Tough Love: 7 Signs Micropractice is WRONG For You

In this episode I discuss seven signs that direct care micropractice might not be a good fit for you including

• Why micropractice stats can sometimes be misleading
• The things patients can sense right away that will tank your practice
• A good “test” to decide if you’re ready to make the leap
• A guarantee I can make about micropractice
• The ways side gigs can hold you back

If you're enjoying this pod, I would love to connect! Real human feedback is so deeply appreciated. Here are a few ways to reach me:

Connect with me on IG @soniasinghMD
Email me at sonia@micropracticemama.com
Learn more at www.micropracticemama.com

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And if you're not sick of my voice yet, check out my other podcast with Dr. Rebecca Berens: The Antisocial Doctors on Apple Podcasts or Spotify!

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Transcript

Speaker 0:01

Hey doctors. You're listening to the Micropractice Mama Podcast, a podcast for women physicians who are striving to practice primary care sustainably and creatively with autonomy, authenticity, and joy. I'm your host, Sonya Singh, internist, PCP, and proud mother of two human babies, one for a baby, and one life-changing micro practice. I wanna empower you to push past whatever is holding you back and make the leap to launching a practice. That aligns with your values and priorities, and finally allows you to take care of your patients, your family, and yourself in the ways that you want and deserve. Are you ready to make the leap? Let's do it.

Speaker 2 0:45

Hey doctors, I hope you're having a good week. I have a slightly different type of episode for you today. Most of my episodes, and generally this platform is about trying to encourage and empower fellow physicians. To consider direct care or micropractice. And that's because I think there are a lot more physicians out there that could do this successfully and could benefit from this practice model that either don't understand it fully, dunno enough about it, or are too scared and feel like they can't, but they actually can. But. What I don't talk about as often is I think there is a much smaller subset, much, much smaller of physicians who maybe think that they can or should do this and they should not. As much as I am a proponent of this model and want to help as many physicians as possible do it, I don't encourage every physician I meet to do, and I don't think it's the right choice for everyone. And I think over the past couple of years as I've had more and more people approach me, I've seen a lot of different flavors of physicians who are exploring this practice model. And there's certain varieties that I can see from a, quite far away are probably not the right fit for this. And I would hate for those people to invest all the time and energy and money in trying to do it and then realize that. It's not a good idea. So I decided to make this episode called Tough Love, and basically I'm gonna go over seven signs that maybe Micropractice is not the right choice for you. And I wanna start with a very big disclaimer on this, which is, first of all, this is my opinion, and I'm talking very much about micropractice of the flavor that I. Do myself and teach. So this is not to say that no direct care practice is right for you these are really signs that you're not probably a good fit for my particular direct care micropractice model that I teach. The other big disclaimer I wanna put on this is maybe some of these things sound like you right now, but it doesn't mean that. That's going to be you forever. So I will like readily admit that there are many times in my life when some of these things apply to me and I was not ready to start a practice and it would not have been a good choice for me. There are people who successfully start practices right out of residency. I think for someone like me, I, I don't think I could have done that. I was really not comfortable with my skills as an outpatient clinician. Probably until. Sometime into year two and now that I'm almost 10 years in, now I even look at who I was at year two and think oh my gosh, I'm so much, I've learned so much since then. But I did not feel really confident and comfortable handling a lot of stuff remotely and just, I was still learning how to be a. Primary care physician. So I did not feel like I could have done a great job at this right out of the gate. I think honestly for me, I would not have been able to do this had I not had things be as bad as they were in my job when I left and have my son as a huge driver and motivation. I don't think everyone needs to have a child to be motivated at all, but for me personally, I just think I. Would not have felt the pressure the way I felt when I had this tiny human looking at me wanting my love and attention and time and having this feeling that I didn't have the bandwidth to give it. And I, if you hear me talk about some of these signs and you start thinking, oh my God, like that, I do feel like that. Maybe I shouldn't do this. Just remember that. These things are dynamic. They can change, and just because you're not ready right now or it's maybe not the right fit for you right now, does not mean in a different season of your life. It may. You know it, that it may not be the right, it may, okay. I mix this all up, does not mean that it's the wrong choice forever. Okay. Alright, so those are all my disclaimers. So now let's get into what the actual signs are. So the first one I would say is if you're considering micropractice or direct care, because you just want practicing medicine to be easier. And that's really the driving motivation. I don't know if that is really. The best primary motivation to choose Micropractice. I, I think direct care generally, and definitely micropractice. There is this big simplification, which I talk about a lot. And I also think, when I talk about the volume of patients that I see, which is like 10 to 12 visits per week mix of in-person and virtual, I'm usually seeing like. Two to three per day, and I'm going into the office maybe four days per week, and I have a total panel of 1 75. When I say those numbers, I think a lot of people's ears perk up and they're just like, whoa, that sounds amazing. That sounds so easy. And Shane, who I had on last week, and I were just talking about this yesterday, where there's like a conversion factor. It's micropractice math, where. You may look at it now and think oh my God, five patients in a day, piece of cake. Like I'm used to seeing 25, but it's a totally different beast. And for me, five patients in one day now is an insane day. I'm like, oh my God, I'm so busy. I have five patients today. I think six or seven might be my absolute record in Micropractice for how many people I've seen in a day. And even that was an anomaly. It was the day before I went on vacation and I was cramming everyone in. I think, and I feel like I'm guilty of this because I do share those numbers a lot, and really the point I'm trying to make is that probably good primary care needs more time and energy, and probably the panel sizes that we are given in traditional practice are unreasonable. And actually when do medicine the way that you want. It takes way more time, than you think it will. But also in micro practice, because you don't have staff, you are doing a lot of the other parts of the task. Faxing out the records request, reviewing all your faxes changing the table paper on the exam table,, you're doing all of those things and so things just take more time than you think they're gonna take. So anyway. When I say those numbers, I think a lot of people just think, oh, that sounds like so much easier. That sounds so much easier. The numbers are, not, they're not exactly what they may seem to you coming from the lens of traditional practice, but also. Running a business, starting a business, being the only person in the business, like the buck stops at you. There's no one, there's no it person to fall back on. There's no staff to blame something on, there's no manager to go handle a difficult patient like it is you is not easy, and none of that is easy and. It's ironic that I'm talking about this because I feel like the vast majority of people think it's going to be way too hard and they can't do it. And so those are the people I'm mostly talking to in this podcast to try to convince them that no, actually you can. But I do think there is a small subset of people that maybe have this delusional belief that once they set everything up that it's just gonna be easy and that this is not gonna be that hard. And these are the people and I've met. A few of these. And these are the people that if they do end up pursuing that, pursuing it, what I see them do is honestly be lazy about it, where they will just copy and paste somebody else's website, be like, I'm just gonna do exactly what that person is doing. Just put it out there, not put a lot of thought into it. Be doing the bare minimum in terms of customer service and patient experience, and then just be like, why is this not working? Or what I have, what has happened to me multiple times is people have approached me and said, do you wanna take a partner? Can I join your practice? Because I think they see from the outside the final result, of having a more well balanced life and a much more manageable schedule and flexibility and autonomy and all those things. And they're just like. I want that, but without any of the hard work of actually starting it. This is a controversial opinion, I have never wanted to take a partner in my practice because I feel like if somebody is a good fit for this model. The best thing for them is actually to be doing it on their own. If they are, if they were, if they're gonna be a good DPC or Micropractice doctor, with my particular flavor of Micropractice, I would much rather for them that they be the ones in charge and they do it the way they wanna do it on their terms and not have to answer to anybody. And that's financially what's gonna be best for them. And that is in terms of autonomy and work-life balance. Probably what is gonna be best for them? I think there's an argument to be made about practice sharing. I think that can work for a lot of people, especially if you're very aligned on your philosophy and your mission and your values. If you find somebody who is truly a great fit for exactly what you have in your practice, then great. You can do that. Part of why I've done Micropractice Mama and not just tried to franchise my own practice is because of this core belief that the best thing for these physicians who are right for this is to do it themselves. I think a lot of people would say I just I really don't wanna do the business aspects of it. In terms of a medical model and like the way DPC doctors practice, like that's how I wanna do medicine. I can understand that. And I do think for somebody like that, working at A DPC that already exists and becoming, employed at A DPC or becoming a partner in A DPC is a good place to start and to see how it goes. I think for most of us who crave autonomy and have a, even an inkling of that entrepreneurial spirit or that kind of. I don't know what the right word is. If you're able to draw and attract patients and, are successful as even an employed doctor at A DPC practice, you will eventually have the thought, could I do this on my own? Should I be doing this on my own? Now that I see how this sausage is made and it, looks like I could do it, should I just do it on my own? And so I think a lot of people, even in that situation, may end up going off on their own. Anyway. Basically the bottom line is that. This is not easy. This it, it may look easy by the numbers, but I will tell you right now in a completely honest, transparent way, that it is not easy. It is just hard in different ways than traditional practice. So my feeling is that, yes, it is hard because you're having to learn a lot of new skills that you did not learn in medical school, that nobody taught you. They're you're learning on the job. Those are all the administrative and business management skills. But also, honestly, it. It's hard in the ways that medicine should be hard. It's hard because you're probably gonna get more complex cases and you're gonna have more bandwidth to actually engage with them and not just send five referrals out, it's hard because you're gonna end up doing a lot more care coordination than you ever even offered to do before. There were times in my old practice where I would just be like, yeah, there's no way I'm gonna get those two specialists of yours to have a conversation. I can't do it. That would be like moving mountains. And now I will try to do those things. It's hard because you're now gonna be more emotionally present. And not everybody, but the flavor of doctor that I think a lot of people who are drawn to Micropractice Mama are people who want to be, fully emotionally present in their patient encounters. And when you're doing that. All the time for an hour. It is draining. Like that's hard. It's not easy to do that. It's hard because you're gonna have to set boundaries. There's not these hard and fast rules or these like clear, you're on the clock from this time to this time the way you are at a traditional W2 job. And so you're gonna have to learn how to set those and how to stick to them. And then there's all the usual hard stuff of primary care, which is saying no to antibiotics and benzos and MRIs that are not needed and, all of that stuff. It is still hard. It is just hard in slightly different ways than what you're probably used to. So number one is don't just choose this because you think it looks easy, because it's not easy. Okay? Number two is do not do this if you just don't really like medicine. I have definitely had people approach me that are like, I've been exploring all these nonclinical jobs and this insurance review and this and that, and I don't know, I'm thinking maybe A DPC. To me what they're saying is, I just don't like this work, and I'm thinking that DPC or Micropractice would be less of this work. I don't think that is a good reason to do this. I think that if you really just don't like medicine and don't like being in clinic, one thing I would ask yourself is, am I just. Really severely burned out because I think if you're burned out or clinically depressed, that really fogs your view and your opinion and your judgment. And so maybe, you actually would like medicine if you were not burned out, but you can't see it clearly right now. Or you may just actually not like it. And if you actually do not like it. You're not gonna suddenly like it, even when you're doing less of it. If burnout is the issue, then I think finding a way to take a break or do something to directly address the burnout before making the decision about whether you're going to start an independent practice or not is probably the way to go if that's feasible. If you just genuinely are like, yeah, I just made a mistake. Dick in choosing this I don't really like it. The problem is, patients can smell that. Like they're gonna know that right away in DPC, something that's unique is. Unlike traditional practice where there's a clear financial incentive to see patients and have appointments and, increase volume in DPC because they're paying you this flat monthly membership fee and it's, up to you and them, how often you see each other and how often you go to the office and all of those things, it, they have to really trust you to do the work when it's indicated to, to come into the office and see them when it's appropriate to see them, rather than just sending them a text and saying, yeah, we'll try X, Y, and Z. And I think on some level they may not be totally conscious or able to verbalize it in that way, but I think patients are very aware of that. So if they reach out to you with a concern and they get the sense at all that you are trying to brush them off or avoid doing work for them. That's it. That's a wrap. Which is why, even though I have the luxury and the flexibility and the freedom to take care of things by text message, I always err on the side of offering the visit. I will never, ever make it feel like. Oh no. You don't need to come in. I, it's honestly, most patients in my practice, because most of them are like busy professionals. They don't want to drive across town and come see me if they don't have to. But I always try to err on the side of offering the appointment, even if I don't think it's absolutely necessary, because I wanna make it clear that I am available to them. I'm willing to do the work. I'm not trying to brush them off. I think it's really important that they get that sense from you all the time because of the way the financial part of it is. Structured. And so if you just don't like medicine, honestly, you may think you're hiding it, but I feel like it shows, and I think it's a, it's gonna be a big thing to overcome if that's something you feel and you're trying to run a practice. Okay. Actually one last thing on this, the other thing that I will say patients will notice is even, beyond just like offering a visit, I really think patients appreciate and notice when you are willing to do mental work for them. So there's times when somebody will ask me a question and I won't immediately know the answer, or I'll be like I could look and I think, just. Being willing to say I, I'm not, I don't, I haven't, it's been a while since I read up on that. Let me read up on it and get back to you. Or they'll present you with a symptom and you'll be like, yeah, I'm not really sure what that might be coming from. And just to say, you know what, let me think about the, gimme a day to think about this. Let me mull this over and then I'll get back to you. If you just don't like medicine, you're not gonna, you're not gonna say that stuff. You're not gonna do that stuff. You're just gonna you're gonna give them kind of a superficial response and you're gonna move on. And I just think there's so many little places where not being a good clinician or not enjoying clinical care is going to show itself whether you're trying to or not. And anyway, I, if you don't like medicine, I don't think this is a good idea. Alright, next. Number three. You don't like patients. If you don't like patients, I think it's gonna be really hard to attract them independently on your own without the machinery and marketing team of a big institution. Let me give you a little background on how I arrived at this particular you don't like patients. I had a conversation with somebody in my course about, whether doctors who are unlikable or like patients don't really like whether they know that they're unlikable. And the conclusion we came to is oftentimes those physicians who patients don't really like, they will just. Say it's the patient's fault. Like they will be like patients just are terrible. Patients just suck. The patients just don't, they just always come in with their 20 complaints and the patients just never wanna play their copays. And the patients, they will just be constantly harping on the patients and it is very normal. We are humans like anybody else. I think it's very normal for physicians to have complaints about patients. It's what we do every day. We're in. It, it is a customer service. We're customer facing and that comes with a lot of frustrations and it's totally normal to have those gripes. I have them. You have them? We all have them. Okay. But I think the people who are particularly unliked. Experience those negative experiences with patients more often and then therefore, have this perception that patients are just terrible. So if you're one of these people who's just oh my God, patients are the worst, and I just don't have any good patients I, you, that may be a sign that. You are not having positive interactions with a lot of patients and they're then responding that way because they're not having positive interactions. And so anyway, if you just don't like patients and you're finding yourself complaining about them constantly This may not be right for you. And again, if you're severely burned out or clinically depressed, you may have this negative, filter on where you feel this way at this moment. But if address that burnout or that depression, maybe you wouldn't, because I will tell you there, there is definitely a time when I was convinced that I just did not like clinical medicine. I did not wanna do anything. Patient care facing. That was in the depths of my burnout in residency when I just thought I had made a terrible mistake and I have chosen the wrong career. And I could not feel more opposite of that than I do now. And I think you have to like really dig deep to decide is this, a true underlying core feeling of mine? Or is this something temporary that's related to my circumstances? And I think the way I view a lot of the interactions that I had with patients that were frustrating, especially in traditional medicine, was that, for instance, I would get really frustrated that. A patient had sent me like six portal messages about adjusting their blood pressure medicine. When I'm just saying just come in for an appointment, but I can understand that. Actually that task was easily accomplished remotely via portal message. The issue was not that the patient was asking me, the issue is that the system is structured such that I'm not getting paid or compensated or valued for that time and energy and medical decision making that I'm doing, and I am getting frustrated because that's free labor that this patient is asking me to do, but the patient does not know that, they don't understand the way this works. Like they're not trying to avoid coming in because they don't want to pay me for my work. Everyone's trying to save a buck here and there. So it's maybe that's part of it, but really, it's very logical for, from their standup standpoint.'cause it's I'm sending her my log, I'm telling her what I'm taking. All she needs to tell me is what, whether she thinks I need to increase or not. And when I need my next BMP. And that seems like she can tell me that, without me driving across town, waiting 45 minutes, sitting there, talking to her for five, having no one really touch me and then leaving, I think once you shift your worldview and your sort of thinking about some of these behaviors, as w. Aren't these just humans acting pretty rationally in a very dysfunctional environment then, you can give a little bit more grace and have a little more compassion for people who frustrate you. Not everyone, a lot of situations. And when I started my practice, I remember my husband was like, after I don't know how long it was maybe eight or nine, like a pretty far in. I like had a slight complaint about somebody who was like, it's crazy. I have not heard you complain about anyone for a year. And it's not like I was complaining all the time before, but it was definitely a lot more frequent that I was like, oh my God, I had this situation where this person said this thing to me or did this and asked me to do this. And it's just, it's so much less in, in micropractice. Anyway, if you just fundamentally feel like you don't like patients and you're constantly complaining about them I would ask yourself where that's coming from. Okay. Number four. If you've never considered or encouraged DPC for your own friends and family, then you might not be ready to start your own DPC. Why do I say that? Again, this comes with caveats. I think people have varying degrees of comfort with treating their own close friends and family. I have zero comfort with treating my own family. I, can tell you I am so an objective. Like I just cannot be clear minded and objective about, especially my own nuclear family. I can look in my kid's ear and be like I don't know. Is it infected? Is it that infected? I would never have that. Thought about looking in adult's ear, like I feel like it's pretty straightforward and clear cut, but somehow when it's my kid's ear, I can talk myself into multiple different, interpretations of the same eardrums. So anyway I don't feel comfortable at all treating my own family, so it's, to me, it's a no brainer to sign my kids up with a DPC pediatrician. I'm also internal medicine trained, so I'm not. I'm not pediatrics trained, so I don't feel qualified anyways to take care of my children. But I know a lot of people who are family medicine who I think do feel very comfortable taking care of their spouse or their kids or even their close friends. So you might say I don't do it for, myself or my family because, I, I feel comfortable managing these for myself. You probably shouldn't be your own doctor, but hey whatever flows your boat. But if you do the thought experiment of if you were not able to handle your family's needs, you were not a doctor, would you consider signing up for one of these services? And if the answer is no, I would explore why? Because that means that you, yourself, internally, are not totally convinced of the value of this product. I think a lot of doctors would answer that question by saying, yeah it doesn't really make sense for me'cause I don't really see my doctor that often. Or, when I do have a need, I ha my pediatrician is a friend of mine is a colleague is down the hall so I can just call or text them. I want you to know if you're one of the people that's doing that. You better be really grateful. You better be buying that person a lunch or a nice dinner or sending them a nice holiday gift because they are doing free labor for you. And that pediatrician, that PCP is probably also doing a ton if they're in traditional practice environment, is also doing a ton of free labor already for other people. And in a way you're part of the problem if you are constantly getting concierge level access and care without paying for it. I think there are exceptions to this. I think there's a lot of times when we have mutually beneficial relationships like. I don't feel as guilty pinging specialists that I refer my own patients to often with curbside and questions because we have a relationship. We send a lot of patients back and forth, they understand that if this is a something that requires specialty care, that they're gonna get that consult, it's gonna come to them. I, the there's exceptions to this. You're not just automatically exploiting someone if you're doing this, but I would seriously think about that. I think there's this culture of, giving our colleagues special time and access and care as a professional courtesy. And I totally get that. Like I, it definitely did that in traditional practice. I would squeeze people in, when. I had no appointments available. If it was a, a fellow physician, I would definitely, be willing to call them or text with them after hours over non-urgent things if they wanted to talk to me. We all do those things, but I really think it's time to, to ask ourselves do we want to perpetuate that or do we actually want to. Respect and pay our colleagues for their time. And when my pediatrician went DPC I was so excited and grateful for her because I was doing that. Like she looked at my kids' ear on her porch. She left formula samples for me outside her porch. She was definitely, I definitely had texted her after hours and on the weekend. And so when. She started her own practice and I was able to pay her to do that service for me. I felt so grateful. I was just like, I'm so glad I get to do this for you. I'm eager to pay. You don't need to give me a discount. You don't need to take me for free. I am going to pay you because you deserve compensation for that time and that energy and the skill that you bring. Anyway, if you, yourself. Would not contemplate signing up for a DPC practice and you would not consider signing up your family and you would not encourage it in your friends, then you are selling something that you honestly don't fully believe in yet. And I, again, I think that's something that you can try to hide. But. It will come out. And when you do believe in the product or the service that you're offering, like wholeheartedly believe in it. I wholeheartedly believe in the product that I offer. I think it's a bargain. I don't feel guilty or bad about the pricing. I think that just comes out in the way I talk about the practice, in the way I explain it, in my meet and greets, in just my general, the energy that I'm putting out about what I do. I think you've gotta get to that point. And I don't think you have to be at that point immediately. Like I said, these things can evolve as you explore. So if you're one of those people, I would say sign up for a practice, and see how you feel about it. And see what it's like, and decide whether you feel like you see the value in it and it makes sense to continue. And if you don't, I don't know, you ask yourself if it's something you really wanna do yourself. Okay. That's number four. Number five. If you are un unwilling to leave your comfort zone, like if you're. If you're uncomfortable with discomfort, I guess by definition, discomfort means you're uncomfortable. But if you're unwilling to experience discomfort, whether that's with marketing, learning a new skill cleaning, doing some custodial work in your office, doing admin tasks, answering your phone, if you are unwilling to leave your comfort zone. You should not do this because starting a practice, starting a business of any kind is going to be inherently uncomfortable. It is going to require you to do new things, to learn new skills, to fly by the seat of your pants. Sometimes it involves inherent risk and uncertainty. It is uncomfortable. Like it, I can guarantee you there is going to be discomfort. And I think, again, like I. I'm constantly trying to tell people it's gonna be okay. We're gonna teach you some skills. All of this is learnable, like whatever. And the most important part of all of this, it's okay to be scared. It's normal to be scared. I think I, I think if you're not scared, something is wrong, like you should be scared. The question is Are you open? Are you willing to take on some of that discomfort? Can you tolerate some distress? Because I guarantee it, it's going to happen, and what I see oftentimes in people who are struggling to grow or, just reach a roadblock is they'll say, I just can't bring myself to market. Like I'm just, I'm an introvert. I don't like tuning my own horn. It's so uncomfortable for me. I just can't bring myself to do some of this marketing stuff and. I will tell you I am an introvert. I am so socially awkward. I, it does not come naturally or easy to me. Even the way I describe myself in some of my bios, my website, whatever felt a little ick when I wrote it, but I've had to do a lot of mental work to just get over that and move past that and convince myself no, these are all learnable skills. I can learn them, I can do them. I've reframed my thinking around so many of these things so that they don't feel icky to me anymore. And I've just had this attitude of it. My discomfort with it is not an indicator that I shouldn't do it or that I can't I notice that I'm uncomfortable. It feels weird. I'm gonna move past that and find a way to get through it.'cause this is what I need to do to make the practice successful. And so I think you have to go into it with that attitude. I have met some people who. Even people who are yeah, I'm gonna do this. And then when I talk to them, they seem unwilling to learn new skills or they have this idea that they're just gonna be able to get away with doing medicine exactly the way they were doing it in their old practice. Yeah, I'll just see someone every 30 minutes and I don't really wanna talk about mental health and I don't really wanna talk about, lifestyle stuff like they, they have this idea that they can continue to do medicine exactly the same way they did it in traditional practice. And that's gonna be enough. And while I'm constantly telling people like, no, you don't have, you don't need bells and whistles. You don't need to sell snake oil. You don't need to have all this extra stuff. Like you can just do good evidence-based primary care. You also have to have this understanding that. Now that you have more time, the way the traditional way of doing things you don't have to be confined by that anymore, and you can do more. And I think a lot of us who choose this have always had this feeling of wanting to do more for our patients and wanting to have more time and wanting to discuss more things and wanting to. Turn over more rocks and not being able to, but I do think there's a flavor of doctor who thinks it's perfectly fine to do medicine the way they're doing and they're choosing DPC for other reasons. And I think they have this plan of oh yeah, I'm just gonna do things like I always did them, but these patients will pay a monthly membership fee. And I don't know that it totally works like that. And so I do think you're gonna have to grow and stretch and expand your mind and think about, how should medicine, not just how am I used to doing it, but how should medicine be done? And that's not easy. Especially if you've been in practice a long time to suddenly shift the way you practice and redesign the way that you engage with patients is, it's hard, but I think you have to be open-minded to doing that. Okay, so that's number five. Number six is. If you cannot take on any financial risk. You probably should not do this. I'm very open about my startup costs and Shane last week was very open about her startup costs. Mine were around 22,000 and change hers. Were around 30,000. I say that all the time because I want to make it clear to people that this is not like a multiple, hundreds of thousands of dollars that you're gonna have to suddenly shell out to start this business, which is what I think a lot of people perceive about starting a brand new practice. But that being said. There is definitely financial risk, in the form of potential lost income as it takes time for your practice to, to grow and for you to reach the point where you can pay yourself a meaningful salary. And I. I've seen the comment multiple times in Facebook groups where somebody will complain about primary care and then somebody will say you should consider DPC. And then I've seen multiple people comment that they feel further gaslit by the suggestion of doing DPC because it's just totally financially not feasible for them. This is just, again, one of the things I'm just find groups to be just so frustrating and annoying. It's like you present a situation, people present a bunch of suggestions to you of things that you could do, which is what you are asking for, and they do not know your financial situation. And not every suggestion that people are suggesting is going to be applicable for every physician. So I don't really know why that's an expectation. It's only tell me things that I can definitely do a shadow of a doubt. Anyway, I just think it's the, I just, I'm so frustrated by FA Facebook group, which is ironic. I have a whole episode on how to market in Facebook groups, but they're really wearing me thin now. Anyway y yes. I'm here to admit to you that this is not financially feasible for everyone. There's lots of ways to make it work. You can have a side gig, you can continue doing per diem, shifts. You can start working on the practice or kind of building a runway before you leave an employed position. Sort of building a following, building a brand. I talked about that in my last webinar. You can do a lot of things to minimize that income loss. You can take a loan, that is an option. There's a lot of ways to make it work if you really do wanna do it. With starting any type of business, there is financial risk involved and that is just a fact of it. And, I'm not here to pretend that's, anyone and everyone can do this. It's just. That's not the case. Okay, so that is number six. Number seven, and this is a little bit of a nebulous one, and you may think with what you just said about, having a side gig or working on it concurrently isn't this contradictory? But number seven is if you're not all in. I would ask yourself if this is something you're really committed to, and what do I mean by that? So it's not that you cannot have a side gig. It's not that you cannot build a long runway while you're still employed to set yourself up for success. It's not that you can't still pick up per diem shifts, in any ER or an urgent care or hospitalist job or whatever to supplement your income, but. It should feel like the practice is the main event, is the main character, is the main storyline. That is what you're trying to do. What I have seen now multiple times is people who start the practice as their side hustle, and that's how they're viewing it. And what I have seen is that a lot of times they just never fully get off the ground. They never reach their potential. They're just this thing that's dragging on in the background like they're pouring time into the resource, the time and energy and money into, keeping it going. But it's really not going anywhere. And oftentimes they'll say, oh, I wanna work on it, but I'm just so busy with my other job. If that's the way the dynamic has become, I think you're handicapping yourself. You're shooting yourself in the foot because I think you, you need that pressure and that drive to really. Get you to a place where it can sustain you. And I will be totally honest with you that, for me right now, micropractice Mama is like that. I think often about if I just let go of my practice and I focus solely on Micropractice Mama, what I could build it into I have so many ideas for things that I could do with this platform. I have not written a newsletter for so many weeks just because this is very much the side hustle. Like this is the mistress, this is not the main, this is not my main squeeze. And to me, my practice and patient care and the health of the practice always comes first. And this feels very secondary. But I know that if I were to just shift my energy completely, if I did not have. The solid income from the practice, my medical practice, that I could totally transform this into something much bigger and much more robust and probably much more lucrative and successful, but. The reality is I'm one human and it's, very hard to divide my attentions. And this is, this is the best I can do at this moment, but I could probably make a conscious effort to scale back the practice a little bit, sacrifice a little bit of that income for now and devote more time and energy to this second business. But I think you just have to be really conscious of those dynamics. And so if your practice feels like it's. A taken a back seat to whatever, even if you're like, yeah, this is just a side gig. If it's taking up all of your time and energy and leaving very little for you to work on the practice, that is going to hold you back. And so again, it's really more of a mental shift than anything else. And just noticing how you're thinking about it and how you're treating it in your life. And I think. Making a conscious decision to say, okay, no, I've gotta treat this like the main event. Maybe even giving yourself a deadline, like I am gonna be out of this other side gig that I'm doing by this time because. I need to set that goal for myself so that I have a little bit more pressure to build up the practice, to sustain me after that point. So I think you've just, you've gotta be all in. I remember the feeling, I felt I talk about it a lot like when I actually quit my. My regular fee for service job. I really felt so just unmoored, like I was just floating without a job and without a paycheck. And that was a very weird, uncomfortable feeling for me. And honestly I thought about having a side gig. I thought about working per diem. I had applied to a couple of things for various reasons. None of them worked out. I was fortunate enough to be able to survive without one, but I think having that completely unattached floating, like this is now or never, like I've gotta make this thing work. Feeling was highly motivating. The amount of motivation I had at that time, the fear that I had of it not working out was very intense. And I think it really drove me to do a lot of those things that I was uncomfortable with. Getting on social media, going to networking events, like doing public, public speaking at various places. Like I, all of that stuff was uncomfortable for me, but I. Was at that time all in and terrified, and it was a make or break situation. I had to make it work, so I did it. Okay, so that is, did I get to seven? Yeah. Okay. Got to seven. I am sorry if this episode scared you. I debated making this type of episode for a while because like I said, my, my goal is to really encourage more people to do this. And I'm scared that people who are actually very well-suited for this will hear something in one of these that kind of sounds like them, and then be scared away. And I hope that's not the case. I hope I've presented enough disclaimers and caveats and. Shown you that, at some point, a lot of these things apply to me as well, so that, these are not total deal breakers, but they're things that you should hear from someone and that you should definitely, chew on and think about before you make such a big decision. And honestly, it's easier for me to say it here on a podcast. To theoretical people than to say it to a real life human being who's coming to me and saying yeah, I wanna do this. I see clearly that they probably shouldn't. I hope that this has helped bring some clarity for you one way or another. I would love to hear your feedback. If I freaked you out with this episode, feel free to shoot me an email and we can talk it out. You can email me at. sonia@micropracticemama.com. That's SONI a@micropracticemama.com. As I mentioned, I'm off socials right now, so if you do DM me, it may take me a little while to respond but I will eventually get to it. And then as a quick reminder, we do have our next webinar, next free webinar, which is September 10th, 8:00 PM via Zoom. It's called Making the Leap. If, you got through this episode and you thought, yeah, I do, my practice and none of those things are me, like I'm on a different page. I think I'm thinking about it. Or even if one or two of these things do apply to you, but you're like, I wanna move past those. I wanna get to the point where it is right for me. Highly recommend joining for that webinar. Totally free, no strings attached. I'm just talking about Micropractice as a model. A little bit more about my flavor of micropractice that I teach people. I talk about the secret sauce, which is what I think I offer and it's a little bit unique from what a lot of other, dPC resources are about, and yeah, it's, there's no obligations. It's totally free. You can log in and, have it in your ears while you're doing your laundry or whatever you're doing on that Wednesday evening, anyway, hope you can join us. I'll put the registration link in the show notes and I'll talk you guys next week.