Know Scrubs Podcast Episode - Digital Health Innovator: Conversation with Dr. Erkeda DeRouen

Know Scrubs Podcast Episode - Digital Health Innovator: Conversation with Dr. Erkeda DeRouen

Dr. Verma: Welcome to the Andwise podcast! We're fortunate to have Dr. Erkeda DeRouen, a triple board-certified family medicine physician and digital healthcare leader, as a member of our medical advisory board. She's also a fractional CMO and runs her own podcast. We're delighted to have her join us today. Thanks for being here, Dr. DeRouen!

Dr. DeRouen: Thank you for having me. 

Dr. Verma: How do you typically introduce yourself to others, given that a third party can never do justice to someone's introduction?

Dr. DeRouen: I'm Erkeda DeRouen, originally from the D.C. metro area, and I grew up wanting to get into medicine. I went to college at Hampton University in Virginia and later joined a medical school program at Boston University. I developed a passion for primary care, particularly family medicine, during my medical school years.

After completing my family medicine residency at the University of Maryland, I worked at a federally qualified health center in the outskirts of Baltimore, serving a diverse patient population, including undocumented and uninsured individuals. This experience opened my eyes to the challenges patients face in accessing care due to financial barriers.

I also became involved in administrative and organizational aspects of healthcare, eventually leading efforts to unionize and represent physicians at multiple centers. This experience sparked my interest in healthcare administration. I transitioned into telehealth in 2017-2018 and grew in leadership roles.

Now, I work as a digital health consultant, helping organizations reduce risk and operational costs associated with clinical errors and non-compliance with regulatory guidelines, ultimately improving patient safety.

Dr. Verma: That's awesome. Your telehealth work. You mentioned, you have many state licenses, right? I think I have 6 or 7, but you have dozens, right? 

Dr. DeRouen: I used to have 51 medical licenses, but I went on pause. So now I have licenses in 48 states and D.C.

Dr. Verma: That's amazing.

Did you obtain your medical licenses individually, or did you use the interstate medical licensure compact, considering that you live in New Jersey? And regarding managing all those licenses, do you use any specific software or system to track the requirements for each of them?

Dr. DeRouen: The interstate medical licensure compact does provide more flexibility in terms of practice locations. I personally used it and met the criteria by primarily working in one of the participating states. Regarding tracking licenses and CME requirements, platforms like Modeo have been helpful for storing license-related information, and NetCE is useful for managing CME requirements across various states.

Dr. Verma: In Boston, I know the cost of living can be quite high. Did your medical school offer any student-subsidized housing, or did you have to find private accommodations like apartments or houses on your own?

Dr. DeRouen: My experience in Boston serves as a cautionary tale for students and residents. I took out extra loans to live in an expensive apartment, which added to my loan burden. While I see these as life lessons, it's essential to consider different living environments to manage finances better.

Dr. Verma: I understand that perspective. As a medical student and resident, I preferred living alone to avoid roommate issues and accommodate my study schedule. However, financially, it added to my debt burden. In my experience during residency at New York University, my rent consumed about half of my post-tax paychecks, contributing to my debt. When I transitioned to Maryland for residency, the cost of living was somewhat lower, but it still had its challenges in terms of expenses.

Dr. Verma: I often discuss my own student loan journey, having graduated from medical school in 2008 with around $160,000 in debt. However, I've noticed that younger graduates face much higher debt loads, ranging from $200,000 to $300,000. One of the mistakes I made was not budgeting effectively because I had the misconception that physicians, even the lowest-paid ones, earned significantly more than the average American. While I avoided credit card debt and shopping addictions, I didn't have a structured financial system in place. Have you ever used tools like spreadsheets, personal finance apps like Mint, Personal Capital (now Empower), or YNAB (You Need A Budget), either in the past or currently, to manage your finances?

Dr. DeRouen: To be honest, I've tried two of those.

I've tried Mint and YNAB. My family wasn't financially savvy, and I chose expensive private institutions for both undergrad and medical school, resulting in significant debt. While I managed to avoid credit card debt and extravagant spending, I didn't have a solid financial plan when I graduated from medical school with loan debt in the low three-eighties, probably close to four thousand dollars. I explored some financial apps but wasn't diligent about it, thinking I'd figure things out as an attending. My advice to anyone entering this phase is to have a plan, understand what you're doing and paying for, seek information, and discuss finances with peers. Many resources, like Andwise, can help navigate these matters. 

Dr. Verma: Public service loan forgiveness wasn't on my radar initially, and my work in Haiti and Nepal probably wouldn't have qualified me anyway. I also delayed loan consolidation, which caused me to have loans with varying interest rates. Eventually, I realized there were companies like SoFi or Laurel Road offering consolidation rates as low as 3%, which helped me save on interest. As a family medicine attending, I've been involved in non-clinical activities, including giving a TEDx Talk. It came about when I was going about my daily routine, and the opportunity presented itself. I've always been interested in delivering a TEDx Talk, and I admire those who are willing to share their ideas on stage.

Dr. DeRouen: Giving a TEDx Talk was always on my bucket list, and the pandemic prompted me to pursue it. I joined a TEDx group and learned about the application process, eventually being accepted. It was a challenging but rewarding experience, and I recommend it to anyone with a unique idea to share. My talk was about using Disney's imaginary process to improve healthcare equity by bringing people from different backgrounds together to create more equitable systems in digital health. This idea led to the development of the Pace Makerz, an initiative aimed at helping patients navigate the complex healthcare system through education, resources, and community building.

Dr. Verma: Your website, DrErkeda.com, is a great hub for all your activities. Pace Makerz is impressive! Are you primarily aiming to connect with patients directly to provide educational resources and empowerment, or do you plan to collaborate with patient groups and community organizations to reach them? How do you intend to engage with patients through Pace Makerz?

Dr. DeRouen: We are currently expanding our patient base organically through the Pacemakers app. Additionally, we offer the option for hospital systems and community organizations to create their own app using our concepts in collaboration with Pace Makerz.

Dr. Verma: You recently took on the role of CMO or CEO at Emma, correct?

Dr. DeRouen: It's Emme. I'm the Chief Medical Officer at Emme, a women's digital health organization that focuses on medication reconciliation and birth control management. Women often play a central role in healthcare, as they typically seek care for themselves and their families. Prioritizing women's health is crucial to improving overall healthcare outcomes.y have to prioritize themselves in order to help everyone else around them.

Dr. Verma: You're doing fantastic work in empowering patients. After completing your residency, did you navigate the financial and administrative aspects on your own, or did you seek professional assistance like lawyers, CPAs, accountants, or wealth managers? Physicians often fall into different camps, from handling everything themselves to outsourcing, and then there are those who hope it will magically work out, which rarely happens.

Dr. DeRouen: I initially had a wishful approach, but I'm not a DIY person when it comes to foundational financial planning. I began with our family CPA and later transitioned to a larger firm to handle the growing complexity, especially with the 40 licenses. They helped me create a financial plan, set up retirement savings, and more.

Dr. Verma: When I finished residency, I had an accountant my dad used, but it was old-school, chaotic, and last-minute. Now, I have a more organized system with a dedicated accountant who handles things throughout the year. I didn't initially realize the different ways physicians can get paid, like as employees (W-2) or independent contractors (1099), which comes with tax responsibilities. With all the different roles I have, I'm curious if you've set up different LLCs or corporations for your work, or are you paid directly in your name?

Dr. DeRouen: I primarily work as a 1099 contractor now, having transitioned from W-2 this year. Over time, I've set up different entities like an LLC for public speaking. Currently, I have an S corp. It's important to understand the rules and regulations for different types of entities, especially when it comes to multi-state licensure and healthcare organization ownership. Different states may have specific designations like PLLCs or PCs, so it's crucial to research your state's requirements to avoid surprises during tax time.

Dr. Verma: Did you set up your LLC and S corp yourself using online services like Rocket Lawyer, or did you hire an attorney to assist you with the process?

Dr. DeRouen: I used the little easy way through one of those organizations, I have been using those. 

Dr. Verma: When you start a company, it's important to be aware of state-specific requirements like annual reports and associated costs. You'll also need malpractice insurance as a physician and potentially business insurance depending on your business type and location, such as general liability insurance for physical spaces. It can be a lot to organize, right?

Dr. DeRouen: I highly recommend owning a board certification if you're considering entrepreneurship with a medical license to protect yourself from potential liabilities. While I did set up my LLC myself, I have legal representation for contracts and have sought advice from lawyers. It's crucial to get legal advice, especially if you're not an MD-JD.

Dr. Verma: Yes, you're absolutely right. Many people hesitate to take the first step in entrepreneurship due to concerns about health insurance and retirement plans. I have set up retirement plans for myself, including a solo 401(k) and individual IRAs, to ensure financial security in the future. It's important to plan for these aspects when considering entrepreneurship.

If you feel comfortable sharing, did you set up some of these for yourself or are you just saving money just separately outside of retirement accounts?

Dr. DeRouen: I transitioned fully into working for myself in May, and I've been saving money. In January, I'll be setting up various financial aspects with my accountant that we've researched. Many people worry about getting health insurance and saving for retirement when they're not employed by someone else, but it shouldn't deter you. There are numerous options and avenues to secure these benefits while working for yourself and even potentially increase your income.

Dr. Verma: I transitioned in January from full-time clinical medicine to working at Andwise full-time. I purchased health insurance for myself and my three kids through the healthcare exchange, and it wasn't significantly more expensive than what I had been paying through my employer.

Dr. DeRouen: Absolutely. Many people worry about health insurance when transitioning to self-employment, but there are plenty of options available through the healthcare exchange, especially during life-changing moments that allow you to enroll outside of open enrollment periods. Don't let health insurance hold you back from pursuing self-employment because there are numerous affordable plans tailored to different lifestyles. Some organizations and startups are also emerging to provide coverage options for 1099 workers and executives, making it easier to find suitable plans.

Dr. Verma: Absolutely. So, as we're wrapping up, do you have any off-the-cuff advice, recommendations, or life lessons that you'd like to share with our listeners?

Dr. DeRouen: Here are three key takeaways: 

Takeaways

1. Don't hyper-focus on your first job out of training, as it's unlikely to be your last. Be open to pivoting and exploring different opportunities throughout your career.

2. Your identity as a doctor should not define who you are entirely. Use your medical skills as a foundation to pursue various interests and create the career that aligns with your passions.

3. Prioritize getting disability insurance while you're in good health to protect yourself in case unexpected health issues prevent you from working.

Dr. Verma: Yeah, absolutely. That's amazing advice. Thank you so much, Dr. Erkeda DeRouen. Thanks for your time. And we'll put your website, your LinkedIn in the show notes. Really appreciate you. Thank you. Thank you for having me.