We are continuing our blog series Careers in Family Medicine. Each week, I will highlight a family physician and their career path. Each one will share their pearls. So far, we have highlighted examples of Rural Practice, Value Based Care, Academic Medicine, US Department of State, Multi-specialty group and Leadership, Direct Primary Care, FQHC practices, Hospital Medicine, and Tribal Health. This week, we take a look at a unique setting of concierge medicine based within an academic setting with Dr. Amruti Borad.
Amruti, give the readers an overview of your career in family medicine.
I am an Osteopathic Family Medicine Physician. I realized I wanted to become a Physician towards the end of High School, so I was grateful to have been accepted to an accelerated medical program between Pitzer College and Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, in Pomona, California. Although I originally planned to become a Neurologist, after completing my third-year clinical rotations, it became clear that Family Medicine was actually the perfect fit for me- I can be a Jackie of all trades and enjoy having long-term relationships with families! I completed my residency at UCLA and continued a career at UCLA in academic medicine for about four years. I thought my whole life would in academics (I love teaching), but life took another path and I started a career in a new UC San Diego Health Primary Care Department, Community Care, a non-academic department focused on patient care. During this time, I was also a volunteer preceptor for one of the UCSD Health Free Clinics until the Pandemic. I then soon became the Department COVID19 Lead Physician, followed by the Clinic Medical Director and the Department Wellness Director. I had the opportunity to achieve my Lean Six Sigma Blackbelt and graduated from the Health Leadership Academy at UCSD Health. This brought me great purpose – the ability to be at the forefront of Physician and Staff burnout prevention and make positive changes for our patients on a larger scale within the healthcare system. Regardless of this passion, I, like many others, reached a breaking point and it was time to make a hard decision. I decided to choose my own well-being and once I did that, a great opportunity came along. I was invited to join a Concierge Medicine practice at UCSD Health, allowing me more time with my patients, resulting better in health outcomes and achieving a true work-life balance. I realized that this was part of the way to for me to find fulfillment in medicine long-term.
What are the benefits of a concierge practice owned by an organization such as a university, both personally and professionally?
In the current state of healthcare, I feel like we are going back to the “good old days” of private practice. Many people are leaving large organizations for that burning desire for autonomy, and putting up their own shingle. However, personally, at this stage in my life, income stability is a necessity and I am in this unique hybrid where my practice has the ability to have a completely different structure and often more opportunities than the normal ambulatory clinics, while enjoying the benefits of being part of a larger Academic organization---access to one of the best network of specialists, the ability to continue to cultivate the relationships I built over the last several years, and exposure to innovation, especially in technology.
What have been the challenges?
Everything in life is 50/50, and I continue to remind myself of this! The challenge is that you don’t have full autonomy and there can be a lot of what I call “red tape” to approve new ideas. Sometimes it is hard to “get things done.” Also, I took over part of a practice for another Physician who had been practicing in this clinic for years. This is always going to be a challenge, no matter where you work. Patients tend fear change and the dynamic between every patient and Physician will be different. There is sometimes a sense that you are “always on,” but the way our practice is set up (significant support from APPs and rotating weekend calls schedules), I don’t feel as much pressure and it is rare that a patient will call or text me, in fact I have to remind them to do so! Patient expectations are also heightened, and I have to continue to learn to balance between providing the best care that I can and having my own boundaries. I continue to accept feedback and experiment with different styles of communication (it’s actually fun!), but at the end of the day, I realize I cannot make everyone happy and I have to be myself. The right patient will find the right Physician for them and vice versa. For me, one of the most important things is that the patient is doing what is best for them.
What specific approaches do you take to enhance your personal and professional fulfillment and joy?
Great question. The number one thing that has helped me is Mindset Management. I work on this constantly. I try to have a positive relationship with challenges. I try to find the gift in every obstacle. I like “in the moment” meditation or “mindful moments” via utilizing techniques from a concept called Positive Intelligence (if you haven’t heard of this, I highly recommend it!). I block time for my family, friends, and myself. Professionally, I used to think that leadership was the path to my fulfillment and it was and I think it I still is. I miss it. But, I have found more joy in the new path I have taken of coaching medical students and physicians, to help them make the best decisions for them. This is my new found way of giving back to my community.
Any tips for those looking at their first job (or those who are looking to pivot) on how to decide?
Don’t necessarily take the first job you apply for. I will admit that I did this and it was one of the best career decisions I made because it was the type of position I was very interested in and I was happy. However, I think it today’s landscape, it’s important to be open to many different possibilities and you won’t know this unless you explore. Go on a few interviews for different types of jobs and see how you feel. It’s easier to do this if you don’t compare yourself to colleagues who are already signing contracts. Everybody’s path is different, and it’s ok to take your time.
If terms of if you are thinking about pivoting, the most important thing is that there really is no “safe decision.” There are always going to pros and cons to every decision, it just depends on what is your personal risk tolerance. The keys are:
-Figure out why you want to pivot.
-What are your options.? Have at least 3 options in mind.
-What is the best and worst case scenario for each of these options? This is different for everyone.
-Pick one option and consider what will be your challenges and how will you overcome them
-Consider how this will positively impact your life
Also, don’t let social media fool you into thinking a different path is “easier,” and know that you can pivot as many times as you need!
Are there any tips or perspectives you'd like to share with readers wondering about a career in concierge medicine?
Concierge Medicine is like slowing down time. You have significantly more time and smaller panel sizes, allowing you to build a relationship with patients, educate your patients, enhance your clinical skills, and depending on your practice, build a strong support system (teams) to provide the best care. When I know I can provide the best care and I can engage with my patients at a deeper level, as the human beings they are, this brings me fulfillment. This also helped me to have a real life outside of work (rare notes to take home, rare build-up of in-basket messages, for example).
If you are interested, I recommend you look into different types of Concierge practices as all models are different, and see what works for you and your lifestyle. For me, part-time work, APP support for in-basket messages/triage, and weekend/vacation call rotation have A great way to do this is to build a solid LinkedIn profile as you can search for these practices, and often times recruiters will reach out to you with different opportunities.
What are the subtle differences between a physician-owned DPC and a university-owned concierge practice?
In a nutshell, Direct Primary Care practices (DPC) have patients pay a membership fee monthly, quarterly, or yearly basis for all medical care. They may recommend their patients also carry a PPO insurance in case of medical emergencies but this often not the case.
Concierge practices also charge a membership fee (often higher than DPCs) that is typically yearly, but they also take insurance to cover other costs. The membership fee is truly meant for increased access to your Physician, which is what our practice does. This would apply to any Concierge practice whether physician or university owned.
Here is a great article that explains the differences.
Any other things you’d like to share?
I am so grateful that you are sharing this kind of information with medical trainees! Knowledge is Power. Leverage your network! As Notorious B.I.G. put so eloquently: “If you don’t know, now you know.”
Great! Thank you for taking the time to share your wisdom with the readers. How can people find you if they want to learn more, either about your practice or your coaching?
Next week the series continues by highlighting Dr. Haroon Samar and serving as a family physician in Military Medicine. Stay tuned! Don't miss any in this series; sign-up to have them delivered to your inbox.
Until then - Have a joy-filled week! Tonya