Dr. Neha Doshi is headed to another shift at the hospital. As she turns her car into the parking lot outside her office, she can feel that something is off.
On the sign facing the street, she notices an empty space where her name used to be. When she gets to her office, she finds a troop of men and women in suits, shuffling uncomfortably back and forth, shifting pitiful gazes between their feet and her stunned face.
In what feels like a series of blows right to the gut, Dr. Doshi learns exactly what her best effort is worth to the hospital. Years of commitment, long hours, running to new patients every 15 minutes, charting until two o’clock in the morning, a massive sacrifice of personal and family time — what felt like a superhuman effort to Dr. Doshi was apparently valueless to the hospital system.
Today will be her last day, she learns, as one of the men hands her a cardboard box.
Dr. Doshi spent almost a year licking her wounds after she was fired. “You don’t feel that as a physician — perhaps as any human being, really — that you’re expendable,” she says. But in a healthcare system that’s increasingly bottom-line obsessed, anything that comes between the system and its profits is likely on borrowed time.
As an employed physician, she strongly believed that as long as she was giving her patients her all — and she was — that she was doing more than enough to maintain some social capital with the administrators who managed the hospital. However, for the administration, patient satisfaction seemed to be an ancillary factor, if it even registered in their decision-making at all. They were responsible for running a business, and Dr. Doshi was costing them money, regardless of how her patients felt about her.
“Every month was very discouraging. People kept telling me I was in the red, but I didn’t really understand what that meant. I didn’t understand the concept of overhead,” she says. Any disappointment administrators conveyed manifested in an increased effort from Dr. Doshi, but as time went on, it felt like the goalposts kept moving. “Nothing you do is ever enough for them,” she explains. “If you see 15 patients a day, they want 20. If you see 20, they want 25.”
It wasn’t long before administrators pulled her aside and laid an ultimatum on the table. She could choose between a salary cut and voluntary resignation. But Dr. Doshi was in the middle of her employment contract — she felt it gave her some leverage in the negotiation. Besides, her patients loved her. If the hospital were to let her go, they’d be sending a discourteous message to the people who depended on her to get care.
It wasn’t long before they did exactly that. Worse than the indignity she felt as her colleagues watched her pack her belongings into a cardboard box was what she came to learn shortly after: The hospital didn’t even tell her patients — all 2,000 of them — that she’d moved on.
That decision amounted to a complete lack of respect for physician and patient fulfillment, which Dr. Doshi believes is the purpose of medicine. That fulfillment can only be forged when patients and doctors make meaningful connections — an especially tough task to accomplish in rushed 15-minute appointments with so much administrative oversight.
In hindsight, hospital life was a painful cycle. Administrative pressure led to overworked physicians, which led to unhappy patients, which increased pressure on physicians, which created more unhappiness in patients. So much pressure brought little benefit, except maybe for those at the top who were crunching the numbers.
Dr. Doshi looks back at her last day at the hospital back in 2012 as one of the best of her life. It forced her to face the truth: Her personal values were in perpetual conflict with the values of the American healthcare system. She had a big decision to make. Should she hustle to get another job at a nearby hospital, or set up her own practice to align her professional life with her personal values? Both were big risks, but in her heart, she knew the answer. “After I got fired, I didn’t ever want to work for anybody else again,” Dr. Doshi says.
It was time to take life into her own hands. To make it happen, Dr. Doshi took a big leap — with support from family, friends, and a bit of sage advice from her peers — and launched her own concierge primary care practice in Baldwin Park, Florida. Underpinning her practice is the core value of low-cost, high-quality care, which stands in stark contrast to the high-cost, quantity-first approach her hospital used to protect its revenue streams.
When she looked back on the hospital experience, many of the rough times stood out in her mind. Still, Dr. Doshi realized there was a big opportunity at hand. She could draw inspiration from her experiences at the hospital and use it to avoid repeating the same mistakes at her own practice.
With concierge medicine, Dr. Doshi aimed to put an end to this cycle of unhappiness and unfulfillment. The big idea? Remove ever-increasing administrative burden and connect more meaningfully with her patients. This way, she could ensure that at her practice, there would be no more rushed appointments, no more metrics-driven commotion, and no more deprioritizing personal well-being for monetary gain.
…at her practice, there would be no more rushed appointments, no more metrics-driven commotion, and no more deprioritizing personal well-being for monetary gain.
Her first move was to publish a website with help from her husband. “We just put my cell phone number right on it, so any of my patients who were savvy enough to Google my name would find my number and hopefully give me a call,” she says.
It worked. Today, 75 percent of the patients in Dr. Doshi’s concierge practice were once her patients at her previous employer. Notably, that’s the sum of the effort she’s put into trying to attract new patients. The remaining 25 percent come from word-of-mouth referrals from that same loyal core, and they all have something in common — they’re unhappy with their healthcare experience.
Dr. Doshi tries to educate her patients that most of the time, it’s the system — not the doctors — who are to blame for the poor experiences they faced previously. Most doctors choose a career in medicine because they want to help others. When they learn that the reality is different from their expectations, some react by staying up until two o’clock in the morning to get the job done. Others fight back to try to find balance.
In the end, both are losing games. “Something inevitably suffers — that’s when you lose your sense of compassion, your sense of caring. You just become totally exhausted,” she explains. “These are all good people, they just got burned out.”
To avoid burnout, Dr. Doshi grounds her practice on a set of core principles — her patients can expect 45- to 60-minute appointments; they can reach her any time by email, phone, or text; and her small team is guaranteed to treat every patient like family. “There’s this idea of the ‘medical home’ that I’m shooting for,” she says. “And I do feel like when people come here, they feel like they’re coming home.”
…when people come here, they feel like they’re coming home.”
It’s a different world from the one she knew at the hospital — one that allows her to live in alignment with her values.
After she was fired, Dr. Doshi’s future turned into one big question mark full of risk and uncertainty. Now, it couldn’t be more clear: stay the course, help your patients, give them your all, and follow your purpose. The rest will follow.
Still, Dr. Doshi knows that making the leap to independent practice brings its own unique blend of challenges. It requires a huge commitment and an undying loyalty to patient satisfaction. Plus, “you have to be a good doctor,” she says. “You have to like people, and people have to like you. If you’ve got that down, you’ve got nothing to worry about. Your patients will follow you wherever you go.”
For any physicians looking to take the leap, Dr. Doshi recommends reaching out and exploring the idea with veteran concierge doctors. That’s what she did when she was getting started, and the conversations empowered her with confidence that was lacking beforehand.
“I went onto concierge websites and called a doctor in Arizona and somebody in Miami and somebody in New York. These people didn’t even know me from Adam, but they were willing to spend time on the phone with me, to tell me how to make it happen, and to reassure me that it can work,” she says. “I think it’s because they’re so happy that they want other physicians to be happy. They want everyone to know that you can do this.”
Now, Dr. Doshi has become one of those physicians. She’s ready at a moment’s notice to tout the benefits of living a life where superlative patient care — not bottom-line protection — is the mission.
She’s ready at a moment’s notice to tout the benefits of living a life where superlative patient care—not bottom-line protection—is the mission.
As for her peers who still work in health systems?
“They just haven’t been lucky enough to get fired yet,” she says.