00:00:04:00 - 00:00:26:18 Justin Nabity This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professional to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers. 00:00:26:20 - 00:00:34:20 Reid Lancaster Let's let's start with that. Doctor Patel, what are your thoughts on that? If you don't mind, I'd like to just start with that question. Why do you. 00:00:34:22 - 00:00:35:20 Justin Nabity About which part? 00:00:35:22 - 00:00:36:14 Reid Lancaster What? 00:00:36:16 - 00:00:37:09 Justin Nabity About which part? 00:00:37:11 - 00:00:45:13 Reid Lancaster Why do you think the IPA has gone from 300,000 to 150,000? So if there's a million physicians in the United States. 00:00:45:15 - 00:00:45:23 Dr. Rishi Patel Yeah. 00:00:46:02 - 00:00:54:00 Reid Lancaster And, 300,000 were a part of the IPA, and I don't know what year it went from 300,000 to 150,000 over the last. Go ahead, Justin. 00:00:54:14 - 00:00:55:17 Justin Nabity Yeah. Ten years is with me. 00:00:55:20 - 00:01:02:22 Reid Lancaster Over the last ten years, it's it's gone down to what? Call it, you know, 15%. Why do you think that is? 00:01:02:24 - 00:01:30:12 Dr. Rishi Patel Well, the biggest thing has been the Affordable Care Act. And really, you know, my dad was in private practice for a number of years. I used to go with him to buy some of the chemo. My mom did his billing growing up. And really with the Affordable Care Act and the introduction of electronic medical records, it really added so much compliance in a lot of different rules and regulations that made it so difficult for private practice folks to really stay in business. 00:01:30:14 - 00:01:47:19 Dr. Rishi Patel And then on top of that, with the advent of and I'm not saying that, you know, obviously the Affordable Care Act had good things that came out of it with, you know, requiring insurance and so forth. But you had a lot of different types of insurance plans that came out that really cut reimbursement or really added different stipulations for reimbursement. 00:01:47:21 - 00:02:12:22 Dr. Rishi Patel And so it became very difficult. And so, I mean, if you look at the practice I'm part of, we have over 20, you know, oncologists and we're considered a moderately sized private practice. But if you're a solo practitioner or private practice, those days are unfortunately gone. It's so difficult to maintain the overhead costs to have an EMR to, you know, keep up with this and that, that most, you know, people have no other option but to be employed. 00:02:12:24 - 00:02:15:21 Dr. Rishi Patel It's really sad seeing that. 00:02:15:23 - 00:02:21:22 Reid Lancaster So you said the ACA and, the invention of the electronic medical records? 00:02:21:24 - 00:02:22:14 Dr. Rishi Patel Yeah. 00:02:22:16 - 00:02:30:23 Reid Lancaster Just purely because of cost. The overhead, to be a solo practitioner, it is becoming impossible to be able to keep your doors open. 00:02:31:00 - 00:02:56:22 Justin Nabity Are you saying that if it was cut in half the cost, that would make a difference or a lot lower? Is it is this just the technology itself is the issue because I think a patient would be like, well, everything's digital. Why wouldn't I want to have my doctor in the 21st century doing digital things that are running their business, if they're not in 21st century doing current tech stuff, and they're probably not a good doctor because they're old fashioned, they're out of touch, stuff like that. 00:02:57:03 - 00:03:14:01 Justin Nabity So I would want the EMR to be up to date. So why is this this, this EMR and regulation requirement? Why is that a problem? Why is that not good for our patients in in this regard. Like what's, what's the, the the indirect effect of what this is doing for them. 00:03:14:03 - 00:03:36:10 Dr. Rishi Patel So I would say this electronic medical records are not made for doctors. They're made for ensuring, for insurance and billing. Really? You know, it was never created with the intention of providing better care. Maybe you could argue epic, right? But, you know, in many ways, epic is completely unaffordable. Most, most people in, you know, small private practices and so forth just use whatever generic, you know, EMR system. 00:03:36:12 - 00:03:54:08 Dr. Rishi Patel All you're doing is putting on documents in one single area. But when it comes to actually providing care, I don't just go based on the EMR, I have a system where I look back at labs and look back at all the documents that I got, and I make a decision, you know, I think aside from maybe having some radiology on the computer and maybe having some labs on there. 00:03:54:12 - 00:04:28:14 Dr. Rishi Patel I don't think having, you know, so-and-so like paper on an EMR makes a difference for me. I always go through everything in detail, but the problem is, is, is fatigue, you know? So really, I was talking to my wife about topics I wanted to talk about because this can be so broad. But, you know, one of the things is an EMR and being forced in a slave on the computer has led to physicians being so unhappy, because I think of my dad and back in the day when he could see patients and really provide care and not have to worry about that, you know, on a given day, I might I'll see my patients, I'll 00:04:28:14 - 00:04:51:09 Dr. Rishi Patel write my notes, I'll go through 200 labs on a computer screen. You know, I put in orders on a computer. The thing I hate the most about my day is that I'm forced to spend 80% or 90% of my day in front of a computer with the least amount of physician interaction, and it makes me sad inside, thinking that every time I go see a patient, the first thing I'm thinking is well after on the computer and take care of this. 00:04:51:09 - 00:04:54:07 Dr. Rishi Patel And then move on. That's the worst thing. 00:04:54:09 - 00:05:01:23 Reid Lancaster That's insane. So you're saying 80 or 90% of your time as a physician is spent, uploading information for the patients? 00:05:02:00 - 00:05:02:05 Dr. Rishi Patel Yeah. 00:05:02:05 - 00:05:12:13 Reid Lancaster So are you doing a lot of this when you're. So the patients right here, you're doing a lot of this, or do you spend 2 or 3 or 4 or 8 minutes with the patient, and then the rest of the time you're doing this. 00:05:12:15 - 00:05:12:23 Dr. Rishi Patel Yeah. 00:05:13:02 - 00:05:14:13 Reid Lancaster Is it both? 00:05:14:15 - 00:05:28:21 Dr. Rishi Patel I would say I try to spend, like, whenever I talk to the patient, I just look them face to face for, you know, how much time I have. And then I actually we have, like, a a dictaphone where, you know, we're lucky. So I have a dictaphone where I'll dictate it, and then I'll have someone type my note for me. 00:05:28:23 - 00:05:36:24 Dr. Rishi Patel But you know, everything else when I'm talking to them, I'm putting in labs and orders and stuff. Everything's just like that. It's horrible. 00:05:37:01 - 00:06:00:03 Reid Lancaster Yeah. You know, Justin, you were talking about. Well, if my physician doesn't have the technology, then they're probably living back in the Stone age. And I don't I'm not attracted to that. And I got to say this from my perspective, let this be from me. I'm 36 years old, but I feel like I'm old enough to remember when I got to sit down with my doctor and he looked me face to face, and I didn't go to the doctor very often. 00:06:00:03 - 00:06:18:13 Reid Lancaster I went once a year for my annual checkup, but man, he was like talking to me about high school. I was an athlete in high school. He's talking to me about sports and how he saw me in the newspaper, and I'm like, I would always go home and tell my dad, man, I'm our doctor is awesome. Like, I really felt connected and he probably looked at me and did some checks and said, this guy is totally fine, but still spent time with me, right? 00:06:18:14 - 00:06:37:18 Reid Lancaster That trust was there, so when something weird would pop up, I can. I would feel totally comfortable to reach out that relationship is there's no time for that. You can't do that anymore. To think about the fact that this guy is talking to me, about me being in the newspaper for sports. You guys can barely talk about something that is detrimental to their health. 00:06:37:18 - 00:06:51:04 Reid Lancaster But yeah, it's more okay. I am owned by the computer screen, I'm owned by the computer screen, and I can't even really have the time to communicate. And if I do, I probably won't be very financially successful at all. 00:06:51:06 - 00:07:09:04 Dr. Rishi Patel Yeah. I mean, I think electronic medical records started off with the right intention of really just finding a way to get everyone together. The problem is, is there's so many electronic medical record systems, none of them talk to each other and none of them are physician centered. They're all billing center. And so at the end of the day, what do you get? 00:07:09:04 - 00:07:18:09 Dr. Rishi Patel You just get a bunch of clutter. You get repetition of movements. Everything is just so discombobulated that it doesn't necessarily help with care. I feel like. 00:07:18:11 - 00:07:36:00 Reid Lancaster I'm glad you're bringing this up. We help doctors start practices. We help doctors manage their current practices that are potentially struggling. And when we talk about EMR systems, the first thing that we say is what is affordable. What do you know about what do you feel comfortable about? But it's price is number one because of what you said. 00:07:36:06 - 00:07:52:17 Reid Lancaster We don't need to have the EMR system be the physician. We need to put data in this, and we need to be able to run this EMR system efficiently so that it doesn't take away from our time. So when price is the number one issue for a solo practitioner, you can see why, the big hospitals are winning. 00:07:52:19 - 00:08:00:01 Reid Lancaster They're thinking, okay, give me the give me everything because we can afford it, which is really a competitive disadvantage to the solo practitioner. 00:08:00:03 - 00:08:17:13 Dr. Rishi Patel I agree. And honestly, you know, at the end of the day, I was I was, you know, like I round at a hospital that we're affiliated with, you know, I was talking to them about, you know, upgrading one of our EMR to another one. You know, epic was asking for $1 million upfront for an upgrade. And we're like, we don't have that type of money. 00:08:17:13 - 00:08:27:05 Dr. Rishi Patel We're a small community hospital. So to even think about that type of amount of money required to just keep an electronic medical record system going, that's ridiculous. 00:08:27:07 - 00:08:28:21 Justin Nabity Yeah. 00:08:28:23 - 00:08:36:12 Reid Lancaster What were some of the topics you and your wife were talking about that you were thinking about bringing up? Because I'm most interested in that, actually. Oh, gosh. 00:08:36:14 - 00:08:57:18 Dr. Rishi Patel You know, I didn't I didn't want to dive too much into the business side of things, but you know, how to keep a clinic afloat and some of the unnecessary business things you have to learn about, you know, thinking about reimbursement, drug reimbursement, services. The other thing we talked about was burnout in general. And then I had it. 00:08:57:20 - 00:08:58:24 Dr. Rishi Patel What else did I have right now? 00:08:59:00 - 00:09:27:20 Justin Nabity Let's do this too, though. Reid, I haven't told you about his background with getting organizing doctors. He has a prior life experience that got him immersed in the thick of organizing and tell us, Doctor Patel, what you did and what that was like and what you see as far as being able to organize now, even when you have prior practices and you have employed doctors like, well, I yeah, I haven't had a chance. 00:09:27:20 - 00:09:28:07 Justin Nabity I mean, you. 00:09:28:08 - 00:09:39:04 Reid Lancaster Get so you're the son of a doctor. So I'm wondering you got to to watch it growing up. You got to see what it was like. Is that tell me why you started this. And what is it? Because you're right, Justin. I don't know about this yet. 00:09:39:06 - 00:09:57:21 Dr. Rishi Patel Yeah, yeah, yeah. So, you know, honestly, for me, when I was a resident in Chicago at UIC, you know, I, I'd heard about, you know, unions and my dad, when he was a resident in New York City, in Brooklyn, he had been part of a resident union. And so, you know, they came up to me and they kind of brought up that idea of a union. 00:09:57:21 - 00:10:20:17 Dr. Rishi Patel And I realized when I was in Chicago, everyone else had their own union. The nurses had their union, hell, the transporters, had their own union. And I remember my first weekend on, there was a big strike and we're having to divert patients over. I remember having to wheel my own patients down, and I started thinking and I was like, why is it that in the name of morals and so forth that physicians are asked, hey, don't do this, don't do that. 00:10:20:17 - 00:10:39:08 Dr. Rishi Patel But everyone else can. How are they not part of the system as well? And so I started realizing I was like, that's not right. I don't think people will listen until you have some type of formalized bargaining power. And I think doctors are so disjointed in general. And there's private practice, there's hospital based that there's been no group. 00:10:39:08 - 00:11:02:01 Dr. Rishi Patel And, you know, the AMA, I remember hearing your podcast with that gentleman as part of the AMA. I disagree with the AMA because I think for the longest time they've not done a good job of really bringing people together. I remember back in the day during President Obama's presidency, and I'm not I'm not trying to be political, but, you know, the president of the AMA and President Obama, we're grabbing lunch and dinner together, and they were both based out of Chicago. 00:11:02:05 - 00:11:12:22 Dr. Rishi Patel What type of, you know, signal does that tell us when something like that is being made, without actually getting the opinion of physicians on how they feel about certain things? 00:11:12:24 - 00:11:14:14 Justin Nabity So then what happened? What did you do? 00:11:14:16 - 00:11:36:07 Dr. Rishi Patel So we we we started the process. You know, we got about 50 or 100 residents at UIC to basically sign a paper. And then we went to our hospital board and we said, we want to start, a union. And they initially were trying to find ways to get us not to be interested in it. And ultimately, once I graduated, I went to fellowship. 00:11:36:07 - 00:11:49:18 Dr. Rishi Patel I heard that it got passed, and now their salaries went up a lot. They have more benefits, but more importantly, they had more bargaining power in determining what safe practice of medicine out there. And I think that's important. 00:11:49:20 - 00:11:54:13 Reid Lancaster When you say we started it, you mean you or was there a couple other people who who were like, there was. 00:11:54:15 - 00:12:09:11 Dr. Rishi Patel So it was me and like four other people. And then we all graduated and we kind of kept the momentum going as well. And then finally we got enough ballots signed where more residents actually, I think was greater than 50% said they wanted a, a union. And then it got passed. 00:12:09:13 - 00:12:22:07 Reid Lancaster I asked that question because I want everybody else out there to hear that. Like, I'm not saying it's easy. I'm not saying you guys have a bunch of time on your hands at that time, but I am saying that it's doable and and that you actually do have the power. 00:12:22:13 - 00:12:46:12 Justin Nabity And there are there are pockets around the country that have these. And why isn't it that every single location has these as the beginnings, the foundation of what would come after you leave? So what you leave an ecosystem that actually is becoming more favorable to you and respecting you more. Let's give you more say in your decisions around how you should do things. 00:12:46:14 - 00:13:08:23 Justin Nabity Why does that not carry forward? Why is it that because you moved on? I know that the way that the rules are, you can't have a union based on your your occupation class. It's based on employer by employer. It isn't that way necessarily overseas, other places. But, why why do you think it's not being carried forward beyond the residency fellowship stage? 00:13:09:00 - 00:13:27:00 Dr. Rishi Patel There's there's this old school idea that, you know, if you're a doctor, you do whatever you need to take care of this. And I think a lot of the older folks would say, hey, no, what do you want a union for? You know, your goal as a trainee should be to do as much as you can, take in as much as you can to become the best doctor you can be and then move forward. 00:13:27:00 - 00:13:45:08 Dr. Rishi Patel And I think that's the type of culture that's always, been perpetuated, you know, onwards. And so I think that needs a change because the reality is, is I was talking to my dad and, you know, when he was a trainee, he could go out and provide good care to people without having to deal with putting in an order or dealing with this or that and that. 00:13:45:10 - 00:14:00:22 Dr. Rishi Patel Now there's just so much fatigue and burnout because of being in front of a computer, because of electronic medical records, because of coordinating care and all these bureaucratic tasks that lead to all these things, that there's no way one person can do it all in one day. 00:14:00:24 - 00:14:04:06 Reid Lancaster Yeah. Your dad's coming from the heyday of medicine. 00:14:04:08 - 00:14:06:03 Dr. Rishi Patel I mean, those were the golden, those were the golden years. 00:14:06:03 - 00:14:23:23 Reid Lancaster When when when there was autonomy. I mean, that's really the number one word. I think that people look at this and it's easy to say, okay, this is a money grab by physicians. It's not that. It's not I mean, look at the CMS cuts over the last ten years is ridiculous. So not only are you getting paid a lot less, but you're in. 00:14:24:01 - 00:14:33:15 Reid Lancaster You enjoy your job a lot less. Physician suicide is is twice that of non physicians in the United States population. Why is that? 00:14:33:15 - 00:14:47:13 Justin Nabity It's double the average population. Yeah I just looked it up to double check the numbers. Well that no no no not that something related to it. What percentage of medical students would you say Doctor Patel, do you think you're on antidepressants or. 00:14:47:15 - 00:14:52:16 Dr. Rishi Patel Is it 50%? 75, like three-fourths? 00:14:52:16 - 00:14:53:19 Justin Nabity 75 00:14:53:23 - 00:14:57:10 Dr. Rishi Patel Holy snap. That's crazy. 00:14:57:12 - 00:15:12:24 Justin Nabity So this is like, this is where the sausage is getting made. This conversation. This is big time. I want to take this offline with you and look at what you did at UIC. 00:15:13:01 - 00:15:13:07 Dr. Rishi Patel Yep. 00:15:13:08 - 00:15:34:02 Justin Nabity And get a process going. Why? Why don't we have this at every single location? If we had every single location, people would start to maybe realize that there is a a serious problem that exists that once you leave, we need to start taking with us some of what we've done in the past, which is in those training years, 75% of medical students. 00:15:34:05 - 00:15:36:04 Justin Nabity That's a problem. Like a. 00:15:36:04 - 00:15:37:01 Dr. Rishi Patel Huge problem. 00:15:37:07 - 00:15:40:20 Justin Nabity I mean, I just look it up right now. That's how how bad it is. 00:15:40:22 - 00:15:56:20 Reid Lancaster I, I think what I'm about to say, I think it's okay for for people to hear. But when you have the tip of the spear of Americans. Right, like, it takes a certain level of person to pursue medicine, to become a doctor, okay? It's not average. It's not an average thing. 00:15:56:20 - 00:15:58:20 Justin Nabity They're giving eight plus years of life to take care of people. 00:15:58:20 - 00:16:19:23 Reid Lancaster Not it's not an average thing. Not everybody can do it mentally. Not a not everybody is even smart enough. I mean, that's just the truth. When you're when you're a struggling patient and you're potentially on your deathbed, you want to look up and think, I'm hoping this guy or this lady is, is really, really, really smart and really, really good. 00:16:19:23 - 00:16:49:17 Reid Lancaster Maybe beyond what I ever could have achieved because I'm looking for life saving results here. And when you have those people going through so much that 75% of them need medicine and just to be cognitively okay, that's, that's, that's that is that's horrible. That's disgusting. And why is that? And why is that. It’s because you have no autonomy. You do not have the autonomy to practice care the way you want to. 00:16:49:18 - 00:17:04:12 Reid Lancaster You have to become a whole bunch of different things just to be a doctor. I mean, I think the biggest thing here for me in this podcast is that you spend 80 to 90% of your time on a computer screen. I don't want to be your patient. I'm sorry. Like, I don't want to be your patient. 00:17:04:14 - 00:17:10:19 Justin Nabity That's that's no patient wants to be a patient to anybody. And that's the way it is inherently across the board. Yep. 00:17:10:21 - 00:17:32:08 Dr. Rishi Patel That's the worst thing about it. And I think that's what's driving depression rates. Right? I think like when I say it this way, it's not really that politically correct. But when you look at how medical school and how training process has changed, you know, back in the day, people that went into medicine were people that really just had some type of connection with society. 00:17:32:08 - 00:18:01:03 Dr. Rishi Patel They liked science, they wanted to provide greater good. I think medical school has changed their admissions to where they're selectively choosing people that are more research or statistically oriented and less service oriented, despite grades. And then on top of that, they add a whole slew of requirements like, oh, you need to have this research paper, you need to have this done this, done this, and that does not, I guess, reflect or add inherent value to becoming a better doctor. 00:18:01:05 - 00:18:17:02 Dr. Rishi Patel And in doing so, I think a lot of the folks that are that are there are just they're constantly doing this, this and that, that they're so disjointed from society. I honestly don't feel like I thought, like my calling come back again until I started back in my private practice and I feel like I'm part of the community. 00:18:17:02 - 00:18:35:10 Dr. Rishi Patel I'm serving it. Me it's it brings me so much joy. But I feel like if you're in a large inner city or you're at a hospital based practice or you know you're kind of moving around, you don't feel like the people that you're treating are actually benefiting from the care you provide. It doesn't feel like, you know, you're part of that. 00:18:35:12 - 00:18:54:02 Reid Lancaster So to go through all of that eight, ten years of school or more to get to it or more to get to a place where you're like, wow, this is this is not what I thought it was. And I think most people sit in that. They're like, okay, I just spent a decade of my life doing this. Not a lot of people are reaching out to do private practice. 00:18:54:02 - 00:19:11:07 Reid Lancaster So they're now they're they're in a position where they hate their lives. You know, they're working 70, 80 hours a week. They're not making the money they thought they were going to make. But what else? What are they going to do? Where are they going to go from being a physician? I mean, that's the truth. What what is there a level that you can step up, like maybe like an astronaut? 00:19:11:07 - 00:19:28:07 Reid Lancaster And, I'm not trying to make anybody feel less, but when you become a physician in the United States, that is like, top tier. Where do you go from there? So you're just going to be miserable for the next 30 years, 40 years of your life. And I truly believe that's where most physicians are today. 00:19:28:09 - 00:19:50:23 Dr. Rishi Patel Yeah, I agree 100%. I think really where we go is we start by creating a unifying process that brings physicians together and is a voice for them. And I think the AMA really needs to be reset. And I think something like what you guys are talking about with getting a union and it's, you know, simplest form that brings people together is the next step. 00:19:51:00 - 00:20:09:09 Reid Lancaster And I also would like people to know that, you know, there's a lot of things that need to change for health care as a whole to change. But if you want to make it change and you want to make it change immediately, understand this. Our company exists to to negotiate contracts so you have a fair chance. We've gone through all the EMR EHR systems so we know which one to get you. 00:20:09:12 - 00:20:25:09 Reid Lancaster We know how to do the business side of things, to get you to a place where you can actually, provide a living for your family and be an independent physician. And so we exist to do many things, but that is one thing. We exist to do. And, we're here to do that. Doctor Patel, you've been wonderful. 00:20:25:09 - 00:20:42:12 Reid Lancaster Thank you for your service. And thank you for doing all the things that that that never made you money, that was outside of medicine to for the better. For the betterment of your colleagues. And, and, you know, we were on a podcast, right before this one. And this gentleman, is a seasoned physician, and he said, we have ten years left. 00:20:42:14 - 00:21:04:16 Reid Lancaster We have ten years left to turn the tide before this becomes, purely corporate medicine. And if we don't do it in ten years, we never will. And, you know, DocNation, I will say this. We have hope and we're fighters. But there's roadblocks left and right. And I will say one of the biggest roadblocks is physicians themselves not being willing to to speak up. 00:21:04:16 - 00:21:09:02 Reid Lancaster And so, very grateful for you and for your time and for your history. 00:21:09:04 - 00:21:17:24 Justin Nabity Yeah. Doctor Patel, maybe for your last word. Share with the DocNation, what you would say to them about joining this cause that we're talking about. 00:21:18:01 - 00:21:39:07 Dr. Rishi Patel Yeah. I mean, I would say about joining this cause I feel like whatever you do, you always have to fight for it, no matter what. Every group, I mean, whether it be nurses, pharmacists, you know, lawyers, any type of group always has to go to the bargaining table. And physicians are no different, unfortunately. And so, you know, bargaining in general does not mean bad care. 00:21:39:08 - 00:21:48:13 Dr. Rishi Patel That does not mean that you are not providing the best care for them. This is you sitting down and trying to find ways to provide better care while being able to take care of yourself. 00:21:48:15 - 00:21:49:22 Justin Nabity Excellent. 00:21:49:24 - 00:21:52:19 Reid Lancaster Thanks Dr. Patel. Yeah, thank you so much for your time. 00:21:52:20 - 00:21:53:11 Dr. Rishi Patel Thank you guys. 00:21:53:16 - 00:21:56:14 Reid Lancaster Have a great day. Thank you. Yes, Bye bye. 00:21:58:20 - 00:22:15:15 Justin Nabity This has been the DocNation podcast. If you like what you heard, be sure to subscribe, rate and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes. 00:22:15:21 - 00:22:23:05 Justin Nabity Don't forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind the scenes content, and join the conversation. Thanks for listening.