Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

We dive into the evolving landscape of health care entrepreneurship with our guest, Tod Stillson, a family physician and entrepreneur. Tod shares his journey from traditional employment to establishing his own single-member professional micro-corporation, offering insights into the advantages of this innovative model. We discuss key strategies for minimizing overhead costs, leveraging technology for virtual care, and achieving location independence. Tod also provides valuable advice for healthcare professionals looking to balance their roles as healers and entrepreneurs and anticipates future trends in this dynamic sector.

Tod Stillson is a family physician, entrepreneur, and Amazon best-selling author of Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy.

He discusses the KevinMD article, “Dismantling the mythical dichotomy of physician career options.”

Our presenting sponsor is Nuance, a Microsoft company.

Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care’s biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled solution that automatically captures patient encounters securely and accurately at the point of care. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows.

Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational.

Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Tod Stillson. He’s a family physician and entrepreneur. Today’s KevinMD article is “Dismantling the mythical dichotomy of physician career options.” Tod, welcome back to the show.

Tod Stillson: Kevin, it’s great to be with you and your audience. I always enjoy talking to you and really hearing from the audience after these podcasts.

Kevin Pho: All right. So Tod’s been on multiple times. Go to KevinMD.com/podcast to hear his story and prior episodes. But let’s talk about your most recent article, “Dismantling the mythical dichotomy of physician career options.” What’s this one about?

Tod Stillson: Yeah, context is everything. I work with second year residents, precepting them in rural family medicine rotations in my rural clinic. I also have a son who happens to be a second year family medicine resident.

And as I kind of watch these doctors go through their process of determining how they’re going to enter the marketplace, what I see really is, they’re just funneled over and over and herded over and over again into the idea that they’re just going to go into traditional employment. And they kind of have this mindset that they really just have two options. One is traditional employment, 90 percent are doing that, or perhaps wade into the waters of private practice, about 10 percent or less are doing that, and that part’s really scary to them. So they sort of just almost mindlessly choose employment without thinking about it.

And I think there’s a lot of options beyond those two options for physicians, and the point of the article is just to bring that forward, to let people know they have options.

Kevin Pho: All right. So let’s talk about some of those options outside of that dichotomy. What exactly are we talking about?

Tod Stillson: Yeah, I think the third space that I really see is emerging, because I talk to doctors every week with SimpliMD about this, is the idea of forming a micro corporation around yourself to kind of house your professional services, and then contracting out those services to various companies that want to use your medical services around the country.

And so that’s a bit different than traditional employment, obviously, where you’re just going to work for one employer, getting one paycheck and working in one location typically. And a bit different than working for a private practice, or in a private practice. Those two elements are really still very tightly connected to the system, so to speak.

And so there are a growing number of opportunities for doctors to work and use their professional skills and their professional services in ways that don’t entangle them in the system quite as much. They maintain a little more autonomy, a little more control. I call that the third space. It’s a very diverse third space, and a physician can pick and choose a host of options that they want to use for it. But a lot of times young doctors in particular, but even mid-career doctors, just don’t know there’s any other option.

Kevin Pho: Now, is this something similar to locums, where they can contract out their expertise to a variety of different entities?

Tod Stillson: Yeah, it’s very similar to locums. So locums is the traditional way of that space, where you would do a short-term locums, typically considered a short-term contract with an entity to provide your professional services. And locums has been around for a number of years and it’s a growing space.

But locums is just one example of what the contracting space looks like when it comes to professional services. For example, its companion, and the best alternative to traditional employment, is employment light. Employment light is long-term independent contracting, where locums is short-term independent contracting. So those are just two elements associated with that idea of being an independent contractor.

But quite honestly, you still can go into private practice, you just want to do it in a way that kind of uses your own corporation in the process. It’ll protect you a little bit. And there’s really a host of other spaces that you can do as a doctor to use professional services. You just have to really know the full menu of options before you just blindly choose the idea of doing traditional employment.

That’s where I feel like a lot of doctors have kind of missed things a bit, that we’re used to following the herd. So Kevin, when you were in training, what did you do after you completed your first year? Did you just turn the knob and go to the second year? After your second year, go to your third year? You just keep following where the herd’s going.

And the sad truth is, the herd for doctors today, and where it’s going, isn’t the best place. And you maybe don’t know that right at the beginning, but three to five, maybe 10 years into it, you’ll find that’s not the best space for you to be in. And so I think trying to provide opportunities and solutions for doctors to build the foundation of their careers on something besides just traditional employment is important. So I really want to try and communicate that to the audience today, and there’s others that we can talk about.

Kevin Pho: So I think that dichotomy exists because residency programs themselves may not even be aware of that third rail of career paths, and that just reinforces the traditional dichotomy.

Tod Stillson: It sure does. I mean, you think about it, your faculty mentors are employees, so they work in the employed world, they’re very steeped in that, and so that’s what they know, that’s what they’re going to really lead you towards. There may be a few faculty members who’ve had experience in private practice, or maybe still have some connections with people in private practice, but the modeling of what you see in your windshield as a young doctor really is mostly traditional employment and occasionally private practice. You’re not exposed to this host of other options typically.

And so again, you just kind of really fall into the trap of just doing what everybody else is doing. And I think that’s part of that experience in this three to five years, that’s why about 50 percent of doctors change jobs after three to five years. You kind of wake up and you go, wait a second, I don’t have to do it this way, I can have some other options. You get more exposure when you’re in the marketplace.

So trying to get a greater exposure for young doctors and mid-career doctors before they feel like they’re stuck is really valuable and important, so they really honestly can enter the marketplace with an idea of what they want to do, as opposed to reacting later and trying to make a change. Change is harder later. It’s easier to start from the beginning in that third rail.

Kevin Pho: Now, you mentioned employment light. We’ve talked about that in prior episodes, go to KevinMD.com/podcast, you can search for employment light to hear more about that. But just to give it in a nutshell, for early career physicians or physicians in residency, just in 30 seconds or less, what are the main advantages of that third space for these new physicians just coming out?

Tod Stillson: The biggest advantage is they retain their autonomy. So when you’re able to put yourself in a position to maintain your professional autonomy, you’re going to control your career.

The second most important part is you’re going to also diversify your income channels, so you’re not going to be dependent upon one employer’s income channel, you’re going to have more diverse income channels.

And then the third is basically, you have greater tax optimization options. So those three things are the very key elements to that third rail.

Kevin Pho: Now, when you bring this option up to young physicians, even your son, in terms of their response, what do they say to you? What kind of response do you get when you bring this previously unknown path up to these residents?

Tod Stillson: They’re actually very interested. It’s fascinating. And I’ve spoken to multiple residency groups about these options, and they, I don’t know, they’re like little kids eating ice cream. They’re just taking it in with wide eyes, like, wow, nobody’s ever talked about this to me, I didn’t know this was an option. They find it very interesting.

And I guess in some regards, younger generation physicians in particular are kind of used to gig economy ideas and the ideas of contracting a little bit more, so it’s sort of easier for them to embrace the concept. But then when it’s applied to the world of medicine, they begin to see the light bulbs turn on and they see a whole lot of other options.

You know, as an example, direct primary care is a great option for a lot of young doctors. And so they don’t feel like they need to either become a traditional employee, they don’t feel like they need to go into quote private practice, but if they go into direct primary care, which is kind of working around the system, so to speak, to directly contract with the patients themselves, those are great options. And knowing that those are options is important.

Telemedicine is another great one. Kevin, I mean, shoot, one of my kids needed to see a specialist recently, and in our geographic area those specialists are really, really hard to get into, like take months to get into. Well, we used a telehealth platform to arrange for a consultation for one of my kids, I mean, I had an appointment in three days, OK, with a legitimate board-certified specialist to manage a particular issue. So telemedicine is breaking down huge barriers and boundaries all over the country, and that alone is an amazing space and option for doctors to work in, as an example.

Kevin Pho: So give us some case studies or examples of physicians that you’ve worked with, and they’ve actually come out and practiced in a non-traditional arrangement. Just give us some examples of what that scenario would look like, for those listeners who want to see some practicality to some of these concepts.

Tod Stillson: So a lot of times it starts by this, whether it be they heard a podcast from you and I, or saw one of my blogs. Most commonly I actually get it from my book. I wrote a book called Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy. You can get it on Amazon. But not uncommonly, I have somebody read the book, then they reach out to me and say, wow, I read this, this is an amazing book, how come nobody’s ever told me about this? And so I explain the process.

I had a cardiologist reach out to me who was finishing up his fellowship, and he’s like, I want to do this, I think this is an important option for me, to do an employment light contract through a hospital that I’m going to work with, and I really want to get this organized. And he had been looking at traditional employment options up to that point, and had done some interviews even.

So I coached him a little bit, told him about the options, reviewed things, talked about both long-term independent contracting, i.e. employment light, and short-term independent contracting, locums.

So what this cardiologist did was, once he caught the vision for it and was inspired to do it, he stopped the traditional employment process he was going through, recalculated, kind of reset himself, chose to take on a locums contract to just give himself some space doing some work for three or four months, just to get himself organized. Then began to shop around in a different way to the hospitals who were willing to sign him on as a long-term contractor, and identified ones that would, and chose to engage in a contractual relationship with them as a long-term independent contractor. And at the same time, simultaneously, he was working with a telehealth company to read echos online as well, sort of a side hustle in addition to the core job that he was doing.

So kind of in summary, this doctor sort of began to see himself for the first time as an independent contractor, empowered as a micro business, chose not to enter into the traditional employment model, waded into the marketplace as a contractor, got some experience as a short term, then led to a long-term, and developed telehealth contracts. And is as happy and pleased as could be, because he has control over his life.

The side story to that is that he has a family on the East Coast, and he’s able to do some of the work that he’s doing not on the East Coast, because of just the way the process works with being able to contract out your services. And so he’s been able to maintain a home where he wants, but still use his professional skills to practice elsewhere, sometimes electronically even, to still accomplish the lifestyle that he prefers, income that he wants, multiple sources, independence, and where he wants.

So that’s a great story of some success related to just having the inspiration to know that something is an option. And if you don’t know it’s an option, you’re going to do what he just about did, and that was follow the herd, sign up as a traditional employee, and just do what everybody else is doing.

Kevin Pho: I can imagine that there are some residents with hundreds of thousands of dollars of loans, three, four, $500,000. And you look at a typical employment contract, there’s a perception of security, and they want to start their life, they have to buy a house and things like that, and they may offer that perceived security of an employed position. So are you encountering that?

Tod Stillson: Yes. Yeah, there’s no question that the large corporations in the marketplace are aware of that need that doctors have, and so they’re playing to that. So they are looking to create financially incentivized, or laden, contracts that sort of secure a doctor’s services for three to five years. So there’s kind of often a payback process into that work, and if you stay with them for so long, they’ll eliminate the debt, and yada yada yada.

And so for a lot of doctors, if you have a large debt, it’s not a bad deal. I mean, don’t get me wrong, sometimes you come down to that financial decision where you might choose to do a certain type of work for a certain length of time because there’s going to be some financial benefits to you. But in your big picture, you might be beginning to organize yourself behind the scenes.

In that particular case, as an example, if you signed on as a W2, you might do some job stacking. You might sign on as a W2 at a 0.8 full-time equivalent in that job, leave yourself a 0.2 full-time equivalent for doing side work. And then at the same time you’re doing that work for that big company who’s paying off your debt, you’re still doing a little bit of side work, developing your skill set for your own independent contracting. And when that contract is up, you can choose to stay, add more or layer in more side jobs, or even leave and go into another area that you want to diversify in.

But there’s no question that large corporations recognize the needs that young doctors have and the financial debts that they have. That’s another reason why young doctors often choose not to go into private practice nowadays. You have $350,000 in debt coming out of residency, and then you look at a buy-in process into a private practice arrangement, you’re just talking about a lot of steep costs involved in that whole process. And most of them are eager to begin eliminating the debt, not adding more debt as they practice.

That’s the beauty and power of a micro corporation, though. A micro corporation is a practice without walls. You’re a single member, there’s really little to no overhead, and you’re not taking on extra debt in the process beyond the cost of just forming the corporation. And so it’s not a lot of extra cost, but it provides you a lot of opportunities to diversify your income channels that can pay down the debt. So again, job stacking is the combination. But some may choose to go into traditional employment just for a season to eliminate the debt.

Kevin Pho: We’re talking to Tod Stillson, family physician and entrepreneur. His most recent KevinMD article is “Dismantling the mythical dichotomy of physician career options.” Now, when you ask residency programs to speak to the residents and introduce this kind of unconventional approach, do you ever get pushback from program leaders and things? What kind of things do you hear?

Tod Stillson: Here’s the deal. Most of these programs are aligned with the big hospital, they’re aligned with their big facility, and there’s built-in soft recruiting, so to speak, that’s associated with all these residency programs. And that’s one of their main reasons, or one of their reasons, for hosting a residency.

And so if they have somebody come in and present an option that’s different than traditional employment, frankly they’re a little bit scared about that, because they’re afraid they might lose those young doctors in terms of the recruiting process.

So I do get pushback from residency directors that I have good relationships with, and they’re like, Tod, you’re right. These residency directors are like shepherds over these young doctors. They’re like, yeah, my people need to know this stuff, but you know what, I’ve got people above me that are going to say no, and I can’t do it.

So the workaround to that at times, I’ve done this with other residency directors, is we have a resident that chooses to host an event in their home that’s not residency affiliated, and have me come in and speak to 10, 15 residents. And it’s just an invite, come if you want, it’s not required by the residency, so to speak. But again, universally, when I do those sort of conversations with young doctors, it’s just a great turnout and they’re just all eyes and love it. So I do get pushback from the institutions, because they’re afraid of the offering, honestly.

Kevin Pho: And my final question, Tod, your take-home messages to the KevinMD audience.

Tod Stillson: My take-home message is, before you think that there’s only one option, pause, look around, explore all opportunities, realize that you do have the power to incorporate yourself. And using that power of incorporation to enter the marketplace provides you with the greatest sense of autonomy in terms of your professional services, but also amplifies the number of options that you have for doing and working in the marketplace.

And I’m just going to list these off real quick, I know this is a summary, but you can do it in private practice, you can do it as independent contracting, you can do it in job stacking, you can do it in direct care models, you can do it in telemedicine, consulting, blogs, coaching. There’s so many ways that you can do the diversification process with your professional services, based on the hard work that you’ve done to earn your degree and earn your license. And I encourage you not to just blindly fall into traditional employment being your option.

Kevin Pho: Tod, thank you once again for sharing your perspective and insight, and thanks again for coming back on the show.

Tod Stillson: Thanks, Kevin.