“Physicians are the hardest working folks in terms of, on average, if you compare the average physician with any other line of work or profession. We’re hardworking folks and there are private equity folks, corporations, non-physician folks in turtlenecks that know this and exploit this. And that is something that we have to be aware of when we are becoming employed physicians.”
– Dr. Virgie Bright-Ellington
A lot of us are interested in transitioning into nonclinical careers or picking up a side gig that we can do in addition to our clinical career. This is something we get a lot of questions about at DocWorking, and our guest has successfully made that transition and can walk us through the steps. Dr. Virgie Bright-Ellington is an internal medicine physician and medical billing expert. She earned her M.D. at the University of Michigan Medical School and trained at the Cambridge Hospital of Harvard Medical School. She has practiced in primary care and psychiatric settings, and then she transitioned her work into the insurance world where she became a health insurance executive. She’s also the author of the What Your Doctor Wants You to Know series, a former NY1 news health contributor and was featured in Dallas News, several podcasts, and national magazines.
Dr. Bright-Ellington has been a guest here on DocWorking: The Whole Physician Podcast before, and you can listen to the episode all about crushing medical debt by clicking the link below. Here, she shares her journey of how she went from a practicing physician to a successful author and entrepreneur. We discuss nanny culture and living in New York City and what ultimately caused Dr. Bright-Ellington to make the transition to a non-clinical career. As a mother, being there for her children was so important, so she started searching for ways to make passive income while still seeing patients on a part-time basis. However, things didn’t go quite as planned, as her father suddenly passed away and got divorced, causing her to rethink her role as head of the household. She then got a job within the insurance industry handling appeals.
We discuss how Dr. Bright-Ellington found her publishing company and PR agent, and advice for others who are considering a similar path. Much of what got her to the next level was good old-fashioned hard work, persistence, and making the right connections. We also talk about investing, specifically using your retirement accounts to fund your startup business venture and the importance of having a solid marketing plan. It’s a misconception that entrepreneurship is an easy road, and Dr. Bright-Ellington pulls back the curtain on what it really takes to succeed.
- Dr. Bright-Ellington’s journey from practicing physician to entrepreneur.
- What to expect when transitioning to a non-clinical career.
- How to use retirement accounts to finance your startup.
- Why having a solid marketing plan is key in entrepreneurial success.
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Please enjoy the full transcript below
Dr. Bright-Ellington: Physicians are the hardest working folks in terms of on average. If you compare the average physician with any other line of work or profession, we’re hardworking folks. And there are private equity folks, corporations, non-physician folks in turtlenecks that know this and exploit this. And that is something that we have to be aware of when we are becoming employed physicians.
Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna, co-host of the podcast, and I want to thank you for being here with us today. If you’re a physician or other healthcare professional or student who’s interested in exploring how to live your best life while doing your meaningful work, you’ve come to the right place. A lot of us are interested in transitioning into nonclinical careers or side gigs, picking up a side gig that we can do in addition to our clinical career. And this is something we get a lot of questions about at DocWorking. So today I’m bringing a guest who has successfully made that transition and who can walk us through the steps. Dr. Virgie Bright-Ellington is an internal medicine physician and medical billing expert. She earned her M.D. at the University of Michigan Medical School and trained at the Cambridge Hospital of Harvard Medical School. She has practiced in primary care, in psychiatric settings, and then she transitioned her work into the insurance world, where she became a health insurance executive, as well as an author of the What Your Doctor Wants You to Know series and a former New York 1 news health contributor. And she’s also been featured in Dallas News, several podcasts, and national magazines. Dr. Virgie Bright-Ellington has been a guest here on DocWorking: The Whole Physician Podcast before, and you can listen to that episode, which was about crushing medical debt, and that was episode 195, and we’ll reference that in the show notes. Dr. Virgie Bright-Ellington, welcome back to DocWorking: The Whole Physician Podcast.
Dr. Bright-Ellington: Thank you so much for having me back. I really appreciate it. It’s always wonderful talking with you.
Jen: It really is a pleasure to talk with you as well. I’m so intrigued by the path that you’ve taken and I know a lot of our guests will be really interested in hearing how you did that, the decisions that you made along the way and what drove you in that direction. And I think there are a lot of us who are interested in actually taking some similar steps. And so I’d love it if we can talk through the process from your vantage point, as someone who has been successful in taking these steps.
Dr. Bright-Ellington: Sure. So I do have to say that one thing in the back of a lot of our minds, I think, when it comes to physicians working in the United States, is that culturally we’re taught to think that if you’re not practicing, actively practicing, you’re not a real physician. Now, there is a tiny bit a nugget of truth, I think, in that if you don’t keep up your education, your CME, your not just licensure, but your subspecialty certification, your board certification, then yes. So I think that’s important to keep up no matter what you’re doing if you’re not actively seeing patients. But it reminds me when you asked about, you know, well, how did my journey start from being a practicing clinician to nontraditional or non-practicing physician work is I remember my kid’s dad, my ex-husband saying to me, he knew that I really thought about once our kids were born that I would not be practicing clinically full time. Now he is a neonatologist, which is a hospital-based specialty, and so you’re doing interventions. So yeah, if you’re a surgeon, if you do an intervention, sure, your skills can get rusty. I am an internal medicine physician. You know, my work is usually in my head, so I really think it’s important. Yes, we keep it up, but I disagree with him in that he was like, no, you cannot you have to at least practice a little bit in order to be, he felt, a valid, a real physician. Otherwise, I was just I don’t know what he thought he was saying. I guess maybe I’m just pretending it was a waste of all the resources and all the folks, you know, that poured into us when we’re in med school and residency is just going to not and I just want to say nah, that’s not true, but let’s keep up our board certification and our CME and let’s put that to bed. And I realize that it was always a conversation and always in the back of my mind, because while I was in training, I thought, you know what? There were two things I really did not want to have all of my income depend on taking care of patients. I thought, well, there’s got to be a way I can take care of patients and not have my income, my livelihood depends on it. So that was one thing. And the other thing is, as I mentioned earlier, is that I knew that once I had kids that I was not going to feel comfortable being trapped in an office, in patients and not being able to be actively involved and around, have the flexibility of raising children. And that was because I’m dating myself. Yeah, well, I’m dating myself. And I didn’t know about the nanny culture. I came from, so I’m dating myself. I grew up in the seventies in Detroit, which have a lot of transplanted southerners who really believed in corporal punishment and basically, you know, we were abused. My brother and I, they felt corporal punishment was appropriate discipline. But we were too scared to tell our parents because we thought we would get in trouble at home, right. And I swore was like, if I ever have kids, I’m not going to be in a position where that can happen to my kids. And so fast forward, I’m in New York City working as a physician and I realized, you know, kids are coming. I didn’t know about the whole nanny culture, but there is still some validity of being around and working in the house and being in the house when your nannies are there. So I’ll just say that was helpful in terms of choosing a nontraditional physician work.
Jen: One question for those of us who are not from New York City, what do you mean by the nanny culture?
Dr. Bright-Ellington: The nanny culture is, there are people who work for minimum wage and they’re actually independent. They don’t work for like a preschool or there’s not a business corporation that they work for that they get employed out. You know, there’s not an employer company that they’re working for. They’re working for themselves independently and they’re everywhere. It’s plentiful. And because you’re in New York City, you don’t need a car and it’s easier not to have a car. The subway system and mass transit system, it’s really easy for folks who are newly starting out or this is what they want to do to say, you know what, I’m going to take care of children full time. That is the services that I offer. And that was not a thing where I grew up in the Midwest and back then labor in terms of they either didn’t have a car or was not thought of as something outside of preschool. Frankly, when and where I grew up again dating myself, this is back in the seventies. So that’s what I mean by nanny culture.
Jen: So when you say you weren’t aware of it, are you saying that you felt that you needed to stay home because you didn’t know that there was a possibility that you could bring someone in to help? Or do you mean that you didn’t want to do that and that was the choice that you wanted to make?
Dr. Bright-Ellington: Well, I was pleasantly surprised when I started having kids. I was in New York City and I’m finding out, wow, I can afford to hire a nanny, just like you can afford to hire house cleaning services. You can hire landscaping services. That’s a thing. And so once I found that out, I thought, well, I had already left full time clinical practice when my oldest was born. My oldest I have two sons now, 14 and a half and 16. When my 16-year-old was born, my first was born, that’s when I discovered that, wow, okay, I didn’t necessarily need to leave full time clinical practice because there would be a nanny in our home, that that was a thing. But I was like, you know what? I’m still happy that I can still work from my home office. I’m still in the house. Even if it’s on the top floor, she’s on the bottom or they’re in the bottom floor or whatever. It makes a difference when you’re still around. When I have the flexibility of saying, okay, I can schedule meetings here and there and then come back down and take, you know, my young one to school or attend an event or support he ended the school or something.
Jen: That would make a huge difference.
Dr. Bright-Ellington: Yeah, that’s what I mean by the nanny culture and why I discovered it late by accident, you know, being a brand-new parent in New York City. And so I had already made the decision. Yeah, at that point I had already left full time clinical practice because I didn’t know that that was an option.
Jen: When you were making the decision to leave your full time practice, how did you make that decision? Number one, did you decide and consider multiple different non-clinical career options first, and did you pursue all of those or one of those? That’s one question. And then combining that question with another question, which is, did you have the job lined up ready to start or did you quit and then give yourself the time to pursue it all already without that full time job?
Dr. Bright-Ellington: So what I going back to referencing in the back of my mind, I knew that I did not want to. If there was a way for me to be a physician, use my physician brain and help as many people as possible without having to see individual patients one after another inside a building, you know, in an office space. In the back of my mind, I thought, well, there’s got to be a way I can make passive income and still maybe see patients for nonprofit organization or that kind of thing. So I started a business and that was I would say within a couple of years after arriving in New York City in the I would say around 2000. And I started a business that was basically a personal care product development company. And so I thought, okay, the launch product will get it out there and that’ll be passive income, and then I’ll run it full time and be able to work from home.
Jen: How did that go?
Dr. Bright-Ellington: So, it turns out that the book that I came up with to market the product ended up being more popular and people were more interested in that than the actual product. The product was a topical to prevent ingrown razor bumps, ingrown hairs and you needed back, this is around 2000 before online marketing was a known thing and I didn’t know what I was doing and didn’t know I needed a marketing partner and how to do it online, blah blah blah, blah, blah. And so I thought, well, I need to write a book because as a physician I was very frustrated with having to just have one on one conversations. There were things that I wanted to like jump on a rooftop and get a megaphone and scream across the country. One of them was look, ladies and gentlemen, cervical cancer is an STD. Now, this is back in the late nineties, around 2000. Before we know now about every lay people pretty much know about the HPV vaccine, but that wasn’t known then, that wasn’t a thing then. And so I thought, you know what, I’m going to write a book, what your doctor wants you to know series, what your gynecologist wants you to know, what your dermatologist wants you know. And the dermatology section was going to talk about our focus and feature the ingrown topical product. That was the plan. And so I had my kid and then by that time, my first child and I left full time practice. I’m like, okay, I’m never going back to clinical practice except to support people, maybe do nonprofit work, that kind of thing. See patients in that capacity, but not full time. Because I’m going to work on this, I’m going to run the company and the book, it needs a book tour. So the book was being launched. My second son was born. I had an 18-month-old and a six month old, and I was getting ready to hit send on the publisher button to send the manuscript to the publisher. And I thought, okay, I can get this done. And we had all the book tours I had planned and I told the publisher, yes, I’m going to do a book tour for la la la la la. And ten days later, my father died suddenly, sudden cardiac death, and he had been my mother’s primary caretaker. And everything stopped and being a sandwich generation doc, I was a long-distance caretaker for my mom who lived in the Midwest now and a parent of two young kids. And when my dad passed away, Dr. Jen, he had been such a positive influence on my life. I didn’t realize that, frankly, that my marriage was a problem. He was a positive male influence, and it buffered me, realizing, oh, my marriage is a problem. And the book tour just got put away. I had to stop whatever I was doing and get a real, quote unquote job with benefits because I realized I was going to have to be head of household and the marriage was going to have to end. And that’s how I came to the insurance world. People call that going to the dark side. But I thought, you know what? I’m well, I didn’t understand that people thought of it that way until a colleague of mine, I called and told her, hey, this is what I’m doing, blah blah, blah, blah. And when I told her that I took a position with and I even tell her what the position is with this health insurance company, she screamed essentially, well, remember what it’s like to be a physician? And she hung up on me.
Jen: Oh my goodness.
Dr. Bright-Ellington: And that was my first clue that it was considered the other side. What I was doing Dr. Jen was I joined their appeals team. And so I tell people, I’m not Dr. No, I don’t do UM and UR, UM UR utilization management. I don’t do that. I’m not Dr. No, I’m doctor maybe. So the appeals department of any insurance company has to determine if the policies that are clinical policies that an insurance company has if they were followed. So if a person’s care or physician submits a claim for care and is denied, they appeal and say it shouldn’t have been denied. And I look at them like, you know what, you’re absolutely right. It shouldn’t have been denied or they’re never going to pay for this. They’re just it’s always going to be considered experimental and investigational. Just get over it. Or maybe if you send me this information, this, this and this, we can get it covered for you. So and I thought I’m participating in supporting quality care in the United States. I was really proud of the work that I did.
Jen: Can I ask you a couple of questions about how you got there? First of all, I’m sorry to hear about your father. I think that sounds like such a difficult situation to find yourself in with two very young children and then trying to help take care of your mother and being such a long distance away. And I can imagine what a difficult situation it was to realize on top of that that your you were going to have to become the sole breadwinner for your family as you became from being married with two kids to being a single mom. So hats off to you for everything you’ve accomplished. I mean, it’s incredible. But you mentioned something that I have to ask you. There are two parts to this question as well. You had a publicist for your books and you had a tour lined up for your books. And even though that never happened, I’m sure there are a lot of people listening who are saying, wait a minute, I want to write a book and get a publisher and have a tour. Like, how did you do that? First question is, how did you find the publisher? What were the steps to get you to that point that you had someone who was managing and publishing your work and helping you to market it? And then if we could, I would really love to go into the question of just how you found the work for the insurance company as well.
Dr. Bright-Ellington: Yeah. So the way that I found my book publisher was the old fashioned way. Again, this is like 20 years plus years ago. This is in the old ages. This is like pre everything, you know, you can literally your fingers can do the walking, you can Google everything. Right? There was like, of course that was all online and my search for a publisher, but I found a publisher who publishes nonfiction, but specifically medically related books. So as a former cardiologist who would have physicians write books about different topics related to diseases or conditions or treatments and then sell them en masse as a wholesaler, basically to insurance companies or pharmaceutical companies where they’re interested in giving them out as promos to feature their work or their products, right, their drugs. And so they picked it up. I found them just Googling and Googling and they picked it up. I was looking for a literary agent prior to that and never really found one. They were all like, Thanks, but no thanks. You know, very first book hadn’t had a book prior. And there’s a thing you never make money on your first book. It just sets the stage. So you can make money, you usually make money maybe on your second book and later. So that’s how I came to finding the publisher. And then I found the PR person, because when I was working on PR for my product, for our company, our personal care product development company, I had been doing PR and went to this journalist convention and met a lot of friends on the way back from sharing a shuttle to the airport on the way back. And we became friends forever. Well, she was in the media in New York City, which, as you know, is like the number one media market in the country. And she just supported me and she would introduce me to this person and that person. And the rest is history. And so fast forward, frankly, I fell into finding it. I realized that to find a real J O B, a real job with benefits, to be able to be a head of household as a single mom and take care of my kids. I just did the old-fashioned thing. I just threw out whatever, I just applied for everything. I just did the old-fashioned online searches, and that’s what they were looking for. So just chance favors a prepared mind. Just doing one thing leads to another. Just keep going.
Jen: So connections and just inertia got you there.
Dr. Bright-Ellington: Well, not inertia. Just looking. I was always, always online. Always. Always online. Always, always. So there’s another thing I want to talk about, too, and bring up is that physicians are the hardest working folks in terms of on average, if you compare the average physician with any other line of work or profession, we’re hardworking folks and there are private equity folks, corporations, non physicians, folks in turtlenecks that know this and exploit this. And that is something that we have to be aware of when we are becoming employed physicians. So that’s something you have to keep in the back of your mind because fast forward when after almost ten years of working for this insurance company, it was bought out by a retailer. And overnight, literally, the culture changed. And I realized, you know what, I need to put out a shingle again, meaning do something else. And it’s a long story, but I realize, you know what, I have to write another book. Now, neither of these things Dr. Jen, would have been able to happen if I hadn’t have been an employed physician as a resident way back then, and taking advantage of 403b accounts and our 401ks when we’re in training, there are usually 403bs. And the reason why that’s important I want to talk about that is because it’s all about having options in life to be able to do nontraditional physician work, to use your physician brain, right. As physicians, we see the needs, but we think that, and the culture tells us we have to go and get private equity or investors or pitch. We don’t have time for that. That takes a lot of time. But what you can do is invest in yourself, be your own investor. And what you can do is and I did this twice, 20 years ago with the first company and the book, the first book, and I’m doing it now with our second company, Crush Medical Debt and the ongoing book series. The thing that allowed me to do that was what’s used to be called back in the day Regulation D financing, which is essentially taking your 403b or your 401k and investing instead of investing in other companies on the stock exchange, you invest in your own company. You turn your company to a C-Corporation, and you invest in it with your own resources, your own 403b or IRA or 401k resources. And I mentioned that it used to be called Regulation D financing. Now they call it ROBs, roll over as business startup. And what that does is, people don’t talk about it, which is really baffling to me because it really saved my life. It really allowed me to transition from clinical work full time to full time nontraditional work, but I’m still helping people as a physician. That would not be an option for me if I didn’t know about this Regulation D financing or ROBs financing. There’s a company called Vintage Friends and they don’t pay me. I don’t advertise for them, but I love them so much because I’ve worked with them twice in 20 years and they allowed me to invest my money from being an employed physician, even starting as a resident to now to say, hey, I don’t need to spend extra time doing investor searches. So just a quick example. Let’s say you have 100K in your IRA, 403b, 401k. You take out a loan to start your business. Well, if you separate from your company before it is paid off. I think I have five years to pay it off. But if you separate from your company before you pay it off, that’s an automatic withdrawal and you’re hit with taxes 40%. Let’s say tax rate, 30, 40%. Then you’ve got the 10% penalty. If you’re under age 59 and a half. So there’s that. So instead of having the whole hundred thousand dollars to invest, you only have $60,000 as opposed if you do Regulation D financing or ROBs. You have that whole hundred thousand dollars to invest in your company. So that’s why I really want to take a moment to talk about that in terms of having options to be able to transition to nontraditional or nonclinical work.
Jen: Yeah, that’s actually a great point. That is a terrific program. Another company that specializes in doing that work is Guidant. And so you’re right on point by mentioning that as an option, but it also begs the question of how long is the runway? How long does it take to get something like this up and running?
Dr. Bright-Ellington: Gosh, thank you for asking that. It cracks me up. I have to laugh because I am so dating myself. When I first did this 20 years ago, it took about when was still called Regulation D financing. It took about 3 to 4 months. Now, 20 years later, it takes not even it took three weeks. Door to door. From the first phone call and say, hey, I’m back. I want to start a new company. Let’s go.
Jen: So that got you the financing. You’ve got your C-Corp up and all of that. But what is the length of the runway from when you begin your business and you’re actually you have overhead that you’re using that startup money to get your business off the ground. What has been your experience in terms of the length of time to go from zero to profitable and starting a business at or have you gotten there with the publishing? Tell me about how that has worked for someone who may be interested in starting their own business.
Dr. Bright-Ellington: Yeah. So, you know, and all the stuff you see on TV and all the stuff that you see in the media, all that glamorous stuff, they don’t talk about that, right? How long does it take for you to get profitable and for you to be able to say, okay, this is a going concern? And I didn’t just spend all of my retirement and now I have no money for retirement and no income. I can’t support my family.
Jen: I hear all the time people who are on YouTube and these other channels that are promoting entrepreneurship or doctor-preneurs, they say like, Oh, it doesn’t cost anything to create this course. And what they’re not saying is, yes, it doesn’t cost anything for you to create the course materials that are already in your mind that you already know except your time. But when it comes to marketing that course, that’s a whole different ballgame. So maybe we should even specifically talk about marketing because you can create a phenomenal product, but if no one knows it exists, then you don’t have a profitable business. So what has been your experience with marketing itself?
Dr. Bright-Ellington: Thank you for bringing that up because that’s what got me into trouble with my first business where I did not realize I needed a marketing partner or a marketing model. I thought well, I spent a lot of time writing a business model and all that, and there was no focus and understanding that I needed to have marketing as primary and or a marketing partner before I ran out of runway and I had to close and get a real job. The thing that’s important, like you said, it’s all about marketing. It’s all about marketing, and that’s where all of my resources go. So my investment, this company only been up and running. This is its probably 10th month. So it’s been less than a year. And yes, in a year or even two years in the business model and marketing plan, I realize we’re not going to be able to get turnover to be profitable in the first year because to your point, the resources part of the expenses and overhead is marketing, hiring a PR firm. So my book publisher has PR marketing people as part of the team, but that only takes you so far, and it’s really just focused on the book in order to market the products that are related to Crush Medical Debt, the master class and the associated books and that kind of thing. I had to hire a PR person and so we’re still in the middle of doing that and that takes a big chunk of resources. I would say I spend twice to five times as much on marketing as I do the I.T. infrastructure every month. So that’s huge. So in my case, we’re looking for sponsors. There’s two pieces of income streams. One is sponsorships for the radio show Ask a Doctor at Doctor Virgie on Voice America and the Doctor Virgie media brand that includes Crush Medical Debt, the book and the masterclass. So there’s sponsorships for that, that’s near term. That’s something that we can get in less than a year. The long term is where do most people get their insurance from? Their health insurance in this country, from employers, right? So we’re partnering with employer benefits companies and things like that, companies that support people getting benefits with their employers in this country.
Dr. Bright-Ellington: So it’s a huge deal. And to your point also, that’s still marketing because no one knows what we do when we’re pitching to folks. That’s why it’s a long-term play for income from the other half, which is partnering with insurance companies and brokers and benefits folks and that kind of thing because they don’t know who we are. So it’s all about marketing, to your point. You’ve got to put marketing first.
Jen: Absolutely. We’ve had previously, it’s really scratching the surface on a very huge topic, but it’s something that there’s so much interest in and so many people who are interested in entrepreneurship and developing a side gig and in reality it’s a huge undertaking, much bigger than a lot of people lead others to believe. And there is a lot more to it than meets the eye initially. And as you and I both learned in other businesses prior to the ones we currently run, it’s a big process. So I really appreciate you sharing your insights. And one of the things we do inside the DocWorking THRIVE community, which is our subscription coaching services, we do have guests come and talk in small group forums where people can just directly ask you questions, and I would love to invite you to do that inside of the DocWorking THRIVE group, if that would be something you would have time to do.
Dr. Bright-Ellington: Oh, my gosh. Dr. Jen, you know, I’ll make time to do it. You know, you make time for things that’s important to you. And this is really, really, really important. You know, I want my physician brothers and sisters to understand that, you know, you have options. It’s all about having options in life. We have options. You have options. And I want folks to be able to understand that. So any time I’m your woman, I’d be happy to. It would be my honor and privilege.
Jen: Dr. Virgie Bright-Ellington, thank you, as always, for your friendship and for coming on the podcast. It’s truly a pleasure to have this conversation with you, and I look forward to many others.
Dr. Bright-Ellington: I love talking with you, Dr. Jen, thank you so much for having me again.
Jen: And thank you for joining us today on DocWorking: The Whole Physician Podcast.