Listen in to hear how private practice and intentionality can support physician wellness with Dr. Sarah Neitzel, a practicing surgical podiatrist who also coaches private practice physicians to make their practice and career fulfilling.
During this episode you will learn about;
[0:00] Introduction to the show.
[1:36] Introduction to Dr. Sarah Neitzel.
[3:09] Moving after training.
[5:54] The importance of personal and professional wellness.
[10:43] Your chronotype and flexibility
[13:13] Learning new things when starting out on your own
[15:29] Getting away from micromanagement.
[20:37] Physician wellness through private practice
[23:42] Coaching other physicians to get started.
[25:57] Dr. Neitzel’s advice for those coming out of training.
- You got to know yourself a little bit. Know your limits.
- Make sure that you got the right team of people.
- “I think it’s important to learn what’s going to work for you and how you recharge yourself.” – Dr. Sarah Neitzel
Does charting in medicine seem overwhelming at times? The tens or hundreds of charts that you still have to finish and sign…it’s exhausting right?
Charting Mastery™ is a 6-week- long group coaching program, led by Dr. Ryan Stegink, where physicians like you, will get equipped with the skills and approach to finish charting at work and get home sooner for what matters most to you.
The first cohort launches in early November 2022. You can get on the waitlist and be one of the first to hear when you can become a founding member by going to…
There will be CME available through reflections on the material, powered by CMEfy.
To learn more about Dr. Sarah Neitzel, go to – www.visionarypracticesolutions.com
Above are the episode show notes and below is the transcript via www.otter.ai.com. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!
Dr. Ryan Stegink 0:00
Does charting in medicine seem overwhelming the queue of messages, labs, patient calls, that never seems to get smaller the pile of pre authorizations awaiting your input, the 10s or hundreds of charts that you still have to finish and sign. It’s exhausting, right. And still, all you want is to be able to go home with your work done, to be able to spend time with family, hang out with friends, practice self care. I want to invite you to join me for a six week long coaching program chartingmastery where you will get equipped with the skills and approach that you need to get home sooner and leave that work at work. To check out more info, and to join the waitlist, head over to charting mastery.net You will be among the first to hear when the doors open so that you can join me on this journey. There will be opportunities to reflect and earn CME after the different sessions as well. And now on to today’s show. Welcome to the MedEdWell podcast. Empowering physicians to get work done at work, then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Stegink general pediatrician and life coach for physicians. Hello, everyone, and welcome to another episode of the MedEdWell podcast where physicians come to be encouraged and equipped to take the next step in their own wellness journey. Thank you so much for subscribing, and sharing these episodes and for engaging with these topics. Today I am joined by Dr. Sarah Neitzel Dr. Neitzel is a surgical podiatrist practicing in western Washington. She has owned her own private practice for the last eight years, having built out a new office space in 2020. Additionally, she has started a second business with a medical pedicure manicure spa that is located within the same office space as her practice to allow high risk patients and clients a safe place to have foot care. Last year, Dr. Neitzel started a coaching and consulting business for private practice physicians looking to make their practice and career one that is fulfilling both for the doctor and the patients. Dr. Neitzel Welcome to the show.
Dr. Sarah Neitzel 2:50
Hi, thank you so much. I’m excited to be here.
Dr. Ryan Stegink 2:54
Thanks. Tell me a little bit about yourself and your journey to medicine.
Dr. Sarah Neitzel 2:58
Ah, well, I went to my medical school and podiatry school in Chicago did most of my residency and training everything there? It was, it was great. But Chicago just really wasn’t my home. So I ended up through residency trying to figure out where I wanted to go. And I’m from the west coast. So you know, I kind of missed my mountains and my water. And so I was trying to pick between, you know, Washington and Colorado, those are kind of my two that I was I was down to, and I couldn’t make up my mind. And that happened to be the year that the Broncos and the Seahawks went to the Super Bowl. So I just decided that okay, well, wherever, wherever I move, it’s going to be whoever wins the Super Bowl. So yeah, it was it was a good choice. And I moved out to Washington, I knew I wanted to do private practice right out the gate. So I made sure that I was kind of lined up with other people that did private practice. But that being said, there is a lot of hiccups that go on when you’re first getting into that, especially if you’re running the business yourself and trying to learn the billing and all the other stuff by yourself. I know better. Now, whenever I start any business, now I have a whole team of people because like, there’s no way I should know how to do those things. We did not get taught that in residency. So while I tried to kind of figure all that out, I did spend a little bit of time working for Wound Care Center. In a larger hospital institution, it was just like a kind of a part time gig. But I did get to see the effects that kind of, you know, the hospitals have to try to think how to word this. I can see where the hospitals are really trying to move a lot of patients through. And I think the doctors really get, you know, kind of sucked into that. And when you can’t spend as much time as you need to, especially with like a wound care patient. There’s so many things that go into diabetic foot wounds, that if I don’t get to spend that time with somebody and we’re just like me Moving me on to the next room, I’m not really getting that like patient doctor relationship, which is why I went to med school, you know. So I really knew at that point, even after having that secure paycheck, and that was helpful for a little bit. I knew at that point, I was like, Nope, I just need to do private practice, like I can’t function, or I don’t have that relationship with people. I don’t have enough time with everybody. And that’s, and that’s hard. And I think, you know, even though I’ve always done private practice, it’s allowed me some flexibility of hours. I think that not getting to spend enough time with patients was actually a harder thing for me than not being able to spend enough time at home. Because I think that really was a big part of why I went into medicine. So I’ve done private practice. It’s been really, really great. And honestly, I’ve read kind of designed how I’ve wanted to practice like three or four times at this point. So I’ve gotten pretty good at like doing that self reflection and like being able to make it what, you know, what will work for me, because that’s
Dr. Ryan Stegink 6:08
important. Well, it’s really helpful just to hear your journey and how you were able to craft that to be what you needed it to be. Because I think that’s one of the big challenges these days in medicine is lack of autonomy, and that in to a certain extent, moral injury from, like, you know, what needs to be done for your patient. The way things are structured, doesn’t necessarily allow that.
Dr. Sarah Neitzel 6:35
Yeah, I was glad when they kind of put a little more of an explanation on the term that everybody was talking about with physician burnout. I think moral injury is such a, such a beautiful way to put that. Because it really is it just goes against everything that you you know, believe your morals and why you went into medicine. I’m really glad that that got descriptive. So
Dr. Ryan Stegink 6:59
yeah, why do you feel that personal and professional wellness is important.
Dr. Sarah Neitzel 7:03
Um, I think that patient care really has two components to it. The first part of it is, is how you’re taking care of patients. And then the second part of it is how you’re taking care of yourself. Because to be honest, you know, we all know this, like, if you’re not taking care of yourself, you certainly really aren’t at full capacity to take care of other people. And I think med school and residency really push us to the limit of being able to do as little for ourselves as possible, and have the maximum impact for other people. And that’s just not a practical and real way to live. It’s not sustainable by any means. So if you if you really go down that route, I think that you’re not able to care for other people. You know, a lot of people lose sleep, you know, we had talked about this a little beforehand, you know, being sleep deprived being a huge problem, and it can affect your decision making. You know, you can always be there for your family, you can even get physically ill. So there’s so many reasons to take care of ourselves. And I think that gets removed from that patient care equation is that part of your responsibility is taking care of you to take care of other people. So I think it’s hugely important, you know, on both personally and the professional side.
Dr. Ryan Stegink 8:23
And for me, I’ve seen that when, yeah, it’s like, if I’m really behind with my notes, or when I first started out, I just felt that I couldn’t even get lunch sometimes. And it affected. My personal wellness, definitely bled into, like, how am I showing up for those patients at the end of the day? And hopefully not right, same mental space as I was at the beginning. Yeah, yeah,
Dr. Sarah Neitzel 8:51
absolutely not. No, totally.
Dr. Ryan Stegink 8:55
So now, for you in private practice? What about that has allowed you to practice the self care that you need?
Dr. Sarah Neitzel 9:03
Well, you know, I think there were, there’s been a few things that I have done, that have really, really helped me. Some of it really, really goes around, while really all of it is going around, you know, how I’m delegating out my time during the day, what part of that time is for me what part of that time is for work? And so, you know, looking at efficiencies within my office, the nice part is, I have complete control over that. So if I want to, you know, change my hours, I can do that. You know, I’ve I’ve changed a couple of times, what kind of patients I’m seeing and what kinds of services I’m offering. And in some cases, you know, I noticed trends because I keep a lot of records for my practice for, you know, kind of our key performance indicators. And I noticed trends where it was like, Man, this one particular group of patients just stress me out. Like, I don’t have enough staff to handle it. The paperwork is insane. And you know, unfortunately, in business, it does kind of come down to the monetary part of it, too. You’ve got to look at your time and your reimbursement. And sometimes it’s like, Nope, it is worth me getting some sleep at night and not laying awake about these patients. Yeah, man, it is to deal with what I’m getting paid. So in some cases, those were decisions that I’ve made over the years. But I think it’s just it gives you such control over your hours to you know, I think if you can do the self reflection, to really look at, you know, when am I working the best during the day? Are you a morning person or an evening person, and be open to changes to that discussion, because I always thought I was an evening person. And I mean, on a weekend morning, I’ll sit with my coffee forever. I, I don’t move very quick. But for whatever reason, clinically, by the time we hit lunch, I am I am on time, my notes are done before I even hit lunch, like I am rockin and rollin. But you notice after about two or three o’clock every day, when I don’t finish any of those, I end up getting behind. And so you know, you can think you’re an evening person. And maybe after really looking at it going, No, I think I’m stronger performing in the morning, may not like it, I need a lot of coffee. But I do a lot better for those first few hours of clinic. Looking at that, looking at the fact that, you know, maybe, maybe you can go do a half day of work, and have the rest of the half day off. And maybe that works for you. For me, I realized once I’m at work, I am solid mentally I’m there, that’s great. I cannot leave work at home, or leave sorry, yeah, I cannot leave work at work. When I go home. If I work a half a day, like I will instantly start doing other stuff. Oh, I gotta finish that, oh, I should make sure I check on that report. You know, and I can’t leave it alone. But I am capable of working really long days when I need to. So for me, I truncated my schedule, basically down to three days a week. And I just work from like, 9am till 7pm. And then those other two days of the week, I am so much more productive in my personal life because I can make more of a plan on how my whole day is gonna go. You know, so for me that works. So I think you need to change up your schedule, but but doing that self reflection, you know, you got to gotta get to know yourself a little bit Know your limits
Dr. Ryan Stegink 12:36
Dr. Sarah Neitzel 12:38
So yeah, all right, right. Yeah, you got to know those limits. That’s important. So no, I’ve changed. You know, I’ve changed kind of what my practice specializes in, in my hours, couple of different times. And it’s been a really good thing for me. So I think that’s a nice thing.
Dr. Ryan Stegink 12:57
Like, yeah, you get that flexibility and more control to really craft, as you said, with that reflection, looking at what you need, how you’re wired priorities. And yeah, that may change in different seasons of life. But at the same time, yeah. How have you seen? I mean, private practice, stressful? I mean, you get all that control, but how do you? How did you learn the things that you needed to? Or get mentors? I mean, when you’re striking out on your own,
Dr. Sarah Neitzel 13:27
right, right. Yes. So like running a small business is stressful, you know, I mean, there, and it’s a different type of stress than then medical school or residency. I think there’s, there’s two things, one, making sure that you get yourself the right team of people. The the practices that are the most stressful for physicians, and that are, you know, kind of the most messy and disorganized realistically, are run by Doc’s who, you know, are smart people, but they’ve got this opinion that like, I was smart enough to learn the human body. So I’m going to learn billing, and I’m going to learn marketing, and I’m going to learn all the things like you’re going to do your taxes, you’re gonna do all the things. It’s, it’s a terrible idea. Like, there are people who just like you went to school for med school, went to school for billing, they went to school to be an accountant, they went to school, to office management. So, like, they have better training than we do in that and and I’m not saying you shouldn’t be aware of the general idea of how those things work, but really let the people who went to school for this, do it. And when you develop that relationship, where you’ve you’ve had some conversations, you’ve really, you know, spend some time with them and you develop that, that close relationship of trust that they can handle it, then it’s just a matter of checking in, you know, making sure that your practice has some systems in place for your employees so that they understand clearly what their duties are, they have ways of following through with it, you have easy ways of just checking in on it periodically. And then you can do what you’re there to do. You’re there to see the patients. So, you know, yes, there’s going to be times where things are more stressful. I mean, you know, we had a billing snafu in our software, lead that all of a sudden, I realized I wasn’t getting paid by Medicare, and I looked in Wait, nope, they haven’t reimbursed me since May. Okay. So we, ya know, and so, you know, that’s, that’s, that’s a chunk of change that you’re waiting on. But we’ve gotten it figured out, it’s just these things take time to process. And, you know, because all of my other stuff is kind of running on autopilot with me just checking in, it’s very easy for me to go deal with when things actually really do potentially go wrong. And you have to come up with a solution, like I’ve got the bandwidth for it, because everything else is, you know, running smoothly without my immediate micromanagement. That’s I’m all about getting away from?
Dr. Ryan Stegink 16:06
Well, I think that’s something that’s really hard for physicians, because we’ve been trained to, it’s like, you have to do well, in school, you have to get the grades, you have to get the test scores. And you have to do like, perfect care for your patient. And, yeah, that’s like, okay, empowering, and delegating. And so not only in the professional in the hospital standpoint, but it’s like now, it’s like, Alright, all of these other functions of a business that you have to entrust to others. And because you can’t do it all yourself.
Dr. Sarah Neitzel 16:40
No, no. And I think having that realization that you you not only can’t, but like really shouldn’t try to do it all yourself. You’re right, it’s totally ingrained into us from from the very beginning. And, you know, especially especially residency, because you remember where like residency, you really, you really had to do everything yourself, because they needed to make sure that you could do all parts of it. And so you get really good at doing your procedure, like getting the patient name setting up doing the procedure cleaning up like you do all of it right? And, nope, that is why you have a back office. And, and honestly, it probably took me a good two years of really actively noticing that I wasn’t using my employees for the things that I should be using them for. And I was setting up my own procedures. And I finally something happened where I go, No, no, like, count up the number of minutes I’m using and doing these things. I could be seeing another three or four patients in a day based on how much time it was taking and like notes is the same way right? Going from like typing your notes each 10 minutes and note to dictating how we’re down to two to three, like those minutes for that kind of stuff add up. So you know, if you start really looking at that, it’s pretty easy to see that your time is worth significantly more than the, you know, 1819 $20 an hour that you’re paying, you should be paying somebody else to go set that procedure up for you. So it’s it’s a numbers game, you know, but I think the the delegating, the delegating is hard. It’s very hard. It’s not easy for many people, including myself, sometimes I still catch myself doing things and I’m like, wait, I could hand this off. I have somebody that can do. Yeah, it still gets me.
Dr. Ryan Stegink 18:36
Even as an employed physician, I find some of that with my paperwork. And some of its just expectations of like, okay, if this is normal, or this can be dealt with in the next two to three days, it doesn’t have to be done right now. I can put it I can sign the form, I can put it in my box, and it will get done. Yep, eventually. Yep. Whereas when I was when I recently graduated, or in residency, it was like, No, you have to call everybody yourself and get it all done right away. And it’s like, okay, maybe this is part of the teamwork or just adjusting my own expectations. Right, right.
Dr. Sarah Neitzel 19:17
Yeah, I don’t think I don’t think residency was what anybody expected. Ya know, it’s it. It makes a difference what your expectation of yourself is, you know, I think we expect ourselves to be perfect and we expect ourselves to do everything and then we don’t realize that we we really could be doing other things with our time.
Dr. Ryan Stegink 19:42
You were to go back to having recently graduated and looking forward to where you are now. Would you have expected to be where you are?
Dr. Sarah Neitzel 19:53
Oh, God, no. God, no. Yeah, I came out of residency I think kind of the same. Same way you did where it was just like, Okay, I have to do this as quickly as possible. I need to see as many patients as I can and everything needed to happen yesterday and why was I more prepared and it just, oh my god, like as if we would have possibly known how to do any of this stuff. We weren’t taught business in residency. But yet here, here I am beat myself up about not being crazy, crazy busy already and, and worrying up still about how you’re going to treat patients and and I was always in the mindset that I was going to have to see as many people as possible. And oh my god, it wore me out so much, so much. It wore me out worrying about it to get to that point. And then it wore me out when I got there. So, you know, I, I really wish I had known then, how this was gonna go for me, because I, I love where this is at now. You know, I have the practice. I’m there three days a week, I decided I really wanted to have a small farm. And so I spend two days a week, kind of working on my farm stuff, and I love being outside. And I get to really enjoy those days. And I didn’t realize that I needed that much of a recharge. But it was also okay to give myself that. And God I think, had I had those epiphanies saying, Oh, I would have done this so much sooner. You know, if I knew what I know now, yeah. Yeah, I wouldn’t have stressed nearly so much about it, but I get it. It’s it’s what gets kind of driven in.
Dr. Ryan Stegink 21:40
So now, with what you know, and your experience and where you’ve been? How, how do you help doctors, like others out there achieve their own personal wellness through private practice? Yeah,
Dr. Sarah Neitzel 21:53
you know, I’ve been, I’ve been part of a couple of kind of coaching groups over the years, you know, I’ve had I’ve been coached, it really took until the last three years before I started embarking on that. And it, it has just made all the difference in giving me that mindset and that courage to really, like, go forward with those decisions, and to be able to just pivot so easily when things are going wrong, or not quite the way I expected, you know, and let’s Okay, let’s turn it into something good. You know, a good example is that that whole Medicare issue was not being paid. I turned around and looked at it and went, you know, I have been wanting to drop my, it’s unfortunately, my lowest reimbursing by about a third, I have wanted to drop that and go more to a concierge style practice. And I’ve been too afraid to do it. And, you know, they haven’t paid me in a fiscal quarter and nobody died. And, you know, I mean, my practice didn’t sink, and I didn’t die. And, and it wasn’t as scary as I thought it was gonna be. So coaching has allowed me to take what what would have been, you know, years ago, just a complete freak out meltdown about not having been paid by an insurance and a full fiscal quarter. But I immediately was able to turn that into, maybe this is actually giving me like a bank snapshot of how my practice would look, if I if I decided to stop taking out insurance, like, I’ve wanted to do it. This is the universe essentially giving me the information of, okay, here’s how it’s going to look financially, this was your biggest concern, now go do it, you know, and I’m so glad I’m now able to get into that mindset. And it is just, it’s helped me so much. You know, I meditate regularly now there’s, there’s so many things that have been enriching in my life personally and professionally from it. So I decided last year to go ahead and start coaching other physicians and and at first, I was kind of working with Docs, you know, mostly who are trying to kind of revamp and redesign their own practice. And I still do that kind of consulting and coaching. But then I started getting a lot of questions from people that were just coming out of residency. And I was like, Oh, wait, so you’re going to actually go the route I did. And you’re going to not, you know, go for the big the big hospital job, you’re going to instead go for private practice right out the gate. This is great. Let me help you do that. And at this point, I’ve set up two to three businesses and it’s really not as hard as it as it seems. There’s some upfront work and there’s the getting your team together. And there’s the you know, really doing that inner work, I think of just practice you want to have because if I had had a coach at that time in my life when I was coming out of residency and getting into this, I mean, I think it would have saved probably a year and a half of the hard lessons honestly, like this one. would have been stuff that I wouldn’t have been so stubborn about doing everything myself and, and I wouldn’t have been so worried and laying awake about the finances and all of that kind of stuff. There’s just there’s a lot that I would have done differently and sooner had I had that kind of advice. So you know, so I am more than happy also working with residents that are coming out. And they’re really thinking they want to do this, with getting them set up and going, you know, I mean, we can get this from zero to fully open doors in like, eight or nine months at this point. So it’s, it’s doable.
Dr. Ryan Stegink 25:35
It’s really amazing. And I think it’s really helpful. I mean, I’ve been coached and been part of Coach Training even now and just how it’s the stories that we tell ourselves and what we make things mean. And so, yeah, the Medicare not reimbursing. That’s just a thing. And then it’s how do you choose to interpret that?
Dr. Sarah Neitzel 26:01
Right, right. Yeah. How do you how do you choose to read this?
Dr. Ryan Stegink 26:06
Yeah, there’s ways that we’ve all gone down those paths. And yeah, those freakout moments, but you can choose to think of it a different way. And so it’s like, what’s most useful or helpful to you?
Dr. Sarah Neitzel 26:20
Yeah, yeah, absolutely. You know, I think the meditation for me was huge. Just getting to unwind through that time. That worked really well for me. And you know, I think some people, they’ve got exercise, and people have got other stuff and, and that’s, it’s just meditation worked for me. But yeah, I think it’s important to learn what’s going to work for you and how you recharge yourself.
Dr. Ryan Stegink 26:46
So in addition to recharging, and finding what works for you, what would you tell someone coming out of training? As far as piece of advice? Hmm.
Dr. Sarah Neitzel 26:58
Probably that, the sooner you can start thinking about how you want your life to look, and how you want your medical career to be, the quicker you’ll find that happy place. I think that self reflection is so important. So huge, it’s so
Dr. Ryan Stegink 27:22
it’s really helpful, because it’s so easy to just go go go. And that’s been what our training is all about. And you could do that for a whole career and then look up and realize that wasn’t how I wanted my life to look.
Dr. Sarah Neitzel 27:38
Right. Right. Exactly. Yeah. And you don’t want to have that, you know, the mid career crisis of, Oh, my God, what if I completely went into the wrong thing? What if I shouldn’t have been in medicine? What you know, what about this? But you know, I think that that’s a good indicator to that the burnout level has just increased so much, because that mid career freakout used to happen, you know, when people were having a 30 and 40 year career, so by like, you’re 15 and 20. They’re going yeah, maybe I should go do something else. You know, right now, people are having that mid career freakout at like, year two, you know, like the tolerance, tolerance, is there, the residency still just as hard. But yeah, I think the demands and the changes in the healthcare environment are completely changing that. And if you can, if you can really figure out what you need and what you want, that risk of burnout and having that happen to you so quickly, I think really, really just diminishes.
Dr. Ryan Stegink 28:39
Well, thank you so much for joining me on the podcast today. If someone Yeah, thank you. Someone wants to learn more about you and what you do, how they might work with you? How could they find out more?
Dr. Sarah Neitzel 28:50
So the coaching practices named visionary practice solutions, and it’s pretty well, just a direct thing to me at this point. But if you go to visionary practice solutions.com You can find all the contact information and a little bit of info about the podcasts that I’ve gotten started doing.
Dr. Ryan Stegink 29:07
Awesome. Yeah, thank you so much, Dr. Neitzel, for joining me on the MedEdWell podcast sharing such amazing insights.
Dr. Sarah Neitzel 29:15
Oh, thank you so much for having me. This was awesome.
Dr. Ryan Stegink 29:19
Thanks. For all of you listening, I want you to consider how you can apply what you’ve learned from Dr. Neitzel on today’s discussion. Then please share this podcast with another doctor in your life and subscribe to the podcast. You can help change the culture of medicine and promote wellness for your patients, your colleagues, yourself. Thank you so much for all that you do. And have a great day.
And now for our important disclaimer. Dr. Ryan Stegink is a practicing general pediatrician. But the MedEdWell podcast does not reflect the views, opinions or beliefs nor is affiliated view Understand. Additionally, the MedEdWell podcast is for educational and entertainment purposes should not be considered advice regarding financial, legal, student loan, medical or any other specific topic. In such a case, you should seek consultation with a certified professional in that particular area. Again, thanks for joining us on the MedEdWell podcast. Have a great day.