Business Innovators Radio - Dr. Vivian Kim – Retina Concierge Specialist – On The Benefits of Concierge Medicine for Patients and Providers

Episode Date: May 12, 2023

In this interview Dr. Vivian Kim shares how making the switch to a value-based concierge model has allowed her to spend more time with patients and learn about them as individuals beyond their medical problems. She shares a powerful story of a long-time patient with macular degeneration who shared her personal loss with Dr. Kim during a recent visit. Dr. Kim realized how important it is to understand and serve the patient as a whole and not just treat their medical issues.Exploring different models of concierge medicine, Dr. Kim explains how direct primary care involves doctors charging cash instead of insurance and how it can potentially lower costs for patients. She also describes hybrid models that combine a membership fee and insurance.Dr. Kim emphasizes the importance of patients taking an active role in their healthcare, particularly through the use of strategic communication with their doctors. She also highlights the potential benefits for the prevention of illness and the overall delivery of healthcare, especially in effective communication between providers and patients.During the interview Dr. Kim referenced a book by Robert Pearl called Mistreated in which he talks about the American health care and how we think we’re getting great health care in America but it’s actually not as good as you think.As knowledge doubles every 12 hours, Dr. Kim explains how concierge medicine can help patients keep up with the latest medical advancements and allow physicians to approach medicine differently. She discusses the significance of diabetes and macular degeneration, two chronic diseases that have become increasingly prevalent in the aging population.Join us for an insightful discussion on how concierge medicine can shift the healthcare paradigm and become a catalyst for better patient-centered care.About Dr. Vivian KimDr. Kim is a highly skilled and experienced Ophthalmologist who has been providing medical and surgical treatments for retinal diseases for almost two decades. She has a particular focus on macular degeneration, diabetic retinopathy, and complex retinal detachments, as well as vitreo-retinal and macular diseases.Dr. Kim has recently transitioned her solo retina practice to a concierge model, offering her patients a unique experience that combines traditional ophthalmology with an emphasis on overall wellness.In addition to her impressive medical credentials, Dr. Kim is also an author and public speaker, sharing her expertise and insights with a wider audience.MegaBucks Radio with Nina Hershbergerhttps://businessinnovatorsradio.com/megabucks-radio-with-nina-hershbergerSource: https://businessinnovatorsradio.com/dr-vivian-kim-retina-concierge-specialist-on-the-benefits-of-concierge-medicine-for-patients-and-providers

Welcome to Megabox Radio. Conversations with successful entrepreneurs, sharing their tips and strategies for success, real-world ideas that can put Megabox in your bank account. Here's your host, Nina Hirshberger. Welcome to today's show. My name is Nina Hirshberger, and today I have Dr. Vivian Kim as my guest on today's show. Dr. Kim is a highly skilled and experienced ophthalmologist, who, who's been providing medical and surgical treatments for retinal disease for almost two decades.

But the real reason that she's on my show today, because I'm very, very excited about talking about this, because I'm fascinated, is that she has recently transitioned her solo practice to a concierge model. And so that's what we're going to get into. Why and what is it and how does it work? and what's the benefit for patients and for Dr. Kim herself. So welcome Dr. Kim to the day's show. Hi, Nina. Thank you again for having me on the show.

And I'd love this opportunity to speak about my practice. Yeah. So let's get right into it. So what is Concier medicine? Well, concierge is actually, believe it or not, is a French word. It actually originates from the Middle Ages. in France, which means keeper of the keys. But more recently in the public, I think people have seen it in the context of hotels

where you have the concierge desk that is basically there to help guests facilitate their way around a foreign city or foreign place, make their life easier while they're traveling in an unfamiliar locations. And it's just basically to make their experience more pleasant and enjoyable. Okay, so that makes sense. So how does it apply to the medical world? So I think the terminology first started or came about at some point 20 or more years ago. Probably the first concierge medical practice started in the late 1990s, but I don't think the practice name originated there.

Probably other words for this could be like a boutique practice instead of concierge practice. But essentially what that means is this is doctors choosing to practice in a way where they're reducing the sheer number and volume of patients they take care of in order to give their patients a better, more attentive experience in their health care. And that makes sense. And I've heard it in the general medical practice, but you're a specialist. And so that's really highly unusual, isn't it? that you would create a concierge medicine practice? That's right. You'll see this, I think, probably in the early 2000,

there were probably 150 primary care specialists who were concierge doctors. Now you might find over 10,000 doctors 20 years later, but I think I'm the only retina specialist who went concierge. And I think that's unusual because in the specialties and the sub-specials, and the sub-specialties, you don't see that model, and I feel that I'm being a trailblazer in order to do this. So why wouldn't you see that model in a specialty practice? It probably has to do, I think, in some ways, how medicine is practiced.

I think in subspecialty care, it's a referral-type practice where doctors are referring, Like, let's say a primary care doctor has a specific problem that they don't have the, let's say, surgical expertise to take care of. So they would send them to a surgeon, which is a, you know, a subspecialty of medicine. And that can even be broken out to even sub-septuptuys like ophthalmology, orthopedic surgery or cardiothoracic surgery. And they're set up and trained to take care of the problem and then move. on, move on, I guess. So it's a reactive solution to an acute or more chronic problem, and there is no system, I guess, or tradition of this all-encompassing care in the subspecialty realm.

Okay, so they get referrals, and that's probably run their practice primarily. But so what made you, I mean, this is kind of a trailblazer, like you said. So what made you decide to switch? I decided to switch for two reasons. Number one, for the sake of my patients. I felt that I was becoming a doctor that I didn't want to be. I was becoming so busy. I had over 5,000 patients.

And I was becoming so busy that my. care I felt was being jeopardized. And in that situation, it would just increase my chances of making a mistake or missing something. And I just was losing compassion. I was so busy and so worried about getting through to the next patient, having patients wait for me, being upset that they were waiting for me, that I was not enjoying the practice of medicine. So I wanted to take that part of medicine back, the joy of medicine back, the practicing medicine, delivering to my patients the kind of care that they deserve and the attention, the attention to detail, the relationship with their doctor. That's what I wanted to bring back to my practice. And that's why I made the switch.

And I think the concierge model is the perfect model to accomplish something like that. Well, it sounds like it's from a patient's viewpoint. I know if you're going to be spending more time with me and you're not going to have 5,000 patients, you know, that I'm probably going to get some better care. So is that the answer? Right. Nobody wants to feel like a number in a factory, right? That you're on an assembly line, which is sometimes what it feels like when you go through these large practices or hospital systems, it can be very efficient. and the design to be efficient, hopefully, but you don't want to feel like a number.

You want to feel like Joe or John or Jane, right, with a name and a last name. No, I would suspect if you're on a, you know, on a rat race and then there's chances for errors, too, a lot more chances if you're just a number, just going through. So now you're slowing down. Right, absolutely. Do you know that medical errors are the third leading. cause of morbidity and mortality in the United States after cancer and heart disease in reverse order. Heart disease and cancer and then it's medical mistakes is a third leading cause of mortality

in the United States. And why does that happen? It's because I think doctors are overwhelmed. There's not enough time to slow down and make sure mistakes aren't being made. It could be from inexperty, lack of training, not enough time to train. for a whole host of reasons. I don't think that doctors and allied health professionals go into medicine for anything else than to do their best and to help patients, right?

It's a helping profession. It's a service profession, and we care deeply. But there are system processes and the way we deliver healthcare in America that leads to, number one, increasing levels of doctors. burnout. It's been reported out to be 64% in the workforce in the United States now in a recent JAMA article. JAMA is the Journal of American Medical Association. And then, so looking at that, of course, mistakes are going to be up there when doctors are burned out, when they're short-staffed. patients are getting the short end of that stick.

You know, you hang around a lot of doctors. Are you sensing that from others that they would really like to change how they do it? That they are timing, 64% burnout. You know, somebody can be saying, wait a minute. Right. It's a crisis. There is an influential thought leader, Dr. Robert Pearl. He is a Yale medical.

school, Stanford-educated plastic surgeon who's actually also run Kaiser Foundation. And he wrote a very insightful book. He's actually had two books published now. And I'm going to recommend that anybody interested in this topic read about it. But his first book published in 2017 called Mistreated. It talks about American health care and how we think we're getting great health care in America. but it's actually not as good as you think because of these factors that we're talking about today, Nina. So are other countries doing better than we are?

I mean, do they not have to see as many patients? Well, I don't know that I can really speak expertly about other countries' delivery since I don't practice in another country. But as you realize, other countries have nationalized health care, like Canada and some places in Europe. So it's a different model, and with any model, there's no perfect solution, and there's going to be pros and cons. I think America, United States, is capable of delivering some of the best health care in the world. But there's also a lot of things that can be fixed. Yeah, that makes a lot of sense. So from a patient, so you've been, so tell me when did you start your concierge model?

Has it been about a year now? It's been almost a year last July, 2022. And tell me some stories about patients and what's happened in their lives. Because, first of all, so all of your patients would have some sort of a retina issue. Am I correct on that? That is correct. I am a retina specialist, which is a subspecialty of ophthalmology. I take care of surgical problems, medical problems.

The interesting thing about the field of retina in ophthalmology is that it is because we deal with diabetes, which is becoming an epidemic in the United States due to the obesity crisis, and diabetes is a fall out of a result of that. There's also the diabetic retinopathy, which is a disease that I take care of as a retina specialist. That is largely my area of expertise as well as macular degeneration, which is a condition that is actually the leading cause of blindness in patients 50 and older in this country. And that is biggest risk factor for that is age and genetics. And then there's genetics that playing that into that. We have an aging population with aging baby boomers. So I take care of, I guess, what you can call chronic diseases. These are becoming chronic diseases because diabetes is chronic, just like heart diseases.

Maculity generation is not something we have a cure for. So it also is chronic like hypertension, you know, high cholesterol, et cetera. Okay. So if you had 5,000 patients before, about a year ago, you went down to a concierge, you went to a concierge model, which means you have fewer patients. Tell me what their experience is like now, then. I have way more time to spend with them. I am learning things about them, not just their eye problem or not just about their eyes, but just about them as people. I had a conversation with a patient who I'd been taking care of for years prior to this conversion.

And then I was doing my usual visit with her. She had maculity generation. And she was sharing her story how why she moved to Fresno in Fresno, California. And she had lived on the East Coast, and that's where I'm from also. And I asked her what brought her to Fresno, and she said that it was her husband. just to be closer to her family because her husband then got sick right after they moved. And he basically ended up passing away. And I thought to myself, oh, my goodness, I was taking care of her doing this time,

a personal loss. And her husband passed away from this illness. And she didn't show any of that. And I was not aware of it because I was just dealing with her as a person in her. with her eye problem. And so when I had that conversation with her, I just was able to realize what I had missed. And I was not, I didn't feel like I was serving her as a whole patient.

Like you don't think that this had some impact on her disease, her eye disease, its activity, it's response to treatment, and all of that. So I just have been able to slow down and enjoy my patients. And they're enjoying their relationship with me. I actually have a number. She's no longer a number to you. Absolutely. She's no longer a number.

And then patients share other aspects of their life. And I actually had advice to give them outside my, let's say, sphere of expertise, which is retina. I had a patient who, and I don't. know how we got up to this topic. I have some, you know, interest in personal finance and she had a question or mentioned something. I said, oh, why don't you do this? And she looked at me like she'd never heard of this before. And I said, why don't you open a high yield savings account? And then she looked at me and said, wow, I don't think I've ever thought about that. Let me look into it. And then, and I feel like, wow, and that just one, you know, second of taking a little bit of time and

Speaking about something else besides just her eye, I was able to help her out. And that's what I feel like the doctor-patient relationship is about. It's not just about the disease and taking care of the one problem that they're in your office for. Yeah, I happen to know a little bit more about you, how you love ballroom as well. I bet you kind of talk about that to some of the patients. Right. I'm an amateur, of course, competitive ballroom dancer. but it's something that they enjoy because they see me as also.

It's that reverse relationship, right? They see me as someone other than just a doctor, right? It just tickles them pink to see that I do things outside of medicine. And I do believe that they say that do you know that probably a high number of Nobel Prize winners, Do you know that they have a hobby or a talent in a field that's completely different from their area of expertise that we gave them Nobel Prize? Scientists, they may have a music passion or they may have an artistic passion. There's something about that creativity and not just focusing on the one thing at hand and being very extremely narrow-focused that I think is enriching both. on both sides of the interaction, meaning for the patient and for the doctor.

And I think that's what it's all about. Now, how can you do that if you don't have time? And your patients obviously must be really, really appreciating this. Well, they love it. They walk out saying, I really love this new model. You have to realize that most of my patients that are currently with me are my previous patients. So they stay with me because they, they trust me and they want me as their doctor, but then they also now get to see that difference, that additional attention and time.

I mean, I'm honored, actually. I've always been shocked that they could even trust me, given sometimes how little time I felt like I gave them. So walk through what is experience. First of all, how long is a time you will spend with a patient now? I used to, excuse me, excuse me, I used to schedule three patients every 15 minutes. Now I schedule them one every 15 minutes. So I've cut down the number of patients and sometimes one every half an hour depending on the patient. So when they are spending that 15 minutes with you, You're just talking about their life and their eyes, or do you even go a little further than that?

Sometimes we talk about other, well, as part of it, when I look at their records, I'm looking at them more holistically now. I mean, ophthalmologists are MDs. So we are actually physicians. We focus on the eyes, but I look at all of their medical issues. I have time to review why they're on all the medications that they're on. And I ask them questions because I'm not an ophthalmologist. I don't know everything about, you know, internal medicine or different surgical specialty.

So I ask patients, what are their experiences? How did this go? How did that surgery go? How did they end up getting that diagnosis? What were the preceding symptoms? And so I'm learning about them. I'm learning about what happened to them in their health care journey. But in so doing, I know enough about medicine.

I know enough about medications and their class and how they work and what they potentially could be doing with the patient. So if they're complaining about something, maybe they're experiencing a little bit of either depression or nausea or something, and there's these relationships that they're not going to know about. I can suggest it to them to ask their physician, right? Why are they still on this blood thinner? Why are they taking two blood thinners?

I just ask them the questions. And if they don't know the answer to the questions, then I can encourage them because a lot of patients, though, are interested in their health care, but they also don't know enough sometimes to ask the right questions with their doctors, right? You don't know what you don't know. So I can suggest to them, well, why don't you ask this question? And I will literally give them the script. So they can educate themselves.

I think an educated patient is a well-informed patient, is going to be a patient who's going to buy into their own health care more and be more proactive and be, have better outcomes as a result, don't you think? Yeah, I would think so. No, what I'm hearing you not saying, is get rid of your other doctors. I'm not hearing you say your primary care, you're actually just being part more of their team.

I am, that's right. I feel like I am an educator and I am an advocate. And I'm an advisor. For them, maybe a family member, you know, I can suggest that their family member does need to go in and see a health care provider regarding something they asked me about? You know, sometimes it's an eye issue and I'll say, listen, I think that this is what's needed. I will even give advice on glasses.

I says, if your glasses aren't working for you, it looks like, and I'll look at them and I say, it looks like the placement's a little low, why don't you go ask your optician or your optometrist to re-look at it for you? And I just encourage them to do something that they should do as educated consumers. People need a little bit of encouragement, right? They don't, they, it's hard, right? Sometimes to take the, not to take the path at least resistance, right? That's kind of a double negative there.

But so just by encouraging them to ask the right question or to take that step that they may be instinctively know, maybe that's what they need to do, but it's kind of a bother or maybe they feel like they're being a bother, I just encourage them. that this doesn't look like it's right. And I would agree with you if it's not working for you, let's do this. And I just suggest an alternative. And that's what people need. I mean, that's what your friends do for you.

That's what your parents do for you, right? Your trusted advisors do for you. They encourage you to take a path, not always the easier one, right, in order to achieve a better outcome. Yeah, but even so, you know, there are other doctors give them five minutes as well. So that's the difficulty. That is actually, that's the difficulty. So that's why I actually had a girlfriend tell me this who's also an ophthalmologist. She is, she says that when she goes, because she understands how health care works and how physicians are so pressed for time, you have to be strategic. She says that she will go and see her doctors and she will,

strategize about which one, two, or three most important agenda items that she wants to place before her doctor, so they get addressed and make it very crystal clear and not mire the doctor with stories that she knows they're not going to care about or not be relevant to the diagnosis or the information that they might need to get to the right diagnosis. like she's the physician, so she understands the system, but she says that she finds that she has to be very strategic because she knows that she only has a certain amount of time of that doctor's attention.

So this is kind of funny because this is like, isn't this kind of like social media? Don't, isn't the whole thing about social media is like people, how do you grab people's attention? Now it seems like video is the key, right? You have to put something out there that's bold and distrable. distracting or or or very mind or sight shocking right to get people's attention to stop for three seconds or 10 seconds to get some message across and this is kind of how it's becoming

in front of doctors you know what it reminds me of it's going back to a slower time a time when you know doctors even came out to the house when you know You know, delivered the babies in the house or whatever. That is right. Go ahead. Well, it's incorrect. Well, Nina, think about it. It's, do you know that knowledge, human knowledge, the information that there is in human knowledge doubles every 12 hours?

So what do you think is happening with health care knowledge, the knowledge of all the of specialties of the body. Our knowledge, and then modern medicine is just exponentially growing, there's no one person. It becomes humanly impossible to deal with that body of knowledge. Do you know that in 1945, back in the 40s, knowledge doubled in 25 years. Now it's 12 hours. that's an incredible, I guess, advancement and information, but it leads to a world where it's impossible to keep up.

So this is the scenario that we're facing. So I feel like we have to do things differently in medicine. And do you know that it takes about a generation, about 20 years, for medicine to change? I mean, concierge medicine has probably been about now around that time, 20 years. It's been around 20 years. And now I'm traveling into the specialty. So when we first started, you gave us some statistics. What did it, what, how many were?

And now it's about 10,000? Is that what you said? By 10,000, yep, yep, 10,000. About 100, maybe in the early 2000, 150. Some trailblazer in 1996. I think it was Seattle. I think I read somewhere that was in Seattle. some medical doctors.

And now there's probably 10,000. And I attend now, there's actually a concierge medicine conference form. And I've attended those now. So there's a growing number of doctors interested in doing this because of what's happening in health care. I also listen to health care initiatives. these are problems. People have talked about health care problems for decades, and change doesn't happen overnight. It will take 20 years to adopt meaningful change, but the process has to start with someone, somehow.

One person at a time. But the point that is, if there's 10,000 doing it now, even in just the general practice, that means that people, patients are desperate and really wanting this kind of service. They don't want to be a number. They don't want the five minutes. They truly want a doctor who listens to them. That's right. If I were wanting a doctor, don't you think you'd want a doctor that you would have access to,

that you could call them up and you would get a live body on the phone, not just an automated machine, triaging you through, you know, for two minutes, and then actually having a person that you know by name, like the receptionist, and they can tell you and leave a message and you know you're going to get that call back that same day? I mean, doesn't that sound like it's the way it should be,

but does that happen? I think a lot of patients know it's experienced. You may get a call back from your physician. You may not. It may get dropped through the cracks. I don't think physicians intend to be, you know, rude or, you know, not giving that service. But I think it's just the sheer volume that causes an attention. Okay, so let's turn the corner. So let's, because you are doing it, so what, so if I'm a patient and I want, I really want to know, what do I have to go?

Do I, is there a monthly membership? What do I need to know about a specialty concierge practice? So interestingly enough, I think that there's different ways that concierge medicine is practiced. So there is a model called direct primary care where the doctors don't charge the insurance and they just charge cash, but they're able to lower what they charge patients because they now have removed the middle. man, the insurance, and all the staffing requirements to get authorizations and to get permissions from insurance to do anything and to get reimbursed by the insurance to go ahead and bill them.

So they've removed all of that work, time-consuming work, so that they're able to pass on those savings to their patients. So this is a model in primary care that's out there called direct primary care. But then there's also other hybrid model. where the insurance is still accepted and there is like a membership free or like a sufficiency and it can vary anywhere from a couple thousand dollars

to even $20,000 depending on the region, locale and that is a hybrid model where the insurance is still taken because if let's say like in my case, in my specialty, I give injections to treat macular, regeneration and these drugs cost you know close to $2,000 so to do a cash model and that would not be possible and this is $2,000 not to the physician but to the pharma companies

this is you know where you purchase the drugs and it costs the doctor $2,000 to get that drug into the office so that you can inject it into the patient so that model would not be feasible I mean a direct primary care model would not be feasible so that's I do what we call a hybrid model where I charge the insurance for medical visits, but then I'm doing a membership subscription fee to be, so I can have a smaller subscription base or panel of patients to keep it more boutique and intimate. So I can spend time with the patients. Well, this has been fascinating, Dr. Kim.

I truly appreciate your time. I'm looking at the clock. That clock is always my enemy. Is there any last minute, you know, last minute things that I didn't ask you, you would like to cover another story, anything before we sign off? I think I just want to make a statement that I think concierge medicine is what every patient deserves, but the realities of medicine don't. allow that delivery. And so really, when I think about it, who is concierge's not for? I think it's really for, I would say that it is not for people who don't care about their health,

who are not willing to be proactive and take charge of their own health and wellness. Because I believe that health care is actually a teen sport. it is not just one person driving a bus. It's actually the patient and the doctor and the team around them, whether it's the doctor's staff, whether it's the referring doctor that's going to help in the health care. It's a sport that takes more than one person. So I think when patients look at it that way, I think that they will find the right environment if they are willing.

willing to be proactive and interested and invested in their own health. Because I think that there's a lot more that can happen on the proactive side of medicine so that we aren't dealing with all the sickness and illness on the reactive side, ultimately. Yeah, that's a good, you know, I mean, you talked about diabetes being one of the, you know, it's becoming an epidemic. That's right. And, you know, which, because of obesity, just coaching them and helping them lose weight, probably. helps with some of the diabetic issues.

But it sounds so easy, Nina. Just lose weight, right? It sounds so easy, but it really isn't that easy because if it were that easy, everybody would be doing it. Everybody wants to be finned and not be subject to all the complications, right, of being overweight, hypertension, high cholesterol, you know, potential heart disease, everything. So it's just not that easy. It's multifactorial. There's psychological issues, there's motivation issues, there's just logistical issues, there's economic issues. So I think

that in having the relationship, that's where it matters. Because if you're just a number, you don't feel like anybody's paying attention to you, then how does that help you? But if you feel like you have a friend, an advocate, an advisor, someone who cares, I think that can make the difference. Yeah. And that's what it's all about. Yeah. Well, Dr. Kim, I so appreciate you spending the time. I know you're a busy doctor, and here you are, you spent the time on this show.

if somebody is interested in being able to take advantage of your concierge medicine and your practice, is there a place that they should go, a contact that you want them to know about? Yeah, they can email me directly. My email is Dr. Kim, the RKIM, at ARC retina.com. ARC stands for advanced retina care, ARC retina.com. And they're welcome to email me. And I'd love to answer the questions. Well, that in itself is unusual.

How many doctors do you know that give you a real email? So I appreciate you being on the show. The information you're giving, I know, will be very valuable to people. So until next time, this is Niner Hershberger saying, go out and make it an amazing day. Thank you for listening to Megabucks Radio with Nina Hirshberger. To learn more about the resources mentioned on today's show or to listen to past episodes, visit megabucksradio.com.