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Dike Drummond MD
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[Transcript]
Physicians Unchained: Retirement Mastery for Doctors – Weekly Tip
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Retirement and Money Part Two:
Winning the Suits vs. Scrubs Battle
Introduction
Hello, Dr Dike Drummond, MD, here with the latest one of my quick tip videos leading up to the publishing of my new book Physicians Unchained Retirement Mastery for Doctors, which will be ready in the later part of April of this year.
This is the third in our three part series on retirement and money, and we've talked about, in episode one, we talked about putting your financial team together and reaching financial freedom. In the second one, we talked about the difference between your money numbers and your money programming, your money mindset, and how you can be worth $20 million and still working full time because you don't feel like it's enough scarcity mentality.
And now let's talk about the continuous battle the polarity at the heart of medicine, between profit and practice, between money and medicine, between the suits and the scrubs.
The Polarity Between Profit and Practice
We as doctors live in the center of that polarity, being buffeted left and right by the demands of the business of medicine, because medicine is not just an art form, it's not just a calling, it's not just a practice, it's also business.
It's a business that profits our employer and it also profits us.
So as mad as we might get at the bean counters for making financial decisions that affect our professional lives, we're counting beans too. Otherwise we wouldn't be able to make it financial freedom, the financial goal of a successful practice, and trigger retirement into your life after medicine.
Maximum Capitalism in Healthcare
Now, I personally feel that the biggest challenge in the suits versus scrubs is the American obsession with maximum capitalism, and it's all encapsulated a Milton Friedman quote, the only purpose of a business is to maximize the return on investment to the shareholders.
Well, not every business is health care, okay?
Because if all we're trying to do is make the absolute most money, like a private equity firm, the absolute most money you possibly can, then there's only two things that are going to end up happening in that business. They're going to abuse their customers, the patients, and they're going to abuse their workers, the doctors, the nurses and the other folks who see patients.
It can't be any other way.
But we live in a world where people say, no margin, no mission. How about no mission? No margin.
Business vs. Practice
And we also live as employees in a world where decisions are made that affect our practice day that don't make any sense at all, except they either make more money or save more expenses.
So for instance, I've never seen a call center, the call center that books your appointments on a template. I've never seen a call center be anything other than disastrous to the mental health and the productivity of the doctors that are brought into its one size fits all scheduling nightmare.
However, almost every large healthcare employer uses them, and I'm sure it's purely for cost saving measures, but if your call center operators have never met you, and if they blow the first appointment, scheduling the inappropriate patient in their first appointment, they can destroy your whole day and often do.
What Is the Practice of Medicine?
Now, what do I mean by business and practice?
Okay, let's just talk about this for just a second, because it's easy to segregate the practice of medicine is what you do when you're alone with the patient or their family, behind a pulled curtain, behind a closed door, or you're in the OR and you're doing a procedure a chance to cuts, a chance to cure, right?
That's the practice. That's where the magic happens.
Everything else is the business of medicine, including your schedule, your productivity quotas, your charting requirements, who you can and cannot refer to.
The Problem of “Leakage”
Meaning the ultimate insult is what's called leakage, right?
So you are employed by a large healthcare system that also employs other specialists, and you're supposed to refer to the specialists inside your system, but your system doesn't employ the best urologist in town, let's say.
So if you happen to refer to a urologist that sits outside the clinic, and urologist is just an example, okay, someone who's outside the clinic that's called leakage, and you're disciplined for that.
Physician Class System
And the other thing that this shows up at is we see classes of physicians.
Top class interventional cardiologists, surgeons, people who make a lot of money, ophthalmologists, people who make radiologists, people who make a lot of money are first class physician members of the employee pool.
However, your poor primary care doctor can't get a break.
Primary care doctor's performance evaluation is just basically the CFO telling them how much money they lose the system every year.
When that's not true.
If you use crooked accounting, sure it looks like a primary care doctor loses the system money.
But if you don't give a primary care doctor some sort of credit for all the referrals into the system, where all the other big producing doctors feed, right?
They feed like sharks on a dead whale.
They don't count that.
So primary care doctors are basically second class citizens purely because of their ability to create money for the organization.
Doctors and the Bean Counters
Now, for all these reasons, we hate bean counters, but we're counting beans too.
We have to admit that, and this whole thing feels dirty, okay, having to modify my behavior to suit the demands of some MBA who's never actually watched me see patients in our system.
By the way, I've been in rooms full of hundreds of senior leaders, and the first question I always ask is, raise your hand if you've ever shadowed a doctor seeing patients in your facility, and less than 5% of the hands go up every time.
The bean counters don't even know how this sausage is made.
How can they give us anything other than financial commands to begin with?
What Happens After Retirement
But here we go.
What about when you trigger the retirement transition and create your own life after medicine?
All of that goes away.
The polarity of money in medicine goes away.
It's not suits versus scrubs.
You're a person again, and you can let all of that go, all of it go and create your life after medicine with the hard earned financial freedom that took you 30, 40, 50 years to build inside this system where the playing field is always tilted against you, to now run with that ball and make it yours.
Taking Back Control
So the ambivalence, the hypocrisy, the quid pro quo, the money based decision making, goes away, because now who's in charge now in your life after medicine, you are.
Hello, Locus of Control.
And this whole money versus medicine balancing act stays in your wake.
You'll never have to deal with it again.
How cool is that?