How Physicians Can Reclaim Their Negotiating Power With Dr. Eric Bricker

You have to actively ask for raises. Guess what happens? People who ask for raises, get raises. People who don't ask for raises, don't get raises

You may recognize Dr. Eric Bricker from his signature whiteboard videos on YouTube and LinkedIn where he artfully and efficiently breaks down some of the most complex topics within healthcare finance, even to those who practice medicine. For example, he unpacks the mysteries of pharmacy benefits and offers a path for primary care to reach profitability and scale.

Dr. Bricker is an internal medicine physician by training, but has followed an entrepreneurial path having launched two companies, the second of which is AHeathcareZ, an educational platform focused on unpacking the business of healthcare for physicians so they can work smarter within the system. He is passionate about enacting change within corporate medicine and giving physicians the perspective and information they need to navigate the complexities and bureaucracy they inevitably run up against.

In a new episode of How I Doctor, Dr. Graham Walker, Offcall co-founder and an emergency physician in San Franciso, speaks with Eric about what physicians can do to not only negotiate a higher salary, but also increase their agency in order to provide better patient care.

“I just want to be a doctor and I just want to see patients doesn't work because the money is so impactful in patient care. And so, if we really want to help our patients, we can't just be a doctor and just see patients. We have to understand how that money flows and how it impacts our patients so that we can help them better,” Eric shared.

Over the course of the episode, Graham and Eric discuss four powerful tactics physicians can use to increase their income and negotiating power, as well as how physicians can navigate some of the hot-button topics in medicine right now, including non-competes, prior authorization, and the role of unionizing.

1. Learn how the insurance system can work to your favor

At the end of the day, guess what? If you want something prior auth, like, you will get it approved…The vast majority of the time, if you want the stress test…you can get it, okay? Maybe you're going to have to delegate that… you've got to be persistent. And so that's like the little secret that insurance companies don't tell you because of course, the protocol is…they're going to deny everything.

Eric emphasizes that understanding the intricacies of the insurance system, particularly when it comes to prior authorization, can significantly benefit physicians. He highlights the importance of persistence and knowledge in navigating insurance protocols to get necessary approvals that improve patient care.

2. Don't worry about non-competes

What can physicians do to just make more money? You switch jobs. This is true across any job, across the economy, any industry. Job switchers make more money, and it's like 30%.

Eric suggests that physicians feel empowered to challenge non-compete clauses in their contracts. It may take some work with a lawyer, but with recent legislation, he believes that health systems are more likely than ever to drop these lawsuits. He believes non-competes should not hold physicians back from seeking better employment opportunities with higher pay.

3. Ask for raises — several a year if necessary

Guess what happens? People who ask for raises get raises. People who don't ask for raises don't get raises. And you don't ask once a year. Shoot, ask twice a year. Ask three or four times a year, ask multiple times a year. And if you're not willing to give me a raise, I'm willing to leave.

Eric unequivocally advocates for physicians to actively seek salary increases from their current employers. This simple, practical advice is a reminder that requesting and negotiating raises can lead to better financial security and job satisfaction.

4. Unionize and organize

And so we just need to unionize. It's been primarily the residents that are starting to do it. And these residents are making a lot more money than they used to make. They're getting much better working conditions, and it's actually not that hard to unionize.

Eric also points out the benefits of unionizing, particularly in cases where other options are limited. Unionization is one way for doctors to improve their work environment and compensation collectively.

You can support Dr. Eric Bricker by subscribing to AHealthcareZ here. And make sure to check out another recent episode with Dr. Jared Dashevsky, founder of the popular newsletter Healthcare Huddle.

Make sure you don’t miss an episode of How I Doctor by subscribing to the show wherever you listen to podcasts. Read the full transcript of the episode below.

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Full Transcript

Dr. Eric Bricker:

One of the topics is like, well, what can physicians do to just make more money? You switch jobs. I mean, this is true across any job across the economy, any industry. Job switchers make more money, and it's like 30%.

Dr. Graham Walker:

Welcome to How I Doctor. We're bringing joy back to medicine. My guest today is Dr. Eric Bricker. Eric is probably best known for his big personality and brilliant explainer and analysis videos that he produces for his company, AHealthcareZ. You can find them all over social media with his unique style of whiteboard drawings and professional passion and excitement.

Dr. Bricker provides insightful commentary and a fascinating lens for physicians to better understand healthcare finance, healthcare economics, and how these factors trickle down to influence of doctors' day-to-day and what happens to their patients. Thank you so much for joining me today, Dr. Eric Bricker.

EB:

Oh, Graham, listen, thank you so much for having me. And I love the intro of bringing joy back to medicine. I think that's great.

GW:

We mean it. Thank you. Eric, I love that I'm actually seeing the background of what I see in your videos when I watch them all the time.

EB:

Yeah.

GW:

Where did the idea for AHealthcareZ and the videos come from?

EB:

Before I became a physician, I was actually a hospital finance consultant who had helped doctors and hospitals get the bills paid back in the '90s, back when it was like paper bills, and still wanted to become a physician and wanted to really help solve. Because it was a billing disaster back in the '90s, and it's a billing disaster today. Nothing's changed.

And so, I really wanted to try to help solve some of those problems that I saw prior to going to medical school in my career as a physician. So went to University of Illinois for medical school and then Johns Hopkins for residency in internal medicine, and actually started a healthcare navigation company in residency and then after residency as well.

It was called Compass Professional Health Services. And we would contract with employers to provide basically outpatient care coordination, insurance coordination, basically all the stuff that a primary care physician doesn't get paid to do. They don't have time to do. Sometimes they just don't do it. You can actually get it through your job.

So if you got, like Southwest Airlines is one of our customers. So if you were a pilot or a flight attendant, you'd be like, okay, you'd have this care navigator through your job that would help you with your insurance and your doctor and your hospital stay, et cetera, et cetera. And we grew that to about 2000 employer clients and 1.8 million people. And then, we sold that business in 2018.

And so to specifically answer your question, when I was sort of free and I was no longer a part of Compass, I'm like, "Okay, well, I'll just start making these videos as a hobby," so I could kind of shoot people straight, and I could give people kind of the good, bad, and the ugly for the insurance companies, the docs, the hospitals, the pharmaceutical industry, et cetera.

Because I wasn't beholden to anybody, and I could just say, "Hey, my point-of-view, how do I see things?" I'm like, "Hey, I'm just going to try to shoot people straight with what I've experienced."

GW:

Eric, you have such a unique style in your videos. Why the whiteboard? It's totally become your brand and your style. I immediately know an Eric Bricker video.

EB:

One of my favorite people is Linus Pauling, and he's famous for having won two Nobel prizes, one for peace and one for chemistry, I believe. And so, one of Linus Pauling's quotes is, "The best way to have a good idea is to have a lot of ideas." And so, I was like, "Okay, the best way for me to have a good video is for me to have a lot of videos."

GW:

How do you pick your topics, Eric?

EB:

My inspiration is infinite. But instead of it being like Sports Center on ESPN where it was like, "Okay, well, this happened and then this happened," it's like, "Okay, well, why is this happening?"

So I'm kind of getting into how the game is played and what's going on "behind the scenes" because that that's the real mystery of "healthcare". It's like a duck where you just see the duck on the surface, but there's all this stuff going on underneath the water.

And the reason why I focus on healthcare finance is because all that stuff that's going on underneath the water is the money. If we could do some things around how the money flows in medicine, I think it would dramatically improve patient care. That's why I talk about this stuff.

GW:

It's really important, Eric. That's something that I think you're unique because you are speaking with your medical knowledge and your medical training, and that's something that none of us get any training in it. Maybe we get a little bit of an elective.

EB:

Yeah. And I honestly think that medical training actually sets up very well for this. Because at the end of the day, I think all physicians are kind of autodidacts, right? To a certain extent, if you're a physician, you kind of have to learn how to learn. Because nobody finishes medical school, nobody finishes residency knowing everything they need to know.

But we as doctors need to understand that, "I just want to be a doctor and I just want to see patients," that that doesn't work because the money is so impactful in patient care. And so, if we really want to help our patients, we can't just be a doctor and just see patients, that we have to understand how that money flows and how it impacts our patients so that we can help them better.

In my opinion, we will be better doctors and we can help our patients better if we understand this. Not as a hobby, not because we're curious about it, not because it's going to help our own income, but because specifically it's going to help our patients more if we understand this better.

So that's why I have gobs of physicians that watch my videos and call me all the time and are like, "Hey, this resonates with me, and let me tell you about what's going on here and what's going on there." So I get calls with inside stories all over the place from doctors all over the country.

GW:

Eric, if all physicians or many more of us had a better understanding of the money, what would we do with that information? Would we be advocates or lobbying or just play the game, play the game better?

EB:

So one would be around like prior authorization. And at the end of the day, guess what? If you want something prior auth-ed, you will get it approved. So A number one for prior auth is that the vast majority of the time, if you want the stress test or if you want blah, whatever, guess what? You can get it.

And so it's a matter of understanding that and then understanding that, okay, yeah, maybe you're going to have to delegate that to maybe an MA or a nurse or whatever, and you're going to have to go through... So you've got to be persistent and blah, blah, blah, but at the end of the day, you can totally do it.

And so, that's the little secret that insurance companies don't tell you. Because, of course, the protocol is, I mean, they've literally taught them this. They're like, "They're going to deny everything."

Two, okay, what else? This whole non-compete thing is a bunch of garbage. At the end of the day, you as a doctor, you can and you should leave your job, and you should go across the street to the competing hospital system. Just do it and be like, "What are you going to do?"

GW:

Because the hospital's not going to actually do it.

EB:

Right, and guess what? Maybe you got to get a lawyer. Getting sued is not the end of the day. You get a lawyer, they'll drop it. Vote with your feet and just do it. And they'll try to intimidate you to not do it, but just freaking do it.

And so, this is true. So one of the topics is what can physicians do to just make more money? You switch jobs. I mean, this is true across any job across the economy.

GW:

Any industry, I think. Yeah, yeah.

EB:

Any industry.

GW:

Right.

EB:

Job switchers make more money, and it's like 30% more.

GW:

Wow.

EB:

Because people are always looking for docs, I mean people are always looking for docs.

GW:

Especially now.

EB:

Yeah.

GW:

Yeah.

EB:

And people are so scared to leave. Dude, just leave. You'll be okay. "I got my student loans to pay back." Just leave. "I got my kids' college savings to take care of." Just leave. You will find a job. You will be okay. It's really the fear, false evidence appearing real. You just got to have the courage to just get over that, and you just got to walk.

Physicians are basically lied to by insurance companies. They're lied to by administrators. If you don't want to use the word lied to, they're manipulated. So the point is is that if you actually understood how the money works, then a physician would be much less easily manipulated.

GW:

How does that make you feel, Eric, when you come to these realizations? Do you feel we've been taken advantage of all along or have things changed over time?

EB:

Oh, yeah. We've totally been taken advantage of. We kind of get used to not pushing back, and then in residency we don't push back. And so, we've been trained to not push back. I've even had hospital administrators admit this to me that whenever they need the physician to work more hours or see more patients, they essentially intentionally guilt trip them into being like, "But this is for the patient." They literally told me, "Yeah, that's a strategy we use to manipulate physicians."

GW:

I think Danielle Ofri had a piece in the New York Times that I always think about where she essentially said the Hippocratic Oath is abused in that doctors and nurses have decided to go into medicine for these hopefully somewhat altruistic reasons. We take this oath that says we're going to put our patients above us, and then the system uses that oath that we said we were going to put patients first to get free labor, work extra hours-

EB:

Oh, yeah.

GW:

... in the name of the patient.

EB:

That's right. And also, I just want to add too, it's not just the "system". It is specific people in positions of power. So people are always like, "Well, we don't like to point fingers." No, there are people who are consciously sitting in rooms making these decisions.

GW:

I want to transition a little bit to what's happening with physicians now. I'm seeing more physicians wanting to leave medicine, begging to leave medicine, or just do something else, whether it's a side gig or cut back on their clinical hours. How did we get here?

EB:

So, one, the reimbursement complexity has really continued to get worse and worse to the point where just the denials and the non-payment and the delayed payment for the independent physician was overly onerous so that they essentially had to sell their practice because they couldn't bill and collect.

And then, the other reason why is because the professional fee reimbursement is just so low compared to the facility fee reimbursement because the big hospital systems have the negotiating power from a commercial insurance, so from like a employer sponsored insurance plan.

So this is the classic thing of the orthopedic surgeon is like, "Well, maybe I'm getting $750 for the professional fee for the arthroscopic knee surgery." But that hospital could be getting anywhere from 16 to $32,000, and the doctor's getting 750. The surgeon's getting 750, the anesthesiologist is getting 1100, and the hospital's getting 32 grand. And it's just because of the negotiating power that the hospital has for that.

And then what really added kerosene to the fire in the last five years was the explosion of Medicare Advantage. Because historically, physicians still had traditional Medicare where you didn't have prior authorizations, and if you didn't, you would get paid relatively quickly. You do it, you get paid. You do it, you get paid. And that kind of existed.

But that was when only 20 to 25% of people on Medicare were on Medicare Advantage, and now it's over 50%. And that trend, it's going to go up to at least 75% that are on Medicare Advantage. So all the problems with delayed and denied payment that used to not apply to your Medicare population, now it does apply to the majority of your Medicare population.

And so you definitely have proceduralist doctors, cardiologists, orthopedic surgeons, neurosurgeons doing spine, radiologists, I mean, those professions that I just mentioned, they're making money hand over fist. In this new environment, they're making more money than they ever have in the past. And then geographically, especially in the South and the Midwest, these folks are easily pulling in over a million dollars a year.

GW:

Because the facility fees are so high, and so then the hospital can give them a nice chunk of that?

EB:

That's right. These hospital systems sometimes are making $10 million per neurosurgeon. So they're like, "Yeah, we'll pay the neurosurgeon a million bucks because we're making 10 million off this guy or woman every year."

GW:

Eric, are there other practical things that doctors can do to respond to the changes we've seen over the past couple decades whether it's to improve their salary or just improve their quality of life of finding a better place to work?

EB:

Yeah. So you're either going to walk, or the other thing too is you have to actively ask for raises. Guess what happens? People who ask for raises get raises. People who don't ask for raises don't get raises. So you need to ask.

GW:

Yeah. That's great.

EB:

And you don't ask once a year. Shoot, ask twice a year, ask three or four times a year, ask multiple times a year and be like, "Look, I want a raise. And if you're not willing to give me a raise, I'm willing to leave." And so you can either leave, you can threaten to leave an ask for a raise, and then the third alternative is you unionize. Because there are some places where they're like, "Well, there's just not enough options here. And so, we just need to unionize."

And we see this with doctors and with nurses. With doctors, it's been primarily the residents that are starting to do it. And these residents are making a lot more money than they used to make. They're getting much better working conditions, and it's actually not that hard to unionize.

GW:

It's always felt to me that physicians, we tend to circle the wagons around our own specialty, but do you get a sense that physicians are becoming more open to that idea of we're stronger together?

EB:

Unfortunately, I think the answer is no. I think we are still heavily Balkanized by specialty. Because to a certain extent, while we're all doctors and we take care of patients, our practices and our patient population...

Like a dermatologist and an orthopedic surgeon actually have very little in common. I mean, they're both doctors, but kind of. I mean, they're super different. It's like one guy's a plumber and one guy's an electrician. That's really different. Yeah, they both work on houses and buildings and stuff. It's hugely different jobs that you have.

And I don't think we're going to overcome that. And actually, that's really been the reason why everyone's like, "Oh, the AMA is terrible." Listen, it's not the AMA's fault. I mean, each physician is so married to their individual specialty society, whereas the American Hospital Association is actually quite unified for all the hospital, and it's been all this uncoordinated effort from a political advocacy standpoint. Whereas from the hospital standpoint, it's been highly unified.

Which is why I actually, from a practical standpoint, I actually, I'm like, "Look, don't rely... " Healthcare improvement in your life as a physician is not going to come at the federal level. It's going to come at the level of your own practice, of your own hospital, of your own county, and maybe your own state. And that's it. So if you want to focus, start incredibly local because PBMs have very organized and effective federal lobbying. Doctors are not going to beat that.

GW:

Is there a way that a physician can get a sense for how much the hospital is billing under their NPI or their name? Is that something that a doctor can figure out?

EB:

So the short answer is yes. And you know which group of physicians that I feel like does the best job of this is radiologists. Because radiologists, they know their RVUs cold. And the key to making money as a radiologist is your RVUs. Because if you're churning and burning and reading, you're literally generating 22,000 to 24,000 RVUs per year. A primary care doc is generating 4,000 RVUs per year. So just the economics of the way that you read films, you're just cranking out RVUs like crazy.

And then, you talk to the finance people within the hospital. Again, you've got to be persistent. You got to know who to talk to. Yeah, you-

GW:

This is part of asking for a raise is explaining your value too.

EB:

Yeah, but believe me, all the radiology groups that contract with the hospitals, they know exactly what the hospitals getting reimbursed per RVU. And what I've really found is that the radiologists, they tend to be good business people because they're very rational and they tend to be dispassionate. They're good at numbers. They tend to be like engineers. And they're very good at just looking at this and just putting together the numbers on the spreadsheet.

I mean, shoot, there's a lot of doctors that don't know how to use a spreadsheet. What is something that you can do as a doctor? You need to know how to use a spreadsheet. And as an autodidact, you need to be able to figure out how to build your own spreadsheets and being able to figure out and track your own RVUs and how you're getting paid or whatever.

So in terms of individual agency and keeping track of stuff, you got to keep track of your own. If you want to make more as a physician and you're not doing your own spreadsheeting, then the first thing you need to do is do your own spreadsheeting. Because guess what?

GW:

Yeah. Get your own house in order. Yeah, yeah.

EB:

That's right. Because that's what other people in other industries do. That's what engineers do. That's what people who work in investment banking do. That's what people who run small businesses. Physicians used to be small business owners. Physicians used to run their own small practices, a small business. You need a spreadsheet.

GW:

Eric, we only have a few minutes left. I've got some rapid fire kind of quasi medical questions for you. Whatever comes to your mind. What's the number one thing you wish patients knew about you?

EB:

This is going to get a little philosophical, that the metaphysical dominates the physical. We live in a metaphysical world that dominates the physical world, and you can experience that metaphysical world through whatever spirituality or religion that you would like. But if you understood how the metaphysical dominates the physical, your life would change so much more for the better.

GW:

Wow. I never expected to hear such a line from an analytical Eric Bricker. I absolutely love that. Eric, what's the best financial advice you think you've ever received?

EB:

Oh, well, this doesn't come from me. This comes from Ben Franklin. And that is spend less than you make. So everyone has probably heard of the book Millionaire Next Door, and there are these people that are referred to as poor accumulators of wealth.

And a number one example is physicians because they tend to spend more than they make. And so, take whatever it is that you're making and spend less. And so, that house that you buy, literally buy a house that's got kind of smaller square footage. And the car that you buy, don't buy the big flashy car. And, yes, the other people that you know that are your peers that are in your age group, they're going to have fancier cars and bigger houses, and they're going to go on fancier vacations. And we're not going to do that.

GW:

Eric, I talk a lot about AI as well. Have you thought of what you think will be the big use case in AI that changes medicine for the better?

EB:

I already think that the natural language processing and turning that with AI into a note is a real game changer. Because the documentation, it's a bear. That, in my opinion, is a huge game saver. To the extent that you can actually have it just listen in on your conversation and generate the note for you, I mean, that's fantastic.

GW:

Eric, if you could design or create a new medical specialty, what would it be?

EB:

The serious oncologist, serious oncologist for serious stuff. Because there's a huge spectrum of like ductal carcinoma in situ for breast cancer versus like serious, serious oncology. Just like with primary care, you got to be... or emergency medicine. You got to triage them in and be like, "Do they need to be admitted? And the equivalent is, "Okay, I'm a community oncologist or whatever." And it's like, "Okay, you need to be admitted to the serious oncologist."

GW:

Do you have a lesson from a mentor, an attending, someone that still shapes how you think about medicine or think about the world?

EB:

Well, every single attending I had at the University of Illinois at Chicago really told me the patient comes first always. I mean, that was really ingrained in me. And then I got to Hopkins and every single attending physician at Hopkins was like, "The patient comes first." And that might be true at all medical schools and all residency programs, but that was definitely true where I trained.

GW:

And then, Eric, last question. One medical myth that you wish would disappear forever?

EB:

I guess one is that people just need to understand T cell clonal expansion. Be like, "Look, it takes three to five days for your T cells to kick in. But when your T-cells kick in, they are amazing. So I get that you're not feeling good now, but if you just knew what your T cells could do and the fact that it takes three to five days for them to kick in, just give your T cells a chance because they will blow this viral thing out of the water so good that you just got to chill till those T cells start working."

GW:

Well, Eric, where can listeners find you and help support the work that you're doing? What's the best place to find you?

EB:

If you're on LinkedIn, just connect with me on LinkedIn, Eric Bricker. And then also too, the AHealthcareZ Channel on YouTube. So if you want to see videos or subscribe, that's where you can go.

GW:

Dr. Bricker, thank you so much for your time today. It's been absolutely great to have you and get to connect with you.

EB:

Thank you, Graham. And thank you everybody for listening.