Younger Docs Talk About Facing Age Discrimination

December 11, 2017

In part one of our younger physician roundtable, three doctors expand on the toughest challenges faced in their burgeoning careers.

A younger generation of physicians is ready to speak out.

They're here to tell you how they feel about facing doubts from patients who think they are just out of high school. They're here to talk about EHRs, having grown up on computers their whole life. They're here to talk about the importance of work-life balance. They're here to be as candid as many of their older colleagues are about the profession of medicine.

Three young doctors who have taken similar, but different paths in their young careers spoke to us for the first ever Physicians Practice Young Doctors' Roundtable. For this exercise, we deemed younger physicians to be 40 years older and below.

Our three doctors are:

Elizabeth Seymour, MD, 34, family medicine, Denton, Texas

Landon Roussel, MD, 32, direct primary care internist, Luther, La.

Brandi Ring, MD, 35, obstetrician/gynecologist, Denver, Co.

The three doctors had so many interesting things to say, we broke this roundtable into two different pieces. Here's part one of the roundtable. Part 2 will be coming out later this week.

You are all in independent practice - something rare for a younger doctor. Merritt Hawkins released a study which found 94 percent of final-year residents prefer employment. What made you decide to go this route?

Elizabeth Seymour: I did not want to work for a hospital. I had an [bad] experience with a medical group that kind of shifted my perspective in wanting to be independent and by myself. A lot of the reason I didn’t want to be in the hospital was the control factor. I wanted to take off when I wanted to take off. I wanted to budget how much I was going to make. I didn't want to be controlled by anybody really. If I wanted to add a test or a service, I didn't want to go through administration and ask: Can we do this?

Landon Roussel: I couldn’t see myself doing medicine any other way….Primary care was the only option for me [to practice medicine] and under the current system, primary care is a widget factory [in hospitals and employed groups]. I feel like that's not making use of my mind. That's not providing value with my time and skills. Being independent was essentially doing medicine for the reason I went into medical school. That was my motivation for being independent [and DPC] and still is. If I weren't independent, I wouldn't be doing medicine.

Brandi Ring: For me, a lot of it was the autonomy. I wanted flexibility over schedule and how much I could see patients. But also when I could take my vacations. How much I could take. Not having to ask permission to do those things.

What made you decide to go to your specific location?

ES: My husband and I are both from [Texas]. We wanted to be home.

LR: I have deep family roots in [St. James] Parish going back many generations. That was part of it. I wanted to be near where my family is, where my family grew up.

This is an underserved area [it technically doesn't meet federal criteria] but it is underserved. The average primary-care doctor has over 5,000 patients. That was part of it. And we wanted to go somewhere more rural. Too much of the hustle and bustle made it hard for us to sympathize with the needs of everyday people and live simply. So that was part of it as well.

BR: I'm from Denver originally. When it came time to choose where I wanted to be, it was finally time to come home and be near my family. This is where I grew up.

Medical school debt seems to weigh on a lot of young physicians' minds when they start their career. Was that the case for you?

BR: It's something you always think about. For me, in particular, it didn’t affect where I wanted to go to practice. It certainly made a difference in what kind of benefit package I was looking at and it's always looming in the back of your mind.

LR: For me, it did weigh on my mind. I directs how I choose my moonlighting opportunities. I was fortunate enough to get a primary-care loan that

was fairly open in what I do.  It was federal government financed, but the only restriction was that I practice primary care in one of the 50 states or U.S. territories. As long as I'm doing that, I'm good with this loan. It's on a 10-year pay back. [The practice is] doing well with that. Ten more years of my life in the grand scheme of things is not unbearable.

ES: Not really for me. I think there is a misperception that if you're in independent practice, you're not going to make as much income. If you don’t work, that's true. You have to work. Just like you have to work anywhere else. I've always had a steady income.

I think the problem for young physicians is they don't get trained [in non-clinical elements] of medicine. They are weak in their coding. They are great medical decision makers, but poor at understanding what they should be paid based on the services and the medical decision making they do every day.

As an independent physician, how do you learn the non-clinical side of the business?

ES: I took a couple of courses. There were a few in residency and I thought they were horrible. I didn't learn anything from them. I took some on my own and I learned a lot. I feel comfortable with it now. I will say, you have to keep up with these codes. They change every year. Your standard office visit doesn't change…but if you add a service, you have to know how to code it. If you're taking federal insurance, there are chronic care management codes. You have to learn to keep up with it. It's ever-evolving and changing.

LR: On the direct primary care side of it, I was very fortunate to have mentors. I was able to go to direct primary care conferences over the years I was in residency, and even my intern year…learning how to do direct primary care…I learned nothing [about the business side of medicine] from residency.  What's been harder is the integration with Medicare. I still haven't opted out [of Medicare] and I'm not sure if or when I'm going to do it. So I have to do a little bit of coding for that and learn those regulations. That's been self-taught….that's been a very steep learning curve. Very steep.

BR:  You definitely have to learn the business side on the fly. There isn't really a good program out there to teach you how to [handle human resources] concerns, ordering supplies, and supply management. I was fortunate. I came into a practice that had been in business for 60 years. A lot of it, I didn’t have to think from the ground up. The biggest thing you know nothing about when you start is how are you actually making money and bringing money into your practice. A lot of that you learn through your partners and through trial and error.

What are the biggest challenges about being a younger doctor?

ES: I don't think we have a ton of challenges. I'm in my 30s, I'm married, I have kids and I'm settled down. But your 20s are hard. You're going through undergrad. You may be getting a master's degree, you are going through medical school or residency, even into your 30s on average. My 30s have been good to me because I've settled down, but your 20s are hard.

When I first started my private practice, I got a lot of comments like, "Oh my gosh. Are you even out of high school?"…I had to tell them I'm out of high school and just because I'm female, I'm not a nurse. A lot of people thought that. [I had to get people to buy into the idea that] I can be a female, young, and a doctor. I can do this. Once I got to know patients, people were fine with it.

When I initially got out of residency, I was in a group practice where I was taken advantage of. They thought I was young and naïve. I wasn't and I wasn't going to be mistreated or taken advantage of. I think that's the one thing, but you just continue to be educated and you live and learn. 

LR: I've definitely experienced similar reactions to my perceived age. A lot of people in their 60s, 70s, 80s - they have kids older than me. They wonder, "Is this guy even out of high school?" So that's taken a little bit of people getting used to you.

On the other hand, a lot of people want a younger doctor because most of the primary-care doctors here are older and near their retirement age…After being in the community over a year, people learn [about you] and word spreads. That certainly helps overcome perceived barriers as far as my age. But definitely in these rural communities things are much slower to change.

ES: I agree, a lot of my older patients told me they don't want an older doctor because some of their doctors had already died unfortunately.

 BR:  I absolutely did have a trial/breaking in period where everyone from the nurses and everyone else finds out if they can trust you. You have to navigate that a little bit in your first couple of years. The other thing that's really hard is trying to get your experience in other areas across. Everyone takes residency as a baseline that you can do the medicine. But your experiences in leadership or organization is a lot harder to get across.