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Thriving as a Subspecialist in Private Practice · Voices of Otolaryngology

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Welcome to the Voices of Otolaryngology podcast series, where we spotlight
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diverse perspectives and insights within the field of otolaryngology.
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I'm your host, Rahul Shah.
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Let's jump into it.
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Welcome to Voices of Otolaryngology.
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Thrilled to be here with Doctor Doug Reh.
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The coolest part of my job is making new friends.
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So what I just found out is Doctor Reh
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and I have tons of professional admiration for Doctor Stacey Gray.
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That's right. So let's pound out. Stacy, if you're listening to this.
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You first of all, you better listen.
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If you're not, that's your problem.
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But anybody who knows Doctor Gray. Stacey Gray text her.
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He did his fellowship, I guess a year after her at Mass Eye and Ear?
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Yeah.
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So Stacy was nine months pregnant when I came for my interview
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at Mass Eye & Ear, and she took me around and showed me everything.
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And then I think she delivered her daughter Kathryn, like two days later.
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And before then you were at Oregon?
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I was at Oregon Health Science. Yeah.
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Med school, Rochester, Oregon, then Mass Eye & Ear, then Hopkins.
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Yeah. It's not a great pedigree.
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I dragged my wife and kids all over the area.
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You did?
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Yeah, well, I dragged them from Rochester, to Portland to Boston
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to Baltimore Two years, probably, I think might be 26 months or something.
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Yeah. That's great. And now you stay in Baltimore? Yeah. Okay.
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I dragged my wife kicking,
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screaming to Baltimore, but she actually likes it there now.
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Doug's fantastic, Doctor Reh, I've gotten the pleasure
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of knowing him over OPPS and his practice in Baltimore.
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I live in the Rockville, Maryland area.
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We can make this whole episode how cool Stacy is.
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We could, we could. Can I give you a cool Stacy story?
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Yeah.
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So Children's Boston, we all rotate through there.
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All the Boston programs spent three months there,
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and we would all cover, call for each other
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and rotate each other with each other.
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You know how good someone is when they sign up.
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Right? Right.
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When Stacey signed out, I mean, I could just sleep
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because she tucked in on her patients.
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It was perfect.
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Yeah. So tons of professional respect for her.
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What's your favorite Stacey story?
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I guess it was the interview story.
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Nine months pregnant and. Yeah, but she was always.
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I mean, I've known Stacey.
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I mean, we were so close and finishing fellowship together.
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She's always been this a great resource, a great friend.
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I would call her. She'd be in clinic.
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So a zoom call, and she's always helped me out with Stacey.
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You know, we do have these podcast sponsored so you can sponsor it.
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Stacey, why don't why don't you be the first individual sponsor, Doctor Gray.
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Doug and Rahul, sponsored by Stacey Gray. Yeah.
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There you go.
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And then I have to do a shout out to my mentor, Ralph Metson, who. Are.
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Our mentor - For many of us.
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- and just an absolutely incredible human being.
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And the reason.
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Thanks for that, Doug,
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I mean, we do talk about the shoulders of giants we stand on.
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And Doctor Metson is one that we all stand on.
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So trust Professor Ralph, you can go ahead and sponsor us too!
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Of the best human beings I've ever met, known and trained with.
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Well right on.
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Well, this is the perfect segue because we're here for him.
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And you let a panel, a terrific panel on subspecialty and private practice.
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We actually have been talking about two of your great mentors,
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and you have many in your career at Mass Eye & Ear.
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So you did a fellowship in Rhinology?
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That's right. But now you're in private practice. Correct.
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So talk to us about your panel there, the audience reaction.
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Just going to tell us about subspecialty in private practice.
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What does that mean.
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Well, so I kind of made a joke at the beginning of the panel.
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I said I'm a recovering academic.
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So I, I spent ten, wonderful years
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at Johns Hopkins as their rhinologist and skull based surgery surgeon.
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I was actually the program director there for for four years.
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And so it was a wonderful experience.
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But I was,
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I think we all get
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to those crossroads in life where you sort of have to make a decision,
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what are you going to do next?
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And I think the, the normal course for me would be to find
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some leadership positions in academics.
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And I really started to,
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just not be a little bit that I kind of wanted to have more control over my life.
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And my dad,
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when I grew up, he was a businessman, and he started and ran his own business.
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He was very entrepreneurial.
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And even though I am a doctor and decided not to follow in his footsteps
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and work in his business, I always have kind of an entrepreneurial
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kind of way about approaching things, and I get excited about that.
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And so I really made a huge, turn 180 degree into private practice.
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And I joined my now partner, Mark Dubin, who preceded you at Hopkins.
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Yeah, except Mark lasted six months there and I less than two.
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Yeah. We'll leave it at that.
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We'll leave the judgment. Exactly.
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So you joined, your group, which is now under the umbrella of ENT
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Specialty Partners.
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Yep. Yep.
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That's right. ESP CAdENT is our large group.
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Run by Ryan Coopersmith, who, you know.
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Well, yeah.
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But we.
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When I joined, Mark and his practice, in 2018,
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we had just, merged with 17 other practices
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in the Mid-Atlantic to form CAdENT which is the Centers
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for Advanced ENT Care, which was a large group practice.
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And then in our journey, we tried to create an MSO,
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which is, as you know, a huge struggle.
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And so eventually we, Mark
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started to run and Ron had done some amazing work
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with ESP in Texas and created what we wanted to create for CAdENT
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which is a true MSO, in the sense that they handle everything,
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compliance, revenue cycle management,
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billing, H.R everything.
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And so IT, and so we merged CAdENT and ESP merged.
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We were probably two similar sized groups.
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And now at this point we have probably over 80 doctors.
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So did that give the genesis of subspecialty in private practice,
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or has this always been on your mind?
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Or are you seeing it nationally.
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How did this panel come about?
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Yeah.
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So I mean, it was my partner, Annette Pham, who asked me to do it, but
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there are, a lot of private practice subspecialists.
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Okay define that and talk about that. Okay.
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So that is a word, right?
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So we know that within, otolaryngology there are different subspecialties.
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We have Pediatrics, Rhinology and Skull Base.
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We have Head/Neck, we have Neurotology we have Facial Plastics.
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We have Sleep.
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Did I miss any?
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Nope keep going. This is great.
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And so most of us, and traditionally when we did a fellowship, would do it
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because we wanted to go into academic medicine,
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because in the world of academia, you sort of need to be a subspecialists
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to sort of survive and thrive in that world.
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But with time,
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these academic jobs are full and people are still doing fellowships.
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And so they're going out
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into our community and being becoming private practice doctors and trying to,
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be a subspecialists within a private practice group.
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And so that poses very unique challenges, to us as subspecialists
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and so the idea of the panel was, we're going to talk
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to the members of OPPS, who are by and large, private practice doctors
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about how you could be a subspecialists in private practice.
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So you can.
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You can do it and you can thrive and survive.
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But there are tricks to it. So let's talk about them.
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So some of the things that we talked about on
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the panel is how to find the right practice.
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So good point.
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Yeah. Right.
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You can’t go into an underserved area and say, I want to be.
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A going to be the only, doctor and a.
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That's right. 500 mile radius.
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So build on that. So, yeah.
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So, I joined, my practice in 2018, as I mentioned.
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And within that practice, there were six partners.
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I was an associate, and there was another rhinologist Mark Dubin.
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We have, facial plastics, doctor.
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We have, neuro with having neutologist.
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And then we have some general practice doctors.
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So, within that practice, it was sort of understood that you could sub specialize,
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but at the same time, you have to carry your weight within the practice, right?
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As private practice doctors, we have to pay our overhead.
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You have to be, generate enough revenue to support your existence
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within the practice.
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So I couldn't go in and say, well, I could have gone in and said,
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I'm only going to see rhinology patients, just like I did at Johns Hopkins
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for ten years.
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And, I would have not been able to pay my rent.
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So, as a new part
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of this practice, I had done a tonsillectomy in ten years.
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I was doing tubes and tonsils and adenoids,
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and it was fun for me to kind of relearn these things,
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but I had to have the expectation that I am a five day a week clinician,
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and I'm doing, general ENT with the idea to build my rhinology practice.
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Now you’d think that having been in at Hopkins
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and practicing in Baltimore County.
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Everybody would follow you. Right.
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And I had developed a very good referral network.
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You have a great reputation. Yes.
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But I still had to build and I would say when I first started in
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private practice, I was about
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50 to 60% rhinology 40% general.
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And over time.
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And this is another question people ask is how long does it take to build this?
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It depends.
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But within my practice, I would say it took me a good five years of hard work,
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sort of expanding my referral network, to create a practice where I'm at,
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where I'm pretty happy that it's about 80% rhinology and about 20% general.
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So one of your partners, Doctor Dubin, told me
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you're just a little bit slow sometimes.
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So the average doc, maybe two years?
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Nah I’m just kidding, say that. Yeah.
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So it took five years.
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Say that again.
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Very important stat.
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You started 60% of your subspecialty, rhinology,
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40% comprehensible otolaryngology.
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You took five years to get to an 80/20.
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Yeah.
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And where are you now 80/20? 80/20.
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Why not. Yeah but I’m happy about that.
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You know, I like I like it when a patient comes in that I did take care of
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for five years to get their ears cleaned, catch up with them.
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In some of the I get a lot of referrals from private,
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from PCPs and Allergists.
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They don't want to hear from me that I. Can't.
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See those kids tonsils out, or I can't clean those ears.
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Right. They don't want to deal with that.
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And so I'm happy to do that.
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And they also know that they're if they have a complex sinus patient
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or anything else, they're going to send them to me.
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So you are on this panel.
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You've given this a lot of thought nationally,
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and you have the expertise of the ENT specialty partners, ESP
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when they're subspecialty in private practice.
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What are you seeing out there?
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Are most content with 80/20?
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Are most 90/10 or completely 100%?
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oOr are most 60/40? What do you see out there?
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There's once they're mature. Yeah.
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Yeah there's a huge disparity.
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So I had Doug Backous on my, panel.
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He's a neurotologist. He practices in Seattle.
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He is 100% Neurotology.
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Okay. There you go. Okay.
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He is like an academic neurotologist in private practice.
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So no tonsils for Doug. Correct.
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And if he gets, if he gets a sinus patient, he sends them
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to one of his partners who actually is a good friend of mine, Greg Davis.
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And so, then there's other doctors
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that we talk to who are sub-specialized who do see a fair amount of general.
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And I think it's it's very variable in terms of where you're practicing
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and how you're starting. Right.
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I think if I had tried to go right from fellowship
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into a practice without having been at Hopkins for ten years,
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I would have
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probably started at 25% right now. Really?
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Well, it depends.
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And the other thing is that I had mentioned when we talked is that I,
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in my group in our division within KESP,
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we have six partners and one associate.
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They're all very good sinus surgeons.
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I'm not going to tell my partners - Good points.
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To send me their, their sinus cases they they'll they'll run things by.
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Yeah. And they're in a clinic.
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They'll show me a CT.
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“How would you approach this?” And for really hard
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like an inverted problem or something that they'll send them to me.
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But for the most part I don't get a lot of internal referrals now that.
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That being said, I as - at Hopkins I trained a lot of fellows that went out
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and into the communities.
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It didn't necessarily go into academics.
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Some of them entered in large group practices where you had 10
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or 15 doctors and they were happy to send, their sinus cases to that person.
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And so I think it's a caveat for every fellowship trained,
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otolaryngologist who's trying to figure out what they want to do
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and what their practice is going to look at, to sort of have their eyes wide open.
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So and those are good questions to ask: Are you going to refer,
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your sinus patients to me internally?
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Or is it something I'm just going to have to build?
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And that set the expectation right?
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I'm going to have to be a general, comprehensive otolaryngologist
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and then build through my referral network.
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Terrific.
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Go back to what you said.
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If you came right out of the Eye & Ear, for fellowship
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terrific fellowship program.
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And you went into private practice with a subspecialty focus.
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You thought you only do 25% of your rhinology. Why?
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I thought it would be be 90%.
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Well I was a Hopkins rhinologist for ten years now.
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I could have so that that sort of built it up for me.
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Yeah. Yeah, that's what you're saying.
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Oh, so what you're. Saying is, if you.
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Like, right out of the Eye & Ear and into private practice, only 25%.
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Well it depends, right?
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I would have had to build it up, build it up, or I could have found a group.
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I think most of the residents that are graduating today
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know how to do sinus surgery,
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and they have really good training in their residency program
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by fellowship-trained rhinologists And so they know how to do it.
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But 20 years ago, that wasn't the case.
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And so you could go into a group with, some older,
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comprehensive otolaryngologists, who say, like, ”you can do my sinus cases.” Yes.
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And so it depends on
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where you're going in the group that you're, you're entering into.
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And then how many other - how saturated it is, I mean, I practice.
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How many?
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And how saturated is the market.
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Saturated is the market. Okay.
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So, you know, the Mid-Atlantic, Baltimore,
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the, the
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Baltimore/DC area, highly saturated with rhinologists.
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It's the same thing with facial plastics, right?
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I mean, you can go and hang a shingle up and say,
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I'm a facial facial plastic surgeon right out of fellowship.
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But how busy are you going to be if you don't do comprehensive ENT?
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So let's let's do a few case scenarios.
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It's incredibly helpful.
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So our audience, let's say
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I'll present you the scenarios because I think I've got in my head
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you come out of an excellent strong residency.
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You don't feel the need to do fellowship.
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You want to go right into private practice,
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but you have a passion for X, Y, or z.
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They can they can do it.
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You can build a subspecialty private practice without a fellowship 100%.
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What do you talk a little bit about?
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But one of the things we talked about is
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what are the advantages of subspecialties. Why?
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And we're all different.
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Some people like to do everything and they want to do thyroid,
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they want to do parathyroid,
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and they want to do a little bit of head neck, a little bit of pedes.
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And I have, to wonderful partners.
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And that's what they do.
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And they are very good at it and they love it.
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And then there are other people like me who like to be
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an expert in something like really good at 1 or 2 things.
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And so I really wanted to be a rhinologist and an enscopic skull-based
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surgeon, and I don't actually do a lot of skull-based surgery anymore
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because I'm in private practice.
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I work at community hospital.
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We don't have a neuro ICU.
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I don't have an experienced endoscopic neurosurgeon to work with.
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So, I've happily moved that part of my practice
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back to the capable, rhinologists at Hopkins to do those cases.
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So someone coming out of a strong residency
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wants to join a private practice.
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And what do they look for?
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If they say, I want to do subspecialty focus,
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I want to build this up, or I want to be comprehensive,
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how do they kind of what are they thinking?
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What do you advise the next generation?
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Well, I would say if you really have an interest in rhinology you should
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first of all, in your training, spend that extra little time.
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I think most residency
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training programs - I know at Hopkins we did a pretty good job of allowing
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the residents to to within the residency, find ways to get extra time.
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And whether that's Otology, Head & Neck, whatever? Whatever you want to do.
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So get that extra time.
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We just we just hired an associate who,
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just finished your residency training at Hopkins, Melissa Lou.
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She's wonderful,
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young associate that we that just started with us a couple of months ago.
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She has an interest in, otology.
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Can she sponsor this podcast?
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It could be Ralph- Melissa.-Stacy.
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I'm thinking about it. She just started doing so. Sorry. Fine.
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We're not. We're going to go back to Boston. Exactly.
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We'll do - Ralph and Stacey can handle this.
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So, she has an interest in otology? Yes.
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One of our, partners is Brian Kaplan.
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Is the, chief medical officer.
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Cochlear does a lot of cochlear implants for me.
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So she's starting to do cochlear implants.
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She's going to do some a little bit more complex otology.
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Is she going to do acoustics? Of course.
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So perfect example.
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She's joining you.
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What percent of her practice will be otology to start with maybe 50 or 60?
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Oh no I think she'll 10, 15%?
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But I’m happy to send her any - So she's got to build it
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up is what - I find her tympanic membrane perforations.
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I'm not going to fix those right.
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But you can can't walk in there and just expect it's going to be there.
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I think you have to have.
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Really I mean here she is coming in and.
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She's happy to do. Of course that's your point.
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And that's the point is if you can do whatever, you can make your practice
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into whatever you want it to be, but you have to be realistic about it.
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And when you're in private, practice, their expectations.
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Whether you're working for a hospital system or you're your physician owned,
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you have to carry your weight and you have to be a good partner
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and whatever that means in your partnership.
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And so those are questions that you should be answering before you take a job.
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Someone like Doug Backous can do it.
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Brand recognition.
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He was an academic for I think 17 years.
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Right?
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And then he practiced in Virginia.
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Yeah, he practiced in Virginia. Mason. He was subspecialized from the start.
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He had done.
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Yeah, he had the relationships, just like you said.
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But I would say that that's the exception. Absolutely, absolutely.
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What other, big issues came up in your panel that you'd like
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to share on the Voices of Otolaryngology with our members?
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I think that they we had, Kevin Watson, who's the,
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CEO of one of the big groups in Raleigh, and he's, part of the Senate.
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So he's got a good business sense.
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And he talked about, if as a practice, if you're running a practice
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and you have subspecialists, there are certain subspecialties
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we know that are, much more profitable than some others, like.
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So you look at facial plastics and rhinology as compared to pediatrics.
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So he said that they've adjusted their comp,
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their comp, formulas a little bit.
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So that part of theirs is a shared model.
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So that the.
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People that are in the trenches seeing the pediatric doing.
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Seeing 60 kids a day...
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and then the rhinologists who are making a lot more money
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in terms of their billings. Wow. It's a little bit of that shared.
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And so again, every practice is different.
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And it's it's sort of the partner sort of coming together
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and figuring out what works.
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We I think we have a very fair practice.
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We, we sort of kill what we eat and we have a shared overhead.
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I pay probably a little bit more overhead.
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But but we're all sort of in it together, and we all have a sort of a fair amount.
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But every model is different.
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So that's interesting that Kevin noted that to make it somewhat equitable,
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because you want to take care of the community, right?
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You don't want to bleed those patients out or lose them.
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Yeah, we know academic institutions face the same issues. Yeah.
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What else came up in the panel that you found an interesting,
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kind of an “a-ha” moment on subspecialty and private practice?
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I think Doug Backous had a lot of, sort of interesting
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sort of tidbits to share about his long journey.
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And, he keeps all his referring doctors on his cell phone,
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and he puts notes into in there about whose birthday and his
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his child is going to Brown University, his child.
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It's his birthday on this date,
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and he communicates it, sends the messages and sort of it's like his family.
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And I think having a good relationship with your referring physicians,
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having, being close to them, being responsive,
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I think that is really important, whether you're a sub
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specialized otolaryngologist or a comprehensible otolaryngologist.
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Fascinating, even more so in a subspecialty. Yes.
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Talk about that. Yeah.
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Well, so,
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you know, I get a lot of referrals from primary care doctors
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that know that I'm interested in rhinology but,
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so I get a lot of referrals and I,
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and I will call them about complicated patients and be responsive to them.
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But I also have other otolaryngologist within our region
19:40
who have referred patients to me for years of complex sinus patients.
19:44
What I've always made it
19:45
clear is I'm not trying to steal anybody's rhinology patients.
19:49
We can all do rhinologic surgery.
19:51
For the most part. We're all well trained to do it.
19:53
But what I'll do is provide myself as a resource.
19:57
So and I'll tell them when we need.
19:59
Hey, if you have a weird CT or like, weird case
20:03
that you just want to get my advice as to how to handle it, just call me
20:06
and I get calls all the time about, hey, how would you do this?
20:09
How would you do that?
20:10
Most of the time after I give them an answer, they take care of it.
20:14
Sometimes I say, you know what?
20:17
That's a little.
20:17
These are referring docs or these are referring otolaryngologists?
20:20
Referring otolaryngologists.
20:21
So sometimes I'll say, you know what, maybe you should have me take a look?
20:24
And so I try to be a resource rather than a competitor.
20:28
That's wonderful. Right. So you work together.
20:31
Exactly.
20:31
Did the continuing education come up?
20:35
So subspecialty private practice.
20:38
Let's not talk about you.
20:39
Let's talk about what you heard out there.
20:40
Otologists, laragology, pedes: How do they balance their continued education?
20:45
I mean you've still got to learn guidelines.
20:47
You have to learn a lot.
20:48
You're 60/40.
20:49
How do you keep up on everything?
20:51
It's hard.
20:52
It is hard. Right.
20:53
And you had an excellent reputation over both.
20:55
So you are, you know, investing in yourself.
20:57
I mean, I try to stay well read and current on the literature.
21:00
I will say, even within the AB Oto when I'm doing my recertification and.
21:07
Yeah. What are you which track are you on?
21:08
I'm on the that you're going to challenge. It's.
21:11
I have to take
21:11
a, an exam every every three months and, Yeah, but are you on a subspecialty?
21:16
Oh, yeah. So I'm on the, allergy and rhinology track.
21:19
So you know, I'm - I'm a pedo-otolaryngologist. Yeah.
21:22
What track am I on? What do you think? Comprehensive.
21:24
Yes, sir.
21:25
Because I love it. Yeah.
21:27
And I don't mind I think I mean Brian, you I'm like, how are you?
21:30
I know you're going to say that, I think I'm like 83%, but I know things!
21:34
it's pretty good.
21:34
I know things!
21:35
Mean, I think I'm only 80-90% in rhinology.
21:37
But what I love about it is I'm learning.
21:40
Oh, I didn't know that about allergy.
21:41
Oh, that's an interesting thing about, you know, so that's what I do.
21:44
So you're mostly - you do it on the rhinology?
21:47
For my MOC, I do rhinology.
21:48
So then how do you keep up on your general comprehensive?
21:50
I try to stay well read and I and I pip my partners a lot.
21:54
If I see something that I haven't seen before or, you know, I'm not quite sure.
21:58
What kind of treatment?
21:59
I'll text them or call them on a weekly basis.
22:01
I ask them and,
22:03
and my partners are very bright and well read,
22:05
and they'll give me good answers about how I should approach this patient,
22:09
this comprehensive.
22:10
Let's flip it.
22:11
As we start wrapping up. Let's flip it.
22:14
We talked about what's good with subspecialty private practice.
22:18
What worries you with your group, CaDent ESP?
22:22
What worries you that you heard about the panel?
22:24
I think one thing that Kevin Watson talked about was the competition model.
22:28
So it depends how big your practice is.
22:30
You need to balance a compensation model.
22:32
You yourself mentioned overhead.
22:34
You pay a little bit more overhead.
22:36
I presume that's because of the rhinology subspecialization.
22:39
What other things do people need to think about?
22:42
So you know, I think as an academy
22:46
we have to think about fellowship training.
22:47
And and so, I during the,
22:51
lecture had AJ Tompkins stand up because I'm on his.
22:55
So I call on AJ Workforce Tompkins.
22:58
He is the Man!
22:59
So you're up if you're on his workforce too?
23:01
Yes I am. So is David Yen.
23:02
Everyone who sits here is on his workforce.
23:04
How big is his workforce? It's actually small.
23:05
There's only like 7 or 8 of you. Yeah.
23:07
Just getting around. He handpicked. Yeah. All right.
23:09
Because he needs people that'll do the work.
23:12
Yeah.
23:12
So if you haven't read the one of the other.
23:16
Amazing! Go ahead and sell it. Go ahead - Yeah.
23:17
What I said to the audience is, if you haven't read the Academy
23:20
Socioeconomic and Workforce Survey, you need to
23:24
because it is just chock full of useful information
23:28
in all areas of otolaryngology and what we're practicing.
23:30
And it's actually over 100 pages,
23:32
but you can flip through, look at the diagrams.
23:34
It's awesome. 100%.
23:35
And so I, one of the sections I wrote was on fellowship training.
23:39
And so one of the things that we brought up is,
23:42
do you need a fellowship to practice?
23:44
And there's a big disparity amongst, subspecialty subspecialties about
23:50
whether you actually need that extra level training in private practice.
23:53
I mean, I think we all understand that if you're going into practice
23:56
in an academic institution, it's in your best interest to do a fellowship
23:59
because that's how you're going to survive and thrive in that environment.
24:03
But in private practice, it's it's a little bit murkier.
24:06
It's a little bit gray.
24:07
And so it's clear that in neuro-otology, if you're going to do complex
24:12
neuro-otology in your practice, you really need a fellowship.
24:15
And, most of the, respondents who were in private
24:18
practice said they use a lot of their fellowship to do their to to do their part
24:23
to be able to compete and survive in their practice and practice.
24:28
And so in rhinology it's a little bit less clear.
24:32
With rhinologists a large majority of of the respondents
24:37
in private practice said, I learned enough in residency
24:39
to be able to do rhinology - most of my rhinologic cases.
24:43
Interesting.
24:44
In the residency training I got.
24:46
So then the question is, is a fellowship?
24:48
Yeah, sure. Useful. Yeah.
24:50
If you're going into private practice?
24:51
And you brought that up before it, like, can't you just go into get good
24:55
training and residency and just say I'm going to be a rhinologist?
24:57
And the answer is yes.
24:58
We don't take up.
24:59
We don't have a board certification or anything else.
25:01
And so, I think
25:04
and because the academic jobs are, few and far between,
25:09
more and more fellows are going into private practice
25:11
for both facial plastics, rhinology and other areas.
25:15
And so then the question is, are we adding value by having them do a fellowship?
25:20
Like what are they getting out of this?
25:22
And so maybe they didn't feel like
25:24
they got exactly good enough training It's a comfort level right?
25:27
It's not a value judgment.
25:28
And that's 100% a good reason to do a fellowship.
25:31
But if you're if you're competent and you feel competent
25:34
and you're just doing a fellowship just to say that you did a fellowship
25:37
and you're going into private practice,
25:39
it's not clear cut that you're going to have a benefit
25:42
from just saying “I’m a fellowship trained rhinologist” in private practice.
25:45
If you're already were competent before you went into your fellowship.
25:48
Extremely well set for our listeners who
25:51
now we have thousands, almost tens of thousands of listeners.
25:53
Thank you all very much.
25:54
And again, thank you, Ralph and Stacey, for sponsoring this episode.
25:58
If you don't know, you've actually sponsored it.
26:00
He's going to send you the bill.
26:01
Oh, yeah, for sure, for sure.
26:02
If there's a URL or link which our team (inaudible)
26:06
and Chris Harris Jackie Cole put on this,
26:08
which will link you to the workforce survey.
26:10
So whenever we talk about, materials, we link them right to just so you know that.
26:14
But let's spend maybe the tail end of this.
26:17
What does the future look like?
26:18
You and I, you and I both did fellowships.
26:21
We both entered into academic practices.
26:23
We took different routes.
26:25
What does the future look like?
26:26
What do you see out there?
26:28
Do you see more of this?
26:30
I think you're convincing me that I do.
26:32
I see a lot more of this subspecialty in private practice.
26:35
So what do you see as the future?
26:36
Do you see less subspecialty in private practice?
26:38
More?
26:39
I, I think a lot more.
26:41
I do too, and that's - A good thing.
26:44
It's not a bad thing. It's a great thing. But the thing.
26:46
If it's 60/40, right, I mean, very rare, it's going to be 95/5, 100/0.
26:51
I think being subspecialized can help us to be experts as well.
26:55
But it's the most important thing is and this is the world of private practice,
26:59
we need to be able to take care of all problems.
27:01
Right.
27:01
But we can't be siloed into just our subspecialty and especially
27:05
in the world of private practice.
27:07
So I think one of the critical things that we need to do
27:10
is when we're training our fellows how to do our subspecialty,
27:16
we also have to train them, especially if they're going to private practice
27:19
what private practice world looks like.
27:22
So most of us who came from academics didn't really understand
27:26
what private practice looks like.
27:27
And so and I think sometimes our residents are exposed to enough private practice,
27:32
during their training.
27:33
And what that the private practice world looks like. Can I interrupt you?
27:36
Yeah, you're absolutely right.
27:38
And Doug Backous - we've talked about him.
27:40
He actually said that, at dinner the other night.
27:42
He said, you know, I went from an academic to private practice, and he said, I
27:45
had no idea.
27:47
Right.
27:48
And so, I think a lot of residency programs are starting
27:51
to recognize that they need to teach their residents about private practice.
27:56
And so what that world looks like.
27:57
And and so same thing with our fellows
28:00
that, yes, you're gonna to some specialized
28:01
but you're going into private practice
28:03
and you understand that this is how it works.
28:05
And this is you need to be able to do
28:07
comprehensive otolaryngology interestingly.
28:09
Right? Yes.
28:10
You need to understand business of medicine. Yes.
28:12
You need to understand what different practice models look like.
28:15
Are you going to be working for.
28:17
Double the work, Doug.
28:19
So do you see it getting bigger in the future?
28:21
5 to 10 years from now, you're going to see more of this?
28:24
I think what we're going to see is that residency and fellowship training
28:27
programs are going to have to change to meet that need, and I really see it.
28:34
I mean, I see it in lectures.
28:36
Last fall, there was a huge, academy,
28:39
lecture and panel, just, residency training and.
28:43
Crucial conversations, part two, alma at all.
28:47
Yeah. And so talk about that.
28:49
Go ahead. Well, it's just a conversation about
28:52
what we're teaching people in
28:53
residency and where we lack and where we're falling short.
28:56
And I think one of the obvious areas is private
28:59
practice business/ business of medicine type of, of of
29:03
learning.
29:05
And the other pearls.
29:06
So I like to have fun with this.
29:07
I'm going to give you some fun questions at the end.
29:09
But anything else you want to drive home?
29:12
A lot of pearls. We have a lot of respect for you.
29:14
The panel was awesome.
29:15
Anything you want to conclude with?
29:18
I just think do what you love.
29:20
Find people you want to work with.
29:22
Be inspired by your job.
29:24
I, I used to tell the residents
29:25
all the time, and to me, the thing that I miss about having left
29:30
Hopkins are the residents and teaching,
29:32
and I still get to work with them at my community hospital, thankfully.
29:35
But it just it's so wonderful to work with them.
29:38
But I always used to tell the residents, if you're not learning, you're dying.
29:42
And you need to always grow and change and change the way
29:45
- find new ways to change your part, to change your practice.
29:49
Ask people like, why do you do that?
29:51
Or and the residents come to my OR all the time.
29:54
And I say, well, how does Nick Rowland and do that?
29:56
Or how does, so-and-so do that?
29:58
Like, do they do it differently than me? And and why do they do it?
30:00
I might just try that.
30:01
Like, I love to change the way I'm doing things.
30:05
I practice now.
30:06
The way that I operate, the way I approach patients
30:08
is totally different than it was ten years ago. Yeah.
30:11
And I think just learning and growing it, it's it's a it's
30:14
the sort of the human process.
30:16
And so we as otolaryngologists have to sort of grow and develop
30:20
and don't be afraid to take a risk out there.
30:23
I'll just say that leaving Hopkins and going into private
30:27
practice was one of the biggest risks that I ever took.
30:30
I didn't sleep for nine months before I did
30:33
it, and I didn't sleep well for nine months after I did it.
30:36
It ended up being,
30:37
I think next to marrying my wife, one of the best decisions I've ever made.
30:41
But it was a stressful time.
30:42
But sometimes I'm sure you've been there where you pivoted
30:45
or made a big life change.
30:47
And I think sometimes those being a not afraid to take a risk
30:51
and make a life change, can really benefit you.
30:54
Yeah. You sleep well now? Yes. Like a baby.
30:57
My life change was joining the Academy, right?
30:59
Leaving administrative health care to serve you all.
31:01
So the same thing, sleeping.
31:04
Oh, I sleep like a baby.
31:05
I mean, nothing brings me down. Do not disturb on my phone.
31:08
I'm good. Real quick, we're going to have some fun.
31:10
Were you in Boston during any of the championships?
31:14
Red Sox, Patriots? Celtics?
31:16
Which one did you get to be there for?
31:17
Okay, so a little background about me.
31:20
I went to Boston College undergrad.
31:21
Oh, cool. And actually lived there.
31:24
I graduated Boston College in 92.
31:27
I was I was a finance major of school management.
31:29
All right. I was in at BU from 93 to 2000.
31:31
And there you go BU and BC don’t like each other.
31:33
You know, you were further along.
31:35
I can't use the phrase that we used to call each other.
31:36
Yeah, yeah.
31:37
No, no. It's okay. Yeah, yeah I guess. Yeah.
31:40
So you were a Boston guy.
31:41
Yeah.
31:41
And so I, grew up in western New York.
31:44
Yeah.
31:44
So they have a football team at a hockey team in western New York.
31:48
I'm a big Bills fan, but I didn't have a baseball team
31:51
and I didn't ever like the Yankees.
31:52
So even in high school, I love the Red Sox.
31:55
When I was a student at, at Boston College, the Red Sox were not good.
31:59
Yeah, easy to get into games. And we could just go and sell tickets.
32:02
And so I was a diehard Red Sox fan.
32:05
And when I went back for my first year.
32:06
So the answer is the year that I finished
32:08
fellowship, they won their second World Series.
32:10
Amazing. Seven. Yeah. What'd you. Do?
32:12
Those are the people on, of course, Dustin Pedroia era.
32:15
Yeah. What did you do when they won?
32:17
Well, I was at home because I had just started working for Hopkins.
32:21
But you were. Yeah, but I celebrated. Yeah.
32:23
Yeah, I was there when they won the first when we were in Brookline.
32:26
Three in the morning, extra innings.
32:28
I got up - Did anybody sleep in Boston for the entire...playoffs?
32:32
So I walked I walked to Fenway.
32:34
My wife said, what are you doing? I said, you have no idea.
32:36
We will.
32:36
We've waited forever for this.
32:38
So, my son, we call him Big Papi.
32:40
Oh, you know what that means.
32:42
Yes, Doug, thank you very much. This was awesome.
32:44
Well received.
32:45
You're very well respected in our community and nationally.
32:48
Thank you very much. Thanks for all. Thank you for having me. Thank you.
32:50
hope today's episode sparked some fresh ideas.
32:53
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32:57
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32:58
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33:00
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33:01
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33:07
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