This week’s is a guest post from Dr. Sandra Weitz, an anesthesiologist specializing in pain intervention. She shares her path from budding physician, through varied challenges, and into the life of a practice owner. It’s a fascinating ride. Here’s a look back at the career of a real-life superheroine who claims you really can have it all.
I can’t help but smile when I think of the Enjoli commercial from the late 1970’s. It was an advertisement for cheap perfume, but to me, it was a feminist call to action. The message was: if she wore this perfume, a woman could have it all. This commercial illustrated the possibilities for me as a woman early on.
When I was six years old, my father, a two pack/day smoker, died of lung cancer. Somehow I thought it was my fault. My solution was to become a doctor and save the world. So, with tunnel vision, I plunged ahead. It never dawned on me that there was any other alternative. I went to college at 16, majored in Biochemistry, and graduated at the age of 20.
The only thing that (temporarily) slowed me down was lack of money. My father, a cutter of women’s coats in the garment district of New York City, left us with no money. My mother worked as a high school teacher. Scholarships, financial aid and work study got me through college, but I didn’t have enough money to apply to medical school. I took a year off to work as a lab technician at New York University and apply to medical school.
Four years later, I decided to apply for surgery residency. I totally bought into the idea that being a surgeon was my route to saving the world. I moved cross country and got married in the 4 weeks between medical school and internship. My husband and I simultaneously started our surgery internships at UCSF, at a time when call was every other night. We were both off call one weekend a month. It didn’t take long to figure out that we had different goals for that weekend—he wanted to have fun, and I wanted to have a clean apartment. We had 300K in student debt and little expendable income, but hiring a cleaning lady was clearly a worthwhile investment.
I actually wanted to be a neurosurgeon. But, somewhere in the middle of my internship, I had the epiphany that surgeons (and doctors in general) don’t really “save” people. Then, one of the Neurosurgery attendings talked to me about pain management—a new multi-disciplinary field that included minimally invasive procedures. After learning more about it, I made my first pivot, switching into an anesthesia program. After that, I did a pain management fellowship. I figured out that by treating chronic pain, I could significantly and meaningfully impact people’s lives in the way I had envisioned, while enjoying reasonable work hours.
After finishing all of my training, I stayed on as faculty at UCSF. As the Director of the Pain Management Service, I thought I had hit the jackpot. I loved the academic environment and had visions of grandeur, including becoming a department chair. I was appointed, as the only woman and the youngest member, to the Department’s Finance Committee. In retrospect, this was probably a diversity move, but it turned out to be a fantastic gift. This is where I learned the “business” of medicine.
Meanwhile, my husband finished his Urology residency and got a job at Kaiser Permanente in San Jose. After a while, reality set in—we were a two-physician family living in the Bay Area during the height of the Silicon Valley boom. The cost of living was outrageous. We had long commutes, were house poor, and our salaries were stagnant. And did I mention all of our student loans?
We mutually agreed that life is all about choices, and after some soul-searching, we decided to look for jobs elsewhere. When we told our nanny that we were moving, she said, “Great, because I was going to quit. You are under-paying me.” That was at a pay rate of $45,000 in 1997. By the time I paid taxes, the nanny, gas and car insurance, I was essentially working for free.
That job search landed us in Baton Rouge, Louisiana. You might wonder how a New Yorker who went to school in Boston, lived in San Francisco for a decade, and married a guy from California ended up Louisiana. We came to interview in mid-May when the weather was perfect. The cost of living was low, the commute was short, and the opportunity seemed to address most of our criteria.
My move involved joining an anesthesia group that claimed they wanted a pain specialist. Despite our conversations regarding my approach to pain management leading up to my accepting the position, once I started, it became apparent our expectations were not aligned.
The anesthesia group thought that I would do “blocks” in the back of a PACU. I explained to them repeatedly that I believed in the multi-disciplinary approach to pain management, and that I needed a true clinic with access to multiple modalities. They laughed. I explained that the clinic and I could generate a lot more revenue than their model. They laughed. I laughed too when I told them I was leaving.
I started my own practice in a rented space within a regional 1000-bed medical center. Within a year, my practice had grown exponentially, and I needed to bring in additional providers to handle the volume. We all know that there are only so many hours in the day, and only so many patients that you can see.
By adding additional providers, I was able to have greater flexibility. If I had to leave to pick up a sick child, clinic did not come to a screeching halt. My clinic hours became more manageable. I made it to every soccer and volleyball practice, every school event, any and every activity that was important to my family. I controlled my own schedule.
As a pain management specialist, I obviously did interventional pain procedures. I went to the hospital’s administration and proposed a joint venture for an ambulatory surgery center (ASC). Why? Because I recognized that they were collecting the facility fee for every procedure I did. Did you know professional fees make up just one-third of total charges, and the facility makes the other two-thirds? I understood that the facility had to cover expenses, but still felt like I was giving up a large piece of the pie. After the hospital declined to form a joint venture, I decided to control my own destiny. At that time, my kids were 3, 5 and 7.
We bought a lot and built a 25,000 sq ft medical office building. Having my own ASC would allow me to capture the revenue from the facility fee. We decided to have my clinic and an ASC on the first floor and lease out the second floor. By the time the building was completed, I hired an additional physician and two mid-levels. Within six months, we had outgrown the clinic space. Shifting gears, we finished the upstairs as a new clinic space with 23 exam rooms, and expanded the ASC to occupy the entire first floor.
Ever since my fellowship, I have utilized a multi-modality approach to treating chronic pain. As a result, I was referring patients to psychological services, weight loss programs, physical therapy, chiropractic care, massage therapy and more. I ordered imaging studies and laboratory tests as part of the evaluation process. I recognized that my practice controlled the outflow of these referrals. By bringing all of these services in-house, I was able to provide a comprehensive approach, improve patient care, and capture the extra revenue.
Over time, I added additional specialties to the ASC and sold shares to other physicians. I invested in an imaging center and a physical therapy service. I started an anesthesia company to provide services to the ASC. Then, I added psychological services, weight-loss services, massage, chiropractic care, and lab services to the practice. The practice and ASC paid rent to my real estate company. All of these businesses were horizontally and vertically integrated with my medical practice to maximize both my patients’ care and the revenue produced.
What did I figure out through this journey? I could indeed have it all.
In order to to that, I took on risk. And at times, that was scary. Especially at the beginning, when I started my practice with three little kids. But I recognized that I could let fear paralyze me, or use it to empower me. Developing an action plan supported by real data allowed me to mitigate the risks I faced. And with each small win, I got braver.
It didn’t take long for large amounts of money to come rolling in without my having to see each patient. The more each business grew, the more it fueled the other businesses, and the more I made. Whether I went on a long vacation, took six weeks off to take care of a sick child, or simply wanted to work fewer hours, I made money. I controlled my own destiny and achieved financial freedom. I sold my businesses on my terms and retired at 53.
Looking back, I feel that I lived a feminist’s ultimate dream. I’m proof that you really can have it all. While I’ve had a successful professional career and owned several profitable businesses, I’ve had a loving, supportive husband and raised 3 children, who each became successful in their own right.
If I can do it, so can you!
Dr. Sandra Weitz is a retired anesthesiologist specializing in pain management. She now splits time between her family and mentoring other physicians in their business pursuits.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.