The Neurologist Is In Episode 12, Part 2: Advocating For Yourself Amid Challenges in Your Neurology Practice, With Dr C. Debbie Lin

In this episode, Rachel Marie E. Salas, MD, MEd, continues her conversation with C. Debbie Lin, MD, discussing some of the major challenges that Dr Lin currently faces in her neurology private practice, how she balances work with other aspects of her life, and the career advice she wishes she had given to her younger self. 

Listen to Part 1: Thriving as a Neurologist in Private Practice here!

Can't get enough of The Neurologist Is In? Make sure you're caught up on all the episodes--find the full catalogue here.

Rachel Marie E. Salas, MD, Med, FAAN, FANA, is a professor in the Department of Neurology at Johns Hopkins Medicine with a joint appointment in the School of Nursing. She is board certified in Sleep Medicine and Neurology. Dr Salas is the Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness. Dr Salas has been the Director of the Neurology Clerkship for over a decade. She is the Chair of the Undergraduate Education Subcommittee for the American Academy of Neurology and is an appointed member of the Alliance for Clinical Education. She is the director of the Interprofessional Education and Collaborative Practice for the School of Medicine and a Co-Director for Interprofessional Teaming for the High Value Practice Academic Alliance. Dr Salas is also the founder and Co-Director of the Johns Hopkins Osler Apprenticeship Program (in Neurology), a medical education research program for senior medical students and the Johns Hopkins PreDoc Program, a pipeline premedical college program. Dr Salas is a certified strengths coach and uses a strength-based approach and coaching to connect to, support, and develop those involved with her educational mission and clinical practice. Dr Salas is a 2019-21 Josiah Macy Scholar, a 2019-20 AMA Health Systems Science Scholar and a 2021 AΩA Leadership Fellow.

C. Debbie Lin, MD, was born in Taiwan, moved to the US when she was 12, and grew up in the suburbs of Philadelphia.  She received her medical degree from Jefferson Medical College.  She went on to complete her internship at Georgetown University Hospital and completed her neurology residency at the Mayo Clinic in Rochester, Minnesota.  She then moved on to complete a clinical neurophysiology fellowship at Johns Hopkins Hospital.  Dr. Lin has been cited as a top neurologist many times in Washingtonian Magazine and Washington Checkbook.  In her free time, she likes to spend time with her family, travel and shop.

Read the Transcript:

Dr Rachel Salas: All right. Hello, everyone. Welcome back to The Neurologist Is In. I am Rachel Salas, a sleep neurologist at Johns Hopkins. And we're continuing the series, but this time we're doing it with a neurologist who's out in private practice. With me I have Dr. Debbie Lin. I know Debbie from years ago. We met in training during our fellowships at Johns Hopkins, and it is a privilege to have her here. She is our first private practice neurologist, and I'm curious to pick her brain on how her practice is going and just some other questions. So Debbie, I'd like to invite you to introduce yourself.

Dr Debbie Lin: Hello, how is everybody? My name is Debbie Lin. I trained at Georgetown for my intern year, and I went to medical school in Philadelphia at Thomas Jefferson Medical College. And then after that, I went to the Mayo Clinic for three years for my neurology residency, and I did a one year fellowship at clinical neurophysiology at Johns Hopkins. I've been in private practice in the suburbs of DC, Rockville to be exact, since I finished fellowship. I've been here about 15 years.

Dr Salas: So what are still some of the challenges currently in private practice that you're hoping will improve?

Dr Lin: We have a twice-a-month meeting among all the physicians to talk about these challenges. So the biggest challenges now are the inordinate amount of paperwork. We're talking prior authorizations. We're talking,--probably the same paperwork you see--disability paperwork, forms for fitness to drive for epilepsy patients to continue driving. I would say the nonstop forms, right? And of course, we just recently changed to a new electronic medical record system, and that's posing some challenges too. We're trying to figure out how to efficiently have patients fill out their intake form, communicating with patients, sending results. So those are the challenges.

Other challenges are time. By that I mean, I'm scheduled out pretty far for follow-ups, also for new patients. So you get a lot of complaints about how long it takes to come in for a follow-up, they can't get appointments. So I guess patient access is a problem. And also with our new electronic medical records, there's a lot of messages from patients. So the phone calls, reviewing results. I think everything is just like time crunch. How do you get everything done in a day?

Dr Salas: Yeah. Everything that you were just saying really resonates in academia. Those are the same exact things. In fact, a lot of the studies out there when you're looking at "burnout," or even "rub out," right, where it's you're not just burnt out and overwhelmed, it's like, now you don't really care, right? And so in admin work, everything you just spelled out is really the number one reason. So it's there, whether you're in private practice or academics. And I do see some positives coming out. There's a lot of new systems and apps, and I think that there's going to be a lot of transition over the next couple years to address, especially the patient access, because that's tough, right? You could understand maybe for subspecialties that wait period. But for general neurology, for patients just to have that first connection, that's tough. And when one out of six Americans suffer from a neurological disorder, that says something. It really speaks to the need for more neurologists and why the national organizations are really trying to encourage and really nurture the pipeline so that future, not just medical students, but other health professionals consider focusing in the area of neurology.

I know you're not just a busy neurologist. I know that you prioritize your family and you stay very busy with that. So how do you do it? How do you handle being a full-time mom and having a full busy practice and doing EMGs? How do you do it?

Dr Lin: I always think about, how am I doing this? I think I am doing it because you just have to prioritize. You always talk about prioritization. What's important to you? Family for me is so important. My husband is also very supportive. He has a flexible working schedule. He is an engineer. I think that's what really made it work. We also hire nannies. We also had parents that were helpful. I think they say, it takes a whole village to make things run. That's exactly what it is. And I came to the realization, I just can't do it all and I need to ask for help. I think initially I was really proud and didn't want to ask for help. I would be like, I can do this. I can do this all. Until it gets to a point where like, okay, I realize I just can't be at two places at once, and I have to make something work. So you get friends to help you, like I said, hire things out or husbands. So you make it work. You make it work. You just have to ask for help. I feel like that was my big mistake saying I could do it all because I'm super. I can't do it all. I just have to admit that and say, okay, I need to ask for help. But as the kids grew older, they're easier. There's less things, like they can let themselves in, make a little snack. As my kids got older, they're now 13 and 15, things are a little easier. But of course they can't drive, so you still have to shuttle them around to different activities. It's just about coordination, I think.

Dr Salas: Yeah. As you were talking, I was reminded of there's always this, and it usually involves some rolling of your eyes right, where it's like work-life balance, right? It's like, oh, come on, how do you balance everything? And now the idea of work-life integration. I think it really comes a bit down to what you said, which is priority. What are your priorities? You can't do everything. Asking for help is another takeaway, at least for me, of what you said, right? Admitting that you can't do it all. We want to. There's a lot of things that we all want to do, whether you're a spouse, the partner, a dog owner, whatever it is: what are your priorities? And you make that list and realize you're human and you can't do it all. And people are always willing to help. A lot of times they're there. We just don't take advantage of that.

Dr Lin: It's exactly what you're saying. I felt that I was too proud to ask, but we shouldn't be, because everybody else is the same boat and everybody else has busy lives, busy careers. And if we just share carpooling, or can you pick up my kid, I am stuck at work. You help each other out and that really works out. We make friends with all the neighbors and people with my kids' class. So if I'm ever in a jam, I can't do something or my husband can't do something, we just text one of our friend, "hey, by the way, I know your kid needs to be picked up, is it okay if you can pick my kids up?" And people are like, "hey, I'm already there, why not? "And we do the same favor for them, right? So if they're in a jam and they need me to do something, I'll pick up their kids. Helping each other, I think it's one of the ways to get through this.

Dr Salas: Yeah, I love it. I think a lot of these things are pretty standard and I think we need to remind ourselves, right? Just to ask for help, be willing to help out whether it's a fellow friend, neighbor, or family member. Let's step up for each other. Especially right now in the time, a global pandemic, like war breaking out, racism, just all the things going on, right? We really need to step out and help each other. So that's really great. I'm glad you shared that.

Dr Lin: For sure, for sure. But like I said, one of the things I come to realize as I'm going through my career is when I was a trainee, resident, fellow, I think I was afraid to ask for things because I felt like I should be able to do it. I should be able to handle it, right? And as I entered private practice, I didn't know about things. Things like negotiating a contract, negotiating what you would like, time, how you want to block your time, what you want to do. I have come to realize, what's the worst that could happen? You know, if there's something you need, something you want, advocate for yourself. I feel like we don't advocate for ourselves enough. And we should say, hey, I need this to be successful. I need this to keep doing what I'm doing. We should ask because what's the worst that could happen. The worst that could happen is your supervisor or at your practice, they say, that's just not going to work, right? But if you don't ask, you don't know.

Like I said, when I first joined, there were no medical assistants. There were no scribes. There were no physicians assistant. That's what I came into. But where I trained at Hopkins, at Mayo Clinic, people had these ancillary staff to help them. And I said, how about let's get a physician's assistant. We got a physician's assistant eventually, and it's great. It's taking the burden off of follow-ups. They're helping me with my paperwork. But that's what I mean, I think we have to advocate for ourselves and don't be afraid to ask.

Dr Salas: Yeah, good advice. The worst people can say is no, right?

So Dr. Lin, when the pandemic hit, right, everybody had to pivot. We had to roll up our sleeves and just say, how are we going to take care of our patients? I imagine the telemedicine obviously was a big player here. What did that look like for you? Talk about what your initial changes were. But then now, as we're going back to whatever our "new normal" is going to be, what aspects did you learn or your practice learn through the pandemic that you're probably going to continue with?

Dr Lin: So great question. When the pandemic first started, everything was shut down. And I joke and said to my family, I had two months of forced vacation. I just stayed home. We didn't do anything. At the time we were wholly unprepared. We didn't have telehealth set up. It was a scramble. It was a scramble to provide care. So what happened was we were staggering staff and also physicians coming in. We were still going to the office. But patients didn't want to come, and I don't blame them. And like I said, we were trying to minimize risk.

Then we got on board with telehealth. And telehealth, initially everybody resisted. They said, "well, can we provide the quality care we do in person?" With time we adapted, we made it work. And I have to tell you, some patients love telehealth, some patients don't. It just depends. And right now we really have a hybrid system. So we allow the patients to choose if they want to come into the office or they want to do telehealth. So we are pretty flexible. I personally really hope telehealth is here to stay for the long run because it really helps some patients who have transportation issues, mobility issues, to get neurological care without having to come to the office.

Dr Salas: Yeah, I couldn't agree with you more.

Dr Lin: Yeah, I think that really, really changed how we practice medicine. The comfort level we had with telehealth, it had to happen quickly because of the pandemic, but I'm glad it did.

Dr Salas: Yeah, I totally agree with you. I think telehealth, tele-neurology is here to stay in some form. And for me, actually, I think it's going to be really my predominant, if not only, way of clinical practice, because you're able to see more patients not only in your state, but even out of state. I'm curious to know if anyone in your group, you all are thinking about, now that you have telehealth, expanding your reach. Do some of your clinicians have licenses and surrounding states so that you can kind of see outside the DC area?

Dr Lin: We do, because where our location is we can see people from Virginia, DC, Maryland, and some of our patients actually come all the way from Delaware to see us. We got some from West Virginia. A few of us do have licenses in Virginia so we're able to see people in the surrounding areas. That's sort of nice. But I have to tell you, we're so busy all the time with just the immediate local people that reaching out further probably isn't in our expansion plan just because we are really booked.

Dr Salas: Yeah, that makes sense. It's definitely interesting to see that perspective from a private practice, a neurology practice, because you're trying to just see people locally. And then for some of the subspecialty, especially at a place like Hopkins, we're trying to get that expertise to where it's needed, right, because it's so subspecialized. Most of the patients I see are not bread and butter sleep issues. They're coming for a lot of times, second, third, fourth opinions. So that's-

Dr Lin: No, absolutely. But I always say that's the big difference between private practice and academia. In academics, I remember patients will bring, we're talking binders and binders of records with them to say, I've seen all these people and these are all the evaluations I had. But in private practice you are the first or second neurologist they've seen, right? So it's brand new. You are the first person they've seen. So everything is a clean slate. You can do whatever you need to initially. So it's not as complicated, but still needed part of service of course. That's why we don't need to reach out as far because we have such a big population to draw from just in our local vicinity.

Dr Salas: Yeah, that makes sense.

So, what is something that you would tell your younger, early career person? What's some advice or something that you would recommend, now knowing what you know, for going into neurology, going into private practice, being in a global pandemic as a clinician, as a neurologist? What's your wisdom?

Dr Lin: Okay, so I thought about this. What made me successful is the following. I think it's absolutely prioritizing, knowing what your goals are, and also advocating for yourself. And don't be afraid to ask for things you know you need or you want. Helping others, having others help you--it's not a weakness. I feel like whenever I ask for help from other people, I failed as a mom. I couldn't get my kid or I couldn't do this. It's not a failure to ask for help.

Dr Salas: Yeah, that's great. So it sounds like you probably would've, and correct me if I'm wrong, probably would've said this to do it earlier in your career, right? Because you talked about not being able to do it.

Dr Lin: Yes, yes. Absolutely. Like we just said before, what's the worst they can say if you ask? The worst they can say is no, right? But if you didn't ask, you wouldn't know if it's a yes or no. You wouldn't know if you could or couldn't do something. And I feel like one of the things I didn't do early enough is just to say, "hey, I need this, I want this. This is what I need to be successful." I didn't ask enough. I didn't ask early enough.

Dr Salas: Yeah. No, I think people are going to really resonate and need to hear that. Did you make the right choice by going into private practice? Do you wish you had done something else? Where are you with that?

Dr Lin: I have to say that for the longest time I kept debating between, should I have stayed in academia versus going to private practice? I think I've come to the terms to say, you know what, I made the right choice. I enjoy what I do. Once upon a time or when my kids were younger, I thought about, well, maybe I will go to the FDA. Maybe I might enjoy regulatory government. And I thought to myself, you know what, I really like what I do. I like clinical care. I like talking to patients, helping them with their problems. So I don't think I have any regrets in my career, but like I said, I just wish I had known myself better and not be so proud to ask for things I needed.

Dr Salas: Yeah. Those are powerful words because I think every time we think about it, the grass is always greener on the other side. But when you really self-reflect and say, I made the right decision. And I was particularly interested in your answer to that question because here's someone who went to top tier academic centers, where going to Mayo, going to Hopkins, Thomas Jefferson, going to these places which are very academic, it's more common than not for those graduates to go into academics. So it's refreshing for someone like you to go through, and now reflecting this many years later and saying, you know what, I made the right choice. If there was anything I wish I had done differently, it wasn't about a different choice. It was more about knowing yourself and giving yourself the benefit of the doubt, and just speaking up for who you are and what your needs were and just asking, right?

Dr Lin: Right. And remember, as we go through life stages, I think our needs become different and that needs to be reflected in our clinical practice and our work. When my kids were little, I wanted to be able to work part-time or I wanted to work different hours, right? But now my kids are older, my hours and needs are different. So I appreciate the fact that my practice, with prompting and asking of course, allows that type of flexibility. Because I think flexibility is very important, because without the flexibility it's very difficult to make things always work in various stages of life.

Dr Salas: Yeah. Thank you so much for saying that. I think that's so important is that understanding. Because I think people, especially their early career, trainees or faculty even, think about all these other things they think are important. But at the end of the day, I think flexibility is so important because, as you mentioned, there are different stages. And even if you don't decide to have children or get in a relationship, you need that flexibility. There's just always things that happen in life. So I'm really glad you said that and I'm glad to hear it's a priority.

And with that, I always want to end, as we're almost close to wrapping up is, what do you do, Debbie? What do you do for fun or maybe some hobbies, or what brings you joy? We always want to see, even though we're all busy doing everything that we do, what do you do when you're not at work?

Dr Lin: When I'm not at work, well, I do the same thing. I yell at the kids, take them do activities. No, that's just life. But what brings me joy are the following. I really like time with my family. Just spending time, whatever we may be doing: hiking, traveling, sometimes just "vegetating." You go to the beach, you just sit there. You're not doing much, but it's just relaxing, relaxing time with them. Other things I do for stress relief, I'm becoming an exercise fanatic, right? So every day I carve out 30 minutes of my time, whatever it is, I'm going to do some exercise, whether I'm doing cycling, cardio, meditate, something. That really helps me relieve stress, and allows me to say, okay, this is how I'm getting rid of stress. And of course there's always retail therapy. So when things get really bad, I go out and say, you know what, there's that pair of shoes I wanted or that purse I really want it. I buy it and it feels a little better. So I think everyone stress relief ways are different, but that's how I do. That's how I do it.

Dr Salas: I like the retail shopping part because sometimes I think we need to reward ourselves. And whether that is that new pair of shoes--and I know your taste in shoes--but it could be a manicure, or having that time carved out for your hobby, but you got to make that time. And I know that you really do value travel. How often do you travel in a year, like for fun, for family times?

Dr Lin: Well, prior to the pandemic, we always took an international trip at least once a year, sometimes twice, just depends, right? And I'm not talking like really far away. Sometimes like the Caribbean, I consider that international, right? So we at least take one or two big trips a year. And then we go to the local beach in Delaware once or twice a year. But probably in the pandemic time, we always go away for spring break. We go away for the summer. And we also try to do something for the winter break. So probably three or four times.

Dr Salas: Well, that's amazing. I just want to show people that you can do it. You can be in a very busy practice. You can be a parent, you can be a spouse, and you can still do the things that bring you joy and take that time for yourself. So thank you so much Dr. Lin. It is a pleasure to have you come talk to us and let us know a little bit more about private practice, especially through the global pandemic, right, which nobody saw this coming, at least we didn't. So thank you so much. I know you're very busy. And so carving out this time to really share your perspective was just really great. And I'm really grateful to have you and to know you. And I know you bring great care to all of the patients that you see and take care of. And I'm sure your family is very proud of you.

Dr Lin: Thank you so much for having me. I'm hoping our little talk helped someone else.

Dr Salas: I'm sure it did. Thank you so much. There you have it, everyone. That was Dr. Lin, a general neurologist in private practice. We'll see you next time.