Dr. Tea Nguyen (00:00.0)

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance-based medicine. I pivoted into direct care, where patients pay me directly for my medical services and have never looked back. 

Dr. Tea Nguyen (00:30.648)

If you're a private practice owner or planning to become one, who's looking to be free of the grind of insurance and your craving simplicity, efficiency, and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast for Specialists. 

Dr. Tea Nguyen (00:53.88)

Do I continue to suffer so that my patients get my care or put my mental health first? It might seem like a strange question, but it's actually very common here in the medical world. This is such a sad, but very common moral conflict that a lot of us have. We have been so enamored in this broken healthcare system that we can't even realize leaving is a viable option. We have inherited 

Dr. Tea Nguyen (01:22.262)

a toxic culture that has put into question our very own personal health. And we work in healthcare. There is so much irony in here and I have a problem with that. So let's unpack it in case you feel that you are at a decision point on whether or not to continue doing what you're currently doing, even though it's painful and hurting your mental health. First off, it's raining here, so you might be hearing some of that sound in the background. 

Dr. Tea Nguyen (01:51.97)

I'm not quite sure, but I enjoyed the ambience for this episode. So let's get into this. I want you to know none of this is your fault. You and I inherited a very broken system. We inherited unhealthy behaviors too, things like self-sacrifice, because we were taught that it comes with the rewards of feeling good enough. But did we actually end up feeling good? Do our families get the best version of us? 

Dr. Tea Nguyen (02:22.444)

Or do they get the worst version? It's really wild to believe that we as healers expect our patients to take our recommendations when we can't even do it for ourselves. That is wrong and it's misaligned. Here's a problem that'll keep you on the burnout train if you don't recognize that you can actually just get off at the next stop or if you have to jump out the door. This is the physician-savior complex. 

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And it's problematic to choose between these two options because the first option makes you believe that you have to sacrifice your own wellbeing to be a quote unquote good doctor. That somehow you're feeling personally responsible for every patient outcome, even those that are beyond your control. And it also makes it really hard to set boundaries because you're always saying something like, but patients need me. 

Dr. Tea Nguyen (03:21.782)

Ultimately, equating self-sacrifice with professional competence or moral worth ties you down to that identity and it makes it really hard for you to walk away or even to deal with complications that are out of your control because you're so tethered to that identity that things have to hurt in order for there to be a reward. And this is how it hurts you as a human and how it undermines business growth. What happens is it prevents you from 

Dr. Tea Nguyen (03:50.708)

setting a sustainable schedule. So you end up working around the clock, which leads to burnout. And as somebody who's married to a general surgeon who is on call every fourth day, it's exhausting for both him and the family because it's brought home too. And we had to go through marriage therapy to ensure that we had boundaries in place. And I share that because I want to normalize getting help. Nobody is supposed to figure it out. 

Dr. Tea Nguyen (04:20.45)

all by themselves. And boundaries are really hard, especially for our household with two working physicians, two surgeons, because now we've doubled the load of the people we care about, our patients, the workload multiplies. But if you don't do that, then it makes it really hard to say no to patients who are not a good fit for your new practice. If you're going into direct care, 

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or if you're looking at leaving your employee situation or if you're just looking to opt out of insurance. If you can't start saying no now and you continue on with this behavior where you feel responsible for everybody's care, you don't have those boundaries, you're just going to wear yourself out in your new model too. And I know that's not your goal. That's not my goal for you. And so you really have to be able to see that this is not sustainable. 

Dr. Tea Nguyen (05:14.86)

staying trapped in a system that forces you to self-sacrifice your own health because you feel the need to take care of everybody. That's really hard. That's exhausting. That leads to burnout. And what good is your business if you're burned out? Because if you're burned out, then who is going to take care of the patients, right? We are going back to point A where you feel like you have to carry the load of all of these patients, but 

Dr. Tea Nguyen (05:42.764)

Listen, one day you and I, just going to be somewhere underground. So why not start practicing your boundaries now so that you can live a long, joyful life and not worry about every single patient or feel responsible for all of them that you encounter? That's really hard. It's really heavy and it's really not necessary. And what I've also seen is people who are so compassionate, so empathetic in caring for their patients. 

Dr. Tea Nguyen (06:13.036)

that they get to the point of burnout because they didn't have boundaries and then they start to carry resentment and then they start hating the practice of medicine and then they show up in a certain way with a certain attitude and that gets reflected in their health too. They're no longer taking care of themselves or their mental health or physical health or it starts to erode relationships at home and with their friendships even. 

Dr. Tea Nguyen (06:41.986)

Or maybe they don't even have time to take care of all of these things, which I like to treat them as a garden. You have to water them from time to time. You have to give it nutrients in order for these relationships to survive. But if you are only focused on the patient, everything else is at a compromise. And then let's say you have your direct care practice. What you might see, experience, or feel is 

Dr. Tea Nguyen (07:09.58)

that if you don't create boundaries and you don't recognize that you can choose certain patients into your practice, you can select for a certain type of person or service you want to deliver, then that also makes it really hard to charge the way you need to charge in order for your businesses to be sustainable because you'll say things like, I can't charge that much. You have some kind of feeling about it. So it's really important to reframe this false 

Dr. Tea Nguyen (07:37.666)

dichotomy where you think you have to choose between sacrificing yourself for your patients or abandoning them for your own health. And that's not even the case at all. There's another reframe. When you burn out, you are helping no one. And that's why you have to leave a failing system in order to build one that works for you. Because when you thrive, you actually get to show up fully for your present patients. 

Dr. Tea Nguyen (08:05.848)

You also get to practice better medicine because it's not rushed. You're not distracted. You're not resentful. You also model healthy boundaries, which patients need to see as well for them to heal. And then you stay in practice long-term instead of leaving it early because now you find joy in the work that you're doing. The truth here is that putting your health first is not selfish. It is a prerequisite for a sustainable 

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medical practice. The problem that we're all in in healthcare is a systemic issue. This is what it does to us. It places the burden on individual physicians to cope with a broken system. is performative to be concerned for the doctor. You know, they'll ask you surveys, how can we improve your experience here? But there really isn't a structural change. You're still taking insurance. You still have to see volume based patients. You still 

Dr. Tea Nguyen (09:04.524)

can't choose the type of services you want to hone in on or the type of patients that's best for you. And it also suggests within this system that burnout is a personal failing rather than a systemic issue, right? A lot of us think that us not doing a good job, not seeing a lot of patients, feeling worn out or just feeling differently is a personal failing that we are incapable that we 

Dr. Tea Nguyen (09:34.402)

I don't have what it takes to be a doctor in this day and age. But this is a systemic issue because in the insurance model, you have to see a lot of patients because reimbursements are declining. That's how you make money. That's how the system makes money. But if your reimbursements are declining, then they're going to have to squeeze the doctor for more time or actually less time. You got to see more patients though. So instead of allocating that 30 minutes for the patient, 

Dr. Tea Nguyen (10:01.902)

It's now 15 minutes and then now we're seeing seven minutes and sometimes it's even two minutes because now we're doing a lot more. We have to be on calls for peer-to-peer calls, prior authorizations. We've got to relearn some codings. We have to figure out if our coding matches with our soap note and so we have these bloated soap notes that nobody can read through. It's too exhaustive. It has a bunch of willy-nilly information that doesn't help us guide the patient's treatment. 

Dr. Tea Nguyen (10:30.572)

It's just another hurdle for doctors to overcome. But the thing is, if you can't overcome the paperwork, that's not your fault. That is a system problem. We did not ask to have more paperwork, more coding, right? We did not ask to see more patients. So I just want you to know this is not a problem. This is a system problem. And when the system doesn't work for us, it doesn't support us. We really don't have to be in it. There is something else. 

Dr. Tea Nguyen (11:00.622)

There's direct care. Here are the different ways the system insults us. First of all, self-care. Self-care does not fix that 60 hour work week or even 80 hour, 100 hour work week. It doesn't fix insurance denials or those administrative burdens I was just talking about, which, you know, sometimes I get PTSD talking about it. So it's kind of like when someone's drowning, literally drowning in the pool or the water or the ocean. 

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And then some guy in a suit walks by and says, just breathe better. And it's like, what do you mean? I'm literally drowning. That is what happens in our healthcare system. The doctors are not being supported and they're telling us to be more resilient. If they really did care about doctors, here are the few things they could be doing. Number one, have reasonable patient loads. Number two, adequate compensation. 

Dr. Tea Nguyen (11:54.818)

Number three, making sure the doctors have administrative support. And number four, professional autonomy. Now, some people are lucky and they get all that. My husband, for example, is a general surgeon, he's in a great place. He's been at the same job that he had right out of residency and he's been there ever since. And I think that's incredible, but it's also really rare. And he is a wonderful contrast to what I have to offer as somebody who helps doctors launch a direct care practice. 

Dr. Tea Nguyen (12:24.066)

And I truly believe that direct care is a structural change to self-care because you're redesigning the practice exactly for you, nobody else. Well, you and your patients, but that's the whole point of the business, right? We're not adding a meditative service in order for you to resolve or treat your burnout. You cannot yoga your way out of a broken schedule, okay? This is about giving you a schedule that you don't need coping mechanisms 

Dr. Tea Nguyen (12:53.806)

I just this just blows my mind this whole topic but so anyway My point here today is that you don't have to choose between your patients or yourself You can have both when you redesign the system that gives patients more time with the doctor where they actually get better where they feel heard and they hear your recommendations and They understand why it's important that you're recommending what you're recommending and they see that you are also taking care of yourself 

Dr. Tea Nguyen (13:23.404)

And this is us here in direct care who is actively changing the system so that we don't continue to perpetuate a system that we inherited, that we had nothing to do with. But if we choose to do nothing, that's still a choice. Then we continue to pass that on to future generations. When you leave the system, the insurance-based model, and you choose direct care, it doesn't just stop at you giving excellent care to your patients. You as the doctor get to 

Dr. Tea Nguyen (13:52.526)

Focus on yourself too, because instead of seeing 25 patients a day, you can see six or even less. And you can reserve the rest of that time to heal, to have mental health days, to do things that matter to you and that rejuvenates your soul. Direct care heals your relationship with medicine because now you're building a system that is sustainable. 

Dr. Tea Nguyen (14:19.958)

AND you get to be selective about how you spend your time and your energy, you escape the system that forces you to suck it up. And instead, you get to choose. This is autonomy. This is what owning a business actually means. You get to build a business that's made perfectly for you. You know, after a breakup, there's this weird part a few months thereafter, it can feel really confusing. And that's what it feels like when you start opting out of insurance. 

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You have this kind of trauma bond, let's just say, where you knew that one thing and only that one thing. But during this phase, this short phase of divorcing it, you're going to have a period of self-reflection. And I want you to lean into that, slow down a bit, because when you're ready, you can then start picking up the pieces to the things that you did enjoy about medicine and then just get rid of the stuff that you didn't like. This is what self-care looks like. 

Dr. Tea Nguyen (15:17.858)

Direct care gives you the time to heal. So I encourage you to start off slow, like a lot of the guests who have been on the podcast have done. So your next step to self care looks like this for us to really change the system. It starts with number one for you to go slow and work on your why. Why is it important for you to leave the system and reflect on that every day? You can even use a parrot app, which is 

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where you can record self-affirmations or dialogue that you can also use chat GBT to create this three-minute narrative where you listen to it on the app, which is a little different from the voice memo if you've got a smartphone. The voice memo is where you can record things and store it for later, but the parrot app puts it on cycle. So you're hearing the narrative over and over again on its own without having to push play all the time. 

Dr. Tea Nguyen (16:14.092)

And what that does is when you start to hear yourself, tell yourself a different story, you start to rewire your brain and you start to believe a new story where you don't have to choose between the two as an example. And then you can just replace those old thoughts for better ones, basically. So I'll put that information down in the show notes for you to know exactly what I mean. So it's going to be the Parrot app, something for you to meditate on or listen to once a day, multiple times a day. That's something that I do. 

Dr. Tea Nguyen (16:42.706)

And also you can use Chat GPT to put in the prompt to create the script for you as to what you'll read and listen to every day. And it really helps when it's your own voice because it'll make it more believable. Just trust me on this one, okay? Just do it. Do it for 30 days. You're gonna feel different. All right, number two on your next step to self-care is setting boundaries. This doesn't have to be crazy. You can start really slow. If you need to take a day off, then do that. 

Dr. Tea Nguyen (17:12.49)

Ask for it, ask for half a day, ask for a full day. And when you get that, make no compromises. Don't answer the phone regarding patient care if it's not an emergent situation. A lot of things often can wait and not everything is an emergency, not everything needs your immediate attention. It can wait until the next business day. So remember, once you retire, they will have to figure stuff out for you anyway when you're not there. 

Dr. Tea Nguyen (17:38.69)

You might as well give them the nudge right now. And what I mean by that is if you're employed, when you're clocked out, you're clocked out. So just find one boundary and set it. Now, if you own your business, you have an insurance-based practice, a boundary might be that you're not going to do a certain service anymore, or you may not take a certain insurance anymore. You decide. This is your world. You get to play around and figure out what's going to work for you. But nonetheless, 

Dr. Tea Nguyen (18:05.378)

Getting into the practice of self-selecting for things that bring you joy and then getting rid of the stuff that you don't enjoy is part of the healing process. And then number three, I think there's a storm coming in, so forgive me if it's sounding a lot louder back here. But number three, I want you to rejuvenate your soul. What do I mean by that? I don't mean to wait for your next vacation. I'm talking about every single day. You're gonna do something. 

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that you enjoy just for yourself. And it doesn't have to be big. It could be something small like buying yourself a nice lunch. I like to buy myself a $30 salad for lunch because I can. I have grown up with money. I'm going to do that because I don't want to wait till retirement to enjoy my money. I intend to enjoy it right now. I also purchased Bose noise canceling headphones so that I can listen to my music or, you know, just zone out so that I'm not doing anything else. I'm doing what I enjoy. 

Dr. Tea Nguyen (19:02.37)

which is listening to music. And I also have a night routine where I'm reading a few pages from a book. It doesn't have to be the whole book. I'm not setting big goals for myself. I'm just slowing down in the evening so that when I go to bed, I'm not wired up and I can fall asleep faster. And I also have an art book that I look at. It's Tim Burton's Nightmare Before Christmas. It's like his collection of artwork that he's done since childhood that they've published. I think it's really cool. 

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to look at stuff like that. But you see, it's unexciting, but it works for me because it allows me to turn off the working brain, even though that's hard for me to do as a business owner, but it's important that I do it. And it's really important for you to start integrating these things to prioritize your mental health so that you could continue to take care of your patients. Direct care is self care because when you opt out of the very thing that is chipping away at your soul, 

Dr. Tea Nguyen (20:00.61)

That's when you can truly heal and a healed doctor is a happy doctor who stays in clinical practice, who can then help and heal patients. Until next time, take care for now. One last thing, if you took anything from this episode, whether it's a small dose of inspiration or even an aha moment, could you please share it with a friend or post it on LinkedIn? The direct care community depends on doctors like you because no one is coming to save us. 

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So it's up to each and every one of us to keep the conversation going to a point where direct care becomes a normalized path for private practice and not some secret that we have to mine for. 

Thank you if you've already done so or if you've given this podcast a review, it really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.