Hello and welcome to today's webinar, The OEM Entrepreneur, Turning Expertise into Opportunity. We're thrilled to have you join us for this important and timely discussion today. Before we begin, let's cover some housekeeping details. There are two features available for communication during today's webinar. You may post general messages in the chat. Messages can either be shared with panelists or other participants. Use the drop-down menu to select your audience. So go ahead and start by introducing yourself. Please share your role and your location with other panelists and attendees. We also have the Q&A question box, which we encourage you to post your questions to. So questions for the panelists should be submitted through the Q&A located on the bottom of your screen. This is the best way to ensure your questions are seen and addressed. Please do not post any questions in the chat as we may miss those. For those who are unfamiliar with ACOM, we are a membership organization dedicated to promoting the health and safety of workers, workplaces, and environments. Please note that today's session will be recorded. The recording will be made available for purchase later this week. And now I'm delighted to welcome and introduce today's faculty. I'm going to start with introducing today's moderator, Dr. Afia James will moderate today's presentation. Dr. James hails from Houston, Texas. She holds an undergraduate degree in mathematics and a doctor of medicine from Howard University. Dr. James completed her residency in internal medicine and a fellowship in occupational and environmental medicine at Yale University. She also earned her master of public health from George Washington University. Dr. James began her OEM career at the VA Connecticut Healthcare System, serving as staff and physician later as chief occupational health services. She was an associate, or sorry, assistant professor of clinical medicine at Yale, where she received the medical education innovation award in 2024 for creating a military toxic exposure elective. Now I'd like to welcome Dr. James, who will moderate and introduce the rest of our faculty today. Welcome, Dr. James. Thank you, Nikki. Thanks for having us. So I'm going to share my screen. OK, so I am going to introduce our two esteemed panelists today. First, I'm pleased to introduce Dr. John Berth, a highly accomplished physician who completed a residency in family medicine and an occupational environmental medicine residency at the Harvard School of Public Health. He served in many clinical roles and as the medical director of occupational health at Boston Medical Center for 10 years. Since 2015, he has led OCMED Consulting and Injury Care, focusing on improving the Massachusetts Workers Compensation System and disability management for organizations in Massachusetts and New Hampshire. In addition to serving as a senior aviation medical examiner in the HIMS AME, Dr. Berth also serves as a medical director for AIM Mutual Insurance. Dr. Berth has also held numerous leadership positions, including past chair of the Massachusetts Medical Society Public Health Committee and a past member of the board of directors for ACOM. Currently, he serves as a co-chair of the Massachusetts Department of Industrial Accidents Healthcare Services Board Guideline Writing Committee and as a chair of our very own ACOM Work Fitness and Disability Section. We're excited to have Dr. Berth join us today to share his valuable insight into OEM entrepreneurship. And next, our next panelist is our Dr. Doug Martin. It's also a pleasure to introduce Dr. Martin. He's a proud native of Louisville, Nebraska. Dr. Martin earned his Bachelor of Science in Biological Sciences with the highest distinction from the University of Nebraska-Lincoln and his Doctor of Medicine with distinction from the University of Nebraska Medical Center. Dr. Martin served as a medical director at UnityPoint Health Occupational Medicine in Sioux City for 25 years and currently works at CNOS in the same capacity. He's also contributed to medical education by writing three books, including Independent Medical Evaluations Practical Guide. He's held numerous leadership roles, including being our former president of ACOM, former president of AADP, and the Iowa Academy of Family Physicians. Currently, he's the chair of the Interstate Postgraduate Medical Association, an SME site surveyor for the Federation of State Physician Health Programs, and an appointed member of the FMCSA Medical Review Board. Beyond his professional accomplishments, Dr. Martin served as a volunteer EMS director, volunteer county public health superintendent, and a member of the National Scout Jamboree Public Health Staff. He has delivered over 1,000 CME presentations throughout his career and has participated in nine ACCME accreditation surveys for various organizations, including ACOM. In addition to his medical career, Dr. Martin is a passionate supporter of Nebraska football. He bleeds Husker scarlet and longingly wishes for the return of Nebraska football dominance as seen in the 1970s, 80s, and 90s, while at the same time supporting the best-run collegiate volleyball program in the country. Please welcome me in joining Dr. Martin and Dr. Burris to the panel. Dr. Burris. Oh, OK. Sophia, you're going to let me go first, huh? I'm going to let you go first. Well, good afternoon, everyone. So I did family medicine and then the Harvard residency. I've been clinically focused and from the get-go thought that I would hang out my own shingle someday. I initially thought I would do so in my hometown in rural Kentucky. I did things like arrange for disability insurance for myself while I was a resident. And it was in the back of my mind the whole time that I've been in practice. So you can see currently I'm in my 10th year as the principal of my own LLC, Lenders and Liability Corporation. And I have a number of other paid and unpaid gigs, if you will. And one of the key statements I would make is often the unpaid gigs can lead to paid gigs. And help to establish a brand. I don't know if Doug would agree with that. But over the years, I've seen other AECOM members follow that same kind of pattern. I can't tell you which of the unpaid gigs were the more important. But I was involved with the local component, AECOM, as annual conference chair and as president. Early in my career. And I think that helped to raise my profile and date. Next slide, please. So many of us have certain, I'd say, areas of focus. One of my, I think, smart moves that I made was in the 10 years while I was at medical center, I stayed as a 0.8 FTE. If you've never thought about doing that, then you should. And I'll tell you why. While I was a medical director at this medical center, I was also a consultant for two government agencies. And then developed a medical directorship at a monoline insurance company. My unpaid gigs were with the Massachusetts Medical Society, including the public health committee and others. And I was on an opiate task force during the opiate epidemic. And that segued to doing reasonable suspicion. For example, this is an example, reasonable suspicion talks all up and down the East Coast. Now, you can see that I did, I was a medical director for the Commonwealth of Massachusetts for 20 years. Actually, quote unquote, retired from there. What is disability management? And it's something that an op doc can do. And it comes in different flavors. Next slide, please. The question is, and Sophia asked this, how would she, for example, think about gravitating towards something other than a salaried income? What would that be? What would it look like? And how do you achieve it? For me, even when I didn't have my own LLC, I was very much aware of my reputation, my brand, if you will. And I gradually moved more towards the disability management part, but kept my clinical wings. So that gives street cred. For me to jump from a salaried employee to starting my own LLC, how did I even dream of doing that? And how could I achieve that? Because the moment you're not salaried, you're eating what you kill. OK, and you're making payroll. That's a way different animal. And some people never have the wherewithal, courage, or ability to do that. I already had somewhat of a book of business and was able to grow that some. But I can tell you that my wife, who's a physician as well, put a very sharp point on it. And she asked, how much are you willing to lose? And I had to say, about as much as I have in that bank account. And if I had not had that money in that bank account, she would have said, get a job, because we have four little kids. So that's the kind of thing you have to think about. I was very fortunate. My father had invested in Apple 30 years ago. And he was very, very successful. There was a little extra money when my mother died. And that really, even though I didn't have to use it, it served as a backup and was enough to have my wife feel comfortable with me going out on my own. So why would I do that? Why would I take the risks to start a business, especially in a state like Massachusetts, where the front line care of injured workers is very poorly reimbursed? Why would I do that? I'm passionate about it. I can convey that passion. And I wanted to prove a point. And so I put my money where my mouth was, and I did it. A couple of little caveats, and there may be some questions to follow. But the moment you're a small business owner, especially a medical small business owner, you just became the rabbit. You just became the prey of choice. I had false contracts given to medical assistants that were in the guise of a receipt, but yet they were a five-year contract. I had employees steal, write checks. I've been the victim of a cyber security attack. And the usual and customary AR slow walk strangle, OK? Accounts receivable is the nightmare of any small business. And that's been a very difficult position to keep filled. If you want to go to the next slide. So one of the things, that's OK. So one key thing, and I'll stop and let Doug speak, because I'm sure they'll have much better things to say than I. But one of the things that I've done successfully is to cut out any middle person over the year. And a lot of people will want to garner your time and take a cut. And sure, you can get the work. But whatever margin, you can't really get to an actual consultant's wage if you're working through a middle person, you see? So if and when you can, go directly to the client. Establish your rapport. Business is all about rapport. It's the secret of any successful business is you have a person to person rapport with their principal or their person that's in charge at that company. If you don't have that, then you can't aspire to have a consistent look of business. But if you can garner that rapport with numerous clients, then that's your security. That means that you can call them and say, I need help with this AR issue. And you can weather bumps in the road that indefinitely come with the practice of this type of medicine. Those are some of my thoughts. I'll let Dr. B. If you don't mind, Dr. Burris, thank you. If I could just ask a couple of questions before we move to Dr. Martin, that would be great. So one question that I had for you is you discuss branding. And it seems like you had a lot of unpaid positions during your career. Do you recommend that physicians look into or accept, consider unpaid positions when thinking to start their own business? Is that a way to get your name out there? Is that what you did to get your name out there and to increase your visibility and also your credibility? Yeah. Yeah. You want to be seen as the subject matter expert. And companies want to employ a physician. Same thing with an attorney. They want to employ a physician who has a network, who is tied in with other people in that geography that get things done. And it doesn't hurt if you're a good clinician. And the best marketing is when that person who you just sutured goes and shows other workers. And that person who you just took care of articulates to the safety professional or the designated employee representative that I had a good experience with Dr. Barres' practice. That is the best marketing. I've tried various web-based efforts. I never have had to go to hiring a full-time marketing person. Most of my new clients come from safety professionals and designated employee representatives who move from one company to another. Most of my new clients come from brokers who have a client and they're looking to solve a problem. And they see me as part of the solution because I charge twice, basically, more than what the DI rates are. I have a whole business model for that. I don't know if that answered your question, but yes. I think my years doing the annual conference for my component design were significant. There I had to talk to various people and just speaking, just going up and getting in front of the microphone and talking about your field of expertise with a passion. You know, that counts. There are nurse case managers there. There are others that are aware of what your interests are. And yes, branding is that. I see that my logo has been taken off this slide. I put it on there and... There you go. How do you even come up with a logo? So I had to hire someone to create that. And so when I give a talk, I put it on there and it's on my website. All that just doesn't go out of the sky. You have to think about it. Just literally getting your own, not Gmail, but a web address that has your company name in it. There are steps that are required. But it's all part of your branding. And you want to be proud of that. And that's something that, as an entrepreneur, you covet. And bad news can travel very fast. So you have to show up to work and actually provide good care. Without that, you've got nothing. So I hope that answers your question. Yeah, thank you. And I'm just going to put in a plug for ACOM. There are a lot of volunteer positions. And so ACOM is always looking for volunteers. And that's a way to get your name out there and increase your visibility and perhaps pick up some business. So there are a couple of questions in the chat that I just wanted to ask you that come from the audience. Dr. Burris, one of them states, I do not understand what a false contract is. Please elaborate. Yes, so this was a business, an obvious strategy for, I think it was a company that provided something like gowns or something to my office. And they gave what looked to be a receipt to my medical assistant. She signed it and then the company said, oh no, that's a five-year contract. Obviously when you look at it, they've done this before. Okay, that's why I'm talking about a small business is a prey of choice. And there's a whole industry out there looking to come after and get money from you. And I literally had to have an attorney send it to that national company to say, hey, you're not going along with it. And they backed off. The moment I was represented, that was their strategy. They expected a busy physician to just go along with it. But I didn't, I realized what was happening. So in order to protect yourself, there's something called an P&O, there's an admission policy. And in addition to your malpractice, I used the one through ACOP and it was excellent. It saved me when my email was hacked. And what they call the threat agents, they weren't trying to get a ransom. They were just trying to redirect any wire transfer. So for example, they masqueraded as me saying, oh, send that $5,000 monthly check to this bank account instead of that one. Right? Hoping that I wouldn't recognize. But the insurance company that I'm the medical director of, their IS person astutely said, oh, there's something wrong there. And they, because that threat agent was monitoring my email for a good number of months, looking for that type of situation. So the Arizona admission policy through ACOP, by the way, they hired an attorney out of New York who got in a technology group out of Canada. And they backtracked, looked at everything and shut it all down. And found the weaknesses in my email and stopped those and took care of it. So that's, yeah. I see you're on mute. Sorry. Yeah, we spoke about this before, just when we discussed entrepreneurship and your experience with the hacking. So what, is it safe to say that not only do you need clinical expertise, but you also need legal representation and legal expertise, as well as a business, someone that, or if you have a good background in business, is that what you're saying? Yes, yes. Okay. I have a healthcare CPA specific award. Okay. And when I've needed it, I'll get legal input. I spoke to an attorney this morning about a potential upcoming business arrangement. Okay. So absolutely. And when I first started, I did have a seasoned practice consultant come in. Okay. So, yes. Great, great. And then there's another question going along the lines of operational. Two questions. Basically, do you have an MBA or master's of business in healthcare administration or if you don't, do you, do or don't, do you recommend getting one in order to, to start your own business or become an entrepreneur? I don't think you'd have to have it, but if you do have it, you'll probably better suited for the C-suite and some larger organization. Okay. Historically, when my grandfather started his business, he didn't have an MBA. Okay. Historically, physicians would have a small business, their practice, just like a dentist does now. So no, you don't have to have it. If you're gonna, if your, if your target is that you're gonna have your own practice, doesn't hurt. I have other colleagues that have that. And if that's an interest, then go for it. But I don't think it's absolutely necessary because if, you know, if you need that level of business acumen, you hire it. Good to know. Thanks for that. And one last question, Dr. Burris, before we move on to Dr. Martin, can you share more about your business model and your rates? How did you come up with your rates? How do you, how is your business run and what business model do you use? Well, okay, there's some secret sauce there. We don't have a, but long story short is, I would dare anybody to come to the state of Massachusetts where the rates were set 30 years ago and provide frontline care and even try to have a viable business model. It is impossible. 30 some clinics have shut their doors. There are no hospitals with outward facing mock med. Think about that. Would you imagine a hospital without a cardiologist? No, but I'm sitting here right now, speaking to you on the fringe of the campus for Mass General Hospital. Mass General Brigham is the number one largest in the state of Massachusetts. They have zero outward facing mock med. I'm embedded in their system using their technology. They don't care. Okay. So it seems like you sought out an opportunity where there was kind of a vacuum and you, that's what made you successful. Well, some of the, in addition to your expertise. So believe it or not, I'm the only mock med clinic in downtown Boston. So think about that. In Manchester, New Hampshire, where by the way, the rates are three times three X, there are six mock med clinics in downtown Manchester, New Hampshire. That is ridiculous. And so I service about $7 billion worth of construction. I find that construction is, the incentives are nicely aligned. They're very much interested in their experience modifier ratio, EMR, not their electronic medical license plate. So experience modifier ratio. And if I provide good care, it helps them with that experience modifier ratio. That's where the real dollar is. It's not the cost of my care. Those are some of the things without going into more secret sauce. Okay. Thank you, Dr. Burris. We'll come back after the present, after Dr. Martin's presentation to take any other questions. So I am going to hand it over to Dr. Martin. Dr. Martin, go ahead and tell us a little bit about your journey into entrepreneurship. So thank you, Effie and John. Thanks for that as well. So it's kind of important to understand my background to sort of understand where I'm at today. I have taken a little bit of a different path than my good friend, Dr. Burris, insofar that I've always maintained a full-time clinical occupational medicine practice here in the Sioux City region. Now, if you go back and you look at the history, 25 years of that was actually for a health system. Two years was for what I refer to as a regional for-profit clinic system. One year for health that went south, you probably know the corporation. I won't give you the long story there, but if you ever have an opportunity to read the book, Pulling the Wagon, I would suggest you read that. It's a fascinating story about that organization. My hospital that I was with for 25 years decided in 2022 to show me the door and subsequently stop doing occupational medicine, which was sort of a bizarre thing, but it created some opportunities and challenges at the same time. But what I basically decided to do was move to a independent for-profit multi-specialty organization, CNOS, which is where I'm at now. And I'm now a physician shareholder in that organization. So I always like to tell people that I think I've seen every different payment model that probably is in existence. Now, there's some other things that you need to know about my background. I, like Dr. Burris, did a family medicine residency purposefully with an all knowing that I was going to be an occupational medicine doctor. Now you might say, well, why didn't I do an ARC-Med practice? And the reason is, is because I wanted to make sure that I continued to be primarily a clinical-based doctor. I had a very wise mentor of mine at the University of Nebraska College of Medicine, Dr. Leroy Meyer, who was an internal medicine physician, who also happened to do some gig work for Mutual of Omaha. And basically he guided me in that direction. And I think it probably was the correct decision for me because in my family medicine residency in Davenport, Iowa, I essentially was able to use all of my elective time, the entire six months of elective time in family medicine to hone my occupational medicine skills. Now, not every family medicine residency is like that, and I recognize that. So obviously I was able to take advantage of that. Some other things you need to know about me. I do quite a bit of what is referred to as medical legal work, independent medical examinations, file reviews, expert witness type things. And I do that within multiple contexts. So not just in workers' compensation, but also in personal liability, medical malpractice, all of those various different aspects. And I just put a couple of websites there if you want to know more about what I do. So the reason that I got interested in this whole entrepreneurial world is, if you actually want to think back about my history, when I was with the hospital employer, which is where I started my practice here in Sioux City way back in 1994. So I came right out of residency at Davenport, moved to Sioux City. Occupational medicine was brand new to the Sioux City community. The hospital had just started the program, really didn't know what they needed to do, but wanted to latch onto that at the time. I was an employee physician for the first five years of my career. And then the administration of the hospital came to me and said, hey, we've had a paradigm shift and we've decided to make all of our doctors independent contractors and no longer employers. So this got me to thinking, okay, if I'm gonna be an independent contractor, what is the best strategy to actually operate that under? And to make a very long story short, after consulting with some tax professionals and attorneys and other colleagues, some of which who had been through this in AECOM at the time they suggested that I start a corporation. So that's what I did. I started Martin Occupational Medicine in 1999, basically as originally a pass-through organization for the independent 1099 income that I was getting through the hospital system. What I didn't know at the time is that that actually set up as an excellent vehicle for what I call optional gig opportunities. So what I'm talking about are those opportunities that subsequently arose above and beyond my typical clinical practice that I had with the hospital system. And over the years, there have been many various different things that have cropped up. And I would echo my good friend, Dr. Burris's admonition that it's incredibly important to understand that a lot of these things initially are best done in a volunteer role. If you are taking the perspective here that you're only looking for the paid opportunities, A, you're probably gonna miss out on a lot of things, and B, you're probably going to miss a lot of opportunities at networking and having individuals be able to see what you are, who you are, and how you go about doing things, which I will give you some examples of this when I talk about the various different things that I've had the opportunity to be involved with in the past. The other thing about this is that being, that I've been through all of these various different payment models, and I can tell you all kinds of stories about the time when I had an employed RVU-based employment arrangement. As you well know, the majority of what we do in occupational medicine does not have a CPT code. And if it does have a CPT code, guess what? It doesn't have an RVU that's been assigned to it by CMS. So that becomes challenging. And I can give you all kinds of examples about how we basically had to make up CPTs for certain things that we've done, how we had to make up RVUs for things, obviously in a negotiated type of strategy, because we really did have to make the proverbial round peg fit into the square hole of that hospital-based system when those things came up. But anyway, having this experience, I think, has taught me a lot about how to identify these various different gig opportunities, and then do some negotiating, set some expectations, and then being successful with them. So if you've got the next slide, that'd be great. So as we think about talking about these things, I've taken an approach that's a bit different from Dr. Burris. I've always been a 1.0 FTE in my clinic. Now, part of that, frankly, has to do with regards to my location. I have told a lot of people this, and I will tell this audience, that Sioux City is big enough to need an occupational medicine doctor to do everything, but frankly, probably not big enough to need more than one. So what that means is, is that that translates into an OCDOC that wears many different hats. And I wear every single hat that you can think of, I think, in the occupant world. We do have a competitor in town, but frankly, that competitor operates their occupational medicine clinic more as an urgent care walk-in type of facility, and does not touch all aspects of OEM, and they don't mind telling people that they freely admit that. But I do do a lot of gig work on the side. Now, you might say to yourself, well, why in the world would you do that? Aren't you busy enough with this full-time clinic business opportunity? And at this point, I usually try to explain to people that it's all an individual decision, right? And everybody is different in this respect. So you have some physicians that are perfectly content with the full-time clinic role opportunity, really are not interested in doing anything outside, and that's fine. There's absolutely nothing wrong with that. And then you have people like me that are always interested in A, learning new things, and B, being able to perhaps help organizations that you see need some help. So that is really the impetus or the driver for why I became involved in a lot of these different things. And what I have found over time is that, it's actually kind of fun doing these things. So if you're into things like physician health and trying to avoid burnout and all of these various different things, I will tell you that being involved in these different gig opportunities and having the opportunity to look in different facets of where I can help organizations and so forth, I think has helped to a great degree in mitigating any of those concerns about burnout that a person might get from just working in a clinic every single day. And oh, by the way, the money's not bad either. I think what you will find when you start to look into some of these opportunities is you'll be shocked at how well compensated these things are, especially if they're able to identify somebody that does a good job. So if I get it in the next slide, please. So I just wanted to go over some of the various different things that I've done and share with you sort of my experiences and how these things came into play. One opportunity that I will tell you that is frequently a good opportunity for occupational medicine doctors in particular is the for-profit plasma center collection world. I happen to be the center medical director for OctoPharma, which is one of two collection facilities that we have here in Sioux City. And that is clearly a gig opportunity. It requires my presence on site four hours per week. It's something that I can do all at once or I can piecemeal that with different visits throughout the course of the week, they don't care. The things that I'm responsible there are primarily donor suitability. That sounds a lot like fitness for duty, doesn't it? So equal sort of ways that you have to think about how to figure those things out. I also play a CLIA medical director role. I already had CLIA certification. That was one of the things that I did actually first thing out of residency because the hospital system came to me and said, hey, you know, you want to think about doing this because the Ockman Clinic was in a bigger building that had a certified laboratory and they actually needed somebody to do that. So already having that CLIA certification helped with that because in the plasma world, the medical director typically has to have that to cover all the various different tests that are done on site. But really the positive of this plasma center opportunity is it takes a lot of the things that we know and do well in occupational medicine and is able to translate that into a slightly different venue, right? So I talked about the donor suitability being similar to a fitness for duty type thing, multitasking, being able to look at various different data sets and data points to come to a decision. I have a training role at the plasma center as well. I train what are called physician substitutes, which are typically LPNs, EMT folks that basically are responsible for the day-to-day management of donor incidences, medical incident reports and those types of things. They also are responsible for doing the initial screening, physical examinations. So I have a teaching role. And of course we do that in occupational medicine a lot, right? So an easy transition there. The Federation of State Physician Health Programs, that's an interesting story. You may know that that's an organization that helps oversee the processes for physicians who have difficulties with substance abuse or alcohol abuse and basically is there to make sure that there's a identification pathway, but then also a rehab and a treatment pathway for physicians and other folks that are in the healthcare world to go through those processes. Just recently within the last year and a half, that organization has decided to certify treatment programs. And through the federation, I had the opportunity to become involved in setting some of the standards for that. And now I am what they call an ETA expert. Well, what is that? Well, in order to obtain the federation certification, the various different treatment programs require an application that meets certain standards. So if you want to think of it, it's kind of similar to the joint commission world where hospitals seek joint commission certification. They have to maintain certain aspects or best practices if you want to think of it, but it also requires a site survey. And so what we do as site surveyors is we actually visit the location. We get to interview the staff. We get to look through the processes. We get to look through lots of paperwork and make sure that those things are established. So why did that come up in my world? The reason that that came up in my world is because of my position as a medical review officer. Frankly, what happened is, is that I was a medical review officer when I was with the hospital system for the state employees in the state of Iowa. I did about 15,000 drug test reviews a year. And guess what? The person that was in charge of the Iowa State Physician Health Program knew my name through being the medical review officer for the state employees. And she suggested my name to the federation. Next thing I know, I've got an email. Hey, we're starting this program. Would you like to be involved with it? We don't really have an occupational medicine doctor. We think it would be a good add. And as they say, the rest of the story is unfolding, right? Another opportunity that is out there is in the workers' compensation world, they oftentimes need medical directors. Oftentimes the managed care organizations are not large enough to need someone that's full-time. It may be very piecemeal. And for a while, I was a managed care work comp director for the O'Hara program, which is a Nebraska-based workers' compensation program. That, folks, was frankly like three hours a month. It wasn't much, but by state law, they have to have a physician in that role. So that became a very interesting thing. Now, I certainly would not suggest to you that authoring books is going to be a great income producer because it isn't, but if you do have a gift or some skillsets in writing, I would suggest that there are some opportunities in occupational and environmental medicine that exist. The best example that I can share with you is the book opportunity that came up with regards to the independent medical examination book that I wrote for Springer. I don't think many people know how that came to play, but I'll tell you how it came to play and how it goes back to Dr. Burris's example of being in the right place with volunteering. Some of you know that for a number of years at AOHC, I did a session on independent medical examinations. Well, it just happened to be that at one AOHC, the representative from Springer Publications who had a display at the exhibit hall just happened to pop her head into my session. And after AOHC, about two weeks later, I get a phone call from her and she said, have you ever thought about turning your PowerPoint presentation into a book? And at first I thought she was nuts. I thought, well, no, I mean, I'm teaching doctors here. This is a CME presentation. Why in the world would I ever want to write a book about something? So I kind of gave her the cold shoulder for a year. Guess what? Next year's AOHC, she's back again, sticks her head into my session again, and bugs the heck out of me after that, like would not take no for an answer. So I caved, okay? I said, okay, I'll go ahead and I'll write this book. It's been wildly successful. And I will tell you, I didn't know this at the time, but there really was never a book that was ever written about best practices in independent medical examinations. Yes, there have been some journal articles that have been published. There have been some short articles in other areas that have been talked about, but never a book that actually was a how-to manual for individuals and physicians who wanted to get into the independent medical examination world. So there you go. As they say, the rest of the story has been written. Another thing, I do a lot of work with regards to other physician organizations and even government entities. Some of you know that I'm the co-chair of the AMA Guise editorial advisory panel. We are continuously updating the Guise to the evaluation of permanent impairment. And that opportunity has opened up a lot of additional doors, at least for me personally, because of that visibility that John talked about. And then on these government panels, it's interesting that a lot of these things that I've been involved with, the RETAIN project, which is a combination project between Social Security and the Department of Labor to try to set standards for individuals to keep them employed, who are kind of on the fringe of unemployment and disability. And then most recently, the FMCSA Medical Review Board. A lot of these government agencies are looking for individuals who have that practical knowledge and skillsets to be able to bring real-world scenarios into policy and development of statutory guidelines, written policies, and these sorts of things. Now, since you're on the right-hand side of this, I are pretty much all volunteer. Our medical and fire medical directors completely volunteer. We have no money in South Dakota to pay county superintendents of public health. We have a little in South Dakota that we have no state income tax, and we get what we pay for. But that's a volunteer opportunity that I think, you know, again, is very well suited for the OEM physician, because I get involved with not only education, I get involved with public policy. I also help then commissioners try to make decisions where to put their budgetary dollars for various different preventive medicine strategies and that sort of thing. Another thing that I can't take credit for, because my wife has been primarily doing this, is that to get involved in mission organizations. And frankly, you know, I don't think it makes much difference what you become involved with, but becoming involved in some charitable type of organization, I think I would strongly suggest that you think about that, because that again opens some doors and some opportunities in other areas. My wife's work, she's a nurse by training in the various Haitian mission organizations that she's been involved with. It's kind of drug me along for a lot of these things. I've been able to meet some rather fascinating individuals across the country that really have opened some doors and some opportunities for me to have other types of work. And then there's a bunch of one-off things that come up, you know, and at this point I would put a little plugin for the very different social media outlets, LinkedIn, for example, you know, Facebook to a lesser degree. But a lot of these one-off opportunities are actually posted on social media platforms. And again, I will tell you that individuals in occupational environmental medicine, I think particularly well-suited to help with a lot of the things just for our experience and our background. One of the things that I point out to a lot of these organizations is that in clinical occupational medicine, it's not just a doctor and the patient. There's multiple holders involved. It's the doctor, it's the patient, it's the employer, it's a union, it's the nurse carrier, it's a case management nurse, it's the human resources director, it's the attorney. And you sort of learn over time how these various different individuals have input, but you have to manage that input. And I think a lot of these one-off things that you'll see actually identifies individuals who have that skillset to take multiple input information together to try to make that work. So next slide, please. So that gives you a little bit of a background on the various different things that I've become involved with. Now, I also would be remiss if I didn't talk to you about things that I have turned down and why. And I'm not suggesting that anything that's on this slide is necessarily automatically bad, but I also wanna point out to you that there are some pitfalls to some of these things that you should pay attention to. John talked about the false contract situation. This actually happened to me with one of our local community colleges where I was invited to actually write up sort of what a job description would be for what we call wind farm technicians. Now, you may not know what that is. You probably are familiar with what a wind generator is, right, these huge multi-story things that have the big whirligigs on them that generate the electricity. Well, about 20 years ago, our local community college came to me and said, well, we don't have a job description for these people, but yet we're going to start an educational associate's degree so people can get certified as a wind technician. Would you write something for us? And I kind of naively said, well, sure. I think I know what that entails and I can give you a decent job description. And the next thing you know, what I have in front of me is a contract to be an adjunct professor for this for the next five years. And oh, by the way, volunteer and not pay. So that was sort of like a little bit of a bait and switch type of thing that didn't go over too well. So I would echo what Dr. Burris has said about paying attention to those things and making sure that you don't commit to something that you're not prepared for. I have had a lot of individuals and organizations reach out to me to see if I would be in a supervisory arrangement for either your physician's assistants or nurse practitioners in a lot of different venues. These would be things like the medical aesthetics clinics, the men's health, the women's health, those types of things, the medical spas, if you want to think of it. I have always been very suspect of that for a couple of different reasons. Number one, the supervisory requirements seem to be a little probably not what they should be to take that risk. Some of these actually cross state lines. So I become a little bit worried about, am I ever actually going to meet these people that I'm supposed to be supervising? In a lot of situations, the answer to that is no. And I'm not suggesting that all these things are necessarily bad. It's just that you have to pay attention to things like geography, medical licensing requirements, professional liability risk, and those types of things. And then I've had a couple of opportunities where I've been asked to be on the board of for-profit companies. That is a whole different conversation and one that probably would be a webinar in and of itself about the pros and the cons of that. Again, not suggesting that all of these are bad, but just be very cautious of what that commitment actually means. I will caution you that initially, it might sound like it's not that much of a commitment. Maybe there are three or four board meetings a year. Maybe you have to say that you're going to be on some committee, whether that's a compensation committee or whatever. It may sound like that's not much, but then when you really start asking questions, you find out that it's much more to it than what you originally thought. So just be aware of that sort of thing. And then the other thing that I will caution you that is becoming very common, especially with the AI world and what that is currently doing with regards to all aspects of medicine, is I've been asked to be a tech advisor on a couple of different software development projects. Again, be very careful about what this means. Individuals may be wanting you involved with that only to use your brand and name. So again, echoing what Dr. Burris said about the importance of making sure your branding and your naming is protected. Make sure that you know what you're getting yourself into. Again, not suggesting that all these things are bad. I'm just identifying certain pitfalls to be looking for. So, Afiya, I think that's it for me. I'll leave this last slide for you. I know we're sort of running out of time here, but these are the things that I've learned, right? Know your boundaries, time management. I cannot emphasize how important time management is. I have elected to do a lot of these things myself from a business standpoint. I don't have any formal business training. I didn't take a lick of any business courses in college other than, I think, a required economics course, which I've long since forgotten what that's all about. But, you know, you just have to be a savvy business person, know what you can do, farm out things that you can't, and always want to be a perpetual learner. I think that's sort of what has driven me. I'm always interested in things that I don't know about, and a lot of these gig opportunities have given me the opportunity to learn about those things. Thanks. So thanks, Dr. Martin. That was great. You've done a lot, you and Dr. Burris, very inspirational. There are a couple of questions in the chat. One is, how does one become an MRO? Is there an exam? Can it be done after OEM fellowship, Dr. Martin? Yes. So medical review officer is actually a required position for the federal workplace drug and alcohol testing programs. The way that you get certified as a medical review officer is that you attend a continuing medical education training course, of which ACOM is one of those organizations. Full disclosure, I'm the course faculty chair for that training course. And then once you go through that training course, you do sit for an examination. There are two organizations that provide that certification. Again, full disclosure, I'm on the board of one of those organizations, the Medical Review Officer Certification Council. If you want to know more about that, send Nikki an email about that. She's got all the information about the ACOM training courses. Yeah, that's great. So I took the ACOM MRO course. It's great. So I do endorse that one too. And oh, someone put in the chat, Dr. Martin, is the book, Health South, The Wagon to Disaster? Yes, it is. Okay, great. And another question from the audience, this is from our colleagues, our NP and PA colleagues. What are some opportunities for NPs and PAs to get into OEM entrepreneurship or side gigs? So admittedly, most of what I have talked about is more geared towards the physician. However, not all. Depending upon your state and the various different rules that are involved, NPs and PAs might become involved in like county health departments, for example. I know that the rules are sort of changing. I can share with you that in South Dakota, it is no longer only physicians who can be EMS medical directors. That is actually a law that changed last year. So now physicians assistants and nurse practitioners can do that as well. There's a very good reason for that in South Dakota, because it's a very rural state. Oftentimes, you just don't have a physician in the rural parts of South Dakota who can fulfill that role. So it sort of depends upon the individual rules that you have in your jurisdiction to look into some of these things. Great, great. If I may. Uh-huh, go ahead. In PPA, if you have an expertise in OCMED, you may be able to approach an urgent care in your area and embed a more focused OCMED practice within that urgent care. Otherwise, I've seen various entities choose an NP or PA to do their what would previously have been considered a quote medical director. It's someone who can fill a role for that entity. I don't think there's any. I think everything we've said is the same for NPPAs. I have one of my daughters who's going to become a PA, and I think the door's open. I did have one comment about one of my reasons for being a 0.8 FTE or some other number is at one point I signed an employment agreement that had an intellectual property clause, and that bothered me because I never know when I'm going to have an idea that has some merit, and I would always want to have some way of whatever that idea is. I want to call it my own and bring it to fruition and foster its value without having an employer think that it's their intellectual property. That's something to think about. Okay. Dr. Burris, how do you negotiate 0.8 FTE as a medical director when most of the positions are 1.0? Well, if they want to, you tell them, I'm happy to do this, and I think I can do it well, but I have these other things that I want to continue to do, and so I'm only available as a 0.8. Generally, that's enough for them to pay benefits, and sometimes it works out great for the employer or entity as well. It's something that you can negotiate and should, in my opinion. Great. Nikki, do we have time for a couple of more questions? Yes. Yes, we do. Okay. This is one of my questions, and audience member had the same one. How do you choose between a corporation versus an LLC? What are some of the things that you have to think about? I guess I'll take that. There's an S corporation. There's various types, and when it comes to that, consult your attorney and just read about it, and that's what I did. An LLC, most positions, it seems like they go that way. It's just more advantageous, and to Doug's comment about the money, I found that a SEP IRA, because I have 1099 income, you can have something called a SEP IRA, and I actually saved significant money towards retirement. It's tax shelter. It's not insignificant. The maximum amount right now for 2024 is $69,000. Are you talking ... That's the self-employed IRA? Yes. Okay. Is that something that you can have in addition to a employer IRA, if you are self-employed and you're ... My wife's an anesthesiologist. She's employed by Mass General as a portion of her FTE. She works at another place and gets 1099 income. She has her own LLC, so you can have a SEP IRA. She has her own LLC, so yes, she has a SEP IRA in addition to a 401k. This is of significance. Type of money adds up. Yeah. I think you only get, I guess, $23,000 in additional. You can deduct expenses at a much, much more significant rate. Anytime I go to ACOM or any other company, that's dollar for dollar for me. Okay. Okay. Perfect. Circling back to the MRO question, would you recommend taking the exam in person in conjunction with the course offered at AOHC 2025, and does one need to obtain materials to study in advance? Thanks, Dr. Martin. The quick and dirty answer is yes and yes. I think that it's maybe an individual decision with respect to the in-person versus the open book test. They are different, okay, and that's one thing that I want to point out. I think most physicians are used to an in-person exam because that's sort of what we were brought up with, and I think that if you attend the course and you pay attention, there's very little chance that you'll fail, but there are a lot of people that like to look at the various different resource information, which is, by the way, available on the MROCC website as far as the study materials. If I could comment, I recently did the open book one, and I found it to be a better, you know, I was able to not garner my time because I'm teaching a workshop. I was able to achieve a recertification as an MRO without doing that at AOHC, so just a little counterpoint. The other main comment I would make about being an MRO, that's FaceTime with the C-suit. If you're talking with a designated employee representative about a difficult MRO issue, a positive drug test, that's time you're on the phone with the decision maker or applying company. Always value that. Okay. Can chiropractors become MROs? Not for the federal system, but it depends on the state regulations. So, for example, in the state of Iowa, under our code 730.5, chiropractors do have the ability to be MROs for state employer drug testing programs. Okay. Okay. Great. And a question about where do you start? So, we've talked about the many different opportunities that you guys have had, and it seems like, you know, a lot of them have come because of networking or volunteering and things like that. So, how, if you're starting to get some of these opportunities or people are knocking on your door, how do you start? Is it the first thing you do is you get an LLC, you establish your business, an LLC in your presence, or is there something else that you do first? You don't have to have an LLC. Okay. You just do it. And, you know, the school of hard knocks. You will be taken advantage of. You will not come out well. A little side story. One of my daughters, her best friend, her father was a partner in a law firm, right? He's getting $400 an hour. This was 20 years ago. And I'm getting a measly 200 or something an hour, right? So, I, you know, I learned of this and I called the person I was doing reviews for, and basically she said, no, no, no, thank you. I lost the contract. Okay. Because I proposed something that wasn't market rate for me, even though I had a greater number of years of experience and education. The society at that time valued that law partner's time more than my time. Great. Thank you. Another question. What are some good medical malpractice companies? Also, should you have one that covers your LLC versus yourself individually? So, there's different realms of insurance and you shouldn't consult your, you know, whoever it is you're buying insurance from, but you need something for malpractice, good old fashioned medical malpractice, but that doesn't help you for certain other things like cybersecurity, for example, like errors in admissions, for example. I have other insurance policies for my company that are umbrella. Somebody falls on my premises, et cetera. So, you just want to not have glaring holes in your coverage. Trust me, the insurance people will barter the maximum amount from you. Okay. Thanks for that. Let's see. Do we have any more questions? No more questions. Okay. Let's see. I have a question about contracts. Let's, for instance, say government contracts. Where would you go to find potential contracts? So, every state has an RFP process. This state happens to have one. It's, you know, you can get on a serve that will give you notice, but the very best way is to be notified by someone who needs. I mean, the government agency, for example, I've gone through RFPs about a half a dozen times. I have currently, you know, at least two contracts through government agencies. And you just, you learned what it is that they need, their criteria. You write it to that audience and you put your name in the hat. And if you're in the right place at the right time, you may have as good or better credentials as the next person. So, I think anything that has a government mandate is an excellent opportunity for you. And once you get started, unless you're egregiously bad at what you're doing, it will keep going. And I've now been 25, almost 30 years at one government agency. And I go there, you know, a half day, once a month. And, you know, it's a nice gig. I do most of the disability evaluations for the state of New Hampshire. Why do I do that? I like to write. I can do it. And some of it is in person and some of it is not in person. And, you know, it's like, you know, I try to do a really good job. I think I give a good value for the reports. And, you know, I was able to win that contract. And that's an example of, I had been the medical director, giving some supervision to a number of urgent care facilities and did that through them. But there wasn't something, there were some things that were not right. And so I extricated from that and competed for that RFP directly. And that's an example of cut out the middleman. Yes, exactly. I have a question about you, Dr. Burris. What services does your business offer for clients? What do you actually provide? What are some of your services? My day job is that I have an office downtown Boston and people come for their care. I do a lot of suturing, as Doug knows, we're doing a workshop at AOC. And it's a full scope OcMed clinic. Right now I have an NP, two MAs, front desk person and a billing person. At times past before COVID, I had a second position. He was an MDJD and helped me with a lot of the writing, editing. So I do a full scope, very hands-on, high level, urgent care. I'm right next to Mass General. If it's a trauma, I have a good home, life or limb threatening, great. But I do a lot of the suturing here. And in addition to that, you can look at my CV. I have a book of business for disability management. And before I did physician level UR, I don't know if your state has that, but somebody has to do it. And then some years ago, I jumped to the dark side where I help adjusters, which sounds god awful as a clinical person, but somebody has to do it. And I literally inject common sense and I can be a worker advocate while I'm doing it. Just during this webinar, two reviews have come in that I need to do. One is a rush. So that'll be part of my day today, but it's probably a surgical procedure that needs to be done. I'll review it and I'll give a thumbs up, thumbs down and exactly why. And how can I do that? I'm not a surgeon. I've just been doing it for years and it's common. Well, I say it's common sense, but it's clinical and human based and they pay me to do it. So I must be doing something right. Doug, I don't know if you have that. Yeah, no, the only other thing that I add to your comments about there is don't forget about the ACOM practice guidelines. Just because you're not a surgeon or not a specialist in maybe cardiology or endocrine or pulmonary or whatever, the ACOM practice guidelines do have the evidence indications for surgical procedures, invasive type of things that we don't necessarily do. And that's how I use that material when I'm asked to review files and ask the question, you know, is it reasonable to have this done or that done or what have you? Yeah. So here's a great example of if you do pro bono work, like I'm the co-chair of a guideline writing committee for the Massachusetts Department of Industrial Accidents. Well, those guidelines are legally enforceable over and above any proprietary guideline, including ACOMs, including the ODG. And so I can, because I helped to write them, I can better cite them. And so then it dovetails into my medical directorship and doing these disability management reviews. So there's a concrete example of how, you know, years of pro bono work translates into my ability to do a job better than I then get paid to do. And paid well, by the way. My wife tells me it's not a hobby down there. She thinks I should stop clinical practice and just keep the money that I gleaned from consulting. I probably would end up with more money in my pocket at the end of the year, but I love what I do and I'm not going to stop. All right. Well, you know what? We ran a little over on time, but thanks everyone for sticking with us and getting some great inspiration from our esteemed docs here. And with that, I'm going to turn it back over to Nikki to close us out. Yes. Thank you all for sticking around for that extra 15 minutes. We will have offer 1.25 CME for this. To our attendees, again, thank you for joining us today. And to our faculty, thank you so much for all your insights. We hope you all found this session informative and engaging. Before we go, we kindly ask that you complete the evaluation that will pop up in a separate window once this webinar ends. I'll also send an email with those instructions on how to complete the evaluation and claim your CME as the evaluation is required in order to earn the CME. Your feedback is invaluable for us to help improve our future webinars. So thank you all for joining us and have a great day. Bye, everyone.

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