Cherisa and Alex Sandrow: Helping Doctors Avoid Burnout With Telemedicine

Dr. Mark Leeds [00:00] Cherisa and Alex, welcome to the podcast.

Dr. Cherisa Sandrow [00:04] Thanks for having us. Thank you, Mark. It’s good to be here.

Dr. Mark Leeds [00:06] Thank you. So I understand that the two of you help physicians to find a new path in their career. A lot of doctors are unhappy with where they’re at with the state of the medical field, especially with COVID. There’s just, when I go on Twitter, a lot of complaining doctors out there about the state of the medical field. So yeah tell us a little bit about like what you guys are doing to improve things and help people

Dr. Cherisa Sandrow [00:34] You got it let me start okay yeah so I guess I’ll start with kind of sharing a little bit of our background that brought us here so we are I’m a family practice doctor and I practiced full spectrum family medicine for the first 10 years of my career. And my husband, Alex’s chiropractor by licensing schooling, but he had, he had a sports med rehab clinic. And so back in 2014, we were struggling, like a lot of physicians. We were both working 60 to 90 hours a week. Which was one thing when it was just the two of us, but when we had kids, obviously life changed and our families all on the East coast. So we didn’t have any family support. So we were lying on the daycare check-in and check-out about how many hours the kids were there because they were there longer than the state limit. And we were just trying to figure out like how we were gonna make some shifts. Our marriage was struggling. We just were not living the dream, so to speak. And we both loved what we did, but it was clearly not sustainable. So that was 2015 when we kind of started looking for opportunities. And I ended up leaving my practice in 2015 and moving into urgent care, locums, and a little bit of telemedicine on the side. And Alex actually ended up closing his practice at one point because we have a daughter who has some additional needs that we just really needed someone to be home more to help with. And so and he was sick of insurance companies and that the like struggles of being a brick and mortar business owner and in health care. And so I started dabbling, so to speak, in telemedicine in 2015. And we had this reality over the course of a year and a half that we could create a life with more flexibility and freedom through the telemedicine world. And this was before telemedicine was cool. Like, you know, five years prior to COVID, most people didn’t even know that telemedicine existed or how to access it. And so we ended up transitioning telemedicine full time in 2017. And I doubled my family medicine income and halved the hours that I was working. And then we kind of started putting a business around it. And so in 2020, we had so many physicians reaching out to me asking how I had created success in telehealth that I decided to put a curriculum together. And both Alex and I got certified in coaching. And that was kind of what started our coaching journey. And without a doubt, a huge foundation to the work that we do is a summation of all of our personal struggles. And so for me, I’ve, I’ve had a history of trauma. I have had some mental health, struggles, with my daughter, I’ve had some mental health struggles. Our life was kind of chaotic for 10 years with a challenging child. And I know that a lot of people can relate to some of this. But we were just over the course of all of this time, I actually had the freedom and flexibility to be doing a lot of the healing work that I wouldn’t have been able to do when I was in clinic. It just wouldn’t have been possible. And so, and then in 2020, I ended up having a medical fraud situation where my NPI was used fraudulently And this and so this is after like doing really well for a number of years and really feeling like I had been creating this life that I was thriving in. All of a sudden I spiraled downhill because that fraud detour was nine months of hell with lawyers and expenses and like a part time job. And so the foundation of the work that we do I mean it’s half helping people learn how to replace their income and most of the time you can massively increase your income with telemedicine with the expertise we already have in medicine but then the other half of it is learning how to heal from the life, like whether it’s burnout or a history of trauma or mental health struggles or addiction, or I mean, you know, so many things. I mean, there’s just, there’s no, there’s no easy way in as physicians in our healthcare system to learn how to take care of ourselves. We don’t have the time. We don’t feel safe accessing help because we’re afraid it’ll put our license at jeopardy. And a lot of us don’t even have the finances because we’re living from paycheck to paycheck, just kind of paying off our student loan debt. And so, yeah, we became radically passionate about teaching others to do what I did because it created the freedom and flexibility that allowed me to heal. And then half of the healing work that I did, half of the resources that I leveraged were things that I don’t think most people even know exist. And so, yeah, so that’s, that’s kind of a, I think, summary of what brought us into our coaching journey.

Dr. Alex Sandrow [07:11] I’m not saying I’ve just had a couple things. So for me, I’ve been in the entrepreneurial space. It was like day one, 1991, I graduate and I go straight into the entrepreneurial space immediately. And I’ve been there since. So having that and that background of constantly in business nature, medicine was just one more step, one more of the steps along my journey. And man, just when you are the owner of the clinic, you very quickly realize that the clinic owns you. And that’s really what that journey was. And it was a multidisciplinary clinic. So I had a bunch of physicians that were all working together collectively, working with patient care. And it was my ideal practice. It’s exactly what I set out to do was to be able to create this comprehensive approach to patient care and have an entire team that has the ability to look at, you know, an individual we can bring on whoever’s specialty is needed at that given point in their treatment plan. And it all sounds great. And it worked really well for everybody but the business owner who, you know, you don’t sleep until, I don’t know, until you stop, right? Like your head hits the pillow and you keep going. So there was that piece. And in 2015, as Cherisa was just mentioning, we started getting more into the coaching space and taking all those years in leadership and the years in entrepreneurship. And we started our coaching journey really there back in 2015. And these days, I would tell you, I think that for me, at least what I look to help physicians with is really it’s two things. Number one is helping create conscious awareness. And it’s one of the things that I live by. That is, until you bring certain thoughts into your conscious reality and your conscious state of being and thought process, you don’t have freedom of choice, right? Most of us, we live in a dictatorship. And the problem is that it is a self-directed dictatorship. And part of that freeing experience, I think, comes from you becoming consciously aware of certain things that they’re operating behind the scenes, maybe for years, right? I, you know, in terms of whether you’re calling it physician fatigue or burnout or docs are just overworked or whatever it is, until you actually have that moment where you become consciously aware of your current state of being, you kind of don’t have that choice. So I really am dedicated to helping physicians become consciously aware of things because that’s where I think that they have the opportunity to kind of blossom into the next best version of themselves. And then the second part that I think I can boil down my passion in working with physicians is this. And we were just speaking prior to coming in on live here. But I think it really comes down to creating margin. And I think, you know, burnout is a very specific term. And I don’t know if every physician feels like they’re burnt out. I think there’s a lot of physicians that I would call it, you know, maybe a career induced fatigue. And I can get into a little bit of that in a second. But the big thing is that we’ve lost margin. And when you lose margin in life, then you don’t have the ability to find some of the self-care and the self-treatment. And you start to have this feeling of, hey, I’m headed down this path. And mind health, neuroplasticity is really, I eventually got myself back into functional medicine. And that’s my field in medicine these days. If I study anything is really functional medicine and specifically how the mind works and how we can create healthy living styles around that. But neuroplasticity is one of these topics that everybody is knowing more and more. And it’s almost becoming kind of a catchword from my perspective, at least. And the thing to know about neuroplasticity, I think, is that it works exceptionally well either direction. Like you can have bad thoughts that will prune synapses and regrow and create additional bad thoughts just as easy and just as likely as you are to create the proper environment to do the same thing with good thoughts. So it’s a little bit of a paradox, right, when you start to understand that more and more. And I think that a huge piece of that is because docs more and more are having less and less margin, which is when you think about the paradox of that, like here we are as physicians trying to go ahead and help people in some capacity, whatever your specialty is, you are trying to help patients get to a different place, hopefully a better place than they currently are. But for most of us, the system has gotten so busy that you can’t even take care of you. And we start to lose the understanding and recognition like the ship goes down unless I actually create some margin to take care of me. And, you know, I’ll throw it back to you here in a sec. But I tell you that one of the awareness pieces that we help physicians and I think a lot of people when they hear and they get to know our story a little bit. And they’re like, you guys did what? You doubled your income in half the time. That’s one of those things where we live in this reality that we aren’t even consciously aware of exactly what’s being done and how I would say to some degree, physicians are being either slighted or taken advantage of. And that is this, when you look at, and we’re talking family care, I’m not talking surgical specialists, but when you’re looking at family practice, integrative specialists, What we see and what we hear is that most of them, they land somewhere between $200,000 and $225,000 a year. And that’s theoretically for full-time work. But the reality is, and I think any physician who hears this will go, absolutely. Whatever it is that you’re working, full-time, 0.7, 0.5, 0.8, it does not matter. Whatever your hours are that you are on paper supposed to work, the reality is that there’s a lot more time, I.e. There’s your margin that’s disappearing. There’s a lot more time that’s being asked and requested from you to show up and do the thing that salary of, we’ll call it $225,000, is actually going to. And from working with many docs now, I would tell you that the average physician that we work with, they’re somewhere between 65 and 70 hour work weeks, right? By the time you figure and show up early to go over the patient charts for the day, none of us have this, but a couple, right, where you actually have the most complex patient of your day, who’s your actual last patient at 5.30, who shows up at six o’clock and takes an hour and a half. And then there’s the 20 chart notes that you have to finish when you get home, because the EMR systems aren’t as efficient as we all thought that they would be. And when you add all of those hours into the day, it’s not a 40-hour workweek anymore. And when you break these numbers down, quickly what you find is that for most docs that fit that description, they’re somewhere in the $65 to $70 per hour price point. And that’s the moment where you hear that and you go, holy cow, and you check in, and that just became that conscious awareness moment. And now you get to decide, is that really where you want to be? Like we’ve joked about this forever, but most people are, you know, they’re paid or worth about a burrito an hour from the neck down. But you get to decide how much your value is and what you’re bringing from the neck up. But that only happens, I think, when you become aware of where you currently are. So having and helping physicians recognize that and then using that as the starting point that we can help guide them on how they can start replacing if they want to replace or how they can bring on additional income that creates more margin and gives them the ability and the freedom of choice in their life. That is a huge piece of, I think, what we end up bringing, especially as a couple to the table. I know that was a lot, but yeah, no,

Dr. Mark Leeds [15:48] That’s, that’s great. Yeah. I like the thing about neuroplasticity because I’ve actually been doing some writing work for a new ketamine clinic that’s going to open. And I had, so I had to do a lot of research on how the drug works and apparently it promotes brain growth and the growth of the dendritic connections between neurons. And that sounds like a positive thing. It is a positive thing. You know, the brain is improving and growing and healing. But then I did an interview on the podcast with a brain scientist about addiction. And he talked about how that same process is what is what creates an addiction, you know, the growth in the wrong way in the wrong place, reinforcing very bad, dangerous, negative behaviors. So yeah brain neuroplasticity and the brain developing you want it to be in a positive way you want to enforce the reinforce the positive like you’re saying right yeah right

Dr. Cherisa Sandrow [16:39] And that’s why with all of the psychedelics it’s so important to like be very conscious of how you’re resetting your default system because, because you have this like maybe magic moment. If that’s what you’re working with to reset your default system. And, if you come out of your ketamine session and then you go back to work and you continue working for the whole afternoon and you’re getting a bunch of stuff done, your default system is not resetting. It’s just going to continue creating all those same patterns. And so, and it’s part of, it’s a huge part of what we do, because if we teach somebody how to replace their income with telemedicine, they will create the same stressed out, burnt out life, working from home, doing telemedicine. If you don’t in that transformation, also create a new foundation for yourself and create a new vision and create clarity as for how you want your life to look and start focusing in on some of those those small daily practices in that we have in every day that we or we don’t have in every day. So

Dr. Mark Leeds [18:10] So yeah so I mean sometimes I’ve did you ever see the movie blood diamonds with leonardo dicaprio

Dr. Alex Sandrow [18:16] No I mean I’m familiar with it but we have not man that’s going on our list right now we got this list of all these great movies and I mean

Dr. Mark Leeds [18:24] It seems it seems really far removed from the conversation but I think when I when I saw that and there’s you know where they’re showing the people that are kind of trapped in the situation where they’re diamond miners or you know they’re looking for diamonds but they’re very poor people and you know the dream is to like somehow hide a diamond and get away with it so you can you know start your life but of course you know there’s no way to do that because they’re looking for that and you know you can try to hide the diamond any way you want you know there’s probably going to be the end of the person if they catch you and I kind of like I don’t know why I just saw like the medical profession kind of being like that like we’re all we’re all working in the diamond mine trying to find our way out, you know, trying to find any kind of hope for escaping. And we’re all like being watched by these overseers, you know, that to make sure that we don’t get out. And I try, I kind of tried, you know, I could have used you guys like years ago because, you know, I was trying to find my way out and along, you know, early on, like I was working for a really difficult, large HMO practice and it was miserable. It was like the worst job ever. And I got this ad for this one sheet of paper that talked about this machine. It could remove hair and it could rejuvenate your face. It had these two arms to it and one did this photo rejuvenation and one did photo hair removal or something. It was like a flash lamp technology, you know, probably kind of like laser. And so I signed up for the demonstration. You know, it sounded incredible. I’m like, wow, what if I had this machine and I could start my own side business and treat people and make enough money to go to my employer and say, I don’t really need this job anymore. I have my own thing going on. So I went and they showed me the thing and it actually burned off hair. You shaved a little bit down to just a little hair that you had to leave there and it would singe it. I’m like, wow, this machine is incredible. And I’m like, where do I sign up for it? Next thing I knew, I had paid the equivalent with a loan over however many years of the equivalent of buying a low-end luxury car with this machine, which is still sitting in a closet somewhere. It’s completely useless now because you can’t, I’d have to buy new arms to get the new heads in. It’s not worth it. It doesn’t work. It works okay, but it’s not like I thought it would. And it was really torturous to use the machine. I actually had some clients, you know, and I’d sit there for an hour. The thing would give me a bad headache and people would be critical of the results and everything. So that was, you know, I can never buy another machine again after that. So I can imagine from machine purchases

Dr. Alex Sandrow [20:51] Yeah

Dr. Mark Leeds [20:53] I can imagine you as a chiropractor I mean I’m sure you’re aware of like the drx 9000 the incredible net stretching machine

Dr. Alex Sandrow [20:59] Yes yes there’s all sorts of crazy stuff in that world for sure yeah

Dr. Mark Leeds [21:03] Yeah so that was my first mistake and then the thing that did finally save me that kind of gave me enough extra income to kind of buy my way out and get away was that a dermatologist gave me a job doing hair transplants. He trained me in his technique. And yeah, I mean, to this day, I’m like grateful for that opportunity. And that gave me just enough to, you know, enough income of doing a couple procedures a day to, you know, to say, okay, I’m done. I mean, it wasn’t really enough to live on, but we kind of had a plan, like we’re going to start our own clinic. And then our next big mistake was really on my part, taking advice from everybody, you know. So, you know, everyone had their advice. It’s like, you got to be on every insurance plan. You have to be on Medicaid, Medicare, and every plan you can imagine. Get on all of them. You have to take care of everybody. And, you know, there’s just everyone had advice, and I thought everyone knew what they were talking about. And, you know, so, yeah, next thing you know, we’re like, you know, fighting for, fighting to, you know, seeing people that they were paying almost nothing a month and taking up all of our time. And you know the rent was high the overhead it just wasn’t going anywhere and it was hard to believe that it just came to an end but it’s like you know we were going more and more into debt and finally the lease renewal came up and like we just can’t afford afford it anymore there’s nothing here and you know that was the end of the lease and you know from there I went back and got a job you know that was the end of me trying to do my own thing for a few years and yeah then you know we tried again but the next time you know […] And so, yeah, this time around, things are working out a lot better, you know, lower overhead, being a lot more careful and I try not to take advice from random people anymore, or at least, you know, think it over and discuss it first. But yeah, I can see like, it’s really hard to fight your way out of that world. And, you know, people, you know, people like patients, not just patients, but the public, I think, you know, they have this misperception that they think doctors are rich and have an easy life. And doctors don’t really do much better than, you know, if you had, say, like a kid in high school who wanted advice, you know, should I be a doctor or a plumber? I’d probably go a plumber at this point.

Dr. Alex Sandrow [23:26] Especially when you figure out the hourly rate. I mean, when you break that down and that’s the finding margin. And that’s, you know, even in what you were just sharing, I think it’s we were in search for those of us that are going, man, there’s got to be something else. This isn’t necessarily what I signed up for. It’s that for most docs, they don’t have that margin in life. Like they don’t have the 30 minutes in a day where they can sit with themselves in their own thoughts and not be pulled or distracted or feel guilty about something. And when you don’t have that margin you end up this you know the saying I think is if you don’t know what you know stand for then you’ll fall for everything

Dr. Cherisa Sandrow [24:06] For something right

Dr. Alex Sandrow [24:08] So it’s we end up in that because we’re just clutching I think for a lot of us trying to figure it out but when you what we’ve seen is that when you can help physicians from the financial perspective create a little bit of breathing room where maybe maybe they can step back a couple hours if they want. For some people, they might just say, hey, I am done with, you know, clinical care. I just want to go to virtual space and that’s, we can help there too. But when you give them a little bit of breathing room, and this is the exciting thing, it’s probably the most driving piece that gets me out of bed to work with docs, is that when you see and you’re working with somebody and there’s a light bulb, but there’s no spark. There’s nothing left in there. But that moment that they’ve gotten a little bit of a vision or they’ve gotten a little bit of margin and you can see that spark come back on. We’re now in a dark room. You can see that there’s a little bit of light in that bulb. That is the most exciting thing, because I think a lot of physicians, we identify ourselves as purely that. And what we try to encourage physicians is that who you are has nothing to do with the letters in front of your name or behind your name and as a matter of fact when you take those pieces away what’s left that’s who you are and for a lot of us we feel like well that’s all I have not necessarily realizing or knowing that you have so much more like your training and your experience and the work that you’ve done over the extended period of time that you’ve done it, you have developed so many skill sets. You develop a totally different way of being able to see issues and problem solve. I mean, physicians right off the bat, like you have to be a problem solver. I mean, it pops up so many different ways through your day-to-day activities and being a physician. So point being, you have all this potential. You just need somebody who can come along and one, help you create the space where you can start to really exercise that more. And two, have people, I think, in your life who are going to bring out the creative nature of what’s inside of you. And that is, I think, what gives a lot of people that spark that comes back on because now they don’t feel stuck because so many physicians feel stuck. And that’s not true. If there is one thing I’d say is that you are not stuck. You just have to align yourself with different people. And then you have to be willing to think differently than you have thought.

Dr. Cherisa Sandrow [26:58] Yeah. And I think to what you were speaking about before, we are not taught as physicians, well, in this country, we’re not really taught how to think. We’re taught what material we’re supposed to know. We’re taught what to think. And so physicians are, I mean, we are one of the most highly educated. We can learn whatever is given to us if we want to. But we all, so many of us think we’re not business people. Like that is, that’s like a limiting belief that I think a lot of physicians take on. And the truth is we weren’t taught business. We don’t, we’re not, we don’t even know our own economy in this country. And we have let alone our economy and our family and what we’re being paid. We have no clue a lot of times what we’re even being paid if we’re being paid appropriately. And we without a doubt have been taken advantage of by the healthcare system because there’s so many hands on every dollar and we don’t have time to figure it all out because we’re busy taking care of patients and that has just been the focus but I think we’re at this pressure cooker right now because it the expectation on physicians has gotten so high and the like pay and benefits and all of the all of the things that make us feel like a job is secure and safe have been wheedled a whizzled weaseled away from us that we’re like what are we even doing here? And I think that the, that the like, current climate is forcing physicians into something else, what else is kind of the question. And so I think that it’s important for us to remember that we are, it’s like Brene Brown says, we are created for community like that we are created for connection. And also we learn best in a mentorship model. I mean, our whole med school residency training system was in some of a apprenticeship sort of model. And so then when we go out and want to do something different in the world, we don’t really know because it was never a conscious thing that we were in this apprenticeship model we don’t know that we need to find somebody to apprentice us in whatever direction we’re going and the truth is like you can find everything you want online but the problem is you don’t know who to trust and so if you’re going online to like find all the information it’s really information overload and it puts people into analysis paralysis and it’s a crapshoot of whether you are going to make the right decisions and the like the amazing thing about what you did which is true for a lot of successful business people successful entrepreneurs is you got back up and did something again and so whatever you did didn’t work the first time and you didn’t you didn’t take that as like okay I’m stuck in the job for the rest of my life you took a break and then you tried something different and yeah and I think that the important thing is like we’ve always had the mindset of if we want to do something different let’s find somebody who’s been successful in this and ask them to mentor us which is actually how I met Tom Davis which when we were just talking about NewScript because I wanted him to help me kind of create this coaching consulting model when I transitioned to it. I knew I wasn’t going to be able to figure that out by myself. And so I think that the other thing that’s really important is for physicians to like, remember how phenomenal our expertise is. Every physician is incredible. And I, and we get beat down by the system in different ways, whether we’re exhausted. And you know, we’ve just taken kind of some paths in life that have made things a little harder on us or whether, whether we’ve been criticized overly over years, or we’ve had some bad experiences in medicine or a malpractice case or whatever it is that kind of starts making us feel worse about ourselves over time. But it’s so important for us to come back to remembering our why we went into medicine, remembering our expertise of how much we have to offer the world, because we are not being paid our worth. We’re not, we’re not owning it. And so many physicians are, when they’re asked, you know, what do you want to make for this job. They don’t even know where to start. They’re like, 100, 500, 1000? Like, what’s the ballpark? Because we’re not taught how to negotiate. We’re not taught how to use the Sullivan-Cotter numbers. We’re not taught how to create a business proposal. And all of those pieces would empower us if we were given these little skills of like, this is what this is worth, and this is what this is worth and this admin level is, you know, worth this salary, it would empower us. But most people don’t even know to ask for that. And so there are all of these little nuances along the way that I think as we can empower one another, we will rise up and feel like we can live into and the top of our expertise, if that makes sense.

Dr. Mark Leeds [33:31] Yeah. I was wondering as far as the telemedicine goes, I mean, there’s a few ways a person could go. And I was wondering like what you would recommend for people that, you know, one way, and I think I’ve seen Tom, is Tom Davis the one that goes around on his Winnebago, like doing telemedicine calls from like anywhere he happens to stop?

Dr. Cherisa Sandrow [33:49] I think he does some of that. I mean, I definitely know that he still uses telemedicine and he travels.

Dr. Mark Leeds [33:58] Yeah, I think I’ve seen him post his pictures where he’s like in his chair relaxing like out in the woods or something and he’s on a telemedicine call. Or on the beach. Yeah. So, you know, it sounds like a great, a great life, but then there’s two ways you could go. You could work for one or more telemedicine companies and, you know, and it would be great if you had this situation where you’re in like a minimal kind of responsibility and contract because, you know, you know, I think the way that we don’t want to go is having people owning our lives more and contracts of any kind scare me. I think back to contracts that I sign, I wonder, is that still active? Did I sign something forever? Am I going to have to give my life away to someone I signed a contract years ago to? But yeah so you could I guess sign up for like working with different people and I think according to tom like he patches and whenever he feels like it does it call if he wants to it doesn’t do it if he doesn’t want to but then there’s also the way of creating your own telemedicine business of not working for anybody but yourself and that has a whole other set of challenges of how do you find people you know like like that was like one of the greatest things I heard from, I think, Kevin O’Leary from Shark Tank. He said, the only thing in business that you really have to worry about is finding a customer, and everything else takes care of itself after that. But that’s not an easy thing to do, because everybody else is looking for that same customer, and you have to be able to connect with people. So, like, what do you recommend people do in that?

Dr. Cherisa Sandrow [35:27] Yeah, that’s a great question. So, the one thing that I, in general, would not recommend is taking a job, a W-2 job with a telemedicine company. Unless you are certain that this is a company that you really want to work with and you really love and you feel, I mean, it may be, you know, it may be the perfect opportunity. So I wouldn’t ever put a blanket statement on somebody, but the majority of the telemedicine companies, if you are working as a W-2 have pretty strict non-competes, although I don’t know if those are all going to go away with the new policy stuff that’s changing around non-competes. But regardless, the non-competes are like a no-go. And so I didn’t want to work for any company as a job. And then the other piece is that, you know, then you have to attend their meetings and you have to, you know, follow all the rules. I’m not really a rule follower. And so on the other hand, they’re like, you know, far other side, you’re coming out of if it’s you that’s coming out of burnout, and you’ve been super busy and trying to have a little bit of respite in your life, then starting your own company wouldn’t be the first step that I’d recommend doing either. And so for people who have a vision of starting their own telemedicine practice, maybe they have their addiction medicine is a passion and they want to do something with addiction medicine and telemedicine, or they have a certification in obesity medicine and they want to do ultimately build a telemedicine practice with obesity medicine or whatever. There’s so many opportunities, but I think that the best case scenario and what I typically recommend to people is they start out working as a 1099 for multiple companies, kind of learning what works, what doesn’t work, what they like about different platforms, what they like about different models of telemedicine. And then once they’re generating income consistently, they step back from their job, they have more freedom and flexibility in their life, they have the ability to breathe and are feeling like they are ready to move into another chapter, then starting to introduce building of their practice alongside of working with, so you have money coming in as you’re building your own practice. I feel like that’s the ideal situation. And so and with regards to the companies, I recommend that people work with multiple companies, not just one. Alex is fond about the saying like one is the loneliest number and I think that it’s in all areas like you want to diversify in your in your income your financial portfolio you should diversify in your career portfolio too so then if one company is making decisions that you’re not really aligned with

Dr. Alex Sandrow [38:48] Or you don’t control

Dr. Cherisa Sandrow [38:49] Things aren’t going well you’re not controlled you can just start increasing your work with a different platform and so yeah

Dr. Alex Sandrow [38:58] I think part of that conversation is somebody is trying to figure out hey which direction do I go I think maybe even like precursory is figuring out where you are first and then having a vision for the future because if you have that and you’re able to put those pieces together then you just follow of the steps to get to that piece. But for so many of us, we end up on this path and we kind of, it’s a joke between us, you know, most people kind of treat their career like this. They get on an airplane and somebody says, where are you going? And they say, I don’t know. Like I’m just on the airplane. And then when they get to wherever they go, they wonder how they got there. But if you actually can figure out where you are and where you want to go it helps create a much different course in front of you and that’s not to take away anything as Cherisa just said because I still think that works but then it does give you that mindset where you’re pre-loading it up front and you go well okay if my goal is to open my own space my own virtual space and have my own clinic, then sure, I’ll go plug into a couple of other already existing communities, you know, for lack of another term, guinea pig my experience with them so I can learn the things that I want to do and the things that I don’t want to do. And I don’t have to go out there and develop a patient panel right now, but I can use that patient panel to acquire a new set of skills that then I can take the best of the best and I could go and apply it in my own personal practice. And you only really create efficiency in your path in getting there by recognizing where you are and where you want to go.

Dr. Mark Leeds [40:53] Yeah, yeah, that makes sense. And it sounds like what you’re describing is kind of like being an Uber driver. If you’re a driver, you can work for Uber and Lyft. Now you’re diversified. You have two companies. You get calls from both, and some Some people prefer one over the other. And then maybe once you get used to it, you put out an ad, you know, maybe on the Nextdoor app or whatever, wherever you can get your name out there inexpensively to say, oh, I’m a private driver. You know, I do Uber and Lyft, but I also do private, you know, if you want to schedule me. And, you know, it kind of reminds me, I used to work for a house call company when I was a resident. And then I ended up working for two of them. And you could take the call or not take the call. You know, they’d call me. If you’re available, we have a house call for you. And I stupidly took, I said yes to everything. I couldn’t say no. And so I was up all night running around. And, you know, I guess it was a good experience for a while. But yeah, I remember the one time I said no, I’m like, I just can’t do it anymore. I felt terrible. But yeah, I mean, it sounds like that’s, you know, instead of saying I’m going to be a driver for so-and-so taxi company, I’m independent. If I don’t want to work, I’m going to take the day off. Or if I want to patch in, I have these different companies that are willing to give me work when I’m ready.

Dr. Alex Sandrow [42:07] Yeah. Yeah. And that is such a far-fetched concept for most physicians, again, because they have put all legs in the one basket, and that one basket is whatever clinic they’re working in, and that’s the diversify as much as possible. And then you get to be the one that decides, right? Do you want to take this shift, that shift, this call, that call? Do you want to just have the day off? Like you get to decide that, but you have to, again, when we come back to this, you have to become consciously aware of where you are.

Dr. Mark Leeds [42:40] Yeah. I think if a doctor thinks that he’s, he or she, they’re being taken care of by their job, they’re working for a clinic or a hospital. And I think, you know, these people are looking out for me. They’re not. I mean, I overheard this conversation once that stuck with me for a long time that I guess this one doctor was known for he was doing all the hospital work for this practice. And he was, you know, doing a great job, except that he was kind of become I guess they thought he was gaining too much power in the practice of being able to, like, set his own terms and whatever. And I overheard the owner saying, you know, let’s move this and this around because we need to keep him on his feet, you know, like keep him from from feeling too comfortable. You know, so they actually were purposely messing with him, you know, without him knowing, you know, to make his job harder so he wouldn’t feel so comfortable and have so much power in the practice. So, yeah, I mean, imagine like you’re like a pawn on the chessboard and they’re just like in meetings saying, you know, we need to make sure this one doesn’t make too much money or gets more patients. Or, you know, I also heard like, you know, you go work for these jobs where, you know, and I get these ads all the time. I just never turn the thing off of I don’t know why I get them. I get tons of these incredible job offers of like, you know, make two hundred seventy five thousand a year and live in the most beautiful, idealic setting and we’ll even give you a sign on bonus. And, you know, to me, I always imagine like a trap, like they set a trap in the woods and they’re just trying to get someone to walk into it. But it does it does sound good. But I’ve heard like, you know, they sometimes have these bonuses. If you see enough patients, you know, you’re going to get like extra money. And but then like the trick is like they give all the easy patients to the PA or the nurse practitioner and then you get only the hard cases. And there’s just no way you’re ever going to get to that number to get your bonus. And, you know, it’s like a hamster or a mouse on a wheel. It’s just there’s just no way to get ahead in those situations.

Dr. Cherisa Sandrow [44:33] Yeah, it’s true. I mean we are we’re kind of set up to fail is not the right word we’re set up to stay in captivity yeah yeah exactly like I mean that it’s really it’s the golden handcuffs it’s really hard to step out there’s a lot of fear

Dr. Alex Sandrow [44:57] Controlled evolution

Dr. Cherisa Sandrow [44:58] The truth though is that it’s like back to what Alex was talking about in the beginning. If you’re real about like how much you’re making hourly, it’s actually not hard to replace $60 an hour, $80 an hour. You can go be a plumber. And I mean, like, yeah, it’s, and so I think that when people have like a reality check of, and the other piece of it is that inherently most physicians are, they’re good people. And so they care about their practice. They care about their partners. They don’t want to leave their partners with more work. They don’t want to abandon their patients. And all of those things are, you know, the altruistic nature of physicians is what has been taken advantage of. But, and I’m not, and I’m not at all saying that we need to like, you know, moving to anarchy. But what I would say is that I see the telemedicine, the telehealth world right now, and a lot of the opportunities that have been expedited because of COVID. I mean, all of this was going on for the past 10 years, but COVID brought it to the forefront of everybody’s understanding probably a decade or two sooner than it would have been. And so what I see is that our healthcare system is going to drastically change over the next few decades. And if we do not take ownership of this transformation, then the same thing will happen. I mean, And like the company, the brick and mortar companies that have created kind of the corporate medicine that we struggle with will move into the telehealth world. And if we’re accepting what they’re offering us, then we will end up just as controlled in the telehealth world. And so being independent contractors, being our own business owners, we can truly create a different model in medicine if we can create value and understand our value and our expertise and understand business a little bit and understand what’s going on in the healthcare world. And start saying no to underpaying and start saying no to overworking. And so, yeah, I think that we just have a lot of voice into the future of our healthcare journey if we stand up. So,

Dr. Alex Sandrow [47:59] Oh, I can’t hear you. Mark, you still got yourself muted. Oh,

Dr. Mark Leeds [48:03] Yeah. Oh, sorry. Sorry about that. Yeah. So there is actually some of what you just said is happening. I think especially with COVID and that, you know, COVID happened. And I think some doctors did realize like, wow, you know, doctors who have their own practices are like, you know, they couldn’t go in their offices because no one could come in and, you know, they had to shut down for a while. And some doctors did realize like, oh, I could just do telemedicine. You know, we don’t really have to physically be in the same room with every patient. I mean, it’s been, you know, decades ago, scientifically proven that the majority of the information we need to treat a patient is through history and conversation. And very little is through, you know, the physical exam that a lot of us do for show. You know, occasionally you find something that you weren’t expecting. But, you know, for the most part, it’s, you know, you listen to the heart and lungs. And unless a person complained of an area, something in that area, you’re probably not going to find any problem there. But, you know, and if you suspect something, you maybe even say, like, for what you have, you need to go to an ER, urgent care in person. Absolutely. But what I’m seeing now is, like, with COVID, that some opportunists, you know, some, what do you call them, you know, like the founders, you know, startup founders, they said, wow, there’s money in telemedicine. And, you know, and these people that are know how to go to venture capitalists and get 50 million, 100 million dollars in funding. And they start these things, you know, they’re, you know, if you search for certain topics on Google and they come up at the top, like these telemedicine companies in different fields. And it’s kind of a problem. Like there was one one or two that got in trouble for pushing Adderall to people all over the place. And that was an issue. And I’ve looked into some of them and a lot of them, like they’re fully staffed by, it looks like nurse practitioners, not doctors. And so being these big businesses that have to watch their bottom line, they’re not hiring doctors, they’re going for people that they can pay. I don’t know how much less a nurse practitioner is willing to work for, but I mean, that’s something like, do you help people navigate that? Is that an issue? Like you go for these jobs and they’re like, well, we’re not looking for doctors. We’re looking for nurses now.

Dr. Cherisa Sandrow [50:13] So, well, for some, I mean, there’s enough companies that are hiring physicians that I don’t encounter that the jobs aren’t available. But what we do encounter is that a lot of the companies want physicians to be supervising the mid-levels. And so we, I mean, I know there’s mixed feelings about that. But the truth is it’s happening. And that’s the transition that health care is going. And so the best scenario is to take some ownership in it and make sure that you are that, you know, the rules, the regulations, that you’re following the guidelines, that you’re that you’re integrating it safely into your practice. And so when companies are asking you to supervise mid-levels that are the NPs or PAs that I think a few of the companies that got in trouble, they were not supervised. They weren’t supervising under correct guidelines. And so they had too many physicians or too many mid-levels being supervised by two little doctors. And it was too many charts that they were supposed to be signing off on. So they were just signing off on them, not necessarily reviewing them or whatever the situations are. I mean, it’s us knowing the laws ourselves and not trusting, not just saying yes to the company expectation of us, but actually saying, no, this is actually not the way it’s supposed to be done. Like this is not legit. And so if you want me to work with you, then we need to change policies and kind of standing up into that. Because the truth is that these companies that are in the telehealth world, startup companies, a lot of them are started by business owners, IT, tech, software people. They’re not medical minded. And so they don’t know the language of medicine. They don’t know the business of medicine. They don’t know the practice of medicine and they need physicians to fill that role, whether it’s medical directors or physician advisors or, and so a lot of the transition, you know, part of it is clinical seeing patients in clinic to seeing patients online or over telehealth, but part of it is also leadership. Like we need a lot of physicians to step into leadership roles and have ownership of that.

Dr. Mark Leeds [52:51] Yeah. Yeah. It seems like on one hand, all of these new telehealth companies, it could be an opportunity on one hand, you know, that there’s more employers, you know, that may be willing to hire doctors, you know, maybe just starting out, you know, if they’re willing to hire a PA, a nurse practitioner or physician, it’s just that they’re paying this much, you know, maybe if you’re willing to start out, you know, just to try it out and learn from it might be worth it. But, you know, there’s also the, like you said, the issue that these aren’t healthcare professionals and they’re relying on people to manage their business. There’s this one doctor I know, and he does manage his own business, and he treats people all over the country. And I’ve had people reach out to me from other states, you know, asking if I can see them as a patient. And I usually say no because, you know, I’ve looked into the laws. There was actually this guy from Michigan, really nice guy, that he wanted me to treat him, and he had researched all the laws. He said, here’s the federal laws, the state laws. You’re allowed to treat me, you know, from Florida to Michigan. And I looked into it. I think he was right. I mean, I had to look at Florida’s position on it, Michigan’s position and the federal laws and everything he said made sense. And I was still afraid to do it. And then I looked, you know, looked into, you know, we had a patient from California. And I think it looks like the California rule is you don’t have to be licensed there under the COVID rules, but you do have to register with their medical board. You know it gets complicated because you have to look at a lot of different things and so I asked this one doctor I said how do you do it because you seem willing to treat anybody anywhere and he said well I have this guy that hired that’s his job he checks all that stuff out figures it out and make sure I don’t go to prison for anything and you know which is a good answer and that was enough to scare me but yeah so when you go to a telehealth company and they say you know I don’t know if they come out and say this or you have a patient pop up on your screen who’s, you know, say you’re in Oregon and you have a patient pop up in New York and it says you’re allowed to see them and prescribe these medications or however it works. I’ve never been in one of those systems, but now you’re trusting them that they figured all that stuff out for you and you hope that it’s correct. But it does take a lot of research to verify and make sure that’s correct because, you know, there’s a lot going on there.

Dr. Cherisa Sandrow [55:02] Yeah, I mean, my guidance would be that you are not able to practice in another state unless you’re licensed there. There were certain waivers during COVID and there are certainly exceptions within bordering states. And so there are certainly exceptions within some of the situations. But I would say that, you know, if you’re wanting to go into your own practice or move into telemedicine and you’re having some of the concerns that you’re talking about that are like wondering what’s what’s legally right what’s not there is an organization called CTeL, C-T-E-L, which is an organization that works with policy and legal and research around telehealth and it is a phenomenal support for physicians in the telehealth world. And so I, if I have a question like this, I would actually send them a message and I’d ask them like, what are the laws around? And they’ll, and they’ll research them and get back to me. So they have the legal team and they have, I mean, they’re doing some pretty awesome high level work and they have a really high level team. And so if you’re a member of CTEL, then you can call them and have them research something for you. And a lot of times they have those resources already, but that might be an investment that’s worthwhile. So I think it’s less than $4,000 for the year to be a member of CTEL. And without a doubt, they provide some great support. Yeah. Like the American, The American Telemedicine Association is incredible, but you can’t be a member as an individual physician. And so with CTeL, you can. You can be a member as an individual physician.

Dr. Mark Leeds [57:05] Okay. So there’s a lot of resources out there. I didn’t even know that existed. And I’ve been doing telemedicine for a while, and I should probably look them up. But that’s, you know, so someone starting out doing this or interested in doing it, there’s a lot to know about it. And, you know, you might go to a coach that, you know, that’s kind of more of like a coach of going, you know, rah, rah, rah. You can do it. You can you can really reach your goals. You know, let’s write down your goals and we’ll talk about it. And I’ll check with you next week if you’ve made any progress there. But going to you, I mean, you’ve been through this, you know, you’ve it kind of reminds me, you know, in the addiction recovery world, They say that, you know, you know, a person with a certain amount of recovery time can help anybody with less time. You know, like if you’ve been on the program a week, you can help the person with one day. And you’ve been in this process for years now. I mean, you have years of experience. You’ve made mistakes. You’ve figured things out. You’ve put together a huge amount of information. So you could help someone to not make the mistakes I made and, you know, get get off on the right foot and not, you know, destroy their finances and everything by, you know, just making a lot smarter decisions. So, and probably also the coaching and encouragement along the way too.

Dr. Cherisa Sandrow [58:19] Yeah, without a doubt. The group coaching program that, so we, I started coaching one-on-one in 2021. I think the end of 2020 was maybe when I had my first client start working with me. And so for two years, I was coaching one-on-one with physicians and then in, and some NPs. And then in the beginning of, or the fall of 2022, we launched our first live group coaching program, which, which we’re really excited about because community is so important. And especially working in the telehealth world where you’re remote, it’s easy to isolate and community is so important. And so, yeah, we really handhold people through all of the things from state licensing to resume updating to the legal stuff to, you know, accounting and an intro to business ownership.

Dr. Alex Sandrow [59:21] Creating margin in your life.

Dr. Cherisa Sandrow [59:23] And we have a lot of guest speakers that come in and we connect people to companies. So a lot of networking opportunities. And so without a doubt, we can help expedite that like fast. What’s the fast line, the journey, the Disney fast pass. Fast pass. Fast pass the journey. You don’t have to stand in line. At every ride.

Dr. Alex Sandrow [59:55] Right. Yeah. We can be your FastPass.

Dr. Cherisa Sandrow [1:00:01] Yeah. Yeah. Except you’re. And we’re continuously, like, working on improving it and, you know, bringing in people who can help us improve the journey and the experience for our clients. And so, yeah.

Dr. Mark Leeds [1:00:19] Yeah yeah you’re probably way better than fast pass because they’ve made that system so complicated I don’t think I’ll ever go back to disney because of that

Dr. Cherisa Sandrow [1:00:29] We have to because we have a nine and a 12 year old so we’ve been to disneyland but they have to go to disney world so we will have to go

Dr. Alex Sandrow [1:00:37] We have a trip to disney world

Dr. Cherisa Sandrow [1:00:38] Although I love animal kingdom and

Dr. Mark Leeds [1:00:40] Oh yeah

Dr. Cherisa Sandrow [1:00:41] I’ll go to animal kingdom in any day

Dr. Mark Leeds [1:00:44] Oh yeah yeah I’m looking at Actually, that’s a, for anyone who happens to be in the area, they have that restaurant that’s incredible, Sanaa. It’s like an African Indian restaurant. And you can.

Dr. Cherisa Sandrow [1:00:57] That’s the only one we’ve been to. It’s a five-star restaurant that’s in the hotel. We went for our first anniversary, which was like, what, 16 years ago? And that was where we ate. It’s so delicious.

Dr. Mark Leeds [1:01:13] Yeah, it’s the best restaurant. But you don’t have to stay in the hotel or go to the park. You can park easily in the parking garage under the hotel and just walk in there and eat without even being involved with Disney or the park at all. Yeah.

Dr. Alex Sandrow [1:01:24] But if you do go, the hotel is also awesome because you literally have the animals at your balcony. Like, literally, we had giraffes at our balcony.

Dr. Mark Leeds [1:01:33] Yeah. Yeah, we stayed there a couple times. And it’s good. Yeah, we just haven’t been back for a while. I just haven’t got, although we may, they’re almost done. I think with the train, it’s going to, it goes from Miami to Orlando and they’re going to extend it to Tampa eventually, but it won’t be long. Yeah. It won’t be long before we can all just sit in the train and relax and not worry about driving. That’s great. Yeah.

Dr. Alex Sandrow [1:01:56] They’ve not started the one from the Pacific Northwest yet. Yeah. It’s in the pipe work.

Dr. Mark Leeds [1:02:06] So, okay. Yeah. So now one, one last question so I understand you mostly work with physicians and what about pas nurse practitioners chiropractors other health care professionals and then all the way down not not down to but you know because we’re not in a hierarchy of that really but say like someone who wants to do like a just general coaching they’re not a licensed healthcare professional like a an energy healer a you know someone that just wants to counsel people but you know be a coach to people? Like, are you able to help people, anyone who wants to get on a video call and help another person? Or do you mainly limit to just working with MDs and DOs?

Dr. Cherisa Sandrow [1:02:47] It’s a good question. I don’t ever limit anything in my life, but that’s a difficult place to be. It’s kind of the jack of all trade, master of none, family medicine doctor, or it’s what brings me back into burnout if I take on everything that comes my way. And so I have my mindset initially was, of course, I’ll work with anybody, but actually we’re so busy now that we really needed to put some boundaries around what we’re doing. And so our current boundaries are that we’re working with physicians, DOs, MDs, that in our group coaching, live group coaching program, we’re not working one-on-one with people unless they’ve already come through our program. And really the only reason for that is because we are wanting to streamline and perfect isn’t the right word because nothing’s perfect and that’s not our goal but we want to really fine-tune and create an incredible experience for the people that we do work with before we start opening up to other people and so at this point in time that’s who we’re working with. I’ve worked with NPs in the past, but I just feel like our, you know, our decision was just to kind of really narrow in what we’re doing and focus on that so that we can make it great before we open it up to other things.

Dr. Alex Sandrow [1:04:36] Yeah. And I think that part of that is, you know, we very much, the two of us believe that you meet people where they’re at, and then you bring them on a journey to the next level. And it’s kind of hard to meet somebody where they’re at and to walk, not necessarily in their path, but alongside of them when you’ve not been there. Right. So I think that’s part of it. And I think, you know, big picture, this is just, this is kind of the entrance into, into our world and what we do and what we look to help with. And back to what was saying at this time and that might change but at this time we’ve kind of really narrowed down into places that we’ve been yeah helping those that we know hey we’ve had this experience therefore we can we can help you along that because at the end of the day we’re trying to create efficiency for physicians and help them gain back that margin and that’s not to say that some of the things that we do couldn’t help other people for sure. And maybe we ended up doing something in the future with that. But we’re very focused on that particular demographic.

Dr. Mark Leeds [1:05:48] I would imagine that the way the healthcare field is now, that there’s a need for healthcare advocates, which could be a doctor, but it doesn’t have to be. Someone that a person could talk to on a phone call or video call and say, my mother’s in the hospital and it seems like they’re killing or I don’t know what to say to these doctors because they all tell me that I don’t know what I’m talking about. What do I say? Arm me with some good information to go in with. And they can say, well, let me look at all the stuff going on. Let’s go over the medicines and make it clear. I’m not being a doctor here. I’m being an advocate and an informer. Not an informer, but I’m going to help you out to get through the process. I mean, that seems like something people really could use because, I mean, the health care system is scary. I mean, […] So, you know, there seems like there’s some need for that, like a health care advocates now.

Dr. Cherisa Sandrow [1:06:57] Yeah, there’s another business idea. Yeah. And it’s not a machine purchase no it’s an awesome I mean you know but we come up with ideas like this all the time and you know the coaches that we work with have taught us no more businesses for a while and so that’s in our mind every time we have a new idea we’re like

Dr. Alex Sandrow [1:07:18] I think every one of our coaches we have a lot of coaches businesses

Dr. Cherisa Sandrow [1:07:23] Right now and so that’s kind of our commitment to ourself until we really have what we’re doing perfected and streamlined and automated. We’re not going to take on any new business ideas.

Dr. Alex Sandrow [1:07:39] You know, I will say, though, I mean, we kind of joke about it here. But the reality is that is what starts to happen when you make those shifts that it’s not an overnight process. But when you make those shifts and you start tapping into that creative center that I believe that we all possess a creative center, at some point, you just kind of feel like the floodgates turn on. And just the creative version of yourself comes to the surface. And, you know, that’s I think that’s where life starts to get exciting.

Dr. Cherisa Sandrow [1:08:13] Yeah. And that’s the that’s the like, you know, red ocean, blue ocean piece. Physicians feel like, well, is there, are there any more opportunities left? Is it oversaturated? No, there’s like a whole three to five decades that you could be thinking ahead of creating business opportunities for in the telehealth world or, you know, in some other area of medicine, because there’s so many things that could be done that are better than what are being done now. And starting a business is actually something that a physician can do because we can do hard things. And so.

Dr. Mark Leeds [1:08:52] Yeah. And I can see the value of working with coaches like you also, because, you know, being a doctor, you know, feeling burnt out from taking on too much. I mean, you get really just tired and you don’t want to think and you’re like, you know, I’m just done. I really don’t want to do anything. I don’t have time to do anything. I’m too tired. And I mean, I was tired this morning. I feel energized now. I’m like, all these ideas are popping in my head. So yeah, you guys are like, you know, great. And I definitely would recommend it, you know, recommend that, you know, that there is something to it. There’s something magical that happens when you’re working with a good coach and especially being in a group like you’re talking about. And you’re brainstorming together

Dr. Cherisa Sandrow [1:09:34] It re-inspires that passion and our why and yeah we love that when we see the light bulb come back on and people and we start to see like the their eyes focus in and you know you see that figure

Dr. Mark Leeds [1:09:49] From the gloft over to the focused look right yeah yeah

Dr. Cherisa Sandrow [1:09:52] Yeah definitely yeah

Dr. Mark Leeds [1:09:54] It’s very exciting okay so Cherisa and Alex thank you again thank you for joining me today on the podcast

Dr. Cherisa Sandrow [1:10:02] Absolutely thank you so much