Day: March 1, 2020

Go TEAM!

Team is a potentially powerful word. It makes us think of a number of positive things: strength, goals, accountability, potential, spirit, togetherness, cheer, and being the best. We have very high expectations about our sports teams and complain bitterly when a player does not seem to be “pulling their weight” on the field or on the floor. We get angry when we watch games and the team does not seem to be cohesive and plays aren’t carried out correctly.

So, here’s a question, why don’t we think of team in the same way when it comes to our healthcare? We talk about healthcare teams, but I feel like patients often think of this as a group of people who are in charge or responsible for their healthcare. Somehow they leave themselves out of the equation as a responsible or accountable party for their own health and well- being. Why? Is it easier to blame the doctor when you have health issues, instead of participating in your health care plan? Does this kind of thinking actually lead to better results? Do patients actually benefit from this? I think not.

I have a physician colleague who always says to patients, “I am a physician, not a magician.” When I first heard this, I almost laughed out loud because it sounded corny and ridiculous. But you know what? He has a point. I get what he is trying to say. I may not phrase it the same way, but my intent is the same. The doctor patient relationship needs to be a team effort to be successful. There needs to be active engagement and participation on both sides to achieve maximum benefit. I have patients that come in every day and say, ” Doc, I need you to fix me.” This raises an immediate red flag for me. This means that the patient is not engaged, is looking for an easy solution, and is not ready to be accountable. It means that it is all up to me. Well, that just won’t do. I am not ready for that significant a burden, especially when I know that it won’t go well. It is just a waste of the patient’s time and my time. I can’t force them into caring about their health by my sheer force of will. I also can’t keep charging them money when I know that they are not actually following the care plan. I just can’t do it. ( I’m not in it for the money, remember?) The team concept is always the way to go. I like making plans together with patients. I like talking with them not to them or at them. I like knowing that they have thought about what they want, whether it is aesthetic goals or general women’s health goals. I like the thought of them realizing that when I remove their fat or tighten their skin, they are committed to maintaining their weight and fitness to keep the results that they want. I like making weight loss plans with them to help them try to lose weight in a way that makes sense and is manageable to them. I like to consider myself a resource and a guide, not a taskmaster by force. Have a fantastic day everyone!

Dr. Katz

Why in the hell is my obgyn doing aesthetics? Stick to delivering babies man.

First off, I want to impress upon you that what I am about to say applies only to me and my personal situation, although I suspect that similar motivations are in play with this trend toward incorporating aesthetics that seems to be popping up in practices all over the country.

Let me start off by saying that I do not have one ounce of regret about becoming an obgyn. I have loved my job from day one. The sheer variety of intellectual stimulation astounds me. I get to take care of women from birth to death and help with everything from their pregnancies, to general health to surgical treatment and even cancer management. I can still remember like yesterday my somewhat circuitous path from music school to pre law and eventually medical school and then the next fork in the road trying to decide on a specialty. I can remember the day I cried with overwhelming happiness at my very first delivery, much to the snickering delight of the other residents in the room. Fortunately the new mother was gracious enough to hug me and ask me to sign her baby book. I remember the sudden lightning bolt of realization that I had found a specialty with infinite possibilities that could potentially provide me with emotional and intellectual satisfaction for the rest of my career. That was a great day.

I finished residency and jumped right into a group practice that I knew was potentially fraught with issues. In my own characteristically undaunted optimistic way, I was sure that I could transform the whole practice myself and bring everyone harmoniously into the future. Yup. Let’s suffice it to say that that did NOT happen! I ended up leaving the practice, taking a hiatus and then starting off all over again on my own, all while trying to raise a toddler. I am just not into the easy way . It’s not enough of a challenge factor…lol

I started my own practice and have been working away for the last 20 years. I am an independent, solo-practicing obgyn. There are not many of us left. The majority of all physicians, much less obgyns, are either part of a group practice or employed nowadays. This scenario helps with a lot with quality of life, less call, less worry about overhead and management decisions and often results in a steady salary. The trade off is that you end up tacitly de-participating in almost all decisions that matter like the makeup of your staff, how your office runs, who you are allowed to partner with and refer to if necessary and your billing process. As a solo independent practitioner, you are free to make all the decisions you want. You have decisions coming out your ass regarding overhead, management, paying bills, hiring and firing and how to carry your practice forward. This give you the illusion that you are in control of all aspects of your practice and your business. This sounds good at first, but you quickly realize that there are many factors that are out of your control. You wonder what the hell you were thinking. You stay up at night worrying and wondering how to strike a compromise between keeping your practice afloat despite ever-decreasing reimbursements without working so hard that you never see your family. Yes, it’s a real mental load on any given day. Still, I don’t regret the decision to have my own practice. I truly feel that it is what I was meant to do. I am able to “keep my finger on the pulse” of the quality of care that my patients get every day. That is a good feeling. I am 100% invested in what I do. It is not just a job. My employees and my patients are like my extended family. That is how much I care and how far I would go.

Having said that, worrying gets old and physicians all over the country have had to get creative in order to maintain their practices and their lifestyle and still stay in business. I am planning to keep going for another 20 years and I realized that I could not do it without changing something or reinventing myself. Here is where aesthetics comes in. I currently practice the full scope of obgyn care( delivering babies, doing gyn surgeries, adolescent gynecology, etc) and I practice aesthetics. I perform Coolsculpting, laser hair removal, head to toe laser services, photo facials, sun spot removal, vaginal rejuvenations, pelvic reconstructions, labiaplasty, morpheus8 radiofrequency micro-needling, etc and I am trying to keep learning new things all the time. Why take all this on you ask? First, my ultimate Wonder Woman goal is to become a “one-stop shopping area” for women of all ages. Aesthetics fits into that niche because it helps to allow me to take care of their health and beauty needs all in one place. That increase in service convenience for multiple issues will ultimately help me keep them healthy and beautiful. In addition to that, those ever-decreasing insurance reimbursement rates aren’t due to improve any time soon. As it stands now I get about 30 to 35 % reimbursement about three months after I do something for a patient. This means that I have to work at least three times as hard as I used to to make anywhere near the same income as I used to 10 years ago. That makes it tough to keep the proverbial lights on and be anything but a distant memory to my kids and family. So, my choices narrow down to working so hard that I never see my family and see so many patients a day that I risk missing important diagnoses and compromise care………..or………find some cash-based alternatives that I feel are effective and worthwhile and allow me to better pay the bills at the same time. I decided to go with option B. Having said that, it is not just about the money. I find aesthetics very intellectually stimulating as well. I love learning and participating in the trend toward minimally-invasive options for a variety of conditions that formerly required extensive surgery. It also appeals to the artist in me that had to somewhat go the way of the dodo when I veered away from the path to music school. I get it that treating wrinkles, hair, fat deposits and laugh lines is not the same as playing a concerto, but there is an art to it just the same. There were a lot of practitioners out there offering aesthetics so why not me? I kept seeing patients come in suffering from complications from procedures performed by unqualified individuals under unsafe conditions. I felt like I had to get involved. I am a board-certified physician that knows a lot about female anatomy. I invested the money to properly certify myself and my employees . I only purchased the best equipment and I am always there whenever any procedures are being performed and my office is prepared for any possible emergency. As I see it, this is a potentially better, more qualified set up than a lot of spas out there. Now before you get your feathers ruffled, please keep in mind that I am well aware that there are some excellent facilities out there that operate safely and with great results. However, my personal experience has taught me that that is not the norm unfortunately. So, when patients start asking why I started practicing aesthetics. I find myself asking, why not? Have a fantastic day!

Dr. Katz