The Road to Becoming a Physician

Episode Transcript

Speaker 1 (00:00):
Eight oh six thirteen ten Wi b a full scope
with doctor Nicole Hemkiss Madison and Wisconsin's direct care doctor.
Of course, you can learn more about doctor Hemkiss and
all eight doctors at Advocate MD, as well as what
makes Advocate MD so special and all about direct primary
care all online the website Advocates DPC dot com. That's

(00:23):
Advocate DPC dot com. Telephone and make an appointment and
become a member at Advocate MD. Six oh eight two
six eight sixty two eleven. That's six oh eight two
six eight sixty two eleven. Doctor. How you doing today?

Speaker 2 (00:36):
I'm doing Wilson, how are you?

Speaker 1 (00:37):
I'm doing great. It's great to talk with you. And uh,
we're going to be talking about a little bit about
your journey of you know, as a as a family physician,
what what you know? Sometimes people like they may hear
some things like, oh, it's all you know, it takes
long time become a doctor. There's a lot of work
going on at that time too, So we're going to
talk about talk about that and uh, and of course

(00:59):
some of the great things you're able to do at
Advocate MB. But first let's real quick kind of get
a refresher for folks about direct primary care kind of
what it is, who it's for, and a little bit
of information as well about the cost doctor.

Speaker 2 (01:14):
Yeah, so direct primary care is a model for primary
care where we kind of separate out your primary care
from the rest of healthcare. You know, things like surgery, hospitalization.
If you have something very unfortunate like a cancer diagnosis
and you need cancer treatments, those things can be extremely expensive.
But most of healthcare for the majority of people, can

(01:35):
be done in a primary care setting and outpatient setting,
so not within the walls of a hospital. And unfortunately,
what's happened in the last you know, ten to twenty years,
last couple decades, is that more and more healthcare has
been moved into the hospital setting, or at least facilities
that are owned by hospitals. And the reason for that
is purely financial, right. It doesn't because a building is
owned by a hospital doesn't mean that there's anything you know,

(01:56):
higher quality or you know, advanced technology in there because
there's a primary care doctor in there. That is purely
a financial reason. So now they're able to build you
more for the MRI, they're able to bill you more
for the blood work, everything that you have done the
physical therapist. So in our model of direct primary care,
we take out family medicine. And it's for people that

(02:17):
have insurance that you know, have high deductible insurances. It's
for people that have you know, even low deductible that
they get plans through their employer and their employer pays us.
But really it's it's a model that could benefit anyone.
If you're looking for a doctor that is going to
spend time with you, it's going to your doctor is
going to be available when you need them. You know
what's happening now in the system, and I'm sure everyone

(02:39):
listening has probably experienced this to some degree, is that
now when you need an appointment with a doctor and
you call to make that appointment, Okay, it's three months,
it's six months, it's nine months, there's a local, large
system here that is no longer taking primary care patients.
I don't really understand how that's possible, but that's what
I'm told. So, you know, I always like to say,

(03:01):
what good is your is your doctor or your health
insurance if you can't actually get an appointment, you know,
so it doesn't matter if they're a nice person or
they're a good doctor if you can never see them.
All of that is a moot point. So in our model,
we're available where accessible. You get an appointment in sometimes days,
sometimes maybe a week. Two weeks would be that kind

(03:21):
of the furthest out. We usually book. When you see
the doctor and the clinic, they're spending forty five minutes
to an hour with you. They're addressing all your concerns
rather than okay, I can take two things off your
list and the other five things you need to come
back schedule another appointment for me. And by the way,
I'm booked up for six months. So it's a very
different experience. And the cost is usually on average around

(03:43):
seventy to eighty dollars a month for an adult. Children
are less. It's based on age, So again this is
meant to be kind of I guess you could call
it an add on or a supplement to your catastrophic insurance.
You still need insurance. You're going to save that for
the big things like surgery, hospitalzation, but for your everyday needs,
your health maintenance, your acute care, your urgent care. Like

(04:06):
you sprain your ankle, you have a sore throat, Do
you have a rash. Those things you can come to
us for those and then when you come in for
a visit. In this model, there's no copey for that visit.
There's no charge for that visit. I told the story
a few weeks ago of bringing my daughter into the
pediatrician and the local large system, and we have insurance
for her. I personally am not under the same ensure insurance.

(04:28):
I have a health share, but she has insurance. And
after all was said and done and that, you know,
fifteen twenty minute visit with the pediatrician, we were build
five hundred and eighty dollars and the insurance actually paid
none of that because it went towards the deductible. But
it's just things like that that make you say, huh, So,
for five hundred and eighty dollars my daughter, you know,

(04:48):
she usually sees the docs in our clinic, that would
be a year's worth of membership and direct primary care
for a kid an adult would probably be you know,
somewhere closer to eight hundred and nine hundred dollars for
a year, adding up all the monthly membership fee. So again,
when you're a member in our practice, there's no cost
for the visit. There's no copay, and it also gives
you that peace of mind of not having to worry

(05:08):
because I think all of us, including myself and I'm
a doctor, when I go into another medical facility, you know,
if it's whether it's for labs or imaging, I'm thinking
in the back of my mind, how much is this
actually going to turn out? The cost because you think
you know how much the insurance covers or what the
price is going to be. It's always a little bit,
you know, different than what you thought.

Speaker 1 (05:27):
It's amazing how affordable it is. And I love the
you know, you don't have to worry about any of
that stuff. The other two doctor is as far as
surprise billing or anything. The other thing too. That's fantastic
about Advocate MD and direct primary care. You actually see
your doctor. I know folks that are making appointments to
quote unquote see their doctor, and there again they're six
months out sometimes and you get to the doctor's office

(05:50):
and you're seeing a physician assistant or somebody other than
your actual primary care doctor. I know there's I've talked
with folks who haven't actually seen their front primary care
doctor in years, even though it's taking long to get
into the clinic for their you know, routine things and
other stuff. So there isn't we talk about what you're

(06:11):
able to do at Advocate MD. There is an amazing
alternative direct primary Care and Advocate MD. It's a great
day to become a member. Start at Advocate MD. I'll
gotta do this. Pick up pone game call, make that
appointment six oh eight two six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven.
You can learn more online ADVOCATESDPC dot com. That's Advocates
DPC dot com. Not only convenient when it comes to

(06:34):
making making an appointment to see your doctor, also convenient
locations of Advocate MD westside in Middleton, right on Glacier
Ridge Road, east side of Madison on South Fair Oaks Avenue,
Janesville for those folks in Rock County and southern Dame County.
A beautiful clinic right at ten twenty one Mineral Point
Avenue in Janesville. And the newest location of Advocate MD
right at thirty two to twenty Sign Road that's right

(06:56):
on the Madison Fitchburg border, and that very very beautiful
nature let's talk doctor about kind of your journey to
become a family physician and what what all you went through.
I find your story is is is really interesting as
far as you know, obviously going to school and I

(07:17):
know you've done some, uh you've done some working places
like Alaska and other areas, but let's kind of just
talk about the journey that that kind of brought you,
uh to becoming a physician.

Speaker 2 (07:28):
Yeah. So, you know, I know, there's a lot of
people that grow up and they knew from a very
young age, you know, and they were five years old
or ten, or they have a parent that's a doctor
in the medical field, so they knew early on that
that's what they wanted to do. I wouldn't say that
that described me. I definitely had, you know, ideas about
what I was going to do. I was always somebody

(07:49):
that was good in school, and I think I was
really good at science and math, so that kind of
maybe pushed me a little bit more in that direction.
But when I was in college, I started doing shadowing
with a physician. I was part of a pre med
fraternity they call it like a pre med honor fraternity,
so we got to have some experiences where we could

(08:10):
follow along with a physician, and so that kind of
helped me a lot to figure out if that was
something that I wanted to do. So people that are
going into medicine, it is it is as you said, Sean,
it's a long journey and it's not an easy journey, right.
There's many stages along the way where you know, people
either decide this isn't for me, this is too hard.

(08:31):
I don't want to put in the hours or the time.
There are personal sacrifices. I mean, I guess this is
very dependent on the person. But you know, many people delay,
you know, getting married or having children until they've completed
their training because there's so many hours involved. Not everybody.
There's definitely people that are married and have kids in
medical school and residency, but the vast majority of people

(08:51):
don't do that. So for me, I did four years
of undergraduate and so you know, usually you're some sort
of a pre med major or not always, but you
have to do your core classes, your core science classes
like chemistry, biology, you have to have a certain number
of math classes, physics, and then you know, you apply
to medical school. Some people take a few years in between,

(09:14):
but in medical school. It is very difficult, I would say,
is somebody that went through undergraduate and did pretty well,
and you know, maybe you're kind of towards the top
of your class. And then you get into medical school
and you realize all of these people in your class
were at the top of their class. I think in
my medical school class of one hundred, I think there
were like a quarter of the class where valve victorians

(09:36):
of their college. Just to put it into perspective, So
you're like, oh, wow, these are these are smart people. Anyway,
So then you realize when you get to medical school
like it's it's not as easy or I mean, you
may not be at the top of your class for
the first time in your life anyway. So in medical school,
you have the first two years are you know, your
book learning, You're you know, you're taking classes basically from

(09:59):
eight am until four or five pm. You know, you're
learning about things like anatomy, physiology, you know, pharmacology, pathology,
you know all of these you know core biological sciences.
And then you're so first and second year, and then
you're also taking exams during that time. You know you
have to be able to pass those exams, and then

(10:20):
your second two years of medical school, or what we
call the clinicals, And the third one is probably the
most important because that's when you go through all these
core rotations, so you have to rotate. All medical students
rotate through family medicine, internal medicine, surgery, emergency medicine, pediatrics,

(10:41):
in psychiatry. I believe I have those six correct, so
that gives them a taste of kind of what all
of these, you know, the major fields would be like.
And you know, within those there's kind of subspecialties. Like
when you're doing surgery, you might rotate with a subspecialist
to see what that's like. But that's supposed to help
you figure out, you know, what kind of medicine you
want to do. But keep in mind in that third

(11:03):
year you're probably working like sixty to seventy hours a week.
I remember having to get to the hospital. I think
we rounded with the attending at six am, so by
six am you needed to have your patient scene and
be ready to present to your attending. So when you're doing,
you know, rounds within the hospital as a medical student

(11:25):
or a resident. In many cases you're rounding with a
team of people. It could be you know six to
ten people on this team and you, as a like
a lowly medical student, are presenting your patient to them
of like, this is Joe Smith, he's forty eight years old.
These da da da dah. And then and then you
are being asked questions like in a way that is

(11:45):
trying to get you to make sure you know that
your patient, but also the disease process and all of
these things. And it's very nerve wracking. I remember. I
remember one time when I was drinking too much Red
Bull to stay awake and I started to develop this
eye twitch, so I had to stop drinking the red Bull.
But it's it's a very intense experience and it's like
one of those things that when you look back on

(12:07):
some of this stuff, you think, how did I do that.
So when you're going through your internal medicine rotations, you're
rotating in places like the ICU, so you're taking care
of extremely sick you know, ICU patients and you're working
you know, thirty six out. You know, sometimes you're working
thirty six hours straight. You spend the night in the hospital.
You see, you take care of those patients overnight if

(12:27):
something happens to them. So yes, that thirty year is
very intense, and then the hope is that by the
time you reach your fourth year, you're going to know
what you want to go into. And for me, I
actually had a time period where I thought I might
go into surgery, and that I kind of also went
between surgery and OBGYN and then finally settled on family

(12:48):
medicine because I realized that there was a part of
the A big part of the enjoyment of medicine for
me was getting to know my patients. And then along
with that, if you're family medicine doctor as opposed to
like an obedian or a pediatrician, we see everybody, you know,
we see all ages, We see the babies all the
way to the grandparents. You know. We get to take

(13:09):
care of husbands and wives and their kids, and there's
something about that family dynamic and being able to take
care of the whole family and to hear their story
and to see how all of that fits together, because
right there's always a human component of all of this.
You know, it's an art, it's a science and an art, right,
So I really enjoyed that part of getting to know

(13:31):
my patients, and I felt like family medicine was probably
the best way for me to do that. Plus I
really liked the flexibility that it gives you in terms
of you can do urgent care, you can work at
a hospital setting, you can work in an emergency department,
you can go to extremely rural places as you mentioned, Sean.
So I did a rotation in residency for about a month,

(13:53):
and then I returned again when I was finished with
residency a few years after residency to work in very rule, Alaska.
So I did that for five or six months again
when I returned, and just to be able to have
those kind of experiences where you're seeing a totally different
population of people that live in an environment that is

(14:13):
very foreign to you, and you know, different disease processes,
different demographics. So that is also kind of helps with
you helps you to become a better physician, to be
able to kind of appreciate the spectrum of all the
human experience and the you know, kind of just see
different patients in different settings. So that was really cool,

(14:36):
And I don't think there was no other kind of
branch of medicine where I could do that. Right, like,
go to pretty much anywhere, you know, you always need
a family doc, no matter what how big or small
the city is. But yeah, so I kind of finished
that went to residency. I did my residency at Wake
Forest in North Carolina. And when you're in residency again,

(14:59):
you rotate through even though you're family medicine doctors at
that point, doctors in training, you rotate through again things
like you know, I would work with a dermatologist, or
I would work with a surgeon that was doing a
lot of skin stuff. I would you know, rotate with
the pediatricians in the hospital to take care of the
very sick babies. I would rotate through again with the

(15:21):
internal medicine docks to take care of extremely sick patients
in the hospital. We rotated with the er physicians. So
so you again that the idea is that to really
have that basis of knowledge, I mean, partially it's knowledge,
Partially it's experience and taking care of those type of
patients that's going to help you to be a better
family medicine doc, even though you might not do those things.

(15:42):
You know, you're probably not going to do most of
that you know, on a regular basis, but it gives
you that kind of foundation of knowledge. And for me
as a family medicine doc now in a direct primary
care clinic. I find that because I have had those
experiences in the hospital or taken care of like sicker patients,
it allows me to have a very different comfort level.

(16:05):
Like when a patient texts me and says, Okay, this
is what's going on. I have this cough, I have
a fever, it's hard for me to breathe, or I
have that you know, I have this pain on my
left side. You know, I am able to kind of
triage that and figure out, you know, is this something
that needs to go to the hospital. Is it something
that I can see in the clinic. Is it something
where I can just give them some guidance and have

(16:25):
them try certain things at home and then we talk
to each other, you know, the next day. So again,
I think that that's really allowed me to become a
better family physician because I've had that kind of range
of experiences.

Speaker 1 (16:36):
And one of the things is interesting when you mentioned
death thought about maybe going into going into like surgical
and folks who listen to the program know this. Folks
that are your patients know this. As somebody that's gotten
to know you over the years, You're a very engaging person.
I don't know that you would. You would enjoy not
having patients be able to respond as you're tying with
the performing surgery. I know you really enjoy that interaction

(16:59):
and getting to know people their families. Not to say
that surgeons don't don't take the time to get to
know their patients just when they're working on them. They're
generally out.

Speaker 2 (17:08):
Yes, definitely, I definitely had that moment where you're in
you're scrubbed into the O R. And I mean so
surgeons usually have a mixture of surgery days and clinic days,
so I mean they do have like you said, they
do interact with patients on certain days, but when the
when the patients is you know, on the table under
general anesthesia and you're in this room where there are

(17:28):
no windows and you know you're you're scrubs so you
can't really touch things, and you it's it's you have
to be very intentional and committed to that field, I
think too, and people that do surgery love it right
because you can see an immediate result from your procedure.
You know, again, sometimes family medicine is a delayed result.
Like I'm gonna I'm gonna guide you as far as

(17:49):
your bloodpressure, your cholesterol. I'll see you back over the
course of three months or six months, and we'll see
if this is improved. But surgery is like an immediate
gratification of seeing the results of what you did. But yes,
I think, you know, parts of my personality would have
been okay with surgery, but I think my need to
just kind of like, I don't know if I could

(18:10):
be in a room for that many hours and not
be able to see sunlight and that sort of it.

Speaker 1 (18:14):
Yeah, I think some of us all have those days
where like, actually just maybe, but yeah, it's it's I
always love, I think, and I hope people. I know
you've done several open houses and other things and hopefully
there'll be one coming up soon for folks that haven't
had a chance to meet with you, as well as
the other doctors at Advocate MD really obviously very very smart,

(18:34):
but also really really good people people. And that's one
of the great things about direct Primary Care and Advocate MD.
You actually get to know your doctor. Your doctor gets
to know you, your family, and it really helps and benefits
you when it comes to treatment and care and really
developing that relationship. It's a great day to start that.
All I got to do is pick up phone, give
the doctors at Advocate MD, doctor Hamkis and others a

(18:55):
phone call, set up that appointment six O two six
eight sixty two eleven. That's six oa two six eight
to eleven. You can learn more online Advocates DPC dot com.
That's Advocate d PC dot com. We'll should do our
conversation with doctor Hemkiss next as full scope continues right
here on thirteen ten wu I B I thirteen ten
wu I B A and full scope with doctor Nicole Hemkiss,

(19:17):
Wisconsin's Directcare dot primarycare doc. And of course as we
talk about talk about direct Primarycare and Advocate MD. You
can learn more online Advocates DPC dot com. That's Advocates
DPC dot com. Great day to pick up phone, make
that appointment at Advocate MD six oh eight two six
eight sixty two eleven. That's six oh eight two six
eight sixty two eleven. And doctor you talked about what

(19:39):
it's like to become what it takes to become a doctor.
And I'm going to guess there are a lot of
folks that kind of start down that journey and probably
say you know what, I'll try something else. Uh, So
there's probably uh, it's probably very difficult to get through.
And I know one of the things that also becomes
a parent is once a lot of doctor actors get

(20:01):
into the systems, much like the patients aren't particularly satisfied,
they aren't particularly satisfied either, and correct me if I'm wrong.
There's there's a bit of a doctor shortage, isn't there.

Speaker 2 (20:12):
Yes, so we know I was trying to look up
the exact statistic. We know that there's a shortage of doctors,
and they said in the next ten years as most
you know, some of the baby boomer doctors are already
retiring or retiring early. But when those baby boomers kind
of fully retire, you know, some of them are working
like past sixty five, we're going to lose I think.

(20:35):
I think they said twenty percent of our physician workforce,
and we aren't replacing them at that rate. You know.
The other thing that's interesting that's happening over the last
five years, ever since COVID medical school applications are down,
there was a weird thing that happened during COVID, and
I don't know that they've explained this but medical school
applications went up, maybe more people were just thinking about

(20:56):
like health and science because of COVID, but then in
the last five year years they have steadily gone down
each year. So in some ways, less people are wanting
to become a doctor, I think because of the fact
that it's it's a long, hard road that you're having
to do, and not necessarily the compensation has kept up
with the rate of inflation or compensation in other fields.

(21:19):
But it is also you know something where again you
by the time you graduate residency, if you go straight through,
you'll be twenty nine years old or thirty years old, right,
So I mean that's that's a long time. And you know,
some people during their mid to late twenties, they're getting married,
they're having babies, and you know, not that you couldn't
do that, but you know some people delay that. But yeah,
so it's it's something I think about a lot because

(21:40):
in our office we have a number of either UW
students that are pre med or that have recently graduated
that work with us, and they are wonderful ladies. They
you know, can do everything. You know, we trade them
and how to do the medical stuff that they need.
To do to be a patient care technician. They are
hard working and intelligent, and I could tell you all

(22:03):
of them could be doctors if they wanted to go
that path, and many of them, almost all of them,
start out that way. But as you said, Sean, sometimes
they get to a point where they start getting a
little burnt out with school, so they decide to go
a different route, maybe like a physician assistant or a
nurse practitioner. And you know, as we've talked about on
the program, I have worked alongside of pas and nps

(22:24):
throughout the years that I worked in different systems, and
there are some wonderful, very knowledgeable ones. But it is
different than becoming a physician. The level of the years
of training, the years of education, their experience, how many
patients they see, how many hours they work. It is
vastly different. You know. It's a very small, minute percentile
of what it takes to become a doctor, maybe like

(22:46):
fifteen to twenty percent the amount of years and training
and hours. So when they do graduate from NPRPA school,
they will now in this day and age, they will
basically kind of be expected to do the same thing
that a doctor does. Used to be like that, but
unfortunately it's kind of morphed into that again for financial reasons.
So as doctors become more and more burnt out and

(23:08):
leave systems, the gap that you know, the gap that
they leave is being filled by non physicians. So in
our practice we only have physicians. That's very intentional. I've
had many people throughout the years, even I've been up
and sold recently that try to convince me to hire
non physicians. But I have done this for a reason

(23:29):
that I think that, you know, physicians are the best
medical professionals to take care of people when we're trying
to address you know, as many of their medical concerns
as we can in a primary care setting and not
have to send them to specialists to do a bunch
of additional testing that's unnecessary. So if we have a
well trained, knowledgeable, experienced family medicine doc, I think that

(23:51):
that is the best asset that we have in a
direct primary care clinic.

Speaker 1 (23:54):
And that's they you mentioned having intentionally having doctors, and
that's you actually have a doctor that you get into see.
Pas and others are fantastic people but and of course
do fantastic work, but actually getting into see your doctor
an actual MD or or what's what's the others? There's
mds and d o yes right, d oh yes, getting

(24:17):
into actually see your physician when you want to see
your doctor. That's a great thing about Advocate MD. The
website advocates DPC dot com tons of great information online.
Today though, is the day to pick up phone, give
them a call, make that appointment. Where you're looking for
something great for yourself, your family. If you're an employer
looking for some great options for primary care for your employees,
check out Advocate MD and of course website advocates DPC

(24:40):
dot com. Great day to pick up phone and make
that call. Six oh eight two six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven. Doctor.
Thank you so much for joining us this morning. You
have a fantastic day you too, Sean, thank you. News
is next here on thirteen ten. Wu ib A