Doctoring Differently with Dr. Naomi Lawrence-Reid

Are you a physician feeling stuck in the traditional career path of clinical medicine? Join us for an enlightening episode of SoundPractice as host Mike Sacopulos welcomes Naomi Lawrence-Reid, MD, a board-certified pediatrician and the visionary founder of Doctoring Differently .

Lawrence-Reid shares her inspiring journey from traditional clinical medicine to exploring innovative and fulfilling career paths outside of full-time clinical practice. Her story is a testament to the power of courage, curiosity, and the willingness to challenge the status quo.

This transcript has been edited for clarity and length.

Mike Sacopulos: My guest today is Naomi Lawrence-Reid. She's a board-certified pediatrician. Dr. Lawrence-Reid is also the founder of Doctoring Differently. Doctoring Differently is an online community that teaches physicians how to explore non-traditional career paths outside of full-time clinical medicine. Naomi Lawrence-Reid, welcome to SoundPractice.

Naomi Lawrence-Reid, MD: Thank you for having me.

Sacopulos: Let's contextualize our discussion here today. Can you tell me a little bit about your path into medicine and pediatrics?

Lawrence-Reid: Sure. I went to medical school in Massachusetts. I did my training, my residency training in New York City, in the Bronx, and I, at that point, like many medical students and residents, imagined a career in full-time clinical medicine. That is why we go into medicine and that is the only career path that we are presented with. So, I initially wanted to pursue a career in the pediatric emergency department. After my training, I moved to San Diego, California, and began working in a pediatric ER. And so that was my initial thought about how my career was going to go. I imagined that I'd be full-time clinical, I would follow the traditional academic path that involved a big department, a tertiary care center. And it was a few years into that journey where things shifted for me.

Sacopulos: So, let's move there. I have a feeling this is going to be a little bit like the saying, "Man plans, God laughs," kind of situation.

Lawrence-Reid: Yes, yes.

Sacopulos: So here you are, you're a board-certified pediatrician, you're working in an ER, and then something happens that I'm really looking forward to you telling me about and you make a non-traditional career change. What happened, doctor?

Lawrence-Reid: Well, I'll start with not just one thing happened. I think when anything dissolves, whether it is a job, a relationship, it's rarely one thing. It's a number of things that happen concurrently, maybe smallish things that happen over time, and then there's the straw, right? The final straw. I, in my first couple of years working in a large pediatric academic center, working in an ER, I recognized what I had heard in terms of, let's start with physician compensation, specifically pediatric compensation. My starting salary was $125,000. I had over $200,000 in educational debt, and I was told that my contract was not negotiable. I was told that this was the best job around for a pediatrician. And by the way, I'm working in an ER so that's overnights, that's weekends, that's holidays. ERs don't close. As I was looking at the landscape within the first couple of years, I was in my early mid-thirties, I thought, is this my life? Is this how this goes? I was coming in on my days off for six hours to chart, which is unpaid time. We were getting our productivity handed to us like baseball players. We were ranked; we saw our views. It did not feel like what I had signed up for. It was not the career that I wanted.

But in terms of that final straw. So, all of that was preceding one fateful evening, I'm going into an evening shift in the ER. I walk into the small back room where they have physicians work, doing their charts. There were desks, two chairs, two computers, and one chair was available to me. I walked in and the arm rest had broken off. It was just shards of metal sticking up. There was a little post-it note that said, "Admin is aware. They're working on it. They know about it." Okay. I do my whole shift with my arm tucked against my torso so I'm not impaled. I do my notes; I do my shift. Of course, we know how important physician notes are for everyone in healthcare getting paid. So, I'm doing my notes that way.

I leave, I come back the next day or a couple of days whenever my next shift was, and instead of a new chair, which runs $80-90 maybe, the administration had taped diapers around the shards of metal on that chair. And in that moment, I stood there, I looked, and of course all of my experiences over the past few years, it all came to a head at that moment, and I just thought, okay, this is the value of physician labor to this department, to this hospital that has over a billion in revenue annually. This is how they treat doctors, because typically we don't quit, we don't leave, we grumble, we complain, and we stay. And in that moment, I just thought, I cannot tolerate this. This is not where I continue to practice and continue to go about my career. And I submitted my letter of resignation that night.

Sacopulos: Good for you. So, I can understand the hesitancy to use a chair that had been rigged with Pampers or whatnot, and you've got my vote, but what happened next?

Lawrence-Reid: Well, I'll back up. As physicians, we are not necessarily equipped with the tools to look for new jobs. That is just not a part of our training. It's just, oh, generally you're already in a city where you're training, you maybe have a family, you maybe have a house. This is where you'll be, so just kind of word of mouth, find a job. And again, as I've said, clinical medicine is the only thing we are taught is a viable career strategy. So, in that moment, I just thought, okay, there was one other kind of large, major healthcare system in my community and I considered getting a full-time or some sort of real organized job over there. And I applied and it wasn't working out, so I just went per diem. I didn't have a great strategy. Again, we are not really equipped with the tools, we're not told about the other things that we can do. But I think the most important part is we are not given permission.

I talk about this a lot. Physicians need permission, and I think a lot of healthcare really benefits from the fact that physicians aren't given permission to do new things. So, despite all of our years of training, our high intellectual capacity, we are still the 20-year-olds who entered medical school who need that permission, who need to be taught and told what to do, and we're so accustomed to it. So even my next step, which was going per diem because I had loans, I had bills, I had no one to pay them but me, I did not have a safety net. I had to find a new job, which, let me tell you, my friends and colleagues were just, even that switch sounded so radical to them. It sounded so, just, "What do you mean? How are you not getting another academic job? How could you get off this path?" There's so much fear because we simply do not know, how do you get your own benefits? What does that even look like?

And I just thought, you know what? I'm so unhappy and I feel so disrespected with the job in general and then the diaper, I thought, you know what? I am just going to go. I'll figure it out. I'm still a doctor. No one can take that away from me. And if it doesn't work out, I'll do something else. Turns out I have a skillset not a lot of people have, and if I want a job, I can find a job.

Sacopulos: So, what type of jobs did you pursue?

Lawrence-Reid: It started, as I said, with going per diem, which sounds like a small thing. It basically means I was not full-time. I pretty much covered. I was a substitute teacher. When another physician went out or was sick or maternity leave or this or that, I came in and helped the department and was able to come in and do my shifts. I was paid hourly and I had to find my own benefits, and it was great, but it was the first step in terms of me having actual control over my career and my degree. I could use it as I wanted in that way. These jobs, "Oh, I'm full-time in this department," You are given your schedule and you really don't have much recourse or say about your duties, the number of patients you're seeing, where you're working, how often you're working, that you can be flexed up, flexed down. And so even in that step of going per diem, I felt like, okay, I have a little bit of control here.

That turned into me starting locums assignments or travel doctor assignments. I'm in southern California. I didn't even have to leave my state. This is a big state. I assumed, I was kind of told in residency, "Oh, locums. Good doctors, real doctors don't do that." They, of course, stay at these big academic urban centers, and locums assignments are always in A states, and no offense to states to begin with A, but those were always very far from where I lived. So it was always kind of a fear-mongering about, "Oh, you'll just be sent out to the middle of the country and you'll take three planes and a bus to get to a site and you won't like it." Anyway, I started to explore locums, had a great experience and in fact still do a lot of that work seven years later. And so it turned into one thing. I was then taught or told that physicians of any specialty could start aesthetics practices. Doesn't mean you don't have to be a plastic surgeon or a dermatologist.

I'm suturing children's faces in an ER, but didn't think that I could run a Botox or filler practice. Took classes, started doing that. Ended up exploring veteran disability, an expert witness and independent telemedicine and social security adjudications, academic consulting. Just found that my degree, I could use clinically, non-clinically, I could use it in a number of fun and innovative ways. And that's how the last seven years have gone for me in this journey.

Sacopulos: Well, it sounds like at some point maybe you were motivated by money when you were trying all different types of things, and maybe you could tell me a little bit about your motivation for trying so many different areas.

Lawrence-Reid: Money was a huge part of it. And I always go back to our training; I often use the term our grooming. As physicians, we have been groomed, although the assumption, of course, is that all physicians are very highly paid and compensated, as I began this interview by saying, that is not always the case, especially in relation to our educational debt. So, money is a huge factor. But as physicians, we often, "Oh, you're not in it for the money. I thought you were in it for the patients." And it's a tension. And again, I was specifically taught not to negotiate. But as I made that transfer out of full-time clinical medicine, of course my initial thought was, okay, I've got bills. It was survival. It was not building wealth, it was, how do my bills get paid every month? And then when I quickly learned, oh wait, that is easily possible here. It just gave me the bedrock to say, okay, well, what else was I not taught? What else is out there? What else can I do? Everything was more highly compensated than my old academic job, every single thing.

And by the way, I was still doing clinical medicine when I wanted to. I was still seeing patients, but I was able to also do remote work that was very lucrative. So, money was of course a motivation, but it also appealed to my personality of just being inherently curious and just, I mean, nice to know that there's always going to be some high compensation at the end of my curiosity, but every day was different for me. Which, again, very much appealed to my personality, but it was fun. At the end of the day, it's very fun to do new things and to use your brain in different ways and to go different places. I really enjoyed it, so I felt like I was a better doctor. I'm a pediatrician doing veteran disability exams, what? But it is very possible and actually very fun to just work in different ways, again, in ways that we are typically not given permission to do and not even told exist.

Sacopulos: Beyond not being given permission, my guess is you encountered some resistance or objections from colleagues and friends. Is that fair to assume?

Lawrence-Reid: How do I phrase this? I think there was an amused curiosity, and maybe a silent assumption that I would fail at this, perhaps. Very few were excited. Because, I mean, they didn't know anyone who'd ever done it, right? If you hear about someone setting off in an expedition to go someplace no one has ever gone, there's a little bit of, "Are you sure? Do you know what's out there?" And so it was more of that. I think probably a lot of people just kind of looked and did a shrug and thought, "Ooh, we'll see how this goes." I can't say I was met with resistance because no one was in my way, so there was no resistance.

Although I will say, you know what? Let me correct myself. When I told my boss at that job in the ER with the diapers, when I told her that I was submitting my resignation, that I was just truly going to explore different things, I thought maybe I would do locums in Boston near my mother where I was from, she gave me, I'd say, the most resistance. I would say that she gave me the most resistance in that way. She said, "There's nothing else out there for you." She was very discouraging. She said, "There's nothing else out there for doctors. You're lucky you even get to work here and you'll be back in a year begging for this job back." That was that conversation. But instead of discouraging me, quite frankly, I looked at her and said, "Well, I'm going anyway, and there's nothing you can do. I don't know why you are giving me this advice." But again, as many deeply entrenched in the academic community, there's just an inherent fear, but a large degree of ignorance about what other career opportunities are available to doctors. So that was definitely the biggest, I'll say, pushback I got.

Sacopulos: Over my career, which, look, I'm not getting into ages, but I'm clearly older than you. When I started out, the majority of physicians had their own practices, and today that's not true. I think the statistics are that about 75% or 80% of physicians work for an organization that is run by someone who is not a physician. Do you think that that contributes to your feeling, and maybe others, of a lack of control?

Lawrence-Reid: Oh, for sure. Yeah. That's a big point I think that physicians often make right now when they cite burnout, when they cite their unhappiness. I definitely think it was an, I don't want to say an inside job, but this has been calculated for some time, and I think it goes back to who doctors are at the beginning. I started to say we're 20, 21, going into medical school with all the right intentions, for the right reasons, we'll say. Family's so proud, community's so proud, and we are groomed in very difficult circumstances throughout the rest of our twenties. We are told clinical medicine is really the only path. You get out at 31, you finish your training in your early thirties, and you just get a full-time job. But at this point, you're paying back loans that are $300,000-400,000. So, we are starting very much behind the eight ball in that way.

So, you have a group of people who are, I'd say, generally very good people. Doctors are good people, but they have been so conditioned and groomed to just obey and follow what they are told. It's very hierarchical, it's very patriarchal in our training and residency and every step you have to be allowed to do more and to go to the next step. So, you've got this workforce that is very much indentured in that way because of our debt to our profession, to this field. You've taught them one way to work, you've attached a philosophical higher calling to that one way that they can practice, and then you now have business and people with financial interest, stakeholders running the show, and I don't feel like they are begotten to any type of higher power or higher calling, but they recognize that our labor, leveraged in certain ways, can generate a whole lot of profit. And so, I think I've said a long way of, yes, exactly. We've got people not in medicine, not physicians running healthcare, but even the few physicians that are at the top. This has become a large, large, large system that individually doctors definitely do not have, I'd say, a shot of reforming individually.

Sacopulos: Doctoring Differently. Can you tell me what it's about and why you started it?

Lawrence-Reid: Sure. I started my journey outside of full-time clinical medicine in 2017, not knowing what was coming, of course. Who did? So, into 2020, at the beginning, I'm thinking, oh, what does this look like for me? I feel like I'm very much on the fringes. I'm doing my locums, I'm doing per diem, I'm doing some aesthetics. I was making more than I'd made, I was feeling good about what I was doing, I didn't have a long longitudinal plan at that point, but I was doing great. I didn't really need one. A lot of people, I'd say humans want that plan, and doctors especially. We want to see the horizon, but I had unhooked from that for the moment. So, into 2020, I continued to do very well in terms of all of the things I was doing, all of the contracting work I was doing. I was continuing to make more. I had PPE provided at my hospitals. I felt protected. I was able to negotiate for hazard pay, which a lot of physicians and a lot of corporations were not able to do.

So, near the end of 2020, I'm starting to see my friends, classmates, colleagues, just drowning. Just drowning, right? I don't need to tell you. There have been a number of studies and reports about the physician experience in 2020, and I saw that kind of from outside. So, I'm calling my friends and classmates like, "Hey, you can do new things. There are other options. You are literally killing yourself." And I don't mean that lightly. Physician suicide rates spiked, right? So, there was a very real consequence there. Of course, physicians also died of disease in Covid, but there was also a lot of self-harm there too.

Sacopulos: Absolutely.

Lawrence-Reid: And as I'm just kind of ranting and rambling at my friends, I thought, okay, maybe this is not the most effective strategy to deliver all of the things that I've learned. And so in that time, I thought, okay, what is our currency? Our currency as doctors is education, right? It is a course, it is a curriculum, it is organized learning, it is assignments. We love it. If we're honest, we really like school. You have to love it at some point to do it as long as we've done it. And so it was in the beginning of 2021 that I sat down and thought, you know what? I'm going to make a curriculum around this. I'm going to be what I wished I'd had when I started in terms of what is possible, just teaching. "Listen, you can do this, you can do that. You can do this; you can do that. You have permission to do it." And it's like, well, who am I to give permission to strangers, effectively? But guess what? It is very effective for doctors to see another doctor who stepped out and did not fall off the face of the earth.

And not to mention at the same point, as equally as important as knowing what's out there is also, "This is how you get your own health insurance, this is how you get malpractice, this is how you get your retirement." All of those things that a lot of entrepreneurs in the United States with high school diplomas, with bachelor's degrees, they do it all the time every day, but physicians somehow have this thought that it is nearly impossible or somehow illegitimate to get those benefits outside of a full-time employer. And so all of those things, I thought, you know what? I can put all of this in a course, in a curriculum, and teach doctors what's possible since that is literally what we are all looking for and what I've had to figure out on my own over these past years. And that was the beginning of Doctoring Differently.

Sacopulos: Excellent. Well, that's clearly what makes you a physician leader. But it occurs to me that there may be some folks that just, it's helpful to them to know that there are options or, maybe as you state, to have permission even if they don't go down that path. Do you find that with people that you work with, that just simply the knowledge that you're conveying to them through Doctoring Differently is somewhat empowering and liberating to them?

Lawrence-Reid: Absolutely. You nailed it. I don't like to speak in absolutes when I talk about human beings, but I do in this sense, because I would argue that 100% of doctors want to know. They at least want to know their job options. Whether they pursue any of them outside of clinical medicine or not, 100% want to know what's possible, and especially the newer generations of doctors coming up now. I am, how many years? 11-12 years out of medical school. I would say physicians older than me, of course, but especially the younger generation, they are coming out. They have trained in a pandemic, they have seen the destruction, they've quite frankly seen how physicians are treated and how our labor largely is uncompensated, is overworked and overwhelmed. So, they are coming out with an energy of, "You can keep your academic title. You can keep your partnership. Just let me come in and work. Pay me so I can go."

And so it is definitely creating a shift and more interest and more discussion about those alternative options, alternatives to the full-time clinical path. But yes, to answer your question, I say, knowing you have options outside of full-time clinical medicine gives you so much more power inside of it. Because guess what? You can be loud about making change, about saying the things that need to be said, knowing that, listen, if I'm rocking this boat too hard and it capsizes, I can see shore, I can see land, I can stand up in this water. I'm not going to drown out here because guess what? Doctoring Differently says I can actually do other things. But if I want to stay here, I can be louder, I can speak truth to power, and I know that I'll be okay no matter what.

Sacopulos: It occurs to me, no career path is easy, right? I mean, whatever career path someone's on, there's going to be some barriers or some obstacles. What are the biggest barrier or barriers for physicians seeking alternative career options?

Lawrence-Reid: Permission. Permission's a big one. I keep bringing that up. It's huge. Permission, it's so intangible, but it is huge. I've now been running Doctoring Differently for four years, almost five years, and I can tell you the number of people I've worked with directly, but also I have a pretty large social media following, I engage with physicians across the country, around the world often, and I have had physicians who I've not worked with or even spoken to directly who have reached out and said, "Listen, seeing you, seeing your website, seeing your social media, you told me and just showed me that I can do new things. You were an example." So, I'd say even seeing that example and getting a little bit of permission, and by that way, permission to say, "Oh, wait, she did it and she's okay. And in fact, she's better," is a huge, huge part. I'd say that is the first one.

But again, going back to who physicians are. When we're coming out of training, we're handed a contract, we're just happy to have it in hand, we're happy to not be residents working 80-90 hours a week for $60-70,000 a year, and so we just sign it. And we become stuck in these non-compete clauses, in these contracts that don't allow us to explore or look out. I actually have a theory that's much more nefarious, that those doctors will never know the true value of their degree in that way. If you are signing, if you're in a full-time contract that has a non-compete, and again, we like our rules, we have our boundaries, our bowling alley, our lane with bumpers so that we can't look out or go another place and experience, "Oh wait, I can actually charge this much to be a consultant or to be an expert witness or to be a medical writer. I can negotiate high rates and tell them when I'm going to work and not just be put to work 12 straight days over the holidays." So, things like that. I think those contracts are a huge part.

But of course, we're just, as I've stated, our medical education I think knows that in some way they're sending us to the slaughter in that way and that we're not equipped with those tools to negotiate, to talk back, to advocate for ourselves, and so a lot of physicians are trapped in kind of bubble in that way of, "I can't leave because my contract won't let me, and I don't have permission to go."

Sacopulos: Is it just medical education? It strikes me that it could be something that starts earlier that we're self-selecting for individuals that follow a set pathway and are not rewarded for any type of creativity whatsoever. Is that unfair, doctor?

Lawrence-Reid: I don't think that's unfair at all. I think the type of person, because, okay, so it sounds like we're back in high school, college. Typically the type of person who starts on a medical path is a go-getter, he or she is getting top grades generally, generally, and it's that kind of a driven person. And again, as you said, so many physicians these days are not entrepreneurs. We don't go into this to be hacking our way through a forest, forging new paths, figuring out new ways. We want to be a doctor, we want to do good, we want to see a sick patient, we want to make them well or better. And that's a very trivial way of looking at the whole profession, but we've all been in high school and college. That's what we all think that it is. But at the same time, we assume that we'll be taken care of at the end of it. We assume that we'll be paid fairly and compensated fairly.

We assume that our labor will be protected or that there is somebody, organization that ultimately is looking out for our best interest and protecting us in some way. And so we have a large sunk cost, right? We have put in a lot, generally all of our twenties, a lot of money, a lot of sacrifice to come out into our thirties and recognize there's no one really here looking out for physicians, there's no one really here advocating for us. I assumed there would be. I assumed that all of my sacrifice, I would have it, except many of us have found that not to be true, unfortunately. But yes, large self-selection here.

Sacopulos: As our time here today comes to an end, I'm interested to know what the future of Doctoring Differently looks like for you.

Lawrence-Reid: Sure. I want as many doctors to hear and to hear this message and to know what's possible. So right now, Doctoring Differently is a near nine-hour digital course where I have put all of my seven years of knowledge and experience and failures and successes and reflections into this course. I initially taught it live for two years with doctors from around the country, but now it is a digital course with monthly meetings, direct Q&A. So right now, I want to meet doctors where they are. I recognize all of those precluding factors that we've talked about in terms of fear and permission and ignorance of just not knowing, but always recognizing we were all created in this way to think that we're not allowed to look outside of full-time clinical medicine, to think that it's completely illegitimate and un-viable, to knowing that so many of our contracts specifically preclude any type of exploration of non-clinical work.

So, I want as many doctors to have that message. And eventually, I want Doctoring Differently to be a curriculum in medical education. I think that all physicians, as I said, 100% of physicians want to know their options. Unfortunately, I think U.S healthcare has benefited from physicians not knowing their options. But I think if more physicians know and understand their worth, their value, what they're capable of, what their degrees can earn for them, the kind of lives that they can have, I think ultimately it'll make healthcare better, I think it'll make physicians better, which will make Americans better.

Sacopulos: How do people interested in learning more about non-traditional careers in medicine find you?

Lawrence-Reid: They can find me at DoctoringDifferently.com, exactly how it's spelled. Also on social media. I'm on Instagram at DoctoringDifferently and Facebook at DoctoringDifferently and on Twitter, X, which is @DocDifferently. And I'm Naomi Lawrence-Reid, so you can find me everywhere.

Sacopulos: Dr. Lawrence-Reid, thank you so much for your time and insights. I greatly appreciate you being on SoundPractice.

Lawrence-Reid: Thank you for having me.

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