Why Would a Doctor Abandon a Steady Paycheck to Become an Entrepreneur?

I joined my first business venture as a high school student in Los Angeles.

I got a phone call one day from one of my buddies who said he needed a substitute violinist to join his string quartet.

“Where are you performing?” I asked.

“At the outdoor mall–The Santa Monica Promenade.  We are raising money for our high school’s concert tour to Europe and we need your help Melinda.  We have almost reached our goal, but we need to perform a couple more nights to fund the trip.”

“How do you guys collect the money?”

“Oh….people just throw money into your open violin case.”

“Hmmm…not sure my mom will approve of that.  I may omit that detail when asking her permission to join you guys.”

My mom miraculously gave me her “ok.”

We were a group of four 15-year-old classical musicians performing on the streets of Santa Monica.   We vivaciously showcased the highly technical parts of the Vivaldi’s Four Seasons–and within 15 minutes–we had 80 people surrounding us and four opportunities to perform for local weddings.  We made $500 all together after counting up caseloads of cash on my first night.  My buddies asked me to join them again the following week…and every night it got even better.  Our group attracted crowds of well over 100 people clapping and singing to our music.  Kids would dance right up next to us and we would collect caseload after caseload of cash each night.  Even after we raised enough money for the European tour, we started booking gigs to be on TV commercials, movies, soundtracks for major bands, A-list weddings in Malibu mansions…you name it.  We got so busy, we recruited a second and third string quartet to keep up with all the gigs and opportunities.    And we started to form strategic partnerships.  The owners of a fancy Italian restaurant at the mall started paying us to perform right next to their patio to help them attract more customers.  One night, my grandma’s friend spotted me playing with the group with an open violin case full of cash.  Unfortunately, news traveled that I became “a street performer” and I was strictly forbidden to pursue this entrepreneurial adventure any further.

That summer was surreal.  I had never felt so alive.  I got to perform with some of the greatest bands and at some of the most extraordinary venues in the city.  I met A-list celebrities and made bundles of cash.  I was living a dream.  My partner, the first violinist, truly lived every musician’s dream: he went from playing on the streets of LA to his current role as a White House musician.  He regularly posts pictures of his performances for the Clintons and the Obamas on Facebook.  We got mocked and ridiculed for being “beggars”…but the opportunities and the money kept pouring in.  I experienced firsthand that with humility, an infusion of passion, talent, and a great business manager….the sky’s the limit in business.

But my carefree days gigging around Los Angeles quickly became obscured by years of rigorous schooling and medical board examinations.  Finally, 15 years passed and I landed my first job as a physician.  I was hired to work for a busy medical clinic ruled by several large HMO contracts.  On my first day at work, 65 patients were scheduled to see me for eye examinations.

“Okay, Dr. Hakim.  You have 5 minutes to examine and evaluate each patient.  If you spend any more time, then you will run late.  You cannot wash your hands in between patient encounters.  That will take way too much time.  We recommend that you use sanitizer instead.”

“What if the patient has a major problem or needs me to explain something in more detail?”

“Huh??  Just stick to the time sheet please.  Next week you will be seeing 75 patients a day, so we are starting you off light for now.  We will watch you in each room and evaluate how you budget your time so you don’t go over the 5 minute encounter.”

There I was working in an assembly line factory.  I had no time to ask patients how they were doing.  I had no time to wash my hands?  I had to play by the rules, or I would lose my job.  I would come home like a corpse.   I could barely move my back from examining patients.  My joints became stiff and cramped from the repetitive motions.   I never really got to know my patients.   I felt suffocated and burned out.  I longed for those days when I would make music with my buddies under the stars….We had inspired so many people, entertained them, and made a ton of cash—on our own terms.  We opened doors to dozens of exciting new opportunities by taking a chance and putting ourselves out there.

Working as an employee in an overcrowded, impersonal medical clinic gave me a nice, steady paycheck–the steady paycheck that would make anyone’s parents proud.  This was a 180 shift from the shame on my folks’ faces when they discovered that I was performing next to a violin case full of dollar bills.  But a part of my soul quickly died after I started working at this clinic.   I desperately needed to revive that part of myself back to life.

I decided to start my own medical practice.  I also started my own internet company, DoctorCPR, to help other physicians find better jobs and resources for their careers.   I finally began to feel the energy and passion of my 15-year-old self again.  I was able to practice medicine on my own terms.  I was able to build something from nothing and create new opportunities for growth for myself and others.

As physicians, we are expected to be compliant with rules, restrictions, and regulations.   We are expected to be risk averse. We are expected to be “providers,” but not necessarily innovators or leaders.  As the healthcare system becomes increasingly consolidated into large overcrowded clinics, we are required to perform to the standards set by bureaucrats and clinic managers.  These rules are often at odds with the best interests of patients and with our sanity.

Entrepreneurship is not only a welcome escape route from the demands of cold, factory-like health systems.  Entrepreneurship is the opportunity for physicians to create a clinical experience infused with their own personalities, quality of care standards, and joy for healing others.   It is the chance for physicians to explore their authentic selves.  If a patient wants to tell me about how her husband passed away, I can now make the time to hold her hand and listen.  If a doctor asks me who the best medical biller is for his office, I can give him a well-researched reference through my new internet company.  I can create true value for thousands of people through entrepreneurship and know that that value is genuine and heartfelt.

Several physician entrepreneurs’ messages are so captivating that they have recently inspired cult-like followings of hundreds of thousands of doctors.  For example, Dr. Zubin Damania, also known as “ZDoggMD” a highly accomplished internist at Stanford University decided to quit his medical job to create musical rap videos about the broken healthcare system.  He gained so much traction across the globe for his bold creativity, that he was invited by Tony Hsieh, CEO of Zappos, to build Turntable Health—a new healthcare system that is revolutionizing the delivery of healthcare in Las Vegas.  He currently has hundreds of thousands of social media followers (humorously known as the “ZPac”) who are passionate supporters of all of his entrepreneurial endeavors.

Dr. Pamela Wible has also devoted a large part of her life to inspiring doctors to become entrepreneurs.  She consistently reminds us about the staggering physician suicide rate (at least 400 doctors kill themselves annually—about twice the rate of the general population).    She teaches doctors around the country that, to find true happiness, they must have the courage to build their own ideal medical clinics and practice medicine on their own terms.   Her viral articles, lectures, retreats, and best-selling books—Physician Suicide Letters and Pet Goats and Pap Smears–have reached hundreds of thousands of physicians who look to her as a role model.

Silicon Beach in Los Angeles has embraced a new generation of forward-thinking physicians who are determined to make our healthcare system better.   I am meeting like-minded physician entrepreneurs all over the city every day.  For example, hundreds of physicians are joining the Society of Physician Entrepreneurs and attending healthcare innovation meetups all over town.  Physicians are starting to join healthcare startup accelerators.  Many of us are joining the advisory boards of new transformative healthcare companies.  Physicians are building healthcare apps, starting new medical practices, building new hospitals, establishing urgent care and surgical centers, developing medical devices, creating telemedicine companies, starting house call businesses, designing electronic medical records systems and much, much more.

We are taking risks, embracing innovation, and realizing that assembly-line healthcare is not going to be the panacea to the nation’s healthcare problems.  Being a cog in the wheel of a large bureaucratic system is leading to physician burnout.

It is a daunting path to become a physician.  It takes years of brutal training, studying, delayed gratification, and commitment.  But even more daunting is turning your back on a hard-earned, guaranteed salary to create and grow a business that inspires you and the world around you.

Although there is tremendous pride in receiving a predictable paycheck, you can’t experience true liberation until you say “no” to the work you are expected to do and “yes” to what your heart feels compelled to do.  There are no guarantees of success, and the odds may be stacked against you with any new business venture.   Maybe I am crazy, or still just as naïve as I was at 15…but every day I am propelled by the belief that taking a chance to transform healthcare is a risk worth taking.

Melinda Hakim MD

Dr. Melinda Hakim, comprehensive ophthalmologist in Los Angeleshttp://www.doctorcpr.com/blog/why-would-a-doctor-abandon-a-steady-paycheck-to-become-an-entrepreneur/ 

The Alienation Of America’s Best Doctors

The best and the brightest simply don’t want to become doctors anymore. Physicians are burning out. They are leaving the profession. They are going bankrupt. They are selling their private practices to big hospitals. They are retiring early. We are facing a growing doctor shortage.

Better to Live and Die in the U.S.A.

The United States healthcare system is often berated for how it treats patients near the end of life. They are purportedly attached to tubes and machines and subjected to unnecessary invasive procedures that cause inordinate pain with no potential benefit, there is underutilization of more compassionate hospice services. This “travesty” is expensive, as the care of dying seniors consumes over 25% of Medicare expenditures. We hear this story so often; it is almost taken as gospel-- but is it actually true? Is it more expensive and invasive to die in America than in other developed countries?

Gun Ownership and Doctors?

According to the Pew Research Center, there are approximately 32,000 gun-related deaths annually in the United States; 19,000 are suicide, 11,000 are homicide, and the rest are accidents, police shootings or of unknown causation. Moreover, there are more than 78,000 nonfatal gun wounds each year. Given the disproportionate number of victims that are less than 40 years of age, the morbidity and mortality of gun violence is significant. Physicians are involved with many types of public health issues, but few are as controversial or divisive as gun safety. Is it really an issue that falls within the medical domain?

O Tempora, O Mores: Affordable Care Act - Big Dream or Big Let Down?

I confess I was a strong proponent of the Affordable Care Act. My reasoning was subtler than the hallowed pantheons of its staunch supporters and the apocalyptic predictions of its detractors. Forty years after graduating medical school I concluded, after many stutter steps, the American healthcare delivery system was economically unsustainable and the citizenry was neither living longer, nor better, despite medical expenditures that dwarf any other developed nation. My career also allowed me to personally interact with cardiac surgeons from all continents and see that their clinical results and research efforts were laudatory by any standards.

High Depression Rates in Resident Physicians — Fact or Fiction?

The December 8, 2015 issue of JAMA had a startling key clinical point; the prevalence of depression or depressive symptoms among resident physicians in training was 28.8%. The data was generated by meta-analysis of 31 cross-sectional and 23 longitudinal studies published in peer-reviewed journals involving 17,560 trainees. Two-thirds of the trainees were in North America, but the others were from Asia, Europe, South America, and one from Africa. Sensitivity-analysis confirmed that no individual study affected overall prevalence by more than 1% and that the incidence of depression was not influenced by study design, continent of origin, surgical vs nonsurgical program nor level of residency year.

Can a Robot Outperform Your Surgeon?

In the current competitive environment, healthcare providers often attempt to separate themselves from their competition by marketing themselves as using the newest technologies for their procedures. This is an age defined by finding the next best thing and the American public responds to this strategy. My personal experience has been in cardiac surgery, but the principles are equally applicable to other specialties, particularly tertiary referral practices.

Hospital Administration Attempts to Cut Costs and Increase Quality at Expense of Physicians

A nonprofit hospital care system in Oregon with 450 beds has been in an acrimonious negotiation with its staff hospitalists for the past 2 years. The mounting economic pressures on this small, community oriented institution have had the expected consequences of hiring new administrators to implement the latest trends to rein in the budget and effect efficiencies of healthcare delivery-- as if that has been so successful in the rest of the country. The battle has really centered over the physicians losing control of their work time allocation, individual decision-making for diagnostic and treatment plans, as well as bristling at bonuses based on the administration’s definition of quality.

Michigan Physicians Society Supports Inner-City Education

Yesterday afternoon I had the privilege of helping to honor the graduating class of 2016 at Experiencia Preparatory Academy. They have 3 graduates this year that have overcome a special set of challenges, including moving from Mexico to the United States and having English as a second language.

Affordable Care Act: Affordable for whom?

Entering its third annual open enrollment period, Obamacare is the subject of cacophonous political acrimony, again, championed by its supporters and vilified by its opponents. Each side presents its own “metrics” of success or failure

Big Pharma Using Mail-Order Pharmacies to Maintain High Prices

The United States has the dubious honor of paying the highest prescription drug costs in the world. Many healthcare economists attribute this to relatively lax cost regulation compared to other wealthy countries; however, a decade of insurers paying only for generic drugs when available and limiting drug choice in specific formularies has had little modulating effect.
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