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EP 09: Getting Started with Practice Management

by Docofalltradez | Dr. Brent W. Lacey

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EP 09: Getting Started with Practice Management – Dr. Brent Lacey

In this episode, we invite Dr. Brent Lacey to share effective strategies and actionable tips on how physicians can: achieve financial literacy, seek out mentorship, effectively negotiate their contracts and mitigate burnout.

 

Dr. Lacey is a full-time practicing gastroenterologist and physician blogger. As Founder and CEO of TheScopeofPractice.com, he specializes in personal finance, practice management, and early career strategies.  Highlights and insights from our discussion below.

Reversing the trend: The importance of personal finance savviness to mitigate debt.

Consider this: Eight out of 10 medical school graduates borrow to earn their degree. Most take on six-figure debt with 18% borrowing $300K or more. The average time taken to repay medical school debt? Thirteen years.1

 

Despite these astounding figures, nowhere along the pathway to earning a medical degree do educators teach medical students how to manage their personal finances, let alone their private practices or business. Dr. Lacey shares tried and true tips on how to:

  • Seek out a mentor, sponsor or advisor outside of medicine.
  • Understand simple business efficiencies [e.g. how to run a meeting effectively, negotiate diplomatically and more.]
  • Establish your own personal board of directors to provide you with sound guidance when it comes to taxes or accounting, legal matters or estate planning.

The art and science of contract negotiation

With new graduates coming into the scene and more physicians moving away from independent practice, it’s critical to understand rights and responsibilities before signing a contract with a hospital or large organization. Among many tips offered in this episode, here are a few that standout:

  • Be prepared and do your research ahead of time. Talk to other people in your specialty to get a good comparison point.
  • Don’t just focus on salary. Think holistically about lifestyle, colleague skill sets, peer experience, work-life balance and workplace satisfaction.
  • Don’t just take what’s offered at face value. Most contract items are negotiable so go in with the facts – not emotion.

Think ‘mind over matter’ when it comes to physician burnout
The U.S. physician shortage is expected to reach between 34,600 and 88,000 in 2025. With high demand for care and short supply of physicians, burnout is a real epidemic. In fact, an online survey of doctors found an overall physician burnout rate of 44%, with 15% saying they experienced colloquial or clinical forms of depression.2

 

While this is a very real issue and should not be diminished, Dr. Lacey emphasizes the power of a positive mindset and creating boundaries. Some tips include:

  • Don’t take on too many extracurriculars and volunteering activities. Learn to say, “no” or “not now.”
  • Find your outlet to release stress. How can you create balance and seek out what makes you happy [e.g. cooking, fitness, travel, etc.]?
  • Identify your support system. Whether it’s family, friends or coworkers, surround yourself with people who create a positive energy and can give you constructive advice.

 

Sources:

  1. https://nces.ed.gov/programs/digest/d18/tables/dt18_332.45.asp
  2. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056?faf=1#1

Ep09 Final Brent Lacey.mp3 transcript powered by Sonix—the best audio to text transcription service

Ep09 Final Brent Lacey.mp3 was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2020.

Welcome to the Physician Negotiator podcast, where no decision is left to chance with your host doc of all trades.

Docofalltradez:
Hey, welcome back. And today on the show, we have Dr. Brent Lacy. Dr. Brent Lacey is a gastroenterologist and he is the founder of the Scope of Practice Dot.com. Dr. Lacy, welcome to the show. Thanks so much for having me. You know, in a crowded space, you have done an amazing job outlining the steps needed to take to have a very successful launch of a medical career. Your Web site focuses on personal finance, practice management and early career strategies for medical professionals. I've been doing this for about three years or so. I'm familiar with all the physician bloggers. And I got to tell you, your Web site is excellent and it's very, very thorough.

Brent Lacey:
Well, I appreciate that. Thank you. Yeah. Here's his pen. A lot of work, but it's been it's been a lot of fun, too.

Docofalltradez:
And, you know, I can tell you personally, I've been the amount of effort and time it takes to build a Web site like yours. I can't even imagine how many how many hours you spent at this. So for that, I commend you. I think your writing is very clear. It's very concise and is very linear. And that's really, really, really hard to find. That's what I struggle with more than anything else, is trying to be a linear thinker. And what I think the biggest challenge that physicians have is financial literacy. And so we hone in on our craft. We we we learn how to practice medicine, but we just struggle with financial literacy. And I think if you look at your what Web site, if you were to go through it from beginning to end, I think you would have a good foundation. So the question is, how did you get such an amazing foundation?

Brent Lacey:
Well, so my my journey is actually very fortunate. My parents were very good at dealing with money and very savvy, you know, from it, really ever since I was a little kid.

Brent Lacey:
And so I remember when I was when I was young, you know, doing budgets with my dad when I was really young. And, you know, learn how to do a checkbook, learn how to do mutual fund investing, learn how to build spreadsheets. When I was, you know, in my teens.

Brent Lacey:
So I was fortunate to grow up with with a lot of education and then, you know, really sort to try to continue that during college and med school and and into clinical training with just reading and reading and reading. I mean, I have a couple of bookshelves worth of business books and personal finance books. And so I've just been reading for over a decade now. And, you know, you know, we were talking a little bit earlier. One of the things we had, you know, I'd mentioned is that, you know, a long time ago, one of my mentors taught me that if you want to be a leader, you've got to be a reader. And I firmly believe that. So, you know, I think that's the number one thing that physicians can do for themselves is, you know, if you're not taught this stuff in medical school, which you know, you're not, unless you're forced to go to one of the five places that has somebody like you or somebody like me teaching this stuff just on their own. You know, you got to go out there and read. You know, there's all kinds of sites out there like yours. Like like the scope of practice, you know, and just books out there that you can get. I mean, you can get an MBA by just going to Barnes and Noble, spending a couple hundred dollars on, you know, on, you know, the top 20 business books and you'll just know so much.

Docofalltradez:
And based upon your parents teaching you how to how to make a budget, you chose to attend the University of Texas, San Antonio, on a Navy scholarship. What made you decide to do that?

Brent Lacey:
Well, so that was that was interesting. So Texas is unique in that they have their own match separate from the national. So suffer from like the national match. So I applied to all the different schools in Texas because that's where I grew up. And so I wanted to go to school close to home. And I loved the San Antonio program. I loved the clinical side of things. I loved the people that were there and ended up ranking them. Well, I ended up ranking them second, actually, as a matter of fact. But I vacillated between them and Houston 1A and 1B and then, you know, ended up ranking. And second. But they ranked me. They rank me first. Yes. And I loved it. It was a great place. Now, the one thing that we didn't really get there and I think, you know, you didn't and most people don't. Is the is how to manage a business, how to run your personal finances. And, you know, so that's one of the things that I really wanted to try to do well. And so I spent a lot of time reading and now I spend a lot of time writing about this.

Docofalltradez:
Fantastic. Now there's the application and there's the acquisition of knowledge, but then there's the application of knowledge. And sometimes it's hard to translate that without a mentor. Now, did you ever have somebody like that in your life to help you apply your knowledge?

Brent Lacey:
Yeah, it did. And yeah, I'd say my my biggest mentors over the course of my life have really been my parents. I mean, they've they've just I mean, I'm incredibly blessed to have two parents that are just really savvy about this kind of stuff and who are willing to teach me. You know, I was in the Boy Scouts for a very long time. So a 12 or 15 years and very active and says it's kind of a natural leadership laboratory. So I learned a lot about leadership and how to manage people and how to, you know, how to leverage influence to achieve a goal, a collective goal with a group, but didn't really get any business mentorship until I got to college. And so I had a really cool opportunity. I went to Texas A&M University for undergraduate gigging, Max.

Brent Lacey:
And when I went to when I started my junior year, I applied for a position on the leadership team of the the memorial student center, which is the student union there at Texas A&M. And it's the largest student run student union in the country. We had eighteen hundred student volunteers and we had a budget of about $6 million. Some is a huge, huge operation. And so my junior year, I was selected to be the director for leadership development and service organizations.

Brent Lacey:
And then I was selected to be the chief operating officer my senior year. And in that capacity, I got to lead all the programming for the entire student union at Texas A&M for the year. And one of things that was awesome about that is I got an opportunity to work one on one with the guy who is the now the director of the student union men and Luke Alton Dorf, who's one of my great mentors. And, you know, he and I worked one on one all year long to shepherd the programming committee, you know, through all the different programming seasons.

Brent Lacey:
And I just learned so much from him. Well, one of the things that you think about when you're you know, or I guess I should say, you really don't think about when you're in medical school and dental school is just the simplex, the some pluses of running a business.

Brent Lacey:
And I'll give you just a basic example. So one of the skills that I picked up from Luke that I think has been hugely valuable for me is just how to run a meeting effectively. And you think about how many times you've sat in a meeting and you just sit there looking at your phone, you're counting the seconds, because usually this is a waste of time. We're talking about nothing. I could read this in an email. What are we doing here? You know, we're just learning how to run. A meeting is a very basic skill that I think all leaders and and business people should have. But that's not something that's natural. It wouldn't even occur to me to seek that out. But I had the opportunity to study under someone who was willing to teach me about that and thought it was important that I learn. And so and so now that's the kind of thing that I have the opportunity to give to others.

Docofalltradez:
Now, typically, when you are in medical school, you would receive some type of mentorship from an attending or resident. Did you receive something like that?

Brent Lacey:
Yeah, our our program at the Naval Medical Center in San Diego.

Brent Lacey:
Our internal medicine program had a one on one mentorship program that they had where they would at the beginning of your intern year. They would pair up a an intern with an attending and it was either an internal medicine doc or a one of the subspecialists. And so I can't remember exactly the specific to the program.

Brent Lacey:
But I do remember that Alyssa Alissa Esposito, who was my mentor, she was gastroenterologist and actually very influential in getting me motivated to go for a fellowship in gastroenterology. She and I would meet I think we met probably every three to six months directly. And, you know, she would she would ask me some questions about, you know, how do I feel like I'm progressing in my in my training?

Brent Lacey:
Am I. Am I getting to where I'm, you know, moving on to the next level? She offer feedback from my rotation directors and things like that. And so I definitely learned a lot from that. But, you know, most of what I learned was was some leadership stuff, but mostly, mostly just medical things. Still, even with that, I wasn't getting a lot of direct business or practice management practical skills.

Docofalltradez:
Yeah. And essentially my understanding is I had I had something very, very similar in my. My mentor was so focused on the medical aspect of or teaching medicine that they really didn't teach me how to engage in business or what what's what is the what are the qualities of a good of a good company. I remember having one conversation with one of my mentors and I was trying to look for a job when I was a resident and I would try to bounce ideas off them. And when I would ask them questions directly, they rarely knew the answer because they were most of them were accum additions and I was more interested in working in private practice. And so even then I was I was pretty lost. And I think it's safe to say that most medical students and or residents get little to no financial education. and/or business education.

Brent Lacey:
Well, and I think that's I think that's true. And I think it even goes a step further. Like what?

Brent Lacey:
What did you I mean, did you get any kind of training on how to select the right specialty, how to know what specialty is right for you? I know. I sure didn't. You know, and one of the things that I think is, you know, I bet, you know, that is not taught very well is how to make simple decisions like that, because we tend to be very, very focused on learning medicine and learning how to be an excellent clinician or how to be or how to do research or how to do surgery or whatever. But all the rest of the stuff we're left to fend for ourselves.

Docofalltradez:
Exactly. And so even now I mentor students or residents or SRN A's. And when I find my colleagues constantly teaching them about medicine, I'll bring them to the side and try to teach them about business, or I try to teach them about certain simple choices, like if you live in a rural area versus a city. These are the consequences of that.

Brent Lacey:
Or, you know, if you are going to negotiate a contract, you need to basically have three or four contracts lined up so that you can compare them. And this is how you compare them. And when they talk to me like, oh, no one's ever said that to me. And my understanding is most of them will go into especially the younger students will go into their first job.

Docofalltradez:
And if you think about an SRO, any they typically graduate from their program at age 23 to 24. And now they have to make a huge decision as to where they're going to work, how much they're going to get compensated and what kind of shifts they're going to be working on. And they have no idea to even turn to. So I try to give them some kind of insight, but there's very little information out there for them.

Brent Lacey:
Well, and we see that we see that in the area of personal finance as well. So, you know, people are, I would say, equally ill equipped to handle their personal finances. I mean, when I got out of fellowship, I started doing well. I started a financial discipleship ministry at my church and then realized there's a great need for this at my hospital, too. So I started doing some lectures at the at the hospital. And the residents and the students and the nurses would come. And even the corpsman, like our medical assistance, would attend these things.

Brent Lacey:
And the the sheer lack of knowledge, the size of the knowledge gap was just absolutely staggering. Members sitting in a room or giving a lecture one time on, you know, how to how to save for retirement. We started talking about, you know, IRAs and falling case and I mentioned off hand. So, yeah, the IRA is basically, you know, how it's treated for tax purposes. But inside, you can invest in whatever you can invest in stocks or bonds or mutual funds. And then someone raised their hand and said, what's a mutual fund? I said, Oh, my goodness gracious. I didn't realize we needed to back it up that far. So just just giving people basic vocabulary and taking it down, just drilling it down to the roots.

Brent Lacey:
I mean, you know, most people don't need to be experts in, you know, the you know, a one exchange and, you know, all these, you know, crazy, you know, investment strategies and things. I mean, just the basics of how to do a budget. Why to have an emergency fund, the nature of compound interest, you know, what is dollar cost averaging? Just very, very basic investing concepts will take people so far. And it's amazing how ill equipped we are as physicians to handle that.

Docofalltradez:
I kind of feel like the financial industry tries to purposefully make it a little more complicated than it needs to be, because I remember when I first came out, I I struggled with this myself. And so some but the first thing one of my peers told me is I needed a financial advisor. So I remember looking, oh, you know, I literally looked at financial advisor and all over town and I went I just basically went from building to building. And I remember driving to one big firm and it was a beautiful building, three stories high, all black glass.

Docofalltradez:
And I walked in through these huge doors and sat on this big leather couch. And the guy looked at me and he said, what's your net worth and or how much you know, how much you wanted to ask? I said, well, right now I don't have anything. He's like, call me when you have five hundred thousand dollars. And then that was the that was the end was the end of our of our exchange, you know. And I said, wow, how can this be so complicated?

Docofalltradez:
So I did what you did and I just started reading and reading and reading and eventually I figured it out.

Docofalltradez:
What's interesting is the reception. So what type of reception did you get with the people that you've been teaching?

Brent Lacey:
It's overwhelmingly positive. I mean, there's it. I usually get one of a couple of things I used. I usually get either that people have sort of a baseline level of knowledge that, you know, they understand more or less how what's going on with their student loans. Maybe. Don't really have a concrete plan. And then just sitting down and talking to them gives them some concrete steps that they can take and an action plan to go, OK. Would do this first and then in six months we're going to have achieved this and this is the next step and then this is the next step after that. And then two years later, you're debt free.

Brent Lacey:
Or the other thing that I get a lot is people go from a feeling of hopelessness to hopefulness. It is amazing. I mean, the the average amount of medical school debt right now is the most recent statistic I read is that people graduate with about $200000 in student loan debt. That's the average. And that, I think is a dramatic underestimate, because that's not counting.

Brent Lacey:
That's not counting people like me who went to school on a Navy scholarship or who maybe did M.D. p._h._d program or something who come out with zero. So there's a bunch of zeros being averaged in there that's not really fair. And then it's also not counting a lot of foreign medical graduates who are coming over here after, you know, you know, having gotten their program paid for in their own country and then coming here to the states. So I think the real number of if you look at people who actually take out student loans, I think it's probably closer to 250, 300, maybe it's 400, I don't know. But I talked to lots of people that have three, four and five hundred thousand dollars worth of student loan debt from just medical school. And that's just for them. And that doesn't count necessarily. Undergrad doesn't count. Graduate school doesn't count their spouses. I mean, I work with people all the time that have five or six hundred thousand dollars between them and a spouse.

Brent Lacey:
And, you know, just you can imagine, you know, if you are sitting on a required monthly payment of five to six thousand dollars, and that's just to do the bare minimum and have the opportunity to pay off your student loans in 30 years. I mean, that would just be such an ankle weight would be so painful. So just giving people some hope and giving them the opportunity to see. OK. There is a way to get through this. There is a way, you know, to to battle this debt monster. There is a way to achieve financial success. And giving them that hope is is huge.

Brent Lacey:
And the number of people that come out of some of these lectures going, wow, no one's ever sat me down and just talked to me about this. I was just planning on keeping this around forever because I figured I didn't have a choice. Now I'm fired up. It's awesome to see that.

Docofalltradez:
That is amazing, you know? And on the other end of the spectrum, we have physicians who are about to retire. And I think the latest statistic I read was, according to the to the A.M.A., 30 to 40 percent of physicians, physicians have less than half a million dollars in their savings account or not in their retirement account, which is a. For like a whole year, I mean, a whole career worth of. Of earning to have that little amount is just utterly amazing. So I think it spans financial literacy, spans all ages. From what I can tell, absolutely.

Brent Lacey:
And I've done financial coaching for years. And I see as many people with, you know, the median household income in America is $50000 for that for a household. And I see as many people that are making less than that fighting to stay alive just paycheck to paycheck, as I see physicians. I mean, so, you know, I don't think physicians are immune to any of the typical mistakes that we see people make. Matter of fact, you know, in general, I find that everybody, regardless of income level, makes the same five or six mistakes financially. It's just that physicians make it with more zeros on it.

Brent Lacey:
Yeah, I remember reading one of your articles that says whatever you do, do not try to get rich quickly. And I thought I think that's very sage advice. How did you so how did you learn how to become a financial coach?

Brent Lacey:
So so actually, I actually learned about it through my church, so I know if you're familiar with with Dave Ramsey. Sure. Not to mention you probably are. Yeah. So I taught Financial Peace University. That's his that's his financial mastery class at my church a couple of times and then decided I wanted to expand our ah our ministry at the church. And so I took three other guys and we went to Nashville for a week for his financial coach, master trainer. And we we had a week long basically series of classes with 150 other people from around the country who were all interested in the same thing and just learned about bankruptcy and foreclosures and, you know, basics of coaching and, you know, how to get people's spouses together and budgeting, all this kind of stuff. And so that's kind of how I learned to be a financial coach. And then, you know, honed those skills over time, just meeting with people one on one and doing coaching. Both, you know, my hospital and then now also through the scope of practice.

Brent Lacey:
And so, you know, what's been interesting to me is see that people make mistakes in patterns. I mean, it's it's almost like it's almost like seeing a syndrome.

Docofalltradez:
Right. So you can diagnose somebody with a syndrome based on the pattern of symptoms that they present with. And it's the same thing. You know, I'm like, oh, this is the this is the student debt syndrome. Oh, this is the I can't get my spouse on the same page with me syndrome. You know, it's pretty funny.

Docofalltradez:
Oh, you know, the student debt syndrome. That would be a great blog post. So you got to write down one if you haven't already.

Brent Lacey:
Ok. I like that. I'll do that. That's fun.

Docofalltradez:
So let me ask you a question. So after you attended, Dave Ramsey's university has finished, what would you call a financial what university? Financial peace. University financial peace like? Okay, I get it. Like war and peace. War and peace. Got it. When you finish that 40 course, what do you get from that? Do you. Does is there a certification program? Do you get mentorship to follow up after that? How's that work?

Brent Lacey:
Yeah. So we had a we had a three month mentorship afterwards with somebody with their seasoned veteran financial coaches who had been doing this for, you know, 15, 18 years. There there was a certification.

Brent Lacey:
They have to be careful with what they call it, because it you know, if you call it a certification, then it's subject to, you know, different medical or medical to different education requirements, Kraus CS and that sort of thing. But basically, I mean, basically the most important thing that I got was the knowledge base and then the practical mentorship afterwards.

Docofalltradez:
So mainly just just getting the skill set developed was really the main value that I got out of that.

Docofalltradez:
Right. And I'm really careful too about not we do not give financial advice. This is really for entertainment purposes and or to help, you know, get you to the right person to help with your finances or help with your legal requirements or whatever. So.

Docofalltradez:
So, for example, when I talk about negotiation, I'll ultimately you need to speak to your lawyer. You need to speak to your account. You need to make sure all the people who are licensed and professionals look over your contracts and your finances to make sure you're making a good, solid decision.

Brent Lacey:
Yeah. And one of the posts that I wrote here in the last couple of months is called Why You Need a Personal Board of Directors. I love that post. That a great post as free as for exactly the same reason. I mean, you know you know, I don't I don't do a lot of my own mechanic work. You know, some. But I mean, you know, cars are basically space shuttles nowadays. So you need someone who's a professional at that. Well, you know, I'm not a tax guy. I have a guy who does Texas for me. I mean, I'm not I'm not an attorney. I have a guy who does, you know, contract work. I mean, and you've talked about this on your site. You know, the importance of having, like, for example, an attorney look over a contract with you because, hey, we're we're not we don't we don't go to law school. I don't know anything about that. I mean, I know enough to to know what questions to ask. And then I need to know how to find a person who I can trust to put in my corner, who's going to be a professional advisor for me in that area that I'm not a professional.

Docofalltradez:
And again, the whole board of directors is very, very important. You've mentioned to what are the other people that you would think are really paramount to have on your team?

Brent Lacey:
So. Well, what's it kind of depends on, you know, what you feel like your shortcomings are.

Brent Lacey:
So for me, I'll just be I'll just be, you know, like full disclosure, I don't use a financial adviser, like I don't have a CFP that that I work with just as an example, because like I said, I've been doing a, you know, sort of a DIY strategy for a very long time. But I've been reading this stuff for a decade. So that that's for me personally. But I think a financial advisor is definitely someone that you should consider. Having a tax professional or an accountant is huge for sure. I am not a tax guy and. I tell you, honestly, those things change so often that I think it's really valuable to have someone who just that is their life is knowing the ins and outs of that. I think an attorney is someone that's really important to have because you'll need it, you'll need it at some point, you know, for, you know, setting up your business. You know, if, you know, looking over at an employment contract, you know, things like that. So a financial planner, tax pro attorney and estate planner, I think is really valuable someone to have. And it could be an attorney, could be an accountant potentially, but someone who can help you set up your estate so that when you when you die and you know, your assets get distributed as you like, either to your kids or your spouse or but hopefully not, you know, a giant piece to the government.

Brent Lacey:
I mean, you know you know, you make sure that it's going gonna go where you want. I think an insurance broker is valuable for for most folks. So, I mean, I'm sure you've written on the subject and I know I have that, you know, there are just so many insurance companies that prey on our lack of knowledge. And so having someone that is not a captive agent, someone who can shop around for a bunch of different companies and find you, the best deal is really helpful. And then the other big one, I would say, would be some kind of a real estate professional.

Brent Lacey:
So at a minimum, you know, all physicians are likely to own their own home someday. But I would say a fairly substantial percentage are going to be in a position to invest in real estate also. And so knowing how to navigate the ins and outs of that for tax purposes, you know, like what can you do? What can you depreciate legally and what can't you know? Where do you buy? What was it worth the right things to consider as you're, you know, trying to figure out how much of a house can you buy, do you rent versus to buy commercial things like that?

Docofalltradez:
You know, I was surprised by the real estate professional, and I can't emphasize that enough because part of the problem with being a physician is people are always coming at us with exotic proposals for investments. And I have so many friends that have been burnt over the years. And me personally, I actually got involved in a commercial deal back in 2006 just before the real estate crash. And unfortunately for me, I did not have a somebody that I trusted. And so things could have gotten a lot worse. But, you know, my my very first two years out, I experienced something like that. So I didn't think that was necessary. But now I am convinced you must have somebody that you know, somebody that you trust on your side when it comes to real estate. So excellent, excellent suggestion.

Brent Lacey:
And for and for all these advisors, one of the things that I really try to coach my students and residents on is the the key thing that you want in any adviser is you want somebody who has the heart of a teacher. You want someone who is going to teach you and coach you to make the best decision for yourself. That's why I think of it as a board of directors. You know, you are the CEO of you Inc or of Yourself Inc or your family Inc. And so you need people that work for you. And so if you've got someone who's just trying to sell you stuff and all they want to do is make money off, you fire them, you need to have somebody that you can trust. And that person is going to be someone that after you sat down with them, you learned something, you know, more after talking to them than you did beforehand. And you are getting the answers to the questions to make the decisions you need for yourself.

Docofalltradez:
Well spoken. OK. Let's change gears a little bit here. You wrote an article called Top Ten Mistakes Top 10 Mistakes Physicians Make when negotiating the contract. I thought it was an excellent article. Clear, concise, very well written.

Docofalltradez:
Wouldn't you personally seen errors like no one would have you personally seen with physician contracts that are erroneous or you've personally experienced? And what advice do you give? Maybe the top two things that you think physicians and or dentists and or nurse professionals need to know about.

Brent Lacey:
So I think the number one thing I think the number one thing I would say is that and this is true, I think in general of any negotiation or any two way conversation, and that is the person that is the best prepared, that has the most knowledge tends to come out on top.

Brent Lacey:
So if you think about if you think about that from a standpoint of let's use an example of our everyday lives. So as physicians, when a patient comes in to see us like for like for my world, if someone comes in with abdominal pain, I understand abdominal pain at a level of 10 out of 10 and patient understands abdominal pain at a level of Web M.D. out of 10. Right. Which is an excellent judge. Yeah. So now we're working towards the same goal in that case. Right now, that is.

Brent Lacey:
But in general, you know, we are we're operating off of my understanding and my knowledge. My experience to get us towards the end point, so when physicians are trying to negotiate a contract, they really need to take the time to read the contract to know what's in the contract, and then especially to know how it compares to other contracts. Is, you know, similar specialties. So, you know, talking to other people in your specialty. Talking to junior employees at that exact firm. Talking to people who have been out of practice for a while and say, how much were they offering you and what kind of guarantees were they offering you when you started things like that. So the more knowledge you have going in, the better you can negotiate, because you know what is reasonable. So, you know, if they bring you a super lowball offer or have, you know, work our requirements or work out requirements that are just tremendously outside the bounds of normal. So I think that's probably the most important thing. And then I would say the second thing is that I would say is just sort of an overarching thing and we can get into specifics, if you like, as well. But it's just sort of philosophically, as I would say, is being afraid of actually negotiating.

Brent Lacey:
So as physicians, you know, we're we're constantly trying to help people. We're constantly trying to approach every interaction with as much empathy as possible, or at least, you know, we try to. And when you're when you're approaching a business negotiation, you really can't think of it like that. It's not it doesn't need to be adversarial, but you need to go into it with sort of a dispassionate view of things and say, OK, this is a business transaction. In this moment, I'm not trying to get someone to be my friend. I'm not trying to get someone to build a physician patient relationship. I'm trying to see to it that I end up with a fair deal at the end of this. And they're trying to see that they end up with a fair deal out of this, too. And so that's what we're trying to work with. And all they all things in a contract are potentially negotiable. And so I think recognizing that is very important and being willing to actually fight for your own side of the contract is is the second big philosophical thing that physicians need to take in mind.

Docofalltradez:
Me personally, I think if you're young and you're coming out of residency, that might be a great challenge. Even assuming that you're going up against somebody, they might be either in a mentor or somebody say you decided to stay in your department. The people that you've been taking orders from, now all of a sudden you have to negotiate with, it could pose a challenge. So in that regard, maybe that might be a situation where you want advice of somebody who can be a who cookie negotiate on your behalf. But like you said, you have to be prepared if you you got to know the numbers. You have to know what's fair so that if you do use a third party, they can advocate for you. That makes sense.

Brent Lacey:
Absolutely. And I'll tell you what's interesting that I've seen over the last I guess I've been hearing about it for the last four or five years. It's this year. We talked about syndromes a second ago. I think new graduates make mistakes in one of two different directions. It's very interesting how this has polarized. One mistake that people make is massively undervaluing themselves.

Brent Lacey:
So they go into a contract negotiation prepared to ask, basically prepare to take whatever is offered. And that's a huge mistake. But then I also see people go in with wildly unrealistic expectations. So, you know, I'll give you a saw. I'm joining a group in the, you know, this summer. And I remember talking with one of the with one of the senior docs there. And, you know, we were negotiating back and forth and he he said, listen, I really appreciate that you're coming.

Brent Lacey:
You're coming into this with a sensible view of what is realistic to ask for. So he said, you know, they've had three or four people in the last year that have been seeking jobs with them. And, you know, they were their expectations were just wildly unrealistic, like, yes, I'm going to come in. I'd like to make fifty thousand dollars a year with, you know, for the first couple years and then a million dollars after that. And then I'm going to have, you know, four weeks of call a year like wait on. On what planet do you think we are all living that this is this is the natural order of things, right? We just wildly unrealistic. So it's interesting to see people make mistakes either unrealistically high or unrealistically low.

Docofalltradez:
It's kind of interesting.

Docofalltradez:
You know, is fascinating. So I think this is a generational thing. I'm writing an article right now about the different generations of physicians and how they behave differently. And Robert Drago's. He's the physician investor. Are you familiar with him? Oh, OK. So he wrote an article recently talking about how he has a group of friends that that he's known for years. And as they've aged, they're trying to find replacements. And he said, well, as he's kept in touch with him. He will check in on them from time to time. Ask them how they're going and they said none of them can leave their practice or retire because they cannot find somebody to match their work ethic. So it's interesting that you say that because I'm kind of seeing that with this next generation coming up, who who have these expectations. Granted, you do want to have, you know, work life balance, but you you can't have it both. You can't expect to make big bucks and then not work hard. You know, something has to give.

Brent Lacey:
That is absolutely a great observation. I've observed the same. And so, you know, you and I you know, I think you graduated in really the era before work hour restrictions or.

Docofalltradez:
Correct. Right.

Brent Lacey:
And I just barely missed the work hour restrictions myself. So it's definitely something I've noticed with the newer graduates that are coming out.

Brent Lacey:
You know, they they typically, you know, if if they're used to training in a place where they only do twelve hour shifts or they only do 14 hour shifts and they have six handoffs in a given day. And, you know, they have the idea of all the weekends off or whatever.

Brent Lacey:
You know, it's I think it's doing people a disservice by making them think that they're going to be able to maintain the same level of work afterwards.

I actually wrote a post last year called Debunking the Myth that Life Gets Easier When You Finish Residency.

Brent Lacey:
Addressing this exact problem, because people come out of that, people can get over that article. People come out of training thinking. Yeah. You know, all you know, they're thinking. I've paid my dues. Now I'm ready to be an attending and work less. And it's not that way in the majority of time in the majority of cases.

Docofalltradez:
You know, the funny thing about that is, though, I think if you are a brand new graduate and you recognize it, you have such a huge advantage against your peers, because if you walk into a practice, say, listen, I'm willing to kill it, I'll do whatever it takes. I'm you know, I'm a junior guy. I'll go to whatever meeting. I'll contribute. You're going to to be a rock star. You're going to skyrocket. You'll bribe, you know? Not only will you be partner within two years, you'll probably running the group and within five.

Brent Lacey:
Absolutely. And that it's it's so funny that, you know, just having an exceptional work ethic has become something of a superpower just by virtue of the fact that lots of people are ready to try to take it easy. And I one of things I was encouraged, my students and my my interns especially.

Brent Lacey:
So you know that you remember. Remember intern year. Right. Although we all try to forget.

Brent Lacey:
But, you know, the thing I always tell my interns is like, nobody is going to come out of this. Nobody is going to come to you in July and think, oh, my gosh, this guy is such a bad physician. Every time you screw something up, the only thing that people think is it's July.

Brent Lacey:
Everybody understands that you're new. Everybody understands you. You're inexperienced. The one mistake that you can make is coming in and being lazy or or or not or just not caring or just not really paying close attention. And those reputations have a way of following you. And you know, what I tell my interns is like what you need to do if you want to succeed here. You need to come in prepared to assassinate your first month. You're your first month. You need to be here an hour earlier than than you think you're supposed to. You need to read five more articles a day than you think you're supposed to. You need to be doing every single thing you can to just be awesome.

Brent Lacey:
Because if you can do that, then the next month, when you're when the new attending comes on, I'm going to be telling them, OK. Listen, Joe is fantastic. Dale really is kind of lazy and those reputations are very hard to shake. And I'd say what those kinds of things that that same phenomenon persist when you get out. And so if you go into a contract negotiation, you like.

Brent Lacey:
Yeah, I really expect to be making a million dollars a year and doing, you know, six weeks of Colyer. And then the senior guys are like, okay, I bring in three hundred fifty thousand dollars a year and I have 15 weeks of call year. And I've been doing this for 20 years longer than you. You know, it's going to be very hard. So it's going to be very hard to shake that reputation over time.

Docofalltradez:
Well, there are twenty six thousand anesthesiologists in practice right now in this country. And I can tell you right now, there are few anesthesiologists that are so notorious that they are known throughout that entire community. And so most of them work independently in the middle of nowhere because no one else will hire them. And I'm not sure how many gastroenterologists there are, but I'm sure it's very, very similar.

Brent Lacey:
Oh, yeah. There's you know, I mean, you know, the American college, a gastro every year is probably fifteen twenty thousand people.

Brent Lacey:
So that's just to the people that come. So yeah. I'm sure it's the same way. But you know, that kind of thing is is pervasive.

Brent Lacey:
And so now I think there are ways to overcome that. And certainly, you know, I. I think it's important for us to just the flip side and that you don't want to go into a contract negotiation, just prepared to take it on the chin with whatever they will, with whatever they offer you, you know, and that's part of being prepared, is being able to know what to expect and know what's reasonable to expect and then be able to stand up for what you actually are worth. And I think that there's there's real value in that. But like I said, it's easy to make a mistake both directions, either asking too much or having too high expectations or too low expectations.

Brent Lacey:
And so the more you can be prepared for that going into a negotiation of any kind. The better the better off you're gonna be in a better off your groups.

Docofalltradez:
I totally agree. What about focusing on money as your primary driver versus something else?

Brent Lacey:
I think that is both very common and a tremendous mistake. So, you know, I'm very much a fan of the saying that money can't buy you happiness, say money is money can buy you stuff and you should get some stuff. Go get you some stuff.

Brent Lacey:
I mean, stuff is great. I love stuff. But but money can't buy happiness. And so for me now I'm in a position right now where just in my in my practice, I mean, I'm a solo practitioner and have been for the last four years. And that has been one of the greatest regrets that I've had the last four years. I mean, I love my team. I love my patients. I still love my work. But, man, I miss being part of a great team. And so the group I'm joined in the summer is one of the best groups in the country and me, if not the best. I mean, it absolutely phenomenal guys and gals. So I think that's a very important thing. And, you know, we when you focus just on the money.

Brent Lacey:
I think. I think what you find is that is that you can easily get yourself into a situation where the where the daily grind is so intolerable that no amount of money, you know, can make up for it.

Brent Lacey:
I mean, you know, how many people do you know that have been in a relationship where like, let's say, you know, I've been in a marriage that, you know, everybody's, you know, making plenty money and everyone's you know, you're live in the right. You got a great house. You got a great car. And you just can't stand being around each other. What? You're gonna be miserable. And that's the same thing with the group.

Brent Lacey:
I think the things that you need to focus on if you're trying to pick the right group to join or trying to pick the right, you know, place to be, you need to think about lifestyle stuff as I think your most important set of criteria. And so that includes things like what part of the country do you want to live in? I mean, the farthest north I've ever lived is North Carolina because I grew up in Texas and I get cold really easily.

Brent Lacey:
So I don't I don't expect I'll be looking at groups ever in Minnesota and Maine as beautiful as those areas are.

Brent Lacey:
I can't stand the code or doctors don't tell a physician. I'll fire that.

Brent Lacey:
Well, yeah, he's he's welcome to have his face and I'll be in Texas. So that's just survive. But, you know, I think you need to think about geography. Think about proximity to family. I mean, if if you really want to be close to your family, you need to be looking at areas that allow for easy travel to your family. I think you really need to strongly consider who your partners are. So one of the things that that that I'm writing about, I'm actually working on a book and this is gonna be part of it is the importance of picking a group or picking a practice.

Brent Lacey:
Thinking of it the same way that you think about approaching dating from marriage. Because if you think about if you think about it in terms of of a marriage partnership, I think a group partnership is very, very similar.

Brent Lacey:
And in many ways it's actually more important. You know, my marriages I mean, I personally believe marriage is the most important relationship that you have in your life. But it's, I think, also reality that you will spend as much or more time with a lot of the people you work with in a 30 year period than you will with the people at home. If you're working full time and so you need to approach it in the same way. So don't just go pick a group based on, oh, I like their Web site and you know, they they have a pretty building. Well, that's that's pointless. You need to really enjoy the people you're working with. You need to have people that are eager to work together, people that are helpful, that are collegial, that really want to build each other up. You know, people that want to mentor you. So if you go join a group and everything's eat what you kill and you know, they don't have time to help you out because they're doing their own thing.

Brent Lacey:
That's not a great place to start a practice, especially if you're so green that you've, you know, never thought about building encoding, for example, or you've never thought about, well, how do I take the right m.a or how do I pick the right nurses or how do I hire a good executive assistant or whatever? So you need someone who's going to mentor you. I think those things are far more important than money. And then, you know, if you find the right place, you know, and you know, then you know and you and you're picking a place that has also decent compensation, you know, you're going to end up being happy and making more money in the long run.

Docofalltradez:
You know, what's interesting is you have to ask yourself if one job is. Is a stand out with respect to reimbursement and or income. There's probably a reason for that.

Docofalltradez:
So either the working conditions are terrible, the your partners might be terrible or the culture might be terrible. So, I mean, for me, when I see these super high compensation, it always raises an eyebrow. And I'm very, very you know, in fact, like I said, that the NSC community is so small, I can look and tell you which job is going to be more challenging than another job. And the only way you get me to go there is to pay them. And so the question is, do you want to set yourself up where the only thing you have to look forward to is money? And I think you're spot on.

Brent Lacey:
Yeah, I think it's a really, really important consideration. And, you know, we don't I don't think we pay enough attention to that. And that's definitely something that any new graduate or any anybody who's in medical school or anybody who's in fellowship residency, if you're listening to this, pay attention to that.

Docofalltradez:
I mean, what Dogville Trisha said. I mean, pay attention to those kinds of red flags. And so if something seems too good to be true, it probably is. You know, find you know, it's amazing if you talk to some of the junior partners, one on one or some of the junior employees one on one. It's amazing what you can get people to tell you, you know, if you're going to interviewing someplace.

Brent Lacey:
See if you can take one of the whoevers, their newest hire or whoever has been hired in the last two years. CV buy them a cup of coffee or take him to lunch and just pick their brain. You'll be amazed at how quickly people will be willing to just start talking about it. And so if you ask him questions like what's the best thing about working here? What's the worst thing about working here?

Brent Lacey:
You'll be amazed at the kind of stuff that people will tell you, like, hey, man, let me tell you about the stuff that they do here. They will just unload.

Docofalltradez:
Exactly. And I think this is a nice transition into physician burnout. So we're having a, you know, an epidemic of physician burnout, 70, 70 percent physicians are burned out. Is it entirely possible that some of these positions are burnt out because they don't like the people they're working with? They don't like the institution they're working with. They don't like the amount of work that they actually have to do for a given institution, you know? So these are these are factors that can potentially lead to physician burnout. But you have a very interesting perspective on physician burnout. Different than what I've heard elsewhere.

Brent Lacey:
Yeah, I think that's I think that's true. I so I tend to take the position that while burnout is very real, I think it is.

Brent Lacey:
A mistake of galactic proportions for physicians to claim that as a mantle and say, yeah, I am burn out or no use. Ah, I have I have burn out. Therefore, you know, that is what now defines me. I am a physician who is burnt out. You know, I've seen post going around here in the last maybe six months or so. Calling it moral injury, which frankly I think is just overly dramatic. I mean, you know, and again, I don't mean to make light of the situation at all. Believe me, I recognize burnout is a serious epidemic.

Brent Lacey:
But if if that's if that's as far as you take it and you say, OK, I am burned out. You know, I have just gotten burned out from this job. And you don't ever address it. You're claiming a mantle of victimhood that I think is putting you in a prison that is partly of your own making.

Brent Lacey:
And so one of the things that I talk to my students and my residents about is that it's it's very important to guard against burnout. And part of the way you do that is by not taking on too many things, not trying, not volunteering for every last committee and every last assignment. Learn to say no to some of these things for sure. But, you know, you also need to have a way of dealing with it when it happens. So, you know, what is your support system is your support system exercise? Your support system is being at home with family. Your support system is, you know, enjoying time with your team. You need a way to address this issue when it starts to come about. And in general, I would say that the best way to do that is by having a really good network of friends and colleagues with whom you can be open and vulnerable, because I don't know how does at your facility, but most facilities, the administration are really lousy at addressing this. You know, they'll bring in someone. They'll be like, okay. Yeah, we need more. You know, we need more yoga. We need more, you know, many more med guided meditation. We need more. No, no, no, no, no. We need more support. We need more people. We need more. Help me more. I know. Exactly. We all know what we need as physicians. But if we just claim the mantle of victim, then I think we've done ourselves and our patients, frankly, a tragic disservice, because what happens is we stay in this burnout mode until we just give up and we go part time. We go for non-clinical work or we just straight up retire. And then what? What's happening to our patients at that point? Well, I'll find somebody. But, you know, we're we're causing them to go through unnecessary transitions where, you know, limiting the number of doctors in there already, you know, shortage situation.

Brent Lacey:
So, you know, there are definitely ways to guard against it. I think we all should.

Docofalltradez:
So it's interesting. I I personally went through some burnout. And I think when you say victimhood, you are spot on. Being a victim is a choice. So if you look at you were in the military, for example, if you get injured in the military. That wasn't a choice. If somebody shot you, that wasn't a choice. How you react to how you've been shot. That's a choice. So if things happen to as a physician and you're not happy with what happened to you, how you react to it determines what the outcome is going to be. And if you choose to be a victim, then you become a victim. If you choose to take that situation and learn from it and then overcome it. And I think you even said this will become the master of your domain. You know, do something about it. You're not going to get burned out. And I think physicians one thing that we struggle with is the whole idea that we are important. The whole idea that we need significance in our life to be to have any meaning and derive meaning from our life. And sometimes in this new health care paradigm, we don't feel significant anymore. We have to do more paperwork than we've ever had to to do. We have to do more prior authorizations. So therefore, it's kind of an injury to to who we are. But again, if you look at it that way and you become a victim, you, of course, going to become burnt-out.

Brent Lacey:
Yeah. One of the things that I that I try very hard to do is anytime I find something that is starting to bother me or things that I don't enjoy is I try to turn that around and embrace it as something that I'm going to find a way to enjoy. So I'll give an example that I give to my students as they're trying to think about what specialty they want to go into. I call it embracing the 1 percent.

Brent Lacey:
And what that what I mean by that is that when you're trying to pick a specialty, you need to love. Ninety nine percent of what you're gonna be doing in that specialty. And you need to not hate anything. You need to not hate that last one percent. And that's not the same thing. It's a. Important distinction.

Brent Lacey:
So I'll give you the example from gastroenterology, and so I'm sure for. I'd be fascinated to know what you think the 1 percent is for anaesthesia because I've never even thought about it.

Brent Lacey:
Bufford But for G.I., the 1 percent is irritable bowel syndrome. So everybody in gastroenterology enjoys the majority of the stuff we love scoping. We love IBD. You know, most of us like liver stuff, you know, and we we enjoy all the intellectual side of things.

Brent Lacey:
We enjoy all the procedures, all that. But irritable bowel syndrome for many people is just the bane of their existence. You know, there are limited therapies. They have patients have severe symptoms at times. It's frustrating because trying to explain to somebody, listen, there's nothing there's not an organic cause of your symptoms. I mean, it's not imaginary pain, but there's you know, all the tests are normal.

Brent Lacey:
There's nothing I can point you to says this is your actual issue. And so if IBS is the only thing that you hate about gastroenterology, well, that's it's really not a good position for you to be in because you'll see four or five patients with IBS every single day. It will consume your life. And so when it comes to things like when it comes to burnout, I think it's really important to take the same approach. And so if paperwork is the thing that you hate the most. Find a way to make it an adventure or find a way to make it a game. I don't mean to make it sound trite, but, you know, find a way to say, OK, I'm going to figure out how to beat the system. Like I hate coding. I hate coding so much. But one of things that I decided a long time ago is like, okay, listen, it's gonna be part of my life. I have to just get over this. So I'm going to figure out a way to make this to make myself the most excellent guy with when it comes to coding. I'm going to be so good at this that you know, that I'm that, you know, it's like me against the world. Right. You know, the world's trying to make it so that I can't figure Cody out. No way, man. I'm going to figure this out. I'm going to beat him. I'm going to be the one who who takes it in this situation. So I think embracing those difficulties and and saying yourself, I'm going to overcome this. It doesn't matter. I will not be stopped. Is is critical. And having that mindset shift is just so important.

Docofalltradez:
So what you're saying is I have to start enjoying to go into the endoscopy suite as outracing.

Brent Lacey:
Well, I think the I think everybody should enjoy going into the adoption is not done.

Docofalltradez:
And that's so true. I think even everybody will have some aspect of their practice that they really don't like.

Docofalltradez:
And you know, for some people, maybe they did choose the wrong specialty. And you don't have to dig deep down inside and and face that face up to that. And if you don't like it, it's up to you. It's paramount that you do something about it.

Brent Lacey:
Well, and I am. Let me address something. I can I can hear. There is there are people out there listening to this that I can hear you guys rolling your eyes. Exactly. Oh, Brent. Guys, this is you don't know what I've been through. You don't know what's going on. Listen, we don't. We absolutely don't know everybody's situation.

Brent Lacey:
And what I do know, though, is I've seen way too many people that have decided that, you know, burnout is what I is. That is what defines me now.

Brent Lacey:
I am a burnt out physician, and unfortunately, no one cares about you as much as you are going to care about yourself. There are people that will help you if you reach out to them. There are people who want to be your support. But if you just decide that burnout is the end of your life, that that is all that there is now.

Brent Lacey:
The only one that is going to care about that, frankly, is going to be you. And if you will just decide that that is not going to be the thing that defines you. You will find people that will help you get out of it.

Docofalltradez:
Exactly. Interesting story. So. This helps put things into perspective. I recently met a gentleman. He has no arms and he has no legs. He has just nubs, OK? And he's born this way. And he says to himself. Everyone's if everybody feels sorry for him and he's like. People don't like looking at me, he said, but in my life I've accomplished becoming a scuba diver. I'm a surfer. I have my own company. I'm a motivational speaker. I'm married and I have a wife. He's like, what I don't understand with people. I have I have almost nothing and I do everything he said. And you all and you speaking to a big audience. You have everything and you do nothing. And so the point is it's exact. It's your perspective. It's all that matters.

Docofalltradez:
Your perspective on on how you can take that information and how you're going to process it and what you're going to do with it. And so, again, I agree with you. I don't want to belittle it.

Docofalltradez:
But at the same time, you know, so many people have so little and you have so much, you just have to make the best out of it.

Brent Lacey:
Couldn't agree more. Absolutely. Well, Brett, I was an amazing conversation. You've inspired me. I think I'm going to go start a program with my as asanas my residents and my nurses. How often do you do it at your institution?

Brent Lacey:
Well, I was doing it maybe three, four times a year, but I've started doing it about once every other month with our residents, and so we'll send out what I started doing as I just I'll send out a poll to the residents and say what he does want to talk about next month. And I give him like five or six suggestions and then, you know, just see what they want to do and we'll go for it.

Docofalltradez:
All right. Well, hey, congratulations on the new job. Congratulations on the on your Web site. It's amazing. And I I'm going to do everything in my power to try to get more people to your Web site. And again, once again, I'd like to thank Dr. Brent Lacy for being on a show in which a call to action work. We get a hold of you. What do you want us to do next?

Brent Lacey:
So I would say the best thing to do is, is go to W W W dot the scope of practice dot com and on the home page you can subscribe. And then also I send out a new blog post about once a week and if you're interested in contributing, you know you can get in touch with me through that. And also on the home page, if you if you go to the home page, you can download my free e-book that has. It's got a great student loan management guide. It's got some of these topics that we've talked about, like a contract negotiation, things like that you'll be able to find there. And it's totally free. So just go to the home page w w w dot the scope of practice dot com and you can download the e-book for free and subscribe. And we'd love to have you be part of the excellent.

Docofalltradez:
And hey Brent, I look forward to reading your book and hey, thank you for being on the podcast.

Brent Lacey:
Awesome. Hey, thanks for having me. My pleasure.

Docofalltradez:
Thank you for listening. We hope you enjoyed the physician negotiator, podcast, show notes and other resources.

Docofalltradez:
Please visit the physician negotiator dot com.

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