Rajee Hari:
Welcome to ProteanPulse, our healthcare podcast from ProteanMed.
I’m Rajee Hari, President and CEO of ProteanMed, a healthcare staffing and recruiting solution provider based out of the Woodlands, Texas. My guest today is Dr. Srinivas Rumalla. He is an internal medicine and family practice physician, and his practice is in Humble, Texas.
Welcome to the podcast, Dr. Rumalla.
Dr. Srinivas Rumalla:
Hi, Rajee. Glad to be here, and thank you for inviting me to the podcast.
Rajee Hari:
Great to have you here. I normally ask my to guest introduce themselves first. So tell us a little bit about your background and how you got into the medical field.
Dr. Srinivas Rumalla:
I’m a first generation Indian, like a lot of us are. And back in India, I’m from Hyderabad in Andra Pradesh and getting into medicine, I was, I was only seventeen years old, and I had to make a choice as a lot of you know, that we don’t do undergrad before get to school.
We got directly to med school from high school. So barely seventeen years old. So at that point, thinking a lot about what I really want to do in the future is a lot less than what the family wants you to do and generally what people are doing. So, obviously, at that point being a doctor or an engineer, was the two most common occupations that were that were touted to be good. And, I picked the the field of medicine and fortunately pretty tough to get in med school in India, especially at that time in the 1980s. There are not many medical schools, but I was fortunate enough to get into the medical school there in one of the the state sponsored schools.
Rajee Hari:
Interesting. Do you have family of doctors, or you are the only doctor in the family?
Dr. Srinivas Rumalla:
Not in the immediate family, but I do have a lot of cousins and physicians here in US. But at that point, not many doctors in the family at that point.
Rajee Hari:
So what was your journey like to come from India to the US?
Dr. Srinivas Rumalla:
Well, I almost finished my medical school in India. Most of the physicians complete the medical school in India. And then come here for residency. I was actually the first one from my state to complete my medical school in US, because I was married to my wife’s a physician from LSU, and she was, able to get me, at the I was she was able to let me complete my last 9 months of my medical school in US. So I’m kind of like in hybrid because I did my, uh, end of my medical school at LSU Shreveport.
I’m still considered a foreign medical graduate, so I still had to go through all the USMLE exams and the, other qualifying exams to get into residency. But I was fortunate enough to get a taste of the US medicine even before I started my residency.
Rajee Hari:
That is interesting. I’ve never heard of anyone else doing this. I thought people had to finish their med school and then come here. So could they transfer all your credit here and take you in as an undergrad?
Dr. Srinivas Rumalla:
Correct. I had to go through. It’s a government order. I had to go through the government of Andra Pradesh and also get an approval from the medical college of India from Delhi. And like I said, I was the only one initially to do it.
I’ve heard some other people have done it afterwards. But, yeah, I was able to do that, but I really think that it laid a foundation for me going forward especially training in medical school here is significantly different than what it is in India.
Rajee Hari:
Wonderful. What happened after that? So you did your US Millie. You did your residency. Where did you do your residency? And what’s your journey after that?
Dr. Srinivas Rumalla:
So again, like I said, my wife was a physician. So we both finished at the same time.
And what we did was call a couple match where we interviewed in multiple residences, and we were able to get in together in one residency. So that’s where and we were both in mental medicine. So if I finished my medical, I mean, my residency here at University of Texas in Houston, and both of us finished those in 3 years and then went into practice afterwards.
Rajee Hari:
Very good. So it’s interesting how working couples, your partnership at home and partnership at work.
Tell us a little bit about how this dynamics works.
What are the what are the things that one can expect when you’re in partnership with your spouse?
What are the highs and the lows?
What are the landmines to avoid when you are in practice together?
Dr. Srinivas Rumalla:
Our journey after med school was, was always together because we both did residency together.
At the time when I did my residency, which was in the early nineties, the internship or the 1st year of residency was the most toughest part where we were working almost 120, 140 hours a week.
Now we do have laws to restrict residents from not working more than 70 hours a week.
So at that point we did not. So our life was almost able to try and survive every day with both of us being interns at the same time, and we barely saw each other during that time.
Once we completed our residency, we did our our paths were different.
I started my private practice, and then she went into a corporate practice with Kelsey Seebel.
So we were in different practices for quite some time. About 15 years ago. That’s when she joined my practice. And then she she does more part time. And then I do full time. The dynamics, it’s good and bad. In the sense it’s good because we can each understand what our our professions require us to do.
Otherwise, very to say that have one physician and one non physician for the non physician to understand the amount of time that we put in and the strengths we go through.
So that way definitely is, uh, is good.
Tough part was, you know, sometimes we try to discuss patients at the same in both in and out of the house. And that may not be because then the work never ends. So you take work home. So that may be the the bad part of it. Yeah. And then, obviously, we are growing up.
We have 2 young kids, and it was a tough few years. Managing both practices, uh, for me and her and raising 2 young kids. Fortunately, we were able to get through that phase. You know, it paid off and we have good kids. And, uh, right now, we are definitely, uh, able to simplify our life and maybe make it a little easier and balance our life a little bit better rather than just work.
Rajee Hari:
Bless your heart. I totally understand where you’re coming from. Talking about family practice and having your own practice.
Have you ventured into any other business other than your own practice?
Have you had any hospitals or anything like that that you worked with?
Dr. Srinivas Rumalla:
So, uh, generally speaking, physicians are not good businessmen. We believe what we see and what people tell us. So that’s the way we trained, uh, in medicine. You see a patient. They tell you and you believe them. So but, unfortunately, in business, as you probably know, that’s not the case. So you have to look at different things. So generally speaking, uh, the physicians are not great businessmen. So definitely there are many opportunities. Uh, I was fortunate enough to venture into a few things. One of the things, uh, is that we built a long term acute care hospital, uh, from ground up. We did that in 2007. This hospital was more a specialty hospital that we built. I was one of the founding partners for that where people who need more than 2, 3 weeks of hospital care instead of taking that bed away in our acute care hospital.
We transfer them to the long term acute care hospital. So we did that and we, uh, we ran that hospital for almost 15 years. I was part of, uh, that that hospital building it up and owning the hospital at that time. For general physicians to get into business aspect as well, the the strength is in numbers. So if you’re able to have, you know, a few physicians or many physicians. There are other opportunities of either building your own, uh, office building, which we did getting into real estate. And nowadays, we have what’s called IPAs or ACLs. IPAs are independent physician associations where you can form an association like that.
And then you can have contracts with the insurance companies. And if you’re able to provide quality care in an efficient manner, the proceeds of whatever savings are there can be shared among the physicians who are involved. So those are kind of the business opportunities that are available for physicians as well.
Rajee Hari:
I love the way you have brought in the concept of entrepreneurship into your practice. It’s interesting.
What do you think is the current trend and the challenges in the field of family practice?
Dr. Srinivas Rumalla:
I’m mostly into medicine. Again, family practice and telemedicine are both primary care physicians, but my main trainings in full medicine, which the biggest difference for people who don’t know is we see mainly adults. Family practices. All, you know, they see both kids and they sometimes do, uh, gynecology and obstertics as well. So I’m purely in total medicine. The challenges were different coming from for the last 25 years. Again, I’ve been in practice since 1996. So my practice started out with more as a traditional practice where we see patients in the hospital as well as in the office. So we used to round, uh, in the hospital in the morning, come back the office rounds, see the patients in the office go back and round in the hospital. So the the challenges at that time, we’re just trying to complete your day, trying to be efficient, obviously, with running around different buildings. It’s inefficiencies there. So for the last 5 years, we have pulled out of the hospital, like most of the primary care physicians. Now they have hospitalists who take care of patients in the hospital. So the challenges now are different than what they were at that time. Again, since we have been in practice for so long, one of the biggest challenges about 10 years ago was going from a paper chart to an electronic medical records. Obviously, a lot of us, including me, are not great with computers. So that was definitely a learning curve and definitely threw everything away for a long time until we got used to the EMR Uh, but right now, if you have got so used to it, obviously, we’ll never go back to paper charts at this time.
Rajee Hari:
It’s like the dial phone to your iPhone. Right?
I mean, it took us some time, but then Now we can’t live without our mobile phones.
Dr. Srinivas Rumalla:
Yeah. Exactly. Exactly. So that’s kind of, but, yeah, we like the electronic medical records. I think it’s definitely streamlined a lot. So but for people who knew physicians and who are coming in, they’re obviously very computer savvy and it shouldn’t be a challenge. The other challenges at this point are are purely related to, of course, because I do have my own practice. We have a group practice and My challenges are related to running the clinic. Uh, the easy part of it is taking care of patients. The tough part is to manage the clinics, the staffing, and also dealing with all the different changes, uh, the insurance companies put on us and, uh, trying to understand them and try to adapt to them. One thing I have seen some positions as well is trying to fight the system, and I think that doesn’t work because then all that would leave is a, uh, frustrated physician. So you have to understand where they where the insurance companies come from and be able to adapt and at the same time, work. That way you are not able to in that way, you’re not frustrated every day of the, of of the day that you are having to deal with these insurance companies.
Rajee Hari:
One question I have is regarding staffing with private practices.
So I am a newbie to the field, but I’m blessed to have so many physicians for all my doctors.
And I work with physicians across the nation.
What I’ve seen is compared to a small practice, a bigger organization has more red tapes.
At the same time, there are some things that are acceptable for bigger specialty multi specialty groups or hospitals which is not okay for staffing a small private practice.
Where do you see the challenge here? What is your challenge in staffing your clinic?
Dr. Srinivas Rumalla:
So the last, again, as we all know, with the pandemic, things have gotten significantly worse with trying to find people. There’s a lot of people have retired a lot of health care workers, unfortunately, passed away.
So it really was a huge challenge for the last couple of years trying to find medical assistance or even physicians or physician assistance in the last 2 years. So things have gotten a little bit better in the last few months, I would say. As far as the the the corporate practices and private practices, I think we are actually a little bit more flexible, but because we don’t have that many cross covering staff.
We probably require them to do the job at their they’re required to in an efficient manner. Obviously, we strive on quality at the same time, we want efficiency as well.
In a bigger group, you have multiple, uh, let’s say MAs or multiple other other uh, people who are who can take care of the things in case you’re not there. So sometimes the requirements both for a smaller practice and a bigger practices can be different.
Rajee Hari:
Another thing that I’m noticing is these primary care and all this, uh, internal medicine, they’re being swallowed by bigger firms like the Walgreens and CVS of the world. And that seems to be the trend. And what I’m hearing from many of the providers is that it’s becoming increasingly difficult to run your own private practice.
What is it that you have to say regarding this matter?
The mergers and acquisitions from private practices to corporate bigwigs.
Dr. Srinivas Rumalla:
It’s very hard for new physicians to start their own solo practice to begin with because there’s so many things that are involved. Fortunately, as far as our practice, my practice is concerned, Uh, we have been doing this for so long, and we’ve been able to adapt to the changes. So for a new physician to come out and do that, it is going to be very difficult just because it’s just not about seeing patients, and it’s just not about about running. It includes so many other things, including the insurance companies, the way you pay, you get paid, uh, the way you don’t get paid, and so many other things. So That’s why as you probably know more, I think more than 60, 70% of new physicians are employed at this point.
As far as the bigger groups coming in and taking over the primary care physicians is, again, it comes to what’s called an accountable care organization.
These are bigger organizations that directly contract with the insurance company. So if they have a group of primary care physicians, they are able to have the volume of patients, then they can go directly and have a direct contract with the insurance company or for Medicare for that matter. So that’s one of the reasons why a lot of these companies have come in and they’re more wanting to take over the primary care practices because the patients technically belong to the primary care physicians, not the specialist.
In the view of the insurance company or Medicare as such. As far as how happy they are with these big corporates, I honestly am not sure. I’ve heard both sides of the coin where, uh, I think it is tougher for people who have been prior practice to go and join these bigger groups and be satisfied versus newer physicians who don’t know how the other side is.
I’m sure they are happy with with the corporate practice as well. Yeah, I think it’s different views based on what your background is.
Rajee Hari:
Interesting. Coming from a patient’s perspective, I was with a private practice, and my primary care provider is a very good friend of mine.
We have a great relationship, and I absolutely love that practice to death.
They merged with one of the big wigs. And honestly, for me personally, I have not seen any change.
I am able to still call them.
I’m able to still text them, but that’s because I have a personal rapport with them.
But one thing I’ve noticed is the front desk. It’s navigating through the the front desk process. Right?
Honestly, I don’t mind it because I feel it’s more efficient. And as I said, I have a relationship, and I love them.
But I am hearing a lot from others that this is becoming too cumbersome. What do you think about that?
What do you think the patient experience is it being affected by this merger and acquisition?
Dr. Srinivas Rumalla:
Obviously, when you have in a corporate world, uh, you have consultants who tell you what to do, and they have their way of thinking is different.
Yes. They are thinking about efficiency. They are thinking of things get done in a in a right way.
However, you lose the personal touch. That’s the biggest thing. And when you come into my practice, we have same people in my office, front office, the last 15 years. So it’s very difficult uh, when you have both MA’s or any other non doctors, people who are working in the corporate world because it’s a corporate world. So people keep changing It’s very hard to get that personal touch. I was taking care as a hospitalist. I was taking care of a lot of patients from other bigger groups. This was even many years ago.
And a lot of them changed to me. And one of the biggest things I asked, why do you want to change?
It’s just, well, we keep seeing a different people every time. Same thing the physicians do.
After every 1 or 2 years, physicians change in the corporate practice. So you don’t get to see the same physician. So I feel like the personal touch is gone. Some people may not mind it.
They may need, okay, I’m being seen on time and getting my prescription on time, so I don’t have any problem with it. Whereas the others especially older population that, I mean, just to talk, just talk to the physicians, talk to my nurses.
I think those kind of things, people feel like maybe a small practice is better.
That way, they know who they are going to, and then they know them for so many years, and they know that they’ve been there for so long. So I feel like both have their own, uh, own benefits and, uh, different way of looking at things. So.
Rajee Hari:
Interesting. That’s that’s how I feel too. Sometimes when I look at this bigger corporate practices.
I feel like that personal touch is lost, but few of us are definitely lucky to see it continuing personally for us, but I hope such mergers and acquisitions doesn’t affect the patient experience individual attention that they’ve been receiving.
So you know, I guess it’s all, you know, win win for all and it’s all, adjustment phase for many.
Having said that, What do you think the strength in merger and acquisition activities?
How is it going to shape the future of health care? How do you see this landscape changing?
Dr. Srinivas Rumalla:
It’s gonna change obviously as you can see so many people have come in. The Walgreens has come in.
CVS has just brought in major, Oak Street Health for about 1,000,000,000 of dollars.
And Amazon will come in. And so everybody wants to get into the health care field just because there’s so much I agree there is a lot of air inefficiency as well, but there’s also it’s one of the most, eye consuming, GDPs of of our country, one of the most expensive part of our country. So this is, I think, still the beginning, but going in the forward, I feel like you’re gonna see a lot less of private physicians. And I’ve now seen a lot of the, uh, specialty physicians being bought over as well.
I think that is the future is corporate medicine. Is it ultimately good for the patients? It’s hard to say.
I’m hoping that still enough competition going forward, like 10, 15 years down the road. Unless there’s a competition, the patient will be the one who suffers.
If you only 1 or 2 systems, then there’s really you just take it or leave it, uh, kind of way.
And I’m hoping that we’ll have at least have enough competition, even if it’s among bigger groups, that way the patient, at least, uh, gets the best of the situation in those, um, among those people, among those groups.
Rajee Hari:
So Wonderful. So I’m gonna go back a little bit yourself, just focusing on you, Dr. Rumalla.
What is the one thing you will tell your 18-year-old self differently?
Dr. Srinivas Rumalla:
What would I tell my eighteen year old right now, you mean? Mhmm.
Rajee Hari:
Yes, sir. If you were eighteen year old, what will you tell yourself? If to do differently.
Dr. Srinivas Rumalla:
Firstly, I would tell that tell myself that things don’t go the way you expect them to.
You always need to be prepared. You always need to hope for the best, but prepare for the worst.
It ain’t any feel as such in the even in life.
That’s that’s the biggest thing is to, we always hope for the best and we strive for the best at the same time.
We need to prepare for the worst.
I still feel like I’d made the best decision of my life again, as I said, it was probably a decision that I made at the seventeen year old mind there at that point, but I still feel it’s the best decision I made.
I love my patients. Uh, that’s the best part of it is is taking care of patients.
That’s the easiest part and the best part. And that’s the thing with primary care is you see generations.
I have 4 generations of patients. I see whole families of patients. So I get to become their friend of. We have seen them. I’ve talked to them, uh, for so many years, almost 25 years. So you become their friend.
And and you get to know them more and more. So that’s the best part of it is is being able to talk to them and and take care of them when they need me the most. We have done something in our world is the greatest thing being a physician, at least. One of the only occupations that not only we get paid for what we do, but we get a true gratitude. True Thank you from patients. Because they do truly feel like we have helped them and that’s what we live for. And that ultimately end of the day after so many years, that’s what matters the most. Yeah. That that I feel is the best part of it. Balance in life is still important.
Unfortunately, I didn’t do that for the 1st couple of decades.
As we all know. It’s just private practice was tough to start out, and you always in a career mode where you want to do everything. And I feel like for the newer physicians, always make sure that the balance of life both work and out of work. Other things that you want to do has to has to be there. And but fortunately, at least for the last 5, 10 years, I was able to get some time off and and be able to do other things rather than just doing practice.
Rajee Hari:
Wonderful. I have, uh, another question that just popped up in my mind when I was just talking to you.
When it comes to your work life balance, Right?
This is such a stressful lifestyle that physicians lead because I see the lifestyle that they lead day in and day out.
What is your way of handling the stress? What is your go to thing for handling the stress?
Dr. Srinivas Rumalla:
For different physicians, it’s different things. Time is probably one of the biggest things for a lot of physicians.
Like, they have no time to do anything else in the day.
And if they have young kids, then there it goes the whole day.
You’re just trying to survive to get up in the morning.
So the stresses are different based on what kind of a physician you are and what stage of life you’re in.
And then you have the stresses from if like me, you have the stress for managing the practice, dealing with insurance companies, and trying to understand why we need to do what we are wanting to do.
It the days of just taking care of patients are unfortunately gone.
So those are the kind of stresses I feel like. And biggest thing is understanding it, being able to adapt to the situations.
And at the same time, I think, you know, there are different organizations that you can have common goals and be able to discuss with other physicians how they handle things.
I think having a community of physicians like that, uh, fortunately, we had the Indian Doctors Association of Houston.
I was the president in 2010. There are many organizations like that.
We have the TMA and the Harris County where we have multiple other physicians who are there, and you are able to discuss some things and be able to say, how do they manage their is, and that’s the best way is to be able to discuss among other people.
Rajee Hari:
Do you have any coping or a stress management method that you follow, like work out or meditation, yoga, anything like that.
Dr. Srinivas Rumalla:
Definitely, anything out of the practice, uh, that you can you can your practice behind and do what you’re doing other than medicine is definitely a stress free thing.
Personally, uh, as you probably know, I, I mean, do hiking. So I do some hiking. Definitely.
The gym helps out a lot.
Just getting together with friends, just going out and forgetting the work place and just having a good time. And I think those are very important.
Just getting out of your zone of just work and families to have other avenues where you can chill and and talk about other things. And the main thing is to think that work is definitely a predominant part of our life at the same time. It’s not the only part of our life and understanding that and be able to give time for both family and friends and your other activities is very important.
Rajee Hari:
Well said, burnout is something that’s very common in physicians, and they do need an outlet.
And I hope whoever is listening to it will catch up from what you have said so far.
So we’re gonna have the fun round, which is the rapid fire round, which I have not had with anyone else. You are my first guinea pig.
Okay. So I’m gonna shoot my questions and you’ll get 5 seconds to answer.
Dr. Srinivas Rumalla:
Okay.
Rajee Hari:
Tea or coffee?
Dr. Srinivas Rumalla:
Uh-huh. Both.
Rajee Hari:
Early morning grounds or late night emergencies?
Dr. Srinivas Rumalla:
Early morning grounds.
Rajee Hari:
Scrubs or white coat.
Dr. Srinivas Rumalla:
White coat.
Rajee Hari:
Stethoscope or blood pressure cuff?
Dr. Srinivas Rumalla:
Stethoscope.
Rajee Hari:
Paper charts or electronic medical records.
Dr. Srinivas Rumalla:
Now it’s electronic medical records.
Rajee Hari:
Hospital cafeteria food or packed lunch?
Dr. Srinivas Rumalla:
Packed lunch from home.
Rajee Hari:
Medical TV dramas or medical documentaries.
Dr. Srinivas Rumalla:
Neither.
Rajee Hari:
White board or sticky notes for reminders.
Dr. Srinivas Rumalla:
Sticky notes.
Rajee Hari:
Crub caps or surgical masks?
Dr. Srinivas Rumalla:
Caps. I can’t stand the mess.
Rajee Hari:
Sunday morning workout or lay on the couch.
Dr. Srinivas Rumalla:
Morning workout, for sure.
Rajee Hari:
Fantastic. That’s it for the rapid fire round and any concluding remarks for our audience today.
Dr. Srinivas Rumalla:
Thank you very much for having me.
I really commend you for doing the podcast and, um, touching so many varied, uh, topics.
I am sure that, people listening to it will have a a good understanding of, uh, of the topics that you have gone through. And, uh, truly thank you again for having me and, uh, wish you all the best uh, both with your podcast and also your staffing agencies.
Rajee Hari:
Thank you so much. Thanks for listening everyone. Don’t forget to subscribe to ProteanPulse.
We are on Spotify as well. You can search for Protean Pulse and remember to leave us your feedback.
I will see you in the next episode. Don’t miss the beat.
Summary:
- Family physicians provide personalized care, building strong relationships with patients that large hospitals simply cannot match.
- In a family physician practice, patients are seen as individuals, not just another number on a chart.
- The welcoming environment of a family physician practice fosters trust, and open communication.
- Family physicians offer a continuity of care that ensures patients receive ongoing support and guidance throughout their health care journey.
- Choosing a family physician practice means choosing a healthcare provider who truly cares about your well-being, treating you like a member of their own family.
- Thank you for listening to Protean Pulse, a healthcare podcast, bringing you the latest in medical and healthcare staffing.
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