#389 - Discussion on the Business of Medicine with Dr. Giep

Hello friends 👋

Transitioning from fellowship to your first attending job? You're probably not prepared for the business side of medicine—and that's exactly the problem Dr. Tung Giep addresses in this episode. Dr. Giep, a neonatologist with over 30 years of experience, shares hard-earned lessons from building and selling a private practice in Houston, navigating toxic work environments, and eventually finding his place in telemedicine. His new book, The Business of Medicine: The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes, tackles what medical training ignores: contract negotiation, non-competes, choosing the right CPA and attorney, and understanding your self-worth.

Ben and Dr. Giep discuss why new physicians get blindsided by job offers, how to vet a practice properly, and the reality of community neonatology versus academic medicine. They also explore the growing role of AI in healthcare and what it means for the next generation of physicians. Whether you're finishing fellowship or reconsidering your current position, this conversation offers practical guidance on taking control of your career—and avoiding costly mistakes along the way.

Link to episode on youtube: https://youtu.be/JTrh0LXRJk0

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Short Bio: Dr. Tung Giep is a board-certified neonatologist with over 30 years of clinical experience. He earned his medical degree and completed his residency at the Medical University of South Carolina, followed by a fellowship at Children’s Mercy Hospital in Kansas City, Missouri. He is board certified in pediatrics and neonatal-perinatal medicine and has served for more than 25 years as a medical director in community hospitals. Dr. Giep founded and led Newborn Intensive Care Specialists (NICS) for 17 years, providing 24/7 neonatology, pediatric hospitalist, and maternal-fetal medicine services before selling the company in 2017.

A leader in innovation, Dr. Giep helped implement a 24/7 neonatal telemedicine program that improves access to specialist care and reduces unnecessary transfers. He currently serves as director of community hospital nurseries and oversees neonatal telemedicine development for hospitals affiliated with a children’s hospital on the East Coast. Raised in a medical family and immigrating to the United States from Vietnam as a teenager, Dr. Giep brings a unique blend of clinical expertise, leadership, and entrepreneurial experience, guided by a lifelong commitment to improving patient care and supporting families.

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The transcript of today's episode can be found below 👇

Ben Courchia (00:01.144) Hello everybody, welcome back to the Incubator podcast. We are back today for a special interview. We have the pleasure of having in the studio with us this morning, Dr. Tong Giep. Dr. Giep, thank you so much for coming on the podcast.

Dr. Giep (00:15.395) Thank you. Thank you for having me.

Ben Courchia (00:17.77) You are the author of the recently published book called The Business of Medicine, The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes. We are very excited to talk to you about this because this is a topic that a lot of the audience members are asking for more information about, specifically people who are transitioning from training to attendingship.

You yourself have a storied career. You've been practicing neonatology for more than 30 years. You received your degree and completed your residency at the Medical University of South Carolina, followed by fellowship at Children's Mercy Hospital in Kansas City, Missouri. And you founded and served as president of Newborn Intensive Care Specialists for 17 years, leading a team that provided 24/7 neonatology, pediatric hospitalists, and maternal fetal medicine services to 15 hospitals across Texas. You currently serve as director of community hospital nurseries and oversee the development of the neonatal telemedicine program for five hospitals affiliated with the Medical University of South Carolina throughout the state. Needless to say, we are very eager to hear your stories and distill the pearls you can give us today.

Dr. Giep (01:34.223) All right, well, I'm more than happy to share some of my stories and my adventures and stuff, but just to clarify a little bit, I was in private practice in Houston for a little bit over 22 years and sold my practice. And I thought I was gonna retire. I did retire for about five months and travel all over the world, got bored and basically figured out that I didn't plan my retirement very well. And that's part of why I wrote the book is to sort of help people toward the end of their career and what they need to be thinking about before quitting medicine. They have to really be prepared because, you know, this is all we know. We've been doing this for 20, 30 years and then all of a sudden you can't sort of turn a switch and turn off your critical thinking and everything you've been doing.

So I came out of retirement and took this position here at Medical University of South Carolina. And I thought it was going to be like an easy peasy type of job at a community hospital. But then, you know, my years of developing nurseries and all that sort of kicked in and did such a good job for the Medical University of South Carolina that after six years, I find myself going from one hospital for MUSC now to five hospitals and developing their telemedicine program for them.

A little bit about our telemedicine program. It's a unique approach compared to a lot of children's hospital telemedicine programs. We actually run these nurseries using telemedicine and we use either nurse practitioners or pediatricians. We go in and we train them. And we co-manage these babies with the people on the ground. So it's not a consultative service. It is more of a co-management.

Ben Courchia (03:40.162) Right, it's a primary, it's a primary, yeah.

Dr. Giep (03:44.236) Yeah, so we're on call for them 24/7 as well. And so when they have an admission, they call us and we have this nice webcam using Teladoc that we can look in and watch what they're doing, you know, when it's a resuscitation or whatnot. We're there.

Ben Courchia (04:02.766) I appreciate the context you're providing and I think that it resonates with some of the things that you are mentioning in the book. I think that at some point early on in the book, you mentioned this statistic from the American Medical Association that one in five doctors plan to leave medicine in the following two years. And that's a statistic that I've come across several times, but every time I do, it sort of strikes me and hits me in the face. And I think that if I don't know if I can, if I'm speaking out of turn, but it seems that the book is really open minded when it comes to that and your approach is more, maybe you will be one of those docs, maybe you won't, but either way you need to be prepared, whatever you decide. Is that sort of how you think about the advice you give to new physicians?

Dr. Giep (04:49.326) Yeah, I've been doing this for a long time. I've interviewed hundreds, if not thousands of new doctors. And, you know, one of the things that I've learned is that the kids coming out of training really don't, we don't get any business training. We don't get any training on how our profession is supposed to work. You know, we get more clinical training. And so I've evolved from my interview process to now sort of not ask clinical questions, because I assume you know how to manage a patient. What you don't know is the business side of things. And so the book is, like I said, it's an introductory type thing to sort of educate you what you need to be asking. What's important on the interview process?

You know, a lot of these kids coming out nowadays, it's all about me, me, me, me. You know, these are my requirements. These are my needs. But really, you know, they need to be asking questions about the practice. Find out as much as you can about the practice. Kids coming out, they get blindsided by the offer, you know. You're used to what, $50, $70,000 a year, and now they're getting offered $150, $200,000 plus, and it's like, where do I sign? And that is not the right thing, not the right approach. And people get blinded by that. And they need to ask the right questions. They need to find out a little bit more. Is this the right fit for you?

Ben Courchia (06:37.742) Interestingly enough, I think that throughout our training, we are prevented from seeing the workforce that we are entering as a business. I think that everybody is being trained under the impression that this is a charitable organization, that you're going to do good for the world, et cetera, et cetera. When the truth of the matter is that, as you mentioned in the book, medicine is a business. And I think that we are very ill prepared when it comes to our entering the workforce to understand the powers at play and how do we navigate all these things. The book itself, it reads a little bit to me like kind of like a case report almost because you open up the book with your own story and you walk us through the path that you've taken, which has taken you pretty much all across the country and the lessons you've learned. And then in the following chapters, you sort of do a little bit of a post-mortem and look at the career and the mistakes and the things you've learned along the way and distill some pearls for us. Why do you think we are trained not to think of medicine as a business? That seems like such a terrible thing.

Dr. Giep (07:49.897) I think there's a multitude of reasons. I think the first reason is that in academia, in training, the academics are so short staffed. And so they're using the fellows, the residents as a staffing model. And number two, they're so protected, you know, when you're in academic centers. You're surrounded by all these subspecialties. And so there's a degree of comfort when you can pick up the phone and call ID or pick up your phone, call cardiology, pick up the phone and call genetics, rheumatology or whatever specialty. It's at your fingertip. But when you're out there in the real world, you don't have that. You're also protected in terms of your time. You can only be on call for so many hours. You can only take so many patients. If you're out in the community, especially in the rural area, there's nobody else that can take call for you. There's no limit as to how many patients you can take care of. You're it. And that's the reality of things.

And one of the things that I've been pushing at the Medical University of South Carolina is instead of just strict academic training for your fellows, that they come out and do a rotation in the community hospital. So they have an idea. Us neonatologists, we're trained to take care of sick premature and sick newborns, right? But in reality, most of the jobs are in the community setting. So we neonatologists are becoming more newborn hospitalists. And the pediatricians are leaving the hospitals and leaving all that deliveries and well babies for who? Hospitalists, pediatric hospitalists or neonatologists?

Well, right now the pediatric hospitalist programs are starting to ramp up, but not to the point where they can take over deliveries and doing newborns. So a lot of times I find us neonatologists being the newborn hospitalists taking care of all this. You know, most academic centers, they don't teach circumcision. They don't teach well-baby too much. It's all focused on sick babies. And so, I see that as a big difference as well, comparing community versus academic. But a lot of these kids, you know, just don't know. And I think it's because of the way academia is set up and it's also economics as well. That's why the focus is more to the institution instead of educating of what reality is out there.

Ben Courchia (10:42.498) That's very interesting. In the book, I think that you mentioned through your story that you've gone from different practices and you've changed positions. And I think that what's interesting about it is that sometimes you find yourself in a certain practice and you can tell maybe a few months in that this is not going to be a good fit, that there were things maybe that you didn't know on the front end when you entered the practice. What impressed me very much is your ability to, number one, recognize that, but also not to sort of accept this sad reality and maybe think about, OK, like, how do I move on from this? I think many, many physicians, there's a lot of inertia. And if they find themselves in a toxic environment, they just accept it and they just ride it out as long as they can until they burn out or they quit in despair. What advice would you give people when they find themselves in this situation to keep sort of that optimism and that energy to say, I can recover from this and find something better because your career definitely demonstrates that this was never an obstacle for you.

Dr. Giep (11:51.331) Well, I think you have to go back to why you went into medicine to begin with and realize that there are doctors like you and I who survive the reality of the real world. And so if we are able to survive, there's hope for the young kids is what I'm trying to say, is that if everybody quit early, there won't be people who've been in this industry for 20, 30 years. Everybody will be gone. But at the same time, I do see a lot of kids that are going into medicine for the wrong reason. And that's why I think part of the reason why they're quitting early is because they went into the wrong profession. They just did not really think it through. I've had people come in and through interviews and I asked them, well, what's the reason to go into medicine? And they tell me to make money. I'm like, well, you could open up a lawn service and don't have to go through all that education, spend all that loan money for student loans and make more money than you and I. You can open up a business and make a lot more money than going the route that we've been in.

Ben Courchia (13:24.726) Yeah, you mentioned that in the book at some point. It's a very blunt statement where you say that if you went into, I'm paraphrasing, but you said if you went into medicine to make money, I'm sorry to tell you, you wasted the last 14 years of your life, which is so true. But I think that's that's true. I think that this is maybe the answer you just gave us is an invitation to pick up a copy of the book and to read it, because it's by reading other people's stories and seeing that, yes, change and evolution is something that is healthy and feasible, that maybe people can find the strength and the courage to do that. The other thing I think that this leads us to is the idea of knowing yourself a little bit better. In the book, you have a sub-chapter, I guess, about knowing your self-worth. And I think that this is something that a lot of people struggle with. I think that we don't really understand how to measure ourselves. And then physicians are then measured by performance assessments by superiors, coworkers. Having a sense of your own self-worth is something that's very difficult and what metrics and variables to use to measure that is difficult. Can you tell us a little bit what your approach is when it comes to that?

Dr. Giep (14:33.762) Well, I think part of the difficulty with the self-worth is maturity. You know, a lot of us have delayed gratification and so we've gone straight from college into medical school and then into training. And so we don't have the maturity level of the real world street smarts, so to say, compared to, you know, your peer who's been out in the real world, experienced real things. But, you know, in order to measure self-worth, you know, you really have to reflect inwards and, you know, understand what brought you to this point, why you went into medicine. And, you know, are you doing this for money or what are you doing this for? Are you doing this to help mankind? Because those are the typical answers I get, but it's just like a beauty pageant. You don't want to be saying the same thing because people expect you to say that.

You really have to have a unique story about yourself that explains why you're getting into medicine. Self-worth is something that's very hard to define. Only you know more about yourself to really define that for you. But, you know, that journey for me took a long time to figure out what my self-worth is. I think that moment came to me, I think I mentioned in the book where, you know, I had been traveling from one job, one position to another, and none of it had worked out for me. And then when I told my dad I was moving to Houston to start my own practice, he was like, you know, maybe the problem isn't with all these practices that you've been with, maybe the problem is you. Have you looked into the mirror? And that really took me aback and just made me self-reflect a lot more. And, you know, for a second I was thinking, is it me or is it the other practices, you know?

I did a deep dive on it and thought about it for a long time and then decided, no, it wasn't me. It's actually these practices. And I think I can run my own practice better. I think I've gotten to a point where I've learned enough that I can do a much better job than these other practices. And that was my Gone with the Wind moment. Now some of your viewers may not know what Gone with the Wind is, but it's a movie and it's a good movie. It's a classic, so rent it if you need to and watch it. It's a little bit long, but it's a good movie. Scarlett O'Hara swore she would never be poor again. So that was my Gone with the Wind moment where I could not fail. I could not come back and tell my dad that I failed at starting my own practice and had to come back.

So that was a moment for me to sort of really reevaluate my self-worth. I knew then that I cannot fail, that I had to succeed no matter what. And that's when I started to ask for help too. And that's the other thing that you need to do is that you can't do this alone. You have to ask for help. There's professionals out there that can help you achieve your goal. Whether that be a consultant, whether that be a CPA (Certified Public Accountant), whether that be an attorney to help you set things up. You have to ask for help. You can't do it all by yourself. And that's how you learn.

Ben Courchia (18:38.51) Thank you for that. I think that the thank you for sharing also these conversations with your father, because I think that these are things that we all experience and seeing how you took that and listened and did this introspective work and then moved on and said, no, I can do this is very encouraging. You have another set of chapters, I think, that are related to the hiring process, whether it is the job interview, whether it is vetting a practice or understanding contracts. I don't really have the time nor will I do this justice by trying to ask you questions, but I'm just wondering during this hiring process, what is the one piece of advice that you would give to people? I encourage everybody to read these chapters because there's so many things about assessing a business's competition, looking at malpractice, looking at non-competes and so on and so forth. For you, the big towering advice that you would give someone who has to go through the hiring process is what specifically?

Dr. Giep (19:40.687) My biggest advice is to read your contract. Read your employment contract. I can't tell you how many people I've come across who has not read their employment contract, does not have a clue how much notice you have to give, what the process is to terminate your employment or how to leave a practice. They're clueless. When I asked them, what about the non-compete? They're like, it's non-enforceable. Therefore, I think I remember signing something, it's non-enforceable. And that's a big mistake. You need to read your employment contract. You need to have a healthcare attorney help you read it and understand it because it's like a prenuptial. It tells you how to get in, it also tells you how to get out of that relationship. So if you think about it as a relationship, you know, it's very, very important. And, you know, that attorney will protect you. And once you know how to get out, it's fairly easy. You need to know what you're signing.

Ben Courchia (21:07.566) And you have a pearl in the book somewhere where you say, you find a good attorney, keep them near or something like that.

Dr. Giep (21:13.686) Yes, yes. It's the same in life about not just attorneys, it's accountants. I can't tell you how many accountants, how many attorneys I've gone through to find the ones that I like now. The good ones, the good attorney is always going to tell you, don't sue. And at the same time, the first reaction is to settle. You know, that may not be the right thing. You know, he should be sitting down with you and going through your options with you. You know, I've seen so many attorneys that recommend, oh, countersuit, do this and that, because, you know, they make money. Win or lose, they make money. And most of the lawsuits, you know, by the time, you know, two years into it, you know, most of them get settled because you run out of money, because these attorneys are very, very expensive and they want you to sue because that's how they make money.

Ninety something percent of all lawsuits get settled and never go to court. Why? Because to me, it's a racket, you know, because that's how they make money. And they won't settle until after the deposition. Why? Because the bulk of the money that you're gonna spend is right up past the deposition, you know, and they'll tell you. Well, we can't settle until we know what they have, the other side has. Well, they're supposed to provide you with all that information anyway, that's called discovery. And so don't fall for that.

CPA, same thing. If they're charging you for responding to an email and you only can get hold of them just before tax time, then that CPA is not the right one for you. They should be advising you how to save money, how to tax plan throughout the year. That's their job. But I'm finding a lot of these CPA firms, you know, you think you need a big firm, you don't need a big firm. You maybe need just a small CPA when you first start off, unless your taxes are really complex, you really don't need a big time CPA. And it's a business too, just like attorneys, it's all business.

Ben Courchia (23:38.351) Absolutely. And then I wanted to ask you a little bit. We're running short on time, so I want to make sure that I get through all my questions. I think that at some point in the book, you do mention that it's not all about strategy and that luck has something to play with it. And I really appreciate some of the tips you give. You talk also about your background and about how in Asian belief you can bring luck and good fortune to yourself by doing good to others. And so I'm wondering, can you tell people also a little bit about how to, what is the importance of luck in this whole career? And also how do you stimulate luck to come your way?

Dr. Giep (24:24.92) Well, I mean, you mentioned a little bit about stimulating luck. You know, I sort of refer that to karma. And so, you know, do good and hopefully some of that good will come back to you. If not to you, then maybe to your loved ones. But just to give you a little bit of some background story, you know, when I was trying to sell my practice, you know, that was one of the most difficult decisions. You gotta understand that was my baby for 20 something years. And to sell that practice, it was a big decision and I struggled with that. You know, not just for days, but for weeks, for months. Was I doing the right thing? But in the end I decided just, you know, bite the bullet and do it. You know, even though at the time when I was signing the papers, I had doubts about it.

But, you know, after the papers were signed, sealed and delivered, you know, eight, nine months later, the main hospital that I started at, where, you know, 30% of my revenue came from got sold to HCA (Hospital Corporation of America). And I was like, ooh, you know, HCA, you know, they, it's, that's not good. And I remember the doctors from that same hospital coming to me. It's like, did you have inside information? Did you know about this before selling your practice? And I'm like, no, no, no, I didn't know. You know, just pure luck that, you know, I did it before HCA bought the hospital.

Well, a year later, after HCA bought the hospital, they shut down the hospital because the land is worth more than the hospital. The same doctors would come to me. It's like, nobody gets lucky twice, you know? And so I go back and I attribute that to, you know, karma, you know, doing good and trying to do good, not just taking care of the patients and doing the right thing, but also doing good in your private life as well. You know, giving back to others and trying to do the right thing, giving back to the community and doing all these wonderful things and those are things that I do to try and bring good karma in and I think I do truly believe in karma. I highly recommend people out there, you know, just do good and hopefully some of that will trickle back to you.

Ben Courchia (27:12.182) Absolutely. We're getting to the end of this conversation. And my last question for you today, I guess, has to do with not the business of medicine, but the future of medicine. This is something you address in one of the later chapters. What do you think? Do you think that there will be an enlightenment of our field and that doctors maybe will get back in the driver's seat of their profession? Or what is your take on what the next 10, 15 years will look like?

Dr. Giep (27:38.479) Well, I don't know if there's going to be an enlightenment. I think, you know, AI (Artificial Intelligence) is going to play a major factor moving forward in the next five to 10 years. It's already here. I mean, it's already seeping into EMR (Electronic Medical Records), seeping into a lot of things that we're doing right now. And I think it's going to be more so in the future. So I think the young new grads coming out have a golden opportunity to shape that future. I don't know what it's going to be like. There's talks about AI replacing radiology, pathology. Maybe that will be true. Maybe I don't see it completely replacing a radiologist or a pathologist, but it will significantly change the landscape out there.

I think we constantly complain about physician shortage. I think AI is going to solve a lot of that. And I think AI is going to be more of the gatekeeper in the future and ordering labs and things are going to be a lot quicker. So I think it's going to help relieve some of the stress and help relieve some of the workload, I think, from us long term. How that happens, I'm not quite sure, but I'm not smart enough to know how that's gonna be integrated in, but I think it will be. So it's up to the young whippersnappers out there to sort of figure that out. I think it's exciting times. It's also scary times for us old folks who've been doing this for such a long time. We don't know what else to do except what we've been taught and learned. But I think things are gonna be very different from virtual meetings to telemedicine. I mean, it's a golden era.

Ben Courchia (29:40.663) Absolutely. Thank you, Dr. Giep, for sharing these pearls with us. The book that you wrote is called The Business of Medicine, The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes. It is available for anybody to read and download on Amazon. Thank you again for sharing your wisdom and your career. We wish you the best of luck and a lot of success with the book. Looking forward to your next one.

Dr. Giep (30:09.944) Well, thank you for inviting me. People out there, go get the book or you can invite me to come and give a talk to your institution.

Ben Courchia (30:19.395) Thank you, Dr. Giep. Thank you.

Dr. Giep (30:21.103) Thank you.