Interview With Dr. Steven Knope: Concierge Medicine, Medical School & Doctors Taking Control Of Their Careers

Steven Knope MD weighs in on concierge medicine, medical school, the future of healthcare, and doctors taking control of their careers.

The television show Royal Pains explores the thrills, challenges, and adventures of Dr. Hank Lawson an Emergency Room Physician who, through a simple twist of fate, became a concierge medicine doctor. Though I’m not an avid fan, I have seen a few episodes and remember thinking, “Sure it makes for great television, but nobody really does that...right?” Well I was wrong. Enter Dr. Steven Knope MD; he has become a leader and innovator in the field of concierge medicine. A quick look at Dr. Knope’s biography and you realize he is part physican, musician, athlete, and ninja. His bio includes a stint as a professional french horn player, triathlete who has completed four ironman triathlons, and a martial artist with a 3rd degree black belt in Kenpo Karate. He is a physician who has always been willing to chart his own course and follow his passion to deliver the best health care possible to his patients. I was able to catch Dr. Knope in between seeing patients and practicing Chuck Norris round-house-kicks to pick his brain a bit; here is what I learned.

How did you get started doing Concierge Medicine?

I was actually asked to start a concierge practice by 4 of my patients 11 years ago.  They wanted more of my time and more access to their physician. They liked my care, but they didn’t like having office visits limited to 10 minutes. They wanted a more personal relationship with their doctor. After they approached me with this request, my initial thought was that this type of practice model was “elitist” and “unethical." How could I limit patients access to my services to only the few who have the means to pay up front? These thoughts forced me to do a lot of reading and soul searching. I ultimately came to the conclusion that our current third-party system was in many ways unethical in it’s own right, and I decided I wanted to begin treating patients on my own terms. So, I started a pilot concierge program with just 4 patients, and it slowly grew into my present full-time practice.

What do you like best about being a concierge doctor?  

I enjoy having the time to practice good medicine and the freedom from corrupt insurance companies, HMOs and the U.S. Government in the form of Medicare.  In short, I am intensely individualistic, and I like practicing medicine on my own terms. For example, in addition to helping my patient when they are sick, all of my patients have a customized nutrition and exercise program. This type of freedom comes with a price, but I feel it is worth the price.

What does a day in the life of a Concierge Medicine Doc look like?  

Every day is different, which is why I like it. In my old practice, I used to see 30 to 40 patients every day!  It was mind-numbing. Every day was the same, and I was always running, always buried in trivial paperwork, always trying to meet my overhead – as Medicare, insurance companies and HMOs determined how much money I was allowed to make.  If you like servitude, you’ll love third-party medicine.  If you are an independent soul, you’ll need to get outside of this system.

What where some of the key lessons you learned while making the switch from a more traditional medical practice to becoming a concierge doctor?  

You have to develop entrepreneurial skills that you never were taught in medical school.  You have to learn to follow your own path and not pay attention to the crowd.  You have to question some of the group-think mentality that was taught in medical school.  As an example, I’ve publicly debated medical professors from academic centers on ObamaCare.  These people pretend to be geniuses in the field, yet they can’t, or simply refuse, to do the simple arithmetic and see that Medicare and Medicaid are going bankrupt. It really does not take a genius to realize that ObamaCare is insane.  They are ideologues, not thinkers.  Learn medicine from your professors, because this is what they know best; but don’t internalize their liberal, socialized medicine dogma without thinking long and hard about it. It is just a simple fact that many academics could not run a private medical practice if they wanted to because they simply do not understand the first thing about making a payroll, paying an overhead, or the basics of “eating what you kill."

What is the best piece of advice you would like to give to today's aspiring doctors?

Think for yourself!  Internal medicine and family practice has sadly become a bad job under the third-party system; there is just no other way to put it. It is almost no longer a profession. The word about primary care has gotten out to students, and very few young doctors are going into these areas of medicine. However, this means that there will be a shortage of primary care doctors, as the demand is continually increasing. There will be great opportunities for young doctors in these areas, provided that they are willing to go into direct practices, without the interference of third-party payers.

You have had some critics. What advice would you give to students on dealing with criticism?

Listen to the criticisms objectively, think about them, and then make your own decisions.  If you think the criticisms are baseless, ignore them.  It doesn’t matter what other people think of you.  Period! Personally, I could give a rat’s ass about what other people think of me.  I’ve written an entire chapter in my book, Concierge Medicine, on the ethical arguments on this topic.  I happily challenge any doctor to debate me on the ethics of our current third-party payer system.  The current system just doesn’t work.  It is corrupt and unethical to its core.  And if you think socialized, government-run medicine is the answer, reflect back on your experiences at any VA hospital.  Does the government provide great care to our veterans?  Not in my experience.  Big government, big business, and crony capitalism are not the answers for our broken system. These things are what broke the system in the first place.  We need to return to the days when doctors ran their own, small private practices if our goal is to provide compassionate, quality, personalized medical care to patients.

You seem to have a lot going in and out of medicine.  How do you stay at the top of your game as a doctor while still maintaining an active balanced lifestyle?

I love medicine, but there is more to life than medicine.  I’m a martial artist and an athlete.  I believe that being physically and mentally strong makes me a better doctor.  You only live once.  You want to be more than a doctor in your short time on this planet.  Be the person you want to be first; this will determine the kind of doctor that you become.

If you could recommend that every medical student read one book what would it be? (In addition to your book, of course)  

Atlas Shrugged by Ayn Rand!  Trust me on this one.  It is a long book, but it will change your life.  If you don’t have time to read it now, put it on your list and read it later.

More: Listen to an hour long interview with Dr. Knope from Medical Spa MD

Twitter With BurbDoc

BurbDoc's not generally happy decided to set the world to rights via Twitter.

What' are docs using twitter for? Making sure that no patients get in the way of delivering healtcare the way that the doctor wants it delivered, that's what.

I heartily concur with BurbDoc's public (and private) patient punishments and laud his commitment to making life as hard as possible for the insurance companies. Bravo!

Some of BurbDoc's memorable Tweets:

• Gitmo can be more charming than my waiting room.
• Fired one asshole today for being a dick to my front office staff and nurses. We'll have none of that shit on my watch. #totalbastardPCP
• #StandingOrders if you ask me what drug is covered by your insurance, I'll give you a blanker look than you can give me.
• #StandingOrders Any gas I pass in the exam room is blamed on the patient. No exceptions.
• #StandingOrders More than 2 calls demanding a pain med refill will get your rx called in to a pharmacy at random. Good luck on your hunt.
• #StandingOrders Asshat to my nurse? Icy Hot gel will be used on your DRE instead of KY, you prick.
• #StandingOrders Anybody being an Asshat to my front office staff gets to enjoy the ambiance of my waiting room for a minimum of 1 hour.
• #StandingOrders For safety reasons and OSHA rules no one is allowed to use the staff shitter after my #morningshit for 90 minutes.
• #StandingOrders Attach this picture of my asshole to all faxbacks to Medco.
• #StandingOrders All patients demanding an immediate callback will go to the bottom of the message pile.
• #StandingOrders All faxes from Aetna Active Health Management go straight into the shredder.

Cost Containment And The Future Of US Health Care: What Does It Mean For Student Doctors?

Healthcare is changing in the name of cutting costs. Will private practice truly remain private?

Click to read more ...

Radiologists Putting Surgeons Out Of Business?

Looks like the scalpel might be getting replaced by a keyboard and mouse

I recently watched a video where patients underwent surgery without a single cut. It's pretty unbelievable! For the past 13 years, Yoav Medan has been working as a pioneer in MR guided Focused Ultrasound Surgery. As I watched this clip,  I had visions of my future self telling my grandchildren (in a crotchety old man voice) about the good ol' days when we used to get to cut our patients open and slosh through their insides during surgery....those where the days.  I guess surgeons will have to start being a little nicer to the radiologists. They may need a job from them someday.

Stop Asking For Permission

Here's to the crazy ones.

By Franz Wiesbauer MD MPH

When we talk to our physician readers at conferences or during coaching sessions, several themes keep coming up again and again: Doctors think they don’t have enough time, enough money or both.

When we coach them, we usually ask them “What could be a way out?”. Very often the response is – silence. Physicians are very often unispired when it comes to creative solutions to their own job frustrations.

Why is this so? We think that it’s the physician-mindset which is the problem. We, as physicians, have a permission-based approach to work. All our lives, we had to get permission for doing stuff: we had to get permission to attend a good high-school, a good college, a good medical school etc. After graduating from medical school, we had the permission to practice medicine as a resident, after the board exam we got another permission, then we go into a sub-specialty and we get yet another……you probably guess it: permission.

So whenever we ask our readers, friends and clients: “…you have passion xyz, why don’t you just try to make it a side-busienss?”, we usually hear: “because I was not trained to do that.” Which basically means: “nobody gave me permission.” Do you think Steve Jobs would have come up with the Apple empire if he had a physician-mindset? Do you think that Mahatma Gandhi was trained to be the leader of a peaceful revolution? Do you think that Richard Branson got permission from anyone to start his multimillion empire? The answer is of course – “No”. And why “No”? Because most of them were the first ones to do the shitake they were doing. There just was no one around to teach that stuff.

So what do these successful people have in common?

1. They had an idea
2. The courage to start
3. The self-discipline to follow-through
4. The abilities of an autodidact

You passed all those difficult hurdles, you went through medical school and you probably are used to busy and exhausting work of a healthcare setting. So it is very likely that you have the stamina to follow through. We also assume, you are a quick and autonomous learner. Moreover, as we know from our talks with many of you, you might even have an idea. It is cristal clear, what’s holding most of you back from just f*n doing it is: FEAR. You don’t yet have the courage to start. And we will change that.

About: Franz Wiesbauer MD MPH is associate professor and clinical specialist for internal medicine at the Universiy of Vienna. His passion for healthcare and technology led him to found a physician e-learning company (123sonography.com) and to co-found MedCrunch.net together with Lukas Zinnagl MD. He is an author at Freelance MD.

Guest post: Submit your thoughts and be heard >

Crushing Wards: Becoming The #1 Chart Jockey

I must begin this post with a small disclaimer: I am not responsible for the level of awesome you will attain with the tips presented below.

Even though my medical school went paperless years ago, I am still regarded as an expert on this subject and can help you understand how to become the best Chart Jockey your medical school has seen...ever! If you think I am exaggerating, check my bio, and everything will begin to make sense.

“What is a Chart Jockey?” you ask. Well, imagine a group of race hoses thundering down a freshly groomed race track, with piles of mud flying in every direction as they pass. At the front of the group, one horse and rider have broken free from the pack. This jockey is the one jockey who will rise to the top and distinguish himself from the rest.

Now think of a group of bumbling medical students walking onto a hospital ward during rounds. They too are all headed toward the same goal, focused on one single purpose, grabbing the chart! However, only one will succeed; only one will become the person who can hand it to the attending physician, at just the right time. And in so doing, only one will pull ahead of the pack. That is the essence of chart jockeying. Some have said, that becoming a great Chart Jockey is one of the best things you can do as a medical student.

Here are five top chart jockey tips. Follow them and you will definatilly be on your way to the top!

1: Practice the art of speed walking without looking like you are about to crap your pants.

The idea is to be fast but don’t look fast. By doing this you, will get a jump on your team as they enter a new ward on rounds.

2: When you walk on the ward, it’s important to keep your head on a swivel.

Take a quick survey of the room, noting the “areas of chart concentration.” This step is important if you want to get the jump on the competition.

3: Never trust a nurse!

If you see a nurse drinking a cup of coffee, using a chart as a coster, I can guarantee it is the one you need.

4: Hiding a classmates chart never hurt anybody.

Going by the ward early and slipping the chart of a classmate’s patient into some inconspicuous location is always a great tactic. Under the crash cart or behind a trash can are my places of choice.

5: Be seen, and heard.

Make sure the right people observe your greatness. Remember, seeing how hard you work is almost as important as them hearing you talk about how hard you work!

I hope this really helps some of you elevate yourself beyond your classmates. Always remember, it’s not always about making yourself look good. Sometimes all it takes is for you to make your classmates look bad.

How To Start A Movement

Derek Sivers speaking at TED and demonstrating how movements really begin with the addition of a first follower.