Yes! You can open your dream clinic—without completing residency.

Hi, my name is Dr. Kat Lopez and I unfortunately know what you are going through if you are suffering in conventional medical training or a conventional treadmill medicine job. I was really afraid of going to residency because I had heard of the abuse that I would undergo. And even though my residency program in family medicine was overall a great and supportive program,

I came to feel during my first year of training that the medicine that I was practicing was simply a training to become a robot doctor. It was to be able to see patients as fast as possible as we were given shorter and shorter time slots in clinic. And it was to learn how to both prescribe and manage a polypharmacy of drugs as efficiently as possible and with the least amount of litigious risk.

And this was never the type of healing that I signed up to learn. And I was deeply hungering to learn about nutritional healing of disease, nutritional prevention of disease, alternative approaches including mind-body-medicine, Chinese medicine. What about these things people have been using for centuries?

Kat Lopez MD

I grew more and more bored and more and more desperate to start to live my passion and my dream of becoming the doctor that I knew could do great things in the world and my residency program was not able to educate me in that way. So I actually resigned from my residency program after the first year. I announced about halfway through and completed my intern year in my family medicine program. I did this with the support of several mentors in my life and I also learned that in a number of states in our fine union physicians can obtain their general medical license with only one year of post-graduate training. I had never been told that. Nobody ever talked about that. There are even D.O. [Doctor of Osteopathy] PGY-1 spots all over the country that are intended to be complete for one year if that D.O. will be going into primary care. 

So I spent about all told from the beginning of residency until I found my dream (where I live now) just in absolute emotional turmoil from feeling like a total failure, a total screw up, feeling like my genius was absolutely unappreciated and unimportant. That all these passions I had for real health and real healing were useless at best and dangerous at worst, that were causing me to become a problem to my residency program and a problem to the conventional medical system in general. I was in absolute grief and despair over thinking that I could never be the healer I was meant to be. I started looking at other educational programs and thought what I can do other than work under my medical license if I can’t get my medical license. I considered things like selling my soul to the pharmaceutical rep industry and taking a job there so I could be paid to drive around and sell devices or pharmaceutical medications. 

And then through meeting Dr. Pamela Wible—who is a liberator of physicians from treadmill medicine—I started to realize that I have all of the emotional intelligence, the educational prowess, the passion and the drive to truly live my personal dream even though I did not have a mentor outside of myself to show me “Hey I want to practice like you. I want to do what you do. I want to work like you work.” I did not have that exactly presented to me and I was empowered by Dr. Wible to define that for myself. Ultimately her support of patting me on the back and saying, “You can do it! You’re going to be great! Your patients will love you!” gave me this fuel through a lot of other healing processes to define what I wanted to be really in my life. And how I wanted to live each day both impassioned by the subject matter in front of me, both in service to the people who can benefit from my personal form of healing and genius and to make a lot of money while doing it. 

So what I ended up creating in my life was a beautiful collaborative practice where I met an experienced mentor in naturopathic and Chinese medicine, Dr. Satya Ambrose. She had just opened a new wellness center in Happy Valley, Oregon, which is about half an hour outside of Portland (where I lived at the time) and she became a close mentor and teacher of mine and over the past two years I’ve essentially developed my personal private practice as an independent contractor in a group of really forward-thinking, loving, relaxed, interesting people with diverse capabilities of healing from acupuncture to body work to naturopathy and as an independent practitioner work on a percent-split basis to enjoy the benefits of the wellness center staff. I have my own staff. I have assistants. I have front office scheduling and website maintenance and these kind of things. In addition, I’ve gotten to essentially grow into a functional medicine approach to diagnosing and treating both complex chronic disease and simply prevention medicine for the people who are feeling kind of crappy in their fifties and maybe 30 pounds overweight and need a little bit of guidance to kind of guidance to get healthy in this second phase of their life.

I not only as my own boss have all of the ability to dictate my schedule, how much money I really want to make, how to go into my community as a grassroots marketer of myself whereby interacting as a teacher, a lecturer, a demonstrator, a colleague, I am basically marketing my group and myself as the community-based wellness-type of physician that I truly am. So marketing feels effortless, attracting patients has felt completely effortless and over the course of two years my practice is filling beautifully with basically no effort on my own other than personally following my passion to learn the functional and natural medicine approach to complex chronic disease. So I am happier amd more fulfilled than I could have possibly imagined. 

This type of practice which is both financially sustainable and extremely fun and basically a deep and intensive learning process as I expand my toolbox from sort of from the pharmaceutical-based medicine that I was taught and trained in. This process has been so easeful and harmonious as soon as I got in touch with what I really cared about, the vision I really held for my life, and got empowered to learn what I needed to learn to make that happened as well as connected with people who were right there helping me from the business sense to how do you write office policies. Well, I guess I can make them up myself. What do I want my office policies to be? So currently I work as an out-of-network doctor. I’m not contracted with any insurance companies and I have a scale for my cash-pay patients, many of whom are uninsured. I give discounts for various things such as for people who have Medicare. I also have a biller in my office who will bill people’s insurance if they have out-of-network benefits for our office visits.

The care that I am able to provide absolutely fills me and my patients with joy. And learning along this process has been so empowering and liberating from the do medical school, do a residency, and get a job—one of these jobs that you’re offered on a piece of paper sent to you in the mail at a big-box clinic. I knew that that job wasn’t for me. It wasn’t harnessing my genius. And I could not express my personal passion for health and wellness through that model. Guess what? I’m not a quick doctor. I would have never succeeded in anyone’s model that requires me to see people in 10-20 minutes. Just never. So fortunately I get to succeed as my own boss in my own practice with a beautiful group of collaborative naturopaths who are helping each other and see our patients together to do an awesome, awesome brand of really true healing. 

So if you’re an exhausted, overworked medical student, intern, resident, or physician in treadmill medicine, I want to summarize for you that I was hopeless, totally discouraged, very, very bored by the type of treadmill medicine I was being trained in and exhausted physically from lack of sleep. I was undernourished and filling up on more junky sort-of calorie-dense stuff so I could make it through the day while shoving as little volume down my mouth and in the bathroom stall as I could so I could not pass out on rounds, really, really suffering in the system that is designed to disempower very intelligent people and wring every bit of productivity out of you as deeply as possible no matter the personal price. And now as my own boss having been supported by other doctors to realized that I can figure all this out on my own just like the dry cleaner business down the street can take money from satisfied clients to do their business. Gosh darn it I can learn how to do the same thing in medicine.

I roll into work at nine or ten or eleven or twelve, depending on the day. I set my own schedule. I can block off days for any of the things I would like or need to do—educational purposes, recreational purposes. And in my clinic itself, the staff juices for us green juices everyday. I can wander around between patients with a quick acupuncture treatment. If I drop something on the floor, I don’t feel like I have drug resistant bacteria everywhere, but can like wash it off and put it back on the table where I was eating. It’s a clean, wholesome environment that I just never thought would be possible. Medical students come through from the naturopathic school and practice their massage and craniosacral work on me so I truly am living in a wellness center where we practice what we preach and I had no clue it could be this good. Just two years after quitting my residency, I’m truly living my dream. I have enough and the horizon is only growing brighter. So thanks for listening! Contact me to find out more!

Pamela Wible, M.D. is a family physician and “liberator of physicians from treadmill medicine.” This video was filmed by GeVe at our biannual physician retreat. Come join us! Questions? Contact Dr. Wible.

Posted in Business Strategy, Medical Education, Physician Retreat Tagged with: , , , , , , , , , ,
Add your comment below or scroll down to read 22 comments

Leave a Comment

Your email address will not be published. Required fields are marked *

*

22 comments on “Yes! You can open your dream clinic—without completing residency.
  1. TW says:

    I love this!! – exactly what I needed to hear this morning as a residency candidate preparing for the match again. Thank you!

    • Kat Lopez says:

      Good luck – it’s a bit intimidating to open an envelope and learn where your new home will be! Residency training is very thorough and hospital-based for many good reasons, but it’s reasonable for an MD with 1 post-graduate year of training to be able to practice primary care, this already surpasses the education required to be an NP, PA, and naturopathic doctor, all of whom are licensed PCPs.

  2. Mina Guzman says:

    Hello Pamela,

    Curious to do this naturopathic medicine

    • Pamela Wible MD says:

      Works great for naturopathy, acupuncture, counseling, massage. Any outpatient medical practice. Happy to help. Contact me if you have questions here: http://www.idealmedicalcare.org/contact.php

    • Kat Lopez says:

      You may want to check out the naturopathic medical schools – National College of Naturopathic Medicine in Portland, OR and Bastyr University in Seattle, WA. Also check out the Institute of Functional Medicine, which is a comprehensive training for doctors in diagnosing and treating the root causes of disease rather than practicing “pill for an ill” medicine. They have training programs all over the country.

  3. Vítor says:

    Inspiring. Congrats!

  4. Steve O' says:

    Hooray, Kat! You deserve delight and joy as a doc! Welcome to sanity!

  5. Michelle Murphy says:

    Wow! So, inspiring! I am wondering though if you felt your knowledge base was substantial enough with only one year of Residency? I’m scared of Residency myself, but I feel like I need it to really learn the medicine I was supposed to have internalized in medical school.

    • Pamela Wible MD says:

      What most people need is pretty simple and with 60 minute visits you can look things up PLUS she has created a holistic team of healers to support her so always has folks to discuss patients with. You can contact Kat directly if you like too.

    • Kat Lopez says:

      I wanted to work closely with a very experienced clinician, so I have been in a mentorship with a naturopathic physician who also does Chinese medicine, senior faculty at the naturopathic medical schools, and has been in practice for 30 years. I also have all the time in the world to look up the proper way to diagnose and manage conditions – I have read a LOT of Academy of Family Physicians overview papers on different diseases, and honestly they are extremely clear and concise and just perfect for everything from COPD to polymyalgia rheumatica. In addition, I had more training than NPs, PAs, and naturopathic doctors, all of whom are licensed PCPs. I have many doctor friends to call and text questions to when necessary, although with the time available to research it’s rarely necessary. I love the OHSU consult line – I can call this high academic hospital and talk with any specialist any time of day or night regarding anything at all. So many resources. I attended a top-10 med school and their training in information processing, gathering, assessment, and researching has been so useful.

  6. gene saltzberg md says:

    This is a great alternative for those of us going into primary care. However, this approach does not work for students, residents in specialized fields (Ex: Emerg. Med, ENT etc.). Our fight has to be to HUMANIZE medical training, get the “ball busters” out of their teaching roles, and provide TRUE emotional support for trainees having a difficult time. This is simple we need to start treating trainees as human beings, and care for them just as we care for our patients!!

  7. Sorry, I don’t buy it. Fix the very real problems with medical school and residency, YES. But don’t pretend they’re not necessary:
    https://dinosaurmusings.wordpress.com/2016/06/08/dropping-out-is-not-the-answer/

    • Pamela Wible MD says:

      A few corrections to your blog Lucy:

      1) I do NOT have a subscription practice. I see all-comers and I take insurance.

      2) I have never turned anyone away for lack of money. I don’t believe in a two-tiered health care model.

      3) Diet and nutrition is not woo (and is certainly not taught in med school). There are HUGE problems with allopathic medicine which does not prepare us to care for patients in an outpatient setting when it comes to prevention, lifestyle, and common sense things people can do to prevent taking drugs for the rest of their lives.

      4) PAs and NPs are providing primary care in an outpatient setting with a lot less training and most are doing a great job. Physicians who want to practice outpatient medicine should not be held hostage to 3-4 year residency programs. There are not enough residency programs to meet the needs of current med school graduates. These students with 300K+ loans should not be sitting at home twiddling their thumbs when they could be caring for people like NPs and PAs.

      5) And yes, I believe that residency programs can be shortened. How does working in the NICU help me provide care in an outpatient setting? There are so many parts of residency that could be structured in a more personalized way to meet the ACTUAL needs of patients and docs who plan to open neighborhood family medical clinics. A tertiary-care hospital-based Pharma-heavy medical indoctrination is not appropriate for everyone.

      I could go on . . .

      ~ Pamela

      P.S. I allowed my community and patients to design and define their OWN ideal clinic (which I opened based on 100 pages of their submitted testimony) and what they want and what residencies deliver are not a great match. Patient engagement is important – in fact essential – so let’s stop holding everyone hostage to a one-size-fits-all medical education system (that need to be TOTALLY revamped).

      • (Cross posting again)
        https://dinosaurmusings.wordpress.com/2016/06/10/dialog-doubling-down-on-dropping-out/

        1) and 2): My bad. I seem to recall you talking about your practice being “full,” having a waiting list and so on, meaning you manage a panel. (I don’t.) Most people who do that are DPC or otherwise subscription based. Apologies.

        3) Diet and nutrition (may as well throw in exercise as well) are not woo at all. I never said they were, nor does any legitimate doctor I know. However they are often used by alt med practitioners as a bait and switch for their actual woo, like naturopathy, chiropractic, homeopathy, and so on. As for that old canard about nutrition not being taught in medical school (not true, BTW) what we do learn about biochemistry and physiology allows us to understand nutrition at a much deeper level than anyone else, if we’re paying attention. In fact, truly understanding the basics allows us not to fall for each new fad diet that promises instant loss of belly fat. The really exciting new stuff about nutrition has to do with the gut microbiome, and how different people respond completely differently to exactly the same foods. Real doctors are the ones doing that research, not the ones with books to sell.

        Use of the adjective “allopathic” is another flag that you’re setting up a false dichotomy between drugs and non-drug treatment, where presumably doctors ONLY use drugs. I use lifestyle measures (like diet and exercise) and “common sense” for prevention and treatment every single day. The idea that taking drugs represents some kind of failure is, in my opinion, foolish. Many people still need medications for things like blood pressure and diabetes even after optimizing their lifestyle. They certainly don’t have to “take drugs for the rest of their life,” but their lives will likely be shorter. The ability to use drugs appropriately is one of the skills developed in training. Opting out of that education is very much throwing the baby out with the bathwater.

        4) Yes, there are many people providing primary care who are not residency trained physicians. However I reject your assertion that they are doing a “great job.” Google the Dunning Kruger effect: the less you know about something, the more confident you are about your knowledge. I’ve written about this with regard to PAs and NPs before. Patients love their NPs and PAs, just like they love their naturopaths, which basically means that they’re either never going to realize what lousy medical care they’re actually getting, or that if something untoward happens, they’re not going to blame them. Is graduate medical education perfect? Hell no! But fix it; don’t forego it.

        5) I disagree strongly that residency should be shortened. Re-structure it? Absolutely. Spending more time in various outpatient settings, possibly free clinics where trainees can experience true undifferentiated primary care while still under the supervision of experienced faculty, would be fantastic preparation for independent practice. But one year of postgraduate training is nowhere near enough time to become familiar enough with primary care to practice safely and effectively on one’s own. All the CME in the world doesn’t make up for treating patients with someone who knows more than you do looking over your shoulder, pointing things out to you, and providing guidance. No, tertiary-care based training isn’t appropriate for everyone. Guess what! I did mine at a community hospital. Again, you’re offering a false dichotomy of “indoctrination” vs “following the dream.”

        PS I’ve read all about your clinic, and I’m happy for you. Somehow I managed to wind up in pretty much the same place, but without going through the burnout phase that you did. Believe it or not, NOT everyone is driven the brink of suicide by medical training and practice.

        As for “allowing patients to design and define” their ideal clinic, you have to remember that patients are not customers and are not always right. All too often they want things that are not medically appropriate. I have patients who would say that their Ideal clinic would be a place where they could get antibiotic prescriptions called in without a visit. Trying too hard to please patients can also lead to inappropriate narcotic prescribing. Slippery slope, that. I stick to treating my patients the way I want to be treated: same day appointments, communication any way they want, all labs called back personally; friendly, attentive, thoughtful, medical care. They seem to like it.

        “Patient engagement” is indeed important, but it’s just the new term for what I’ve always done; involving patients in their own care, soliciting their input to treatment decisions, and providing lots of patient education. Frankly, my patients are most grateful when I take the time to explain why all those alternative treatments they found on the Internet are a waste of their time and money.

        I could go on as well…

        • Pauline says:

          Lucy,

          Due to your (lack of ) understanding of nutrition my mother almost died due to a bacterial infection, under the hands of Los Angeles UCLA’s most renowned doctors. The doctor also had a “Stein” at the end of its last name…

          Take this from a real life patient, but most importantly open your mind and thought to these bright minds that are contributing greatly to a new generation of medicine, please.

          Regards,
          Pauline

    • Kat Lopez says:

      Hi Lucy! Thanks for your comment.
      I hear your value the comprehensive residency programs in the US. I do as well. But…Necessary, as you state? To practice medicine? Well, that’s simply not true…are you aware of NPs, PAs, and naturopathic doctors? They all practice medicine with less than 5 years of training. There are a lot of practicing MDs and DOs who are not board certified or eligible – I was just contacted by a resident in Puerto Rico, where 80% of docs did not complete residency. Nobody’s “pretending residency is necessary” – we’re stating that it’s the case based on reality.

      In addition, I didn’t just stop training, I changed course…to train in a cutting-edge approach to treating complex chronic disease primarily through proper nutrition. I do at TON of fascinating continuing ed. Did you mistake the Institute of Functional Medicine for woo-woo? You may want to check into it. The IFM is run by highly experienced MDs who have become world-renowned for their success in healing difficult diseases; the Cleveland Clinic just opened a functional medicine program because the efficacy of the approach is unparalleled (addressing the underlying causes of disease using nutrition and approaches to decreasing inflammation in the body).
      Have you heard of Dr. Esselstyn or Dr. Fuhrman, eminent cardiologists who reverse severe coronary artery disease with diet alone? They’ve written several books, you may want to read one, they’re amazing. I think it should be illegal for docs to NOT reveal to their patients that there is a failsafe nutritional method to getting off their cholesterol meds, antihypertensives, diabetes meds, and gaining radiant health. Try reading up on those guys.
      Also, writing off Mind-Body Medicine (I trained with Harvard’s Center for Mind-Body Medicine) as woo is a mistake – their unique approaches to mental health disorders (which I now teach as ongoing classes at my clinic), such as severe PTSD, has been shown my extensive research to far exceed the success of counseling and medication combined.

      Just some food for thought.

      • Sorry, Kat, but yes, every last modality you mention is nothing but solid woo, magical thinking, and pseudoscience. I urge you to check them all out at ScienceBasedMedicine,org, my go-to site whenever I need to sort out science from pseudoscience.

        On the topic of mental health, by the way, check out the writings of a wonderful young psychiatrist named Maria Yang MD. I’ve been following her through training, board exams, and now practice. She avoids the stereotypical portrayal of psychiatrists as the ultimate drug pushers without ever invoking the kind of woo at Harvard (no, the name doesn’t impress me) and elsewhere. Food for thought, as you say.

  8. Although I did complete a residency and go on to fellowship training which allowed me hospital surgical privileges, I completely agree with this article. I have transformed myself from my family physician to a complete non-surgical and surgical wellness and aesthetic provider. This includes bio identical hormone’s, vein therapy, laser therapy, injectables, and surgery. In fact I am in the middle of an event that I created which was open to all colleagues who wanted to add to their skills and providing simple aesthetic services to their patients. The most interesting thing about these new threads that are placed with an acupuncture needle, they were originally used for medical therapy instead of dry needling. See the following link:
    http://lasermemphis.com/rejuvn8-pdo-SugarThreadLift/

  9. Evah says:

    Hey dr Lopez
    This article brought the smile back to my heart! I have been suffering to find a residency program. And i was always interested in finding something more “natural” I didn’t know that MDs can go through this route. I would love to know more information .

  10. Vandana says:

    Dear Pamela, seeing your video kind of gave me a ray of hope. My husband was studying medicine from a school in Caribbean. He was ready to take his MD exam about eight years ago. just then the destiny struck and and a lot of family problems and personal problems showed up and also he injured his spine and became disabled for some years. Though he was really doing wellin his studies, he could never take his exam. His aim to get into medicine was to serve heal not only physaically but mentally as well with a touch of spirituality. He is under depression for not being able to accomplish it and all his years hard work and money gone to waste.

    Is there any way for him to get back in? Complete his MD without having to take all the classes again that he already passed. OR start practicing? Please guide.
    Thanks.
    VG

    • Pamela Wible MD says:

      IMG grads must do 2 years of US residency to practice. US gads only need 1 in many states. If he wants to practice overseas then he may need even less years of training. Check out other countries he may be interested in . . . and always keep joy in your heart. Serving humanity is a treasured gift and the most fulfilling thing you can ever do with your life!

Click here to comment

Has your dream job turned into a nightmare?

Pamela Wible

ARCHIVES

Copyright © 2011-2017 Pamela Wible MD     All rights reserved worldwide     site design by Pamela Wible MD and afinerweb.com