Mentoring Physicians and Nurse Practitioners in Value-Based Healthcare

Dr. Tom Davis, MD, of Tom Davis Consulting, joins Health Professional Radio where he discusses his business of mentoring, consulting, and educating physicians and nurse practitioners in value-based healthcare.

Dr. Tom Davis MD FAAFP started his Family Practice in a picturesque little river town on the Pickney Bend of the lower Missouri River in 1994. Working under one of the nation’s first total-risk Medicare Advantage contracts, he and his partners grew a small, single specialty clinic into a regional healthcare system complete with an urgent care, cancer, surgery and diagnostic centers and a micro-hospital. Having completed a $130m merger with another regional health system under his leadership, Dr. Davis shares his mastery of Medicare Advantage with organizations, clinicians, and patients across the country, so all can experience the same sustainable success.

– TRANSCRIPT OF INTERVIEW –

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard. Thank you so much for joining us. Our guest is Dr. Tom Davis. He’s joining us here on the program to talk about his business of mentoring, consulting and educating physicians and nurse practitioners and value-based healthcare. Welcome to the program Dr. Davis, how are you?

Dr. Tom Davis: I’m fine, thank you very much. Good morning to you.

N: Well give us a little bit of background about yourself. Who is Dr. Tom Davis?

D: I’m a board-certified family physician. I came out of residency in 1994 and I joined a small single specialty group in a little town in Missouri, basically the Town Doctor. It was very, very fortunate set up for me. My partners and I were able to get a hold of one of the first full risk Medicare Advantage contracts that was offered when the program was revamped in the mid 90s. We were able to rip that contract apart, understand the systems, the incentives with the help of some colleagues. We eventually grew that teeny-tiny little practice into a Regional Health System with more than 100 doctors. We had our own hospital, our own cancer center, our own urgent care, diagnostic center, surgery center and would learn a great deal along the way. During that time, I was fortunate to be in a position to mentor some extremely talented and skilled clinicians. So when it came time to pass onto another stage of my life, I decided to take that experience and expertise and apply it to the broader population of clinicians and physicians who are increasingly struggling to try to find their way.

N: You started Tom Davis Consulting and I’m sure you did that for a very good reason. You just explained what you were doing when it came time to go into the next phase of your life. What in your opinion are the greatest challenges for young clinicians that are leaving training and getting out into the world?

D: Well young clinicians are being sold a pig in a poke. They are being charged outrageous levels of tuition to learn skills that are increasingly being commoditized. And these are lifelong investments that they’re making. They’re spending their youth, they are committing to more than a million dollars worth of debt once you include all the taxable income, they have to generate to pay that off. They’re being left at the other end with a set of skills that are going to be supplemented and increasingly replaced by computer technology and by the financialization of healthcare. And I believe Neal that that is being reflected in the fact, there is a suicide epidemic along for young clinicians today and I think it’s those folks that are feeling increasingly trapped, they have no place to turn and they’re turning to substances, they’re disengaging, they’re dropping out of the profession and they’re killing themselves. And that is the biggest challenge that I see, that these clinicians have made this investment, they jumped over the huge bar to get their education. On the other side, it is nothing like they imagined it would be or what they were sold it would be. What I try to do is help them understand that there are other ways to recover their investment and live a joyful life other than just working as an employed doctor for the next 30 years.

N: There’s another segment of the healthcare industry that not doctors, but nurse practitioners, do they have the same challenges as clinicians? Because the risks are increasingly becoming identical.

D: You’re actually correct. When a person owns a company that depends on skilled labor, one of the tactics to keep their cost down is to spread out the definition of skill to broaden the definition of who qualifies for the guild and that is one of the tactics behind expanding nurse practitioners responsibilities and opportunities. Unfortunately, what you see is the same thing as you see with physicians. They’re just a little behind the curve. Their cost of education are going up, their compensation is falling behind on inflation and their services too are increasingly being commoditized. And I was fortunate enough to work with a great group of nurse practitioners when I was in practice. I helped them. They were professors of several training programs so we had tons of nurse practitioners rotate through our clinics. I have seen the profession evolve from being its own unique niche, it’s supplement to medical care to try to become a replacement for primary care providers. And it’s unfortunate that these young nurse practitioners are being subjected to the same pressures as physicians.

N: You talk about your experience mentoring and there’s always a positive spin. Talk about some of the challenges that you and your colleagues have encountered in mentoring some of these doctors. I mean, are they all young and impressionable and ready to take on new ideas readily? Or are some of them kind of stuck in their ways and it’s a bit of a challenge to get them to think a bit differently?

D: Well increasingly, we’re seeing the trainees coming in jaded and disengaged in an earlier stage in their education than they have ever been before. And part of that is because the doctors, and the nurse practitioners, the faculty that are teaching them are also jaded and disengaged and so they’re picking up on that. So that’s the first challenge, is to re-engage their passion. The second challenge is that they’re being groomed for a specific role, nurse practitioners and primary care physicians. They’re being groomed to work on the factory floor, they go from one room to another to collect the data and close the chart. That mentality is coming from their earliest moments that they’re hitting their training and an even larger obstacle to overcome is to get them to begin to think outside the box, that there are other other ways to live a clinician’s life than simply the 9 to 5 grind that employed medicine offers.

N: Let’s talk about this “gig economy” that I hear mentioned. What is the gig economy?

D: So the gig economy basically is any form of economic exchange, which minimizes the friction of making that exchange. So Uber is a great example. You want to ride, you just go on and click and there’s somebody waiting to give it to you. The person that’s waiting to give it to you doesn’t have to worry about taxi licensure or doing anything more than passing the driver’s test and passing the background check. That is increasingly being applied to medicine through telemedicine services and other kind of care management services and it provides a great opportunity for young clinicians to really recoup the investment that they’ve made on their education and prevent themselves from actually becoming a commodity.

N: Is that, I guess, the mentality that one has to subscribe to in order to decrease their risk of being burned out? Can you, I guess, cultivate that mentality early in your career to prevent it?

D: Well that’s an excellent question, the answer lies in the balance. First of all, you have to learn how to do the job. I mean you have to develop your skills as a scientist and as an artist, as far as being clinician. You have to learn how to make the connection with your patients and how to extract the information that you need to come up with a good treatment plan. And again that is a skill, it’s also an art, but it can be learned. You need to have that foundation before you can start wandering out into the gig economy. It’s very much like somebody who’s just gotten a driver’s license working for Uber, that really doesn’t work. It doesn’t. But somebody who’s been driving for five years and has a clean record, that makes a lot more sense. The opportunities to gig are going to have a profound impact on the workforce going forward because more and more closures, especially as the Generation Z folks get in there. I’ve seen it in the younger Millennials but I can’t wait to get my first generation Z climb and see how they think. They’re not going to put up with 9:00 to 5:00, they are not going to put up with the employment model. They are going to go for a pure quality of life and that means “gigging,” controlling how much they work and then pushing their value as much as they can by branding themselves in different ways. And as the younger doctors do that and the older doctors move out of the workforce Neal, the implications for workforce shortages based on how our system is designed are going to be profound.

N: Well we’d like to learn some more about Tom Davis Consulting. Where can we go online and do that?

D: Well I’m all over the web. I have a web presence on Twitter, on Facebook, LinkedIn and I also blog every day, I have a weekly newsletter. My website is tomdavisconsulting.com. I’m coming out with a new book here next month about telemedicine from a patient’s perspective called “Telemedicine Confidential: Keeping Your Family Safe” and that’s to help patients navigate this new world of the gig economy which presents challenges for everyone.

N: Well I would like to talk with you again once your book comes out. It’s been a pleasure talking with you today though Dr. David.

D: Thank you Neal, likewise.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the show are available at hpr.fm and at healthprofessionalradio.com.au. You can also subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure to visit our Affiliate Page at hrp.fm.

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