Episode 114: An Important Program We’re Working On To Cultivate Physician Autonomy w. Dr. Jessica Jameson

I’ve been working on a standalone educational program for a number of months with a couple partners. It’s called the Practice Accelerator, which is a curriculum and online course designed to help equip pain physicians who want to start a practice or to substantively revamp an existing practice in a setting where they have decision making capacity. Today, I am interviewing Dr. Jessica Jameson, another partner on this program.

Justin (01:05):
Jamison about her journey, as well as some of the course content in this program. If, and when you decide to register for this course, you’ll get access to 18 different micro modules of content spread out over four weeks, plus fillable practice management templates, including a business plan and practice proforma. We’re also building into this course office hours throughout the month in which it occurs. So that course participants can hear from their peers, as well as discuss specific questions that they have about practice launching or operations with the course creators. It will be no surprise to you that cultivating physician autonomy is a core value of mine and of this show and the practice accelerator about what you’re going to hear today is the latest in our efforts to provide tools, to equip physicians for this important work. For more detail about today’s episode and applicable links as always, you can check out the show notes@apmsuccess.com slash one 14. Thanks for listening.

Justin (02:06):
Hello and welcome to episode 115 of anesthesia and pain management success. I’m very pleased to be joined by my friend, Dr. Jessica Jamison. If that name sounds familiar it’s because Dr. Jameson joined us back in episode 60 to talk about her experience in launching her practice access spine. We have come a long way since then, and we’re going to talk about some exciting stuff here today. Dr. Jamison, thank you for joining.

Dr. Jessica Jameson (02:31):
Thank you. I’m excited to be here. Thanks for having me back.

Justin (02:34):
So when we spoke most recently we talked about your experience in launching your practice and then scaling very successfully in the last handful of years. And it’s been a really interesting ride, and this is an area where you and I are both keenly interested is helping and providing resources for physicians who are either in independent practice or considering a move in that direction. So I’m really excited to talk specifically today about the time in which you were asking yourself, you know, w how are things going right now, and the practice that I’m in. And then there was some challenge or circumstance that you’re facing where you’re like, I think moving in a new direction is the right answer for me. And then that caused you to step out on your own to do a new thing. So take us to that time, period. Describe a little bit about what you were thinking.

Dr. Jessica Jameson (03:27):
Okay. So, you know, when I first came out on fellowship, I joined an individual who’d been in private practice for about 15 years and was employed by that individual with the plan of becoming a partner. And so as time went by the goalposts moved a little bit, and as I often do and at the end of that, I sort of just said, boy, this isn’t going to happen. Right. And for multiple reasons, not only did the goalposts move, but the requirements to become a partner also changed. Could that have been prevented in hindsight, maybe, you know, maybe I could have gotten that all written down at the beginning, but I’ll tell you when you’re first coming out of fellowship, you have no idea what questions to ask, even if you asked like 10 people you’re still, I think, just not prepared for it.

Dr. Jessica Jameson (04:11):
You’re just trying to figure out how to actually be a doctor on your own. So I did that and then I decided to leave there and I actually joined a hostile group. And that during that time was really when I said, okay, I can do this. So what happened with the hospital group was that as happens with many hospital groups, is that you really had zero autonomy. There was really no ability to influence the way you were practicing, hiring, firing any of this kind of stuff. And so it was during that process that I, I started to realize that I wasn’t able to care for patients the way I thought they should be cared for. And so I started to sort of toy around with the idea of, okay maybe, maybe I can do this on my own. Maybe I can set up a practice and have some significant fulfillment from that practice and take care of patients the way I wanted to. And so ultimately I looked at the pros and cons and I made the leap.

Justin (05:04):
So you mentioned the moving goalposts. I know that’s a common challenge. I was actually talking to a friend this weekend looking at a potential opportunity for employment. And he was describing some of the roles he was looking at seven years was the partnership track. And that is assuming that no goalposts move. So I know that’s a very common challenge. As you’re thinking about, you know, you mentioned briefly, if you could have asked every question, it would have still been difficult. Is there anything where you thought, you know, what if that was something that I had zoomed in on, perhaps I could have seen the signs, or is it the kind of thing where you just needed to sort of live through it and get the experience that comes from that?

Dr. Jessica Jameson (05:42):
I think I probably needed to live through it. I had this sort of like maybe naive trust that, you know, people were, were just sort of good and they wanted me to be part of their practice and that naivete had to away. And that could only go away through some hard knocks, I think. And now, while I still believe that most people are good I trust and verify. It’s probably the best way

Justin (06:06):
To, yeah, absolutely. So when you, when you made this decision, this, you have this mental shift of saying, I don’t have the autonomy and the decision making power in my current role that I want, and I want to start pushing in a new direction. Obviously you’re still going to keep your, you don’t wake up and rage, quit your job. And then, and then try to pick up the pieces. You’re, you’re putting the, you’re laying the groundwork in the meantime. What did that look like for you as you started to take the steps started to look for the resources, find the connections to do what you had set out to do?

Dr. Jessica Jameson (06:35):
Well, that was my biggest challenge was that there just wasn’t a lot out there. There wasn’t a lot out there. And so you really did have to sort of piecemeal all these things together. So, you know, what I did was I spent time with the billing department in the hospital and tried to figure out, you know, they were saying, oh, you’re not making any money and tried to figure out what, what were they doing incorrectly? And I learned a lot about billing that way. I talked to a lot of friends that were in private practice. I talked to some of their you know, CEO’s or practice managers, depending on the situation. And just started asking questions, like questions about contracting, you know, how, how do I get on an insurance contract? How do I get them to contract with me and want to do that, those sorts of things.

Dr. Jessica Jameson (07:17):
And so that process was a good year of sort of spending all of this extra time, trying to find this information. And, and it was extremely frustrating because it, it just seemed to me that, you know, there’s so many people that have done this. Why is there not one central source that says, Hey here’s kind of the step-by-step process would have made it so much easier and really would have made it, I think a decision I would have been able to make a decision on taking that leave a lot sooner. Had I known exactly what was in that in that list of things that needed to happen

Justin (07:47):
As you move through this roughly 12 month period of data gathering and everything, did you find that it intimidated you and perhaps gave you like a gut check moment or did it sort of steal your resolve S T E L T to encourage you to keep thinking like, you know what, I can do this let’s go

Dr. Jessica Jameson (08:06):
Probably it depended on the day. I mean, some days I would look at it and say, oh my gosh, I have three children on the primary breadwinner. I just, is this worth it? Right. And so you’ve got to ask yourself those kinds of hard questions, but then also you’d have to ask yourself the question about, you know, what do I, what do I want my life to look like in 10 years? And is it worth putting in the effort now to get there? And so mostly it just sort of made me say, yeah, yeah, I have to do this. I have to do this. And, and, you know, thankfully being part of a hospital system every day, you go in and, and you’re you realize what your role is there. And you’re sort of a shiny trinket on the shelf as I like to say it. And you always feel expendable. And so that helped me on a day-to-day basis to say, yeah, I don’t want, this is not what I want to be doing for the next 30 some years.

Justin (08:54):
So that makes a lot of sense. I’ve asked them many of these same questions, take it. It’s funny in the financial advisory journey, there’s a lot of similarities where you take the first job and that usually doesn’t work out. And then you take a second job. That’s kind of the opposite end of the spectrum. Cause it’s like a reactionary move. And then you kind of usually end up with the Goldilocks solution somewhere else. You know, older and wiser. That’s absolutely how it has unfolded for me as well. So I want to pivot a little bit now and share kind of what you and I have together been working on in recent days. And this is one of the things that I am so excited about with launching the podcast a couple of years ago, and the people that have been able to meet. I look at you, Dr. Jamison, as someone who’s been, I’ve learned so much from, and it’s been a really exciting journey these last few months to be able to create a place where there, we can shorten the learning curve for people who want to get some of that experience and not beat their head against the wall for 12 months, trying to figure out what is the path. So describe what the practice accelerator is.

Dr. Jessica Jameson (09:56):
Oh, okay. So this is, you know, as I mentioned before, where I was looking in 8 million different places and trying to ask a million different questions of people, I didn’t know, all sorts of places. It, this is sort of the brainchild of that. So this is a unique opportunity, I think for people to say, okay, what does it take for me to start my own practice? What does that look like? What are the important things? What are some of the pitfalls? I think that’s a big thing. Cause you, you don’t know the pitfalls until you’ve, until you’ve committed them, whatever they are many times. And so this course really brings together. I think all aspects of people, management of the insurance side of things, of the business side of things. We do not learn that in medical school, I don’t care what medical school you go to.

Dr. Jessica Jameson (10:38):
If you have an MBA, you may learn some aspects of business, but it’s medicine is a very unique business. And in, in some ways it’s similar to all other businesses, but in some ways it’s very, very different. And so being able to kind of have content that says, here are the steps you need to take. Here are the things to watch out for. And then maybe the most important thing of the course is to have access to, to, to the professionals who have done it and can answer the questions. And if they can’t answer the questions, they can certainly put you in contact with someone who can, and that to me may be the most valuable resource that I would have probably given anything for back when I went to start my practice.

Justin (11:17):
And so this one month course that is going to be launching a beginning of October. Describe a little bit about the format.

Dr. Jessica Jameson (11:25):
So the format consists of you know, it’s broken up into these four different weeks, and then there are kind of bite-sized pieces of information through those weeks in video format. So it’s kind of a lecture series that you can take at your, you know, when you have the time, when you have a few minutes to take, to sort of digest each section, there are some what we would consider pretty impressive deliverables. Things like proformas and financial plans, things where, you know, it’s really, we’re trying to make this kind of a plug and play for people so that you take your information, input it into this and you’ll have what you need to get a bank loan or a line of credit or these sorts of things. And then intersperse fair. There’s what we affectionately term office hours. So those are, you know, the, the question and answer sessions where you can meet up with the course directors. So the three of us who are kind of leading this charge and ask questions and discuss topics that have come up during the week during this process, everybody’s at a little bit different stage when they take the course, I think. And so that kind of levels the playing field and allows people to kind of ask questions that are related to whatever stage of, of the process that they’re in.

Justin (12:33):
One of the things that I appreciated most about the last time we ran one of these courses, that was the, the conversations had amongst the course participants in office hours and having other physicians, sharing their stories, sharing their challenges, and having that be a sort of alive collaborative place where there’s a dialogue happening amongst participants about comparing notes. Here’s what I’m seeing. What are you seeing? What are you doing? And then being able to speak with yourself, myself and Amy Reynolds, who is your practice operations manager. I think that’s one of those like X factor type of dynamics that I, to be honest, when I was working with you to put things together, I couldn’t have foreseen, but really have enjoyed that.

Dr. Jessica Jameson (13:18):
Yeah, no, I completely agree. I think it’s an, I think it’s really invaluable because it feels, it feels very isolating. You know, you’re taking a course and you’re asking questions of the three experts, but there’s something there’s something to be said for having other people who are thinking about doing the same thing, doing the same thing at a different stage. Maybe they’re a little bit ahead. Maybe they can give you some tips on, you know, how they found their office manager, how they found, you know, their front desk person, these sort of just things where it’s just such a great forum for, for learning and for collaboration that I don’t think you get anywhere else.

Justin (13:48):
Talk a little bit about somebody who’s listening to this and thinking, wow, there’s a course. That sounds really interesting. It’s going to help me launch a practice, but I have no idea if I’m ready to do that. It actually sounds terrifying and intimidating. And if I put myself in Dr. Jameson’s shoes where she spent six months talking to all these people, maybe I feel like I might get scared away rather than feeling building momentum. Is this a good fit for someone like that?

Dr. Jessica Jameson (14:10):
Absolutely. You might get scared away and that’s okay. Right. That’s okay. It’s not for everybody, but I think at the same time, you know, if you have the opportunity to, even if you take the course and you go through the entire thing and at the end, you say, ah, this is not for me. I still think you will have answered that question for yourself. And what I would hate to see is people sitting in jobs that are maybe less than ideal for them, just because they’re afraid they can’t do something right. And so if you don’t want to do it, that’s different, but if you’re afraid you can’t do it, or you’re afraid you’re going to get scared away. I still think this course is great for you. We talk a lot about really defining your, why are you doing this right? Cause it’s not easy and it’s not for everyone. And I think once you’ve established, why you really want to do this, what your reasons are. It, it becomes a lot easier to use that as your motivation to continue on during those challenging times.

Justin (14:58):
One of the things that I’ve seen is that, you know, having coming into launching a business or launching a practice and acknowledging it’s going to be a significant challenge, doing that at the outset is really important. Being realistic with yourself about the uphill climb and having a plan, having a plan to get there. And one of the things that I, I think one of the cross sections of the course that I liked best was talking about the different roadmaps. There’s like, we can bootstrap, you know, you can do locums for awhile. You can build slowly and gradually and pay as you go, essentially for the expenses that you’re going to incur on one side of the spectrum, we’ll call that like the extreme spending as little as possible while taking the maximally sort of financially conservative route, which has its pros and cons to the other side, which is you’re just taking from personal savings, a bunch of money that you’ve saved up. And perhaps we’re bringing in a partner and they’re chipping in, and maybe there’s a bank loan and you’re just going to open your doors on day one. That’s a very different approach also. And in terms of marketing and operations, in terms of what it means for your personal finances and your family, you know, you mentioned if you’re a breadwinner and you’ve got a couple of kids there’s real life implications to that. And without understanding, how are we going to get from here to there,

Dr. Jessica Jameson (16:16):
That’s going to

Justin (16:18):
Impact your day to day existence, probably your relationship with your spouse. And there’s a lot to think about. So being able to understand what are the different options in terms of getting from here to there? What I have found is that it can actually lower the hurdles, the mental hurdles, pretty significantly to say, wow, I can, I can still work a day or two a week doing anesthesia or other locums, or I can have other sources of capital that perhaps I didn’t even think about. And in, so doing significantly decrease the risk involved in practice launch,

Dr. Jessica Jameson (16:56):
I completely agree. And, and just back to that risk, I oftentimes tell people, you know, I would, I would much rather take a risk on myself because that to me is a pretty safe bet. Then than to sit in a job where I’m not entirely fulfilled or entirely happy about the way things are going,

Justin (17:14):
I feel absolutely the same way. I know that you are someone who’s been a trusted advisor and counselor to many physicians who have tried to do this in the past. Are there any questions that have commonly come up for you that people have sought your perspective on? You know,

Dr. Jessica Jameson (17:27):
We get, I get a lot of a lot of HR questions because I think that’s a skillset that is again not taught. And so managing people is probably one of the biggest questions I get from, from colleagues kind of who are at various stages of starting practices or eight and in private practice, maybe they’ve been in for quite some time, but that’s a big a big challenge. And, you know, there’s some ways to effectively do that. You know it takes some time it takes them, it takes a messing up like most things do, right. It takes some poor handling of people until you realize, Hmm. I don’t think that was the right way to do it. Right. And so you got to make some mistakes, but that’s probably one of the biggest things I get. I also get a lot of sort of these people who maybe haven’t started the practice and are saying things like, you know, reimbursement’s going down, I don’t want to have to, you know, what are you going to do when reimbursement X, Y, Z, or when this kind of stuff happens.

Dr. Jessica Jameson (18:18):
And I think, you know, the beauty of being in your own practice is that you can pivot really quickly and easily, much quicker than other places can. And I, and I talked about this during the pandemic is that, you know it’s, this is a little dramatic, but it seems that I w th the pandemic kid and within about 24 hours, I had the entire practice launched on telemedicine and all of the front staff calling everyone and saying, we’re going to do this on telemedicine. And here’s how we do it. Versus our local hospital system. It took them weeks, weeks to figure out how to do that. And so that’s significant loss revenue, right? And so just things like that. And I think, you know, reimbursement is going down, but there are some tricks to to the way you grow the business to the way you staff your business, that I think can hedge against that to some degree

Justin (19:05):
Makes a lot of sense. What would you say to somebody who is considering this, but thinking, you know, what the prior auth burden right now, for me as specifically an interventional pain doc, is so onerous the thought of having to do patient care, oversee operations, and then deal with all this back and forth from insurance companies. It feels like it might break me in half. What do you think when you hear someone share something like that?

Dr. Jessica Jameson (19:30):
Well, to me that doesn’t hold a lot of water, because when you’re employed, you’re still dealing with the prior offs. You’re still dealing with the peer it’s, you’re still doing what, those sorts of things. And so no matter where you are, there are ways to sort of ensure that you were documentation meets what’s required. And once you kind of standardize and template that whether you’re employed or not employed it’s the same thing. It’s the same thing. It becomes more and more onerous, but physicians are getting smarter or, or more effective at figuring out what is required to get XYZ approved for their patient. And being able to make their documentation match what is needed in order to make that happen. And so, to me, prior auth has a reason to not open your own practice. It doesn’t make a whole lot of sense.

Justin (20:13):
Somebody is listening and thinking, this sounds amazing. I want to take the next step. What should I do? Where should they go?

Dr. Jessica Jameson (20:20):
I think they should go to our website, which is practice cell.com and right on there, you can you can register for the course and we’ll get you all set up and get everything rocking and rolling, and we’ll be ready to go in no time. Great.

Justin (20:37):
Dr. Jameson, appreciate your time this morning, jumping on before you’re taking your kiddos to swim practice early in am. So it’s been a pleasure speaking with you today. Likewise. Thank you.

Justin (20:49):
I liked what you heard this week. Head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you want to leave a review in iTunes, that also really appreciate it. Thanks for using some of your valuable time to join me today on APM success.