

Well, yeah, you're looking in a lot of ears.

Yeah, yeah, A lot of like sinus infection, a lot of that globus A lot of ear pain. That's tmj, a lot of sinus pressure, that's really migraine. And so you have these same conversations over and over and over, but then figuring out the nuance of this is how this patient needs to hear it versus that's how that patient heard, versus, like, you look at their facial expression and, you know, it's not. They're not. They're not buying it. And so being able to pivot and approach things a little bit differently, like, it's a little bit of a dance when you're managing the doctor versus what a lot of people do, which is they develop a shtick and they just say the same things over and over and over again. Not tailor it to the. To the individual patient. But to answer your question, which was getting involved in the management, I think it's important to recognize when you do start to stagnate professionally that you need to kind of reinvent yourself and start challenging yourself in different ways. And for me, it was getting involved in the management of the practice.

I just wanted to ask a little bit more. Drilling down into, okay, you finished residency, you are going into this question group, and they give you some sort of, you know, contract of like, okay, you're an employee, and then you can be a partner. Like, can you give any details of, like, of what that looked like and how you sort of assessed, was this a good contract or not? Or how did you do that?

Well, to me, this practice was like, clearly the practice to join. And in a funny story, I hadn't organized myself quite as well as I should have, and I spaced my interviews too close together. So the guy who was previously the CEO of my practice ended up driving me to my next interview so I would get there on time. But that's. That's what a baller he was and how confident he was that this was the product. Right. Like, I'll drive you there. Good luck. See how they see how they work out. Like, we've. We've got the product here, and it is, it is to me, if you're going to join a private practice. We are in New York, New Jersey now, into Pennsylvania actually, starting in Houston soon. We are the practice to join. It's that. That's it for. For so many different reasons. And so there was no decision there in terms of the contract. I, you know, I've done a bunch of interviews on contract negotiation now, so I know how to do it better than I did before. I didn't have a clue. I didn't, you know, Podcasts weren't a thing back then, so I didn't. I didn't read a book on. I just did what everybody did, which is you got the contract and you handed it to the lawyer and you said, what? You know, what changes should I make? And like any. They were not significant. Like, you couldn't. It was a done deal. They knew I was joining them, and so any leverage that I previously had was out the window. And so, you know, just for your listeners, negotiation starts at the interview. That's when. That's when the dance starts. When you're interviewing. You're interviewing them, they're interviewing you. You got to realize when you're done with your training, you're the prize. There are not that many doctors, and there are a lot of positions, and you are the prize. And so you're negotiating. You know, don't be a jerk about it. But start to figure out, like, what. What are their priorities? Like, what is important to them? Oh, we're looking for someone to take more call. We're looking for someone to work weekends. We're looking for someone to be on these committees. We're looking at someone to do it. What are they looking for? And then you can use that as leverage later on. But don't tell them you want to join them, because then you've lost all your leverage. Leave the fact that you might join someone else out there, and then you negotiate stuff from the contract.

Yeah, I do think it's. It's so hard for people on the medical education path to get in that mindset because it's like, oh, we try so, so hard. We just want to get into a medical school. And then for residency, it's like, okay, you just want to. You're trying to match. You just want to.

You.

They tell you where to go, okay, whatever. I'll take whatever. And then when you finally are, you get out into the workforce and you have so much value. It's so hard to really understand that. And you're kind of just like, okay, I'll take whatever job I can get. Like, what advice would you give to people who just finished their training to be able to kind of, like, understand their worth and get in that mindset?

Well, a lot of times you might not be interviewed by a physician. Right. And so you need to recognize, like, they don't know what you've been through. You know what you've been through. You know what you can do. You know what you're capable of. Own that. Right. And bring that not arrogance, but confidence to the Interview. And I think that'll go a long way towards realizing that you're the one with the leverage and recognize just it's economics. There are a lot of positions and not that many. There's just keep in your head, doctor shortage. There's a doctor shortage, right. They need, they need you. Right. And you know, they might pretend that there are other people looking for the position and there will be other positions even if it doesn't work out. There are plenty of positions. Now, academics is a different story. Right. Also, if you're applying to my practice, forget that. Don't take that advice. Just don't negotiate ahead of time. Bring your contract to your lawyer. Right. Once you've just taken our, our deal and come work with us, don't worry, we will make like everyone that joins us eventually. Not everyone, but almost everyone eventually becomes partner. Right. And so there's.

Yeah, I was curious about that is because, you know, that's not the case everywhere. And in a lot of practices you do have to buy in for quite a bit or so. How is that structured?

So we have a sweat equity.

Okay.

So that means you just, you work for us for a couple of years and you know, I'm not going to disclose anything about the contract because it's variable, but you work for us and then as, as long as you make the, the things that we. Goals that we set out for you, you become a full equity partner. You get just as much equity as I have right now. You get just as much equity as someone that's been with the practice since its founding as one of the founders. Right. And when, when the doc. When doctors retire, there's no buyout. They just retire. They had the benefit of being in this practice the whole time and did really, really well because of it. That's the structure. There's no buy in, there's no buyout. You just. And it was not my idea. Like I said, I'm Dr. 121. And so it started off with three different offices that all came together and they agreed on this. And most of them at this point have retired. But their foresight in creating this fantastic organization and their ability to walk away from it with nothing even after they built it. I mean, it's, you know, it's an incredible idea that they've created and it's what has allowed us to become so big. So, yeah, you join us, we tell you ahead of time, this is how you become partner. And if you do that, you accomplish that, then you're my partner. Equal share.

That's Amazing. I think that's fairly unusual.

It is unusual and I think it's the magic of our practice.

Oh, I think that's really. I think that's great. It's also. There's something for things being fair like that. No matter how much money people make, if the person next to them is making more, that's always bothersome. Now, if they're making more because they're seeing three times as many patients, well, that's a different deal. But I think there's something nice to get along with your colleagues when you know that everybody's not being treated fairly.

And there's some complaints about fairness because we have, like, the way that we do our distributions has to do with fixed and variable expenses. And so if you work a certain amount and collect a certain amount, then you might make more than the person next to you, you might work harder and see more patients. But because of their payer mix or because of the procedures that you do, like, you end up making different amounts of money. And so there is not. There is. There can be some, like, bitterness and resentment because of it, but for the most part, like, everyone's really happy with how they do. There is, I think there was a study and what are they, capuchin monkeys, where they would give one of them a cucumber and they were really happy with it. And then you would give its neighbor a grape and then the monkey would throw the cucumber at you because it was no longer happy with its cucumber. Right. Like. And so that's, that's. We're primates. Right, like that. And, and so that's how we're built. But everyone knows the system going in.

Yeah, yeah, right.

Like, they're not surprised by it. It's very, we are very transparent. Like, there's nothing hidden. And so, you know, it's not like there, there's a surprise. Like, this is the formula. This is how we decided to work it. And so, you know.

Well, and it sounds to me like there's no chance of this being sold to private equity or, or that type of thing. Well, I don't know. It just seems like the way that structure. But I don't know. I guess we, we don't have to get into personal stuff.

I mean, it's, it's. We've been approached a couple of times. Nothing's been appealing enough because. And I think the fact of the matter is what private equity does is they roll up smaller groups and turn them into us.

Right, right.

They turn them into a group that's as big as us to, to benefit from economies of scale and more leverage with insurance companies. And so, you know, they can approach us, but it's going to be really hard for them to come up with something that's appealing enough for us to want to sell. And, you know, for 200 people that are different in age from like 36 years old to maybe 38 to 70, making like, disparities of income that can be pretty wide based on, you know, how much productivity they have and getting them all to agree to whatever formula, the private. Because of that fairness that you were talking about. Like, how are you going to get everyone to agree or most people, enough people, enough for it to, to pass. Right. Again, it would be a big challenge. It's possible. These, these, these private equity people, they've got a lot of money. So I'm not saying don't approach us, approach us, but there better be some big pockets involved. But, but like you said, it would be a real, real challenge to make it appealing enough for that to happen.

Yeah, yeah. I feel like a lot of times those structures, it's, they, when the people who have been there and have all this seniority have a big ownership, those are the ones who really want to sell to private equity. The younger people, of course, don't. And so that's, that's when it ends up. I mean, then it's a lot easier for private equity to come in there and do that because there's some people at the top that really want to make the deal. So.

Yeah, when you're selling to a junior partner, your junior partner doesn't have much money.

Yeah.

When you're selling to private equity, they've got a lot of money. And then what you're doing is you're selling your junior partner like you're selling the physicians that you've now recruited into your practice, thinking that was one thing, and now you've sold them like a commodity. Yeah, that's what ends up happening. But, but it can only happen if the structure is very top heavy and ours is clearly, clearly not.

Yeah, no, I think that's, that's great.

Well, how are you going to maintain, like, the fairness and just collaboration? You talk about how you're able to kind of drive to the board meeting as the company continues to grow and is so large scale.

That is an incredibly insightful question, because that is something that we are struggling with right now. Right. Like, we used to have higher attendance at all of our meetings because we had a smaller footprint. And so we'd go to these meetings and everyone would know each other. Be a lot of congeniality. But, you know, as we've grown and grown, we are, we are at a point where we need to consider how we're going to do that, and that's one of our big challenges. And hopefully, if I do get elected to the board, that's something that I'm, I'm going to want to grab the bull by the horns and figure out how we can keep everybody interested and engaged and feeling like they're a partner and feeling like it's their practice and being involved in the decision making that goes along with the practice. I think, you know, one of the things is there are a lot of great ideas out there, and so making sure that there's a path for them to get to the top and to be heard not just from our physicians, but from our staff as well. When you're a practice this big, you know, if you're, if you're in a single or like a few physician practice and you've got a front desk staff, and the front desk staff goes, hey, Doc, I think, you know, we've been having some trouble with this. I think we should do this. Like, it's very easy for that information to get to the top, but in our structure, it's hard. And I, I want to make it so that the physicians and the staff have a way to get their ideas heard and appreciated and, and considered. And I think that'll help a lot with this continued engagement. But I think we're going to have to break up into regions. All right, like, we can have one meeting a year where it's all of us, but we're going to have to, you know, break up into these different geographic regions in order to keep everyone attending and engaged, because otherwise you end up with disengagement, which is a problem. Then they don't feel like they're part of the practice. They don't feel like they're owners. They feel like they're just working in corporate medicine, that it's not their practice anymore, and that would be a death knell for us. So we, you know, I don't want that to happen.

Yeah. Yeah. Well, just talking about continuing to grow. And at the beginning of the podcast, again, you talk about how, how you like to be challenged and flex different parts of your brain and continue to do all these different things. How do you find the balance, like, being able to challenge yourself and also be content with, like, what you've done and what you've made.

Yeah. That's always the balance, right, of, like, striving to achieve, yet being okay with what you have. And it seems like it's a paradox, but you can do both at the same time, right? Like, you can be proud of what you've done and still try, strive to achieve. Like, striving to achieve doesn't have to come from a negative place. It doesn't have to come from a need to prove yourself, right? You've already proven yourself by being here, right? By being in med school with your classmates, like, looking around and being like, I deserve my place here. As much as a lot of us do struggle with. With, oh, what is it?

Imposter syndrome?

Imposter syndrome. Yes. We heard all the time, and yet the words escaped me. Yes. You know, so we all struggle with. A lot of us struggle with probably the ones who seem like they struggle it with it the least. Probably have it the most, is my theory. But. And it took me a long time to really grapple with this myself, but I think it. It just. You can do both. You can be okay with what you've accomplished and still strive to do more because you enjoy the challenge. Not that you need the challenge in order to prove yourself right. Like, if you grew up in poverty, you've got this, like, desire to not have to be in poverty every anymore, right? You want to achieve so that you can pay your bills and pay your house and pay your car and have food on your plate and clothes on your back and not have to worry about that anymore. Right? That comes up from a place of needing that in order to have Maslow's hierarchy of needs. But for those of us who are in a comfortable place, I think it helps to recognize that achieving for the sake of achieving is just enjoyable, right? Not because you have to, because you recognize that, but it's part of who you are. And you like flexing those muscles, and it gives you purpose, and it makes your life more fulfilling and enjoyable. So that rather having it come from a negative place, having it come from a positive place. I'm great. I'm great. I've done a lot, right? Do I want to do more? Yeah. Why? Because I like to. Yeah.

I think that's like. I like what you said about just being able to flex different parts of your brain. And, you know, whether that's a creative side, whether that's a business side, starting a podcast because you enjoy communication and want to learn more about that, I think that's just an important aspect to be like, okay, I want to do this Because I'm interested in this aspect of myself, and I want to see that flourish and grow rather than I want to do this because I want to put this on my cv. So I think that that was an important point.

Well, the CV stuff also, when you're choosing what to put on your cv, like CV for the sake of cv, I get it. There's a game. Don't hate the player, hate the game. And you got to play it. Right? Like, I did research, too, on stuff that I didn't care about in order to. To buff my cv. But there will come a point in your career where you don't need to do that anymore. And you can pursue stuff just because you want to and because it fills your cup and because you like flexing your brain in that particular way. And it's gonna happen. It will eventually happen. But until then, don't hate the player, hate the game. But you gotta play.

Yeah, you got to keep still building your cv.

I know it, I'm told.

But we won't take up too much of your time. But I do ask, as we're kind of wrapping up here, I do ask all of our guests this. As somebody in my second year of medical school and for all of our listeners who are on different parts of their medical education journey, what advice would you have for somebody in my position?

Great question. I love that you're asking people that, because in, you know, our retrospectoscope, I'm sure all of your attendings use that word also, right? Using my retrospective scope. What is it? What is it? I wish that people had. Had told me or I had. They probably told me it. I just didn't listen because I know better, right? But it's enjoy the people around you, right? Like, whatever's going on, like, lean on your friends. Sometimes we feel like when we lean on our friends, we're.

Occupying more of their, you know, we're asking of them.

But actually, when you land on your friends, you do fill their cup. They want to help you. So when you need their help, ask for it. They will enjoy helping you. That's why they're your friends. So lean on them, give the help to your friends, check in on your friends, ask how they're doing. Because, you know, suicide is, is, you know, twice as high in our profession and happens in medical students, happens in, in residents. And so it's really important that you check in on your friends for that reason, but also because you enjoy them and you're on this ride together and nobody gets it quite like your Classmates, nobody gets it quite like your colleagues, what you're all going through together. And so no matter what stuff you're going through, make time for your friends. Make time to hang out and chat and lean on each other and complain to each other and, you know, do what you do everything you can to enjoy your friends, because that's ultimately what the journey is all about. Your accomplishments and your achievements, fantastic, great. But the people that you do it with really make it right. The Harvard study that we all, we're all talking about now, about the best predictor of happiness and health and longevity is the strength of your social connections. And that's obviously true. You know, we all experience it and so be intentional with that information about how you choose to spend your time and your energy. Other people is really where it's at. And that will, that will fill your cup. And then one other thing is, you know, you clearly know this because you have this podcast, but like, have your hand in something else, whether it's in medicine or out of medicine, have something else that you use to define you as you that is either medicine adjacent or completely different from medicine, because it'll just also help you use your brain in a different way, help you be a more interesting person, help you fill your cup on those days where you feel like garbage because everything went wrong and you're such a screw up and nobody in the history of medicine has screwed up as badly as you and you don't know right, those, those days you feel like that it helps to one, have those people to lean on and to have those other things that define you to lean on. So I know, yes, for one thing. And I gave you two.

No, that was great. I love that. I think that's so important. I love my friends so much.

Great group of friends. I think that's. And I feel like all of your friends seem to really get that. Yeah, you're all really important. You all make time for each other.

Yeah. And that's been something I've been reflecting on a lot recently. So that was great that you said that. And yeah, this was an awesome conversation. Thank you so much for being, being here. Can you plug your podcast and where can people find you?

Yes. So Succeed in Medicine. Right. Succeed in Medicine.com is the website Find it on Succeed in Medicine where all your podcasts are identified. I just had an episode come out this week or actually next week that everyone might want to check out about microplastics. So all the things in the news, I know it has nothing to do with like the practice of medicine. But it's all, it's been in the news and there's a lot of fear mongering around it. And the short answer is, I'll give you the Cliff Notes version, all of its fear mongering, all this stuff is safe. Keep microwaving in your plastic containers. Keep food and it's fine. It's safe. They're not endocrine disruptors. They're not your mic. You're not going to have microplastic strokes or end up with image. It's all fine. But just that just to demonstrate, like the variety of stuff that I have on my show, right. I'll talk about leadership and communication. And I have this episode on Microplastics, another episode on how to be more charismatic, another episode on how to excel in academia, but this one coming out next week, Microplastics. So check it out. Check out my show. And if you want to start a podcast or you're a doctor who has a podcast and you want to join the Dr. Podcast network is DrPodcastNetwork co. At some point it'll be.com because we did get the that URL now, but Dr. PodcastNetwork co and again me succeed in medicine and join my practice, ENT and Allergy Associates, New York, New Jersey. We're, you know, we're a fantastic practice. You should all check out otolaryngology and then become my partner.

Love that.

Love that. We got that exclusive too. And you guys know where to find us @Generations MD on Instagram and TikTok. And you can email us ataskgenerations MD gmail.com and we will talk to you guys soon. Bye.

Bye.