Managing Student Loan Debt

A Government Program You Need to Know About

As graduation approaches, medical students are concerned with two things: having as much fun as possible before internship starts, and what to do when we have to start repaying the massive amount of debt accrued during school. I can't help you with internship, but I do want to point you to a relatively new (2007) government program which graduating students should seriously consider. The video below explains the value of combining Income Based Repayment (IBR) with Public Service Loan Forgiveness (PSLF) instead of entering forbearance as a resident. These two programs combined could save you $200,000 or more in the long run. The best part? To qualify you only have to work for a non-profit, and 80% of hospitals qualify.

Finally, make sure to file a tax return during your graduating year even if you didn't make any money as a student, as the next year's IBR will be based off that income. Check it out and let us know what you think!

5 Uncommon Approachs to Residency Interviews

Thoughts from the interview trail

Finally the interview season is wrapping up. Here are 5 points to emphasize before embarking on the path to the rank list.

1) Interviews are more exhausting than you might originally think.

It takes a lot of work to put on your "game face" for 36 hours, to make sure you don't say anything inappropriate and to think of insightful questions to ask so you don't look disinterested. Be careful when planning your travel schedule to include time for rest, as a tired interviewee comes across as boring and unenergetic, traits which stellar board scores can never make up for.

2) If you don't enjoy the residents or attendings at an institution, perhaps it just isn't a good fit.

Don't be too hard on yourself. If you're miserable at work, you will not be academically productive and your patients will not get the care they deserve. The best team is a team with excellent work relationships, and though in your head a program might be your top choice, perhaps you will be better off in the long run somewhere else.

3) There's no reason to be nervous. 

Most interviewers these days just want to get to know you. Occasionally one will put you on the spot or ask tricky questions. You can prepare for the typical interview questions by pondering them ahead of time (things like "what was your biggest failure?"). The unexpected interview questions like, "what is the therapy for recurrent acute myeloid leukemia?" are likely questions other students would struggle with too, so just be humble and move on rather than letting one question destroy the whole conversation.

4) Some interviewers are quiet and difficult to talk to.

Perhaps this is the way they are typically or perhaps you just don't have much in common with the interviewer. A solid strategy at this point is to take control of the conversation by bringing up topics that augment your applications, either academic or personal. Perhaps if you've done a lot of travel, you might ask "are there opportunities for residents to do international electives?". Or if you're strong in research, perhaps you could ask, "what are the research opportunities like here?".

5) Be confident. You might think you don't deserve the interview or are concerned about matching, but they brought you in for a reason.

If you're at the interview, you're qualified to do the work. At this point they want to see if you will be a good fit for their program, a program which they have worked hard to build and which they have big dreams for the future. If you're a part of that future, they will be interested regardless of your board score.

One excellent and very detailed book to check out is, "The Successful Match: 200 Rules to Succed in the Residency Match" by Dr. Katta and Dr. Desai.

Best of luck to everyone going through the match. Please feel free to comment, as discussion makes us all better.

Interview: Preparing for Physician-Entrepreneurship

Troy Heidesch, Founder of Smart HouseCalls, speaks to students about starting a business.

Remember the blog post in December about Dr. Toby Bond? Well as it turns out, Troy Heidesch consults as a part-time Nurse Practitioner in his office and is equally as innovative. Troy is founder of Smart HouseCalls, a new start-up which connects patients to their physicians more effectively using webcam technology. His system is HIPAA compliant, high definition, stable, secure and most importantly, billable. Using this technology, quick follow-ups and educational meetings can be arranged over the internet face-to-face with the provider rather than over the phone with the office staff. This has the potential to make an enormous impact in rural areas where access to healthcare is a serious issue as well as add convenience to patients who might not otherwise follow-up due to a busy schedule. I was able to sit down with Troy to discuss his work during the start-up process--hopefully you'll find his insights helpful.

Q: Tell me what you're up to.

A: I am the founder and CEO of a Biotech startup called Smart House Calls. We have built a telemedicine platform that allow physicians to communicate with patients from anywhere to anywhere with an internet connection and then charge  either the patient or the insurance company for that interaction. This improves patient access to timely and convenient care, decreases emergency room visits, and is an income accelerator for primary care providers.

Q: What has been the most challenging part about starting a business?

A: Patience and getting over self-doubt. You expect that a great idea will sell itself. After a few months you realize that success is in the execution rather than in the idea and execution takes time. I believe that self-doubt is common to most entrepreneurs. You think, “Who am I to build a potentially very large enterprise?” Then, as you immerse yourself into trying to succeed, you start seeing that you are really no different than other successful entrepreneurs. You read voraciously, talk with anyone who will listen, and suddenly you find that you are executing and doing a respectable job.

Q: How have you changed your clinical practice to allow time for your business?

A: I work as a consultant for primary care practices seeing patients and then installing our system. This is now giving way to full time within the company as sales begin to ramp up. I get up at 5 AM, do a little work for Smart House Calls, go see patients, and then work until about 7 or 8pm before spending some time with my family. On the days when I do not see patients, the hours remain about the same (and that includes weekends!).

Q: What should students who have entrepreneurial interests be doing to prepare for a different career when they graduate?

A: Read. Great book to start with is “The E-Myth Physician” by Michael Gerber. Decide whether you want to be an employee in your own business or be a CEO at the beginning. They are VERY different from each other. A physician as an employee will spend the day seeing patients and spending time every week to make sure the staff is paid and will pay attention to billing. The CEO will build systems that will work regardless of personnel and will be able to scale. They will spend most of their time thinking five years ahead and implementing strategies to push the business in the direction they envision.

Q: Any other comments?

A: If you have a great idea, talk about it to everyone person you meet. Do not worry about someone stealing your idea. Ideas are a dime a dozen, it’s the execution that is hard. By talking with everyone about your idea or plan, you will gain insight into the marketplace to help determine whether you really have something that people would want to pay to get. Finally, drop any ego or worry of losing control, hire people who are obviously much better than you. They will make you better and will pull your business to success much faster (success may not happen at all without this type of talent). A people should hire A people. If you hire B people they will hire C people and so on. Your idea will flounder and die if your first hires or partners are not exceptional.

So readers, what are your questions about starting a business? Leave comments and we'll get the discussion started.

A big thanks to Troy for his time and insight into these issues. For more information, see their website at SmartHouseCalls.com.

Dr. Toby Bond & The Future Of Private Primary Care

Using the EMR to Minimize Stress in the Office

This past month I have had the pleasure of rotating with a visionary internist who is leading the way into the new era of American primary care. In a time when many independent physicians are closing down, Dr. Bond is just getting started, opening his doors in the college town of Athens, Georgia in 2010. If you're a student interested in someday going out on your own, you should find his business model encouraging and his managemet tips helpful.

Dr. Bond, while considering himself an "old fashioned family practice", has done a number of things very differently. "We've embraced the technology," says Dr. Bond. "By opening our doors in 2010, I was aware of the future of the electronic medical record. We invested heavily in a system that would work for us, and designed the office to be paperless from the ground up." By accomplishing a modern office, he is now years ahead of offices who are laboring to transfer established paper charts to their EMR. And trust me, this makes a world of difference in job satisfaction. "I'm done with the note when I leave the room. There's no stack of charts at the end of a long day."

When discussing why his office runs so smoothly, Dr. Bond gives credit to his staff. "Hire a strong office staff, train them well and compensate them accordingly." The office staff is indeed very impressive. They are well-trained to work as a unit. Each member of the team plays a vital role in the workflow of building the initial electronic chart, scanning records, scheduling specialist visits, drawing labs and recording phone notes. And at the end of the day, it is all available at the click of a button.

In marketing his practice, he targets those patients who will appreciate the technology. "We have an online patient portal, so we market to those who might appreciate the access." By using targeted advertising such as the nearby University of Georgia athletic events, his practice is well attended by young university-associated patients.

The electronic record is more than a note--it has major implications in billing, which is tracked by Dr. Bond directly. "Previously practices would be months behind in billing, often resulting in a large number of write-offs on labs and procedures." By combining the practice's electronic system with some knowledge of how notes are related to billing criteria, Dr. Bond is able to stay organized and on top of the current records. The use of computers to simplify the complex billing process will be what allows future independent physicians to keep their doors open.

The final product of a clever business model? A smooth work day, healthy patients, organized records and a much happier physician. "Medicine is a hard job no matter what specialty you're in," says Dr. Bond, "but it is much more enjoyable when you have time to spend practicing medicine rather than worrying about documentation." Seems to me that the small-town doc isn't going anywhere after all.

For more information you can visit Dr. Bond's website at www.drtobybond.com

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?

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