On Episode 16 of Decision Dialogues, Karl Graf joins Jennifer Faherty to speak with Dr. Ruby Kim, who runs an independent medical practice, Premier Spine and Sports Medicine. Ruby discusses her decision to establish an independent practice and talks about how she weathered challenges while staying true to her vision for patient-centered care. She also shares insights on assuming risks and striking a healthy work-life balance.
The summary below has been created by a professional transcription vendor upon review of the recorded presentation. Please excuse any typos as well as portions noted to be inaudible.
Thanks for joining us on Decision Dialogues. We’re thrilled to have you along. My name is Jennifer Faherty and I’m the Chief Client Experience Officer at Modera Wealth Management, LLC. Today my colleague Karl Graf, who is a Principal and Wealth Manager at Modera Wealth Management, and I will be chatting with Dr. Ruby Kim. Dr. Kim is an interventional pain management specialist who is fellowship trained and board certified in physical medicine and rehabilitation. She runs an independent medical practice, Premier Spine and Sports Medicine, in Englewood Cliffs, New Jersey. She also serves actively on the board of the New Jersey Doctor-Patient Alliance. Welcome, everyone, to the show.
Thank you for having me.
Thank you, Jennifer. Thank you, Doctor, for joining us. We appreciate you taking the time to share what you’ve learned along the way. Tell us a little bit about your practice, specifically, and how you arrived at this particular business and being independent as a physician, which is a fairly rare thing these days.
Yes, it is a very rare thing these days, and the percentage of independent physicians continues to go down every year, which is unfortunate for healthcare as a whole. So to backtrack, I actually did what most new graduates do. I joined a large practice thinking this is where I need to be—grow in a large practice. But I did choose one different thing. I chose a private large practice because I knew I wanted to go private, rather than joining the corporate ranks of medicine. So by doing that, I started learning a little bit more about how private medicine works. Unfortunately, that practice does not exist today. A lot of things happened with the principal partners there health-wise. But in moving on, I actually moved back to New Jersey where I’m from. And when I came here, I joined another private group.
So what point in your career did you decide it was the right time to go out on your own? And it sounds like you that was your intention all along? Is that the case?
Yes, it was my intention all along. I wanted to go private, I knew that that’s what I wanted to do more than going academic. There’s really three main routes of practicing—choosing an academic center, where you like to practice under the larger corporate umbrella of medicine, or joining a private corporate medicine, like Kaiser Permanente that most people know of, or Summit Medical Group locally, Riverside Medical Group locally, or just putting a shingle out there and really working by yourself. I was planning to do more of the private corporate structure. However, when I came back to Jersey, I realized that things were different here. And the group that I was planning to join didn’t really function well, in my opinion, in delivering healthcare. So somehow, I suddenly became by myself and I was ready to start and keep going, I just kept going.
So that entrepreneurial spirit, did you always have that? Or did you arrive at it while you were working? And where do you think that came from?
I know that came from when I was a kid. My parents are both accountants, and they have their own business. From the get go, they always told me, you are never going to work for a large corporation in the end. That’s where you start. That’s where you get your legs. That’s where you learn your experience, and learn how things work in the world to get a good structure. But from that you should have something else that you do on your own, that you can really mold into who you are and what you want to be and how you can give back to your community, and also to help you live your own life with the lifestyle of your family.
It’s terrific advice. And it’s kind of against the grain of what most of us hear about the medical world these days. You know, physicians in our experience have been consolidating, joining big groups. So did that make the decision more difficult? And did you find it, or have you found it difficult to carve out a place as an independent physician?
It was difficult, especially since all my colleagues were joining bigger groups, negotiating contracts with the big groups. And so we had different things to discuss even amongst ourselves when we’re talking about what are you getting, what am I getting? What are your bonus structures set up like. It’s very difficult to find a place where we can both understand each other even amongst my own colleagues, even with my own husband, he didn’t have the same upbringing. His parents said, just become a doctor, once you’re a doctor, you’re set, you join a big group, you’re good. You know, like, just become partner of a law firm, you guys are good. So we didn’t see eye to eye for like, 10 years, actually. It took a very long time for my husband to understand my own entrepreneurial spirit that I was learning since I was a child. So it is difficult within my own personal home, as well as with my own colleagues, to find my own place in this world. Does that make sense?
Yeah. And I’m actually, I can jump in. I’m curious, are there support networks for entrepreneurial or independent physicians? Are there groups where you can help support each other? I know in the financial world, there are those types of groups— we’re independent advisors, and so we have independent peers that we can get together and network with.
So in the past, there really wasn’t anywhere for anybody like myself to go to when I was searching for help. And I was asking this person, that person. There was no group to turn to for help. And in this process of being on my own for eight years now, I found some other like-minded physicians, and so we actually all got together as healthcare continues to become larger and larger. We actually bonded together and founded our own organization called the Doctor-Patient Alliance, where we align ourselves with our patients. And so we are now able to grow together and fight for each other’s rights against the large corporate insurance companies.
That’s very interesting. So how receptive are other practitioners to that kind of an arrangement? Are you seeing more and more physicians moving that way? Or is it a very small group? How are you finding that as you make your way?
So we actually started off with more specialized physicians, people who are more able to provide a service that not many people can provide. And let’s say it’s an ENT specialist, or it’s a dermatologist, an orthopedist or a spine surgeon on pain management, even an acupuncturist, a physical therapist. So all the sub specialties started to find each other through this group. And we’re empowering each other, to help each other through all the different rules that are constantly being laid out by all the different industries that regulate us as well. And then we are able to share information amongst ourselves and empower each other so that we can succeed together rather than trying to do the independent fight alone.
So did you have a mentor prior to the formation of this group? And how did you discover that group? It’s a needle in a haystack, it sounds like.
My mentor, I would say, would be my fellowship director, Dr. Michael Furman. He has the perfect mindset of private medicine but in an academic setting. He has a perfect hybrid of that, so that he’s able to practice medicine in the private world while publishing papers, writing textbooks. I helped write several chapters within his own textbook that he created that most fellowship trained doctors use now in order to learn how to do pain management. So it was a wonderful hybrid—I realized that you can do it if you look for it. And if you want to create it, you can create it. And he was a wonderful mentor—he still is a wonderful mentor, I still see him.
Oh, that’s a terrific attitude. And I can see the enthusiasm you have for him and the help that he’s given you. What about the management aspects of a business or the financial and other preparations before you went to launch? You know, what kind of considerations did you go through when you made that choice? And how much support did you have then internally?
That was the most difficult time period of my life. I had no support. I had no financial support, personally, myself, other than my husband, and we were newly graduates of residencies and fellowships, and we had a lot of debt. We just had a baby boy. I had some medical issues with him as well. So we were in a tough stage of our lives when all of a sudden I realized the group that I had joined did not practice medicine the way I thought was best for patient care. And it was more financially driven. And that really bothered me. So I decided to leave on my own and decided to just start my own practice. And there was really no resources other than me knocking on doors, asking for help, literally saying, help me help me. Really just asking any doctor, I would randomly go to doctors’ offices and see, do you have space for rent? How much? Where did you get that? How should I do this? So it was a lot of just asking around and I was new to the neighborhood. So it wasn’t that I even had fellow colleagues to even bounce ideas off of. It was a rough time period.
I can jump in quickly. Before joining or rejoining Modera, I actually also was out on my own. And interestingly, one of the things that I was good at money-wise was saving. And then when I went out on my own, I realized in some respects, I had to take more risk and be okay with certain levels of financial risk that I wasn’t used to in my personal life. But as a business owner, I kind of had to do that. So I almost had to unlearn certain lessons and learn new ones. So I don’t know if you could talk a little bit about that. Maybe some of the lessons you had to learn or unlearn as you made that decision.
I 100% agree. I learned to save, save, save. That’s how I was raised—to save, save, save. And then what am I saving for? And I didn’t know how to take risks. I mean, I’m a very non-risk taker. So I had to really put myself out there the way you did as well. And really just feel very vulnerable at that time, because I had nothing else to lose, I really had nowhere else to go. So I hit rock bottom in a sense. And yet, I also knew this was a clean slate where I could do what my mentor did, create what I wanted to create, set the schedule, the way I want it set for my own personal life, but also for work life. Let’s say I want to do EMGs that day, I don’t have to do—see a patient, go to EMG, do that back and forth. I can set aside, this is my EMG day and be more efficient in the way I ran the practice. This is my ultrasound day. And this is when I’m going to do all ultrasound guided injections. So I took his model, and I merged it into something that would work for my life as well as for patient care.
So it sounds like you really—the power of your conviction and how to practice the right way overrode every other concern that you had and your view of how to treat patients and how they should interact with medical care, which I think is a great credit. It’s amazing how, as you said, you’re not a risk taking person. But that enabled you to go and do what you had to do. Is there any particular thing or a couple of things you think you could have done, perhaps in retrospect, a little bit differently? Or what was the most important lesson that came out of that process?
I learned to listen to my inner voice and follow my gut instincts. I learned quite a lot during this period, where I had to try different things to see what worked, what didn’t work. I worked for a lot of different smaller companies as well while setting up my practice so I would make some side income. And in doing so, I learned how to do medicine in New York. We had different laws in New York, versus New Jersey—workers compensation, car accidents, Medicare, health insurances. There’s so many different rules and regulations. And in putting myself in so many different buckets, I was able to gather all the information from those different buckets, and then bring it all into my practice, ultimately, and then provide the best care that I wanted to do versus how other people ran their practices.
And so when you started off, did you have enough patient flow right away, or how did you negotiate that? Did you have some lean times? And how did you handle your finances until you started to get more traction?
So I had no patients. It was really tough. It was literally little by little, word of mouth. And that’s literally how I’ve grown—word of mouth is so amazing, it’s so powerful. And then once one person loves you, then their whole family starts to come see you. Then their friends come, then the person in that building shares somewhere else in their building, and then all the people in that building start to come. So little by little, that’s how I grew. It was very organic. The time and the money I spent in marketing really didn’t pay off for myself, considering what I was doing. Nobody really knew me and I was just one small person in a world of so much marketing out there for healthcare, and my dollars wouldn’t really be able to compete with that. So I just did what was best for each patient. And by doing so I grew organically.
So it sounds like the holistic approach is the best marketing tool that you had, right? Putting patients first.
I know that we can all relate to that because in our part of the world, we are kind of against the grain too in that most of the financial advice business is oriented towards products or something else or larger institutions. And we try to take a holistic view, so we can very much appreciate what you’re doing. So since then, what other decisions have you had to make over time to keep your practice moving in the right direction? I’m sure there have been challenges along the way. Anything that surprised you or once you got going, did it start to flow more? What kind of infrastructure did you have to build around yourself?
So I think I had a couple of challenges. One is, of course, setting up shop and finding people to help me because I don’t know how to look at insurance companies or look at billing or look at who takes what insurance. I don’t know what those cards even mean. So I needed help around the administrative aspect of it. So that’s where I needed to hire people to help me run the practice portion of it. Once I was settled for about five years, and I was doing well, I was growing, I was very happy and settled, I had a big hiccup that came up. Like you said, all these corporations are buying up small practices. And same with the hospitals, the hospitals are also looking to buy small practices. The local hospital in this area, which will remain unnamed—that hospital provided me an opportunity to either join their big group or be evicted. I chose to be evicted.
And I had to quickly find a new home. I wasn’t ready for that. I hadn’t looked for real estate. I didn’t know rentals. I didn’t know anything about starting my own practice in an actual, I guess, business setting, like a startup. I had been renting space from the hospital. So they had provided me that infrastructure. So that was another big hiccup about five years within starting. Ultimately, I’m very happy I went through that experience. I learned that I don’t need the big hospital systems, they need me. And that was a huge one for me, because I felt very pressured into joining them. But I knew that I provided something that was unique and special, and that patients were looking for people like me. They didn’t want to be gobbled up by the big corporations where honestly, even as a physician, I don’t really care because I’m not held accountable as much anymore. Whereas this being my mom and pop kind of store, I’m held accountable for every decision and every action that my employees take and that I take.
It sounded as if the hospital was threatening you. But that’s because they felt threatened by you?
Correct. But I was so thankful in the end. It was a wonderful learning experience. And I found that from here, in my new setting, I was able to set things up the way I needed things to run more efficiently. And then I also use this opportunity to actually start a new business. And I started that—it’s called MediGlow. It’s a medical spa. So we have a second business here at the same time where I can run it at the same time. It’s beautiful here, it’s aesthetically pleasing to the eye. And yet, it’s the most efficient way to run both practices.
Wow. So that gives you the luxury of exploring other aspirations that you have and you’re doing it. So in terms of managing the practice, I know that it sounds like you really enjoyed the time with your patients and helping them. How do you balance that with the management needs, you know, looking at finances? Do you have a system or does someone help to make that easier for you, so it doesn’t consume too much of your energy?
In the beginning, I took care of everything myself. So I would see patients during the day. And at night, every night almost, I was working on all the managerial aspects of it. With time, my husband made a very good point. He said, you can’t continue this long term, you need to figure out a better system. So it was either hiring somebody or carving out time within the work day to do it. So what I decided to do was not work on Fridays—one day a week where I would just not see patients, work in the office, take care of all the managerial aspects of running a practice, so that I wasn’t taking up time at home and away from my own quiet time to rejuvenate, recover, be with the kids, be with my husband. And that has been a big element of what he contributed to my practice.
That work life balance—it sounds like that’s always a work in progress but you’re always trying to find ways to accommodate that. And how does your family feel? How is that going for you? And do you have any advice for anyone about how they might be able to try to manage that better?
I think you can do whatever you want to do. As long as you find something that works with your family life, with your personal life and create a system. I think the biggest problem people have is time management. And I use—I love Google Calendar, Google Calendar. I look at that all day long. So that manages my life. I literally just put in the time of when my appointment is, time it takes to travel there, is all built in there. So I know when and where I need to be every day. I put alarms on so I’m never late to things. So being accountable to yourself has been really a big part of running your practice, then with that integrity, people rely on you, they’re not worried about, you’re going to be late, you’re not going to show up. And so I think reputation really goes a long way in ultimately, in that sense, so that your reliability is there. Patients know I’m not late. If I am late, it’s very unusual. And they’re more than kind and patient with me on those unusual days. So I think time management has been a large part of running the practice well.
I’m curious, though, actually. It sounds like you are really managing really well. But you almost have so many hats. And you know, as you’re growing, do you see yourself eventually just doing management and maybe stepping away from the patient side? Or do you think you see yourself always kind of doing both?
I don’t ever want to step away from patient care. I love it. It’s why I became a doctor. I love the joys and making them happy and feeling better. They come in with a lot of pain, they can barely walk, they’re leaving literally dancing, happy. And so those high fives, those hugs, that’s what brings me joy to come into work every day. I wish I had more time doing that personally. The management is boring, I’m good at it. I’m very good at documentation, all that boring stuff. But that doesn’t bring me joy. It’s just what needs to be done so that I can get things authorized, and so that the patients could jump up and down with joy. So it’s hard to step away. I know a lot of doctors as they grow larger and larger, they step into the managerial role. But I also foresee that that would be where I would be far more unhappy. I wouldn’t get energy and what I want to go to work for everyday, yeah.
So how does that work with your second business? Are you managing that one also? And is that something you plan to continue to grow? Or is it a sideline?
That’s something I’m doing in conjunction with my sister. So she’s actually taken the head lead on that. She’s an eye doctor, I’m a pain doctor, but as we’re aging, we are looking for Botox, fillers, skincare, how to still look good. And while we were looking for things like that, we didn’t find a lot that met exactly our needs. I guess clarity and understanding why they’re asking me to do XY&Z. Then you know, it’s a cash driven business, what’s in it for me, what’s real, what’s not real. And so a lot of the places we were going to couldn’t provide us the details that we needed to feel comfortable getting the treatments, getting the medical expertise that we needed. And so we decided to do this together. We did a lot of time researching, studying. And then together, we’re able to grow our esthetics business so that we look natural, but also age with more grace. We’re not ready to look like you know, grandmothers yet, even though we’re heading that way. And so she runs that whole practice. And in this scenario, I work for her. I am her doctor that she uses to do injectables since I’m a needle jockey. And I am her employee. And so I do love that I get to do what I love as a practitioner, but not run the business. And she’s been doing fantastic with that.
Well you get more time with your sister as well, I guess, right?
Yeah, so that was actually a big issue in the beginning of whether we should really work together and open a business together. Our family had a lot of concerns about that. And we did have to really work through it and try to figure out what would be the best way of handling things, who’s really the boss, who’s going to be the vote that’s going to decide things. So that was definitely a lot of working through family-wise, in order to find the right balance for ourselves.
It’s great that you can communicate that clearly with them. I’d like to ask you—go back to the beginning, you said your parents kind of inspired you to become a professional, to work for yourself. How do they look at you now?
Oh, they’re super proud of me. Very, very proud of me. They’re so happy for me, they see that I have that great work-life balance. If anything, they encouraged me to spend more time even taking care of just myself. This year post-COVID is the first time I’m actually, I guess turning a new leaf. Thinking about how to spend more time seeing old friends like Anna, you know, my old friends, getting together, getting my hair done, getting my nails done, spending a little time alone working out which I always love to do but couldn’t do consistently. So I really worked on trying to incorporate just an hour here or there during the week, which is actually scheduled into my calendar now. Otherwise it won’t happen. And so that’s where they’ve always said you need to do that. But I didn’t feel I had the liberty to do that until COVID hit. Since COVID, I realized there is something to what everybody has been telling me for a while. And so I decided to actually incorporate that into my post-COVID life.
Well, it’s interesting how that caused many people to try to reassess what they were doing and how they were doing it. Are there any other aspects that come out of that, that might impact your business or some things that you’d like to implement there as well?
What I loved during COVID is that we are all able to find a new way to practice medicine. Telemedicine really took off, we had to embrace it, we had no choice, it was a scary time for us as well. And we were able to incorporate technology and just really have the patients find a new way to communicate with us. And they love it because they’re not needing to leave their workspace, let’s say, or they’re home with their kids, and bring all three kids with them to the office, when they can do a quick telemedicine call with me and just get their meds renewed, get their physical therapy renewed, just basic little things that we don’t necessarily need so much time together in a room per se. So I love that telemedicine really took off during that time period.
And obviously, it sounds like something that will continue so that you can use your time in the office for patients who really need it. And for others, you can offer them much more convenience. Sounds great. So traditionally, we ask this question at the very end of all of our guests, and so you will have it as well. What was the last non financial related decision that you had to make today?
Oh, that’s a very good one. I just came from my first lighting design consultation. I’m building my own home. And as I’m building that, I had to pick out lights today. And that was really fun.
Wow, that’s a great way to end our conversation. And thank you, Dr. Kim, for joining us today.
Thank you so much for having me.
It was really informative and very interesting. Thank you so much.
So thanks very much to Karl and Dr. Kim for letting us listen in on their conversation. We appreciate their time and perspective. And thank you for tuning in. We hope you’ll join us next time on Decision Dialogues for more stories from successful business owners. So long for now.
Dr. Ruby Kim is an interventional pain management specialist who is fellowship trained and board certified in physical medicine and rehabilitation. She runs an independent medical practice, Premier Spine and Sports Medicine, in Englewood Cliffs, New Jersey, where she serves communities in New Jersey and New York and prioritizes patient-centered care.
Alongside her sister, Ruby started a medical spa, MediGlow, which specializes in esthetics. In addition, she is an active board member of the New Jersey Doctor-Patient Alliance.
Ruby graduated from Johns Hopkins University with a Bachelor of Arts in Neuroscience and earned her medical degree from Rutgers’ Robert Wood Johnson Medical School. She completed her residency at NewYork-Presbyterian Hospital and her fellowship with Orthopedic and Spine Specialists.
Modera is an SEC registered investment adviser which does not imply any level of skill or training. For additional information see our Form ADV available at www.adviserinfo.sec.gov which contains a full description of our business, operations and service offerings including fees. Statements made in the podcast are not to be construed as personalized investment or financial planning advice, may not be suitable for everyone and should not be considered a solicitation to engage in any particular investment or planning strategy. Statements made are subject to change without notice.