It’s never too late for physicians to change directions and land new jobs [PODCAST]

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“As I approached retirement from medical practice, I had an epiphany to take up writing and attended the Harvard CME course on Writing, Publishing, and Social Media for Healthcare Professionals. I met some extraordinary people working in the health care universe who wanted to share their insights. Through my writing as an advocate for patients and physicians on popular social media platforms, I landed a new job. I was recruited by the CEO of a health care startup to become the director of digital health communications. Sharing my experiences as a physician and helping tell the stories of the many professionals with whom I collaborate, I feel a new sense of pride in the work that I do. I am no longer personally delivering medical care, but I know what physicians go through. I intend to make their insights known to a broader audience than might be heard in grand rounds at a hospital. That is my new mission, communicating the connection between patients and physicians, a relationship that requires trust above all else.

It’s never too late.”

Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.

He shares his story and discusses his KevinMD article, “It’s never too late for physicians to change directions and land new jobs.”

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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 Paul Pender. He is an ophthalmologist, and he’s the author of the book Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America, and he wrote the KevinMD article “It’s never too late for physicians to change directions and land new jobs.” Paul, welcome to the show.

Paul Pender: Thank you for having me, Kevin.

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?

Paul Pender: OK. Well, I practiced ophthalmology in New Hampshire for 38 years and felt I was looking out for my patients. I became a patient advocate and also an advocate for physicians. And then you gave me a break, and for the last 24 months, you published several of my essays and helped jumpstart my writing career, which I then found led to this job possibility that I just landed.

Kevin Pho: I think it’s going to transition nicely into that KevinMD article that you wrote, and it’s titled “It’s never too late for physicians to change directions and land new jobs.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Paul Pender: Well, as an avid KevinMD reader, I came across a piece that was written by a woman who was getting disillusioned by the system and decided to start her own lactation counseling business. And I thought, “Well, that’s very interesting.” And then it made me also think about a friend who changed his career from family practice to radiology because he had to pay off so much of his student loans, that he still managed to keep his humanity about him, even though he was doing a lot of studies and helping people get through a rough patch.

And then I thought about my own travels. From the point at which I was writing essays on your platform, a CEO of a health care startup contacted me, and we began a conversation that has continued for the last year or more. And he’s asked me to advise his company and to try to really focus again on the patient-physician relationship.

Kevin Pho: You’ve been practicing ophthalmology, you said, for 35-plus years. Did you ever have that inkling in, you know, the first 30 years of your career that physicians can do other things than see patients in a clinic?

Paul Pender: Yeah, although it really wasn’t something that I was going to grasp onto. I think sometimes we have second thoughts, but I really enjoyed my patient care responsibilities. I enjoyed being in the operating room. And it was really only later that I sort of felt, you know, there are some issues that are bigger than I am, and one is what’s happened to this trust that was supposed to be part of the physician-patient relationship. So as I started to think more about this, and the pandemic hit, I had time to write, and so I put together this book, and it’s been an exciting journey so far.

Kevin Pho: So you mentioned something about the change in trust between doctors and patients over the years. Go into more detail about that. How has that trust changed over the last few years or so?

Paul Pender: It used to be that doctors weren’t being second-guessed as much. It used to be that you could do things that were medically indicated and feel like you had the authority and autonomy to make those decisions. And then that started to slip away, and we had to sort of rationalize our decisions to third parties. And so I think trust was eroded in a lot of different ways, and my book goes into more detail, both external and internal factors.

But what I found is that when I think back to the times where the patients really trusted me for their care, it really comes down to, they expect me to really work on their behalf, to look out for their best interests. And I thought that was somewhat slipping away when corporate medicine began to take over.

Kevin Pho: So give some examples of how corporate medicine eroded that trust between doctors and patients. You mentioned things like pre-authorizations and perhaps having our decisions second-guessed by non-physicians, but do you have a story or an example that you could share where that trust is being eroded?

Paul Pender: I think the general feeling that doctors have is that they want to be treated as professionals and not have people who are not even affiliated with the field of medicine second-guessing their decisions. So I think when you find that you are starting to feel less effective in your role as a physician, I think it’s led to burnout. It’s led to other feelings of inadequacy, or “I just wish I found a different way to do this.”

Some of the problems that doctors have faced universally have really been becoming computer entry specialists, when really not many of them were initially trained, at least in my era, to do that. So the amount of clerical work that doctors have been required to put out has also compromised the time that they can spend with patients. So the concept that you have to bring your work home and fill out your medical records at home, I mean, the term that’s used is pajama time. But, you know what, you’ve got other things in your life besides doing work after work.

Kevin Pho: So now you are an author, and you’re a consultant to this company, and this is after practicing for almost 38 years. So what were some of the challenges that you faced when making that transition into some nonclinical areas of medicine?

Paul Pender: OK. Partly it’s developing a vocabulary that’s common to the business world. Physicians have their own vocabulary, certainly, but there were certain times where, in all humility, I’d have to ask people, “So what do you mean by that?” Or there are expressions or terms of art that are familiar in the business world that I just had to learn. So yeah, I was advising on behalf of patients and physicians, but I had to understand what the business elements were and how you could communicate that.

Kevin Pho: So what are some examples of some business terms that you had to kind of verse yourself in?

Paul Pender: Yeah, I think it starts with the book Think Like Amazon by John Rossman, who really was part of my formative education as I was taking on this new role. And it really has to do with looking out for the customer. The customer is really not just the key, but your entire business has to be very customer-friendly.

So in this new company that I’m part of, Vxtra Health, the idea is that you have to really be looking out for the patient’s best interest. It’s no longer just a term to say that it’s patient-centric. It’s really about how are you going to improve the patient’s experience, their overall experience, and how can you work through a moderately restricted field like the middle market and offer these employer-sponsored health benefits that will kind of transform the way that health is delivered.

So my take now is that the business of a startup has to do a lot of different things. It has to find believers, it has to tell about their core values, and it has to really embrace the idea of disruptive change, because the way things are going now, not a lot of people are happy about it.

Kevin Pho: Now, there are a lot of physicians who think as you did in terms of the corporatization of medicine and the deterioration of the doctor-patient relationship. Now, when you made that transition out of clinical medicine, did you have any mentors who could guide you through that? You mentioned that book as one way that can help you make that transition, but any other resources that you had?

Paul Pender: I started to read some of the important books, Steven Brill’s book on America’s Bitter Pill, about the state of health care. Marty Makary’s book The Price We Pay was instrumental in my thinking about transparency being very important to help reduce costs and to allow people to shop for health care. So there were a number of books and articles that kind of started to guide me to this place.

And really, to his credit, Larry Hightower, the CEO of Vxtra Health, really kind of saw me as a project. And so he kind of would keep sending me emails and articles and things that he saw online, and inspirational messages to sort of keep me going. And I think part of the reason why it was so effective was that it showed me that there really is an alternative.

I mean, a lot of people on KevinMD, and I say this with all sincerity, you know, they’re still in the grief period. They’ve been dealing with these factors that they don’t have any control over, and they’re feeling less like physicians. And so I think Larry and his team have essentially introduced me to an idea that yes, you can change this. You can actually offer something that’s different.

And in this middle market for employers, they work under a different set of guidelines than we have to follow, you know, with Medicare, Medicaid, and other things, because they use the guidelines that are from the ERISA law. It’s the Employee Retirement Income Security Act. And so they can customize their plans for their employees, and our goal is to make those experiences of the employees and our patients just the best they can be.

Kevin Pho: We’re talking to Paul Pender. He’s an ophthalmologist, and he’s the author of the book Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America, and he’s the author of the book “It’s never too late for physicians to change directions and land new jobs.” Paul, one of the changes in directions that you took is now writing a book. You’re a published author. Tell me about that experience.

Paul Pender: Well, first, I was rejected numerous times, as you couldn’t expect, you know. I finished a Harvard writer’s course and felt really inspired about writing a memoir, and then met a publisher at the meeting and submitted kind of a book proposal. It was rejected. Then I came up with a different idea, about mentors. That was rejected.

And then I really found someone who was really instrumental in my writing. It was someone I used for editing purposes, and she put me in touch with a publisher. And the next thing I know, I’m writing this book that was kind of a takeoff on a history and physical, with the chief complaint of distrust in health care. And what evolved over time was the written manuscript, as well as an e-book, and then finally a narrated version by Nick Gallagher, who is a fantastic narrator. So it’s also in audiobook form. But it wasn’t as easy as I thought it was going to be.

Kevin Pho: Now, for those physicians who are interested in stepping outside the proverbial box and doing something outside of clinical medicine, what would you say is your number one actionable tip for these doctors?

Paul Pender: Be passionate about what you’re going to do. I think that some people leave medicine, some people find a niche within medicine, and some people shift specialties, as I mentioned in that article. But really, it’s about, you’ve got to be driven by something that you feel is bigger than you are. And I think if you do that, you’re going to feel fulfilled. And if we can actually kind of change the discussion so that the physician is actually in the driver’s seat, rather than tagging along or being an afterthought in a health care plan, then I think there’s some hope.

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

Paul Pender: Well, first of all, I want to thank you again for inviting me. This is a real honor. And I would say that right now, if I could actually just glance at this statement that I’ve written: There’s a whirlwind of tech money and a new definition of health that has taken over the conversation. KevinMD has to address this new phenomenon. I think its readers and contributors are, for the most part, still in a grief stage, but what comes after should not be acceptance of one’s fate, but rather the desire and the means to make the change.

So I think the change that I think can occur is in this particular niche. It’s in this middle market, because the larger corporations are already spoken for. But in the middle market, a lot of these employers started family businesses, and they have their stories to tell as well. They want to stay in business, and they also want to provide superior health and health benefits to their employees. And that’s what we’re hoping to provide.

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

Paul Pender: Thanks, Kevin, for having me.

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