Rock Star Physician – A Review from the White Coat Investor

December 20, 2015 MST 

 

I had an electronic copy of Rock Star Physician given to me this summer. I’m always interested in seeing what physicians are writing, especially if it is financially related. This book is not 100% financial like most of the books I review on this site, but I felt it was worth reading and writing up for two reasons. The first is that underlying the financial success of all physicians is a high salary. As I often tell groups I speak to, physicians have already done 90% of the work for financial success by virtue of their high salary. The last 10% is far easier. Rather than dealing with the 10%, like most of this blog and most of the books I review, this book deals with the 90%. It gives plenty of tips that will help increase your gross income, the raw material from which your nest egg is constructed.

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The second reason is that career longevity is another key to financial success. While it is possible for a supersaver to save a huge percentage of his income and retire after just 10-15 years to a lengthy, but relatively frugal retirement existence, it is far easier to retire to a life of luxury if you actually work for 25, 30, or even 40 years. Career longevity comes from doing something you love. If you are being paid well, feel like you’re making a contribution to the lives of your patients, and have control over your work environments, you’re much less likely to feel a need to punch out early. For example, I left the military on the first day I was eligible to leave (and in fact, skipped a week of vacation every year so I could leave a month early using “terminal leave”.) Why did I dislike it so much that I was willing to give up vacation (which I obviously value very highly) to leave a few weeks early? Well, I felt underpaid, I didn’t feel like I was making much of a difference (my “emergency department” practice consisted in large part of sick call-diarrhea, colds, rashes etc,) but mostly I had precious little control over my work environment. In fact, it was relatively routine for my partners and I to be deployed halfway around the world for up to 6 months with as little as 24-72 hours notice. If my entire career felt like that, you’d better believe I’d be hypersaving and looking forward to that retirement date. But as Seth Godin has said, “Instead of wondering when your next vacation is, maybe you should set up a life you don’t need to escape from.” That’s what I’m trying to do, and you may find this book will help you to do that.

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How To Be A Rock Star Doctor:The Complete Guide to Taking Back Control of Your Life and Your Profession by Rebekah Bernard, MD, is a delightful 317 page book with all kinds of very useful advice for the clinician. She likes to use the analogy that as a physician, you are “on-stage” with your patients, and that the better you play your part, the more you will enjoy it. Early in the book, she states this:

Whether you’re just starting your journey in residency or you’re a seasoned pro, you may be experiencing burnout, struggling to remember why you wanted to become a physician in the first place. Charting and never-ending paperwork may be just starting to beat you down, or perhaps you’ve resigned yourself to a life of prior authorizations, declining reimbursement, and 10-minute visits while fantasizing about the unlikely possibility of an early retirement. Good news, there is a way to take back control of your life and your profession. The secret lies in learning to become a rock star physician! The results: Get out of work earlier, spend less time on needless documentation and make your patients happier by following the rules of Rock Star physicians. Using these simple strategies, you will learn to modify your “on-stage” behavior to get the most out of each patient encounter, maximizing profit while improving patient satisfaction, and protecting yourself from burnout and compassion fatigue.

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Most physicians have heard that what patients really care about, are these three characteristics in this order:

Availability, affability, and ability.

Dr. Bernard focuses on all three of these in the book, showing how to not only be an excellent physician by your standards, but also by the standards of your patients while at the same time maximizing your income for doing so.

 

I thought her tips on ensuring adequate acute appointments were genius. Not only does it recapture a lot of the revenue that may otherwise go to urgent cares and emergency departments, result in better continuity of care (it takes a primary physician much less time and effort to deal with an acute but non-life threatening complaint than a physician who has never met them in an UC or ED), but most importantly it actually decreases your work because it eliminates all those unpaid phone calls, emails etc. She says that since the only way she can get paid is to see people in clinic, she sees people in clinic and that’s all she does. Want a refill? Come to clinic- we have space today. Want your lab results? Come to clinic- we have space today. Want a prior authorization?- come to clinic. Sports physical? Come to clinic. Parking pass, jury duty disability, school medical excuses- you know the drill. Of course, you must set aside enough slots in your workday to provide this sort of availability.

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Another great tip was to actually capture billing for the add-on visit, such as a husband wanting his lab results during his wife’s visit. Discuss his lab results with him, but generate a bill for it. He’ll either be glad that you could do that in such a convenient manner, or else he’ll learn that you don’t work for free. Either way it is a win for you.  Checking out one child’s ear while seeing another child for their well-child visit is the same thing.  Other tips include using the problem list and a printed out copy of the patient’s last visit to make you more efficient.

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When she discusses the section on affability, she even advises taking an acting class. In reality, physicians are expected to always be empathetic, even when we don’t feel that way. So when you do feel that way, show it. When you don’t, act like you do.

One of my favorite sections is the “just by looking physical exam” where she shows you how to get an 11-system physical exam from the doorway. The section on managing difficult patients is also worth the price of admission ($9.99 on Kindle, ~ $20 for the print version.)

 

Toward the end of the book, there is a nice section on charting efficiently and avoiding undercoding. I got plenty of training on this in residency, but I’ve found that experience was fairly rare among physicians in general. There is also a nice section on issues that only women physicians face that I found enlightening, such as what she calls micro-inequalities such as not only being paid less, but then not getting the same benefits either. She quotes studies that indicate that the average woman would be better off (financially) as a mid-level than a physician because they simply don’t work enough hours to amortize their upfront investment in medical school.

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A Bit of Criticism

The one thing I didn’t like so much about the book is that much of it only applies to physicians who are in an outpatient clinical practice with significant control over their practice. Hospital-based physicians (emergency docs, hospitalists, anesthesia, pathology, radiology etc) will find it significantly less useful. Dr. Bernard is a family practitioner, and I think that pretty much every FP in the country would benefit from reading the book, but the more different your practice is from an outpatient FP clinic, the less you’ll get out of the book. Perhaps it should have been titled How to Be a Rock Star Family Doctor. You will also find the book is fairly light on direct financial advice, which is too bad. It would have been nice to see some discussion about choosing a retirement plan for your practice, which benefits to offer employees and where and how to shop for them, and how to influence your payor mix and interact with insurance companies and government payors.

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Overall, it is a quick read ideal for either a relatively new graduate, or a physician feeling burnt-out in his current practice. Buy your copy today on Amazon!

Have you read the book? What did you think? What have you done to improve your practice to promote career longevity? Comment below!