EPISODE 19: A Brave New World- Healthcare in the Post-COVID Era with Tom Davis, MD FAAFP

Join Dr. Andrew Tisser (Talk2MeDoc Podcast) with Tom Davis as they talk about healthcare in the post-COVID era. With the changes that COVID-19 has made way for, you have to accept that the world has indeed changed. Tom explains what people in the healthcare industry have to anticipate and recognize. He goes into detail with his take on credit scores, student loans, the importance of prioritizing self-sufficiency, and the value of creating multiple sources of income.

By the end of this episode, you will decide what you want your life to look like and live that life. Stay tuned, and enjoy the podcast!

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Today’s Guest

Tom Davis, MD FAAFP

Dr. Tom Davis, MD is THE national expert in value-based healthcare delivery and full-risk insurance contracting. A family physician for over 25 years, angel investor, founder of 6 companies, co-founder of 8, he has successfully managed thousands of patients under Medicare Advantage and other value-based care programs. He is a sought-after consultant, speaker, and trusted advisor.

Before creating Tom Davis Consulting, Tom was a founder and leader of one of the nation’s first value-based health systems, Patients First Healthcare of Washington, Missouri.  As a practicing physician and leader on the Board of Managers, he leveraged the resources of one of the first total-risk Medicare Advantage contracts to deliver exceptional patient care. Innovating tailored care delivery systems, creating high-performing risk code education and compliance programs and personally on-boarding new clinicians, Dr. Davis helped grow a small primary care medical group into an integrated regional powerhouse, complete with its own hospital and diagnostic, imaging, surgical and cancer centers.  Today, as the founder and president of Tom Davis Consulting, Tom enables clients to leverage value-based systems for sustainable revenue generation, strong clinician engagement and the delivery of superior patient care.

Driven by the tremendous improvement in patient outcomes he personally witnessed, Dr. Davis became known for empowering physicians to collaboratively innovate– creating new systems of delivering cost-effective healthcare, generating an equitable, sustainable core compensation for clinicians so they can remain engaged, in-place and high-functioning. Through consulting, educating, speaking, and cutting-edge education, Tom helps clinicians, providers, insurers, investors, healthcare executives and governments achieve true transformations in value-based care environments.

A graduate of the University of Missouri–Columbia School of Medicine and its top-ranked Family Medicine residency program, Dr Davis is a current Diplomate of the American Board of Family Medicine, a Fellow of the American Academy of Family Physicians and a member of the American Academy of Professional Coders where he holds professional certifications as a compliance officer and risk adjustment coder. Having served as medical director for a regional rehabilitation facility for over 20 years, Tom shares his expertise in integrated healthcare delivery as a faculty member of the Washington University School of Medicine in St. Louis, Missouri.

You can find Tom Davis on…

Website: https://www.tomdavisconsulting.com/
Facebook: https://www.facebook.com/TomDavisConsulting/
Twitter: https://twitter.com/TomDavisConsult
LinkedIn: https://www.linkedin.com/in/thomasdavismd/
YouTube: https://www.youtube.com/channel/UCPDw6kNblZesskt-bfad9_Q?

Key Takeaways

• Tom speaks about the value you can create as a physician if you can anticipate what is coming.
• He cautions that given COVID-19 the world we trained for is gone.
• Dr. Davis feels optimistic that young physicians can make the appropriate changes to thrive in this new society.
• He makes some recommendations about not paying student loan debt?
• Dr. Davis recommends investing in one’s mind and skills.

“Your medical training was to socialize you… to make sure that you stay in place and generate revenue for the people who who are running things. And the first change that you have to recognize is that the dollar bills that you are generating running on the treadmill are now completely worthless”

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Check out other great episodes with Michelle Flemmings, MD and Karen Panzarella PT, PhD, CHSE

Disclaimer

All opinions expressed by the guest in this episode are solely the guest’s opinions and do not reflect the opinions of Andrew Tisser DO, Talk2MeDoc LLC, or any affiliates thereof. The guest’s opinions are based upon information he considers reliable, but Andrew Tisser DO, Talk2MeDoc LLC, nor any affiliates thereof warrant its completeness or accuracy. The guest, Andrew Tisser DO, Talk2MeDoc LLC, or any affiliates thereof are not under any obligation to update or correct any information provided in this episode. The guest’s statements and opinions are subject to change without notice.

Transcript

Andrew Tisser 0:05
Dr. Tom Davis, welcome to the Talk2MeDoc podcast.

Tom Davis 0:13
Thank you. It’s a it’s a privilege to be here.

Andrew Tisser 0:16
Well, thanks for saying that. You already sent me a little bit about yourself that I’ve recorded for the listeners. But if you could, in your own words, give our listeners a little synopsis of who you are, what you do and your role in healthcare.

Tom Davis 0:29
Well, I’m primarily a husband and dad, but professionally, I came out of residency in 1994, and joined a teeny tiny little single specialty group in rural Missouri, about the same time that we signed on to one of the first risk Medicare Advantage contracts. This was the middle 90s and the only reason we got it is because nobody else knew what to do with it. So we took it, we ripped it apart and 18 years later, we we sold the health system that we created to a regional competitor for 132 million. So I the number usually gets you some credibility in business circles, but I, I present it as evidence of the value that you can generate, if you can recognize what’s coming and then bend the future towards you.

Andrew Tisser 1:18
That’s a fair point, I think, dealing with the current events right now. What is your advice to people to anticipate what’s coming?

Tom Davis 1:27
Well, the most important thing is to recognize that the world has truly changed. And that the world that if you’re a young Doc, the world that you dreamed about, and trained for is gone. And I’m really sorry about that. There are a lot of people who’s, who are older than you whose futures and current status depend on not recognizing that and they are going to try to pull you along if you’re if you’re a younger clinician. But your ability to have a fulfilling life depends on your flexibility and ability to internalize the idea that, that the world has changed. And you fortunately, if you’re younger, you can make those adjustments and really make a new one that will serve your own mission and, and and serve your patients.

Andrew Tisser 2:25
Fair enough. Well, could you give some more direct guidance? I know that’s I don’t think people are talking enough about that. There is a new world and we aren’t going back to normal. But what do you say to frustrated burnt out early career Doc’s going into this and now how we’re coming out the other side?

Tom Davis 2:45
Well, it’s a tremendous opportunity. You’re no longer you’re no longer trapped in the wheel ruts of what you imagined was possible because of debt or because of other other limitations. I mean, really The advantage of a brave new world is that it’s new. And so you can really chart your own course. But you have to really question challenge the assumptions that you have internalized going forward. And you know, Andrew, this is really, really tough, because you and I going through a medical training have been socialized to stay in the Ruts. Initially, that training was standardized so that you and I wouldn’t really go off the reservation as far as medicine goes and give medicine a bad name.

You know, that was back when our education system began in the in the 50s. But now, it’s to socialize you to make sure that you stay in place and generate revenue for the for the people who who are running things. And the first change that you have to recognize is that the dollar bills that you are generating running on the treadmill are now completely worthless. And that is a very strong signal. But all you have to do is take a look at the Federal Reserve’s homepage. And you can see that in the past six weeks, about $4 trillion has simply been summoned into existence. And for each dollar bill that’s created, the dollar bill that you have in your pocket is worth that much less.

It’s really not reflected in prices yet, but it well, and there’s no sign that they’re stopping. So really the only asset that you and I have in life is time. And the only question that we have to answer is how we’re going to spend our time and it’s important to understand that running on the treadmill after the dollar bill is an illusion. What is real is how you feel inside about what you’re doing about the life that you created and, and and what you’re doing and really that means electing or choosing not to pursue a lot of the social status symbols that, that we, as physicians have been socialized into being are do once we complete our journey, and instead go for the ultimate goal for the ultimate status symbol, which is self sufficiency. And you can do that you can do it.

Andrew Tisser 5:20
Fair enough. I mean, I think just looking across the country with you know, this was the, the job with the largest security we would ever see, right? You know, if I go become a doctor, I’ll always have a job. And we got mass firings of physicians across the board 50 to 80%, pay cuts, etc. I think it’s becoming more and more evident to physicians, nurses and everyone in healthcare that we are very replaceable.

Tom Davis 5:47
Absolutely, and really has been a deal. You do what we need you to do and an exchange will give you as high status as we can and a regular paycheck that’s above average and That deal has been altered. I pray that it doesn’t get altered further, but it will. And really the first concrete step I can recommend for your listeners just to go buy a book. And this is not one that I’ve written, it’s written. It’s called transitions. Making Sense of life’s changes by William bridge is it’s a classic in the genre. And it’s for people who are making a journey of transition either voluntarily or involuntarily. And the lessons learned are, are are deep, they’re intimate. And it is a book you’ll keep by your bedside and reread over and over again, as you as you try to navigate your way. Have you had a chance to read that yet, Andrew?

Andrew Tisser 6:41
No, no, I will add that to the queue. I’m wrapping up a book right now. So I think I’ll do

Tom Davis 6:47
that one next. Absolutely. It’s absolutely mandatory. The second thing to consider and I this is this is shocking, but hear especially from someone to someone in my generation, but if you’re it Your physicians out there listening and are still paying on their student loans. I would, I would make the serious give serious consideration to not paying any more on your student loans, just stop. I know that those payments have been suspended. And the interest has been suspended, I think was for six months was the last deal.

But really every nickel that you put towards your student loan is wasted. And the reason is in this brave new world, the banks and people who are loaning you money are going to base the decision on whether to loan you money is whether you have an income stream to support that. And you know, credit scores are such an intimate part of our lives and not paying you’re not paying in the former world not paying your student loans would certainly give you a hit to your credit score.

In the New World, its credit score is not going to be used as a proxy for whether or not you can access money. It’s going to be used as a proxy. What’s going to be used as a proxy is your ability to generate income. And, you know, that is something that’s very startling statements very startling, but I can tell you that future events are going to bear that out. I wouldn’t put another nickel towards your student loans and let the and let the chips fall where they may I have a number of clients who have secured loans for buildings in their offices for equipment, and increasingly the tactic there Andrew is just to walk away and you know, take the hit to your credit score, because no matter what, you’ll still be able to earn money. But the commercial real estate that out that out that’s out there is basically tissue paper, I mean, it has some value, but only a fraction of what it’s marked to market.

And you’re gonna have to pay taxes on that you’re gonna have to pay upkeep on it. You have to balance that against the damage to your credit, and increasingly people are are starting to consider walking away and you know, these are amazing samples of I know, you have to decide for yourself. But these are examples of the huge changes in mentality that you have to make if you want to thrive in the new world.

Andrew Tisser 9:13
So you’re saying, you know, my, my payment is $3,000 a month, you want me to just default on my student loans right now

Tom Davis 9:22
I say that if you are paying on your student loans, you have to recognize that that that that is a waste of money, that the time is going to come in the very near future where no one is going to be held responsible for the balance of the student loans. You really think that’s true? I absolutely think that’s true. I fact, I can tell you that that’s going to be true, because the student loans are being held against people with disposable income and the one thing that the government needs is for people like you to spend, and so you know, they’re willing to take the heat and eat that

I mean, student loan outstanding balance is only what one To $1.3 trillion, Andrew That’s nothing. That’s nothing. They just they just voted. You know, in the past six weeks, they just voted $6 trillion. So, uh, you know, that suddenly becomes a drop in the bucket. It’s an example of a, of a brave new world that you do want to think about now, the people that are doing that, that are, quote unquote, defaulting on their loans are the ones that are already having trouble paying for it, especially on the physician side, they’re the burned out ones, the ones that are trapped, and you know,

I tell them, if it’s a choice between, you know, abusing drugs or hurt yourself or not paying your student loans, well, that’s pretty, pretty easy choice to make. For someone like you who is keeping it together, you are going to see moral hazard and staring in the face, meaning that you’re not going to get any benefit for having kept current on your student loans because they’re going to be canceled for everybody.

Andrew Tisser 10:56
I could see that with with federal loans, but it Now what about all of us that have refinanced and hold with a private lender right now, your advice still hold?

Tom Davis 11:06
For those who have who, for those who have the federal federal guaranteed loans? Yes, my advice still holds for that. For your individual situation. You know, that is up for you to decide, I promise you, I promise you that you are going to get the opportunity to refinance and write down those loans going into the future, ad infinitum. Because your current income is more important to the system than then paying off those loans. Remember that the banks that the banks that own those loans, the federal government, just banks just backstop them. So all of those loans there are guaranteed even if you have them with a private lender, because the Federal Reserve has announced that it’s going to buy any business bond and any any mortgage or security bond that’s out there.

So if you decide Not to pay, the bond that is based on your loan won’t become worthless because you’re not paying, because the Federal Reserve will buy it for you. And you know, these are kind of complex things that people really don’t understand. But you know, when you’ve been deep and deep in business and when you have seen how the money flows, you can see it happening sooner than other folks. And for you young Doc’s out there, you need to realize that the world has changed. And the people that want to keep you in place, have every interest in making sure that you don’t recognize it. And how you’re going to experience it is the is the slow and steady degradation of the guarantees of income and and labor that you’ve, you’ve been led to let to anticipate.

Andrew Tisser 12:49
Wow, those are some powerful messages, Tom. Well, what else can we do? I mean, I think a lot of a lot of us Doc’s and other healthcare professionals are very disenchanted right now. With the current state of medicine, the the administration at different hospitals, etc, you know had how do we protect ourselves against further degradation?

Tom Davis 13:23
Well, I heard your question and I’ll tell you what, for folks that are, again, are young and are looking to see how to take advantage of the future. The most important thing is to recognize that the Pete the things that you’ve learned in medical school and residency are only part of what you’re going to need to succeed in the Brave New World, it’s going to be up to you to improve your talent stack or your skill stack on your own, with your own self directed training program. And, and that’s very, that’s very challenging. For those of us who have kind of gone through the hoop jumping of medical Education.

So you have to figure out where you want to go. And then start developing at a whole set of unique skills that are tailored to you. So that you can get there. And I’ll give you an example. When I was making my transition out of the employed system, into into my own non clinical career, I decided that I wanted to be a professional speaker. So I did the Dale Carnegie speaking course, which is absolutely gold plated. It was absolutely fantastic. And it really gave me the skills to and the confidence to market myself as a professional speaker.

And it’s a it’s a nice, it’s a nice revenue stream. In addition, I wanted to look at doing some expert witness work. So I went to the seek se AK training courses, and I think I have about 50 hours of training in them in there now. And I learned to be an effective expert witness and that allowed me to market with confidence and to push my price point. So those are just two examples. The challenges Andrew is that the we are socialized not to accept that we’re socialized to be given our education, even if we’re able to direct it a little bit ourselves. So what we have to do is, we have to decide what we want to do, and then build our skill set to do it. And only one of our revenue streams should be selling our expertise into a third party payer system.

You can sell your expertise outside of that you can also sell non clinical expertise in a number of different lines. And really, once you get outside this kind of tightly regulated market into which most of us sell our healthcare services, you will be astonished at the value that you have as an MD, especially if you have residency training, and you’ll be equally astonished at the quality of life that you can lead

Andrew Tisser 16:00
Yeah, that’s fair. I mean, I’m, uh, for those who know me, I’m a big proponent of multiple streams of income. I talk about it all the time on my my personal Facebook group for young physicians. I think you need to insure against catastrophes like this by doing lots of different things. And I know what you’re talking about is investing in yourself and investing in your mind. So you know, courses and books and things like that, in order to gain the skills that you could use to mark yourself going forward. I think it’s very important. Good advice.

Tom Davis 16:33
Absolutely. And none of these revenue streams needs to equal what you anticipated earning coming out of residency, but the some of them can be and the nice thing about having multiple different revenue streams is that when one dries up, another one usually gushes. And it’s, it’s very nice to balance it. What what isn’t nice is that it’s active. You can’t just sit back and you know, go and punch The clock and expect the paycheck to show up. And that was what was holding a lot of doctors back pre COVID. But now they’re seeing that, that the deal isn’t, hasn’t been altered has been altered more than they thought. And so now they have no other alternative. And that’s why physician advocates and transition coaches like myself and my colleagues are really just doing a booming business because the physicians have realized that there’s no safe space anymore.

Andrew Tisser 17:29
That’s fair, do you think systemically as a whole healthcare will fundamentally change post COVID and not just the way we look at it?

Tom Davis 17:37
I do I think we’re going to develop into a wheel and spoke method of healthcare delivery for primary care and a cognitive treatment where patients will get used to contacting a will be given a number, a telephone number or an address that they can access and then there’ll be Take them through an AI to kind of screen them to see whether or not they can take care of themselves. And then once the AI is complete and the patient decides they want to talk to a clinician or the AI decides they need to talk to a collision, then they’ll go to a mid level provider, or like an APN.

And and then the physician will kind of oversee a lot of these APS and they will actually intervene when the APN ask them to intervene. And the thing about this is that there’s no site for this, anybody can do it anywhere. You can be in Seattle and supervise a nurse practitioner or pa in Florida. And it’s kind of a hub and spoke kind of approach to healthcare delivery, which is going to be the antithesis of what most primary care doctors when it’s a medicine for because it’s really going to further commoditize our labor, and it’s also going to further fragment the system so that you really won’t get that good have that good relationship with your patient, face to face medicine will exist, but it will be a luxury good, and they will be and people will pay cash for it.

And they probably will be will be special, high, high priced third party payers willing to indemnify people if they’re willing to pay for that. And so there’s going to be a subset of folks that are going to be willing to subset of patients, physicians that will be willing to offer that. But it’s really going to be a luxury good, the mass delivery of healthcare is going to be in that virtual hub and spoke approach. And the reason why I know that is that the people that are running the show, they take a very, very much an industrial mindset of care delivery to their system.

Whereas you know, you and I know that healthcare is an emotional product, you got to have that connection in order to be effective. But these folks they don’t have that experience or they forgotten it. And so they’re really going to look at different ways to adjust the treadmill so they can keep their productivity up and their labor costs down. It’s really going to be very jarring for the clinicians in place now who are going to make that transition. And they’re quickly going to be very disillusioned with, with the type of job they’re going to be asked to to perform. It’s going to take a lot of heavy duty socialization in medical school and residency to groom the next generation of doctors to be able to practice in that in that environment long term.

Andrew Tisser 20:24
Well, medical schools are pretty good at brainwashing us. So I said don’t figure it out.

Tom Davis 20:29
They aren’t they are that I anticipate that there will be national change the version cares it start that start absorbing all the all the local chains. So that when the physician it gets to the physician, he makes a decision you got to be seen in person, there’ll be a place nearby where they can refer you. And that’s going to lead to really homogenization of licensure, homogenization of, of regulations, in order to really promote to that industrial model that the formerly before COVID.

Andrew, it was you and I, the physicians and our need to see the patient face to face that was the speed bump. Well, that speed bump has been flattened. So the next speed bump our state borders, and those are going to need to be flattened. And before the federal bailout of the healthcare system, I would say that that was going to be a challenge because all the healthcare systems have load stones of commercial real estate or around their neck.

And, you know, they really are going to have to work hard to write the value off. But now the federal government has put in about 150 150 130 billion dollars in the system. So now they’re really partners with the health systems and employers. And so, you know, we physicians were we’re out of the way telemedicine has done that. And now in partnership with the government, the state borders are gonna are going to start getting pretty creaky. And really, you and I are going to have to watch out for our own best interests because the people who employ us, as evident recent evidence has demonstrated will not

Andrew Tisser 22:10
that’s a strong message. Absolutely. Well, I think let’s transition the show a little bit. We’re running out of time just to get you to get to know you a little bit better. So, Tom, I know you gave us a book recommendation Do you have any others

Tom Davis 22:26
for folks that are looking for transitions and to transition in a non clinical or non traditional careers? My partner john jerk and I have our soft launching a website called clinicians cooperative calm. It’s a it’s a forum meant to be a place where clinicians who are some were in their journey of transition can connect with with experts who are professional guides and helping people learn about hospital administration, working with insurance companies, all the different speaking all the different

All the different disciplines that you can imagine were soft launching right now and I’ll send you a coupon good for three months free on the forum that your your listeners can experience. But john and i found ourselves so overwhelmed by all of our, by all of the demand and certainly our colleagues are as well there needs to be some kind of few too many sites where people can economically explore their options. And and this is the mission of that the mission of our of our forum is to do just that.

Andrew Tisser 23:33
Great, thank you for that. I’ll share that and for the listeners. Don’t forget to listen back to Episode Two where I interviewed dr. john G. Rica. So Tom, what do you like to do for fun?

Tom Davis 23:46
For me for fun, I like traveling in my RV with my wife and my two dogs. That obviously has been curtailed, but we go all over the place and it tickles me to do a couple of telemedicine encounters.

Wherever I am we’ve been doing in Alaska, I think we’ve done it in 46 out of 50 states and about a half dozen countries. I just love the sense of freedom that that gave me is doing a telemedicine encounter in a private place that’s completely divorced from the fluorescent lights that I used to deliver so much of my health care through. So that and reading and, and finding different ways to to serve my peers. I’ve been very fortunate in my in my life, Andrew and I want to spend the rest of my professional career paying that good fortune for

Andrew Tisser 24:34
fair enough. And I know you’ve already given early career doctors and other health professionals a lot of advice in this episode, but if you could give them one overarching piece of advice going forward and how to navigate the coming wave, what would that be?

Tom Davis 24:50
Take two days, turn everything off and shut the door and start journaling and start deciding what it is that you want. Your life to look like and then live that life. Don’t live someone else’s life life is too short to live somebody else’s dreams.

Andrew Tisser 25:11
I could not agree more and if people agree with your message or want to find out about you and your services, how could they get in touch

Tom Davis 25:18
with you go ahead and and and hit us up but clinicians corner clinicians cooperatives calm and and we’ll be happy to connect with you there you can also email me directly at Tom at Tom Davis consulting and I also teach telemedicine at telemedicine mastery comm I’ll have all the links to you, Andrew.

Andrew Tisser 25:38
Absolutely. For those students. that’ll all be in the show notes. Well, Tom, this has been a lot of fun and you’ve certainly given me a lot to think about and I’m sure our listeners as well. So thank you again for coming on the show.

Tom Davis 25:50
Andrew, it’s been a privilege Hang in there.

Andrew Tisser 25:53
I will you as well. Stay safe. Thank you