Knock Knock, Hi! with the Glaucomfleckens

This episode kicks off with a listener email from someone facing a conundrum: she finds out about getting tenure within a few weeks of turning 40, all while wondering if she should ditch academia and go to medical school instead. Kristin and I dig into what it would actually take to start med school at 40: the family logistics, the physical toll of taking overnight call as you get older, the financial reality of avoiding debt at that age, and whether it's even possible to "test drive" medicine before committing. From there, we get into an update on the health systems behaving badly that I've been calling out, including why I keep getting cease and desist letters from hospital systems but never from insurance companies, and what's really going on when hospitals fire independent doctors and replace them with more expensive locums. We wrap up with a couple extra questions: whether it's weird for a doctor to use their iPhone flashlight during an exam, and a genuinely tough one about whether you'd want to get tested for a fatal genetic disease like Huntington's if it ran in your family. Takeaways: A listener asked whether it's worth pursuing medical school at 40 instead of pursuing tenure, prompting a discussion of the financial, physical, and family challenges of a late-career switch to medicine. Independent medical practices are increasingly being pushed out by hospital systems in favor of contracts with private equity-backed groups, sometimes at a higher cost. Corporate Practice of Medicine (CPOM) laws, like Oregon's, are gaining momentum in more states as a way to limit corporate control over medical practices. Will has received cease and desist letters from hospital systems for his content but has never received one from a health insurance company. Will and Kristin discuss whether they'd want to get genetic testing for a fatal disease like Huntington's if it ran in their family. — We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: https://bit.ly/kkhcopilot -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Coming to you from a hotel patio in Lebanon, New Hampshire, this week I dig into the ACGME's newly released revisions to resident work-hour restrictions. We walk through what's actually being proposed: eliminating the mandatory 8-hour rest period between ordinary shifts, cutting required rest after a 24-hour call from 14 hours down to 12, and loosening call frequency from every third night to every second night. Despite some pushback that current restrictions have made residents "soft," I think these changes go too far and put both patients and physicians at risk. Then it's back to more familiar territory: eyeballs. After getting my own eyes irritated in the indoor hotel pool, I break down the actual science behind why your eyes turn red around chlorine. Spoiler: it's not (directly) pee, it's a gas called chloramine that forms when chlorine reacts with body oils, sweat, and other impurities, stripping the protective oil layer off your tear film. Takeaways: The ACGME has proposed eliminating the 8-hour rest period between ordinary scheduled shifts for residents, with a public comment period open until October 22nd. The proposal would also reduce required rest after a 24-hour in-house call from 14 hours to 12, and change call frequency from every third night to every second night. I oppose the proposed changes, arguing that sleep-deprived residents make more medical errors and that the current 80-hour work restrictions strike a reasonable balance. Red, irritated eyes after swimming aren't caused by direct contact with urine, but by chloramine gas, formed when chlorine reacts with sweat, body oils, and other impurities in the water. Chloramine gas strips the protective oil layer off the eye's tear film, causing redness, burning, and dryness. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠https://bit.ly/kkhcopilot⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week Kristin and I are talking business; specifically, how doctors go from having a great idea to actually building a company around it. We're joined by Dr. David Lortscher, a board-certified dermatologist, co-founder of Curology, and author of Why Doctors Win: The Doctor's Guide to Creating or Joining a High-Impact Startup. David breaks down why so many of the most successful healthcare companies of the last few decades, including Intuitive Surgical, Gilead, Regeneron, UpToDate, were founded or co-founded by physicians. He makes the case for why more doctors, nurses, PAs, and other clinicians should be in the room when healthcare companies get built, instead of leaving it entirely to people with zero patient care experience. We get into the real differences between venture capital and private equity, what VCs actually look for before funding a startup, and the story behind how David built Curology, including the surprisingly counterintuitive pay structure that helped it scale to treating millions of patients. Kristin and I also talk about our own version of this, how she basically became CEO of Glaucomflecken so I could keep doing what I actually want to do, which is make dumb videos and still practice ophthalmology four days a week. Takeaways: Over half of the top 100 most successful healthcare startups founded in the last four decades had a physician founder or co-founder. Venture capital funds early-stage companies with high growth potential, while private equity typically buys existing businesses and tries to make them more efficient, often through cost-cutting. A successful startup needs both a transformational product and a clear path to winning the market, not just a clever idea. Physicians don't need to quit clinical practice to start a company if they have a good support system and trusted co-founders. The two things every successful startup needs are a truly transformational product and a clear path to winning over the market. — Want more Dr. David Lortscher? LinkedIn: https://linkedin.com/in/DavidLortscherMD X (Twitter): @DavidLortscher To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠https://bit.ly/kkhcopilot⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. To get your Henson Razor go to ⁠hensonshaving.com/knockknockhi⁠ and use code knockknockhi to receive 100 blades for free with the purchase of a razor. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week I'm tackling two things that have been on my mind. First, I saw a piece of content from another physician creator explaining why they left private practice, and the framing bothered me: the idea that private practice is inherently about squeezing as much money out of patients as possible. I get where that creator is coming from, but I think that's simply a culture problem at that practice, and I don't want med students or residents seeing that content and writing off private practice entirely. I talk through why financial pressure and reimbursement cuts are real, how to spot when a doctor is actually upselling you, and what to look for in a practice that shares income and actually operates like a partnership. Then I get into something a little heavier: an angry, anonymous email I got accusing me of tanking a hospital's reputation and making it harder for them to recruit, just for reporting on the neonatologists who were fired there. I break down why I make these videos, how seriously I take sharing information on my platform, and why I think doctors get blamed for administrators' decisions. Takeaways: Financial pressure in private practice can be real, largely driven by declining reimbursement, but it doesn't have to dictate individual clinical decisions. A key sign of a healthy private practice is one that shares a significant percentage of income among partners rather than paying doctors only for what they individually bring in. Patients who feel like they're being upsold on elective procedures should trust that instinct and seek a second opinion. I stand by my hospital accountability videos, arguing that I'm amplifying stories from healthcare workers who can't speak publicly themselves due to non-disparagement agreements. I explicitly condemn any threats or violence directed at hospital administrators or CEOs. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠https://bit.ly/kkhcopilot⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week I'm sitting down with Dr. Fran Heydanek, OBGYN, mom, and one of the biggest medical content creators out there fighting misinformation. We start with the wildly common experience of getting scammed by fake podcast invites (yes, it's happened to both of us), then get into her actual path to medicine: integrated arts classes, a rejected dentistry detour, a brief love affair with pathology, and a med school that apparently banned water in the lecture halls. From there we go deep on the business of being a doctor who also makes social media content: how she films, edits, and posts everything herself, how she decides which brand deals are worth it (spoiler: no liver detoxes), how she balances a full clinical schedule with content creation, and more. Takeaways: Podcast scam emails targeting content creators are common; both Will and Dr. Fran have nearly fallen for fake booking requests. While Dr. Fran shoots, edits, and posts nearly all of her own content herself, it can be challenging to balance with a full clinical schedule. She still works as a full-time OBGYN and has no plans to leave clinical practice, even as her content career has grown, not only because she loves her job but also because it is important for credibility. Not all brand deals should be accepted. Dr. Fran turns down brand deals for products she wouldn't personally use, and I agree that most offers aren't worth the credibility hit. Dr. Fran's early career included a fashion blog that helped fund her wedding and car payments before medical school and before she started posting medical content. — Want more Dr. Fran Heydanek? @pagingdrfran - Instagram, TikTok, Facebook, YouTube To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠https://bit.ly/kkhcopilot⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices