Independent Physician Spotlight: Demetrio Aguila

New feature! We put out a call to celebrate independent physicians, and we’re featuring a different doctor who’s decided to go (or remain!) independent to restore their autonomy and provide better patient care. This week, meet Demetrio Aguila, who’s the founder and medical director of his own practice Total Pain Solutions. You can connect further with Demetrio on LinkedIn.

1. Demetrio, give us a little background on you and your practice. Our surgical practice is focused on permanent surgical solutions for chronic pain. About 50% of our practice is the resolution of postherpetic neuralgia, of which there are roughly 200,000 new cases in the U.S. annually. Our goal is simple - restore hope to the hopeless by offering permanent fixes for which the temporary band-aids of the past have been ineffective.

I am a diplomate of the American Board of Plastic Surgery and the American Board of Otolaryngology, specializing in peripheral nerve surgery and the surgical management of acute and chronic pain, as well as general plastic, reconstructive, and microsurgery and general otolaryngology.

In our practice, we regularly see patients from all 50 states and 31 foreign countries (so far). I am the only surgeon in Nebraska, Iowa, Colorado, and South Dakota to offer micro-invasive carpal tunnel surgery with real-time ultrasound guidance, allowing patients to return to work the same day, without restrictions. I am also a founding member of the International Surgical Society for Nerve-Induced Pain. I am also an active member of numerous other organizations, including the American Society for Peripheral Nerve, American Society of Pain and Neuroscience, International Headache Society, American Headache Society, American Society for Regional Anesthesia and Pain Medicine, the Society of Physician Entrepreneurs, the Catholic Medical Association, and the Free Market Medical Association.

I currently serve as the Leader of the Nebraska Chapter of the Free Market Medical Association. A former U.S. Air Force combat flight surgeon, I served 8 years in the reserves and 13 1/2 years on active duty, traveling to 46 states and 31 foreign countries. I graduated from the Boston University School of Medicine, completed my surgical internship at Wright State University, and completed my aerospace medicine training at the USAF School of Aerospace Medicine at Brooks AFB, TX. I completed my otolaryngology-head & neck surgery residency at Mount Sinai Medical Center in New York, and my plastic & reconstructive surgery training at the combined Johns Hopkins University / University of Maryland Plastic & Reconstructive Surgery Residency Program.

Further, I completed my fellowship in Peripheral Nerve Surgery at the Dellon Institutes for Peripheral Nerve Surgery. I am also a fully-trained medical acupuncturist, having completed the Medical Acupuncture for Physicians Course at the David Geffen School of Medicine at UCLA and the Helms Medical Institute under Drs. Joseph Helms and Richard Niemtzow. I am the CEO and President of Healing Hands of Nebraska, and the founder of Healing Hands of America, the 501(c)3 non-profit that runs the revolutionary M25 Program (https://m25program.com) that offers patients innovative options for specialty care while avoiding crushing medical debt, recently featured in CNN’s Champions for Change. I received my Masters of Theology from the Augustine Institute. I enjoy playing ice hockey, hunting, and teaching martial arts, and I live with my family in the Omaha, Nebraska metro area. I am also currently in formation to become a permanent deacon in the Catholic Archdiocese of Omaha.

2. What do you see as the biggest challenges to physicians going (or staying) independent? How are you addressing these challenges? The biggest challenge to going independent is debt. So many of us were told when we were in high school that we should “leverage” debt in order to go to college and get ahead. Those graduating from college with a mountain of debt find solace in the knowledge that they can defer their payments until after they graduate from medical school, often piling on even more debt on top of that which they accumulated in college. By the time they graduate from medical school, they start in a residency that, when seen in light of the work hours, often pays barely more than minimum wage. By the end of the training, with over a million dollars in debt, many physicians feel boxed in, unable to do anything other than take the big paycheck, and the golden handcuffs, that are offered by the big hospital systems, a deal that is married to the administrative horrors of the health insurance system as well.

These physicians feel that they don’t have any other options to get out from under the weight of that debt, and find themselves trapped in a system that promotes profit over care and burnout over well-being.

The biggest challenge for physicians who want to stay independent is restoring the doctor-patient relationship through direct care. Direct care is the way of the future, and ironically, is also “traditional” medicine in the truest sense. For thousands of years, direct care is the way that medical care was practiced all over the world, and still practiced successfully today in many countries, and in a growing number of communities in the U.S. Breaking free from the hospital/insurance system is the other side of this coin. Hospitals treat us as expendable widget-makers, with those who are willing to work silently on the assembly line being the least bothersome. I once had a hospital CEO tell me that “physicians are a necessary evil in the delivery of healthcare.”

Shedding the shackles of fear that hold us back and giving ourselves permission to determine our value, independent of what the hospital administration or insurance industry tell us, is the key to maintaining independence.

Direct care is more fair to the patient and the doctor, is more affordable for the patient, and more sustainable for the physician.

3. What are the biggest benefits for going independent? Independent practice is how we are able to maintain autonomy. The only committee that has to approve any changes in the practice is the one that I see in the mirror every morning, and if we can’t agree, then we’ve got a bigger problem! Independent practices are more adaptable and flexible, able to meet the needs of the patient in real-time. Subsidiarity is the greatest benefit to the patients. The best person to solve the problem is the one closest to the problem, with minimal (if any) interference from third parties, particularly those who have never met the patient. The result of this intimate doctor-patient relationship in direct care is a significant reduction in overhead costs, and the savings can be passed on to the patient. The patient receives higher quality of care, with more time spent with the physician, and at a more affordable price point, with transparency, and fairness built right into the model. The employed physician model is the classic “one size fits none” approach, and only serves the shareholders, not the patients or the care-givers who are in the trenches with the patients.

4. What's your advice to anyone who's thinking about making the leap or deciding what path to take straight out of training? Do it! If you’re in training, you’ve been living a modest lifestyle (I hope!). If you want to have the freedom to build or join a practice that is of your choosing (and not one that has been thrust upon you out of financial necessity), then continue to live as a resident until you’ve built up a big enough nest egg to be comfortable with the financial risks associated with stepping out on your own. This means driving your beater and living in a small house until your debt is paid off early. Cash is king, and if you’re not beholden to those debtors, then you won’t feel the need to bow before the altar of an employed position in order to feed yourself and your family.

As Dave Ramsey says, “you’ve got to live like no one else, so that later on, you can live like no one else!”

5. Are there any resources you can recommend to help physicians who are considering this path? The first resource I would recommend is Dave Ramsey’s Financial Peace University (https://www.ramseysolutions.com/debt/debt-101). If you want independence, then you need to know how to make your money work for you rather than you working for your money. Secondly, I would recommend the Free Market Medical Association (https://www.fmma.org), dedicated to transparency, independence, and fairness in the practice of medicine and the delivery of healthcare. Thirdly, I would recommend resources like Freedom Healthworks (​​https://freedomhealthworks.com/direct-primary-care-startup/), a company led by Christopher Habig, that specializes in helping physicians transition to direct care, both primary care and specialty care, with a concrete pathway to independence that works for the physician AND the patient.

6. How can other physicians who are inspired support you? If you’d like to support us, first I’d ask you to check out the M25 Program (https://m25program.com), the mechanism by which patients can receive specialty care without incurring crushing medical debt. Your tax-deductible donation will make it possible for patients who are willing to invest in themselves through community service to access the care that they need without going bankrupt.

Secondly, I would ask you to check out our YouTube channel (https://www.youtube.com/@TotalPainSolutionsbyHHNE/videos) to learn more about the surgical solutions that we offer to treat patients with chronic pain and spread the word. If you’re a surgeon and you’re interested in learning more about how to treat these patients, please reach out to us and we’d be happy to help you along the path.

And finally, and most importantly, if you’re the type to pray, then I would ask you to pray on behalf of our practice, our patients, and our families. And if you’re not the type to pray, then please either consider starting, or ask one of your friends who does pray to do so.

Connect with Demetrio on LinkedIn and learn more about his practice here.

Resources Referenced in This Interview

Here's Demetrio's list of resources for anyone who wants to go independent or remain independent as a physician.