Hippocratic Hustle

Sonal Patel, MD

Newborn Pediatrician Visits in the Home

Special thanks to this week's Sponsors, ZigZagExplorer.com and Curbside Real Estate! Let them know that The Hippocratic Hustle sent you!

Sonal Patel, MD formed her own special company providing home pediatrician visits to newborn babies. Her practice is called NayaCare.  Through these newborn home health visits, she places an emphasis on the maternal-infant dyad - acknowledging the needs of both individuals entering life's new chapter.  Her Sessions focus on breastfeeding or formula feeding, safe sleep education, and screening for maternal depression.  Lets learn more about how she formed this amazing business.

What you will learn:

• How Sonal's own newborn experience inspired her to start this unique practice
• How Sonal set up her practice
• How she developed a business plan
• How she came up with her fee schedule
• If Finland and Sweden can do it, we can too!
• How Sonal marketed her practice
• How she has found ways to bill insurance or use patients HSA
• What overhead that Sonal incurs

I know that time is your most valuable resource so I really appreciate you spending some of it with me. If you enjoyed today’s show, please share it!

If you'd like to help me improve and grow the podcast, I'd love if you could take 60-seconds to leave an honest review and rating on iTunes. Reviews and ratings are extremely helpful when it comes to the ranking of the show and I genuinely love hearing from you!

Lastly, don't forget to subscribe to the podcast, so you won't miss an episode!

Friends Talk Finances:

Student Loans

Bonnie Koo, MD a dermatologist and personal finance blogger (MissBonnieMD.com) joins host Carrie Reynolds, MD for a regular segment where Carrie and Bonnie chat about all things financial. Bonnie is SO SMART about this stuff. She is also one of the moderators of an online Doctor Mom Personal Finance Group (10,000 members!), and is active on the WCI and Boglehead forums.

What you will learn:

• All about Bonnie and Carrie’s backgrounds and families
• How the White Coat Investor was an inspiration for both Carrie and Bonnie
• Mistakes Bonnie and Carrie made with their finances
• Carrie and Bonnie’s plans for Student Loan Payoff
• Managing Student Loan Debt
• Almost all physicians graduate with some medical school debt
  • Average Debt at graduation is $183,000
• Student Loan Refinancing Options
• Public Service Loan Forgiveness Program
  • Created under the College Cost Reduction and Access Act of 2007 (CCRAA), before President Obama came into office
  • First beneficiaries of this law will receive forgiveness in October 2017
• How fast should I pay off my student loans?
• Live like a resident
• Moving is killer for living like a resident
• Make a spreadsheet with all your loans and interest rates
  • Laying out your numbers on paper you FEEL the loans
  • Make a chain link representation of your loans so debt is visible
• Negotiate for a salary that has a bonus structure- so all your bonus money can go towards student loans
• How to debt snowball
• Paying off student loans is a game- you’ve got to keep your mind in it
• Round all the payments up- to apply a little more to the capital each month
• Carrie would buy a condo in the mountains if it weren’t for her student loans
• Try to pay both pre-tax retirement saving AND student loan payments
• Support your sisters to pay off their student loans

Resources Mentioned:

Whitecoatinvestor.com
Boglehead.org
Student Loan Info at Student Loan Hero
First Republic Bank
SoFi.com
MissBonnieMD.com 

Send us feedback and questions to [email protected]

Megan Oxley, MD 

Michigan Progressive Health- A Ketamine Infusion Clinic

Megan Oxley, MD is a Board Certified Emergency Medicine physician. She graduated from Wayne State University in 2009.  Her career started in inner city Detroit, then took her to rural Maryland and she now works at Henry Ford Wyandotte Hospital.  Dr. Oxley enjoys the fast pace of the emergency room, getting to know new people, putting patients at ease during a stressful time in their life and enjoys having the ability to make people feel better immediately.  She is honored daily to be a part of helping people heal.

Megan founded Michigan Progressive Health in May 2016. Listen to this podcast as we follow the steps that one needs to take to open a small infusion clinic- with no business experience! We also learn why Megan opened the clinic and who benefits from ketamine infusions.

What you will learn:

• What is Ketamine?
• What are the indications for its use?
• Who administers Ketamine therapeutically?
• How does an ER doctor without outpatient experience start a clinic?
• The process that Megan went through to build her business
• Strategies Megan used to promote her business

Resources mentioned in the show:

Wix.com- Website building app

Learn more about Ketamine:

1. Murrough, Perez, et al.  “Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression”  Biological Psychiatry 2013 Aug 15; 74(4): 250–256.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725185/

SUMMARY:  In this article, there were 24 patients treated with six IV infusions of ketamine (.5mg/kg) over 12 days.  The overall response rate was 71% as defined as a reduction in the MADRS scale by  greater than 50%.  The median time to relapse after the last ketamine infusion was 18 days.  25% were symptom free at 90 days, 75% of patients had symptoms free days between 11-27 days.  Side effects were reported to be a mild significant increase in dissociative symptoms.  One patient had to discontinue therapy due to an increase in blood pressure that did not respond to medications (highest BP 180/115).

1. Shiroma, Johns et al.  “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal of Affective Disorders. 2014 Feb;155:123-9.

http://www.jad-journal.com/article/S0165-0327%2813%2900778-7/abstract

SUMMARY:  In this article, there were 14 patients treated with six IV infusions during a 12 day period.  12 subjects finished all six infusions with 92% response rate and 66% went into remission.  5 out of 11 responders remained in “response status” during the next 28 days.  For the 6 out of 11 responders that relapsed, the mean time was 16 days.  Response was defined as ≥50% improvement in baseline MADRS score and remission was defined as MADRS score ≤9.  No subject experienced severe dissociative symptoms or hemodynamic changes that required stopping the infusions.

1. Correll, Maleki et al.  “Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.”  Pain Medicine. 2004 Sep;5(3):263-75.

http://painmedicine.oxfordjournals.org/content/painmedicine/5/3/263.full.pdf

SUMMARY:  This article reviewed 33 cases of patients with CRPS that were treated with ketamine infusion.  The patients received a prolonged low dose infusion of ketamine, on average 10-20mg/hr over 2-4 days.  76% of patients experienced complete pain relief after the first course of treatment.  Pain relief lasted at least three months for most patients.  Adding a second course of treatment allowed over 50% to be pain free for over a year.  One patient had to discontinue additional treatments after the first infusion after developing elevated liver enzymes.  These did normalize after treatment was stopped.

1. Feder, Parides et al.  “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.”  JAMA Psychiatry. 2014 Jun;71(6):681-8.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1860851

SUMMARY:  In this double blind, placebo-controlled cross over study, a single dose of ketamine (.5mg/kg over 40 minutes) was compared to midazolam.  Authors note a significant immediate reduction in the CAPS score and frequently this reduction was maintained for over 2 weeks.  The only side effects noted were transient dissociative symptoms, none of which required stopping the infusion.

Katrina Ubell, MD

Weight Loss for Busy Physicians

Katrina Ubell, MD is a pediatrician turned certified life and weight loss coach. She helps busy women physicians permanently end their weight struggle through coaching and the latest weight loss research. She also hosts the podcast Weight Loss for Busy Physicians. She lost 50 lbs herself utilizing the tools she teaches and now weighs less than she did in 9th grade! To learn more, check out katrinaubellmd.com

In this podcast Katrina and I will discuss: 

• How Katrina came up with the idea of being a Health and Wellness Coach
• There is isolation and shame for women physicians with weight issues: more than the average woman
• How we self inflict the idea that we shouldn’t have a problem with weight because we understand the science behind weight loss
• Willpower is a muscle- it ends up fatiguing
• Business Coaching helped Katrina make a plan with her own business
• What are the different Types of Coaching?
• How does one become a Coach?
• What lifestyle improvements came with this new Life Coach Career?
• What Does Katrina enjoy doing in her free time?
• Women Physician Niche—How to find Friends
• Katrina’s Podcast: “Its like you’re in my head”

Resources Mentioned in this episode:

• Life Coach School
• B-School
• “Quiet - The Power of Introverts in a World That Can't Stop Talking” by Susan Cain
• Weight Loss for Busy Physicians Podcast on iTunes

Here's the intro! I hope you will enjoy the new Hippocratic Hustle podcast. I have some amazing guests lined up and I know you will enjoy our candid chats. Visit the website at www.hippocratichustle.com for more information. Questions or comments can be directed to [email protected]. Thanks for listening!