149 - Why Physicians Must Stop Prioritizing Volume Over Value in Their Medical Practice - REPLAY

Are you stuck in the cycle of seeing 25–30 patients a day just to stay financially afloat in your medical practice?

In this insightful replay episode, Dr. Brunel Joseph joins Coach JPMD to break down how the high-volume, fee-for-service model is quietly draining physicians — financially, emotionally, and professionally. If you're a physician feeling overwhelmed or undervalued in your current care model, this conversation reveals exactly why that may be happening.

• Learn how managed care helped Dr. Joseph reduce patient volume while increasing revenue.
• Discover why value-based care strengthens physician-patient relationships and improves outcomes.
• Hear real-world comparisons between fee-for-service and managed care from a physician who's done both.

Tap play to hear Dr. Joseph’s honest take on why volume isn’t the answer—and how shifting your practice model could give you more freedom, impact, and long-term success.

Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

Transcript

Coach JPMD (00:00.278)
Are you interested in seeing less patients and making more money? Welcome back to another episode where I help younger physicians decrease stress and increase income by transitioning from corporate to independent practices, even without any business experience. So in this replay episode that I recorded a couple of years ago with Dr. Joseph, he describes how managed care has helped him reduce patient volumes while increasing revenue and how discovering the value-based care

strengthens physicians-patient relationships and improves outcomes. So, listen into this replay episode and we hope you enjoy it. Today we have the honor of having a good friend and colleague, Dr. Brunel Joseph on the podcast, but it's been a long time coming. We had two failed attempts and it's been an impossible mission trying to get that to Joseph on. The first time we actually recorded from your office, right? Yes, yes.

And you know, I feel like I'm getting old. I'm telling stories now. So, I'm to tell this story. So, we recorded in your office. We had a great conversation. I thought it was great. And you hung up. I hung up and I tried to play it and it was gone. There was no audio. And that was almost a year ago. I was embarrassed. And I think Dr. Joseph would be the only person that I could actually have mustered the courage to say, hey, could we do it again?

Yes, yes.

Coach JPMD (01:24.308)
So he came to my house, we were in a rental and I said, you know, we're going to do it live and we'll record it then. Well, we recorded it. We had a very good episode and it was garbage again. So for those podcasters out there, for those who they're trying to do something different, let me tell you, it was hard for me to ask Dr. Joseph to come back, but he did. And here he is, Dr. Brunel Joseph.

Thank you for coming on the Practice Impossible Podcast and we're so happy to have you. And, you know, why don't you tell us a little about yourself or maybe even catch up with life because, you know, I haven't seen you in a couple of weeks and months. So, what's been going on?

Yes, thank you so much. Thanks for having me and I appreciate the opportunity to be here. Well, it's been busy, you know, for what we do. We are working every day. between now with family, you know, when we started this, it was just me, a single guy, you know, working every day. But now, family is growing.

So you say family, I know you got married. So tell us about how marriage life is and it's been, you're past the honeymoon stage, right? It's because you're past the year, right?

Oh yeah, my goodness. Yes. Well past a year, two kids now. Daughter is three and a half. My son is two and a half. Yes. Yes. flies. Time flies.

Coach JPMD (02:44.398)
you kidding me? Two and a half already? He's been two and a half?

Coach JPMD (02:49.824)
And your wife, is she working or she...

So my wife has actually been home since the pandemic and with the kids being so young, at this stage she's starting to, she wants to go back. I she's been itching to go back to work and she's starting to get to do some coverages and things like that to just to start to kind of fill it out and see how, she wants to do.

What did she do again? She's entire audience.

She had her own practice which she closed that down when the pandemic hit and at the time, she was pregnant. So the pandemic and the baby came early also. So we needed to close things down and now we're in the process of thinking of going back and open again.

Now, when you say open again, open to have another baby or open another pregnant.

Dr. Brunel Joseph (03:49.806)
No, no, no, wait, the baby thing is done. We have two beautiful kids, a boy and a girl. We have the perfect set, so we are done. No more babies.

So why don't you tell our audience what do you do, how you end up in Spring Hill, and your background.

Yes, yes. I'm primary care physician with sports medicine background, sports medicine fellowship trend. Currently, we practice basically 100 % mileage care, almost 100 % mileage care. I came to Spring Hill. I was in my residency in Illinois at the time, originally from Haiti, tropical guy. I moved to the US, ended up in Illinois doing residency. I wanted to.

get back to Florida. That's where most of my family is. At the time, my mother was in South Florida and she was older and I wanted to come being in Florida so I can be closer, spend more time with family. And I interviewed with Access Healthcare and at the time, I was supposed to take a position in South Florida and Fort St. Lucie and they told me to come and see most of the operation is open in Hernando County. And they told me, hey, I want you to meet this young

smart doc that we probably would want you to work with. And the rest is history. I came up and it's been over 10 years now.

Coach JPMD (05:17.294)
Yeah, so that I'm not sure why he said young, but that doc was me. And I'm not what's that. And we were looking to expand the practice and we definitely enjoyed having Dr. Brunel and Joseph in our practice in Spring Hill. But then, know, life happened to me and ended up having to give up the Tampa office, right? So you took over the Tampa office. But even before we get that aspect, you said you're from Haiti. Were you born in Haiti or raised

Born and raised in Haiti, moved to the US as a teenager. I was 19 when I moved here.

In Haiti, In French? Yes. French. Yes. And moved here, went to UF for my undergraduate degree and ended up staying in Florida and ended up again moving back to, I mean, I've been around with, I moved back to the islands for a few years, moved to England, did some medical training there and in England, go to Illinois for my residency and fellowship and came back to Florida.

You know, I'm not sure if I knew that about you, about the England part. What do you think is the biggest difference that you saw in British medicine in Europe versus medicine here? What was the biggest difference?

Well, the biggest difference obviously is the payer, right? You have one payer, mostly in England, you have the National Health Service, the NHS, funded by the government. And only a few, selected few people can afford to get a private entrance on the site if they do not want to wait on the NHS. Like we all know, if it's run by the government, it's slower. If you need something done, if it's urgent, it's going to get done. If it's emergent, it's going to get done. But it was the slower pace than the National Health Service. I'll give you an example.

Dr. Brunel Joseph (07:03.03)
in England, if you need a knee replacement, for example, that's an elective surgery. It might be important, but it's not emergent. Then you might have to wait online for a few months. Yeah, maybe could be even six months.

Two months.

Coach JPMD (07:17.654)
So you see the physician, they schedule you. Is it because the scheduling is so far out or because they don't have enough physicians?

Well, it's a combination of things. the way the National Health Service works is that we go to medical. When you're done, you have to spend some time working for the National Health, the NHS. But the same physicians, particular surgeons, they also have their private practices that they run. So an example, if you come to me as an orthopedic surgeon on the NHS service, it's going to take you longer. Things are little slower there. But I can go next week.

To the, to the, to

private practice and do it for you privately. that kind of, again, this is, I'm saying the negative part of it, Obviously the positives are it's, you pay more taxes, but you are covered on the insurance for emergencies or for medical care. It's all covered that way, but it's not, you're not going to get the service the way I mean, it's not a fast service like it is here in the US.

Sorry, sorry. We distracted from that because I was always interested in finding out what your personal experience was because you've done both. Yes. So you did your residency and fellowship in Illinois and you decided to do sports medicine. Correct. So I know that remember having conversations with you and saying you wanted to do sports medicine here, you were thinking about being a team physician. Did you ever do that? I

Dr. Brunel Joseph (08:33.91)
Anyway.

Dr. Brunel Joseph (08:46.872)
I I did some coverages. I covered some teams, college and high schools. When I came back to Florida, what I really wanted to do is a mix. I wanted to do practice which I can do my general managed care practice. And I had that vision of having like sports medicine and doing sports injuries and concussions and things like that on the side. But I kind of soon realized that managed care really demands your full attention.

in terms of the things that you needed to be there for your patients. And we'll talk more about that in terms of it's not you come in and I take care of your headaches and bye-bye, right? You're responsible for the comprehensive care of that patient. so that requires a lot more. So then I decided to focus more on managed care and that was a good decision on my

Yeah, so when did it click for you that managed care was a good decision? I know that some physicians still are practicing a fee-for-service, they're doing a lot of injury medicine or how should I say auto accidents and things like that. When did you feel it kind of clicked for you?

Well, when I really kind of realized and managed here, the preventative care piece is very important, right? So we need to do more prevention. I I saw a quote, if we could prevent, if we could eat better and exercise, we can prevent 70 % of the diseases and the money that we spend on health care in this country, right? So it clicked for me when I realized I didn't have to see 30 patients in a day. I didn't have to see 35 patients in a day.

I could see 10 patients a day and spend time with those patients, do good preventative care. And in terms of the financial reward, it's probably better. So I feel better because I'm taking better care of that patient. I spend more time with my patient. And also the financial reward was also better. So you kind of click for me there.

Coach JPMD (10:52.974)
So what do you say your colleagues are doing? Do you talk to your colleagues about what you do and how your former residency training colleagues?

Most of my colleagues that I went to school with are still doing fee for service. Some of them are my sports medicine guys, some of them chose to do 100 % sports medicine and some do family care but not sports but not managerial either. So it's mostly fee for service and most of them are in the grind. They are seeing 30 patients, 25, 30 patients a day. I if I remember correctly, you have to take like to break even, you have to see at least 17 patients or 20 patients a day.

And to make a profit, have to be in the 20s, 30s, in terms of fee for service.

So are they seeing younger patients? Because I couldn't see myself, I mean at this point, doing this 20 years now, I couldn't see myself seeing 20 patients. If I see 15 patients a day, I'm like, that's a lot. Because you do so much for your patients, how are they able to manage that? I mean, how are they able to do everything for the patients with chronic conditions?

So, what's happening is most of these guys, they are now doing a comprehensive visit for that patient every time, right? If you have to see 30 patients, obviously, I'm going to take your blood pressure, give you the medication for that, then you might have to come back for…

Coach JPMD (12:11.374)
So you're churning them but you're also having them have to come back to manage other problems. So it's one problem at a time. So you've been doing this how many years now? What? 10 years? 10 years. 10 years. What would you say are three things that you really like about managed care? I think you mentioned one but what are

10 years.

Dr. Brunel Joseph (12:32.152)
Two more things. The preventative care piece is very important to me because I think the fact that we are responsible for the overall health of the patient, then you take your time to do a lot of preventative care. If I make sure that the colonoscopies are done, I make sure the mammograms are done, then you can prevent the colon cancer. We can catch the breast cancer early. you're going to the patient

doesn't have to go through as much. We will not to spend as much. So I like that managed care is really preventative care focus. That's one. Again, I mentioned the fact that the financial reward is better for sure. And you build a better rapport with your patients as well, right? Because the patient knows, you will make sure the patient knows that you're there for them. You're there for them weekend, day 24-7.

And my patient, they know to call me. It's my job. They know that I'm okay. They call me on Saturday because they have a burning question about something. Because of that, you build a better relationship with your patients. They will open up to you more. So I think those are the things that I really like the most about my industry.

I agree with you 100 % and it's building those reports and I think I mentioned in the last episode, know, five things, five reasons to embrace managed care is because if you see a 65 year old patient, that 65 year old may live another 15, 20 years. If you have a good rapport with them, you prevent care and you do what you need to do to manage their care, they're never going to leave you. So that's guaranteed income. even if they do leave you, I had one patient who left.

And he came back, you know, with his, I actually wouldn't, he was embarrassed to come back because he thought I was going to yell at him. And I said, no, no, I just want to know why did you leave? Well, it was closer to my house. It was 15 minutes from my house. But doc, that other doctor was just yelling at me and pointing his finger in my face and telling me I have to do certain things. And I just felt horrible. I'll never leave you again. So I'm sure you've had those experiences.

Dr. Brunel Joseph (14:44.43)
I've had similar experience. I have the most recent one, especially I've been seeing for a long time as well. And there's a group that came to town where they provided other things, including transportation. And that was the drive for her. They can take me home, take me to the office. They do the x-rays in the office. They do everything there. And she called me to tell me, she said, I have to leave. I'm like, that's okay, that's going to work better for you. But she came back because then she realized that they pick her up and they have to go pick up.

15 other people. She's in a van for most of her day. And when she gets there, it's like she's a number. you know me. That's why I came back. Because you know me and...

It's all about the relationship.

So what are three things that you would change? Things that you're like, man, this really sucks.

Things to change is the perception of managed care by other specialists. And even some primary care doc don't really get managed care. So there are some people you'll meet in our profession, you'll say, hey, I do managed care. They're like, for some reason, there is a negative connotation that some people have about managed care. And I think it's because the primary care doc controls, they feel like they control too much.

Dr. Brunel Joseph (16:09.006)
of the care. And the other things, I don't know if it's something I want to change is just like, because it's managed care, it's more detailed, it's more involved, you are responsible for, it's a bigger responsibility, so to speak, right? You have a fee for service patient, they come in, let's say you did the bare minimum, they leave two days later, something happened, they end up in ER. As a fee for service doctor, it's not, I mean, yes, it's my patient I care, which didn't happen. However, you're not

So on the hook, so to speak, for whatever happened to that patient outside of. So as a minor care person, the hospital called me, they texted me and said, hey, I have your patient here. Can you see him tomorrow? Because I'm thinking about discharging. But if you can't see him, then I'm going to keep him here. I will see them. it's you always, your responsibility for that patient continues. So what else I would change about minor care? Maybe on the patient side, some patients also

don't recognize what managed care is. I still have some faith and it's hard as a physician, you don't know what you can teach the patient or what you cannot. I have a patient come to me, blood pressure was kind of elevated, I wanted to come back in a couple of days. They said, oh, that guy feel bad, I don't want to abuse the system. They think if they come back to see me again next week, then I'm going to be billing the insurance. So there is an education part, both for physician.

need to be educated more about managed care and the general population as well. it's like, what's the, how do you do that? How are you supposed to do that as that gray area of what you're supposed to tell the patient or not?

And I think one of the things I find really difficult for me to even accept is some of the HEDIS measures. don't know if you're... There's a HEDIS measure that where they're all over us and if a patient has cardiovascular disease or even diabetes, they need to be on a statin drug. Sometimes the patients are intolerant to it. Sometimes their cholesterol is a normal. So I haven't found a good study that tells me that if a cholesterol is normal, we still need to prescribe a statin.

Dr. Brunel Joseph (17:54.35)
Yes.

Dr. Brunel Joseph (18:03.192)
Yes.

Coach JPMD (18:17.102)
Long-term studies. mean, I'm talking 20, 30, 40 years. So, and there's no way for us to get rid of that measure. So, I find a little annoying because as a physician, we should have the ability to say, we should exclude this patient out of this criteria so that we can meet that measure. But, you know, they want 85%, 90 % compliance, which I think is a little crazy.

Thank you.

Dr. Brunel Joseph (18:40.952)
Correct. And the other part is like the patient and that goes along with the patient's responsibility. The patient that blood pressure medication, they say the patient is not compliant, but sometimes the pharmacy sent it too early or the patient cannot tolerate it. And so you have all those measures that you're supposed to meet that can be challenging.

Absolutely. So what's the one thing you would tell a younger physician such that by doing that one thing it would make their lives much easier?

I would say being open to learn, right? Being open to learn and not just... And we both know we don't get trained in medical school for any of this. In terms of the financial side, the payers, out of training, I did not know the difference between fee for service and managed care. I heard about it and I wanted to acquire more. I wanted to learn and I felt like this was the way of the future. So was willing to do that. Just like I said, outside of...

Even all the physicians who don't know about managed care look at it a certain way outside of people coming out of training sometimes and some of them are not even willing to learn because they have heard that managed certain things about managed care. So I think what I would say is to be open to learning about different peers, open to learning about different insurances, obviously open to learning more about medicine because obviously

You have so much more to learn as you finish training. Those are the things I would maybe get a mentor. That's something I thought about I should have done early. Get a mentor because sometimes a lot of us are in a little bubble. You don't know what the next parmica guy is doing. If there are certain questions you don't want to ask, you know how it is.

Coach JPMD (20:25.71)
It's a competitive landscape. mean, if you ask this question or if you know what this guy is doing, he's going to take patience away from you. And there's so many patients out there. There's so much. You don't need to think that way. But those are great points.

Yeah, but even financially, that's a big taboo also within our field. can't talk finances.

And that's one of the biggest things we should be talking about. Yeah. Because we're coming out of debt. I saw on a, I was on a Facebook group, a physician community Facebook group and one of the questions from a physician and I guess this is public knowledge because it's on Facebook so I can say it. But he had three kids and he just came out of residency making $250,000 a year and they're living in a 2,000 square foot home. They have debt. They owe people money and he wants to buy a house.

should he buy a house? And I know you know the answer to this. The answer is no. Exactly. No, no. But you know, the old me 20 years ago would have said, yeah, yeah, but you make enough money and you should, you know, get out of the rent. No, no, no. Pay off your debt.

No

Dr. Brunel Joseph (21:38.098)
yeah, I that's another thing when you said what else you thought to go back, financial education. my goodness. In terms of, if I know then what I know now, I would be in much better position today. Right? Within the first three years of finishing, our responsibilities were not much. I was a single guy making good amount of money.

If you go back and think, okay, I was making good amount of money. Yeah. Yeah. And it was just me. Yeah.

I'll tell you what I was doing. I was flipping houses with student loan debt. What business did I have doing that? It's just nuts. But I did it and we learned from our mistakes and we try to, we're trying to at the practice impossible, keep people from doctors from doing this this type of stuff. I think people are getting it. It just takes a little bit longer and we need guys like you who can come on and share your experiences and tell us what

we should do and what we shouldn't do. And I so thank you for coming on for a third time, but this one is actually recorded and I see the levels on this machine going up and things are recorded. So I think we're good. think we're safe. Thank you so much, Dr. Joseph and we'll see you soon.

Definitely, most definitely.

Dr. Brunel Joseph (22:57.973)
to do it.

Dr. Brunel Joseph (23:01.848)
See you

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