Have you settled for “not bad” on your career journey? We focus on nonclinical careers and leadership topics on this podcast, but today I have an inspiring clinical treat for you – if you love clinical medicine but are struggling with what you are ‘supposed to do’ – get ready to listen to some career motivation!
In this episode of The Career Rx we’ll discuss:
- How med school doesn’t prepare entrepreneurs – but business IS part of medicine
- How to design a career you love while staying true to your core mission to help people
- Why looking to the future can help you more than looking to the past
Today we welcome Dr. Una of EntreMD as she gives her advice on taking charge of your practice, how to make that business thrive (and why you must!), and how to not lose yourself in the chaos. She takes us on her own journey of trial and error and how she reached her goal of only seeing patients one day a week, all while fulfilling her other passions, and helping tons of patients – and physicians – in the process.
In this Episode:
[1:10] Welcome our guest, Dr. Una
[5:05] Clinician vs Entrepreneur (what they don’t teach you in medical school)
[10:30] Stop calling your practice a “practice”
[18:00] You’re actually allowed to change your mind
[21:40] You deserve better than “not bad”
[26:10] Does your current story reflect your goals?
[29:20] If you listen to nothing else, listen to this answer
Links and Resources:
EntreMD Business School from Dr. Una
The EntreMD Podcast – Follow to catch the other part of our conversation
Industry Insider – learn exactly how to land a rewarding nonclinical career without a new degree, connections on the inside, prior experience, or a pay cut
The Branding Rx – 18 hours of CME, mastering digital strategies for advancing your career, building your business, and growing your professional brand
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Thanks for joining me on this episode of The Career Rx!
TRANSCRIPT: Episode 85 – The Business of Clinical Medicine with Dr. Una
Hey there. I'm Marjorie Stiegler and you're listening to The Career Rx Podcast, where we tackle the important things they don't teach you in medical school. Like how to treat your career, like the business it really is, with strategies to accelerate the kind of success that you want, because you deserve a career you love, and a career that loves you back. Are you ready?
Let's get into it.
On today's episode of The Career Rx, I'm doing something very special. I have a guest Dr. Una here with me today, who has done so so many amazing things. And as you know, on this podcast, it's my goal for you to realize you can have any kind of career you want. Do anything that you want. There's not just one paved path. And Dr. Una is absolutely an amazing example of that. So she's with me today, we're going to get to talk all about it. Welcome to the show. Dr. Una.
Thank you so much for having him super excited to be here.
That's my pleasure. I'm so happy to get to talk to you. Before we talk about careers, your career, and and how you've, you've done some of the amazing things that you have. Why don't you in your own words, just give us a few sentences about yourself and sort of your story in a nutshell. And we'll of course, unpack the rest over the next few minutes.
Yeah, so I am a pediatrician by training. And I have done a lot of things. So I started off like no good resident, I got my first attending job. And then I went on to start my own private practice, and then went on to build it like a business, meaning that it can run without me. So now I see patients once a week, because that's what I want to do. And, you know, after figuring out entrepreneurship, which is not something we learn anything about, I decided to pay it forward and show doctors like you can, you can do this stuff. I mean, it's easier than the Krebs cycle, we've had to learn really hard things, you know. And so that's when I, you know, created EntreMD, which is a separate company to help doctors figure out how to build profitable businesses, so they can practice medicine the way they want, and they can live life on their own terms.
I love it, you know, I'm going to go ahead and just say that you and I have a lot of similarities. And so people who have spent time on my website, looking at the branding prescription are going to feel like they're, you know, like, what this sounds the same. And I just want to go on record saying I don't know if it is the same. But this is, we this is a live example right now of lifting each other up and really helping each other out. Because you can teach other physicians business all day long. And so can I and there's enough for us to be able to work together as allies and colleagues, which I just love. So I just, I didn't want to miss the opportunity to say that.
I love it. And, you do this so well. So I'm glad we get to do this together.Thank you and you do really, really well as well.
Tell me if if I can the sort of if there was a transition for you, between your academic and your private practice and what motivated you to make that switch?
Well, I wish I could say I made a, you know, calculated decision that that was what I was going to do. But that's not kind of that's not the way it happened. I think, you know, as an introverted introvert, I never really thought I would own a business maybe a decade from after I graduated my private practice time, 15 months after graduation. So it turns out, you know, I worked for this doctor, he was a neonatologist. So he couldn't work in his private practice because of the conflicts of interest. And after I'd been there for about nine months, he's like, well, here's your next contract is for five years.
I'm like, I can't do a five year contract. Like that would be long time. But I was gonna move anyway. So when he found I wasn't gonna sign the contracts, like, listen, you're doing everything you would need to do in your own private practice, you should go start your practice. And so he's the one that planted the seed, and then a number of other things happen. And you know, about six months later there I was with my practice. I didn't know though that I wasn't doing everything. I wasn't doing the business end. And so when I got in, there was like, the school of hard knocks. But yeah, that's kind of how I got there wasn't intentional, but boy, am I happy it happened.
That's so interesting. And you said school of hard knocks. And that's how so many of us have learned, you know, all the things that we've done this sort of outside the, the pre prescribed path, or the sort of hamster wheel that we're all on. has, has taken a little bit of just just doing it and just learning as you go. So I think, you know, tell us a little bit about what you know, how it came for you where you were in your private practice, probably working more than full time to how you are today, one day a week.
So it's a lot of transitions, but I think the biggest one is I came to the realization that You know, I'm a great clinician, but being a clinician has nothing to do with being successful as an entrepreneur. They're two completely different skill sets. And is just that it's a skill set. So if I can acquire those skills and add it to my clinical skills, then I'm golden. So the things I used to say, well, they're running big, better businesses practices, because they're better than me, not really true. They just knew things that I didn't know. So it gave me back the power the control, like you're in charge, you can do this stuff.
And so I started learning all the things, embracing all the things. And I thought about it, what other career do you work the same position until you die? Like even Walmart people go up. So I'm like, I don't want to have to do the exact same thing till I'm 70. Right? Yeah, I want to be able to transition and do more of running the practice, do more of reaching out to my community, do more of those things. Because that's what I want, right? Like, my dad is 84, he still reads his anatomy textbooks and tries to have conversations with me. I'm like, I don't want to talk about anatomy. So for some people, they want to do that forever. I just did. And I believe as entrepreneurs, you should be free to do what you want to do. Right? Yeah, the cookie cutter thing and medicine, where we follow one training system, we all came out the same, but after that, you can choose.
I love that. And you know, you said a couple things that I want to circle back to so you know, right, right out of the gate, you've said you know that you're an entrepreneur, which I mean, you are, but it's hard. You know, you're always that way, right? You may have an entrepreneurial spirit. But there is a an inflection point. And I think so many physicians don't, we don't think of ourselves as a business. We don't even think of our actual businesses as businesses, right? You think of it as your practice, it's your private practice, we have a whole different set of terminology.
And there seems to be something about the you know, quote, business of medicine that people don't like, because I know because we want to help people, like we're not in there to like, get a bunch of money, but you do have to make a living, you got to pay back those student loans. And you do deserve to be rewarded for your efforts. So tell me a little bit about that sort of mindset shift, even within your private practice, because I know you do a lot of other entrepreneurial things, even just within sort of a very traditional medical model of you being a doctor, talk to me about that mindset shift and becoming an entrepreneur.
So first of all, I think for, it's something we have to come out of resistance to, right, like, we can say, we want to help people, we don't want to talk about the money. But if you look at the whole picture, it doesn't make sense, right? It's just that we've been protected from the money, money conversations, which, which is why we're where we are. Now, this is why we have half of the problems we have in medicine, because you get up from your office, you put your stethoscope on, you walk in a room, you see a patient, then you get paid. That does not make any sense. Right? Right.
Because somebody had to go marketing to get the patient's, somebody had to check the insurance and make sure it was active, somebody had to collect the copay. And when you're done, somebody is going to send out, you know, claims to the insurance company, somebody is going to follow up on those claims and make sure you get paid. That's how the money got in your account.
Right. So you cannot say, I want to help people, I don't care about the money, you do care about them. And you've just been shielded for that conversation. And that's why when doctors come into private practice, it’s a rude shock. Because now all these other components, you're the boss, now you have to figure out how to make them work, right? So one of the best things you can do as someone who owns a private practice, is to keep your practice profitable. Because if you don't do that, your doors, your doors have to close the patients that you care so much about, you're not going to be able to help them you're going to have to fire your staff, and the community would have lost an amazing physician.
So I have patients who come to me and they're like, thank you so much for not selling out to the hospital. My kids get to get a doctor that cares about them. For me, I'm just a number. So one of the things I do for my patients because I love them and I want to help them is I figure out how to keep it profitable, how to make money, how to keep us afloat. Even in a pandemic.
Oh my god. Absolutely. I got to tell you the words that you have said, like I know I knew that already. Right? If you weren't a guest on my show, I could probably have told people like yeah, in order to help people you got to make money so your business can grow. But the way that you just said that is so meaningful and impactful. And I have like goosebumps, I have absolute chills just thinking about it.
You provide jobs, you take care of patients, the community needs a doctor like it is.. It is a business and you must make money to be able to continue to serve people and, you know, serve doesn't need to be volunteer, you're providing something that is of tremendous value to people. And so I think that's great. Thank you for saying that and saying it with so much, you know, business and also so much heart. It's great.
If the listeners can do one thing, maybe it would be stop calling your practice a practice. And that's not because it's not a practice. But it helps you rewire reframe the way you think about it, say my business, because that's what it is. And we shouldn't run away from that. I know, we complain about the suits, but we complain, we created a vacuum.
Yeah, that's great by the suits and like the administrative leadership that we perceive to be bossing us all around, right? And all of the, the baseless hoops that you have to jump through in order to get you know, paid and by, you know, that reimbursed right, I mean, how condescending whatever ridiculous, you know, paradigm this all is and then the bill comes to the patient, and they can't even decipher it. And they don't understand, you know, they thought things were covered. And it's just there. It's a mess, as I've said before, and that's why it's so important. For us to have that business perspective, I think and be at all the tables, obviously, not a single person needs, we have all the tables, but collectively as physicians, we've got to be at all the tables to do what we can to make things the best they can be. I realized it's a big giant monster right now. We've got to do what we can to make it right for patients.
So okay, Dr. Una, tell us also a little bit about how you went from then that mindset shift, you had your own successful practice? What happened for you to, you know, what happened in your life? And then what did you do to be able to execute this to scale, and yet you are working one day a week, because I know a lot of people are thinking, Yeah, I'd love to work one day a week, she's so lucky. But I'm guessing if you're lucky, you probably helped create some of that luck. So tell me, tell me how that went down.
So the first was a decision. You know, I probably started talking about this in my early 30s. And I was like, you know, by the time I'm 40, I'm going to be working one day a week. We called it the great divorce, it actually had a name in my house. And grant, I didn't know how, but I decided that that's what I was going to do. So the first thing was a decision. Just one decision.
So the great divorce… it was a deliberate decision, you didn't know how but you knew when…
I knew when I knew when. And then. So what that meant was that I would have to start getting results through people. And I'm an introvert, and I'm pragmatic at my core, I don't want any kind of conflict or any of that. So that's one of the most challenging things I had to do was to learn to get things done, even though I wasn't the person directly doing them.
So I had to train my staff and let my staff be, I would always ask myself, Is this the best use of my time right now? Right, because if somebody else can do what I'm doing, I need to get it off my plate. It also meant that I had to invest a lot in training, training, you know, my MA's, the front desk, all of that stuff, I had to invest in training them, because if I, if I don't train them, then I have to stay, there's nowhere to go. I had to bring on an office manager and she is amazing, amazing. And bring her on. And, you know, my practice is about 11 years old at this point.
So I need you to think about giving up stuff like your baby, right? It's like you in the practice are one. So you literally have to divorce yourself from stuff. And I'd have to hand off roles, and maybe they don't get done exactly the way I would do them. But you know, B+, A-, we have to take that and let them grow into into it. So building a team, and training the team and fighting to build a culture was one of the biggest things that I had to do.
And of course, paying attention to the numbers because if the money doesn't work, you are staying. It's right, you're not going anywhere. You know, so, you know, the marketing of the practice, the patient retention, all of those things they had to, to work on them. And then you know, one of the things that's it's not a downside, but it's a hard thing to deal with is that the patients are like, I only want to see Dr. Una, I wanna see Dr. Una and I, you know, I have to kind of think about us like, Okay, why do they say that though? Right. They say that because I'm very personable. They say that because, you know, work to get them in and out on time. They say that because for the moms they know, I care about them almost as much as I care about their kids even though I'm not there.
And I was like, Well, those are all transferrable skills. I can show the other doctors who work with me how to make this is what I do. Like the simple things I walk in, I always compliment the parent, it doesn't matter what they must have something I can compliment, right? And simple things like that you can reproduce that. So that light ball. Yeah, Doctor Una was not here, but that person is okay. You know. So those are some of the things that I had to do. But yeah, so since I turned 40, I've been I've been doing one day a week.
That's fantastic. That's so great. Now, obviously, I love hearing your story. And I'm sure other people are enjoying hearing your story. But as you and I both know, people listen to podcasts and stuff like this. So they can learn something for themselves, right? Like, how can we? How can they take something that we are talking about and apply it for themselves. So part of part of my thinking and doing format, getting to interview people like you is to be able to share your story so that someone can think differently about their own practice and their own possibilities, you know, what they might be able to do.
And I think in order for people to really wrap their heads around some of that, it's important to kind of pull back the curtain and show some of the rest. I mean, you told me, just before we started recording this, that you had scaled to a variety of sites and really made something huge. And then realized, maybe that was not actually the direction that you want to go. Can you tell us a little bit about not only how you've succeeded? And also then how you pulled back?
And truthfully, there, there are a lot of those things, right? Like, there's, there's a lot of them, but for that we had opened up a second location, and you know, it was like, Okay, we're gonna scale this, we're gonna grow this. And I really had I really struggled to reproduce the culture, in the primary office at the secondary office, right?
Well, you know, the second office, and I was like, people are not having the same experience, we're not having the same kind of reviews. And then truthfully, I'm a path of least resistance, you know, live the not easy life, like lazy life, but you know, like, don't make it more complicated than it needs to be. And I'm like, having two sites is complicated, you know, and I decided, I don't want to do that anymore.
You know, and so I shut down that office, which people where like, “you shut it down?” Yeah, I shut it down. It wasn't serving me, I wasn't able to reproduce it the way I wanted to. So I did that. I was like, you know, I can do a little bit of expansion on our primary location. But I have all this other stuff I want to do, I don't have time for this to be complicating my life. So we took that back. And that goes to say, you can do something that doesn't work the way you want. And you can change your mind. And it doesn't make you less successful. I mean, we're not married to this stuff, you know?
You know, what you've just said, I think is so important. So people didn't hear it. Like, I want to, like, say it again, you know, because people feel trapped, I think a little bit and that you went, we went to med school, and we did a residency and then we started working down a particular path. And there seems to be a societal expectation, and also our own self imposed expectation that we now should or must do, whatever it is, right?
There's something that we think that we have to do or keep doing, either because someone gave us a chance or because we worked so hard to get there or because you know, there's all this sunk cost, right? Like I spent a decade studying, and but how could I turn my back on this kind of stuff? It's not not easy to make those decisions, but really important. And what you're telling me seems to be in line with that. Do you agree? Or am I just imposing my narrative?
I do. And the truth of the matter is, if we track back to why we went to medical school, most people, they'll tell you, they wanted to help people, right? We didn't say we wanted to be in exam rooms. And there's nothing wrong with exam rooms. I'm just saying that's, that's a process. That's a method. So the more in tune you are with who you are and what you want to accomplish, and a change you want to make in the world, the easier it is to make those decisions. It was easy for me to shut that down.
Because I was like, this is not helping me go where I want to go. Yeah, this is becoming more of a hindrance and and think about your your, we're not trees, we can move, we can shift, we can change, we can do different things, and still end up with our ultimate goal. Right. So. So yeah, we don't have to feel stuck. We have to be centered some kind of way, but we don't have to feel stuck at all.
Yeah, I love that we should not feel stuck at all. And the other thing that strikes me too, is that not only was that second practice, not serving you, which is in and of itself. I mean, that's free standing. That's enough reason, but also from what you described, you weren't able to create the impact that you wanted with it, either for the staff or the patients. And so it really wasn't serving anybody else either in the way that you would envision.
So I guess I'm just adding that as like sprinkles on the Sunday, because even if it had been, you're still well within your absolute rights to say, “this isn't for me.” But it sounds like it also just wasn't for anybody. And I think it's great to be able to explore that kind of stuff. And then make decisions that are sometimes easy and sometimes hard about whether you want to continue, you don't ever has to continue, right?
You never have to. You never have to. And sometimes it could be a good thing, right? Because there's some people who will probably like, “why did you shut it down?” But I have pretty high standards, right? Like, I don't want people to be in my office longer than an hour. Door to door, I want them to be an hour and gone, you know, I want them to have a very personable experience. It's not like he was a, it was a horrible practice. But it wasn't my vision. It wasn't my dream. It wasn't what I was trying to create. So it was it was kind of like, it wasn't up there. But it wasn't bad. And sometimes those decisions are hard to make. Right? Like, yeah, you know, and I was like, Yeah, but it's not doing what I want.
And now I feel like I gotta say that again. And not because your words don't stand on their own. But just in case, you know, people are multitasking with the podcast, they're driving. I mean, how many people do you know and I know that are in the midst of their career saying, “it's not bad. But it's not everything that I ever wanted, but it's not bad.” And if it were like the worst, then yes, it's easy to say, You know what, that's super toxic, it's horrible. It's abusive, get out of there. But when it's just sort of not bad. I mean, you deserve so much better than that. You don't have to be in that if you're if you're so busy. And then you take a breath and you realize that that's the best thing that you can say is that it's not bad. I say pull the ripcord and get out of there.
Well, so wrapping up in a couple of minutes. But tell me a little bit if I can pry on this. Now I know you have so many other things you do. Obviously, there's your podcast, I know that you have some programs that you teach your speak, you do a lot of similar things as I do. So you and I are kindred spirits in that regard? Is this what you're doing with your other four days? Or really other six days in the week? Or what are you doing now that you've pulled it back to one day.
So I do a lot of things and it's all fun. So I do EntreMD is like the second phase of my career, and really what I consider my legacy, right. So I know how frustrating it is to want to start a business and feel like you don't know what you're doing, and you're stuck. And you can't really do it. And those are the times people can do it. And that's what led me to do this, like, there are many other Dr. Unas out there.
And I'm like, No, we can rock this, like we can do this really well. And of course in 2016 was when it dawned on me that medicine as we know it has changed forever. And so being a physician and not having entrepreneurial skills, and not knowing how to compete and not knowing how to build a brand, not knowing how to negotiate is just a recipe for disaster, we're in different times.
And so with EntreMD, I have the podcast so that on the podcast, you can check it out, you're already on our podcasting platform. And then I have the EntreMD Business School, which is like, Oh, my goodness, gives me goosebumps every time I think about it, but it's just a place for doctors to come and get the community, right. Because sometimes you feel alone, the community, the coaching, the accountability it takes to build their own businesses. And that's whether it's a private practice, whether it's a coaching thing, whether you're starting a skincare line, whether you have a platform, like podcasts or YouTube channel that you're monetizing. We do all of that in there. So, so much fun. And then you know, I'm a mom of to four babies. So, oh, I spent a lot of my time, you know, doing the baby stuff. And truthfully, in the beginning of the practice, I was gone a lot. And they were little when I started my first was 18 months old, and I had a four month old. Yeah. It's two little babies. And I had two more while I was still, you know, doing all the things. And so I feel like I can give them back those years that they didn't have Mommy, you know, so?
Oh my gosh, you know, the more that you and I talk the more I'm like, oh, same same sister. I feel Yeah. My kids were little tiny babies at probably the peak of my academic demand, right? Everybody wanted me to come speak about something like I mean, that was when I was busiest. And man I missed a lot of things.
I went back to work way too early after having them and I I was you know in hindsight maybe everyone's like this in hindsight I didn't give them the the focus that I wish that they had when they were little little but now they're still pretty little. They're in elementary school and I love that I have the flexibility that if it's like, they're gonna read a poem, and we're gonna have lemonade and animal crackers, like, I can be there, even if it's at 11 in the morning, there is nothing standing in my way from that. Even if it's short notice, I could still do it, which I love. And so I love that you are having that with your four babies. That's so important.
Yeah, I love it.
I have two questions for you. Before we go. I mean, obviously, I'll put links and things to all the things you've mentioned in the show notes, so people can come in and check all that stuff out. I want to ask you, if you could, you know, what would be sort of your most Golden Nugget, a piece of advice for other physicians who are listening, who maybe this is resonating with them a little bit? I mean, you've covered a lot. And so it could be in any in any way. But for someone who's feeling like it's not that bad, or it's not that good, what would be your advice to them/?
Alright, so I'm going to give you two one is going to be really short and one is going to be the real advice. So the first one, are there things you've been thinking about? Just do it. Like, this is not the rehearsal, this is the real life this is it, right? You're writing a bestseller with your life, if you don't like what's being written about it, change it, like just do it. Yes, yeah.
But the long winded version of that is this. There's something that keeps me in check a lot. And that is my 90 year old self. And I talk to her a lot. Right? And I think about it, like, who do I, my nine year old, the nine year old version of me, does she look at me now and say you're doing the things that made me everything I was supposed to be, right? She looked at me and say, Oh, now that you're younger, you have the time you have the energy, and all of that you're doing what you should do. So they turned out we were the greatest of all time. And when I say greater than all time, I don't mean greater than anybody else. I mean, the best version of you. I love so if you travel there, at your 90 year old self is looking at you. She's like, you are slacking, but you need to buckle up and do whatever it is you're supposed to do. Because you have one shot at this, this is not the rehearsal, you don't get another one. So if you don't like the book written about you change it.
I love this so much. Because you know, we hear advice all the time that's similar but different, which is, you know, what would what advice would you give to your younger self, but what I'm hearing from you, which is super wise, is to look ahead at your more senior self and what what would that woman Think of what you're up to now? And when you say, you know, get after it. Correct me if I'm wrong here, but I don't think you necessarily mean to be busier, do more do everything. But to be doing the right things. Whatever is right for you.
Yeah, it's not all the things is the thing. Everybody has the thing, right. So like now we're talking about private practice for somebody else that may be building your brand. Somebody else you had this skincare product that you can you cannot stop thinking about. You've been thinking about it for a decade is time to say yes to it, right. Somebody else is like, you know, I wanted to create institutional change. Go for it. I don't… whatever the thing is, right? Because that's the thing about life. There's no prescription for everybody you know, everybody doesn't get amoxicillin we get different things. Right. So whatever the thing is, get to it. Yeah. The only prescription is the career prescription. Right? Don't Don't take out that prescription. Every doctor needs that one.
So I want to, I want to close, this has been so lovely. I'm so happy that we decided to do this and for people who are listening if you if you want to know, I mean Dr. Una reached out to me to be on her podcasts. I hope you will check it out. And I agreed and said, you know, why don't we just double up so we're having a marathon recording session. We're going straight from her podcast to recording mine, which has been so fun and exciting. And you asked me in closing on your podcast, to give the one reason why I thought people ought to share that episode. Can I ask you the same thing? If people are listening today? Why should they share this episode so that other people can hear it? What would be the reason?
So this is my reason. We live in the strangest time for physicians. Strangest, we're in the middle of a pandemic. Doctors are losing their jobs. This is a medical crisis. In the middle of a pandemic. Doctors are collecting unemployment checks. We have never had this little autonomy ever. We've never been so devalued in the healthcare space ever. But we can change it We don't have to sit and take it.
Like Dr. Stiegler says, We need to own tables everywhere. Right now, if you can share this episode, what you're doing is you're creating a ripple effect, a ripple effect of doctors who have said enough. I'm not doing this any way anymore. I'm not complaining about it anymore. I'm not whining about it anymore. I'm going to be the change that I want to see. We're going to change this damn doctors who have never heard what you just heard. Their doctors have never heard about Dr. Stiegler podcast and he or she is showing us how to brand ourselves, showing us how to build online businesses how to go do non clinical careers, the whole nine yards. There are doctors who are going through all kinds of things and don't even realize there's an alternate reality. There's an alternate reality. And she may never be able to reach them to tell them there is but you can. So sure.
Wow, that's so powerful. Thank you so much. I'm gonna copy and paste that into edit that into every episode. I have my new outro there it is. You heard it. Dr. Una. Well, thank you again so very much for being on the show. It's such a delight to get to speak with you. And I know that listeners of the career prescription everywhere are just glowing from this conversations and thank you so very much. That's it for today with the career prescription. I will see you all next time. Bye for now.
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