I have the greatest job in the world. I'm a doctor. I love my work and I look forward to walking to my office each day to take care of my patients.
It's sad to me that so few other physicians feel the way I do.
Though I'm a single mom living with my college-bound daughter in one of the most expensive cities in the world, I enjoy a work/life balance that affords me the energy and enthusiasm to be present with my patients while at work, and with my daughter while at home.
In fact, I'm deeply proud that my child is considering a career in medicine in part because she observes my deep sense of satisfaction as a physician. We both agree that I have a fantastic job.
I recognize that my situation is unusual in an era when personal and professional dissatisfaction seems to be the norm among healthcare professionals.
But I also realize that it is not a coincidence. The joy I feel in my work and in my personal life is the result of a particular path I chose.
I'm telling my story in the hope that it will inspire my many medical friends and colleagues who feel like indentured servants to a broken system. I learned that it is possible to do things differently and to make positive changes for yourself, your family, and your patients.
Time to Talk & Listen
As an osteopathic physician specializing in physical medicine and rehabilitation in New York City, I have the privilege of treating one of the most diverse and interesting patient populations on the planet! My patients come from all walks of life, and many different socioeconomic, ethnic, and age groups, reflecting the amazing diversity of the city we call home.
What they all have in common is that they truly care about their own health, and want to be active partners in their own healing process. They seek my expertise to accurately diagnose problem and organize treatment plans to improve the quality of their lives.
The core of my practice is focused on making detailed evaluations of my patients' problems, and identifying and modifying risk factors for illness and injury. I employ osteopathic manipulation and also provide patients with comprehensive lifestyle-based programs to support optimal health and disease prevention. I have successfully treated thousands of people over my 25 years of practicing medicine with this low tech, low cost practice model. It is extremely gratifying.
It works, because my practice is designed to allow for the most important factor: Time.
I see an average of 6 patients per day, and they pay me for my time. This gives us the opportunity to go deep, to really figure out what's going on. I have the time to ask about sleep, stress, dietary habits, drug and alcohol use, and the details of their personal and professional lives. These factors are part of the problem--and also part of the solution--in every clinical situation.
I consider myself a "primary care physician for musculoskeletal issues." But the key to it all is having time to really listen, to let my patients tell me their own perceptions of their bodies, their fears, their obstacles. These conversations are very important.
My most important diagnostic tools are my ears, eyes, and hands. My practice model affords me the time to complete a thorough hands-on physical examination. I can read the body in a way that an MRI never could. In many practices, this approach would be a luxury. To me it's a necessity.
People come to me with both acute and chronic problems; some of them have been through everything that high-tech diagnostic technology has to offer. They are still in pain, and their problems remain a mystery.
More times than not, nobody has ever done a thorough physical. The patients have been through all these tests, but nobody's ever touched them!
Why Be a Doctor, Anyway?
We all made the decision to become physicians. We spent many long, difficult years studying hard and taking care of the sick during sleep deprived days and nights. We helped many become healthier and we witnessed many die.
We have earned the privilege to impact the lives of other people in a way that most other professionals can never approach.
As a profession, we doctors have achieved the goals we have set out to achieve, yet most of us are miserable, resigned, quitting, frustrated, and discouraging talented young men and women from entering medical school. Why incur a large financial debt to enter such a dismal profession? There is something very wrong with this scenario.
My personal journey through medical school and residency training was likely similar to yours. I witnessed many personalities, practice and lifestyles that were appealing and many that were appalling. I observed thousands of doctor-patient relationships and skill sets that shaped my professional life.
I knew early on that I needed to practice my version of "good medicine" which meant patient-centered integrative care that helped people feel better, stay healthy, and improve the quality of their life.
Time & Money
The average duration of a physician visit in the US is 6 minutes! I know I cannot be an effective doctor in 6 minutes. In such a short interval, all anyone can do is write a prescription to manage symptoms or order a test.
My patients deserve better.
I spend an hour with each new patient and thirty minutes with follow-ups. I get paid for my time, and this allows me to hear my patient's stories, as well as their concerns and fears.
I have set up my own rules for time and compensation, which support my ethical and professional standards. I receive payment directly from patients, in exchange for three very precious things: time, expertise and experience. Fees are fully disclosed in advance. There are no surprises for anybody.
Since no third-party is dictating my pay, I have the ability to modify fees at my sole discretion. I can offer a discount to a student, or a struggling actor, or someone who is having financial troubles. I am not at the mercy of a corporate or legislative bureaucrat.
My overhead is low. I have one part-time receptionist and together we handle scheduling. By removing the time-consuming gymnastics of insurance from clinical practice, it is amazing how simple it is to contain costs and restore the pleasure of practicing medicine.
The direct-pay model allows me to create a structure in which I can optimally be of service. I am fully engaged, caring and valuable to my patients.
Define Core Values
I have zero conflict between my practice structure and how I take care of my patients. That's because I established my practice according to my core values, not somebody else's corporate mandate.
Of course, initially I was a bit tentative leaping into private-pay, solo practice.
I had the false security of working for a hospital-based practice that was scrambling to stay solvent in the fast and furious world of ever-changing insurance regulations.
This was 8 years ago, when I saw the handwriting on the wall. My hospital-based practice was crumbling under the weight of mismanagement. I could not impact the direction of the administrative decisions and I knew I needed to make some decisions of my own.
I knew I needed to create a structure in which I could practice truly good medicine AND make a living.
Let's face it: choices have consequences. I have this conversation with my patients every day. We discuss the impact of daily choices as they relate to health goals. Eighty percent of how we age is defined by how we behave. The ways we eat, sleep, move and manage our stress are game changers. Self-care is indeed health care.
As physicians we don't often consider the impact of our choices on our own personal health or the health of our patients. We may not even feel like we have choices.
But the truth is we are constantly making choices about how we are practicing our profession. Our business models, our ways of interacting with patients, the atmosphere in our offices, the way we feel at the end of the day--all these things reflect choices we've made—or abdicated—along the way.
I organized my practice according to my priorities. The highest quality patient care was top of my list. This was non-negotiable. I needed to protect the time in which I interact with my patients. My choice to keep cost and patient volume down allows me to do what I do best.
The road to creating my practice wasn't always easy. But it was much harder to live with the constant feeling that my mode of practice was out of synch with what's best for my patients and what's good for my own health.
Creating a vibrant, healthful and fiscally sound practice doesn't require any superpowers--just a willingness to make choices aligned with one's values.
It is time we as healthcare professionals take back our power of choice. We are highly educated and deeply committed professionals equipped to serve our patients with our expertise and our humanity.
We are artists informed by science. We must position ourselves as such. Only then will we transform healthcare....one patient interaction at a time.
Lillie Rosenthal, DO, is an NYC-based integrative physician board certified in Physical Medicine and Rehabilitation. She is an expert in lifestyle management with a focus on injury prevention, pain management and biomechanics. Dr. Rosenthal successfully treats conditions such as low back pain, tendonitis and repetitive stress disorders. She is a consulting physician for the New York City Ballet, American Ballet Theatre, Metropolitan Opera as well as several Broadway productions.
Dr. Rosenthal has lectured nationally and internationally, and has been featured in several publications and TV shows including the New York Times, Consumer Reports and the "The Dr. Oz Show."