How this physician escaped the system [PODCAST]

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“If you are happy with where you are in the current system – that is wonderful, continue what you are doing. However, if you are feeling trapped, frustrated, or like the work you are doing is no longer meaningful, then there are plenty of opportunities for you to get out of the system. Start looking at your options – start learning about them and looking for opportunities now. Whether you end up deciding on an alternative clinical career, a nonclinical career within medicine, or a career outside of medicine altogether – you have the skills you need to succeed as long as you are persistent. There are options if you want to stay employed and opportunities to start your own business. The critical thinking skills, listening skills, and drive to succeed that you need to survive training to become a physician can help you create a career that will support you and your family and allow you to live a fulfilling life. The first step is to start.”

Nithya Natrajan is a family physician and can be reached at Blossoming Mamas.

She shares her story and discusses her KevinMD article, “How this physician escaped the system.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Nithya Natrajan. She is a family physician, and she wrote the KevinMD article “How this physician escaped the system.” Nithya, welcome to the show.

Nithya Natrajan: Thank you for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Nithya Natrajan: Sure. And a lot of that ties into what I wrote about as well. So I’m trained in family medicine, and then I did a geriatrics fellowship, actually. And then toward the end of fellowship, we had our baby and had a lot of complications, and I kind of totally changed the path of my career and life. It just kind of woke me up to, you know, I can’t return to that kind of system.

So I ended up working with an REI for a couple of years, doing mostly women’s health, some non-IVF infertility, then transitioned to non-clinical for about a year. And last year I launched a business providing breastfeeding medicine and perinatal support to patients in South Carolina. And I also did a lot of training around the breastfeeding medicine, as well as a lot of learning about how to start a business. So now I’m doing that and also doing my non-clinical work on Medicaid.

Kevin Pho: Wonderful. And when you talk about the system that you said you couldn’t go back to, describe a little bit about that system. Why couldn’t you go back to that?

Nithya Natrajan: I remember very clearly in residency we were talking about what the most important part of being a physician was, and I said the most important part was taking care of my patients and providing for my family. And I was met with, you know, a big no from our department chair, actually. And he said, “No, the most important thing is that you make money for the hospital system and for our practice.” And that just did not resonate with my goals as a physician or as a human being. And, you know, I think that was kind of where this started, that I felt like I couldn’t continue in this for my entire career.

And then when we had our first baby, we had several: I had two life-threatening hemorrhages, and then we had a lot of complications with breastfeeding, and our baby had jaundice. And I think after going through all that, it kind of woke me up and made me realize there’s no point in continuing to do something that makes you unhappy or makes you feel like you’re not providing the type of care and giving back to society in a way that’s meaningful. And so after that, I decided I was not going to go back to the traditional system of practicing medicine, and ended up doing some locums with the REI that I was talking about.

And then I started working non-clinically. After doing about six months of non-clinical only, after our second baby, I kind of missed doing the patient care. And that’s when I really looked into what options there were for starting your own practice in a way that you could really control how much time you spend with patients and the kind of care you give. That’s kind of how I found direct care and direct primary care, and decided to start the direct care perinatal practice.

Kevin Pho: So I want to talk about your practice in a little bit, but I want to get back to that story where the director of that hospital system told you that the primary goal of being a physician is to generate income for the medical institution and increase productivity. Now, you were of course taken aback by this, but I’m curious, what was the response of your fellow colleagues around you, the other physicians who also heard that? What was their response?

Nithya Natrajan: So it was during our morning meeting in residency, and nobody else had said anything. There was silence after he asked a question for maybe 30 seconds, which feels like a long time when nobody’s talking. And so that’s when I gave my answer. And I think after, nobody really said anything, and it was toward the end of our morning conference, so then everyone just went to clinic after. So I think the response was nobody responded.

But I think a part of that is because they didn’t know how to respond, right? When you’ve trained all this time to take care of people and then are suddenly told your only function is to make money for this hospital conglomeration, right, how do you respond to that? Especially when it’s coming from your department chair and you’re a resident, and that power dynamic is there as well. You can’t really come back and say no to that in that situation.

Kevin Pho: Now, when you made this transition to your current practice, what were some of the challenges that you faced going from a system that you trained in to something that is admittedly less traditional?

Nithya Natrajan: You know, I think the biggest challenge is just realizing that you can do it and that it’s OK to do it. Because, you know, as physicians we spend all this time in training, and the next step is always very well defined. From the time that you’re an undergrad through the end of your training as a resident or fellow, you always know where you’re going to go next. And, you know, you have some choices, but not really many. And I think when you start practicing is the first time that you really start having choices in what kind of work you do, but we’re not really taught about what those choices are. And so for me, I think the hardest thing was just accepting that it’s OK to do something different if what you’ve been doing so far is not working, or you feel like it’s not really aligned with your goals or your desires for what you want to do for your work.

Kevin Pho: And I think what you said has tremendous resonance. I think all along medical training, we go to medical school, residency, and some of us go to fellowship. It’s very well defined. And I talk to a lot of physicians who take that non-traditional approach, where they’re not practicing medicine full time, and certainly they find it more fulfilling. So that leads me to my next question. Now, there’s not a lot of guidance, as you said, in terms of taking that next step. So how did you find the mentors? How did you find the guidance to guide you out of that traditional role of a physician into what you do now?

Nithya Natrajan: So, you know, I think a lot of this kind of happened by chance for me, and that’s part of why I wrote the article as well, because I want people to understand they have options. So the locums was with my dad’s practice, and so that kind of worked out to where I had a more flexible schedule as a clinical physician for a few years in private practice. And then a lot of his patients were cash-based, so that kind of introduced me to this idea that you don’t have to take insurance and deal with that whole system. And then the non-clinical positions that I got, one of them was through a residency contact who was doing something similar, and she kind of connected me with somebody that was at Medicaid, and that’s how I got into that role. And then a lot of the other positions that I’ve had non-clinically have been through networking at conferences.

But, you know, I think there are a lot of resources that people don’t know about, and I kind of started finding those as I was looking into what do I do, because at first I didn’t know. I had no idea what options there were. And so I think, you know, a lot of it for me was by chance, and I think some of this is chance and luck, but you kind of have to make those opportunities, to open yourself up to get those chances.

And so, you know, I think the resources that are out there, there’s a lot of things like the Non-Clinical Career Academy, and a lot of different Facebook groups for physicians that are interested in non-traditional careers. The Female Physician Entrepreneur group has been amazing. They taught me so much about how to start a business and how to start a practice, and, you know, they’re just so giving and open. And I try to give back to that community as well, now that I’ve gotten started. And then the direct primary care community is the same way. They have so much to offer, and they really are supportive of helping other physicians build your own practice and learn how to do it on your own, so you can really make what you want out of it.

Kevin Pho: So go into more detail in terms of your current practice, and tell me some of the challenges that you face in terms of building that up into what it is today.

Nithya Natrajan: So my current practice, I’m providing breastfeeding medicine and perinatal telemedicine support to patients in South Carolina. You know, when I first started, there are so many options. I think the hardest thing was trying to figure out how to put this together in a way that makes sense and in a way that would be valuable to patients. And then I think the other thing that’s really hard is marketing, right? Because when you’re working for a hospital, the patients kind of come to you, and the hospital kind of manages all of that stuff. And so I think just marketing and building all those components and putting them together was really difficult.

But at the same time, it was so valuable, because I understand every piece of the puzzle of my practice. I know what goes into the EMR. I know what goes into the credit card system, and kind of the idea of how to set rates and how to put everything together in a way that makes sense and is valuable to people. Currently, I just launched at the beginning of January, and, you know, we’re having our baby in a couple of weeks, so I’ve been focusing more on doing educational campaigns. I haven’t been seeing a lot of patients yet, and I’m planning to try to grow that more after my maternity leave, sometime this summer.

Kevin Pho: Now, I assume that a lot of the people that you’ve trained with probably go into more traditional practices. Now, have you kept in touch with them? Are they taking any interest in going a non-traditional route and perhaps starting their own non-traditional practice?

Nithya Natrajan: So I’ve kept in touch. Well, we have a text group where we occasionally talk to each other. But one of my co-residents, she was also my co-fellow, and we’ve just stayed really close the whole time. And that’s kind of where the idea for the article came from as well, because she and I have talked about this so much over the years. And her goal is to eventually kind of get out of insurance-based practice, you know, somewhere down the line. She’s still kind of in that whole system, and they need that for their family at this point. But she and I have discussed this, you know, at length, and I feel like, for her, she may actually go a non-clinical, non-medical route with what she wants to do long term.

And then I’ve talked to other residents, and I’ve talked to my younger brother, who’s also a family physician, and just others who really are kind of supportive and interested in this movement of bringing it back to the doctor-patient relationship, and cutting out a lot of the excess that kind of causes increased burden on the physician to, you know, maybe see more patients than is reasonable, and adds a lot of that non-clinical, I guess, stuff that goes into practicing at a hospital. And so I think it’s definitely a movement that’s gaining strength. And I think it’s something that patients are really happy with as well, because they feel like you actually get to know them and have time for them, and your focus is on them. It’s not on billing, it’s not on documenting, which you still have to document, but, you know, you’re not spending more time documenting and billing than you are actually taking care of people.

Kevin Pho: We’re talking to Nithya Natrajan. She is a family physician, and she wrote the KevinMD article “How this physician escaped the system.” Now, there are a lot of physicians who don’t necessarily have the luxury of divorcing themselves from a traditional practice. Do you think that it’s possible to carve out the life that you want working for an insurance-based practice or working for a large hospital system? Is that even possible at all?

Nithya Natrajan: I mean, I think it depends on what your goals are. So if your goal is to make so much money and you don’t really care about having as much control over your work schedule, you can certainly make it work. And I know people that are happy in that system, and they’re fine with where they are, and that’s great. If that works for you, that is fine. For me personally, I don’t see that system going anywhere that’s going to improve in the future, because it seems like it’s just gotten worse and worse. And, you know, you get less and less time with patients, less time to focus on their needs. And I think a lot of patients and physicians and health care workers in general are just frustrated with the system.

So I mean, I think you can make it work. I think there are certainly systems out there that are making this work well for their providers and for their patients, but it’s just not something that I’ve seen or heard from the people I’ve talked to or from my experiences.

Kevin Pho: And for those physicians who are ready to make that move and break away from a traditional insurance-based practice, what would you say is your number-one tip that you could share with them based on your experience?

Nithya Natrajan: I would say just get started, and really start looking at your options and making plans for those next steps. It does take some time. So, you know, if you’re going to set up your own practice, I would give yourself about six months to research everything and look into what you need to get it set up. But I think the biggest thing is to get started, because if you don’t get started, you’re never going to go anywhere. You’re going to be stuck in that same place. And so if you really want to get out, then the most important thing is for you to start doing research and figure out what you want: if you want to stay clinical, if you want to go non-clinical, if you want to maybe start a business unrelated to medicine, or go into a job totally unrelated to medicine. I think that’s the most important thing, to figure out what you want and then just get started on it. Start doing the research to figure out how to make it happen.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Nithya Natrajan: You know, I think it’s that you can really build the life that you want. You just have to be willing to take that leap of faith and go for it, and kind of get past the analysis paralysis a lot of physicians have, where they analyze everything and then don’t ever take that step. So just take that step, go for it, and find what you love and do it.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Nithya Natrajan: Thank you.

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