Dr. Kaneriya | MD Internal Medicine
About This Episode
Doctor Shalini Kaneriya takes John on an engaging conversation revolving mostly around what it’s like to be a doctor as well as how she ended up starting her own practice. Dr. Kaneriya also shares some insight on how she got to where she is now and some advice from the road.
[00:00:03] Speaker 1 Here we are with another episode of the Go with John show, and today we have Dr. Kaneriya with us. Welcome.
[00:00:10] Speaker 2 Thank you, John. Thank you for the opportunity to participate in your podcast.
[00:00:14] Speaker 3 Thank you.
[00:00:15] Speaker 1 Yeah, I was looking forward to having you come in for a long time. So tell us a little bit about what you do. So your doctor, you have a practice you’re in. Where are you located?
[00:00:25] Speaker 2 I’m located in Herndon, Virginia. OK, so I finished medical school in two in 1998 and started practicing medicine in 2001. OK, I will tell you that to my parents dismay, I never thought I would have my own practice, never thought that that was in the books for me. I, I enjoyed doing what I did, doing what I do and working for somebody. So I’m excited to share my story.
[00:00:50] Speaker 3 Great.
[00:00:50] Speaker 1 So where did you go to medical school?
[00:00:52] Speaker 2 So I went to medical school in Pennsylvania. I went to Jefferson Medical College. It actually is a six year combined program. So I don’t know if you know what I can find.
[00:01:01] Speaker 3 I have no idea.
[00:01:02] Speaker 2 I went to Penn State for two years right outside out of high school, OK? I knew that I was going to be a doctor.
[00:01:09] Speaker 3 Wow. So I was like a straight shot.
[00:01:11] Speaker 2 So I’m going to make a joke here. I think I had three choices.
[00:01:15] Speaker 3 Yeah.
[00:01:16] Speaker 2 As a senior in high school to be a doctor, to be a constitutional lawyer or to be an engineer. This is for my parents and.
[00:01:26] Speaker 3 Oh, your parents gave you those options. OK, if
[00:01:28] Speaker 2 I didn’t want to be a doctor, I could be a constitutional lawyer. Right. Or I could be an engineer. And honestly, I really had a skill set that was meant to be a doctor. And I’m joking about this. But, you know, my parents were immigrants. They came to this country in the 1970s. And honestly, they felt that the most important thing was security. Right. Security of a career. So being a math teacher might not be the most secure career, albeit it’s a valuable and necessary, you know, occupation. So that’s when I decided and honestly, I, I would not look back. Now, the same question is going to happen. My son is 16 and a half. Right. Will I do that to him? No, because we’re in a different situation, right?
[00:02:09] Speaker 1 Yeah. So how tough was it growing up with your what kind of a life did you have at home with your parents? And, you know, it’s really interesting. A lot of the very successful people that have been on this show came from very, very humble beginnings. And they were very happy.
[00:02:24] Speaker 2 I had an amazing childhood. I had no trauma in my childhood. My mom stayed home. She took care of us. I was the oldest of three. My dad worked full time. There was never an absence of love, Mom. I had all my needs met. But did I wear the latest clothes? No. Did I shop at fancy stores? No. Did we go on fancy vacations? No.
[00:02:46] Speaker 3 Did you care?
[00:02:46] Speaker 2 Did I care?
[00:02:47] Speaker 3 Absolutely not. Right?
[00:02:49] Speaker 2 Absolutely not. And I was never wanting for anything and I absolutely appreciated what they did and what they could give me.
[00:02:57] Speaker 3 Right.
[00:02:58] Speaker 1 Right. It makes you who you are.
[00:02:59] Speaker 2 Yeah, absolutely. And even now, you know, my my you know, you know, kids. John Lee, your son, when you leave the house, the first thing you want is, can I get water? Can we stop somewhere? And I always make the joke. I said there were no water bottles when we were growing up.
[00:03:12] Speaker 3 Right. You drank water from this tap, right. Or the creek or the.
[00:03:17] Speaker 2 Yeah, maybe. And then you got in the car like you didn’t stop anywhere. There was no there was none of that. There was no door dash and Uber and things like that that we, we
[00:03:26] Speaker 3 all have to. It’s crazy.
[00:03:28] Speaker 1 I still can’t get my head around all that.
[00:03:30] Speaker 2 I know.
[00:03:31] Speaker 3 I know.
[00:03:31] Speaker 1 Yeah. So grew up in Pennsylvania. I grew up in Boston, grandma.
[00:03:35] Speaker 3 I grew up in Virginia and Annandale. Oh wow. OK, I’m a local girl.
[00:03:39] Speaker 1 Wow. Yeah. So, so that’s fantastic. What part of Annandale.
[00:03:43] Speaker 3 What Street
[00:03:45] Speaker 2 Monoplane off of
[00:03:46] Speaker 3 Woodburn Road. Wow.
[00:03:47] Speaker 2 Yeah I was, I went to TJ for high school and I was a candy striper at Fairfax Hospital.
[00:03:55] Speaker 3 Very cool. Very cool. I know.
[00:03:57] Speaker 1 So then you go to
[00:03:58] Speaker 3 college, go to college
[00:04:00] Speaker 2 there for two years. That’s and that’s a unique I mean that’s a difference. I would say, you know, it was a good school. It was a great school. I wouldn’t change it. But it defined who I was to not have a four year college experience. And you get to go straight to medical school, right? I was in medical school at age eight. Nineteen.
[00:04:19] Speaker 3 Wow.
[00:04:20] Speaker 2 So I, I was a full fledged MD by twenty twenty two.
[00:04:25] Speaker 1 That’s amazing.
[00:04:26] Speaker 3 Yes, that’s amazing.
[00:04:28] Speaker 2 But it changes you. Right. So I’ve had a long career. I’m forty six. Right. So I’ve been practicing since two thousand one. Yes. Right. So I, you know I maybe you know the same. Most people my age have not been practicing as long as me.
[00:04:41] Speaker 3 Right.
[00:04:42] Speaker 1 Right. So you get out of college and you go to work where.
[00:04:47] Speaker 2 So first college. That’s cool. Yeah. Then I was still in Philadelphia. I was at Penn for my training. There’s three years, there’s four years or two years of college, four years of medical school. And I did three years of training
[00:04:59] Speaker 1 right now at your
[00:05:00] Speaker 2 internship. That’s my internship and rest. And then my first job was in Boston at Brigham and Women’s Hospital.
[00:05:06] Speaker 3 Wow. So, yeah.
[00:05:07] Speaker 1 So how did you get that job?
[00:05:09] Speaker 2 I applied to I knew I wanted to be in academics. OK, I wanted to be at the best place. Right. I was engaged. I actually got married. My husband was up there too. And he was his is a physician. He was in training. And Boston was an amazing, amazing experience. It was a great job. I worked with super big wigs. You know, it was interesting to be a smaller fish in a big sea.
[00:05:32] Speaker 3 Mm hmm.
[00:05:34] Speaker 2 I wouldn’t it really helped me. You know, I came from an academic setting. I came from Penn. Then I went to Boston. Right. And it was wonderful. So it was actually really hard for me to transition back to Northern Virginia after being at, you know, what I would consider one of the meccas of, you know, medical care.
[00:05:53] Speaker 1 So how long were you in Boston? Five years. Five years. So then you come back to Virginia? Yeah. And what did you do when you got to Virginia?
[00:06:00] Speaker 2 When I came back to Virginia, I decided to be a hospitalist. So hospital medicine. I’m sure you now know it’s the people who take care of the patients while they’re in the hospital. And that was in 2005. OK, so I was a hospitalist at Fair Oaks Hospital. I decided to do that so that I could meet. A lot of people need a lot of doctors. I could see how care was rendered in Northern Virginia. I didn’t I didn’t know what it was like. I didn’t want to take another job because leaving a job is a big deal. Right. You know, and, you know, in medicine, people don’t leave jobs like they stay in the same job forever, even if they’re unhappy. You know, I think this generation that’s coming out now is probably going to be better at making
[00:06:42] Speaker 3 changes, leaving the building and leaving. Right.
[00:06:45] Speaker 2 And asking for what they want from the beginning. Right. And that’s that’s a big deal for my generation, I would say, John.
[00:06:51] Speaker 3 Yeah, we
[00:06:53] Speaker 2 weren’t in a lot of us, especially female docs aren’t good at. Telling what we want, sharing what we want.
[00:07:03] Speaker 3 So what do you think that is?
[00:07:05] Speaker 2 I think we signed this oath, the Hippocratic Oath. It says that we, you know, are committed to our patients. And so that line gets blurred very easily. The line between, you know, our health and their health. Right. Right. And I still struggle with that now. But in my you know, we’ll talk later. But in my current model, I just have fewer patients. So there’s I’m able to set boundaries better. But I think it’s a really common thing. And there’s a high, high need. Right. Everyone needs something from you. And I think in medicine, it’s different than other businesses. And you can I’d love to hear what you think about that. Sure. It’s almost like you have to help somebody. Like there’s no end of your day. There is a moral obligation to assist.
[00:07:52] Speaker 1 Right. And I think I think in real estate, it’s very similar. You know, when you’re when you’re helping somebody with their their their house transaction and they’re trying to sell their house or they’re trying to buy a house they can’t sleep at night. And, you know, you get that phone call at eight o’clock at night and they’re they’re worried and they’re anxious. And you spend half an hour chatting with them and you can bring comfort. You know, you may not be able to solve the problem, but you can at least say, you know, here’s what your options are. We can do this. We can do that. And really, it’s only been in the last, I want to say, the last five or 10 years where in the real estate contract, the day ends at nine p.m. So any business that hasn’t been conducted before, nine p.m. now goes on the next calendar day before that was in the contract. It was not unusual for me to be out at somebody’s house at 11 o’clock at night because they couldn’t sleep. So I can totally you know, if you’re going to represent people in a real estate transaction and you’re going to do it with your heart and you’re going to put your heart and your soul into it, when they have a problem, you have a problem.
[00:08:59] Speaker 3 And you.
[00:09:00] Speaker 2 So that’s exactly the same. Yeah, it’s and it is. I remember when we moved here and I remember how many times we texted back and forth and called the the agent that we used and yes. Our current agent when we sold our house. You know, you’re right. If they become like family, especially when they’re good.
[00:09:16] Speaker 1 Yeah, exactly. You know. Yeah. Because they have the they may not have the answers, but they at least they have the options.
[00:09:21] Speaker 2 Yeah, that’s true. And you know, I think that’s half of it. Right. Having someone there that cares, that knows what you want.
[00:09:30] Speaker 1 Right. And it swallows you up whole.
[00:09:32] Speaker 2 That’s what I know. Because you need that. Yeah, you need that. And especially whether it be medicine or real estate. So I would say that, you know, I was looking for the right practice. I was looking for the right practice to join. And I actually found it. And I was there for eight years. Right. And so, you know, you probably don’t know. You know, people just know the local practices. Sure. It was a practice in Fairfax. Right. And there were two other docs there at the time. And honestly, that was my home for eight years. And I think I grew my practice, my base. Yes, my my patient base. I established it and I established my reputation right. With my peer group. Right. Just like as an agent, you would establish it within Long and Foster and then, you know, outside of Long Foster with different different companies. Yeah.
[00:10:17] Speaker 1 And your reputation is everything.
[00:10:18] Speaker 3 Yeah. Same rules. Yeah.
[00:10:20] Speaker 2 I mean, and you know what? You have to go the extra mile every single time.
[00:10:24] Speaker 3 Yeah.
[00:10:25] Speaker 2 It doesn’t matter. And so I did it then and I have to continue to do it now and it just becomes a way of living sort of you know your sort of your creed.
[00:10:35] Speaker 3 Yes.
[00:10:36] Speaker 1 Yep. Yep. Exactly. So you were at this practice for eight years and then what.
[00:10:40] Speaker 3 Yes.
[00:10:41] Speaker 2 So that’s that’s what the pivotal moment. Again, I don’t know if there’s an analogy in real estate, but medicine is changing and has changed quite a bit. Yes. And it is increasingly being managed. And I felt like I didn’t want to sacrifice being the patient centric focus that I had just because we were managed. I never wanted to lose sight of the patient. And I felt and, you know, I think this is sort of just what people feel. I felt that I could do it better.
[00:11:16] Speaker 3 Right.
[00:11:17] Speaker 1 So when you say you were managed, what does that mean?
[00:11:19] Speaker 2 So managed means when you work within a company, it’s really not even the practice. We were part of a physician organization, physician management group. And the goal of that is really to maximize outcomes. Outcomes means avoid hospitalizations,
[00:11:37] Speaker 3 reduce
[00:11:38] Speaker 2 illness, reduce hospital days, medication use. I mean,
[00:11:42] Speaker 3 so increase revenue,
[00:11:43] Speaker 2 increase revenue, write, reduce need of insurance to pay out. Right. OK, so when you do that, what happens? You have to document you. There’s just a lot of I’m going to call it nonsense. I understand why. Right. But you have to be efficient. When you do it. Mm hmm, you have to be efficient and then you have to continue to be patient focused, right? You can’t just be typing and getting all this data. And so that was I found that I felt like I could have done it better. Mm hmm. That was in my head. But that was what drove me to to leave that practice and join and start my own right.
[00:12:18] Speaker 1 So is it was it was there was there a part of you that also said that I can create a better life for myself? There’s got to be a better way. Did you have so burdens or stresses at night when you got home that you said, you know what, there’s got to be a better way to live?
[00:12:34] Speaker 2 You know, I’m going to really tell you, I my life was my lifestyle was I was I was OK with my lifestyle. I worked hard financially. I was I never thought about it. From a financial standpoint, I’m going to be really honest with you. Sure. What drove me was wanting to be able to continue to go the extra mile and continue to keep my reputation where it was and be surrounded by like minded people who felt that there was a mission. And I didn’t feel that in my current in that practice, I felt that people were jaded. Yeah. And most practices people are jaded, right? They’ve had their own experiences. They’ve been in the health care field for a long time. So they their outlook on patient care is, you know, they don’t have to make eye contact. Maybe they can be they don’t have to say the please and thank you. Right. There’s just even more of that. And to me, that’s really important.
[00:13:31] Speaker 3 Mm hmm.
[00:13:33] Speaker 2 And that creates a sense of trust.
[00:13:35] Speaker 3 Right.
[00:13:36] Speaker 2 And then that trust, even at the front end, helps
[00:13:40] Speaker 3 me at the back end. Mm hmm.
[00:13:42] Speaker 2 Right. Mm hmm. So I felt that that whole interaction, I wanted to own it.
[00:13:47] Speaker 3 Yes.
[00:13:48] Speaker 2 And kind of way into it and define
[00:13:51] Speaker 3 it, if you will. Yep. Yep.
[00:13:53] Speaker 2 And so I knew that was a big undertaking. Yes. But and and I was I was discouraged
[00:13:59] Speaker 3 by who
[00:14:00] Speaker 2 I was discouraged by, you know, the Accountable Care Organization. I was part of the management. They said really no docs going on their own right now. Right. Right. No. You know, friends were like, you know, your your kids are going into high school and you really want to do this. This is they need you.
[00:14:16] Speaker 1 Yeah. This is really important what you’re telling me.
[00:14:18] Speaker 2 Like, I was definitely my husband did not discourage me. He was my biggest advocate. My parents in my my family were my biggest advocate. But I would say that I was people that of always just say, are you sure you want to do this? Yes. It’s OK where you are.
[00:14:34] Speaker 3 Right. Is it that bad? Yeah.
[00:14:38] Speaker 1 The reason that the reason I’m laughing, it’s been really almost every single thing, especially when I was young, because I don’t listen to anybody anymore when they tell me you can’t do that or it’s not going to work because but every single thing I’ve ever tried to do in my life, when I share it and I’m excited about it and I’m telling people that I want to do it, the naysayers, you are surrounded by naysayers in this world and I don’t really understand what it is. Do they do they genuinely care about you? Do they are they really worried that you’re going to fail or are they afraid you’re going to succeed? I really don’t know what the answer is or why there’s so many naysayers around. But but I but I think the people that are successful when when you hear stories like this, I hear this kind of a story over and over and over again. Everybody told me I couldn’t do it. It wouldn’t work. And, you know, so congratulations for listening to your own inner voice and pushing through.
[00:15:32] Speaker 3 Right.
[00:15:33] Speaker 2 And I think you’re right. I mean, there’s so many reasons for naysayers. I think in mine it was more risk aversion, right? Yeah. You know, it’s a lot of work. Do you really want to go do that? Right. And is it really that bad? And honestly, it was the best thing I ever did. And I think the reason is it allowed me to learn how to take a risk.
[00:15:51] Speaker 3 Mm hmm.
[00:15:52] Speaker 2 That’s let’s just start there, right. As a human being, I’m able to take a risk. It changed me as a person.
[00:15:58] Speaker 3 Doesn’t it feel good?
[00:15:58] Speaker 2 It’s amazing. Yeah. And and it it gave me more confidence in myself. Yeah.
[00:16:03] Speaker 1 And you didn’t really have any business experience.
[00:16:05] Speaker 3 Zero.
[00:16:06] Speaker 1 And you had no business classes in your school. Really. Just the
[00:16:11] Speaker 3 basic zero. Zero. Yeah. So, so, so that was bold.
[00:16:16] Speaker 2 But there was an algorithm. Yeah. OK, there was an algorithm in this sense that I just followed a list. Yeah. What I needed to do.
[00:16:25] Speaker 1 So Dr. Kaneria, that is really amazing and so impressive that you just went out and started your own business. So we’re going to take a quick break. And when we come back, let’s learn more about the steps you took to get your practice started. So we’re here today with Dr. Kaneriya. We’ll be right back. All right, we are back with Dr. Kaneriya, and thank you so much for sharing your story. It was it was it was great to hear that. And it’s always nice to hear how the parents influence and their foundation is laid for success later in life. So it’s pretty amazing. So tell us, how so so you you were out of great practice and you wanted to go out and start your own business. How did you do it?
[00:17:12] Speaker 2 So first of all, I think I was determined, you know, and so I made a landing page, you know, I couldn’t solicit my patients, so I made a landing page and patients could find me. Right. Right. I had a friend who helped me manage those patients in those messages and, you know, assuring them that I was going to be right back. So I knew that people wanted me back. Yeah. I mean, I got some phone calls. When I left that practice, I left kind of abruptly. I had people call my my dad to find out where I was. Wow. This gentleman who had been taking care, he says she’s my doctor. Yeah.
[00:17:46] Speaker 3 Where is she? You know,
[00:17:49] Speaker 2 I had someone drive to my house. They looked me up my good to make sure I was still OK. I mean, so I got a lot of love during that time and I realized even more so that I had a mission. Yeah. Come back. Right. Like it wasn’t just I couldn’t just take a take a break. Right. I had some friends to take a break. Take a year off. Yeah. They said I can’t
[00:18:09] Speaker 3 I mean,
[00:18:09] Speaker 2 yeah they people need me
[00:18:11] Speaker 3 back. Exactly.
[00:18:12] Speaker 2 So I, I had to get find space first of all. Right. And at first I thought I want to have a beautiful space like, you know, esthetically pleasing.
[00:18:23] Speaker 3 Right.
[00:18:23] Speaker 2 A beverage station and then in the waiting room, you know, that’s not financially feasible when you’re starting out. Correct. And you know, John, I think you’ve actually been to my Yes. Space before. I have seen space. And a dear friend, physician friend offered to lease me space at a very reasonable price. And I was there for two and a half years. And it was a very simple space. And I wouldn’t call it threadbare, but it was very simple.
[00:18:53] Speaker 3 Right.
[00:18:53] Speaker 2 And nothing fancy about it. You know, furniture was probably from my father, my father in law’s practice, urology practice in Pennsylvania, like literally it was twenty plus years old.
[00:19:06] Speaker 3 Yeah.
[00:19:07] Speaker 2 I never did a patient once comment
[00:19:10] Speaker 3 on the way it looked. Sure.
[00:19:12] Speaker 1 Never, because it’s really not about that. It wasn’t about the human connection.
[00:19:16] Speaker 2 It I never got a comment once. Right. You know. Oh my gosh this doesn’t look nice. Is this new is it’s not because it was neat. It was neat and clean. And that’s when I realized, you know, that they don’t care about the fluffy. Right. So I just needed to focus on getting the billing, getting the staff and, you know, and then holding on to the patients.
[00:19:37] Speaker 1 Right. So website office,
[00:19:41] Speaker 3 space office, space
[00:19:42] Speaker 1 station staff,
[00:19:44] Speaker 3 equipment and then equipment.
[00:19:45] Speaker 1 That’s a lot of ground to cover.
[00:19:47] Speaker 3 Yeah, but
[00:19:47] Speaker 2 I will tell you, the hardest part was
[00:19:50] Speaker 3 staff. Yeah.
[00:19:52] Speaker 2 Because I that’s really makes or breaks the business.
[00:19:55] Speaker 3 No.
[00:19:56] Speaker 2 Have you had those kinds
[00:19:57] Speaker 3 of struggles
[00:19:57] Speaker 1 and we have. Yeah. And in fact I think that that’s and you and I have talked in our business discussions about how difficult it is with people. We’ve had we’ve had periods of time. You know, I bring Nick into the conversation routinely on the on the podcast. But Nick has been in many, many, many our meetings with me. And it’s really it’s really so hard. You got to have the right people that fit with your personality, with your management style, you know, and I’m really a hands off, you know, manager. You know, I give people policies and procedures and direction, but I don’t really stand behind people and make sure they do their stuff. So if you have somebody who’s not going to read and follow the processes, then we have a problem. Right. So unfortunately, I’ve gone through some difficult times where we didn’t have the right folks with us and we had to work through it. And but it is everything. I mean, I think the folks that you work with make or break your career. I think for me, my dad, my business day.
[00:21:00] Speaker 3 Yeah.
[00:21:01] Speaker 2 And they’re also your tribe. Yeah, they’re good people. They it’s not just that they’re, you know, the people that do things for your pay for your product. Right. For your business. They really are your people. And I think when you realize that so I knew that I wanted people who felt the same way about patients and that were as hard working. And I knew that I had to model that hard work, which I was willing to do. Yeah. So, you know, I would say that it took me a long time to ever leave before my employees. I would say that probably happened in the last year and a half, like it was not a common occurrence. Right. And, you know, I it was funny because in the beginning I would be the person that would turn the lights on. Take the trash out. Yeah.
[00:21:38] Speaker 3 Do everything. Yes, literally.
[00:21:40] Speaker 2 Yeah. And I, I remember telling myself that I would know that I’ve made it or progressed when I wasn’t the. And doing those things right and finding the right people and understanding how to hire people, you know, not falling for, you know, just just doing enough research and understanding who is going to be a right fit, what.
[00:22:00] Speaker 3 Yes. What they need. Right.
[00:22:01] Speaker 1 It’s impossible to
[00:22:02] Speaker 3 predict.
[00:22:03] Speaker 2 And I’ve learned that. I’ve learned that. But I’ve also realized that if it doesn’t work out, it’s OK. You just get back and find the right person. Right. You know, and the people I have now and the people I’ve had, I really am lucky, really lucky. I try to find people who I can take care of. Right. Who then take care of me and take care of my patients. And that’s and they know what I want. I my nurse right now, Emily, she’s always you know, when she’s training someone new, she’ll say Dr. Kaneria loves it when people write things down. Right. They want to know that you’re learning and picking up stuff. So, you know, if she says anything, make sure you’re writing it down. Right, because she does not want you to believe that you can
[00:22:45] Speaker 3 remember it in your book. You can’t. And we have that. I mean, I’m like
[00:22:48] Speaker 2 very big on that. Like, yeah, right. It if I’m talking, please write it down. Yes. Like I need to see you writing.
[00:22:53] Speaker 1 Yes. We have that rule here. Oh do you. So yeah. Well we’re having a meeting. Somebody better be taking minutes.
[00:22:59] Speaker 2 There is not this like memory thing going.
[00:23:01] Speaker 1 Oh it doesn’t exist because everybody remembers what they want to remember. Yeah. Yeah. And they remember it. How they want to remember that.
[00:23:07] Speaker 3 Yeah.
[00:23:08] Speaker 2 And I would say I’m different than you John because I didn’t delegate because the product was me. Of course I was the products of that. That is something that I have learned now. Yeah. And it took me much longer. Four years. Yeah. I would say four to five years. Whereas you, you know I think some people are better at it and it took me adding another physician to be able to learn, you know, her saying to me, why, why are you doing that.
[00:23:36] Speaker 1 Yeah, but we’re not we’re not that different because I you know, when I went into real estate, I did everything myself. I was answering at one point one hundred and fifty emails a day. Not not to one hundred and fifty different people. Yes. But you get conversations going. Yes. And at the end of the year I save all my emails and for three years anyway. But I back them all up and you know, and then I could divide by three hundred and sixty five because I think that’s how many days we have in a year. And I would get the answer to how many emails I was doing in a day. So when I hired my first assistant part time way back in the day and she’s still with me today. Oh my gosh, I don’t know how many years ago that that is, but we were we were doing one hundred and fifty emails a day. And that first hire was that was the hardest one. But I did everything myself and answered every phone call, answered every question, went to every single listening appointment, went to every single settlement. Did you know just just like Lillian Jorgensen my mom does today? Yes. Yes. And, you know, it’s I’ve grown to the point where I’m forced to delegate and I don’t really like delegating. And that’s really my own. My own. One of my flaws is that a lot of times I can do it myself faster than I can explain to somebody else how to do it right.
[00:24:49] Speaker 2 And I think about that and I think about that. And I think I am doing a disservice if I’m just doing it faster. Exactly. I’m catching myself now and saying it’ll take me two steps or three steps more to tell someone to teach someone a they’ll learn something. Yes. And the business will eventually be more efficient. So I’m telling myself that. But it’s an active thought process. It’s hard,
[00:25:11] Speaker 3 it’s hard, it’s hard, it’s
[00:25:12] Speaker 1 hard. And you keep growing. You’ll get forced into it.
[00:25:15] Speaker 3 That’s true. That’s true. Because you just have no choice.
[00:25:18] Speaker 2 Well, because you can’t answer those emails and that email somebody else and they say, could you help
[00:25:22] Speaker 3 me with this exact response? Yeah, exactly. Exactly.
[00:25:28] Speaker 1 So so you said you were going to feel successful when you weren’t the one taking out the trash. Yeah. And so really a benchmark that you had for your.
[00:25:37] Speaker 2 It’s a it’s a it’s I’m being facetious. I know you say that. I would say that my success didn’t come though after I transitioned to my own practice. Of course, I was doing that for from twenty sixteen until twenty eighteen.
[00:25:55] Speaker 3 Right.
[00:25:55] Speaker 2 And John, I kid you not like it was like you described. I was seeing twenty three to twenty five people a day. Right. Charting and note taking and documenting and answering phone calls for several hours more. Yeah I had a good staff. I mean it’s not like I didn’t have, I had, you know, front desk, I had medical assistance, I had a nurse, but it was too many patients, too much to do to do it the way that my brain likes to do it.
[00:26:19] Speaker 3 And your heart.
[00:26:20] Speaker 2 Yeah. And my heart. Yeah. You know, and that was tough. And I went through a really tough period where I thought, I just don’t think I can do this. Like, this is really hard and it’s hard because my patients wanted me and I hadn’t trained them well enough to be able to be OK with a physician assistant or in what we call mid-level, you know. Sure. Person like a physician assistant or nurse. Practitioner, then it was really hard to find an associate. Mm hmm. You know, I was thrilled. I was looking and you know what? People didn’t want to jump into the fire with me.
[00:26:58] Speaker 3 Right, right. Right. I mean, can you blame them?
[00:27:00] Speaker 1 No, because you’re crazy. You started your own business.
[00:27:03] Speaker 3 Yeah.
[00:27:03] Speaker 2 Like, you know. You know, and when I would you know, when I was interviewing other physicians, the first question they would ask me was, when are you going to a concierge model? Right. And I was thinking, OK, I’m really sorry. That’s not what I’m looking for right now. I’m looking for someone who wants to do what I’m doing. And it just increasingly became evident that the practice was not going to grow
[00:27:26] Speaker 3 right in this model. Yes.
[00:27:29] Speaker 2 And then my lifestyle wasn’t going to change and my family was suffering. My kids were suffering. And actually I was suffering.
[00:27:35] Speaker 1 Right. And so that’s where you get to the point. Yes. That I was looking for before, where you start to tell yourself there’s got to be a better way.
[00:27:42] Speaker 2 There’s got to be a better way. Yeah. And so I think my husband and I had a heart to heart where he said, look, something has got to change and this is for you, right? You’re not seeing your kids grow up. You’re just working all the time. And that’s when I realized that I was OK. I was mentally, morally, professionally OK. Stepping away from the fee for service model, using with insurance alone and transitioning to a practice, telling my patients that I could possibly no longer see them if they couldn’t pay a fee.
[00:28:13] Speaker 3 Right.
[00:28:14] Speaker 2 And that was hard. That was probably one of the hardest things I had.
[00:28:17] Speaker 1 Yeah. So what percentage of your patients do you think you lost when you transitioned?
[00:28:23] Speaker 2 I, I probably had 1500 patients. Right. Two thousand patients. And I lost at least a third.
[00:28:30] Speaker 3 Wow. If not. Yeah. Third. Wow. Yeah.
[00:28:33] Speaker 2 And that was really hard because I care about so many of them. Right. If I go anywhere sometimes I will see people that I used to take care of and many of them have migrated back, you know, to me for a variety of reasons. And that’s always just so wonderful. It’s like meeting an old friend.
[00:28:50] Speaker 3 Right.
[00:28:52] Speaker 2 You know, that they said, OK, well, I’ll stick it out with this practice or I’ll go here. Or their insurance wasn’t the one that we take. And then they’re back when they hit Medicare age. And it’s just like seeing it really is like seeing an old friend.
[00:29:04] Speaker 3 That’s nice.
[00:29:05] Speaker 2 Yeah, it is really nice and it was sad. But you have to you know, I also gained by being able to do well for the patients I had. You know, there’s so much satisfaction I’ve gotten in the last couple of years in this new model. Right. I am able to do home visits at times. I’m able to go see patients in the hospital and be much more involved in their care. I’m able to do research and call doctors and get, you know, get some knowledge about what needs to happen for this patient, facilitate their appointments. I can pay my staff well enough to do these things and they not bad. And I
[00:29:42] Speaker 3 write right.
[00:29:43] Speaker 2 And not be looking for another job when I’m, you know.
[00:29:46] Speaker 3 Right.
[00:29:47] Speaker 1 Not complacent. And I think. Yeah, yeah. You’ve started to find the secret sauce. Yeah. Your secret
[00:29:52] Speaker 3 sauce. Yeah, yeah. And then you know, so what.
[00:29:56] Speaker 1 So what. So your biggest challenge was staffing
[00:30:00] Speaker 3 and the transition. The transition. Transition. Okay. That was so
[00:30:03] Speaker 2 true to the concierge model and just how to execute it in a way that people, patients understood why. And I’m going to tell you, like I feel like most of my patients understood why. They said to me, you know, I got a letter from somebody who said, I don’t know how you’ve been doing it for so long. Mm hmm. Right. And so, I mean, gosh, like, because I wouldn’t talk about how I’m doing. Right. That it’s not it’s irrelevant to their health. Right. Right. But I had so many people that actually cared about how I was doing and that that really it was very emotional because it was the first time that I expressed my inner feelings myself to people that I had been caring
[00:30:48] Speaker 3 for for ten plus years. Right.
[00:30:50] Speaker 1 Right. Amazing.
[00:30:51] Speaker 2 Yeah. It was really I think it was important to go through, if you will, because I had an option of having somebody from the business that allowed me that helped me do the transition. They’re called special docs, special docs, consultants. And I was really I was really anxious about the transition. And Terry Bauer, the CEO of Special Docs, said, Ciani will take care of you whatever you need. I said, I want someone from special docs in the office. Yeah. Explaining it to the patients. And she said, OK, we will rotate our staff. We’ll make it happen. Wow. As it came closer, I said, Terri, I don’t want it because I want to be the person who tells each person why right now. The why took me like five minutes to spit out. And so every patient I was running overtime because I didn’t start it. I’m transitioning. I started way
[00:31:40] Speaker 3 back. Yes.
[00:31:43] Speaker 2 I think at some point my I think patient. My friends feel like you’ve got to shorten the spiel, right? You cannot go back to, like, you
[00:31:50] Speaker 3 know, 1970 to 72
[00:31:53] Speaker 2 and then finally come to it. They’ve lost the whole story.
[00:31:56] Speaker 3 Right. Right, right. You know, so
[00:31:59] Speaker 2 but that was my own. That was my own evolution.
[00:32:01] Speaker 3 That’s who you are. That was my evolution. Yeah. That took time.
[00:32:04] Speaker 1 Yeah. Yeah. Fantastic. Great story. So we are going to take another quick break. So we’re with Dr. Kaneriya. And thank you for sharing all that. We’re going to take a short break. We’ll be right back. All right, we are back with Dr. Kaneriya, and thank you again for coming in. I’m really enjoying our our conversation today. Thank you. So we’re coming. I don’t know if we’re coming to the tail end of covid, but we’ve been 18 months now in our covid world. So tell me, how did that impact you and what did you do to get through it? And, you know, what is your what is your vision for the reality of medicine in today’s world?
[00:32:49] Speaker 2 I mean, first of all, it’s probably similar to you. It was just hard to believe that it was happening. Right. I wasn’t one of the people that could have said I predicted it.
[00:32:56] Speaker 1 I don’t think anybody could.
[00:32:57] Speaker 2 Anybody people that said that. Right. They predicted something like this was due or bound to happen. Yeah. Maybe it was the scientists or, you know. Right. The specialists. But I just still remember someone coming into my office saying there’s something called covid-19.
[00:33:12] Speaker 3 Right.
[00:33:12] Speaker 2 And you’re not going to be able to get medications and thinking, what?
[00:33:16] Speaker 3 Yeah, that’s right. Yeah, yeah.
[00:33:18] Speaker 2 But, you know, it was a rough year. And again, back to the whole comment about staff. I had amazing staff that helped us pivot as we needed to do. So we were working from home for about two weeks, three weeks initially in March when everything kind of started up. And then we slowly started coming back in. Right. And there were people that didn’t feel comfortable, I’m sure, in your business that didn’t feel comfortable, you know, in person. And they worked from from home.
[00:33:49] Speaker 1 We’ve done almost everything remotely. And and we’re going to continue and we’ll talk more about that as we go on with this conversation. But, yeah,
[00:33:55] Speaker 2 and there was a period of time where I was the person coming in because I wanted to make sure that people knew that I wanted to still help them. And so there was a gentleman who’s a patient of mine who had palpitations. And he I really didn’t feel well. He fell short of breath. And I said, let me evaluate you first, because I really don’t want to send you to the emergency room and overload the E.R. and just dump you on the E.R. because I’m so scared of covid.
[00:34:19] Speaker 1 Right. Right. And there could be somebody
[00:34:21] Speaker 3 it could be somebody
[00:34:21] Speaker 2 else. I have something else that they’re dealing with.
[00:34:23] Speaker 3 So we came
[00:34:24] Speaker 2 in, I did the EKG, evaluated him. He actually had a heart rhythm issue. And I got him straight to the cardiologist. So he avoided the E.R. and it was just it made me feel like I was not worsening the health care problem.
[00:34:37] Speaker 3 Right.
[00:34:37] Speaker 2 Well, the other thing that really helped was telemedicine. You know, telemedicine has been around for a while, but insurance hasn’t really picked, you know, picked it up. And so doctors really were resistant to using it because the cost of the technology was, you know, a certain amount. And then you you have that. Then you have patient resistance to new technology. Right. And then you have insurance reimbursement. Right. And really, the people that you would would have used it, you know, would have been the elderly, because there’s so many times when someone can’t make it and can’t get in and you just want to lay eyes on something. So telemedicine just took off. And, you know, insurance companies in Medicare basically said we would reimburse. Right, we’d reimburse. And all things covid related would almost be free. Right. Right. Co-pays for covid testing and things like that. And so, again, my business model allowed me to not worry about how many visits I was seeing per day because we are our income wasn’t determined by that. So we had days that we were just doing phone calls all day or telemedicine or, you know, just emails. Right. And it wasn’t really didn’t affect my it did not affect my bottom line like it did a a traditional primary care physician. And there’s a lot of people that whose practice is closed and there really were unable to keep going for telemedicine. It’s amazing what you can diagnose via video. I mean, I’ve done I’ve seen everything, really. And it’s just you can really help somebody and especially if you know them well enough. Right. I think that’s a big difference. You know, there’s those Teladoc practices out there now. Insurance companies oftentimes have their own providers. And I think that’s great in a pinch to reduce like E.R. visits and things like that.
[00:36:26] Speaker 3 And maybe
[00:36:27] Speaker 1 for younger people, that may not have some
[00:36:30] Speaker 3 issue.
[00:36:30] Speaker 2 Exactly. But, you know, I used it. You’d be surprised. Mental health, there was so much anxiety and depression during the pandemic, especially for patients or people that were older. Yeah. And were lonely that didn’t have family. Let’s say their grandkids couldn’t see them because, you know, they were separated so that, you know, it was really helpful to be able to at least see your doctor, talk to your doctor, you know, be able to do a little therapy and and, you know, just provide support during that time. We also did this not not similar to this, but sort of a town hall Zoome meetings once every couple of weeks over the last year.
[00:37:07] Speaker 1 So how many people joined in on this? I would say
[00:37:09] Speaker 2 50 to 100, right. Yeah. And so and
[00:37:12] Speaker 3 then we just put out a lot of and then we put it on our website. Right. The video. Yeah.
[00:37:15] Speaker 2 And we had pulmonologists come on, we had two who are dealing with covid. And so they gave us a perspective of the. But all we had infectious disease, come on, right, and so we had a different types of we had a GI Doc, GI, you know, effects of covid, they were all local docs. Some of them actually were docs of patients, you know, that we were you know, that we had in our practice. So it was kind of cool for them to say, hey, that’s that’s Dr Vali’s my doctor, you know. And it was it was fun, right? It was really fun. It took a lot of work, though.
[00:37:44] Speaker 1 Yeah, but you got to have fun. You know, it was a new world. And I think I think it hit us all by surprise. So how quickly did you get that up and running?
[00:37:52] Speaker 2 I would say by April or May, yeah.
[00:37:56] Speaker 3 And pretty quickly.
[00:37:57] Speaker 2 And then the other thing was, is that I had hired a new physician. Yeah. In and right before the pandemic.
[00:38:03] Speaker 3 Right. Just before. Just before I knew it was coming. Yeah. No, but
[00:38:08] Speaker 2 and honestly, she is amazing. She is a you know, I can’t really say more about how wonderful she is and what how great my practice is now with her in it. But it was hard because she you know, people weren’t really looking for new doctors. Right. Everyone was kind of locked down at that moment. Right. They were just kind of like, you know, just settling in, like almost hibernating until it to ride it out. Yeah. So her practice has started to take off kind of later in the pandemic.
[00:38:35] Speaker 3 Right. Good, good. Good.
[00:38:37] Speaker 1 So. So on the on the so but I think the, the, the video and the what did you call it.
[00:38:44] Speaker 2 We called it town halls.
[00:38:46] Speaker 1 Town halls. And then what do you call your system that you use for a meeting.
[00:38:49] Speaker 3 A place
[00:38:50] Speaker 2 that was it was Doximity me. So we did our we used doxie dot me. Got it. If you go to our website, you know, lifetime internal medicine dot com and you click on the top. Right, right. It says physician versus this patient waiting room versus waiting rooms. And you click there. I mean, it’s just so neat. Yeah. You click there and it says your enter Doctor Canary’s waiting room. Yes, please. She will be with you shortly.
[00:39:11] Speaker 3 Yes. Yes. That is so neat. Yeah, yeah. Yeah. So neat. That is.
[00:39:14] Speaker 1 Yeah that’s cool. Now the whole experience by video is improved if you have a relationship with the person already. Right. So you don’t want you don’t think video is going to replace in-person meetings.
[00:39:26] Speaker 2 I think that they have a role. I mean, they can be, especially when you’re dealing with blood pressure and cholesterol. But I think you just like John, you say you like to do this in person, right?
[00:39:35] Speaker 3 Exactly. It is a
[00:39:37] Speaker 2 I think there’s a different experience in person with somebody when you’re looking them straight in the eye and you can really help them move the needle to getting better. Right. Therapist, for example, there’s been a lot there’s a lot of therapists out there that are doing everything virtually right because of, you know, they can now. But patients want to see somebody, right? They want to see them, you know, face to face.
[00:39:58] Speaker 3 There’s an energy in the room, energy.
[00:40:00] Speaker 2 There’s a sense of support. There’s a sense of like, you know, not being alone in this world.
[00:40:04] Speaker 3 Mm hmm.
[00:40:05] Speaker 1 So do you think you’ll ever go back to no video or do you think you’ll always have this video as part of your program going forward now?
[00:40:12] Speaker 2 Because I don’t think we can I don’t think we have a choice not to. I agree with you. It’s amazing. I mean, and patients ask for it. Can I do a virtual with Dr. Kaneriya?
[00:40:20] Speaker 3 So I do a phone call.
[00:40:21] Speaker 2 Can I do a virtual, you know, and you can do it from your house if you’re not at work and for some reason or your phone or your. Yeah, I’ve done I’ve done it from the car and it’s not, you know, you know, waiting for my daughter to play soccer. Yeah. And it just there’s too much bright light.
[00:40:37] Speaker 3 Yeah. Yeah.
[00:40:38] Speaker 2 I prefer being in a professionally so. Sure. Up.
[00:40:41] Speaker 1 Yeah. You got to be in the zone.
[00:40:42] Speaker 3 You have to be in the zone.
[00:40:44] Speaker 1 The amazing thing is that in our industry when covid hit, we had to pivot immediately to video meetings and it was really hard and it reminded me of when the Internet was kind of first born because I was in business long before there was ever an Internet in 1999. And I miss yeah, I miss those days. I don’t I don’t think I, I don’t really think we got started up on the Internet really to the late 90s. I know it was around in the late nineties. You were getting kind of forced onto it and there were just a lot of problems. It was really glitchy and it was just like when covid first hit, there was weeks and weeks and weeks that the Internet was just so overloaded with people, you know, you’d be having video meetings and it would be like glitchy, staticky, you know, people were dropping off. And, you know, now it’s pretty reliable. And, you know, thank God for all the amazing engineers out there, which he passed on that profession, but who were able to pull the Internet together relatively quickly so we could all function. But but everything is a lot better for us. You know, when we do floorplan reviews and things like that, we share our screen and we can have four or five people looking at the same screen at the same time from different locations where before we used to have to all get together in a conference room, past floor plans around the room, do sketches. And, you know, with this covid, it forced us to do things online. And we’ve learned it’s much better online and we’ll never go back to the old way.
[00:42:09] Speaker 3 You know,
[00:42:09] Speaker 2 the other thing that’s really been neat, it’s made the world a little
[00:42:13] Speaker 3 smaller. Yes. So, yeah,
[00:42:15] Speaker 2 for example, I feel like I have access to people and specialists that aren’t. Just in northern Virginia, yeah, because it’s all about licensure and medicine and the health care, so you have to be licensed in Virginia. I have college kids that I see that see maybe a psychiatrist in there going to school, let’s say, in Albany. So I found somebody who is licensed in, like all but in New York that, you know, she’s mostly in New York that could see her. It’s not just limited to Northern Virginia, to Virginia. So it’s really neat. And then, you know, patients that are older and sick, if they can’t make it, it’s so nice to be able to do a virtual visit to discuss the problem. And if it can be solved by a specialist, you know, and you don’t have to trek to Hopkins or Georgetown. You know, my mom was in the hospital recently and she had her follow up virtually. How wonderful
[00:43:07] Speaker 3 is it is like it’s
[00:43:08] Speaker 2 just it’s just it’s it’s just life changing, you know?
[00:43:11] Speaker 1 Agreed. So we were all ready for a change. We just didn’t know it.
[00:43:15] Speaker 3 I know. Yeah, I know. We’ve learned a lot. Yeah, we sure know without wanting to.
[00:43:20] Speaker 1 That’s right. Some some it’s who moved my cheese. Right. My gosh.
[00:43:25] Speaker 2 I know. Yeah. And I think it’s not that the world has changed permanently. Right. And I agree in terms of business, the business world, you know. Yeah. But I think it’s really important to still continue face to face for me. I’m motivated by seeing people. So when I’m at home, I don’t feel the same excitement. Like I love seeing people in person. I love the rapport. Right. And I think you’re the same way.
[00:43:48] Speaker 1 Yeah. And I think most successful business people
[00:43:52] Speaker 3 are that way.
[00:43:53] Speaker 2 I love I mean, I’m motivated by just my cause, like what I’m doing and knowing that what I’m doing is worthwhile and it serves a purpose and that the people around me look to me to for that guidance and that sort of mission mindedness, if you will, you know. So if I’m ever sort of having a day, I make sure I realize. Wait a second. I mean, I’m allowed to have a day. Right.
[00:44:16] Speaker 1 But a day when things are not necessarily going your way.
[00:44:19] Speaker 2 Right. Or, you know, there’s something happening in your own personal life or whatnot. But at the end of the day, you realize that person is here for your advice, your recommendations. And it’s it’s a wonderful feeling to to have that person be there, you know, and looking to you for, you know, advice and assistance. And then you realize that that’s what you’ve created. And you walk into work. You’re like, this is what I’ve created. It’s such a wonderful thing.
[00:44:46] Speaker 1 It’s pretty amazing what you’ve done. It’s very
[00:44:48] Speaker 3 impressive.
[00:44:48] Speaker 2 Thank you. It’s very it’s definitely a labor of love and it’s my home. In fact, I remember when we first moved into so we have a new space we moved into in twenty eighteen. And I remember one, one person who was working with me said, gosh, this is so nice. I feel like I should take my shoes off, you know. And I said and then I think she went to go see the old space which we talked about. Yeah. She was like wow those were humble beginnings and it felt neat to, to see the growth. Yeah.
[00:45:17] Speaker 3 That person,
[00:45:18] Speaker 2 you know, that we didn’t just have the fancy space first.
[00:45:21] Speaker 1 Right, exactly. And I think that was going back to what I was talking about at the beginning, you know. What was your childhood like? Yes. Yes. You know, it does. It does to me. It always feels good to be able to take a step,
[00:45:32] Speaker 3 you know, slowly.
[00:45:34] Speaker 2 Absolutely. Yeah.
[00:45:35] Speaker 3 Yeah. So that’s
[00:45:36] Speaker 1 wonderful. Dr. Kaneriya, thank you so much for coming in today and sharing your story with us.
[00:45:41] Speaker 2 Thank you, John. Thank you. I feel honored to be asked to speak and join you. You’re an amazing business person and a great friend. So thank
[00:45:49] Speaker 1 you. Thank you so much.
[00:45:50] Speaker 3 Thanks.
[00:45:57] Speaker 1 Thanks for joining in on this episode of the Go to John show. Now go out there and build something extraordinary.