010 - Matters of the Heart with Georges Joseph, Jr, MD

From big city training to a small town on Florida’s gulf coast, Dr. Georges Joseph describes his journey as a young Haitian boy to a successful interventional cardiologist.  Dr. Joseph is a Board Certified interventional cardiologist who has special training in structural heart diseases.  He completed his Interventional Cardiology fellowship at Albany Medical College and his cardiology fellowship at Louisiana State University in New Orleans, Louisiana.  He has numerous board certifications and in this episode, we discuss what he is doing in Hernando County Florida to PRACTICE: IMPOSSIBLE.  He has performed a number of complicated procedures in our local community hospital that have helped decrease the need for patients to be transferred to tertiary care facilities.  His story is inspirational to younger specialists who are looking to grow their careers while caring for managed care patients.

Show Notes

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

Intro 00:00
Welcome to the Practice Impossible podcast where your host, Jude A., Pierre MD, also known as Coach JPMD, discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission, should you choose to accept, is to listen and be transformed. Now, here's your host, Coach JPMD.

Coach JPMD 00:24
Thank you for listening to the Practice Impossible Podcast, I'm looking for 10 ambitious physicians to show how they can dramatically increase their income in 90 days or less, even if they just started in their careers. Plus, everything I've learned running my practice for 20 plus years to completely eliminate debt in three years or less. That's with no additional administrative work or stressful practice chores like completing chart notes, and more time to enjoy with your family and friends. So before you continue this, press pause. And if you're interested, so email me at info@Coachjpmd.com and I'll send you more information. That's info@CoachJPMD.com. looking for 10 ambitious physicians to dramatically increase their income in 90 days or less, and show them how they can eliminate their debt in three years or less. Okay, so thanks for doing that. So let's get into our next episode with Dr. Georges Joseph. So I was told by someone that is going to be remain nameless for now that my podcast needs to include some jokes and to be fun and, and not be so sterile. And so I'm going to start off with with a joke. So this one comes from a patient and I never remember these jokes, but I had to actually write this one down. Where do you go in your house if you want to live long? The living room. Alright, one more. I know that was probably pretty cheesy. But what did the drum say to the drum stick? My heart beats for you. I thought that was pretty cool. But anyway, let me get into the episode. So we're in Episode 11 with Dr. Georges Joseph and Dr. Georges Joseph is a cardiologist who actually comes from from Haiti. So Dr. Georges Joseph is a trained cardiologists, interventional cardiologists, who I guess started his career in Florida, where he attended Edison college, in Fort Myers, and then completed his medical technology degree at the University of South Florida. And then his internship towards his medical technology degree at Bayfront Medical Center in St. Pete. He then went to Ross University School of Medicine in Dominica, West Indies, and then completed an internal medicine residency training at my alma mater University of Miami School of Medicine at the John F. Kennedy Medical Center, and then completed his cardiology fellowship at Louisiana State University. After that, he went to the Alberni College of Medicine or Albany Medical College, and completed his interventional fellowship in cardiology, and structural cardiology, as well as transcatheter aortic valve replacement. And he's got a pretty impressive resume here, as I looked through it, and graduated with high honors. And, you know, it's an honor to bring Dr. Georges Joseph onto the podcast to talk about his experience coming into Hernando County where where I practice and I've been practicing for 20 years, and he describes how he's able to he's able to do certain things that he wouldn't have possibly been able to do, and if he stayed in a big city, so we welcome Dr. Joseph to our podcast and want to have a known to Earth conversation with him about his experience and how he feels we can practice Medicine impossibly. Welcome to the Practice Impossible Podcast. So we're today joined by Dr. Georges Joseph MD, interventional cardiologist, who is in Brooksville and Dr. Joseph, why don't you tell me a little bit about yourself or tell us about yourself?

Georges Joseph, MD 03:46
Alright. So again, my name is Dr. Georges Joseph. Actually, Georges Joseph Jr. I'm a junior because my dad is Georges Joseph is a senior, just small background. I'll be brief, because it's it's long, so we don't have a lot of time, originally from Haiti, grew up in a country like Haiti has its own hurdles and its own challenges. Now, fast forward, unfortunately, at the age of 13-14, my mom passed from cancer, she had cervical cancer that metastasized to the lung. And she fought it for a little while. from Haiti, actually, she came here in the US in Miami, she actually passed away in Miami, after many, many, many trials and try chemo's a lot of stuff. Finally she passed. Was hard. You know, 13-14 years old. That's kinda hard. But at that time, I guess in Haiti, we went back to Haiti where we studied partly, I was a kid in Haiti, a teenager at that time. And my dad looked at the country back then and said either he had the, for some reason he had that kind of vision that it feels like the country was not gonna you know, offer you know, our family, what we our potential what we could, you know, become. So that's why we actually came to the US at a very young age. So sole purpose was to for education. Because my dad was a physician in Haiti, we were well off in Haiti, that was not a problem, but for education purposes. And he felt that, you know, the country would not offer us, you know, what, what we could, what we're capable of, and what, that's why we came here.

Coach JPMD 05:26
And what year was that? When was that?

Georges Joseph, MD 05:28
Oh that was ninety nine, the year that my mom passed away in 1999. Yes, yes, yes. So that's why me my sisters, and my brother, we finally immigrated to the US. Before that, we used to come to the US to vacation. The US was our vacation spot, by the way. So when we're a kid, that's what we used to do. But finally, we finally came here for good. And then we started we studied. So from my end, I think at that very young age, very motivated, very motivated in school and grades. What actually I started college at 16, very early, very early in life. And then from college, fast forward, decided, actually, since at least in high school, that's when I decided to become a physician. Because growing in Haiti, you have to remember, my dad did a lot of great work in Haiti. And as a youngster, you seeing your dad doing all this kind of work, you know, saving lives, you know, it actually helped shape what I wanted to do in the future. So that's why I decided to become a physician. I didn't know what kind of doctor I wanted to become. But I decided to become a physician. And then fast forward hard, hard work, study a lot. And then finally decided to go to medical school, I did medical technology before, which is a lab tech and then decided, Hey, you know what, I don't think that's enough. Fast forward to go to med school. Excel, do well, and then residency from residency to fellowship, from fellowship to interventional fellowship, so I'm fast forwarding everything here.

Coach JPMD 06:56 
Sure. Sure.

Georges Joseph, MD 06:57
And, and to where I am today. So now let's talk about at least the past few years, because that's where the biggest challenges were because going to school is one challenge. Starting a practice after school is the biggest challenge. So that's, that's where I think we should at least spend a little bit of time because it was a tough decision. Because after interventional fellowship, it's about just for somebody to have an idea to become an interventional cardiologist, if you really count all the years, about 15 years total. Okay, it's about 15 years to really do this between you know you start your college and medical school, you spend, I spent about after medical school, I spent about another three years of residency, three years of fellowship and one year in directional. So that's been seven years after med school to become an interventional cardiologist.

Coach JPMD 07:47 
That's, that's a lot of years.

Georges Joseph, MD 07:48
It's a it's a long, it's a long, it's a long road, but now finishing in 2018 and trying to figure out exactly what I want to do. So that's the biggest hurdle. So absolutely.

Coach JPMD 08:02
So you, sorry...

Georges Joseph, MD 08:03
Yes.

Coach JPMD
You had an, you had an opportunity to go from big city to small city.

Georges Joseph, MD 08:06 
Yes, yes.

Coach JPMD 08:08
And I think that's when I kind of met you.

Georges Joseph, MD 08:10 
Yes.

Coach JPMD 08:10
Around that time, and you were trying to make a decision to come to Springhill versus...

Georges Joseph, MD 08:14
Correct. So I came from my fellowship in interventional cardiology, and structural heart, which is that's where we do a little bit more advanced than just interventional cardiology. It was at Albany Med. Albany Medical Center. Big center, big city, you know, the way we did a lot of there. So my program director actually offered me a position to the point that he offered me his practice. That's how big that was. That's how big that decision was, he was like, hey, George, I want you to come in here, I'm gonna give you all my patient, you don't have to pay $1, you just walked in tomorrow, all my patient goes to you, okay? He wants to he wants to focus more infrastructure and stuff like this. He was like, I want to give you all my patient. That's how much I want you to be in our practice in upstate New York. So I look at that opportunity. And I'm the kind of guy who was really driven. I said, you know, it's a great opportunity, you know, you given something on a silver platter, but I want to create my own with my own practice. I want to start from scratch, I want to do this, this is something that I want to do. Wanted to do for a long time. And that's what I wanted to start. So between that decision, it was a tough decision to turn away a big practice that they hand you out of fellowship with no money, you don't have to pay $1. You just walk in and practice in upstate New York.

Coach JPMD 09:39 
So you know..

Georges Joseph, MD 09:40
That was big!

Coach JPMD 09:40
So so you know that our audience is going to say, why did you do that? What was I mean, what was so enticing about where you are now?

Georges Joseph, MD 09:48
So now I looked at that opportunity in upstate New York, and I wanted to find a place where I wanted to start from scratch to build my own practice. That was the big difference. So should I take something that's already been built? And then I, you know, I didn't really work hard for? Or should I just come in and build my own practice my own way, and really feel it's a different feeling. Let's put it this way. Okay. It's a different feeling. So that's why I didn't, and also Florida, I wanted to come back to Florida. That's the second part of the decision. Because my family's in Florida, everybody's in Florida, I wanted to come back to Florida, versus staying upstate New York, kind of away from family. So those who play a role between family and wanted to do and build a practice from scratch was the to whether stuff that makes me decide whether I want to stay in upstate New York versus coming down down here in Florida. So..

Coach JPMD 09:51
And so, you know, some of those decisions obviously have to be made with the lens of your business knowledge. So where did you? Or how did you learn the business knowledge? Or where did you get that information from? That helped you be where you are today?

Georges Joseph, MD 11:05
So everybody asked me that question. And as a matter of fact, I didn't spend a minute in business school by the way. It's something came natural. Okay. So the business part of the medicine, I actually learned as I go, I did learn as I go. And I'm a quick learner. That's a second thing. Okay. Very, very quick learner, a lot of stuff. There's a little mistake I made
at the beginning, from the business part of the medicine and from the, you know, medicine part from the business part, you know, that I didn't know. And then you you figure it out when you start having hurdles with insurance company then you like, oh, that's how it works now. Okay. So you figure it out. So I learned as I go, and I learned very quickly. So that's why I from from the get-go when I started when I met you here that you actually helped me make a big decision. Because remember, I was between Brooksville and Miami or Fort Lauderdale area. So I got two position offered around those two places. And finally, after I met you, I was like, this area might be a better, it suits me better. It suits what I want to do, my vision, and everything is my specialty, my skill set, this area would benefit from my skill set way better than Miami, or Fort Lauderdale. So that's another...

Coach JPMD 12:25
Yeah, that's a big decision. Because, you know, I know that there are some procedures that were not being done, I believe, prior to you coming to Spring Hill, and you gave me a story about, you know, one of the first procedures you did in Hernando County...

Georges Joseph, MD 12:37 Yes

Coach JPMD 12:38
I can't remember it was kind of way over my head, because you know, I'm 20 years out of residency. So some of the things you're saying I'm like, what, what's that? What? You do that?

Georges Joseph, MD 12:47
Yes, yeah. So you know, that's, and that's, that's one of the reason even after I've been here for about a year or so. And I, I felt like I absolutely made the right decision, because there's that procedure I told you about, it's called a Patent for Mental Valley Closure. So before I came here and this in Spring Hill or even in Hernando County, nobody ever heard what I this people have strokes, people go home with strokes, people go home, we have recurrent, multiple strokes. And I started that program right here over in the county. So I was the first one to actually close what we call a panel, which is a small hole inside of a heart chamber, that can cause stroke. And I was featured, you know, I went to the radio station, we talked about that, how it happens and why people should know about this. And before that, nobody knew about this stuff. So those set of skill set, it was very important that I felt like this was the right place for him. And then since then, I've been helping a lot, a lot, a lot of folks with this kind of issues.

Coach JPMD 13:46
Sure. And so how do you get support from the hospital system? Let's say you're bringing in new procedures. And, you know, I know some of the hospitals have been transferring a lot of these patients. And for from our standpoint, we do a lot of managed care.

Georges Joseph, MD 13:58 
Yes.

Coach JPMD 13:59
And we'd like to be involved in that. So there's gonna be two questions around that.

Georges Joseph, MD 14:02 Yes.

Coach JPMD 14:03
So how do hospitals support you? Number one.

Georges Joseph, MD 14:05
So number one, the hospital, especially all the hospital in town are supportive, in the sense that they give me the tools as soon as I asked for it, for example, the pain for metal valley closure, it's a special device that they have to bring in, they have to make an investment to purchase those things for me to be able to use them. And so far, you know, the hospitals in town here, especially Oak Hill has not have any issues in providing those kind of tools for us to use here, especially for me to use to actually help this patient. So that's the biggest way the hospital support. Because if the hospital is not investing and not actually bringing these things then, you know, doesn't matter my skill set, it's not gonna happen. So which means the hospital is is a big, they play a big, big role, in actually, you know, to facilitate all these things that happen. So this is one of many stuff that I've done that the hospital actually help with. The second one is mechanical support for patients having heart failure, and somebody will come in with a heart attack, you know, the hospital also have to purchase those devices and have them become available for me to use them. So those those are the biggest way the hospital supports, you know, the practice.

Coach JPMD 14:11
And what are your challenges with the nursing staff? Because I'm sure nursing staff maybe unaware of these some of these procedures and...

Georges Joseph, MD 15:26 
Correct.

Coach JPMD 15:27
Are there training programs or training seminars that you give to nurses as well?

Georges Joseph, MD 15:31
I do. So actually, when every time we start this program, we actually have a sets of nursing staff who are interested and actually learn. So we send them places to learn and also with the cooperation of what I know actually teach them how to manage the nursing side of these complex procedures, because once I'm done with the procedure, the nursing has to on the bedside, have to know how to come to know for the consideration and proper care for that patient was very sick. The nursing staff has been very receptive, some hospital better than others, but the nursing staff have been very receptive so far. And that's why the program is still alive.

Coach JPMD 16:10
Yeah, that's great. And so, you know, we're appreciative as a primary care physician, you know, sometimes we we have patients that go to tertiary care centers for some of these procedures. And the cost can be astronomical, and we as primary care doctors can't manage patients when they're in a hospital 50 miles away. I remember having a patient whose wife had a brain bleed, or fell, and she had dementia, she had other medical problems. And they airlifted her to a local hospital 50 miles away in Tampa, and ended up unfortunately passing away after a couple of weeks. But I could see the husband who was heartbroken because he wasn't able to see his his wife, because he went 50 miles away and he couldn't drive that distance. And so I know that, you know, dealing with these procedures, and doing the procedures locally, definitely will help family members stay local.

Georges Joseph, MD 17:00
Yes, oh yes.

Coach JPMD 17:00
But also save costs as well. Because, you know, I'm not sure how much you knew about Medicare Advantage prior to coming here. But you know, it's a huge cost advantage for us.

Georges Joseph, MD 17:10 
Correct.

Coach JPMD 17:11
And so what do you what do you know, now that you didn't know about Medicare Advantage?

Georges Joseph, MD 17:14
So again, when I when I first met you again, I another guy that I have to mention, his
name is Rob Forman. Yeah. So Rob Forman is a is the guy who actually brought me in town. So in that, you know, we met, and he taught me a lot he taught me I think the team at the time I came to interview, he spent about a few minutes, just given me an idea what managed care was, and I had no idea and fellowship, you have to understand fellowship, they don't teach us anything about the real business part of medicine. They teach you medicine, and then the business part you have to figure out when you get out. So I started learning at that time. But as of now, as you can imagine, I've learned more about managed care, I've learned about, you know, the cost saving, the efficiency of the care. And you know, I've never met, I've heard about Dr. Singh, but I've never met him, I would like to meet him at one point in life, but I've never met him. But I'm sure that I've done a lot like switch to the older Hospital in town. A lot of them, I take a lot of managed care, take care of a lot of managed care and a lot of physician for either the hospitalist or the primary care side. So far, I've worked with them a lot, because you know, those stuff that I provide, and actually, for example, I had, actually I think it was three months, three to four months, when I started working here. I have one of the hospitalist from managed care, who actually approached me there was a patient they were about to send to Tampa, because for some reason they turned him down here over at a local hospital in the area. The physician think like he was too high risk to perform a certain procedure. And he approached me say, Dr. Joseph, can you think you can do thank you can help this patient? Let me look at the case. So actually look at the patient. I said, Yeah, I think this is something we can do here. And then they put me on console that came in and took care of the patient a day or two later, the patient went home after I did a high risk procedure on a patient and the patient didn't have to get transferred to Tampa General to get these high risk procedures. So since then, I think that's the first time you know, he was one of the hospitalist for managed care patient here. And that's the first time it was okay, Dr. Joseph. So then from now on, we'll probably you know, we'll be talking. So and since then, I've been taking care like a lot. I'm talking about a lot of the managed care patient in the hospital in the community, you know, anything that they think we should do in town, I said, let's do it here. Let's take care of the patient, their family here, their primary care is you guys over here, we know the patient, let's take care of them in town rather than sending them away. So we've been doing a lot of that lately. So that's why I had a lot of managed care patient in my practice or, in the hospital, I took care of them.

Coach JPMD 17:46
So So you've described a lot of the things that you've done and learned in residency and some new grads may not have the gumption or the the will or the drive to learn the business of medicine. So what would you tell a new grad coming out? So you got a new interventional cardiologist graduating and they they're not sure where to go, they're not sure what hospital to go, what would you tell them? What would you tell that new grad? K, so you've done it, you're the you're hard working, you're you're pushing forward. But looking back now, you know, I kind of I'm focused on kind of figuring out what's the one thing we can do such that by doing it makes everything else easier, necessary, or unnecessary. What would you say would be the one thing that you could have done differently? Even though you're forging forward, you're building a practice. What would be the one thing you'd say, oh, maybe I could have done this differently?

Georges Joseph, MD 20:18
Then a new grad I've, since then I've actually met a couple new grads that we're trying to, you know, recruit in the area also. So the new grad, the first thing is, the first thing they have to figure out is, what is their goal? Long term goal, okay, as a new grad, because some new grad and I've met, they want to come in, they do their shift work, they do their couple of you know, calls, and then they want to go home. And you know, that's what they want to do. If this is what you want to do, that's fine, okay, you find a practice that matches that. But I can tell you that when I started on my own, by myself, you know, to start the practice, I work the first 90 days without stopping. Okay, that's, that's what I want to do. And that's what you know, that was my goal. So if somebody cannot handle that, then you can think of what else you'd just join a group and do your regular calls and stuff like this. My phone was on 24/7 for the first 90 days until I had one days I had somebody, Hey, can you please help me? So one of the other guys in the community, I said, Hey, can you help me at least stick some night calls for me, if there's something else you can still call me. But since then, that's the way I've been practicing. And that's a way to actually grow the practice is because I'm available, you have to be available, if your patient needs you, you're a heart doctor, your patient needs you, they can't find you, that's not a good thing. So again, new grad has to figure out what you want to do, what's your long term goal is if you want to start your own practice, perfect, it's not gonna be easy, okay? It's gonna be tough. And at the same time, there, the cost is not only the fact that you are on call, but the family also because I, you know, my family, I told them, hey, we're going to build this practice the first year, couple years, three years, you know, it's gonna be tough. And after that, we can try and to get other, you know, interventional cardiologists on board to get, you know, expand the practice to other stuff like that. But as you're starting the business, part of it on your own is going to be tough. So that's the thing about the new grad is figure it out which way you want to go, if you want to take the road like I did, it's gonna be a tough one. Versus if you want to join just regular practices, and then be on call with 5-10 other physician, and then do your regular schedule. That's, that's something you really have to figure out on your own in terms of how you want to go. So I look at the past three years, that's probably a few things. That's not one thing, there's a lot of stuff. Well, we could have, you know, I've could have done different in terms of the practice itself. Now, I joined one of my partners here, over at the area. So something you always wonder, because even if I started, you know, on your own, but you also partner with somebody else to do it. One thing you think about, you know, could I have done it all by myself without, you know, joining anybody to partner with at least to help grow practice, that's one thing you always wonder. And but when I think back, I'm like, you know, if I did take that route, I don't know if it would have been as beneficial because you need somebody, you know, somehow some way to help you even though you feel like you want to do it on your own. But you need that guidance. So I feel like that, you know, that's one thing I was wonder about. But now three years, almost three years into it. I feel like this was the right decision. It's at least to have at least like have a mentor somebody with me, you know, in my practice, even though I'm building my side of the practice, but he was my mentor to help guide to help at least help avoid some of the mistakes. So I think that's that's important.

Coach JPMD 24:23
So where can we find you? If someone wants to?

Georges Joseph, MD 24:27
So our office is right here in Brooksville near Oak Hill Hospital so we about a couple blocks right here on Cortez. So easy to find me is you can either Google me, that's another thing. As a matter of fact, a lot of my patients met me. They met me on Google before they met me. So a lot of them go online. They say Oh, Dr. Joseph, we saw your reviews. I'm like, well, maybe I should look at my reviews. I haven't even looked at my reviews. But I've been focusing on you know, taking care of my patient and then providing a phenomenal and exceptional care in the community, and but a lot of my patient, that's how they met me. So you know, just my name, Dr. Georges Joseph and Google and then in Brooksville. And you should you know, my name and the address of the practice will show up. It's I think it's 10065 Cortez Boulevard. That's that's where we were locating.

Coach JPMD 25:20
Sure. And I will link to your profile also on the show the show notes after the podcast.

Georges Joseph, MD 25:26
Yeah, yeah, the practice. So those are the places that's, that's where you find me in our practice. And my patient right now, you know, the the practices growing, they should, you know, any patient wants to see me, they should be able to see me, you know, we have a short waiting, I try it. That's why I work so hard. I try not to make my patient who wants to come into the practice wait for more than at least three to four weeks maximum. We're trying to get him in as soon as possible. You know, depends. No matter how busy I get. I trying to get those new patient, you know, in as soon as possible, especially if they have heart issues and stuff like this. We try not to make them wait for too long. So that's very important to us, yes.

Coach JPMD 26:08
That's great. Well, I really appreciate this discussion, Dr. Joseph, and we wish you well, and with that attitude. And I know that you're going to be successful. And you'll probably be expanding soon. So many interventional cardiologists wants to join you.

Georges Joseph, MD 26:26
Yes, thank you Dr. Pierre. We're looking we're actually looking, we're actually looking, you know, for interventional cardiologists who come and then join the practice and expand we actually are looking right now.

Coach JPMD 26:35
So wonderful. That's wonderful.

Georges Joseph, MD 26:37 That's a good thing.

Coach JPMD 26:37
What a great conversation. Thank you so much. And I'm sure we'll be talking soon.

Georges Joseph, MD 26:41 
Thank you Dr. Pierre.

Coach JPMD 26:41
What a great conversation with Dr. Joseph, we so appreciate him coming on our Practice Impossible podcast. And you know it's great to hear from young physicians coming out, doing amazing things in the county and innovative things as well. And I think it's great to hear how he's learned from some of the things that he's gone through in his career, and we totally wish him the best. And if you want to see how he practices, or what he does, and if you want to reach out to him. I'll leave the website in the show notes. But don't forget to share this podcast with your friends and your colleagues. Because that's how we get the word out and how we help physicians Practice Impossible.