Dermatologist discusses contract negotiations, physician assistants hiring and training: newbie vs experienced, hospital managers and disputes, Advanced Practice Provider relations, and racial conflicts with patients and family. Dr. Johnathan Ledet, MD
What have you learned about training staff?
Do the office managers help?
Contract negotiation tips?
What do you do when you hospital system starts changing contracts and you start getting paid less?
Stick with the conditions and skills you have that you are Great at, not Good at. How to know when you should just refer out something that you could technically do but you know another person is better at?
Should u hire a Physician Assistant: Any drawbacks, perks, compensation, and training?
Is it better to hire a physician assistant who has no experience in your field or to fine tune someone who has been it in for a while? What and when are some of the best way to train your Advanced Practice Providers, physician assistant and staff?
Dr. Ledet goes over the different pay structures of a physician assistant (advanced practice providers) and is it worth hiring them or just another doctor in your same field?
He likes one topic, once a week and not on weekends so you can have more time with family.
Why is documentation for yourself and Advanced Practice Providers so important.
Even though nurses don’t directly bill the bottom line of the hospital, what effect do they have on care and the office?
Why is the consultation before doing any procedures on a patient vitally important?
How does location depend on how much room for negotiation you can request for a salary? You have to know what you bring to the table and what your value is worth… how do you estimate that?
Private practice vs hospital system: does private practice actually allow you to make more revenue or does it have hidden costs that may not have been factored in before leaving a good hospital career?
Why is it that hospital can negotiate contracts with insurance companies but individual practices usually have to take what the insurance gives them?
Why is the average physician on their second job within 5 years?
What are the 2 main attributes he is looking for when hiring staff… interviewed 48 to fill 6 positions? Also a couple of what not to do examples.
Everything you tell a patient before XYZ is education, everything you say after XYZ is an excuse in the patients eyes.
When you have a 7 week waiting list to get in, and you have to cancel appointments because of the doctors own family illness, how to you present that to the patient as well as getting them rescheduled?
When working as a hospital system doctor, when you have clashes and disagreements with your team, can you discipline or does it have to be channeled with managers?
Being an African American male doctor, how do you handle patients when they mistake you for the “help” or say things like, “oh are you the doctor?” He gives a couple of good examples of handling and diffusing the situation without getting upset.
Has he ever had to fire a patient for being racist?
What is being an Uncle Tom or acting white mean and have you experienced it from your own family? How can you or someone else diffuse that situation if they find their friends and family mention it often?
Should you give “less fortunate” family members money and if not what can you do to support them?
Show notes can be found at www.adoctorsperspective.net/100 here you can also find links to things mentioned and the full transcript.
Justin Trosclair 0:06
Episode 100 position assistance contracts race and staff. I'm your host, Dr. Justin trust there. And today we have Dr. Jonathan lead. That's perspective. So in 2017, and 2018 podcast Awards Nominated host as we get behind the curtain looked at all types of doctors in guests specialties. Let's hear a doctor's perspective.
100 episodes 100 episodes, and I'm still going strong. This is crazy. What a ride. It's been. I hope you've enjoyed it so far. I mean, we've had a spotlight series on women, African American doctors who actually ended up being lots of women to acupuncture docs we've had every profession I can think of, maybe not audiology still want to get one of those. They're difficult to find, apparently. But you know, I can see why a lot of podcasts stop around 25 to 30. It's a lot of work. It's time finding guess no replies. following up with people you really, really want to get on the show, matching up schedules. It's been really fun, learned a lot so far. And I think if you're honest with yourself, you have to have you enjoy some of the marketing that we've talked about on each episode. We've had certain shows just on that we did have a video social media spotlight series A while back, and today, we've got for the first time a repeat guests. So episode one and now Episode 102 milestones with one of my best friends, Dr. Jonathan ladette, we are going to talk a whole lot a whole lot of things. But before we do that, I want to share with you a couple of the reviews, testimonies, if you will, or things that I've heard. Here's one,
the fact that you're trying to find those little nuggets, man, I love it, I dig it and I'll support it for whatever you need for me.
Justin Trosclair 1:54
I think you're on a mission. I support that mission. The more we can have intelligent, emotional, intellectual, Sharon and in this profession, the better. That was Tristen David McCarron said,
If everybody in the chiropractic profession had and I'm not blowing smoke, had your mindset, your critical thinking mindset, we would not be in trouble we would be seeing 30% of the population right now. So, so press on what you're doing
Justin Trosclair 2:21
to people made the same similar kind of comment. Nathan Cashin and Olivier Roy is help rejuvenate me and restarted my own podcast again. And then Roy said,
that felt like a therapy basically, for me asking those questions all those like, you know, why are you doing this? Why do that? How can you make it better? So it was good for me to do it. Also, putting this together. It's such a good idea. I, you inspire me to do something like that on my side. You know what, Heather Denison
said, I think you do a great job. And you're the only person I know who asks about personal life. And it's so charming for people to Little People want to know about that. So I think that piece of it is great. CT said,
Yeah, I think you're you're you're a great host, a great interviewer. And I really impressed because the way you're able to weave those questions, and also kind of follow up with that I was talking about, I thought it was really smooth. So I really appreciate that.
Justin Trosclair 3:16
g Mark Strong really liked him. He did the laser interview, he actually bundled our interview together with a package. So if you bought a laser, you'd actually get a USB drive with a bunch of different things, including that interview. So that's really cool.
Thank you so much for this podcast, you're doing great job bringing together different professions and conversation.
Justin Trosclair 3:34
Jean Anderson from Australia was like, hey, technology fails. I'm glad we could do this. Again. That's only happened two or three times ever.
So I really like how you're expanding the the spectrum of doctors, you know, I know you had a pharmacist on other fellow chiropractors, I know you have a temperature is it's going to be on so I'm excited. I'm a fan. I look forward to subscribing to Doc, a doctor's perspective
Justin Trosclair 3:57
podcast, someone said, you're doing an intellectual NPR style, learning about other doctors podcast. And I like that you go long, you're great at conversation.
so grateful you're doing this and helping spread the word. Let's keep building our networks and get to know each other. Okay,
Justin Trosclair 4:13
so those are some of the comments, really appreciate that, obviously. And if it's your first time listening, there you go, some social proof. And I do want to play one more from a guy he's gonna be interviewed a couple of weeks from now PJ. He's a big fan. He's also got a really cool story. So I interviewed him and here's what he had to say.
And you are doing great work. I've been listening to your work met. I mean, I admire you doing what you're doing, building the band, you're doing, reaching, bringing people together, educating us, although chiropractic is a theme, but you are you're obviously including marketers and influencers and which I really love in the medical space. I just listened to your Ben Baker interview, the marketing, branding tonality, guy. Um, I mean, I've been triggered scribbling notes getting smarter and smarter about what he had to say, and agreeing with most what he's a lot of it with a couple caveats from our business experience. But I don't know I admire what you're doing. And I'm not ever going to try to do what you're doing. But as you know, I've started a podcast, which is designed to help me patients. And so I'm taking a card from you a little bit in your deal with this little tiny world of knee surgery recovery. And anyway, I just I like it just like what you're doing. I guess I tell you what, when we included your little awesome promo, by the way, super awesome. It makes my podcast feel so much bigger, because you're there. But there it is at the at the button at the end of an interview. And it's boom, there you go. I'm just interested in it, it's got like, Guys are kind of, kind of for real kind of kind of thing. So it helps a Believe it or not having you as a an advertiser, and it's such a an appropriate it and well connected kind of thing.
Justin Trosclair 6:03
Alright, so back to the episode 100. What are you going to look at today? We're gonna have negotiation tips, office managers, training staff hired staff, what are you looking for? Should you hire a physician's assistant? What are some of the drawbacks? The perks are about compensation, training and you want somebody fresh out of school? We're not out of school. You know, has he had any experiences being an African American? Where there's been some confusion? Some hurt feelings? We even mentioned Uncle Tom. And what does that what does that have to do with anything? And what can you do about it? If you are curious, about 55% of the guests have been male 45% female 80%, white, 13% black, only 3% Hispanic, and 5% Asian. So that's not that great, right there. Looks like I might need to try to diversify a little bit more in that area, and international about 12%. So that's kind of a breakdown. Hope you stayed with us. First part of interview we submit little couple little jokes here and there. And then we get right into it. Okay, so thank you so much for paying attention. Thank you for being a part of the program. I love y'all. Thank you for the reviews. Share it review us on iTunes and Stitcher, wherever it is. Let me know. a doctor's perspective.net slash 100. Let's go hashtag behind the curtain.
Live from China and Tulsa. We got a great doctor on the show today. He's board certified mole surgeon fellowship trained this guy's done it all been at two different hospitals. Second time guests on the podcast episode one episode 100. The milestone please welcome back to the show. Dr. Jonathan the debt.
Hey, thank you for having me.
Justin Trosclair 7:45
Absolutely, man. I'm pumped Pump Pump payment. You know what? There's couple good things. One, we just hit 100 episode. That's a good thing. Alright. Trump and the president of China, they just shook hands and said all right, trade wars over. That's pretty good, right?
That's right. I think that's really good. Our country,
Justin Trosclair 8:00
not too bad things happened. One president george bush, the first passed away. And the other bad thing is 51 whales off the coast of New Zealand washed up on shore and passed the way. JOHN, I gotta ask you, which one is worse?
Well, you know, I think this goes back to you know, 94 years old man, that's a that's a heck of a life. So, you know, obviously, someone who was president of our country, who was probably the last president to get things done in a bipartisan manner. You know, because I think a little bit went off the rails when President Clinton was up anyway, I think you have to mourn the loss of a great human being every time we can.
Justin Trosclair 8:41
Indeed, indeed, Phil's animal lovers. Still both tragic.
Yeah, it's still tragic. Obviously, I think that, you know,
well, they never do. I mean, the question is, like, there was a wealth on just the other day with what 17 pounds of plastic in or something like that. You know, anyway, I think humanities effects on on the planet, or, or, you know, our minutes, but that's a that's a topic for a different day.
Justin Trosclair 9:06
Job. What is your what's your love for this? Fake climate change? I hear you're a big supporter of just polluting the world. I heard that's what you like to do.
So fake comments age. So, you know, people who think comet teens is fake, I guess you just think science is fake, as well. So you know, I think humanities obviously had an effect on our planets. think that, you know, obviously, the world goes through hot and cold spells, the science can't dispute that. However, it's never one this fast, you know, in such a short period of time,
Justin Trosclair 9:40
that might be the key as fast and who knows what'll happen? Anyway, I'm messing with the man. Let's
go to the real reason why you're on the show. So you worked in one class middle, learn some things about contracts, dealing with staff, a manager that's appointed upon you, physician's assistants, and you've had a corporate change. So you know, you all of a sudden, now your pocket book has changed a little bit as well. And you're like, wait, I mean, we had a contract, but now that's changing. So like, that's been going on two years, man.
Yeah, you know, changing hospital systems was not an easy thing. did like the town I was in. But at the end of the day, you know, you're, you have to be happy in the job you're at, and your family, you know, most importantly, has to be happy. My wife wanted something that was a little more Metropolitan. I did really like Jonesboro, the administration, you know, there's several changes, they sort of not honoring contracts and etc, trying to mess with people and things like that. So, you know, I think they were shocked when I left because they they always said, hey, you're getting paid well here. And, you know, the question I was at them was that they think I was getting paid? Well, because I was there. They think I was getting paid well, because I was the one doing the work. And putting in the effort. You know what I mean?
Justin Trosclair 10:58
Yeah, would you say even in among them, you're probably in the top 5% of terms at this point. And like production?
I don't know about how 5% I know, there's some some people it's hard to quantify. I think in system jobs, I'm definitely in the top 5% Um, but there's some private practice individuals who work very hard. And you know, they're super efficient. And yeah,
Justin Trosclair 11:22
cosmetic orange is because there's a lot of terms that they want to do Botox they do and all these like facial things that's just like profit like crazy, because it's all cash. And you're kind of like, Nah, man, I'm doing surgeries for cancer removals and all that type of stuff?
Well, you know, I think that one of the things, as we get further into our training and our practices and whatnot, I think you learn that, I think it's personally best just to stick to the things that you are great at not good at the things you're great at, and the things that you are only good are adequate at, you let somebody else do them. You know, there are certain flaps such as what's there's a flap called a pyramid, forehead, when you take someone's forehead and put it down and those in I mean, I can do that flap, I have the technical ability to do it. But you know, my plastic surgery colleagues and ear, nose and throat, or I guess it's, it's actually EMC. So I ear, nose and throat, they do the more frequently. So I think it stands to reason that they do them better, and I have no problem sending it to you. Because we want the patient to get the best outcome. That's what it's really about.
Justin Trosclair 12:28
Alright, so I was I wanted to ask you about staff and things like that first, but you kind of mentioned it already. You've had to train a couple PhDs. And sometimes it seems like they might go out of their wheelhouse. What's going on with that? Well, can we how can we manage a PA and train a PA so that they're doing a physician's assistant, so that they're doing what I want? Because I'm the doctor that signs their notes? What can we learn? What have you lost so far?
Well, the biggest thing I learned is, you know, it, it matters when you get the person you know, if you get them fresh out of school, you get them fresh from a different jobs. You know, when I was seeking out my first physician assistant, I purposely targeted someone that had no dermatology experience, because that way, I was able to train them, you know, like the way out, I basically wanted them to be trained. So we will talk about things and discuss things. In that way. I know, you know, training, even from specialist to specialist, maybe different different training programs, training in different areas, you know, my partner is 66. So, you know, he's literally old enough to be my father and he was trained to different areas. So sometimes when we look at problems, we approach them a little differently. And sometimes the reasonings are the reason we do those things are different. So I think with the physician assistants, religious matters when you get them and you know that you kind of set the tone with them. The must current situation is a little bit unique. I came in they already here they inherited me I inherited them. I didn't really have much six not changed a little bit Oh Holly practice, but I didn't have a lot of say in that.
Justin Trosclair 14:05
Um, so is that a for people who are in your same position where they're like, maybe I'm happy with certain aspects of them, but I want to train them in other areas? Is there a way to have like a sit down or like a they were coming in on a Saturday, I need to retrain you on a few things. I really don't like how you doing this, I love this, this and this, but like we got to get this situated? Is that a possibility in that system?
Oh, certainly is I mean, what our current mid level providers advanced practice providers, excuse me, that's the more PC term nowadays, because, you know, I think most of them don't like being referred to as mid level. So advanced practice providers with them, meet with them every Thursday, our current ones every Thursday, and we pick a topic and you know, we spend 20 minutes of me going over it, and then you know, 15 minutes of questions. So we do just one topic at a time. So that way we can really get in depth on a topic rather than trying to cover multiple topics. Try not to do it on the weekends. Because, you know, people's family time is valuable. I mean, that's, you know, the work life balance is key. You know, you mentioned, I think in any of these jobs, it's going to be what you make it but also what is the person will give you, you know, I like to be I would sell them on like to be great, I tried to not use negative language whenever I speak with them. Like I don't say, I don't like how you do this, I'd say, yeah, I think we have some chance, a chance to improve this, or we can enhance the way we do this. This
Justin Trosclair 15:34
you have to hammer notes, like, Look, if you don't document correctly, we don't get paid correctly, if you don't document you can get in trouble. And then ultimately, I gotta get in trouble because you didn't do your job correctly. And I'm responsible for signing off on all your shots. I
yes, I think that is very important, I think in any specialty was the dermatology, rheumatology, any specialty, any, really any discipline of medicine, you know, if you're, if you're a chiropractor, so if you have a chiropractor, chiropractic associate, even though that person is a doctor, you know, you want to make sure that you guys are doing things in a similar vein, right. So that way your patients can get the best experience possible. So, you know, documentation is important, you should document so that you could build appropriately that keeps you out of hot water with patients keeps you with administration would government, you know, nobody wants to really to get audited. But if you do get audited, you know, like you don't, it's not something you want to live in fear of you say, hey, if I get audited, these charts can stand on their own. Everything's done, the i's are dotted, the T's crossed, and I go find any
Justin Trosclair 16:40
when you're working in a big hospital, because normally I think you know, there's a lot of private practice with a lot of, you know, hospital doctors out there, and sometimes you're going to clash. Staff members not going to be very good. They always messing up the schedule, they undermine you, they undercut you, they talk about you behind your back, or you know, I mean, there's there's lots of like, you know, negative things that can happen with staff, physician's assistants and things. Are you able, as the doctor to like, discipline them? or do anything like in that fashion? Or does it have to go to some kind of like, appointed manager and all that type of stuff?
Well, I think the best I think the best offices, both in system jobs and in, in private practice, you want to be in lockstep with your manager. So you don't want to I personally think that, you know, obviously, I think there's some generational differences. But I don't ever want to go to someone and say, Well, I'm discipline you because of this, because really, you know, we're not that's not our role of were unhappy with something I like to have that all documented with the manager, what do we talk about hasn't been an issue before. And then we talk about corrective action. I try not, try not to not confront people directly. Also, don't ever refer to people as staff, you know, I try to maintain a positive vibe, I call them my team, I said, Look, you know, I address email is if I address it to the whole department as a team, if I address it to, anytime I'm addressing more than one person, I said to him, I need you to do X, Y, and Z, or we fell short on X, Y, and Z, how can we improve this, also, I think empowering them in there were some issues at this office, and we try to correct them. And that started with getting on the same page with the manager, manager, letting the manager supervisor, whoever you're working with, know what your expectations are, and how you expect the office to be run.
Justin Trosclair 18:31
Right? There's got to be kind of tough, because you're a medical profession is so interesting. You gotta have nurses, you need, you know, a team, but an ultimate, in a sense, it's all based on what the doctor does, it's my charges that keep this hospital, the flow and or my clinical float, like he is great, but a nurse really can't bill,
they can't build, but they have a profound, anyone on your team has a profound effect on how the patient procedure office, you know, I get compliments, they lose a very proud of it, they say, oh, everybody's been so nice to me, you know, things are organized, and people checked on me. And they called me to make sure I didn't have any pain or bleeding or anything like that. So those are all good things, I think, the best offices, you know, you include everyone in the process, and I always tell my team, you know, you see them for me, and you see them after me. So really, the better experience they have with you better their overall visit is going to be, you know,
Justin Trosclair 19:27
they're not going to complain to you. Like if you were short with them or made a joke that they didn't like, they're not going to really tell you because like you're working on their face temperature, you know, or wherever they're Yeah, they're going to go up to the front manager and check out like, they start Vinnie, and you may or may not ever hear about that. Yeah, until it's too late. So is there a way to counteract that,
a way to counteract bad patient experience? Well, you know, some of it's also going to be personality driven in my in my office, I have a rule with except with rare exception, I don't operate on people without meeting them first having a consultation with them. So we can discuss, you know, how the procedure is going to go, they can meet me they can get a sense of my personality. So that way, they can decide if they like me or not, you know, because they you know, they're I think the era of paternalistic medicine, in any disciplines over a patient's lot more educated now, you know, they're researching, you know, they say, Oh, I saw you trained with so and so tell me how this when that when they want to know, have you know, have you had any problems at any of your stops? Have you? Have you done this procedure before? You know, what's the success rate, all those things. So, you know, and I think a console visit for me, helps alleviate some of those things so that when they come in, they're prepared, they haven't experienced a great experience.
Justin Trosclair 20:47
Let's talk about real quick back to the physician's assistants University office, you know, in a hospital setting, you kind of get Captain like your most places, it seems like you get a fee for supervising a PA, and then it's kept but like in a private practice, sky's the limit, you just whenever you want to, you know, percentage they get a flat salary, is it really worth either quote the headache or be the profitability to hire a PA versus just say another doctor?
Well, I think that's more of an admin question. For me, you know, I think patients want to see positions, by and large, most of the time they want to see a physician. So is it more profitable to hire I think, administratively they probably retain more on the, on the Advanced Practice providers, because you know, they get paid less than us. Right. They so they cost less their malpractices less and all these things. Now, from a standpoint of managing them, you know, is the juice worth the squeeze? I think that goes to the relationship that you have, I think if you have someone who you've invested in, and he's trying to India real asset to the office, think this, I mean, I really think that starts at any level in your office. And again, the front, the manager, the, you know, the nurses and whatever. But specifically with advanced practice providers, that could be a real asset. But if they are not basically on board, they don't want to do things, kind of what you want them if there's some friction between the two of you, then then they could be a real detriment to the office, I believe, you know,
Justin Trosclair 22:18
I was listening to a guy who he trains chiropractors to sort of educate doc medical doctors better on like what we do, because any given day, 30% of their pain, their patients are like back pain, musculoskeletal stuff. And that's obviously what we want to see. Right? And so some like 80%, will the patient be like, yeah, I go see a chiropractor. And they'll be like, okay, cool, that's fine. But only 11% will actually actively refer to they won't like you should never go. So that that's a change, that's good. But there's only 11% actually give referrals to the chiropractors like so that spread is where you know, we can make the biggest impact on society. And one of the things that some of the jobs that I've noticed for it for chiropractic in the hospital Orthopedic Clinic setting is the Cairo is doing most of the ortho his exams, because there was like, Look, maybe one out of five is a surgery candidate, and it kind of wasted my time. So go see Dr. Justin, he'll do the exam, he knows exactly what I need for a surgical console. And if they don't meet these criteria, then you can take them PT in the office can take them, and then you know, likes it. Now, all my day, if I have 20 available appointments, they're all actual surgical candidates, and I can actually treat more patients that need to be seen throughout the year. And I was like, wow, that's, that's kind of cool. And it kind of made me think of like the PA situation where you might trust them with certain things. But once you once you train them to say, hey, look, if you see this, you send it to me immediately. Like you don't be doing surgery, you know, you might be remove this thing, but if it's on the face, don't touch it, you send it to me, because I'm the one who's better at it. I
think that is a function of you working with him every day and training them and you guys kind of having a shared vision of what the patient experience should be in your office.
Justin Trosclair 24:03
Okay. All right. What about contract negotiations? How much sleep? Do you have to kind of like, know what you're worth, to really have a foot to stand on? Or he had to just take what they offer? Because I mean, they just hire, somebody else will take it, you know,
what's your thought they get each situation is different. You know, I think if you want to be in downtown Dallas, if you want to be in, you know, Miami, something like that, if you if you if there's an area that highly desirable is basically going to depend on how bad they want you I think there's room for negotiation in most of those unless it's like, Hey, you want to go to Austin, Texas in Austin is a hotbed for, you know, dermatology, let's say, because it is, then you will have less power to negotiate. But I think obviously, in anything Justin, as you know, it's you need to know what you're what you're bringing to the table. And I don't think that you can actually get a sense of that until after you've worked somewhere, you know, the average position is on their second job within five years. And I think the reason, you know it is because the first job sometimes you don't know what you're worth. And then sometimes it goes the other way, sometimes you have a situation, that's great. And you don't appreciate how great it is right? I have a friend who she's now in private practice, she had this job in Kansas, and she liked it. She didn't love it, you know, she she was a god, it's it's a, it's a good job. It's not a great job. Because, you know, they asked her to do like some administrative things. And she didn't like that in nickels worth our time. And then she left that she joined the group of friends. And they thought it was going to be like this great bonding thing where you have all these, you know, these like minded individuals, and it turned out not to be like that, because two of them on the practice. And two of them were quote employees there. I mean, they had their own practice, but they had the pay is to the other people who had the staffing who had the building the you know that that
Justin Trosclair 26:00
you guys over two feet, throw your weight,
right, so they had to pay a percentage of collections and whatnot. And so she went from one stage to the next that she actually made much less in her quote, private practice.
Yeah, situation, because she didn't know how good she had it back in or other good. You know, she just didn't realize all of the things that were available for, you know, the head for deferred income had a whole bunch of different things that you have to consider, you know, private practices is great not to ramble on private practices is great, I think. But I also think systems asking me can be great as well, if you find the right situation for you. So all of this thing, all of these things are situational.
Justin Trosclair 26:45
You got overhead, and the more money you make, the way these work is your overhead will still increase because now you gotta hire another nurse, another staff member health benefits, all of a sudden, a 30,000 salary ends up being like 45. Sure, you know, so there's a is that level, but in the medical filmmaker, and if you're lucky, what 45% you're not so good. 60 to 70% overhead. So you like to consider like, Oh, I brought in, I don't know, a million worth of businesses hospital, I only got paid what 40 or 50%? I'm going to start on my own. Well, good luck.
Good luck. You're exactly right, with a good luck. Because I mean, I think people underestimate the value of working in systems. I mean, just for example, when you're negotiating contracts with insurance, if you're a private practice person and you one individual, or you have yourself and one other person, then you're not going to have much leverage, you know, my institution has 400 doctors. So when they negotiate contracts, they negotiate on behalf of 400 physicians, and they say, Do you as an insurance want access to this many doctors so they can command a higher price?
Justin Trosclair 27:53
That's so foreign for so many physicians like outside of what you are, and the rest of the people that listen to this, we don't get into option, negotiate fun you want this or not? Like that's your choice, like you want $30 for your treatment, or not. That's all you're going to get. There's no negotiating. It's so crazy.
But I just think what I think it's just that I really still think it's situational. I think that if you can show someone how much you are actually worth in what you're bringing in. And if you know, you know, if you know to work, then basically you can I think you obviously everybody wants to get paid a million dollars and work two days a week, but that's just not pragmatic. You know, that's not realistic. So you have to say, Okay, guys, listen, these are the things like with my current job, right? So they wanted me to come be in another building, and they said, Okay, we'll build you an office. Just come let's get started. And then, and then we'll, you know, we'll put you here, we'll get everything done. And I said, um, yeah, I, I would not, you know, I told him, I said, I wasn't willing to take a step backwards basically said, you know, money, Judah, make sure the office is built before I show up, you know, I wanted to make sure my team members, you know, I got to hire all of them myself. I had to interview 48 to get six, you know, so and it because it starts with having high standards, right?
Justin Trosclair 29:15
Are we looking for
a day, I was looking for, number one, the strong work ethic. And number two, being a great team player. I mean, some of these interviews Justin more comical, I had a young lady walking, you know, because just by the nature of these medical assistance, LPN jobs there, you know, the majority of the applicants are female. So one lady walked in, sat down, she says, How much does his job Hey, and I was like, excuse me, well, how?
I was like, wow, someone failed that or how to interview class, you know? So I was like, well, this is not going to work. Well said, Well, you know, this job will pay a salary commiserate with Jared experience in what HR the show word, you know, so, yeah, it's just funny, you know, it's like some people just basic things. I had another young lady, you know, she walked in.
And she was club my suit. Yeah. You know, she was dressed like she was going out with some friends. You know, it would it would have been more of a fitting for a an application that leaders and not an application to a professional medical office. So there was a little
Justin Trosclair 30:22
both ways. Yeah, the guys because you walk out of bed, like, come on, man. guys can do it. You're not. You can't wear a hoodie.
You probably shouldn't wear a hoodie unless you're interviewing to be a rapper. You know, I think that if you're interviewing to be a rapper, that might be
Justin Trosclair 30:39
all right, team player like it. When you're fresh out of school? Well, residency, I should say, Do you even have an inkling of how busy and streamline you can make yourself to guess like, I estimate, I could see 20 people in a day, but in residency, we can only see eight, but I bet you I could see 20 because we were just twiddling our thumbs half the day? Well, I think, you know, we don't have as much red tape. You know,
I think but you also have to remember residency programs are designed to train people. Okay, so it's not going to be this super efficient system, because the attending physicians, you know, that the slow down, and they have to make sure like, you know, they're being extra thorough, because they are teaching you things, even without talking, you know, they're in a room ever much airman, you know, yes, it's a Friday afternoon clinic. And, you know, you would ask all these questions was seemed to be very mundane, what color is the chair you sit on, and blah, blah. And then soon, you know, soon enough, you like, oh, he asked the color of the chair, because this person has an allergy to blue dye
from their chair, you know, like, you just, you know,
that's why they call our professions and art and not a, it's, it's, it's an art, right, it's an art to practicing that.
Justin Trosclair 31:52
People don't realize that most of the time, it's like you expect, but it's subtle new ones, especially with what you're doing, you're going to reconstruct somebody's arm or their friends. I mean, there's a lot of chance to make somebody really ugly, are make them look like they did before they came in.
So obviously, in any of these surgeries, you so I always tell people, number one, that they're always let them know that there will be a score, you know, so you could set the expectation. But really, in truth, you want to make it look like nothing happened. Yeah, you want to get them a great outcome sending in your profession, you want to just people, and then you want them to feel as good as they've ever felt.
Justin Trosclair 32:27
We always do the caveat, the first visit, right? You're probably going to be sore, you probably going to be source, if you felt like you had a flare up, it's okay, that's normal. Because if you don't tell them, they may not show up the next day, and then they're mad at you talking negative methyl group that
was right. I think sometimes complications with any thing happens. And I think you have to set that expectation was
gonna, if you tell somebody, hey, I think it's going to take somewhere between eight and 15 visits to get you better than they understand. And they're not going to, you know, basically, I had a mentor who told me anything you tell a patient before you do anything is education. Anything we tell them after is an excuse. So let's make sure we keep it together. I like that.
Justin Trosclair 33:06
So before his education, afters in the
exact same thing, but that's our patients receive it Oh, you're making excuses for why didn't have Why? You know, why do I have a scar? You know, on you know, like when sometimes this happens to me. Patient said, well, you told me that one movie score said no man, no sir accent that never came out. My name is not you know, they tell you never say never. But I'm like, Listen, I'm saying that I don't ever say I don't ever tell patients that will not be a score. I say I tell you, right up front, there will be a scar. And I mean, people come in, you know, they come back and like their three or four months following they go, wow, there's no score there. You said there was going to be one it's like, well, there's one but it just looks good. which is which is right?
Justin Trosclair 33:49
Well, especially if like you know, you're loud talker. I'm, I'm not sure if that's how it is at the office. But I have to assume is like if you're chatting with your staff, like man, I really gotta get out of here by like, no later than five to my kids are sick. I really got to get out of here. You got some patient that over here is that around for 45 you finish something up, and then the next visit they're like, didn't come out quite as good. You know, I did not rush it. And they're gonna think
Justin Trosclair 34:15
took five minutes your surgery, but it didn't come up quite like we wanted right now because I was rushing it. Right.
Right, exactly. So I try to you know, we try to have those conversations out of earshot I and I tell patients, I wouldn't say I don't see anything about them that I wouldn't tell them to their face, we try to keep them abreast of situations. You know, my wife was sick about a month ago or so, in, I canceled a couple patients because basically, I knew I needed to get home to be able to take care of my kids. And I kept the patients' of breath. We told them up front, that as a sick, sick wife, you know, I had my team call them and I said, Hey, I apologize for rescheduling the surgery. My wife is sick, I got to do these things happen.
Justin Trosclair 34:55
That's one thing I do like about you, you don't have this God complex and you care about your family, you want to be a part of your family. And it's not like work is all there is. And the patients I think understand that if they get told that, like you said, You're letting them know, I think they respect that. So if you do have to cancel, they're not like, I waited six weeks for this appointment. And now I gotta wait another who knows how long to get rescheduled? Right. How do you handle that? How do you when you're when you're booked out six weeks, eight weeks at a time and you got to reschedule somebody like because of your fault? What do you do?
Well, what you do is you do whatever it takes to give that patients the best experience, you know. So what you do is you try to work them all in over the next week, if you can, you know, you come in a little early. You talk to your team. Yeah, talk to your team verse, right, because they Yeah, they ultimately, are the people who make a lot of decisions in the office, you know, because I can only because
Justin Trosclair 35:48
I took off work to come see you already took the work off, not gonna take off another day. Right,
exactly. So, you know, you try to find something that's workable in that within that patient schedule. You know, like, we've come in early, like before example time off the entire last week of December, right. So what we did to compensate for that, though, because we have lot of
deductibles, etc. So we are working three Fridays in the road to try to help offset those days that we will not be performing surgeries.
Justin Trosclair 36:17
What a pious man to work on a Friday.
Yeah, I don't want to use that. Um, you know, say it. So this is one of the things because you just work four days a week. I mean, make your schedule like chiropractors
Justin Trosclair 36:32
record like three or four as well. Oh, Fridays? What?
Are you kidding me? Well, I think that's, I think that it's important to have that family time as well. And my team, we work hard Monday through Thursday, you know, we put in Yeah, a lot of
Justin Trosclair 36:46
our so I'd say we you know and that people can get overtime in your four days. Yes.
People get overtime regularly in our four days a week.
Justin Trosclair 36:53
Yes, sir. That's that's something it's not like you worked six hours and data. Exactly. I mean, you don't have it as nice as as we do with these two or three hour lunch breaks this, I mean, yeah, you know,
I got a candidate I am. I'm a little jealous of the two and three hour lunch. But you know, if I get if I'm going to have a lunch break, that long, I rather just cut the day short. You know, like, I believe that for 10s. You know, I'm I met with our vice president the other day, and I told him I said, you know, for 10s is more efficient than five eights, it just really is. I think, I think you will burn out, you know, the you you get less burnout doing that, because I think that you're able to have a little downtime. And
Justin Trosclair 37:33
that's important. You can power through that last Thursday, or like that last hour of every day. Because, you know, Friday, do a three day workweek three day vacation every week. That's like, it's so refreshing. It is like Friday is normally just decompressing. You got all day Saturday, that's just chill. And then Sunday, you can kind of geared backup. I mean, that extra day is huge, huge.
believe it is huge. Because I mean, also you you can do, you can get things done, you can go to the bank, well, during normal hours, you don't want the hustle again.
You can take your kid out. On Fridays, I take my oldest daughter will go get a smoothie, you know, and I just, we'll just hang out, you know, I go to it's like $5 smoothie, Smoothie King. So we go go through the king, we hang out and we just talk about what we're going to do that weekend. And, you know, ask her how school was this week and who she played with and things like things that, you know, and she has a little sister. So I think that's important for us to get that time alone. So that way she you know, it's just her.
Justin Trosclair 38:35
Indeed, indeed. So one of the things if you read the title of this episode is called Reese, you are a successful African American. And we kind of probably touched on it the first episode you came on, but probably not that much. I was a little, you know, gun shy with some questions that I've asked. But, you know, over last year, Around this time, we had a six week session, just African American doctors or something I'd like to ask because you know, as a white male, well, you know, we don't really have this consideration.
Yeah, white privilege, right? It exists.
Justin Trosclair 39:03
Yeah, I mean, that's there. So it's a it's a, it's a two fold question. We can cover one or the other, I'll just let you know what they both are. One I've heard sometimes people get mistaken for the help or like, Oh, are you the nurse? Are you they have those type of experiences of just not, you know, getting that instant respect that they're supposed to have? And so I'm curious if a if you've experienced any of that, how do you deal with it? And is there ways to kind of, like remedy it. So it doesn't become an issue to start with?
Well, I mean, this virtually happens to me every week. Okay, so every week, every week, but it's not, you know, it's you can only control how you react to things right? Like, lot, you know, your worldview, my worldview is pretty positive. I think you know that about me. So, when someone says, When they asked me, they say, Are you the doctor? I say, well, that's what the sciences and it kind of like defuses the situation, you know, they laugh, walk. Yeah, that's, that's it, you know, and like I said, patients are savvy now there, you know, usually, a lot of them, you know, they've looked you up on the internet, they've, you know, they know where you're trained and all these things about you, but
Justin Trosclair 40:09
sometimes a big sign by the elevator.
Yeah. Yeah, I do. But you know, it's funny. I just just this past week, I was in the elevator with the patient I was going to do surgery on I told them the Good morning with the elevator up with them to make small talk about patient did not realize it was me. So I walked in the room. And I was like, Oh, so how was the dragon? And he was like, Oh, that's pretty good. You know, I was like, so how was breakfast that whatever it is, like, how do you know where I was? Like, why saw the bag when you walked in? You were in the elevator? You know, like they did?
You are wearing the coder. And
that's another thing. I don't wear white coat, you know, being run by merely surgery. I mean, it's not necessary, because I would I think I would, you know, I know I will take it off in between every case. So I think that's another way people can help avoid that is have the the white coat the context clues, so to speak. Patients, but no, my scrubs have my name on says Dr. Jonathan Jayla debt. I think that it is most of the times done malicious things just like hey, okay, well, you are people if I showed you a picture gram of a bunch of different ethnicities, and that's a who's the smartest person here. And when it comes to math, I mean, just stereotypically you would probably pick the Asian person, right? I mean, you're married to an Asian woman. So basically, they would say, and you know, I have an Asian team member and I tell her, I need you to be stereotypical Asian and do this calculation for me on xy and z, you know, so you know, kind of joke about it, things like that. Then what was the second part of question sees me?
Justin Trosclair 41:39
I guess it's like, can you avoid it? I think you answered both at the same time, which is good. You ever get discouraged? I guess the like you said, I guess people aren't really malicious about it. So there's less of like,
Oh, my gosh, a black
Justin Trosclair 41:50
it happened twice. I had it happen once in residency with a really old guy. And he's a question as you see, now you want to see my D know I had tend to get more white coat is like, are you adopted a policy, Roddy, you know what I mean? So like, whatever, right? I get it. And then another time, I had a patient when I was in Arkansas case, it was like, I don't like you very much. And I was like, Can you tell me why that is? And he said, I can't tell you right now. So anyway.
So I mean, you know, you're not going to stop on all racism. I think that you know, you treat people with respect to them, they're the day neither do let them know that you are one qualified and capable of doing your job. And to you're going to do, you're going to treat them just like you would treat anyone else. I always tell people we treat you like family that we like
Justin Trosclair 42:40
that we let the you ever have to fire a patient because of Yes, any kind of racial, know,
I fired a patient, I've not fired them over race. Generally, if they have if there's any kind of race issue, they just won't come back. You know, you can kind of, you know, if the visits going sideways, right? And you've adjusted people that you know, this person's not going back because for whatever reason, sometimes every personality, um, they don't always get along. You know, I'm an outgoing person. I am allowed talker I am also a close talker. Also stay really close to people when I talk to them. So I think that makes some people uncomfortable. I you know, I try to be as open and inviting some people don't like that some people want is strictly you know, they try to ask you about their life in how things are going on. And I've had people tell me before I had a lady once told me, she's like, Oh, I don't really want to talk to you about my personal life. I got asked her what kind of dogs yet because I noticed she said she had like a something on her purse. I said dog moms ago, what kind of dog his hat do you have? And she said, Oh, well, I don't like talking about my personal life. The doctors I said, Okay, not a problem. So then, like, we started talking about the weather, and later in the conversation said, Okay, I have a congress vago.
He's gonna crack the ice a little bit. The frost that she'll
Justin Trosclair 43:56
want. It goes a long way, though, right? Especially like in China. Some I have to get on my wife. I'm like, hey, she's the translator. I'll ask them, you know, someone just like kidneys. A daily living my shoulder hurts. Oh, keep doing what? You know, is that overhead? Is it reaching as it using a backhoe? Like, why does it hurt? And then sometimes we'll just ask like, oh, how do you how does your kid or how's this going? And, and sometimes it's like, it's culturally like kind of inappropriate a little bit to ask certain questions. But I'm like their own. They have grandkids, let me tell you, they're going to be excited to say anything about their grandkids. And sure enough, it breaks the ice with that grumpy person, right? And then defuses the situation? Exactly. Now, I have a question I've never asked. And I kind of preface it beforehand, if I could ask you this question. So I didn't want to come off. Like, that's a racist question or whatever. There's a thing called Uncle Tom, if you could explain what that is. And have you ever experienced it? How do you do that? Because there are a lot of professional African Americans that have come out of the poor and succeeded. So give it if you could give us a little background about that. And have you experience it? What do you do about it?
Uncle Tom, there might be another term. So I'll go Tom, basically, it's like, you know, this comes from Uncle Tom's Cabin. Right? And in Uncle Tom's Cabin, there's a black man is a slave, his name's Tom. And he gets like the because he refuses to, like, till the the whereabouts of like, you know, they're looking for other slaves. And he doesn't. He doesn't reveal where they are. Right. Right now, in the racial context, the quote Uncle Tom, it's a pejorative term, right? It's basically it's like you're giving up your ethnic background, or whatever your traits and practices like, you know, when I was growing up, I was going to call the whiteboard, because I tried in school. And that's, it's like, Oh, are you trying to be white? You know, you're talking Why? And I'm like, No, actually, I'm just talking hockey properly as on whether it's, it's. So I think that you know, my mom, my mom didn't graduate high school. So she said, make sure you get an education. So when they call you an Uncle Tom, it's like, oh, you're, you know, when they use it in that sense. They're like, Oh, you're trying to hide the fact that you're black. And I know that, you know, that never comes up. I tell people front and center on black. I like everyone. I don't I try not, you know, I had a white man and my as my best man at my wedding, whether, even though I got pushed back from family, you know what I mean? Yeah, all the time. Basically, it's like a, it's like a negative thing. So it's like, also set goals for you given into the white man, you know what I mean? And I mean, I don't look at it like that, I think that you need to, I've always prided myself on being able to stand with anyone, no matter what their race, their trade off smart, they are,
Justin Trosclair 46:43
whatever. What Can someone do, because not everybody's going to be as strong as you are. And they're like, Look, I went and I went to school, I graduated, I got a Master's, I got a PhD, or whatever I'm like, at the top of my game, you know, they might have like a brother that's like, not really living up to their potential or something. And it really affects them, maybe get some depressed or anything like that any, any way to overcome that are ways to handle family members that might be like that,
man, I think all you can do is encourage them, you know, encourage them to do better for the for themselves. And I think that I think it's the best thing to do, I think that you encourage people to pull them. Like, I always tell people help me help you, you know, help me How, how can I help you help yourself? Right? Is that that old adage of teaching them to fish get teach a man to fish versus giving them fish? Is he teaching the fish, then basically, they know how to fish for life. Whereas if you given a fit, give them fish is just the name of it. So I think if someone's not living up to their potential, I mean, you know, you can't give it a jealousy. I think if you talk to anyone who is successful person of any race, there's always jealousy using within the family, your someone? Because this person didn't achieve the same level. But you said you had same opportunities I have, but if I can help you, I will.
Justin Trosclair 48:05
Yeah, just help me out. Man, you got the money? I just need a couple hundred bucks. Yeah, come on. No,
that's not a good way. I think that that enables people, I think if you start enabling people, then you're really gonna have a problem with them later, I believe, you know, always, once you start giving people money to solve their problems, then they're just going to keep coming back.
Justin Trosclair 48:26
It's not going to fix it. You know, it's part of the group one time and the head honcho there, either the same things like I got a sister, she's always short, I started giving her money one time, and not but a month to later, she was short again. It's like, wait, I just give you $500 a month, how you still short? And so yeah, you just can't like said you got to find another way to help out your your family or your friends to help themselves. Okay, cool. Cool. Where are you seeing yourself in the next five years? what's what's on the plan?
Well, you know, I like that I really liked the job and the institution and Morgan for in Oklahoma. You know, I think in the next five years, want to grow our practice, we are we recently interviewed another young lady, another dermatologists to join us a general dermatologist, I would like to grow our practice that like, you know, just community outreach, I hope that we're still, you know, trying to advance our specialty and let people and take great care of patients from on a personal level, I would, you know, hope to have the channel motivate, must my sister to go back to school, I hope that happens. Hope that, you know, she kind of sees the light of day, I have a younger brother, who's 20 years, 11 years younger than me, so 26. And I hope that you may get yourself together in the next couple years really been trying to, you know, be a better brother a better friend to him and text them every day because you know, he's prototypical millennial, not not to be negative, or any millennials out there. But you know, he didn't basically he said, my talk on the phone, he likes to he preferred to do everything. He prefers to do everything, like via text message and whatnot. So, so my professional plan, the next five years, I'd like to grow our practice. Also, at some point, I would like to get a an MBA, because I don't know that I'm always going to do surgery, I think that some point, in order to help advance medicine you need to, especially for a particular system, you need to be making, like administrative decisions and saying yes, politician, right. You know, things like that, I hope to get an MBA and and see where that takes me just kind of have that in my pocket for the time that when it comes in, I need to
feel the urge to do something else I can help in another man or I can do that
Justin Trosclair 50:42
was good. In a couple years, all your kids are going to be in school. And so you should have a little bit more time to devote to that. Like right now. I mean, what a new kid and my colleague, I barely have time to do this. I can imagine like enrolling in the class and trying to figure all that out. I'm just like, you know, if they're in school, I can study while they're studying. And maybe maybe a little bit easier on the time at that point. Right.
Right. I hope that I'm able to do that. But I do hear that kids now have so much homework that it's it's just insane.
Justin Trosclair 51:11
Yeah, it's out of control. Yeah, that's what our hours and hours and hours. Yep. I mean, you can't change it. They said there's some schools are experiments where the kids don't get homework. They make somehow I don't know what they're doing in this class, the see minute, and I guess I just have to study for their tests. I mean, that'd be pretty sweet as a parent, I'm guessing, but I don't think that's caught on. It's too ingrained. Yeah, right. Exactly. Oh, real quick, any any advice? Any new advice now that you got two kids, a loving wife any tips on how to manage your time at home better or keep the love alive? You know,
I think you got to you got to make time for each other basically, mean, I think you have to do that you have to basically at the end, you have to put it on the schedule, man, everybody's busy. You have all these things, they try to get the kids in bed, you know, my wife and I, you know, try to have work life balance, you can't let you you want to you want to work so you can live not live to work, I think, obviously appreciate and that person, being able to support them, like do little things like my wife went to see see me this weekend continuing medical education. And I was telling her that basically, she should go get some coffee because she likes having fancy coffee. And I took care of the kids this morning. And I put I put them to bed so she could you know, get some rest and go to bed earlier. So like doing those little things. I think you gotta remember to treat them as if you know, they're brand new and like, you know, just let them know that you're around for him and your support.
Justin Trosclair 52:39
I man did we forget anything? Anything that you want to cover any farewell tidings know, man,
I just like to appreciate you having me on the show. Think of the joy listen to this podcast a lot and just, you know, your interactions in interview and other doctors. I think that's really good. I think it's good to hear different perspectives. You know, you did you did the African American week. I know you did a female. We know that you've interviewed people that are you know, older that basically started their career when medicine was totally different. You interview you've interviewed different disciplines, man, I think it's a great show. And I hope I hope you show has a fantastic 2019 and hopefully, you know, one day you'll get on that Tim Ferriss level of that Joe Rogan. Oh,
Justin Trosclair 53:26
that'd be sweet. Alright man, appreciate it.
All right, thank you for having me.
Justin Trosclair 53:34
Let me know what you think a change the logo, updated it to honey comb style backgrounds, a blurred out like rehab sweet. And then there's all these little icons that illustrates different types of doctors specialties inside there, we got a new Asian EDM style intro a kind of dig it. Let me know what you think about it, though. Also, for the first time, I'm now giving a fifth no needle acupuncture chapter complete with pictures of points and everything that you need for knee pain. That's right knee pain.
Justin Trosclair 54:06
to take a second say thank you so much for listening to the show. If you haven't left a review on your favorite listening app, please go ahead and do that. One thing I've realized, I'm putting out a lot of links all over Instagram, Facebook, this podcast itself. And if you ever change the link, or shut the website down, all those links are now gone and did. So I just want you to know if you're listening to some of these episodes, and I mentioned a link and it's going to head on over to a doctor's perspective. net, you're probably going to find that thing you're looking for on the top menu, search around and I'm sure you'll find it all the books that you find their acupuncture broken, no needles, the free chapters, you can download the 360 degree health from exercises stretches financial health, what is Chiropractic and the free chapters for their t shirts, resources. And we even have a financial support site now. It's just a doctor's perspective. NET slash support. There's one time support, there's monthly support, go ahead over there and check it out. Something that I'm offering right now with the needless acupuncture. If you buy the book, you also get the electric acupuncture pin for free as a bonus. And that electric acupuncture pin helps you not only stimulate the points stronger, that helps you to locate the points as well. So that's a huge plus. And then with the today's choices tomorrow's health book, I'm offering a bonus of a one hour one on one coaching session to go along with the purchase of that book. Actually, there's three different bonus packages if you head to a doctor's perspective, net slash no needles as getting close to the end of the year. Are y'all ready for the 2018 Top 10 I mean it is too early right now but it's going to be here before you know it that will be available for download later on just like the 2017 is now you just heard a great guest implement one thing make your practice and personal life as best as it can be.
We just went hashtag behind the curtain. I hope you will listen and integrate with some of these guests have said by all means please share across your social media. write a review. And if you go to the show notes page, you can find all the references for today's guests. You've been listening to Dr. Justin trust Claire giving you a doctor's perspective.
Transcribed by https://otter.ai