Regain Autonomy And Improve Care With Private Practice Medicine with Dr. Marcelo Hochman

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Join Daniel Wrenne as he sits down with Dr. Marcelo Hochman, the founder of South Carolina’s esteemed Facial Surgery Center, double Board-certified facial plastic and reconstructive surgeon, and President of Independent Doctors of South Carolina (IndeDocs).

In this engaging episode, they delve into the intricate landscape of medical careers, exploring the choices between private practice and employment, and the critical role of financial planning.

Dr. Hochman, also Past President of the Charleston County Medical Society and a provider of pro-bono care to children with vascular anomalies, shares profound insights on challenges faced during medical training, the importance of exposure to diverse career paths, and the impact of financial considerations on career choices.

The conversation extends to satisfaction levels among independent practice physicians versus employed physicians, with age-related variations adding an intriguing dimension.

Discover valuable advice, personal experiences, and resources for medical students, residents, and practicing professionals seeking to make informed decisions about their careers. Explore the mission of IndieDocs and the importance of preparing the medical pipeline for the future. 

Transform your financial outlook today! Access our exclusive free resources for physicians and conquer financial stress. Access here.
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Full Episode Transcript:

Daniel Wrenne: Marcello. How are you doing, buddy?

Dr. Marcelo Hochman: good. Thanks for having me.

Daniel Wrenne: Yeah. It’s good to catch up again. I know we chatted last time. we weren’t recording, but I was excited to have the conversation and, and share with everyone. I know you have a lot going on with your practice and then you have some other things that you’ve gotten involved in on the side that keep you really busy.

And so I thought maybe that would be a really good starting point if you could just kind of. Share a little bit about what you have going on professionally and some of the things you’re involved in right now.

Dr. Marcelo Hochman: Marcel Hockman. I’m a physician. I’m a facial plastic and reconstructive surgeon. I, um, an independent solo practice, though I started my career for 10 years as a full time, uh, employee of an academic medical center. So I was in academics for 10 years and then I left and went into private practice.

that have still maintained an affiliation with the medical center because of some of the things that I do. So my practices ranges or includes, you know, children and adults in children, reconstructive surgery for vascular tumors and vascular anomalies, all the way through adults and elective cosmetic surgery.

So that’s the nature of my practice. So I have a mix of not only children and adults, but insured patients, non insured patients, self paid patients, and, so I kind of have a good perspective on what both physicians and patients go through, in the system that we have,

which has led me to be involved over the years with, local and regional, medical organized medicine, uh, organizations.

So I was president of our medical society and I’ve been involved in lots of legislative things and currently I’m president of Kind of a fledgling organization called independent doctors of South Carolina. So that’s what my wife says is my my second job So

Daniel Wrenne: yeah,

Dr. Marcelo Hochman: it’s a lot of time

Daniel Wrenne: those early stage organizations or really anything, they seem, seem to gobble up your time pretty good


Dr. Marcelo Hochman: quickly. Yes,

Daniel Wrenne: they need a lot of attention to get going. so you’ve worked in all different areas. I’m really curious. Really just in general about this whole shift in medicine. I have my theories about it, but like, I know the shift has been towards hospital employed.

I don’t know the stats exactly. I know there’s been a shift away from private practice. I would assume it’s pretty substantial. I know over the past 10 years or so it’s, it’s happened, but, what are your thoughts on why that’s happening? What’s going on there? Like, why are so many physicians, gravitating to hospitals and away from private practice?

Dr. Marcelo Hochman: sure. So that is definitely the trend and in fact in the last year or two I can’t remember when the crossover occurred where More than 50 percent of physicians in the United States were employed by a practice or system in which they had no ownership. So basically we’re employed physicians, right? and that trend has continued since that crossover point.

So, and I think it might be 60 40 now, independent practices being the minority. You know, for the first time, well, now it’s a continued trend where we’re the minority, in medicine in general. And, lot of things contributed to that. you know, it started happening a little while ago where financially it became harder for, especially primary care practices, pediatrics, family practice, internal medicine.

as there is more reliance on third party payment systems, more technology needed to interact with those, payments, you know, from the, the third party payers, including government programs like Medicare and Medicaid, were decreasing, it literally just became a squeeze for a lot of practices to survive, right? And then, so there, there was this big trend towards hospital systems buying, acquiring primary care practices. The idea that they had at the time was, well, if we can get the primary care physicians to refer to the specialists in our system, that’s where they make their money anyway, right? Which is, know, the big margins are in the surgical procedures and that kind of stuff.

So that was a trend that started, you know, and again, I don’t know the statistics exactly, but it was pre COVID, right? so that was five, six, seven years ago. And then when COVID hit, that put a big stress on everybody, right? I mean, that, that was a big, big stressor. So post COVID and during that time, you saw a lot of practices shifting over and, being acquired, it’s interesting though that at the same time, hospitals were divesting themselves of some practices because they no longer really needed them or it wasn’t financially, didn’t make sense for them anymore.

So, I mean, locally here, pediatrics, you know, all these practices were let go, basically. The contracts were not renewed. Just the other day. a dermatology group that had been acquired by one of the hospitals in the state was told their contract was not being reviewed. So there, once you become employed, you’re obviously at the mercy of your employer, which is, you know, good and bad for some businesses in medicine.

I think that’s a bad idea. so I think the big push was initially financial and as there’s more consolidation of the systems and more just growth. of those hospital systems, which rely on volume to maintain or to generate their revenue, they need more physicians, you know, and fortunately, a lot of the younger generation coming through training, are no longer exposed to private practice, so all they see, all their mentors are system medicine people, and their mentors are system medicine people, and they come out thinking, well, that’s the only option.

Daniel Wrenne: Yeah.

Dr. Marcelo Hochman: that’s kind of the trend that we’re fighting against and there’s a lot of good reasons why I think we’re, the timing is great for this, but for the patient point of view physician point of view to start bolstering and there’s going to be a shift back towards, independent medicine. May never be the majority again.

But I think it’s going to be very substantial.

Daniel Wrenne: Did you say that, you thought it was bad to be employed? Or was, is that the right wording you used?

Dr. Marcelo Hochman: Well, I may have said that, but I’m glad you asked because so, you know, Employment in and of itself isn’t bad, right? I mean being independent isn’t for everybody. Being employed isn’t for everybody either. You know, I think however that the way the systems and by when I say systems, I mean the hospital systems and the third party payer relationship with the systems, is not good for medicine.

It’s not good for patients. You know, everybody has their story about, you know, they don’t know who their physician is anymore or, you know, your physician has left. So basically you just get assigned another physician.

So patients are kind of herded inside these systems. so there’s an effect on that. We know, and I know, you know, the cost of healthcare is unsustainable. The way that it is now, a lot of different reasons, which is why independent medicine is a good antidote to that. so I don’t mean that being employed is bad.

In medicine, it’s a little bit different than being employed in a lot of other businesses. You know, a lot of them, you know, we all depend on employees, and I don’t think my staff thinks that being employed is bad, Right.

Daniel Wrenne: Right.

Dr. Marcelo Hochman: as a physician, and as a patient, Overall, I think it’s much better when the doctor and the patient are in control of a lot of decisions, which, within the health system, that control is taken away.

Daniel Wrenne: we’ve had many guests on, particularly people that shifted out of the big healthcare system into like cash pay models or like direct care. I’ve heard many of them say that they felt like they were having a hard time providing the best possible care for their patients in the system.

And I think that ties into what you’re saying is there’s just, there’s a lot of conflicts. It’s like, if you’re in primary care and you have 7, 000 patients, it’s impossible for a human. It’s one person to manage that and take good care of them. And then on top of that, they’re like, there’s pressure to increase it, even


Dr. Marcelo Hochman: Well, right. So, I mean, I think that that is what I see as the, at the very, very bottom of the whole issue, is that there is always going to be, always going to be, a conflict between the agenda of the physician as far as medical and the system as a business. I mean, it is very difficult to reconcile those two things, unless the person in charge of the business is the one providing the care.

Because I feel very confident that I make decisions that are medical. that aren’t particularly financially the best for me, right? But I have a fiduciary responsibility to my patients to provide the best possible care. So I can juggle those things because they’re under my control. A physician who’s employed, and again, I’m not bashing being employed, I just think that a lot of the issues that are buzzwords now, like burnout and all these other things, are a reflection of this very core, discord that there is between what the agenda of the doctor is and what the agenda of the system is.

Not that they’re not interested in private care, good care. It’s just that when it comes down to maximizing the business side, that always wins over because that is the business that they are in. whereas the doctor Can juggle that and have control over that and I can make decisions for an individual patient at a particular time Which is not Mandated by a little box.

I check on Epic, you,

know, which is the electronic most common open record or shorter. It doesn’t matter My point is that I am able to make decisions not necessarily that fit an algorithm Which, is designed for billing purposes, you know, so.

Daniel Wrenne: Yeah.

And ultimately act more in the interest of the patient. I’ve thought about that a lot, with young people, especially a lot of people coming out of training. I don’t know the stats on this either, but I would assume it’s even more pronounced that they’re going to hospital employment type setup than the established ones.

and I’m just curious. I wonder if they know that what they’re getting into, maybe not. I mean, you can’t know what you’re getting into and

Dr. Marcelo Hochman: Right. No, I understand what you’re saying, and I think that’s one of the, so that’s one of the things that IndieDocs, or the, the organization that I’m leading now, is one of the things that we’re very interested in doing is exposing medical students, residents, fellows in training, or physicians in training at every level, regardless of specialty, to independent practice.

It’s because think what you’re alluding to is that, you know, if you don’t know that you have this option, then you don’t know you have this option, so you assume you have to do the other. So, we all train in a system because that’s just the way you get taught. Except that when I was going through training, there were actually rotations through.

Daniel Wrenne: Yeah.

Dr. Marcelo Hochman: You know, but if those don’t exist and there’s some specialties that still do that, but many don’t, then you just don’t see that as an option or what you see is this big system. And as an individual, you think, how can I duplicate that? You know, how is it that I can provide all the financial things and all the insurance, you know, you know, Pre certification, I mean, you see this very, very large organization, which it’s hard to imagine how you would duplicate that if you were in charge of that. Well,

you don’t have to be that big, you know, you can, it can be just you and do, do it on a smaller scale. If you’re taught how to do it,

Daniel Wrenne: and there’s a lot of baggage that comes along with being big. It’s very difficult to change first of all, there’s all this red tape and insurance and billing and stagnant and, you know, old ways of doing things and lots of old guys being like, Oh, this is the way we do it. Just cause this is the way we’ve always done it.

Don’t ask questions. That kind of thing is. Rampant in big organizations.

Dr. Marcelo Hochman: yeah, you know, and again, the, that was the reason that I left, after 10 years. At an extraordinarily busy practice, I’m very grateful for the opportunity that I was given when I first came out of training by the chairman that hired me. it was great until it wasn’t great. And the reason that I decided to leave was I had things that I thought I needed to do to promote my practice, right?

So, priorities one, two, three, and four, whatever those were at the time. Those priorities within the department’s priorities were maybe, you know, 9, 17, and 47, and 93 or

Daniel Wrenne: Oh, God.

Dr. Marcelo Hochman: And then if you put the department’s priorities inside of the system’s priorities, it became very clear to me that those things that I thought were important were never going to happen.

They just were never going to happen, right? so that’s what I thought, I’m going to do this on my own. And again, not that it’s easy, it’s work, you know, all that kind of stuff, but at least I felt that it stood out to be true that you at least have control, you know, autonomy, which is another thing that’s been recognized as key to enjoy what you do, regardless of what your professional,

Daniel Wrenne: Hmm.

Dr. Marcelo Hochman: being able to make decisions, good and bad, right? So it’s not like it’s all roses by any means, but at least you feel you get, well, gosh, you know, I made a mistake. I can fix that tomorrow as opposed to I made a mistake and now I have to wait on a committee to decide, you know, and I mean, it just gets bigger and bigger and bigger and that individual.

Ends up invariably feeling like they don’t have control.

Daniel Wrenne: Do you think, uh, in your experience when you were at this larger system, was taking the best possible care of patients I’m imagining that was at the top of your priority list, but did you feel like the organization had that at the top of their priority list? Maybe they said it was the top of their priority list, but were there actions

Dr. Marcelo Hochman: Well, again, you know, if I was the CEO of a hospital, you know, and now the big trend is to have MDs, you know, in leadership positions. I mean, that’s a big topic, Right.

But I can tell you that as soon as that MD becomes an administrator, they are more an administrator than an MD. Because their agenda and their priorities are now business related.

Of course, they want to take good care of patients, and there’s some amazing thing happening. I mean, you know, there’s a role for the systems. I am not saying that we should get rid of them. We can’t get rid of them. You know, I mean, if I have, you know, certain things like a, you know, brain aneurysm or something, I want to be in a hospital, not in a outpatient surgery center.

You know, I mean, there’s clearly a role in research and all those kinds of things. So it’s not that their intent is not to take care, I mean, I, I truly believe that, I mean, you still have physicians that are, and nurses, and personnel who are doing a great job. It’s just that when it comes down to it, the decision is always going to be biased towards the financial side.

Daniel Wrenne: So I think it’s a how you’re prioritizing the values. And I see that a lot with physicians that I think that ties into burnout and dissatisfaction and then leaving people leaving jobs and that kind of thing. It’s like a values mismatch. and there’s a bunch of examples that we’ve already been talking


Dr. Marcelo Hochman: Yeah, I mean, And

that’s exactly it. I mean, there is that fundamental, fundamental discord between, you know, there’s a term, you know, that’s been popularized. Last few years, you know, moral injury, you know, which is what this is, is, you know, what you should be doing. You’re going to do that because that’s the best thing.

However, this computer screen is not letting you do it. You know, you’ve got something there that doesn’t let you go on to the next step, you

Daniel Wrenne: But the idea with the moral injury though, isn’t it that you kind of like over time, the longer you ignore it, you essentially like sell your soul to the devil type. I mean, it’s more


Dr. Marcelo Hochman: you start compromising, you know, and that discord between what you think is right and what you’re forced to do leads to,

a lot of stress and a lot of, bad decisions, you know, that you then feel bad about, you know, and, and then you don’t have any


Daniel Wrenne: and you’re being a human, you don’t want to be at the core. Like it’s cognitive dissonance. It’s like,

Dr. Marcelo Hochman: Right.

Daniel Wrenne: it’s all like, how am I, how did I turn out to be this person? You know, like you start asking those questions.

Dr. Marcelo Hochman: Right. So, you know, it’s interesting, you know, when, right now there’ve been, you know, recent surveys where the perception of doctors. ourselves of the profession is very negative. So there’s in general sort of a dissatisfaction in medicine, right? Like a physician by physicians. And when you start asking or when they ask, you know, what is it that you enjoy the most about medicine?

By far is the doctor patient relationship is the relationship with our patients, Right, I mean, every day there’s an interaction that really becomes the highlight of your day. financial satisfaction is down at the very bottom. It’s like 18 percent of doctors put finances as the reason why they’re in medicine.

And, the reason they’re in medicine is for this taking care of people, right? The problem comes in again with autonomy, not having control over your way of practicing medicine. So now, just like you said at the very beginning, you’ve got to run through X number of patients in a day. You can only dedicate, you know, 11 minutes per patient, you know, because there’s only so much time, you know, in the day.

So the one thing that doctors get the most gratification from is being curtailed, and, if a patient has a complaint in my office, I can take care of that or address that immediately, right? Whatever it is. I mean, I may not like it, whatever, but as a physician in the system, there’s always passing that complaint on to somebody else so that there’s a disconnect between the doctor and the patient.

The patient no longer feels like their doctor is the one taking care of them,

Daniel Wrenne: Right, well, so if I were to highlight that, I agree. It’s like I’m talking more on like a, individual experiences level. in my experience, most physicians do rank, you know, patient care and the relationship is top top. That’s the reason they did what they did. And, and then financial is, you know, lower somewhere on the priority list.

but I think what I’ve seen sometimes happen is when you kind of clarify that or put that out there. And then maybe you realize that the hospital system that you’re working in is in direct conflict with that and causing a lot of the problems and autonomy, autonomy would be the ability to change it so that you can get back in line is not there.

So you’re kind of in a, like, no way to change. You’re in a straight jacket. so then the next thing I would naturally raise is like a third party observer is like, okay, well. What if we could, leave and switch it around where you’re like, patients are number one, and then we shape everything around that, aka private practice.

then, when I bring that up, it’s like, immediately the stuff that starts coming up is financial, which is so interesting because it’s the low thing.

Dr. Marcelo Hochman: But that’s, well, right. So it’s not the reason you went into medicine, but then when you’re in charge of your own business, like in any other business, that’s one of the scare points of going into practice, right? So how do I do it? You know, how do I get the money to do this? How do I manage payroll? How do I know how to, Sign up with insurance companies, that kind of stuff.

is the reality,

Daniel Wrenne: Mm hmm.

Dr. Marcelo Hochman: Which scares a lot of people because they haven’t been exposed to how to do it. so again, it goes back to the training type of things where, you know, if you realize that you know, your business is taking care of patients and there are lots of resources that you can outsource to take care of the things that you don’t know how to care of.

And of course, you know, I mean, it’s a process. You know,

you make bad decisions about good decisions. At the end of the day, you have control and that is a great source of satisfaction. it’s not for everybody, but it’s, you know, at one point, remember physicians were all independent practices,

Daniel Wrenne: I know,

Dr. Marcelo Hochman: and, um, we’re the same type of people.

It’s just, you know, times have changed and all that. So there’s always going to be a subset that really just feels more comfortable with the security of a paycheck. I mean, there’s nothing wrong with that if you’re willing to. You know, to balance the other things, I know that the security of a paycheck isn’t worth all the things that I feel like I have to Compromise.

on, Right. So, yeah, so my income is, I know that it fluctuates depending on the time of the year. You know, if I want to take time off, I know what the repercussions of that are. But you have control over that. I mean, you can figure it out, so. Yeah, so the financial part is one of the biggest scare points. about doing it on your own and it becomes very important.

Daniel Wrenne: Right. But what I, my pushback on that is like, okay, going back to square one, you’re telling me patient care is number one. The financial is less of a priority, like it’s lower,

Dr. Marcelo Hochman: to go into medicine.

Daniel Wrenne: correct, but like, remember back to that day, you know, like, because I think, if you can back to that viewpoint, that’s a really virtuous in some ways, like view of life, like money doesn’t make you happy directly.

Dr. Marcelo Hochman: Yeah, right.

Daniel Wrenne: It doesn’t get you anything. It’s just a tool. And so I think part of that too, is you get the student loans along the way and then you go early in practice and then you’re like, man, this financial weight starts to slowly weigh you down but I think it’s helpful to remember back to the time when you were thinking a little more clearly and it’s like, well, maybe I can on patients are most important because I mean, it shocks me how many people I talked to that are like, I’m having a hard time taking the best care of patients possible, but I’m making really good money.

And it’s like,

Dr. Marcelo Hochman: Oh, yeah.

Daniel Wrenne: you know, what do you think you’re going to think when you’re 80 looking back about that? You know?

Dr. Marcelo Hochman: I mean, I, I agree. I mean, it’s complicated in terms of the you know, everybody has their own financial situation. You know, come out of medical school with 200, 000 in debt. How am I going to do that? You know, all of a sudden, you know, having a steady income. Seems to be very, you know, pretty, uh, like a good deal, right?

but again, if you don’t have anybody teaching you about how to look at this early, early on in medical school, start thinking and looking around to see what the different options are and all that. And at the end of the road, yeah, you, you see, I got 300, 000 in debt. How the heck am I going to get out of that hole?

Well, okay. Then you sign off with something and you get a, all of a sudden you’re making more money than you ever thought you could, but you’re still in that hole, you know, and then very quickly you feel more confidence in your medical abilities, you feel more confident in how you’re doing things. And then you start looking around and you think, you know, gosh, what am I doing?

Daniel Wrenne: Right. Maybe I should make a shift. yeah, I mean, it would be good if there was more resources and training which it sounds like your organization is working towards that.

Dr. Marcelo Hochman: that.

is one of, one of our goals is to attract early on medical students and residents to join so that they have mentors and examples of, you know, so one of the things I, you know, I tell people who are in training is trying to decide what you want to do, you know, what kind of practice do you want? and part of figuring out what you want is, you know, who do you want to be like?

You know, it’s like, who, who do you see practicing medicine the way you would like to see it practiced? For whatever reasons. It may be their clinical skills or whatever. And then, you know, what are the, you have to be honest, and this is the part that most of us figure out much later in life, not that we figure it out, but we start thinking about it.

But if you can actually start thinking about. What is it that you really would like your practice to be like? You know, who do I want to be like? You know, what are the pressures that you have? I mean, what are the financial pressures? Is it debt that you already have? Is it, you know, your family has medical problems that you have to take care of?

I mean, there’s a whole list of things that I go through when I talk to, or when I give that talk, that helps you start focusing on The life and the practice that you would like to have

Daniel Wrenne: Mm hmm.

Dr. Marcelo Hochman: and what you might need to do to make that happen in the long run. And I think the sooner, those are things that I’ve learned the hard way, right?

mean, most of us learn everything the hard way, but it’s kind of nice if occasionally you get a little bit of advice that you can take a piece of and apply it early on, right? so that’s when things were very interested in doing.

Daniel Wrenne: hmm. That sounds a whole lot like a financial plan. a little bit of a different flavor, but it’s like essentially So, you know, we help families one on one in our planning business and really at the core, we, what we do is we help them like identify what their ideal life looks like, like you were just describing, but you know, their practice in their professional, the whole deal, and then take it back to today and say, okay, well, what.

Steps do you need to be taking when you’re specific to your money? That’s the financial part specific to your money so that you’re using it as a tool to get there faster. And you can do, I mean, that’s the thing about whether you go to private practice or, you know, whatever direction

Dr. Marcelo Hochman: Of course.

Daniel Wrenne: you can use your money as a tool and, or, or even just.

Like student loans, for example, there’s all kinds of things in the, like student loans, now everybody’s income based. So if you start a practice and your income zero, you’re not going to pay anything on your student loan. So it’s, it’s actually not too bad of a situation. And that’s kind of part of the, you know, some of the levers you can pull with your finances.

But I think having a plan, I’ve noticed a lot of people, are really intimidated about going the direction or going away from the big, huge, secure hospital system. Partially because they just don’t really have a concrete plan with their finances. And that’s where the fear starts to pop up like you were saying with the finances.

It’s like, what if I don’t make the study paycheck? Or, you know, all the other things.

Dr. Marcelo Hochman: Yeah, so, you know, and if you’re, aware of that early on, then you have more of a chance of at the end of the seven, eight years of training to have a little bit You know, more sense of where you might want to be. You may still want to be employed. I mean, I’m

Daniel Wrenne: Right, right, right.

Dr. Marcelo Hochman: that’s not for everybody, but, but I think when you’re in your sixth, seventh year of training and all of a sudden you’re having to think about what am I going to do, it’s much easier to go the, well, I think I’m going to go over there and And get paid and, you know, just, you know, quote, take care of patients, which is what it’s always sold as, you know, but then all of a sudden you have a non compete clause, you know, so when you get tired of being employed, you can’t, and now your kids are In school in this

Daniel Wrenne: In a private school in a million


Dr. Marcelo Hochman: all that kind of stuff, and now you’re either stuck or you have to move, you know, and so there are a lot of other things that go along with being employed.

Which, so I like to say you kind of pick your headaches, right? I mean, there are headaches on both sides. If you’re an employee, you have X headaches. If you’re in private practice, you have X headaches. Which headache do you feel most comfortable dealing with,

Daniel Wrenne: But the problem in the employment setup is a lot of the headaches. There’s no medicine for it. Like you can’t get rid of it. You

Dr. Marcelo Hochman: Lack of autonomy.

Daniel Wrenne: Yeah, basically autonomy. Whereas in private practice, small business, there’s all kinds of effective medication for the headache and autonomy is your ability to change things to make it better.

So you have to get used to the headache. And

Dr. Marcelo Hochman: So, again, the more prepared you are for either scenario, you know, the better off you’re going to be, you know, so,

Daniel Wrenne: Have you seen any statistics about burnout as it translates to private practice versus employment or

Dr. Marcelo Hochman: Yes. Yeah, so there is, you know, so satisfaction with medicine, right, as a, profession. and again, that’s just to sidetrack a tiny little bit. When you treat medicine as a profession, you make certain decisions. When you treat medicine as a job. then you make other decisions and you feel pressure.

There are different pressures, right? And I think that’s, again, part of that discord that we were talking about before. So, but in terms of satisfaction with being a doctor, there’s higher satisfaction among, independent practice physicians than employed physicians. There’s also higher satisfaction In physicians that are over 40 years of age and those that are under 40 years of age, which is kind of interesting, but I think that also reflects that there’s probably more employed doctors under 40, right?

Because that’s kind of the pipeline that’s happening right now. so, you know, it’s human nature. I mean, that?

translates into probably most businesses, you know, that at some point have to pick. Which one suits you best, you know, you want to be the owner. Do you want to be the employee?

Daniel Wrenne: and I would guess that the ultimate compensation is higher as well and private practice Maybe not early on but

Dr. Marcelo Hochman: I don’t think that’s necessarily true. So no

I think that the So, you know when you when you look at compensation, I mean, you know this better than I do probably but you know compensation as an employee may be Your salary, but it also may be that they cover your malpractice insurance and they provide a place for you to work and they provide, you know, so are there all these expenses that you’re kind of paying for but not really so you have X amount of dollars to take home.

Whereas when you’re the one providing for all those things, the numbers may be a little bit bigger individually, but it ends up being. To say, right but at least you have the opportunity to do more, but I, I don’t think that there, I mean, employee employment salaries are pretty good,

Daniel Wrenne: Oh, yeah, it’s hard to, especially, I mean, if you’re in a really, if you’re a very, very productive, like from an RVU standpoint, physician, like that becomes impossible to replicate in some ways because the hospital is just, I

Dr. Marcelo Hochman: well, so, yeah, so you mentioned one of, the words, I don’t know if your audience, you know, if they’re familiar with the whole RVU, you know, that whole payment system, but again, the RVU or the value that that position is providing the hospital. Right? So, the neurosurgeons are a very large revenue stream for the hospital.

So they can afford to incentivize the neurosurgeons with bigger salaries than, that’s why they got rid of the pediatricians. Right? Pediatricians basically use codes that are all just office visits. Which are very low generating for the system. However, as a person, as a doctor, you can make that work in your own business.

It’s just that for the hospital, you’re costing them more than they are getting from you. And that’s why they got rid of all the primary care doctors. At first they thought, well, the referrals into the system would make up for it. And it turns out the doctors are going to refer to whoever they want to anyway.

Right? and they were costing them money because they don’t generate much as a, as a family practice doctor for the system. But as a doctor, or as a group of

doctors, you can be fine financially, you know?

Daniel Wrenne: one single, Example, maybe I can think of one where they started a practice right out of training. It’s extremely rare. I think it used to be common back in the day. I imagine it did a long, long time ago where that was just, cause that was just the way that people did it. But I know Dennis, for example, as a comparison, they, a lot of them do start their own practices, sometimes just straight from scratch, right out of.

Training, but I’m kind of an entrepreneur, lean type personality, and I love the whole, I’m a big believer in entrepreneurship. And I think a lot of these problems get solved when you put good entrepreneurs at it and small businesses and young people are some of the smartest people and haven’t been kind of squashed yet.

Like they still kind of have a lot of creative ideas. And I feel like. The more young entrepreneurs we can get in medicine will help to solve a lot of these big giant healthcare problems, but it’s just not happening. Like, I just, it seems like it’s extremely rare, especially the youngest.

Dr. Marcelo Hochman: Well, you know, so dentistry, part of the reason that what you described is so much more common is that they avoided the third party payer arrangements for much, much longer, Right, So dentistry is very, it’s like veterinary medicine in the sense that it’s all, most of it is right, So the patient is paying for the service that they’re getting from their dentist, right.

Medicine fell into the trap of a third party payment system, a while ago. So that leads to a lot of the issues that eventually translate into some of the things we’ve already talked about, is that how do I duplicate what I see, which is this giant system? And it’s very daunting. Our dentist coming out of dental practice has had mentors their whole training.

Which are doing it

Daniel Wrenne: Right.

right, right.

Dr. Marcelo Hochman: in the way that they say, well, I can do that. You know, they’ll show me how to do it or I’ll join a practice and then I’ll eventually take over the practice, which is what medicine used to be like, right? But they’re in control of all that because they’re not beholden to a lot of other regulations.

I mean, you know what I mean, in terms of insurance payments and government regulations and all that kind of I think going back to the same thing is if we can get medical students, physicians in training at different levels exposed again to private practice, there will be a subset of them that will.

side of this is really the more the patients demand that, the more of that there’s going to be. Right. So, you know, again, given a choice, patients prefer the old setup of, you know, they can go in and see their doctor and they know who they’re seeing and all that. There are a lot of things that have to change from the patient’s point of view, benefits.

I mean, it’s very multi layered, but again, you don’t have to change the whole thing. My whole involvement in all of this has always been to just try to open doors. So that people can have a choice, an alternative to the system, you know, so

Daniel Wrenne: If I’m, if I’m listening, I’m in training and I am kind of like, I’ve struck, we’ve struck a curiosity with them in terms of like this whole private practice idea, but, but they also are like, yeah, but what you’re saying is right. Like all my, all my people around me are not in that. And I don’t even have nobody around me is doing that.

And like, I just don’t see the path. Do you have any suggestions for them to like find, I don’t know, find a source of education or influence outside of that,


Dr. Marcelo Hochman: that’s the biggest softball that you’ve thrown all day, so join IndieDocs, you know, so go to www. indiedocs. com, Independent Doctors of South Carolina, and that is part of what we’re trying to build, is, we just had a webinar a couple weeks ago, we’re having one in a week, it’s free, you know, the next one we’re talking about is unpacking the financial side of independent

Daniel Wrenne: perfect.

Dr. Marcelo Hochman: The last one we had was the pros and cons of independent practice, so a lot of what we’re talking about. It’s free for medical students, residents, and

Daniel Wrenne: Oh,

Dr. Marcelo Hochman: you know, people in training, and the goal is just to get them interested, so we sent out the link to all the medical schools and all that kind of stuff.

You know, I mean, that’s part of what we want to do

Daniel Wrenne: that’s perfect. Uh, and you get, you got, you got some experienced independent physicians involved in it that are kind of guiding the thing and like yourself and, and you get the young.

Dr. Marcelo Hochman: and you know, we’re going to have a meeting in January In Columbia, you know It’s statewide. It’s gonna be our first meeting And there’s going to be you know Amazing speakers that have experience and this is also for people who already in independent practice you know, I mean to talk at a different level of You know, what do we do about this and that or the other, but for, you know, how do I do this be, you know, some nuts and bolts type of workshop and, you know, that kind of thing.

So it’s, you know, we’re really trying to gear it for, again, one of the things we’re interested in is preparing the pipeline for the future, you

Daniel Wrenne: Yeah. Do you have to be in, um, in state to do the webinars or the conference?

Dr. Marcelo Hochman: Well, so, technically you can join IndieDocs, you know, I mean, you can join the webinars. The webinars are free. Right.

so wherever your listeners are, they could join the webinar, to become a member though, you know, we’re independent doctors of South

Daniel Wrenne: Right.

Dr. Marcelo Hochman: now, big picture

Daniel Wrenne: One day you’re going to have independent doctors of the U. S.

Dr. Marcelo Hochman: Exactly. Independent doctors of Ohio, you know, independent doctors. But, you know, but we want to get this Right. here. you know, we’ve done some things in South Carolina, you know, is a very small state. So, there are lots of things that can be done and tried that then can serve as a template for other places, you know. but those are the things I’m very interested in that I’ve been involved with. You know, it’s just projects that, that work here, that then can be translated to other places.


Well, that’s great. I think that’s, that’s a good, good place to end it. Definitely go and check that out if you’re interested in learning more. And I’ll link to the. Website in the show notes. So you guys be able to pull that right up, Marcel. It’s been good chatting with you. I appreciate you

Now, likewise, thanks for having me and, if I can be of help to anybody, please share my information.

Daniel Wrenne: Awesome.