Episode 12: How An Anesthesiologist Carved His Own Career Path From The Beginning w. Dr. Aalap Shah

May 4, 2019


This Episode

You Will Learn

  • Tips for medical entrepreneurship as an early-career physician.
  • Options for building your own clinical schedule.
  • How training in process improvement can bring breadth of perspective in practice consulting.
  • How working with a locums company can fit into the life of a self employed anesthesiologist
  • How to use social media to build brand and credibility

Resources & Links

Show Notes

I talk with Dr. Aalap Shah about how he dives right into entrepreneurship in anesthesia, some of the specialized training he pursued in order to help him add value in practice consulting, how he has managed to build his own schedule with his clinical practice, and his advice for other anesthesiologists interested in following in his footsteps.

Show Transcript

[[the auto-generated transcript was a little rougher than usual for this one 🙂 ]]

Dr. Shah: [00:00:29] This week I have the pleasure of speaking with Dr Aalap Shah. One thing that really jumped out to me about a lot was his entrepreneurial spirit and how he’s exercised that in the field of anesthesia specifically, as he has started a few businesses. He has served as a consultant for practitioners to help them make their practices more efficient. And he’s someone who’s really carved his own path as an anesthesiologist with some unusual nonmedical training when she’s found to be really helpful in his business endeavors. So if you’re interested in entrepreneurship and anesthesia or maybe you’re just looking to use your medical degree to earn some income on the side, you definitely won’t want to miss this episode.

Justin: [00:01:26] Hello, welcome to the anesthesia success podcast. I’m really excited to introduce to you our guest this week, Dr Aalap Shah, a lot as a consultant, processes optimizer, entrepreneur and musician. In addition to being a boarded anesthesiologist in both general and PA pediatric anesthesiology, I first found some of Aalap’s work on Kevin md.com where he wrote a column there and eventually I became familiar with a handful of his other pursuits, both personal and professional, which I’m excited to explore with him today to get some insights into the life of an entrepreneurial anesthesiologist. Thanks a lot for being here a lot.

Dr. Shah: [00:02:00] Awesome. Thank you for having me here today.

Justin: [00:02:03] so I saw on your CV to start out that you were born in Syracuse, New York and that you now reside in West Hollywood, California. So personally, having been to both of those places, I know that there are a few more disparate locales. I’m curious, growing up was, did you always have a vision of getting to the west coast or did that just kind of unfold over time?

Dr. Shah: [00:02:22] You’re actually right since the age of Eight, I’ve always had my sights set on California. I think it was just personal preference. I’ve lived in every state that has cold weather. They have a reference now whether it’s upstate New York, Michigan. I thought it was okay, well maybe it’s time for a change of scenery. I had that at age eight age 18 him along and I was like, okay, so you can get outta here. Ancient 28 came along. I’m like, okay, well, position still still making the way out there. so I think at the ripe age of eight 31 I was able to make my way out to Los Angeles and although there are obviously column was about, you’re living in a city with so much traffic, it’s, it is exactly kind of what, what I expected it to be and I’m really happy, I guess to prime myself and making my way out here, especially for someone who’s not originally from California and that’s pretty difficult, especially in the medical world.

Justin: [00:03:26] Cool. so I’d love to, you’re a man of many interests and proficiencies and I’d love to it why don’t you just give us a couple of minutes and unpack all of your different endeavors both professionally and personally and, and kind of give a three 30,000 foot flyover of your life for our listeners.

Dr. Shah: [00:03:42] Sure. As you mentioned, my path has been any, anything but a straight line. Professionally, my interest in medicine actually grew out of the interest in the human brain. When I was in high school, it was a big reason why I chose my major, a neuroscience major, but I went to college. However, some, even back then I had always had know sign interests, always felt the need to compliment oh my ambition in medicine or what was traditionally thought to basically be a stable career in medicine. And even back then, and I, I had, I was actually DJ back then, and had a lot of interest, you sort of, and having a side business where I can go places and music and make everybody happy. And I remember applying to the Wharton Bachelor’s program to actually be in business and I remember writing about one to have a music business and run that.

Dr. Shah: [00:04:44] It wasn’t, my vision was, and I would say I had no idea what running a business was like back then. It’s not like a much better off today, but I remember I always had slight interest in business or entrepreneurial side interests aside for medicine. I, there was something that I learned to sort of keep some of compressed during my training, but I always continued to play the piano. The cello language is something other musical interest in the side. What Abel throughout my career I throughout my training rather, again as things that I kept on the side and when I went into medical school that was a whole other sort of pivot point where I then had to make a decision about my specialty. And even that decision opened up my eyes into all the other things and skill sets that I can hone and develop as a clinical anesthesiologist.

Dr. Shah: [00:05:38] So then, over the past 10 years, addition to my side interests, I took it on myself with the help of my residency program with the help of my fellowship program to engage in research programs or Richard tragics rather and called an improvement projects to really help studies how things like statistics, outposts, biggest research, oh, collaborative projects with people in all sorts of specialties outside of human medicine. And we know it works together towards the one unified vision of improving patient care. So today, fashion forward, I still have all of these varied, silenced grace. I so at like being a physician, taking care of patients in the wide variety of settings. I like being able to apply my knowledge from working in other fields, in and out of medicine to making my specialty in my personal care for my patients better. I salute, enjoy music, not just for myself, but allowing it to help enhance recovery, enhance our workflow and enhance morale for all of us working with a lot of hours in the operating room. And so that’s, with all that being said, I feel like rapid, all that under one umbrella is kind of my life and my life story and the way I envision so of my career going on everything hand in hand in hand.

Justin: [00:07:05] Yeah, that makes sense. So I’m curious, did you choose anesthesia with an eye towards self employment and towards sort of this multidisciplinary approach to medicine and to life? Or did that kind of open up to you afterwards? After you’d made that decision.

Dr. Shah: [00:07:18] It was someone afterwards in medicine, in medical school rather, like trend during the time where people were still very traditionally focused and having air going through a residency program immediately after. and I still think that’s very important. we spend a lot of money, we go through this training so that we, this is really the only way we can get, clinically certified and we see all this. The only time we get our clinical training is so I think it’s really important for people to go and learn the skills of being a doctor. I think it’s very important. That’s what’s sad. I felt as being different from another profession or we actually had to go and hone our skills, the combination of our critical thinking and procedural skills. So I still think it’s very important and to do that.

Dr. Shah: [00:08:04] However, my eyes were really set on busy doing something different, not just simply going and providing as Asia and a seven to three or nine to five model, but really, in a way that I’m continuously engaging and pushing the field forward in my own eyes and really pushing myself to learn about the business side of medicine, which I agree with you is not taught in medical school at all. So although you receive a lot of clinical training, we don’t receive any training about, insurance companies, the issues with dealing commercially, even within an academic setting, the issues with billing. Why is important to have a civilian billing company looks at your procedure and diagnosis codes and the importance of having a company as such that you don’t have, issues double billing practices, surprise billing, but you more so about, the world of how, physicians and a billing company to negotiate to each other, how billing company and patient insurance companies negotiated with each other.

Dr. Shah: [00:09:10] But how that plays into a group practice where then they make all that simplify for you and they pay you out at a certain unit of value, a certain salary. And so, in coming into medicine, everyone just thinks that they’re blindly handed a paycheck and we, for better or worse or tactics or human cells a blinded or in the dark about, where this money’s actually coming from. But in California it’s, we all, especially in procedural heavy specialties like anesthesia of surgery, we are encouraged, if not required to form individual corporations for both tax and liability purposes. And just by doing that, we’d start learning about what the difference of being an independent physician or being your own corporation, where you pay yourself and it’s like, and how that’s different from a traditional salary position or even a traditional position in a university setting where again, you have your wt, you have a paycheck, even have benefits. But then again, you don’t see the, what happens behind closed doors issues, insurance companies and the negotiation discussions that are had at a much higher level. Right. I feel like everyone, even if you go into academic medicine, you should know about that.

Justin: [00:10:28] Yes, totally agree. And that is why this podcast exists to break down this huge informational asymmetry that exists between the people in the, the, the top of the insurance building and the people with the boots on the ground and the ors. So, so in that context, briefly maybe describe your current clinical practice and your current consulting practice and then I want to dive into what it means to be a self employed physician.

Dr. Shah: [00:10:54] Exactly. So my actually under how being a self employed physician, I allow myself both my clinical activities as well as time for consulting activities. But really everything is a contracted opportunity or a Gig and that’s how I collected that I pay myself a salary out of, everything that I get from all of my clinical emphasis health and get. That being said, it does allow me the, a little bit of flexibility in terms of the schedule of what I do on any given day. And I usually do it week to week. For example, Mondays and Wednesdays I tend to work at some of the community nonteaching hospitals in the East Los Angeles area. where I provide both or clinical or services for general surgery and pediatric and surgeries. This includes general surgery. Abdominal surgery is urology, outpatient procedures such as gastroenterology, colonoscopy, endoscopy, and Wednesdays, even some Fridays we do, I do ob anesthesia, no, I’m in a labor and delivering in it.

Dr. Shah: [00:12:04] and we do procedures to help laboring females, with their pain as they’re about to have the most wonderful thing happened to them in life and have the baby. And other days, I’m Tuesdays specifically, I have a mobile anesthesia unit and I actually go out in the community even more so in the rural areas to dental offices. And we provide general anesthesia for children, many with special needs who need full dental restorations, a lot of tooth extractions procedures that you can’t be done, under, simple local anesthetic or even nitros oxide. and with pediatric patients, which allows me to use my fellowship in pediatrics on Thursdays and Fridays is usually a mix of either or services, maybe, some consulting, which I’ll get back into a second here. And some work at surgery centers where I provide, again more clinical services but in a very outpatient setting and through my billing group directly, which again, bills in a different way.

Dr. Shah: [00:13:14] And so the consulting is consulting is a very broad term. I usually give myself Thursdays and Friday sometime for that. Consulting can range anywhere from writing and public speaking. And when we actually go a year, right, is a certain blog articles very similar to the one that you saw Kevin MD, writing blog articles is a good way for companies and physicians a light to increase their SEO and really increase a freshness to lever you’re trying to do from both their personal and professional websites. Consulting also includes things that sitting down with the c suite people or leaders, nursing managers at surgery centers or hospitals alike. And seeing how we can improve care, whether it’s increasing the efficiency or productivity of the physicians, improving the scheduling and other words in Chris and again, the efficiency, decreasing waste, improving, the ordering of products and improving Jayco site redness, Jayco stands for it and joint commission accredited health organizations instantly decreasing the fines, loving against certain, centers of basically because they’re not up to par what certain the safety guidelines or clinical guidelines.

Dr. Shah: [00:14:31] It also involves working with the device companies or an industry or an industry. People will try to connect with the healthcare arenas and book the academics and to help them vet their products, and see which things are cost effective and can be incorporated. And the hospital, basically a hospital, it was imagining like an assembly line, what they’re going to bring in and what they’re going to into this, into the clinical workflow. And that’s a big issue, especially in this day and age where, there’s lots of buzzwords or innovation and medicine technology, but there’s a very poor means rather of incorporating them into the workflows of huge institutions in a way that’s cost effective in a way that everyone can adopt it. Would I just get them throughout? And that’s, that’s a huge issue because there’s a lot of technology out there that people will bring in and then they get, you’re basically done in a half ounce manner and it’s huge cost to the institution and rubs the CEO’s of these different hospitals the wrong way when something is introduced in the carry girl the entire way. And so, that’s where I feel there’s a little window for us to step in and help the adoption of these practices and products and the way that we should be beneficial to everybody.

Justin: [00:15:54] Yeah, that makes sense. And I know that in that vein that you have some specialized training, namely Lien l e a n and six sigma, which were a couple of buzzwords that from my undergrad days and managerial accounting was hearkening me back to Villanova. And, these are certifications more commonly associated with production, manufacturing and quality. In that vein. I hadn’t actually heard of it before in the medical world. I don’t know. Is that a, is that a common thing? Maybe talk a little bit about how you came to acquire those and why you had an interest there.

Dr. Shah: [00:16:23] So it’s not a common thing. And I can tell you that because it’s one of my research, one of our research papers that our institution, University of Washington we produced, we looked at, the research studies, which uses lean and six sigma, which is another traditional, quality improvement process improvement curriculum. and you’re right. And these things were actually born out of engineering and manufacturing enterprise out of very, very different systems. but at the time of us doing this project, we realized that there are only, maybe you’re 60 or 70 research papers that actually talk about lean and 600 practices in the healthcare arena. This is especially important because of number one, most importantly, reimbursement practices regardless of insurance type or a surgery or procedure type or whatever reason, the patients in the hospital, we’re enriching practices are starting to follow a patient outcomes and patient outcomes.

Dr. Shah: [00:17:27] A very closely tied to process improvement, quality improvement measures in the hospital. And when we talk about that in a hospital, we’re talking about things to improve patient safety or decrease the cost associated with each patient’s care. These are extremely important things because in this day and age, the US healthcare system is like the most expensive out and we have pretty average outcomes. We obviously know that right away just by any definition that quality is pretty mediocre. So my interest, in that was actually came from just being an anesthesiologist and working with different surgical subspecialties and seeing how, two different surgeons, even in one of the surgical subspecialty that have dressed the different results that did the same surgery and different times. And our patient could be in a hospital for two days from one surgeon to know four days for another.

Dr. Shah: [00:18:22] Each of those days is associated with a certain dollar value to both the patient and the hospital. Right. Along those lines, we obviously, I’m not the only one who realizes there’s a huge importance and emphasis and quality improvement. We received mandatory, not quality and Tricolor, both through our anesthesiology residency program as well as through our house staff quality of safety committee, which hosts their own auditing proven curriculum for residents and fellow trainees who are interested in picking up or doing some kind of quality improvement project or under institution. Like I said, this has actually become a, a requirement by the ECG me, the American council of Graduate Medical Education. And so out of the traditional curriculum is lodge in the curriculum. My own observations and experiences as a clinical anesthesiologist. And then taking my interest in research and realizing that a lot of the same testicle methods or apply methods and research to be using quality improvement. that’s where I realized that I could really dig out a niche. And I started doing that in a residency or started doing outcomes based versus projects and even small scale quality improvement projects where you make a small test of change and you see the results before or after that controlling for kind of phone and variables. And I realized there’s a huge demand for those kinds of projects. Planning a research is the way I see it. That’s what I’ve got mean to the quality and preliminary though.

Justin: [00:19:58] Yeah. Interesting. So I’d imagine there’s probably a lot of people listening to this who think it’s, a lot. You haven’t, it’s not like you’re a, a 63 year old has been doing this for decades. You, you’ve jumped very quickly from academics, doing a couple of fellowships and then throwing yourself into self employment and consulting and other things very quickly. So maybe you could share a little bit about specifically how that journey happened transitioning from academics and then what are some things that somebody who is interested in that and this sort of entrepreneurial professional existence, what might somebody want to keep in mind if they, if they want to mirror your progress there.

Dr. Shah: [00:20:33] So I’m definitely going to say first things first when Carlis of your, your track or your ambitions as a medical student. And I will definitely emphasize that it is very important to, clinically positioning yourself as a doctor and then you

Speaker 4: 00:20:48 just receive it. You spent, now there’s about 300 or $400,000 and an education that you, so you do clinically practiced medicine. Then it’s something that’s special that no one else can really mesh with. unless you’re going to medical school you can do that. It’s, and so I still tell everybody that first and foremost that you are a doctor. They went to medical school, you can go to a residency training. This is really the only window of time where you can really get the clinical pearls because it gets harder to do to get those skills. We have continuing medical education where I would see pay even more money to make sure you maintain the centrals in your board certification. and he will never receive the same clinical training as you’re doing a residency. So first things first is I, I do think that the first question you have is do you really want to be a clinically practicing doctor?

Speaker 4: 00:21:39 And if so, I do encourage everyone to go through and do the residency program. And it was out of my own residency program where I learned to start balancing, things even personal lifestyle, going to the gym, making time for yourself, music in my case. and then it allows you to sort of figure out what other things can you do to compliment your career, your medical career. If you can do it in a residency when you’re definitely crunched for time, you have a higher chance for success going out as an attending physician. Now for those who are in residency who are looking to now your career, not a question is what can I do to really enhance and orange book career. And that’s where I can say that, okay, well I do agree that having, you need to have a clinical balance where you see patients, we need to see patients that are weak.

Speaker 4: 00:22:33 But I do agree that by, you need to figure out some kind of independent schedule or something even within the realm of your academic title or even within your group practice that so that you’re not doing the same thing day in, day out. And the top of that I’m approaching here is something called burnout. Burnout is a very difficult topic because it’s a term that’s applied almost overly, too much. Every time you see a physician having an issue you’re like, is that physicians are burned up? No, they’re pissed off of the system. They see it, areas for change, they’re not burned up. But then there are physicians who are actually burned up. unfortunately there that is an issue and those are the people who are going in vain. They are the people who aren’t necessarily listened to by their group leaders or whether hospitals, people who really do want to work hard and are this emotion and carried away sometimes by not feeling that they don’t have a voice feeling that they are simply there to push your buttons or an a push syringes.

Speaker 4: 00:23:37 And I was talking about how I felt very my first year as a clinical anesthesiologist and I feel that a majority of actually feel the same way. I do think a lot of people come out and they have families already and obviously your priorities are to provide for their family. So it’s a lot, it’s a little bit easier for them to quote unquote keep your heads down and do their work and just do what it takes to keep a stable practice. But I do think more and more so, especially with the newer generations in medicine, we’re realizing that money is not the only thing. We’re looking for room to grow and we’re looking for roof. Realizing there’s other things that are incorporated into job satisfaction and the money is not even not even the main thing that contributes to it. So I mean there’s lots of studies out there now through the Ama.

Speaker 4: 00:24:26 There are always other American medical associates. Even if there are other organizations showing that people really are looking for room to grow, you’re looking for in a position to be directors, to be in charge recurring services, to be in quality improvement committees, to be involved in industry. There is even more of a push enough for academic universities, academic institutions to partner up with industry so that people are exposed about, and even in medical school and we look at Stanford sold medicine, if that about 30 to 40% of people even more and looking for hybrid training after medical school where they don’t go through a traditional residency. It, those were schools I biodesign or just working with startup companies and working for big consulting firms. So people are realizing that there’s a lot of additional skill sets that they can pick up while or in before her residency. So there’s a lot out there.

Justin: [00:25:25] Yeah. So for, for your journey when, when was it, just for our listeners who can get a little clarity on the timeline here, when did you conclude your, your final, I know you did a fellowship or maybe two after residency. One was that, and then what, what did it look like to, you mentioned like incorporation, thinking about liability and then getting a couple of days a week Gig at a hospital, a plus, some consultant. There’s like, there’s a lot of different things that it seems like it, it required a lot of initiative on your part in order to set in place. How did that, how did that transpire?

Speaker 4: 00:25:53 Sure. So I can go over a limited the, the the realm, the relevant timeline here. I finished your medical school back in 2011. I did actually year of research within medical slave in the form of residency training to really pick up some of the research skills that I still use to this day. I did my actual residency training in University of Washington, Seattle 2011, 2015. That includes the year of internship. For me it was a mixed medical surgery and can ship and then three years of anesthesia training, finishing 2015 I did a year of clinical training as a pediatric anesthesiologist fellow in Boston, followed by about six months of a research fellowship slash certificate, a little position that had made within the department sort of as applied research slash innovation fellow within the department where I was doing some more research, but also I’m working on things innovations such as a smartphone application or prototype.

Speaker 4: 00:26:55 After that, I came out to my first clinical attending job at cedars at the group practice in 2016 I did a full full year there. It was only then in middle or end of 2017 where I decided to really fully become more of an independent physician. However, I was independently set up before that are at cedars as an escort. And like I said earlier in the interview, we are almost recommended if not required to make the only call a medical corporation here in California, which has both financial benefits as a tax pastor in many ways as well as a liability protection, not gonna want to hear about over and above your current malpractice coverage if something was to happen. there is protection against your personal assets are filed as an independent corporation. So it was actually just by making myself an independent corporation where I started learning about Mrs [inaudible], I when I, someone told me to go and pay $2,000 to incorporate, I was so excited about that.

Speaker 4: 00:28:07 But then when I realized how easy it was to do yourself and probably lead to the few hundred dollars when I did it the second time around from my Mobile Med spa company, I was like, wow, I kind of saved a lot of money here and everything along the lines, getting an accountant and being in charge of your own finances, your own deductible spreadsheets, keeping a charity of your own cases. And I started doing that. I’ll born out of my first approval practice. Those are good skillsets. Cause when I went and started doing more work with surgery centers and eventually working with the dental anesthesia clinics, dental clinics rather, and other groups in the La area, and I saw people started doing things with slight nuances, I realized that I needed to keep my current with my spreadsheets. I’m a huge lover. Spreadsheets by the way. and huge, organization skills and all the tenants would attempt to run well s carb and basically take care of all my benefits.

Speaker 4: 00:29:07 Like I said, as an independent physician, we have to provide for all of our own benefits. We create her own retirement plan we pay for on a practice. So we get sound. Some of the things that are actually downside because we didn’t have to cover them yourself. The upsides though are that a lot of these things are deductible expenses. So although these things in an academic setting and maybe covered by the group or by the university as an independent physician, you take care of them and yourself, but these are deductible expenses. Right. in addition to that, there’s things like, obviously your health vision, your disability insurance premiums. Yeah. A lot of a lot of expenses

Justin: [00:29:46] settle into it. Yeah. Yeah, that makes sense. And that’s something that I’ve encouraged a physicians with whom I speak clients and others, if you’re looking at private practice job or something more on the self employment, self funding benefits side versus something in an academic center, the benefits in an academic setting are often so valuable that you don’t appropriately account for the, the differential. There’s obviously this assumption that well, private practice you make a lot academics, you’re taking a haircut on compensation. Not always true necessarily to the extent that you presume once you account for benefits and what you pay on the self employment side or the private practice side to, to gross that up appropriately there. It does tend to squeeze that margin a little bit. But I’m curious, so you had this job at cedars and then you eventually, you’re, you’re right now in this situation where you’re a couple of days a week at a hospital ASC and doing these other things. How did that, how did that transition happen?

Speaker 4: 00:30:42 So, after cedars sure, we get the surgery center and the work isn’t as regular. And one of the biggest things of being an independent physician, especially in anesthesiologist where you’re trying to make your own schedule is that there’s some days where it rains and you’ve got lots of work and lots of pieces. There’s some days where I’m able to pick up two different games within the same day and really almost serving away, double up an income. but there was some days where the cases cancel or it’s very, very slowed. It, you’re sort of geared up for a full day and you’re there in the hospital waiting around and calm and you only do a few cases and so you realize that you just based on your pay structure, you know we were being paid per case reimbursed. You know the case that when you start having to look for a different gigs were on looking at the lucrative gigs or being able to know work in different settings where even over the course of a day you can line up different cases and different locations so that you can make some kind of average income for yourself.

Speaker 4: 00:31:46 But you have to be really on top of it for yourself. Cause you can go a month where you make only a fraction of what you would make the next month just because it was a slower month in the wintertime or the surgeon is on vacation and they’re not scheduling cases. Anesthesia has a very special sort of, especially because you’re in a way following the surgeons. We’re working as a general anesthesiologist is falling down of the surgeons and the surgeons that operating, you’re not there either. And so you’d have to really diversify your skillset and make yourself available and a lot of,

Justin: [00:32:19] so is your compensation in that context tied to like RV use per procedure?

Speaker 4: 00:32:24 So and when it comes down to, I mean at the end of the day that is the end part of the equation is building in relative value units for the listener for especially procedure have you specialties procedures are given a unit value based on the complexity of the procedure as well as a unit value for the duration of the procedure. And a specific modifier is things that make, for example, the patient more complicated procedure, more complicated where you have to put in additional lines or monitors or special medications. We learn about our, we use more so in the realm of a being as part of a group practice where you realized or even in independent practice where you know that each procedure is associated with number of units, the group who actually bill out a certain number of units that are billing company and they will compensate you at a dollar value called a relative value unit.

Speaker 4: 00:33:23 And so for the most part, as a practitioner, especially as someone just joining a group, you will only know what you’re being paid out as in terms of the relative value. That doesn’t mean that’s not actually the value unit groups sees what the group administrators and leaders actually pay themselves. or what the insurance companies are actually willing to actually pay out for us. When you’re dealing with more commercial insurances in the surgical center setting, in a way there’s an extra benefit to that because as a physician you don’t want to be changing or trying to cherry pick your patients based on insurances saying that, oh my patient has a PPO insurance. I’m going to try to be more of those cases. That’s what should not be done. and I, I’ve seen a lot of that happened in the surgery center world where, people try to take the Cadillac insurance patients for themselves, they’ll screen them ahead of time and they’ll push for those cases, especially when there’s a reason to them being counseled.

Speaker 4: 00:34:23 So right away, coming into as well as how a lot of red flags where people engage in dangerous practices by not blend sells insurance company. At the same time you realize that there is, a financial benefit. We have a practice which has lots of Medicare medic health patients, there’s pays a much lower value unit and then you see groups trying to struggle to put together a practice or work at a couple hospitals settings that have a good pair mix. In other words, not just medicare medic health patients who are in dire need of medical services, but also your PPO insurance patients that make it group viable to actually help, bring the hospital to somewhat of a profit. and so that was a lot of what I learned or the second year after the cedars and then learn about any of that during my first group practice cause we were paying a dollar value per hour it half never pay a set dollar value per unit. So each subsequent year I’m learning more and more about the billing practices. But to answer your question, yes it really comes down to the relative value unit, what the group is able to bill out at and then collect versus what they’re able to actually pay you out at as an anesthesiologist.

Justin: [00:35:42] I’m curious in that, in this time, did you ever consider working with a locums company or were you always thinking I want to stand on my own two feet and bargain for myself and looking at a job with a community hospital for example.

Speaker 4: 00:35:53 So it’s locums, there’s, there’s, there’s obviously it’s a whole different discussion but I did set up and I am actually still signed up with Lopers companies. Okay. Locos companies other onwards for the listener, locum tenens companies or companies that are out there to help find people, either temporary her DM or even permanent placement or permanent jobs and they connect them with hospitals, surgery centers, groups. I’m all over the United States now. There’s obviously a big pusher look was companies, they definitely 10% on a lot of email recruiting emails, especially for gangs. an areas to have sometimes trouble with getting physicians to come out from there. Especially in rural areas. The states where there’s a general need for physicians. Yeah, no. I have actually, I still continued to work with lupus companies to find the occasional per diem or sporadic jobs. They need coverage and a surgery center.

Speaker 4: 00:36:53 Sometimes I always keep my eyes out there for a dream program placement job. It has everything I can tell you, over the past two years with over thousand emails, I have still having a thought green permanent placement job. I’m always looking, I’m always, comparing the traditional permanent job up there too. What I have right now and it’s hard because right now I don’t have to take any call and it’s are the sort of leverage, what is other groups the other local groups are actually putting out there. Yeah. But at the same time they do help find some pretty cool and once in a lifetime. Once in a blue moon for cakes. Yeah. Even consulting things even you know things where you go in place lines for device company I did didn’t help with finding one of the groups that I send up with do ob anesthesia with which I was able to get a few days a week with that group.

Speaker 4: 00:37:49 We’re a locums company. Okay. None of the things with the locals companies that if you’re a private practice group or a hospital, usually pay look was company and a good amount of money for both the hiring as well as successful placement of the anesthesiologist within your group setting. And there’s a lot of startup companies, right, are out there that try to help this process happen in a more timely fashion and a better cost to the hospital or the surgery centers. Yeah. But either way, to answer your question, I think there is some benefit to having a local group, especially if you don’t have a permanent job yet or you’re trying to create your own schedule and you’re looking for something every now and then. I can tell you every now and then I get a cool locums, email about something in like Aruba or something like the Virgin Islands and I send those to my colleagues, especially those who are finishing residency who are looking for temporary gig. Yeah. and who are looking for something fun and non committal, especially in the beginning. Yeah.

Justin: [00:38:51] So cool. Yeah. I’ll have to tell my wife to check out a rube, but before we sell it. So with the community hospital role that you’re doing now on Monday, Wednesday, that is, it sounds like that’s on nine locums thing, is that right?

Speaker 4: 00:39:04 that’s correct that that was through a group that is Hannah found each other through gasworks stuff. Com. Okay. That was one of those job finder websites. But yeah, the same. They’re actually, I believe disappeared. I reached out to even before I finished my residency. And Fellowship training. Okay. Yeah. And even then when I came here, I didn’t actually, I interviewed with them and the, and then join them right away. And then the year after I joined them only on part time basis. So it was one of those things where it was called because I didn’t feel that I had to commit myself full time so I can work with them part time and then set my schedule for doing some other things at the dental anesthesia work and Tuesdays and again to give myself the flexibility of doing multiple things and only, yeah.

Justin: [00:39:51] Yeah, that makes sense. So if there’s somebody out there who’s name is these resident or maybe a fellow who’s thinking, I loved the way that a lab has created this power of self determination for himself and he has a Monday and a Wednesday thing that’s different in a Tuesday thing that’s different. And Thursday, Friday is something else. And really liking the sound of that very diverse, lifestyle while still earning a great income. What would you say, how would you encourage someone to, take the first step towards being able to have that, that autonomy?

Speaker 4: 00:40:21 Yes. so again, the first step is first and foremost is don’t sacrifice your clinical training. if you’re ever a type person in medical school or in residency, I definitely encourage it to take full whole of your clinical in medical education. that being said, I encourage those in, in residency programs to seek out a rotation if it’s available. We do spend some time working with a group or a private practice, that is closely associated or friendly rather, with your residency program. For example, in my residency program, I don’t even have this anymore. They had a rotation where they have spent a residence up to Spokane eastern Washington for a few weeks and they actually got to work in a private practice and work with the schedulers over there and they’ve got to sort of see what the workflow is like in a private setting.

Speaker 4: 00:41:16 In addition to that, I think social media has actually helped quite a bit with encouraging people to connect and network with like minded people even before people have finished medical school or residency. Like Instagram really wasn’t that big one. I a resident I don’t want is this medical school but I’ve learned a lot from Instagram. and I’ve connected with people all over the country, even in my own specialty where we, when we can like work to get her through her around ideas, talk about major hot topics that are affecting doctors overall. so what I’m going to do is start networking and networking out of your own residency program while you’re in residency. Again, on Instagram, get on Twitter has people in the academicians are starting to communicate a much better on that interview or in research or you don’t want to do independent consulting work, but you want to do research in the side.

Speaker 4: 00:42:13 You wanted to call any criminal work. People are engaging more on Twitter than they are on open access to those which are journalists that allow you access to the cutting edge research as and when it’s published. People are doing that in a better job of that on Twitter and Instagram. So get on there and start networking with colleagues that are above at or below your rate and you can restore your first job because you may even find different job or Instagram. I’ll be honest with you. it sounds absolutely crazy to me. That’s so crazy. But dividing people that are, have great practices that are looking to join practices that are, are coming in with the same leg mine. They’re not coming in just a minute, a dollar you’re coming in because they’re like, oh, we really liked the fact that you’re doing this stuff for patient safety.

Speaker 4: 00:43:03 We’re looking to work along with them, partner with people that can really enhance a Qio program or do this for us or that can do regional nerve blocks. And so I’m like, you can never really find this in a traditional website. And this day and age, a group practice, it’s word of mouth is still the best way to find that presidents. But now in age, people want to know that you’re not just someone who’s be pushing propafol. Yeah, well they want to see what helps you to switch, to distinguish yourself, how you communicate yourself, not just in a hospital, in the clinical norms but professionally over social media. So that’s the second thing I tell people is this, again, engage in network over social media. The third thing is learn about the business side of medicine. Force yourself to do it.

Speaker 4: 00:43:52 Take a Webinar, half the people just like yourself, Justin. I mean there’s, like go to the seminars. and I know my, I do in full transparency. I work along with the financial advisor and I have been working with one since I even finished residency and it’s been a great experience cause it’s been a lot of teaching. from the get go it makes but super personal finances, let alone the finances for running your own independent corporation led one, running a side business. I’ve learned about insurance company and learn about the insurance companies in the area where you want to practice for those who are what of the law and do you do private practice and eventually you want to do that a one to work with a group or as their own practitioner. Again, learn about different billing nerves, start talking to them.

Speaker 4: 00:44:47 you don’t have to commit to them and learn about what their practices are with preauthorization. Learn about within the ability she tactics are how aggressive they are with different kinds of insurance companies, how successful they are, the rates they charge for, doing the billing for you, how been sadly the air with coding and not just current putting practices but it anticipated coding practices as medicine and telemedicine continue to evolve. These are all very high yield things that people don’t really even think about even several years into practice. But if you start thinking about that, you’ll start and you’ll have a better way of communicating with your actual billing group and your actual group once you get onto the practice or reading or just east of getting it. And getting the Internet. I started reading about this things and talk to people that are already established out there.

Speaker 4: 00:45:42 but it has to be done hand in hand with your clinical training and she never sacrifice, going to the hospital or trying to, take extra time off just to do that. It has to be done hand in hand. And that’s tricky because we have a lot of things to balance. You’re getting balanced that in a residency that is a sure fire way of succeeding with a good balance when you’re done with your training. Yeah, that makes sense. And if somebody says, I think that sounds great, I’d love to learn more about these different things, but I don’t even know where to begin. Do you have any sources that you might recommend out there on the interwebs that, that we could throw in the show notes here? Sure. I mean, I always love to make myself available as a resource, as someone who’s not there that I think, a lot.

Speaker 4: 00:46:25 a lot of the inflammation can, it’s just really, right. So asking people within your own specialty or really out there who are established. I think talking to your residency program director usually has, knows about you the best and knows about your, the way you learned the best can be a bit of research for you, but they didn’t connect with the people even within your academic if tuition that you can talk to. but really going out there looking for you can do, you can do courses. There’s certain coursework, sorry. So for example, the American Society of anesthesiologist, they have an entire practice management, consortium, sub society that meets annually. encourage people to be involved in things like that. People will also learn about some of these things. There are some of their political action committees and each, especially has that associated with that or your state medical societies.

Speaker 4: 00:47:27 And those are good ways to network with people in your specialty who are looking out for the greater good or the specialty. And I would see a lot of that deals with the business side of medicine or this side of that specific expression. So those are good initial resources to look out to. Really you want to find, someone mentioned it is a good mentor. it’s very hard to find a good mentor. It’s really different. One is you’ll realize is with net for themselves and not going to tell you every single one of your billing practices because in a way it’s all proprietary. We’ll have to make the income somehow, but you send people to start talking to him. They’ll start leaning in the right way and just keep your eyes open, ears open, digests much as possible and realize that no matter what you’re going to make a few mistakes and lung barriers is not going to be perfect after yet though. And realizing that regardless of any of the resources that I mentioned to you, the biggest person you’re gonna learn from it as yourself. Right? You have to go through the experience, you have to try, you have to fail, in order to learn what it takes. Okay, great.

Justin: [00:48:32] Great. So I know, you, you talked about social media and the importance of networking and I would imagine for the self employed physician, the value of having your own brand can be really important. And I know you’ve got a lob shot, md.com, the domain that you’ve got all of your different sort of business ventures there, you’ve got Linkedin, you’ve got Instagram, you’ve got, you’re probably on Twitter I’d imagine. And all these other things. Describe kind of the importance of that for the self employed physician and any tips or tricks you might have learned or landmines to not step on that would be helpful to know for our listeners, but also for me,

Dr. Shah: [00:49:06] so that’s something that, I’m not going to pretend to be an expert on. I think I’m still learning the game. I came to Instagram, I had a personal account I created a few years ago. but my physician account was, it really, everything that came with social media thereafter list really over the past year. Again, it was something that I didn’t realize that I could bridge medicine. but, in terms of building a brand, I realized that obviously social media is definitely the way to do that. So for me, what really got me into social media, I guess the way you said it is that you definitely want to have an account. You want to figure out who your targeted followers are, who your targeted audiences. But then for me specifically, it was like, what is my major pain point and what is something that’s unique to all of the things that I’m doing that I can tie together?

Dr. Shah: [00:50:06] And that is the point that I want to sell all of these different things to different gigs. I’m just writing things that I’m doing are all secondary. The main message down was kind of via crops and what the main message is, is being independent almost in a way. Almost like being a rebel to the system, you know? so building a branch or came out of my painful, it’s like what was really the main thing that motivated me to go away from a traditional path in medicine, private practice or an academic setting. So, then an Instagram really I don’t have much experience with Twitter. I’m just starting to use Twitter. I don’t have, don’t have much of a crowd there. But I wouldn’t think the biggest thing for ’em, I mean successful branding yourself is again, the pain point and figuring out how to connect with your targeted followers on her Instagram such that they can learn about and really feel your pain point.

Dr. Shah: [00:51:12] so I like social media, because it does allow you to brand yourself in different ways. For me, number one, it allows me to focus on medical education. It allows me to focus on a residents that are going through the process and realizing that there are so many people and as so much ain’t out there for even completing residency. And I have so many questions out there. And so I have a column that just serves to mode, motivates a residents and medical students and talking about, some of the issues about sort of being held down by a traditionals system. So approaching the idea of burnout and the loss of individuality in medicine. the second thing is innovation. I think every physician should be or should be involved with innovation. It doesn’t mean you have to come up with some crazy medical device.

Dr. Shah: [00:52:09] It just means that you have to be, at least, apprised of, good evidence based techniques other than that get improve something in your community, the hospital, whether it’s southern to decrease incidence of an infection, decrease your patient’s length of stay. And so using social media to talk about those things and show those things, and engage discussion, whether it be over your Instagram feed or your story or whether it be even over a Twitter post. And the third thing is really just show yourself as a doctor because the end of the day people are looking up to you at the end of the day. People still have a lot of respect for medicine, which is great cause it’s, mess has gone girl, a lot of rough patches in this country. And so people want to see that you continue to provide medical services that you work with patients, that you’re a compassionate individual.

Dr. Shah: [00:53:08] And so you want to be able to, first of all, more importantly, you want to be able to show that by being genuine. You want him to do that in your everyday practices. you don’t want to be artificial, you don’t want to come across as being artificial and social media. And I think a lot of people, I don’t, Instagram is notorious for people trying to go out there and like look great. And that’s what gets the most likes and most interaction. And so my biggest tip for you is sort of figuring out how you can use some of these things on social media, some of these more superficial qualities and bridge them with the organic genuine things that you’re doing, your own pain points, and then display it on social media in a way that allows you to tell your story, without being too aggressive or I was too showy or I’m a senior violating anything that shouldn’t be violated on social media.

Dr. Shah: [00:54:02] And so that’s the fine line that everyone has to, should have to tick. I take that approach. so the three tiered approach because I bet three columns and Instagram and I’ve really used Instagram and use that medium as a way of showcasing everything that I’ve been trying to do, but everyone should have and does have a different way of showcasing their talents and their pretty points and social media. I’m just showcasing one way of doing it. But coming in with an organized approach you’d taken care of. If you’re doing, don’t get to do a lot of social media posts, how to create your content ahead of time and try to time it and always, keeping everything scratch. I always have like a memo pad, whether it be an audio thing and my phone, a memo pad near the shower or near the bed where I can, write down my ideas very quickly.

Dr. Shah: [00:54:56] and then either convert them to an article, to a post, talk to my SEO company and search engine optimization company or a photographer about putting together a photo shoot and related to that cause together and then publicizing on the web, whether it be opposed but of your writing Gig, whether it be a blog post, something on website. so those are the things that I think are important when it comes to branding yourself. figuring out your social media algorithm, having a website as a landing page for any of your social media, outlets. and in planning out all your social media posts ahead of time such that you’re not like struggling or desperate to try to put a post together. so those are some of the things. Again, I’m learning a lot of this myself currently. and I think as a physician, I think, taking a good, simple approach like when I’ve talked about is a good way to just getting started off. realizing that everyone’s got their own individual flavor. He had to figure out what it is for yourself. And then you have to put them in the spotlight.

Justin: [00:56:02] Yup. It makes perfect sense. cool. So I want to ask you one last question a lot and I very much appreciate your time today. so as a physician and an entrepreneur, your, your path has been very demanding, requiring a lot of sacrifice. So I’d love to hear a brief story or anecdote reflecting on a proud moment of yours when you thought all the time that I put

Dr. Shah: [00:56:24] in all the long hours and late nights and call shifts. It’s all worthwhile because of today’s work. Sure. so let’s see. Okay, I can think of, all right. So my experience last year, last May, when I was at one of these community hospitals, like I said, well I wouldn’t, my biggest issues is I’m trying to improve the quality of care that is delivered in non hospital type settings. and basically last year, I had a case where I was, doing or providing anesthesia for a c section. again, she’s such an is the kin for laboring females about to have a baby who have some kind of contra indication or having a problem with a normal vaginal delivery of their baby. And so this patient has propped originally just the operating room, given whatever kind of anesthesia is needed urgently to make them comfortable so that they can deliver the baby without harm to the baby or in a month.

Dr. Shah: [00:57:32] And so this was happening pretty urgently because there was a problem with the laboring moms. I’m uterus. so a c section was done and when the baby came out, the baby’s heart was not beating and the baby was blue and was not breathing. and although this is not uncommon, within the first couple of seconds to baby was not making any moments of breath and their heart had completely stopped. And this is really trying because in this specific community hospital, there’s no pediatric ICU, whereas no inhouse pediatrician even. And so everyone was panicking. I’m trained in pediatric anesthesiology. So as soon as the baby was born, I called my colleagues to come take care of mom and I went to take care of the baby with the rest of the other ICU team and everyone else with rushed him to the operating room.

Dr. Shah: [00:58:27] But it was really, really scary because, I’m dealing with, babies whose heart wasn’t beating. we started doing CPR and it was, I just remember some of all, everything that kind of learned, kind of just felt like a snap into action, dealing with the airway, putting in er urgent lie as an umbilical vein line. I’m giving medications, I’m good a line to get the heart beating, but sending that’s appropriate for the baby’s size and age of being, less than 30 minutes old and just dealing with all that. And I remember just, it just sort of seemed like it was taking all day. And I remember almost giving up. And in about the 10 minute mark, we heard like the baby step to cry and then baby actually perked up. after we gave that last dose of Epinephrine, I guess remember, cause I, that baby was for sure. Wow. And I just sort of remember like that happening. it was just crazy. I’m almost brings tears to my eyes thinking about it and I mean, fortunately, I mean, I mean the baby did fine afterwards. They went to the ICU at another hospital and I remember the mom texted me and mother’s Day,

Speaker 5: 00:59:41 mmm.

Dr. Shah: [00:59:42] Once you left the hospital with their kid. and she was really, really thankful. Wow.

Dr. Shah: [00:59:48] Wow. And I mean, I just made me feel that, I think those moments are lost on us in medicine. Yeah. And, is it hard to come by because you don’t get to see like, you need, need me, you give medications. we do the same thing day in, day out. We trap or patient off and recover. We don’t really get to see how they do afterwards. Yeah. This case, like the more you involve yourself, you actually got to see something all the way through completion and you get to see the results of your hard work. Yeah. And you get this as soon as of feel like you actually did your job and helping save someone’s life. Yeah. no, that was a very special moment to me. Wow. Special moving forward.

Justin: [01:00:30] Yeah. Awesome. Well thank you very much for sharing that story and thank you very much doctor Aalap Shah for your time today and thank you for joining us on the anesthesia success podcast.

Dr. Shah: [01:00:30]Thank you Justin. Thank you so much for your time. Pleasure.

Show produced By: Justin Harvey Show Music: Great Scott:  Don’t Hold Back