Ruth Solomon, MD (00:00)

So the average care doc, whether it be family medicine or internal medicine, you usually carry a panel of about like 1,500 to 2,000 patients. And that's pretty standard.

Pauline (00:10)

Two thousand

patients. I I just have to interrupt you for a second because that sounds like a lot of lives to keep track of.

Ruth Solomon, MD (00:19)

it is.

Pauline (00:20)

Two thousand, you said.

Ruth Solomon, MD (00:21)

Yeah, yeah,

Pauline (00:22)

Per year.

Ruth Solomon, MD (00:23)

it can

be.

Pauline (00:40)

Hi everybody and welcome back. I'm Pauline Walfisch and I am here with my faithful and very cheeky co-host, Megan Nelson. Megan, can you get us started and introduce our guests today and why we're here?

Megan (00:55)

Absolutely. Hi Pauline, thank you. so have you guys ever wondered why you have a doctor's appointment, you waited weeks for it, and it only lasts, I don't know, seven to fifteen minutes? Maybe your doctor's writing their note the entire time you're trying to explain your illness. Well, today we're gonna get to the bottom of this. Dr. Ruth Solomon is a board-certified family medicine physician and the founder of April MD, a direct primary care practice located in Babylon.

York. This innovative model of primary care prioritizes preventative health, personalized medical care, and a true partnership between you and your doctor. So today she's here to talk about how she's making a difference, what it's like to be a working mom, and how she brings her personal values into her work. Welcome, Dr. Solomon.

Ruth Solomon, MD (01:44)

Thanks

for having me.

Pauline (01:46)

Thank you so much for being here. we met a couple weeks ago at a networking event and I was so impressed with your practice and the model that I have been telling everybody about it. I want to just kind of get started because, you know, I think we hear so much about like primary care doctors

We don't hear her talk about family medicine that much. I think the first time I heard of it was a friend of mine in the South who was bringing her newborn to the same doctor that was treating her. And I was like, What are you doing? Like, no, you have to go to a pediatrician. And she was like, No, like we see this doctor for everything. And I was like, That's a thing? So that's that's you, right? That's family medicine.

Ruth Solomon, MD (02:30)

Yeah, so family medicine is a board specialty. So a lot of times when we talk about primary care, we're talking about the doctors who are kind of your frontline for care. So in the American healthcare model, we're talking about family medicine doctors, internal medicine doctors, general practitioners and pediatricians. That's usually where that comes in.

Your GYN side of OB, you know, the person that you would go to for say like your pap smears or your breast exams also falls in that umbrella as well. So what makes family medicine specifically different is that we get multidisciplinary training. the saying in family medicine is womb to tomb. You take care of patients who are from day zero to day 100. And so you have to do...

rotations, you have to do training within all of the different subspecialties. So you do hospital, emergency department, pediatrics, OB-GYN. There is a competency for the American Board of Family Medicine that says that every family medicine doctor has to have a minimum requirement of specific skills. You have to see a certain number of patients, do a certain number of care hours within each specialty.

to make sure that you have like a good encompassing knowledge. So that way you can be the doctor who, you know, sees everybody. I think what's different for us in New York is because there are so many really big health system players that a lot of family medicine doctors will end up just seeing adult patients and might not necessarily use their full acumen of skills because, you know, there is a Cohen's, you know, there is a Lennox Hill, there is a Northwell and an NYU and a Stony Brook. So

you kind of end up, and this is not unique to like New York per se, I think this is like a metropolitan area where you just have this like condensed heavy set that there are just a lot of healthcare networks. That's what you end up seeing. So it's kind of a foreign concept. But when I was growing up, it was the same thing. I saw the same doctor up until, you know, I was an adult and that was the same doctor. She also did my pap smear So like I saw one person for basically everything. And that's how.

kind of isn't in other countries too.

Pauline (04:35)

it's I mean it seems so foreign to me, especially because it's New York and we have so many providers, but like our healthcare system's pretty fragmented. You see one doctor for this, you see another doctor for that, and even if those two things are related, I remember taking my father to a doctor to an orthopedist and the doctor being like, No, no, I only look at hands, I don't look at knees.

And I was like, Well, he's having the same problem with his hands and his knees. And he's like, Well, you have to make an appointment with the knee doctor. And I was like, I'm gonna lose my mind. there's clearly a systemic thing that is happening. Like, this is not I do hands and you do like, Hello, can we look at the body from a holistic lens? And so that's what family medicine does. Not to mention the relationship that you have when you're working from

I love that womb to tomb. Like my son just graduated from the pediatrician and it was like devastating for all of us, right? If I if I if he could continue

Ruth Solomon, MD (05:27)

Ciao.

Pauline (05:31)

that relationship into adulthood, like what kind of difference might that make?

Ruth Solomon, MD (05:36)

Absolutely. And I think it does speak to sort of like a bigger problem within healthcare. To your point, everything is very fragmented. And so, you know, when from the patient point of view, and I've experienced this myself, you know, if I'm going to the doctor, I don't want to have to retell my story every time. I don't want to have to go through everything. And for some people, depending on what it is, that can be a very traumatic experience to have to relive and re go through everything every single time.

example I always give is I had a patient who had high cholesterol. They could not tolerate a statin drug. And if that person saw anybody else, it would be like, why aren't you on statin? it's like, again, I can't do this. I've done this. I've tried it. It doesn't work. well, did you really like, is it really a statin? And you have to go down and explain yourself again. Whereas if you're just seeing the doctor who knows you, like, yeah, we've already done this. Moving on.

let's focus on what's important and not waste time while we're here. to your point, yeah, unfortunately, that's kind of the way things have gone.

Pauline (06:34)

I kinda suspect it might be why the US has the highest healthcare costs and the poorest outcomes, but I'm just a social worker.

Megan (06:45)

Can you talk us through the model that you've created your business around the direct primary care model versus the traditional insurance model that

we normally think of like I go to my primary care, they take my insurance. If I have an issue, then they'll refer me to other people and I go once a year for fifteen minutes and

Pauline (07:09)

Or seven.

Megan (07:10)

or seven. Yeah.

Ruth Solomon, MD (07:11)

Yeah, so the traditional model that we're all kind of familiar with is the insurance system that for most people, it's like an employer based health plan. And the idea for that is that, you you're paying your monthly premium, especially if you have like family or dependents, and that is supposed to then give you some kind of health care coverage.

Unfortunately, there's a very wide spectrum of what's covered. So some people might have like a really big deductible and large co-pays, essentially you go to see your doctor, your doctor bills, your insurance, your insurance will decide whether or not to pay your doctor. And depending on like what the plan is that you have dictates your coverage.

so because of that, then, you know, people can end up having fragmented care. The direct primary care model basically just eliminates the insurance. So there's no middleman and you just pay your doctor directly, just one flat rate fee. And that includes all of your primary care services. So, you know, if my patient has a cold and they need to be seen or they need a letter for work, that's included. If you have high blood pressure, we're adjusting your medications.

Maybe it takes like three or four visits in the month to get that figured out. That's all included. If you have a really bad sore throat and maybe your kid just got diagnosed with strep and think you have strep, you come and I swab you. It's just one flat rate fee. Everything is included and you're not guessing. There's no co-pays, there's no extra. It's just something that you can plan your life around and it keeps things very simple and cost effective and transparent.

There's no guesswork with direct primary care, which is nice.

Pauline (08:49)

You mean you wouldn't have to go to urgent care for your throat swab?

Ruth Solomon, MD (08:53)

And that's also the beauty of direct primary care.

So the average care doc, whether it be family medicine or internal medicine, you usually carry a panel of about like 1,500 to 2,000 patients. And that's pretty standard.

Pauline (09:07)

Two thousand

patients. I I just have to interrupt you for a second because that sounds like a lot of lives to keep track of.

Ruth Solomon, MD (09:16)

it is.

Pauline (09:16)

Two thousand, you said.

Ruth Solomon, MD (09:18)

Yeah, yeah,

Pauline (09:19)

Per year.

Ruth Solomon, MD (09:20)

it can

be.

Well, so like your panel would be like the number of patients that you have. Your patient visits could vary. Like some years you're gonna see more, some years you're gonna see less. Always see more patients in the winter than in the summer just because everybody gets sick in the winter. But yeah, like your panel of patients is, you know, that's the cohort of people that you're kind of like responsible for, if you will.

with direct primary care, again, because insurance reimbursement has gone down, unfortunately, over the years, and insurance companies get very creative about what they don't want to pay for. So you have to see more patients to make the same amount of money. So with direct primary care, because I don't have to worry about all of that, I can keep my panel much smaller, which means that I can have same-day appointments, I can have next-day appointments, I can see people before work, after work.

I try to keep things as flexible as possible because I also understand that you have better things to do than to be at the doctor's office. You have a life to live. I feel like my job is to make sure that you stay healthy so you can live that life.

Megan (10:18)

So what really happens, what's the difference when someone decides to you and then they have an appointment? What how would you describe the difference that would would happen in within the appointment? What's that like?

Ruth Solomon, MD (10:32)

Yeah, so I would say that sort of like the, guess, general flow patients come in. I have a waiting room, but it really is just like a prop. It's kind of just like if you want to put your bag down because you're not waiting, you're just coming in to see me. I'm the one who's like, you know, triaging, doing your vitals and everything. And then we sit down and we chat and, you know, we just go through.

what it is that you're concerned about. And I try to give people as much education within those sessions as possible. All of my appointments are 30 minutes as a standard. So it gives me time to talk, but more importantly, it gives me time to listen.

And I can definitely

Pauline (11:07)

Hmm.

Ruth Solomon, MD (11:08)

say that even in my old job, you know, because you're so pressed for time, you're kind of just picking out keywords really quickly and you're trying to, you know, go through.

your thought process as fast as possible because you know that you have a waiting room full of people because you have to just like get through it as quickly as possible. Whereas for this, it's like, I will sit down and listen and I'm not missing things. able to really hone in on, you know, what's happening. Dr. William Oelser, who's like one of the fathers of like the residency training and that type of like model of doctor care.

he has like a quote and I'm paraphrasing it's like the patient is telling you the diagnosis you're not listening and that is something that I think is again like it's a lost art within medicine because of the model of insurance and how things are structured we're not giving doctors the time to sit and listen and really get to it which of course doesn't serve the patient either because then you leave feeling like nobody listened to me I didn't get my problem fixed you know I'm doing something and it's not working for me and then I might have a follow-up in like

three or four weeks and that's not gonna be working for me in the here and now.

Pauline (12:16)

Right. And because my doctor has two thousand patients, they're not gonna remember this conversation in four weeks and I'm gonna have to start all over again and be like, Remember when I told you

you're not trying to remember two thousand stories.

Ruth Solomon, MD (12:31)

You know, I will say after a while, it's a weird thing. Like something clicks for you, but no, you're right. Like there's always going to be details, which is also the reason why your doctor is writing notes in the appointment. So that way they don't miss anything and they don't forget anything. to make sure that all the big things are being hit and covered because, you know, even when you go home and you chart at the end of the day,

you want to make sure that you didn't miss anything and you didn't miss any of big stuff. So that's also part of the reason why your doctor might be staring at their computer screen and not actually looking at you is because they're trying not to miss anything. Because to your point, there's 2000 stories you kind of have to keep in your head.

Megan (13:06)

Mm I've noticed my impression and I have a lovely doctor. I think she's very smart.

Ruth Solomon, MD (13:11)

Mm-hmm.

Megan (13:11)

very

kind. I don't get the sense that she loves the insurance model of care and the fifteen minute appointments as well. And

Pauline (13:20)

Sure.

Megan (13:21)

what it feels like to me that I've noticed because I've been with her for long enough that I've noticed it go from thirty minutes to fifteen minutes. what I feel like is happening in an appointment is her

Quickly reviewing everything that is important, like you're still on this, you're still da-da-da. Do you want to talk about this? listening to any current issues I might be having. And her it feels like her mind is just going, okay, who do I refer her to here, here, here, and here. Like it doesn't feel like she's going, hmm, how do we tackle this issue? it's

Almost like, okay, you're here for a minute, and then I'm gonna send you somewhere else to someone who can spend a little bit more time with you.

Pauline (14:01)

Someone who specializes

in the exact thing. And I could

totally derail us here and talk about how like healthcare has been corporatized and how there are these large medical practices that are owned by insurance companies and how perhaps there's incentive for making referrals to specialists and so less and less primary care is actually treating versus

being the gatekeeper of like you go here, you go there, you go see this specialist. And like you, I have a I have a primary care physician who I've been seeing since I won't say how old I am, but like

Megan (14:37)

Ha ha ha.

Pauline (14:38)

for 30 years. he knows my whole family. He know I like you said Dr. Solomon, it's amazing that he can keep track of our names and our stories.

And also it's a different kind of appointment than it was when I first started seeing him.

Ruth Solomon, MD (14:54)

I will also say too that there is the, again, like it kind of unfortunately always comes back to this, but there is like that crunch of time where I could sit and I could ask about, you know, all of these things and kind of get down to it.

especially if you're in private practice and you have to compete with these bigger healthcare systems and you have to compete with like all the resources that they have at their beck and call, unfortunately because it is a for-profit system, there is like a cost benefit ratio that you kind of have to do in your head. Is it going to be worth it for me to run down this thing that I think might just be like, for example, hypothyroidism or do I just send you to the endocrinologist?

And that person can focus on that one thing. then, you know, at least I got you where you needed to get to because I still have like the other 40 people that have to see today.

Megan (15:44)

Yeah.

Pauline (15:45)

Yeah.

Ruth Solomon, MD (15:45)

And it is unfortunate. And I think that also it does lend to reputation, if you will, that like, primary credit, all you do is refer out. And it's like, well, no, it's not just that I'm referring out. It's that they're

that I have to be able to serve as many people as possible in a limited day and still be able to go home and then finish that work. And then, I don't know, hopefully see my family. The other side of it, to your point about the corporation side of medicine, and I think a lot of people don't understand this, when you're an employed physician, you still have metrics that you have to meet. And it's...

insane that this is like legal and this is a thing. it also depends on like, what's the healthcare company? What's the contract that you signed? for example, they have this thing called RVUs. And you know, those are basically like your productivity units. And some employers, if they're very aggressive, and you don't meet a certain number of RVUs by the end of the year, you might actually have to pay your employer back. Or you might not get your year of end bonus,

And it's not every single corporation that's doing that, but it does exist within the industry. And all of us know that it exists within the industry. And the other part of it is that it's kind of hard to leave your job because if you have a non-compete, you might have something as small as, well, it's like one year and five miles, but some of the bigger healthcare systems will say, no, your non-compete is entity-wide.

So you can't practice within five miles of any clinic or any hospital that's within our corporate umbrella. That might put you out of Long Island, depending on which system it is. So there are also pressures. And then of course, we all have these crazy student loans that we have to pay off. So you kind of can't So

being able to go out on your own into private practice, it's a big leap. And not everybody can do that.

I really do think that unfortunately, I don't think there's bad players per se within the system. It's just we're all victims of the system and then the C-suite does really well.

Megan (17:46)

it can lead to burnout and people not being able to do what they got into the field to do. And that is really disheartening.

Pauline (17:55)

physicians, healthcare providers, all of us, none of us got into this because we didn't care about people, right? And

Ruth Solomon, MD (18:04)

Yeah.

Pauline (18:05)

I I have had experience working in corporate health care and I had a lot of physicians who reported up through me

None of them were like, yeah, RVU system. I'm really gonna like work this and and make the most money unanimously

they were like this is this is not why I became a physician.

So you're fighting the system with your

Ruth Solomon, MD (18:31)

And I do think that slowly we're going to start seeing more doctors that are moving in this direction, where it's like, let's just cut out the insurance.

Interestingly enough, like health insurance in America really started with a model that one, it was not for profit, but it was not for profit when it first started. But two, it was catastrophic coverage. So it was like, you know, a bunch of teachers got together, said, we're going to pay Baylor Hospital.

I think it was like 50 cents a month. And if any of our teachers get sick, their care is covered. And so was like this idea of catastrophic care that was taken care of. then you still, when you went to go see your doctor, you just paid out of pocket. over time, things have evolved. But that was originally what the model was. And so this idea that maybe we start cutting out the middleman and just direct to consumer, and that way,

keep costs low, unnecessary referrals, unnecessary blood work, we're keeping things more efficient, but also keeping people healthier. I had a patient who basically had urinary tract symptoms, urinary tract infection symptoms, excuse me, and wanted to tough it out because this person had a high deductible health plan, didn't want to end up with a bill.

So trying

to tough out a UTI at home, I don't know how you do that, ended up giving themselves a kidney infection. So now you're in the hospital for a kidney infection for something that could have been taken care of in the office. And it was again, the access to care. Like this person was like, I can't afford to pay out of pocket because my plan is super high deductible, even though I'm still paying a monthly premium anyways on top of it. And I'm gonna have to pay this copay on top of that and ended up in a worse

Pauline (20:13)

Yeah.

Ruth Solomon, MD (20:13)

position.

You know, so that's what I'm trying to do with the direct primary care model is, prevention, prevention, prevention, prevention. Like, let's get in front of problems instead of getting behind them.

Pauline (20:25)

Yeah. You know, I think behavioral health, so psychiatry and s therapy, we've been doing this for a long time because healthcare doesn't value mental health the same way that they do physical health and we couldn't not burn out, we couldn't take care of our families, and so that's why there are so many psychiatrists and therapists who don't don't take insurance.

we hear from from people who call all the time, like, but I have good health insurance. I wanna be able to use my insurance. And I understand that. And also like I know from for therapy what the difference can be between going to a clinic that takes your insurance and seeing somebody privately. And I can explain that when it comes down to like seeing a therapist who specializes in something versus

a generalist who like doesn't have much experience. how would you answer that for your primary care model versus traditional primary care?

Ruth Solomon, MD (21:24)

That's a great question and it is something that comes up often. So what I'd like in it for folks is, the big thing will be like, well, you know, I only see the doctor once a year. And so I'll ask them like, so you only see the doctor once a year. So let's, you know, analyze that a bit. If you didn't have to wait two hours for the appointment, if you were sick and you knew you could be the same day or the next day.

If you knew you didn't have a copay and potentially another bill coming down the pipeline,

Would you see your doctor more often? And the answer is always yes. No one has ever said to me, no, I wouldn't. The answer is always, well, yeah, obviously. I would go away more often if I knew that those things were not in the way. I'm like, well, that's exactly what you're getting. The flat rate allows you to be able to take advantage of what you need when you need it.

And the

beauty of it is, again, if you have to come 10 times for the month, we're good. And that's fine. And I want to see you because I'm not going to make appointments with people if I don't think they're necessary. So let's get in front of these problems before they become bigger problems. And I think that's kind how I have to sort of change and shift it. think also, not to say that we do things for financial reasons, but I think sometimes it can help for people to kind of understand.

If you look at what a marketplace plan is, What's the deductible. So what are you paying in a year just to have the insurance? Then what are you paying for the deductible? Then what are you paying for the copay? And then what is your out-of-pocket maximum? So a lot of people don't understand that there's also an out-of-pocket maximum for a lot of these things before your health insurance kicks in 100%. So if you added all those things up, what I'm trying to get is nothing close to it.

Megan (23:04)

A lot because

my insurance just changed and I'll tell you it's a lot. Insurance, yeah.

Ruth Solomon, MD (23:09)

Right? You know, so what I'm

trying to do, it's a lot more cost effective as well. And there

have been a few studies and a few, data analysis, and it sort of shows that across the board, patients with direct care doctors tend to do better than patients who are in the traditional healthcare system, even those who have chronic illnesses.

And again, because you have access to a doctor who can like, again, get in front of problems, you know, keep you out of the hospital. We're doing everything that we can because I'm incentivized to keep you out of the hospital because that's my job. You know, my whole thing is I want to keep you healthy so you don't have to these other services.

Pauline (23:49)

It's sort of like a shared risk model of you want to see me as little as possible and keep me as healthy as I possibly can. for somebody like me who might be a little suspicious of corporate health care, right?

Often I'm left wondering, do I really need to come back? Or are you just trying to get another or I'll hear this from my clients, or just wanna get another copay out of me? somebody just this week in session said yeah, they can't give you a prescription during your physical. So even if you're out of your medicine, if you're there for your physical, you have to make a follow up appointment to come back

Megan (24:27)

That's true.

Pauline (24:28)

to get a refill

on your prescription.

Megan (24:30)

That is true.

Somebody said we can't talk about this prescription unless you want it because it's gonna cost you Yeah.

Pauline (24:40)

'Cause that's not why you're here. You're here for a physical.

Ruth Solomon, MD (24:43)

And that's insurance companies. That's

Megan (24:45)

Yeah.

Pauline (24:45)

Right.

Ruth Solomon, MD (24:45)

to make sure that you're not gonna get a bill later on. And it's annoying for sure.

Pauline (24:52)

Yeah.

So I mean, I it there's like a million stories, right? Somebody else who who works with us was calling their doctor who they've been seeing for many years and were like, I have a question about this issue I'm having. And the not the doctor, but the the office representative was like, I'm sorry, they can't talk to you on the phone. Do you want to schedule a telehealth visit? She was like, I just wanna ask like a two minute question. And they were like, Can't happen. Do you wanna come in or do you wanna have a telehealth?

and so people don't don't go to the doctor. They don't trust their doc and and I love their I love their doctors, right? Like this is not them, this is the systems that they're working in. And so if I can come and see you from my physical and get a renewal of my birth control, I have now saved two half days from work that I had to take off to go see somebody, months of waiting.

Two copies and I I feel taken care of instead of like a number in a mill.

Ruth Solomon, MD (25:46)

And we can, yeah.

And we can also make sure that we're doing the proper follow-up by monitoring your blood pressure, making sure that we're checking in with the symptoms to make sure that you're not getting migraines and we're doing the things because again, sometimes there's this idea that like, you just take a medication, it and

forget it. No, all these things need to be monitored, you know, and to give you the proper guidance that like, hey, maybe if you were...

getting your depot shot, you shouldn't be on that long term.

There needs to be a break in between. If you're on OCPs, we need to be monitoring your blood pressure to make sure that your blood pressure is okay. And sometimes those things get skipped because you're just rushing, rushing, rushing, rushing, rushing. And again, I can speak to it because unfortunately I was that doctor and I got tired of it and I hated it and I felt like a failure every single day.

And

I was like,

something's got to give. I got to do something different. fortunately, I am in a position where I can do this because I have a very supportive husband. I wouldn't be able to do this if I didn't have my partner on board with me. we're in a place where we can kind of make this happen. And unfortunately, a lot of people, like I was saying before, you just can't because you're just stuck with life things.

Pauline (26:55)

Yeah. The

Megan (26:56)

Yes.

Pauline (26:56)

the the golden handcuffs.

Megan (26:58)

Yeah.

Ruth Solomon, MD (26:59)

The

golden handcuffs, yes.

Megan (27:01)

So let's talk about that. what does this mean for you as a mom to be able to shift to this model and this opening your practice and what what has that been like for you?

Ruth Solomon, MD (27:14)

feel like it's been a really good adjustment that gives me a good work-life balance in the sense that I'm definitely the type of personality that I need to have something to do outside of my kids. I have two boys, they're wonderful. I love them to the moon and back. remember I had my second son, I had read something online. It's like having children is like watching your heart walk outside of your body.

And it's like, that is so true in so many ways. But at the same time, I think that I can be honest and say that being a mom is not the only job in the world for me. That's not enough. I need something else for myself. And I don't think it's wrong to say that. And being able to own my own practice and own my business has allowed me to also get time back for my family. Because before it was like, you know, I would work.

12 hour days and then I'd have to come home and then do my charting and finish. So it's like, leave before the kids get up. I'm home before, after the kids go to bed. And then by the time the weekend rolls around, like, I'm exhausted and I'm not as present or in things as much as possible. And I'm kind of just playing catch up all the time. And I'm just always feeling like burnt and drained. Whereas like now it's like, you know what? Hey, there was a thing at school. I can make sure that I block my schedule so I can go to the thing.

and be there and I can show up for the concert and I can be home for bedtime and we eat dinner as a family and we sit down and talk and those things are important to me. And I grew up with working parents, like my mom worked outside of the house and so I grew up seeing that I come from a working class family so it was a little bit more of the extreme where it's like they worked really long days. So it's like the kids, kind of got to fend for yourself a little bit.

But it was important to me that like, you know, at least like one meal a day, I'm sitting down with my kids and we can like, you know, have that connection. And I think that's important. So it's definitely given me a better balance where I can still do what I love and I can still kind of like follow my vocation or calling or whatever it is that you want to label that. But I can also be a mom and I can be present for my boys and I can be there for them. And I think it's important as a mother

who has

sons that they see here's a woman who's working, here's a partnership between two people who are working together to build a family. And I think it's important to model that because I will hope that, if one day I had daughter-in-laws that they would come back and be like, yeah, he gets it. Cause your mom raised you the right way. It's like, good, I'm glad, you know, like it's important for them to see that.

Pauline (29:42)

That that is

Megan (29:42)

Yeah.

Pauline (29:44)

that's the goal for all of us, right? That one day they're gonna be like, okay, my mom did something right. you know, you were saying like when you were in that traditional model, you were working really hard, long hours, bringing work home, writing notes, and what I heard you say is leaving at the end of the day not feeling good about the work that you do.

we as parents bring our work days home with us even when we don't think we do. There was a study that showed that they looked at the correlation between kids' school performance and their parents' perception of the quality of their day, the previous day, and like when parents felt that they had a stressful or bad day at work.

the kids had more challenges in school the next day. I think when we when we think about parental mental health and we do this work every day because we're not just like helping the person in our room, but we are helping the future generations that when mom can feel good about her work and not work at a pace where she's burnt out.

She can pour more back into her kids and then the kids can have better academic performance, better social relationships, better outcomes. And even though our parents were working parents and they worked hard, working hard 30 years ago is very different than it is today. Like I don't remember my parents were also working people, but like they went to work, they did their job, they came home.

Megan (31:20)

They didn't have a microphone with people sending

Pauline (31:20)

Now, now the

job comes with you. Like there's no end. So I think what you're doing is really helping futures from so many different directions, right? Like you're giving your patients individualized attention where they feel cared for and taken care of and have better health outcomes, and you're doing it in a way that feeds

Your

soul more without the like burnout, and then you can pour into your kids so that they can be healthier functional adults, and I think that like this is what our society needs more of, and not.

Megan (32:01)

we talk about when we talk about balance, right? It's and it's never a perfect thing, but it is like

What we want. talk to my clients about it, it's like the burners on the stove, maybe you can only have three going full blast at a time. And you have to turn down one in order to turn up the other. So if one's like family, your job, your own yourself and friends, let's say. It's like it's really impossible to have them all going at full speed, And we have to take one from the other. And when your job is required.

requiring that you spend a significant amount of your focus. It's not just one other burner that kind of suffers, it's a lot of them. And so this

Pauline (32:42)

Yeah.

Megan (32:43)

is like reclaiming that a little bit.

Ruth Solomon, MD (32:45)

Yeah, absolutely. And I will say that when it comes to burnout in medicine, it does have like a sex difference. And you will see that female physicians are the ones who unfortunately carry more, get more MyCharts, get more inbox calls, get more, with the admin and the extra outside unpaid hours work.

than their male colleagues will. then you're right. It's like, you know, everything suffers. Like I'm not gonna be a good mom. I'm not gonna be a good wife to my husband. I'm not gonna be a good me to me. And I wasn't for a very long time and I can be totally honest about that. Yeah.

Pauline (33:21)

and you know, for many people listening, like they don't have the privilege that you have to be able to break out of those golden handcuffs, right? They need the health insurance, they need the financial security, they need the guaranteed paycheck, right? And so maybe they feel like they have no option.

Megan (33:38)

We need women in medicine. And I I I really do hope that that shifts soon. And I think you're being an example of it is creating a different vision for what women who are young and getting into this practice might feel now. But that that that's not sustainable.

Ruth Solomon, MD (33:56)

Definitely not. And to your point, I do think that again, you're going to see a lot more direct care practices popping up. And something that's kind of been like a nice, like, I guess, side effect of this is that when I'm out and I'm talking to, because, you know, every once in a while, I'll get like a phone call from, you know, maybe like a medical student who wants to like rotate or, you know, they want to do some kind of like shadowing or something. Unfortunately, the current malpractice insurance I have does not allow for that.

But when they ask and they inquire, it's like, yeah, like, and a lot of people are like, I didn't even know this was an option. And I was like, keep it in the back of your head, tuck it back there. Because on graduation, you have other ways of being able to be a doctor than just going into, you know, being employed or going into, a corporate structure or a private practice where you have to take insurance. There are other avenues for you as a physician.

Pauline (34:45)

And there are probably

ton of people listening who were like, yeah, and I can't afford to pay my health insurance and also pay you a monthly fee.

this happens in behavioral health all the time. Like where we we we do the cost comparison, it makes complete sense to us. And then also they're not feeling that same cost comparison because they're comparing against, I'm not gonna go to the doctor. I'm not going to go to a specialist. I'm not going to pay my deductible. I'm not going to pay my co insurance. And so paying for you monthly is more. And that's unfortunate. And

That is the state of our healthcare system. But more and more, and I don't think that this is a good thing necessarily, but more and more people are choosing not to spend money on health insurance. Like I'm hearing so many people say, like, I think I'm gonna just take the risk and like pay the penalty, and it's because health, especially in New York, health insurance is so expensive.

And so if people are making that decision, this kind of model seems like a no brainer, right? 'Cause

Ruth Solomon, MD (35:51)

Yeah.

Pauline (35:52)

it or they buy the catast catastrophic plan and use this kind of model.

Ruth Solomon, MD (35:55)

Yeah.

Megan (35:55)

That was my question. Do people

use typically if they or do some people that use this model then they'll go and buy a catastrophic plan for if they need to be hospitalized if something major happens like that.

Ruth Solomon, MD (36:09)

Yeah, so the catastrophic plan is an option if you unfortunately were in the hospital or you had an emergency department visit or something of the sort, just so you have that as a backup. The other option is something called health shares. And to be honest, I wasn't even aware of this until I was doing my research into how can I pivot from where I'm at

because I was actually thinking about just leaving clinical medicine altogether. So I was like, what can I do with my doctor skills?

Because yeah.

Pauline (36:38)

Which is crazy when you go

back to the beginning of this conversation where you talked about how much training and education and competencies you have to have as a family medicine doctor and you were so

burnt out that you were like, Mm, maybe I'll just bake cookies leave medicine altogether.

Ruth Solomon, MD (36:55)

Yeah, yeah, that's kind of where I was at. And so in my research of direct primary care, I learned about health shares. So health shares are not health insurance, but what they are is basically

Everyone's saying that we're going to pool our money together. And this is like a list of things that will be covered by this health share. So sometimes people will do that because the monthly expense is a lot lower. And then you have like the hospitalization or the emergency care that will be covered with Unfortunately, no system is perfect. So with health shares, you have to be very good about reading the fine print to make sure that you know exactly what's covered because they basically will list out like, this is what we take care of.

Pauline (37:32)

for the everyday person, you don't know what you don't know. It's like when I go to

Ruth Solomon, MD (37:34)

Mm-hmm. Right, yeah.

Pauline (37:36)

buy a car and they're like, Do you want all these things? I'm like, I I don't know what those things are. Like, sounds

Ruth Solomon, MD (37:41)

Right.

Pauline (37:42)

great. Sounds like you're offering me a lot and also

I don't know what those are. I can't imagine having to like read the fine prints and know what all of the possible things I might need are.

Ruth Solomon, MD (37:53)

Yeah, as with everything, like some health shares cover more than others, but those are also an option that are out there as well. So yeah, like catastrophic coverage or health shares, just to make sure that you have like those, big unexpected things that we can't predict in life covered. I do have some patients that will have like a high deductible health insurance plan their employer and they have a health.

savings account and as of this year, health savings accounts, you can use that money to pay for direct primary care memberships. The IRS made that it's okay to do that. So I do have a handful of patients that also do that as well. They just have like a high deductible plan at work and then they use their HSA dollars to pay for their direct primary care membership. So that's another option as well. and I always tell people like, again, full transparency in all things.

Direct primary care might not be for you and your family. You kind of just have to like sit down and figure out what works. But at the same time, what I do want people to kind of take away from it is, I'm giving you everything upfront so you know exactly what you're getting. You kind of have to sit down with your insurance and do the math and calculate. And when you really take in how much you're spending, this is a lot less and you get a lot more for a lot less, you know.

But yeah,

so those are like other options for like supplementing if you will.

Pauline (39:07)

So these direct primary care models are popping up all over the place. You are in Suffolk County on Long Island and licensed in New York

State.

Ruth Solomon, MD (39:16)

Mm-hmm.

Megan (39:17)

I imagine they're really helpful in more rural places as well, where you don't have these large hospital corporations that have a lot of providers. I'm imagining that that could be really helpful, but I

Ruth Solomon, MD (39:30)

direct primary care practices are killing it. They do

Megan (39:32)

Yeah.

Ruth Solomon, MD (39:33)

extremely well for exactly that reason. You don't have like a ton of resources around and you know, a lot of the doctors are full. like you just physically cannot take on any more patients. So yeah, even like in upstate New York, you know, there are direct care practices and they're doing fabulously. Like they really do serve a need for patients and everyone in the community is happy, you

Megan (39:55)

It's so important. I mean we know that like are closing around the country and in rural areas, so there's deserts, really healthcare deserts, to be able to have someone who can who they can go to for these needs, so

Our podcast

is obviously what no mom told you. When it comes to being a mom, being an owner of a direct primary care model practice, what's the one thing that no one told you that you had to learn the hard way?

Ruth Solomon, MD (40:25)

so kind of, think in a positive light and sort of like circling back to what we had talked to earlier, being a working mom makes me a better mom. Like having a job outside of the home makes me a better mother. And I think that, you know, I, I've taken time off between kids where like you're at home and you're kind of in the thick of it. like, I wouldn't say that I was like a hundred percent like a stay at home mom for a very long period of time, but like being at home.

and like sort of like your only, I focus is your kids. That for me is a very bad thing and it doesn't work well for me. And I think it's wonderful that there are women out there who are stay-at-home moms. I think that's amazing and it's incredible and it is probably one of the hardest jobs on the planet. And I don't take away from that, but just for me as an individual, I'm a better mother when I'm working 100%.

I am more grounded, I am more focused, I am mentally in a better space. I can pour into my kids more and I can really be present in the moments that I'm sharing with them.

And I don't take the time that we're spending together for granted. So I would say working has made me better as a mother.

Pauline (41:36)

I love that.

And I I I'm gonna argue that probably being a mother has made you a better physician. But

Ruth Solomon, MD (41:43)

10,000 % true,

absolutely. there is no, know,

Pauline (41:46)

Goes both ways.

Ruth Solomon, MD (41:48)

Oh, a hundred. like in other countries, when you're doing training for doctors, a lot of the time there's, instead of having like an undergraduate degree first, and then you go into medical school, some countries will have like kind of a combined program sort of a thing. So you end up having doctors who are much younger when they graduate and start practicing than, you know, in the US.

there's pros and cons to everything. But I think there's something to be said for having a person who has life experience, who is then taking care of other people.

Even when I was in residency, it was very common

to have a mom come in with her kids and the appointments for her. And the kids are just coloring in the coloring book or whatever. And that's just like, know, because you have to take care of mom when she doesn't have a babysitter. And you just, you have to have that level of understanding. But the level of like, man, girl, I get it. Like, trust me. Because now I've got my own two little rascals are all over the place and are doing all the crazy stuff. And when I have moms who like, even just like the mom guilt that comes with

well, I didn't do this and I didn't this. Like, girl, I'm a board certified physician. My kid ate strawberries for dinner. Like you pick your battles. It's fine. You're doing the best that you can.

Megan (42:47)

Totally. Totally. I don't have

Pauline (42:49)

Yeah.

Megan (42:53)

the judgment of parents that I would have had when I was twenty-six. You know? It's like, yeah, no, we're all struggling here. We're all in this together. We're all figuring it out. I'm just gonna help you figure it out and then I'm gonna go to the person who's gonna help me figure it out. You know? It's like that's what it is.

Pauline (43:10)

Yeah.

Ruth Solomon, MD (43:10)

And that's it.

Megan (43:11)

yeah.

people want to know about

Your practice, your website is aprilmd.com. Is that right? We'll

Ruth Solomon, MD (43:20)

Mm-hmm. Yep.

Megan (43:21)

we'll definitely post it

in our notes, but I wanted to make sure that we shout shout that out for you.

Ruth Solomon, MD (43:27)

my

social media handles for Instagram, TikTok, Facebook. It's @AprilMDLI for like Long Island. So it's all the same. So if you go Instagram, @AprilMDLI, you'll find us and then all of the silly videos that I do.

Pauline (43:42)

Yeah. And we're

gonna drop all of this information in the comments below. So make sure like, comment, and follow. And if you've heard that before, sorry, but it actually makes a difference. So thank you.

it has been so much fun getting to chat with you about primary care and physician moms. So shout out to the physician moms out there who are doing double duty taking care of everybody. Thank you.

Ruth Solomon, MD (44:09)

thank you so much for having me. This was super fun.

Megan (44:12)

Thank you for being here.

Pauline (44:12)

It was fun, thank you.

I will think of you when I'm sitting in the waiting room waiting for my doctor, who I adore and also has a very crowded waiting room.

Ruth Solomon, MD (44:22)

Well, when that person retires, you can call me.

Pauline (44:26)

Thanks everybody for listening.

See you next time.