Dr. Nitesh Paryani: Sure. So, as you mentioned, I’m a third-generation radiation oncologist. So, of course, people assumed that I wanted to be a radiation oncologist since I was two years old and that couldn’t be further from the truth. I actually wanted nothing to do with medicine growing up. It was the last thing I wanted to do because I think it’s what was expected of me. So, I went to college and I actually studied political theory about as useless as they come. So, I used to joke it was either med school or McDonald’s, and I’m still not sure if I made the right choice.

But really, what happened was I had an opportunity, an amazing opportunity to work in the United States Senate as an intern, which was great. I learned a lot, and I got to see a lot, but it kind of made me start wondering what I really wanted to do with my life. I realized you know, working for a Senator that in politics, it was more about who you knew than what you knew. I realized that I’ve been blessed and I’ve been pretty smart given a decent brain. And I could put that brain to use in better ways.

And my uncle who was a radiation oncologist kind of latched onto that opportunity and said, “All right, come see me in the clinic, see what you think.” And I said, “You know what, this actually isn’t as bad as I thought. I actually do enjoy this.” So I ended up—I worked for a little bit after college. I was a management consultant and then ended up going back to school, and went to med school. And at that point, I was pretty sure that you know, radiation oncology was the path for me. I haven’t looked back since. I guess that’s not completely true. I’ve looked back since, but in the end, I think it was the right decision for me.

Dr. JB: And so how many years did you take off between undergraduate and starting medical school?

Dr. Nitesh Paryani: Just a year. So I worked for a year and kind of applied for medical school during that year because at that point, by the time I was a senior in college, I kind of knew that I wanted to go to med school and I did the MCATs and all that. And it was a great year. I worked in Washington, DC. I got to travel across the country as a consultant, so it was a great experience. Actually, since I had the interest in healthcare, I kind of focused on the healthcare side. So, I used to joke that I worked for the bad guys. I worked for insurance companies and other such organizations, but it taught me a lot, and I got to learn a lot about, kind of their operations.

Dr. JB: So that shadowing that you did of the Senator, or the internship you did in the senator’s office was when you were an undergrad?

Dr. Nitesh Paryani: It was actually my first summer after undergrad.

Dr. JB: Oh, nice.

Dr. Nitesh Paryani: Yeah.

Dr. JB: How did you get that job?

Dr. Nitesh Paryani: I just applied for it. I couldn’t believe it. And they actually told me in retrospect, the reason they picked me was based on a recommendation letter from one of my professors. And I remember one of the legislative assistants looking at me going like, “You need to go back and thank that, man, because he wrote you an amazing letter,” and I have thanked him many times since.

Dr. JB: And did you tap into him to write some more amazing letters for you since?

Dr. Nitesh Paryani: Exactly. Well, he wrote me out many beyond that. I think you actually, you might have heard some of my med school letters [inaudible 03:20].

Dr. JB: That’s awesome. So, then you went to medical school. Was medical school what you expected was going to be?

Dr. Nitesh Paryani: Not at all. So I went to med school, having had a full-time job prior. So my expectation was it was going to be a lot like work. I would come in at eight, we’d done at five and that was it. I struggled quite a bit in my first year because I hadn’t study for over a year. I hadn’t been in the school environment and I wasn’t, I thinkprepared for the true difficulty that medical school involves.

I mean, and again, my background was in political theory. I didn’t have a hard science background like a lot of my classmates. So really, the first two years were a big struggle, and I’ll be honest, many times called my dad and said, I’m dropping out, I’m done. I don’t want to do this. I want to go back into the business world. And I don’t know why, but I kept pushing myself. And again, I’m glad I did it. By the time I hit the third year and hit the rotations, I started to realize what all that work was for. And I think it kind of helped reinvigorate me.

Dr. JB: Yes. So a lot of my listeners are people that are interested in going into the field of medicine—pre-med and even some medical students themselves. So could we talk a little bit about that in terms of what you meant by you struggled in the first couple years of medical school?

Dr. Nitesh Paryani: Sure. I think people don’t realize, you know, I’ll never forget, one day I was in medical school and I was dropping my car off to get serviced and there was an attending physician there and was reading some textbook while I was waiting for the car to even the oil to get changed. And so he obviously struck up a conversation and he said, “Oh, are you in medicine?” I said, “Yeah, I’m in my first year of medical school.” And he looked at me and he said, “how’s it going?” And I said, “to be honest, it’s really hard. I’m studying a lot. I don’t have much time.” And he goes, “the best piece of advice I can give you that was given to me when I started medical school is…You probably have a lot of hobbies right now, right?” And I said, “Yeah, there’s a lot of things I like to do.” He said, ‘You need to give up all, but one of them.’

And that kind of hit me pretty hard. He said, ‘You can have one hobby outside of medicine for the next two years. That’s about all your life can tolerate,” and you know, it kind of put things in perspective. And I think it was really—although it’s sobering advice, it’s good advice because medical school is really hard as you know, and your free time almost disappears. And I think kind of reframing that perspective to think, okay, well, this is a temporary period of time, but I really need to focus and limit my outside.

And for me, that was very hard because I used to have a lot of involvement in outside activities, but I realized that that was true, that I needed to limit my time outside of what I was studying because at the end of the day, there’s just not enough time.

Dr. JB: Yes. But I think something very important about that recommendation wasn’t that you had to eliminate all of your hobbies.

Dr. Nitesh Paryani: Correct, but one, and that stuck with me, you can still keep, and you should still keep some hobby because at the end of the day, I think we’ll all go crazy if we’re just studying medicine 24/7, and that reality, we need to accept that reality.

Dr. JB: So isn’t that interesting because even beyond medical school, I don’t know if you’ve noticed this yourself or experienced this, but a lot of people in the healthcare profession actually give up all of their hobbies.

Dr. Nitesh Paryani: Mm-hmm. And I think about it a lot of what I was like before Medicine and after, and I think how diverse my interests were, how diverse my activities were. And certainly, that scope has narrowed. I think now that I am an attending physician, I’ve tried to reopen some of that scope, but of course, life gets very busy in a lot of different ways. The more you progress through life, but certainly, there is sort of a loss that happens that I think we probably don’t talk about a lot

Dr. JB: Yes.

Dr. Nitesh Paryani: And likely is the purpose of your podcast.

Dr. JB: Exactly. So here we are, we’re going to talk about it. And so why do you think that is?

Dr. Nitesh Paryani: What do I think it is that we don’t talk about it or that it happens?

Dr. JB: Well, both. Why do you think it happens and why do you think we don’t talk about it?

Dr. Nitesh Paryani: I think it happens because it has to. I think the sheer volume of what we have to learn, what we have to do, what we have to know is underestimated by anybody who hasn’t gone through it. So, I think that’s just the nature of the job. It is a job that inherent to it is sacrifice And I think if we ignore that, we ignore our peril.

Why we don’t talk about it? I think there’s a few reasons for that. I think one of it is sort of this culture of sort of this tough guy, a military culture that we sort of adopted in medicine that has sort of been carried on from previous generations that you don’t complain about it, you just do it, you suck it up, and I’m not sure that that’s the best approach.

I think another reason we don’t talk about it is we just don’t want to acknowledge it, we don’t want to really admit the profound sacrifice that we’ve given. I think as human beings, we tend to minimize suffering and sacrifice just as a natural instinct. And I think this carries over into this realm as well.

Dr. Nitesh Paryani: I mean, I think there’s probably some concern that we might see a drop off in people interested in entering the field. I think that’s a reality, that I think if we really dive into that, people may be a little more scared to jump into it. I think the other is just as human beings, we always have a hard time admitting tough things to ourselves, right? that are incongruent with our own self-view. And I think that’s just kind of reality of this.

Dr. JB: No, I mean, I agree with you. But the unfortunate thing is that even with us not talking about it, even with us ignoring it and pretending, you know, just keep moving everything’s okay. Everything is not okay.

Dr. Nitesh Paryani: That’s true. I think that’s absolutely true. And I think what I’m seeing—and I’m not involved in educating new students. I mean, to a certain extent, I do some, but I’m not a faculty member at, I’m not a school, but at least what I’m hearing and what I’m seeing is there are some changes happening in that regard. And I think that’s a positive thing. I think that there is, you know, I finish residency before the whole work hour restrictions, and now there are work hour restrictions, which I don’t think is a negative.

I don’t think I gained a lot from working 36 hours in a row, other than the abuse it did on my body. I don’t think it was in the best interest of patients that I did that. I do think there was value to me being kind of the only person there, but I think that can be recreated in other ways without the physical stress and the emotional stress that those kinds of work hours create.

Dr. JB: Yes. I think one of the funny things about these work hours is that it doesn’t carry over into when you were an attending.

Dr. Nitesh Paryani: That’s also true. I think that’s very true, but I think, you know, and I think when you’re an attending there’s…And I think this is kind of what I wanted to touch on in some of this podcast is, there’s a certain amount of control you have over your profession that I think a lot of physicians have given up. And I’ve given it up by the nature of the jobs that they’ve taken and the roles that they’ve assumed and the contracts that they’ve signed. And I think that is…If we look at what I see is the big concerns going forward for medicine, that’s my biggest concern is, you know, we saw what last year, the AMA reported that this was the first year in which more physicians were employed than self-employed in the history of medicine. So greater than 50% of doctors were employed by somebody else. And I mean, don’t get me wrong, there are advantages to employment.

You don’t have to worry about running your practice or your billing, you can, in theory, come home and do your own job and go home. But there are a lot of downsides that we don’t talk about a lot to employment. And a lot of that is like you said, work hours, you don’t get as much control over that. As a practice owner and as somebody who’s in private practice, I decide when I want to work and when I don’t want to work and I bear the financial consequences of that. But I think having that freedom and that control over your future and your profession is really important.

Dr. JB: Yes. So why do you think this change occurred?

Dr. Nitesh Paryani: Well, as I said, I think for a lot of people, I think there’s a couple of reasons. Number one, in medical school, we don’t adequately prepare physicians to manage a practice. There’s very little to no curriculum on that. And that contrasts to say dental school, where practice management is a component of their curriculum because they want dentists to go out and practice and own businesses and, and manage their accounts and all of that. So, number one, we don’t teach it so people don’t feel adequately prepared.

Number two, the cost of medical education has risen so high that, students are graduating with several hundred thousand dollars in debt. And then the appetite for further debt and starting your own practice is zero, right? I mean, how many medical students with 300,000/ 400,000 in debt, want to go another couple hundred thousand in debt starting their own practice and delay their payment for their work by several months So I think that’s part of the problem.

And then I think the other is just, as physicians, we’ve kind of allowed ourselves to sort of be bottled out of practice management, whether it’s through the lack of interest, whether it’s through all those factors I just discussed, but I see more and more docs signing these contracts that essentially negate their ability to run their practice. And it’s concerning to me.

Dr. JB: And you entered medical school with the kind of like this business background-based experience.

Dr. Nitesh Paryani: Exactly. And so I had a little bit of an advantage in that respect because I had that background and I had the desire, but that being said, it was still a huge learning curve for me. I started my own practice. I was employed for several years by various different organizations, moved across the country because one practice went bankrupt and another practice went bankrupt. I had a bunch of people making financial decisions for me.

And all the while, even in these bankrupt practices, my personal practice was doing great. I was doing very well. I was seeing a lot of patients. I was bringing in revenue. It was the bean counters above me that were making bad decisions. And so that’s what inspired me to start my own practice. I said, “Listen, I can’t keep having my major life decisions being decided by somebody else.”

Dr. JB: And so what was that experience like being like, all right, I’m going to do this on my own.

Dr. Nitesh Paryani: It was terrifying. So I started this practice and ended up opening the doors in November, 2020 in the middle of a global pandemic.

Dr. JB: Yeah. Perfect timing.

Dr. Nitesh Paryani: Yeah. Perfect timing. Exactly. When I started the process, I’d started probably six months to a year prior. There was no pandemic, everything was etic. So, my expectation was I was going to be up in a normal, regular medical practice, not in the middle of a pandemic. But that being said, it’s gone really, really well, knock on wood. You know, I’ve continued to see growth. I’ve continued to see things go well.

Initially, it was a lot of work. But now that I’m in a place where it’s a little more established, I’m finding that I can carve out time for myself and control my own schedule more, I’ve hired another doctor. Not really because I needed one, but because I wanted to have more quality of life. And that’s a decision I never would’ve been able to make in a previous practice.

They would’ve said, sorry, we don’t have enough money for another doctor, but I was able to find somebody who was in a similar mindset to me who didn’t want to really work all the time. And I was able to make it work. At the same point when I was busy enough to get a practice extender to see some of my follow up patients, I was able to make that decision in a day. I didn’t have to go to six meetings with administrators to justify the rationale for all those things.

Dr. JB: Yes. do you find that as your practice gets bigger, some of these bureaucratic things that you had experienced in your prior place of employment would have to be applied to what you’re building?

Dr. Nitesh Paryani: So far, I’m not big enough yet. I’m myself, a doc and a nurse practitioner. So I luckily, knock on wood, haven’t encountered that. I mean, will that happen potentially? I’d like to think, though, with it being a physician-led organization, that although it may become more bureaucratic, the outcome of those bureaucratic decisions may be more palatable than what they were in previous scenarios where they weren’t necessarily physician-led practices.

Dr. JB: Yes. So what would you say to another physician who is thinking about trying to go on their own and build their own practice, but clearly had no training or background? Like, what are the first steps?

Dr. Nitesh Paryani: I think the key is building a good team. You know, what I did early on was identified a billing company you know, a third-party company that was experienced in my specialty that really knew what they were doing. I got a good banker; I got a good attorney. If you build a quality team, listen, you’re not going to, you’ll make more money doing it all yourself. But I traded that for my time, my sanity, and also just what I viewed as a more assured chance of success.

And so I think, as physicians, we do work in teams. We’re taught to work in teams in the healthcare setting, but I don’t think we’re taught about these business teams—a good accountant, I should also mention it as part of that. And so, it helped that I assembled that team in advance of doing anything.

The other thing I think we have to accept is a little bit of uncertainty, which is physicians, we’re not very good with in our own personal endeavors. We work in a world of uncertainty in medicine, but we struggle a little bit with the uncertainty of knowing that there’s going to be some rough months that you’re probably not going to make a lot of money. And you really need to plan for that accordingly, whether that means saving more from the employed job you had previously, or taking out a larger amount of loan to be able to cover your living expenses.

All that being said, and I did a lot of research into this in my practice, I don’t know many stories of a physician opening a practice and not doing well, having to shut down, right? Because we have a service that is in high demand. We are the provider of that service and we have control over the quality of that service, especially when we’re running the practice ourselves. And I think, I would encourage anybody who’s considering it to take the leap. You only live once. This is your chance to really gain control of your future, of your destiny and to really bring your passion for medicine back. And that’s what it’s done for me. It’s reignited my passion for medicine.

Dr. Nitesh Paryani: I think so. I think I had experienced a lot of physicians experienced, which was a high amount of burnout. I think I was working long hours for somebody else who made the rules. Actually, even before I started this practice, I was looking at potential exits for medicine non-clinical roles, going back into the business world, using my MD in a consulting fashion, or working for a pharmaceutical company or something of that nature.

But I realized that it wasn’t the patients and the patient care that was burning me out, it was the administrative and bureaucratic things. And I’ll give you an example. As a radiation oncologist, part of our job is we have to be in the building when radiation treatments are being delivered, and we have to supervise the care. And in my old practice, and I was about a month away from giving notice, I had already started to develop my new practice.

So I was doing what I needed to do, but I was ready to leave. And I remembered the administrator sat down with me one day and said, “We need to talk, you badge out six seconds early last Tuesday.’ And I smiled, and I said, “Okay.” And I smiled with a big smile on my face. And I said, “Rest assured, it will never happen again.” And I turned in my resignation the next day. I was telling the truth; it was never going to happen again. But it was that kind of micromanagement, that kind of bureaucratic and administrative nonsense that was eating in the joy of my profession.

Dr. JB: Wow. And so when, during your time in medicine, did you first start developing these symptoms of burnout?

Dr. Nitesh Paryani: You know, it was probably towards the end of my residency and right as I got into practice, might have been probably when it kicked in my residency, was tough. It was a tough residency. We worked a lot, we had high volumes and we didn’t have a lot of support. And so I think that’s where it kind of started. And then think worsened through my first practice. I joined a practice that was a big multinational company that ended up going bankrupt about a year and a half into the practice.

And again, my personal practice was doing well, but the larger company filed for Chapter 11, ended up getting bought out and I left before all that happened. But that kind of stuff, I think really, really played a toll on me because at the end of the day, I realized that it was about so much more than my personal practice of medicine about how my future was going to be controlled.

Dr. JB: And so, even though your personal practice was doing well and you were bringing in money, when they filed for bankruptcy, you lost your practice in that?

Dr. Nitesh Paryani: Well, I could have stayed. I chose to leave. And the reason I did was I knew that, you know, my field it’s a very technology-heavy field, so if the parent organization was filing for bankruptcy, I wasn’t going to get the technological tools that I needed to grow the practice.

Dr. JB: Got it.

Dr. Nitesh Paryani: And so that was a conscious decision on my part. You know, they offered me the ability to stay with the new organization that was buying them out and they had a contract for me and all that, but I made the conscious decision to say, “Listen, this is probably not, what’s going to be the best for my long-term career,” and turns out it was a very good decision because I just got a phone call that the company that acquired it was about to go bankrupt again, so the cycle will continue, thankfully without me.

Dr. JB: Wow. I think you said something about an MBA.

Dr. Nitesh Paryani: I don’t have an MBA. So, my background was, I studied political theory, but I went into to the management consultant world. So, I used to joke with people kind a practical MBA, so not as rigorous as an MBA, by any means. But I learned you know, and I did do some online coursework in Corporate Finance, Managerial Accounting, that kind of stuff. Yes. I just at least have some familiarity, but again, my approach has been that team approach. I rely on, the lawyers the lawyer’s job, the accountant to do the accountant’s job and my billing team to really kind of step up and handle some of those aspects so that I can focus on taking care of patients. But also, manage the practice in a way that’s not all-consuming.

Dr. JB: Yes. So you don’t need an MBA to have a successful practice?

Dr. Nitesh Paryani: I don’t think so. I mean, knock on wood, I’m doing it so far. And I know a lot of folks that have, but I don’t think it’s a required component to really being able to manage a practice.

Dr. JB: And so going back to the beginning of what you said you are third generation radiation oncologist, correct?

Dr. Nitesh Paryani: Mm-hmm.

Dr. JB: So your uncle and…?

Dr. Nitesh Paryani: My grandfather, yeah.

Dr. JB: Grandfather. So, did they also have their own independent practices?

Dr. Nitesh Paryani: So, my grandfather started off his profession, his career when he moved to Florida from India as an employed doctor, but eventually, went out on his own. My uncle joined him and my grandfather passed shortly after mine, joined him. Back in those days, they didn’t have the radiation protection that we have now so the physicians and the technicians were exposed to high doses of radiation. So, he actually developed cancer as a result of his radiation exposure. So, he passed in the early 80s. My uncle took over the practice and actually grew it quite a bit and sold his practice prior to my joining him.

Dr. JB: Got it. Okay. So, you kind of precedence of people in your family who had been successful in terms of running their own practice.

Dr. Nitesh Paryani: Exactly. I had, I think some good role models, in that respect. And I probably haven’t leaned on my uncle as much as I should. But part of that has been because it’s something I want to do on my own. I really want to… every now and then I’ll shoot him an email and say, “Hey, does the contract look good to you? Or does this look like something… what would you do in this situation?”

So, it’s nice to have that sounding board. But also, I think even more so, and kind of what you alluded to, is to have that example of, listen, this is doable. This can be done. And a lot of people say, well, it was a different era back then. Of course, it was a different era and a lot more docs were private and independent, but that doesn’t mean that…You may not be able to achieve the same scale or the same degree of success that our predecessors did, but I think the opportunities are still out there.

Dr. JB: Another interesting thing that you mentioned was that you did not know of a lot of physician-run practices where they’re not really successful. And so one question that I would ask is whether there were several independent physician-run practices that got eaten up by these major health systems. So what happened with those in those situations?

Dr. Nitesh Paryani: So, I think that’s a different story, right? Because obviously those…if they weren’t successful, the health system wouldn’t have swallowed them up again, right? The health system wouldn’t have been interested if they weren’t doing well. I think the scenarios that I’ve seen are two separate scenarios: one is that doctor who’s on the verge of retirement and is looking for what to do with their practice. This is a great exit ramp for them. They can get a nice buyout, maybe have a contract where they work for a couple of years and then the health system takes over. I think it’s unfortunate that that’s the route that a lot of practices chose rather than bringing on partners or selling to other physicians which I think would’ve been better for our profession—maybe not for the individual, but for our profession.

The other scenario is practices that maybe aren’t at the end of their career, but are selling out the health systems for increased reimbursement. A lot of times if you’re billing under the tax idea of a hospital or a large health system, your insurance contracts go up 20 or 30% once you’re acquired. And I can see the draw there; personally, it’s not something I would entertain because, for me, freedom and independence are of greater value than monetary reimbursement. But I can certainly understand where folks are coming from when they do that.

Dr. JB: Okay. And you work with insurance companies?

Dr. Nitesh Paryani: Yeah, I bill directly. So, I bill directly to insurance companies, and I’m contracted with almost every insurance company in the area—at least anyone who will have me on panel. And that’s another thing we don’t talk about, how difficult sometimes that can be to get on panel with insurance companies as a sole practitioner. But yeah, I do all my own billing making through a billing company.

Dr. JB: Yes. so, what do you mean it’s difficult? It’s not just you just hand an application and then all of a sudden…

Dr. Nitesh Paryani: Yeah, that’s what I thought when I started. So a lot of these companies they don’t like to deal with smaller practices because it’s a resource thing for them. If they can have one point of contact for a hundred doctors, they’d rather have that. And I can understand that from their perspective. A lot of times they tell you that their panels are closed and it can take a lot of persistence to get on their panels. And unfortunately, it can also take accepting rates that are sometimes comically low. And I’ve done that in order to grow my practice and get started. And then as you get busier, you can either try to renegotiate that rate or drop certain payers if you have to, if they just won’t pay you a reasonable rate.

But certainly, my approach has been, I, the one of a volume; I’ll take whatever I can get. But now as I’m getting busier, I am to look at some of those things and saying, wait a minute, if this contract is paying me a rate that’s significantly less than all the rest, maybe it’s not worth continuing my relationship with them.

Dr. JB: And do you partner with hospitals too in the area?

Dr. Nitesh Paryani: So I have. I chose to partner with a health system. Part of the reason is because of what I do. Equipment costs can be quite high. So, I do utilize some of the equipment at a nearby hospital. And that’s been a bit big positive for me. That partnership has been mutually beneficial, I think. I was lucky to find a health system. I think that whose values correspond with my own. I think that’s been a positive relationship, but I think it certainly has helped contribute to my success

Dr. JB: Yes. And I can see how life as a business owner can be very, very busy and stressful, especially as you’re growing your business. And so how have you managed to balance or integrate your business life with growing your business and your family life and obligations?

Dr. Nitesh Paryani: Sure. So, I’m a single dad, which makes it even tougher. But I think one of the benefits that I have with, again, my own practice is I do get to set hours. I share custody of my kids with, with their mom on the 50/50 split. And on the days that I have the kids, I adjust my clinical schedule. So, I get off earlier. I can spend more time with them, pick them up, and I’ll work after they go to bed. And I think, again, that’s a benefit that I think as an employee doctor, I may not have been able to do. Being a business owner is busy and stressful, but one of the huge benefits is I get to do a lot of that work on my own time, I get to define when that work gets done and it can be done, especially the business management aspects can be done remotely.

I don’t need to be in the hospital doing that work. I can do that at nine o’clock at night, oftentimes, from my bed, sending emails and doing what I need to do, or things like that. So again, I think there are pros and cons, but I think although the workload may have gone up, what I appreciate is the increased flexibility in how I get that work done.

Dr. JB: And what hobby have you continued to engage in?

Dr. Nitesh Paryani: So for me, it was—and this is, again, going back to my undergraduate roots, it’s advocacy and politics. I’ve always been interested in politics and advocacy. I’ve been very involved with the medical society with the Florida Medical Association, I’ve continued my involvement, I actually serve on their board. And that’s something that I encourage all doctors to get involved in even just a little bit, just to get a taste. I think it’s tremendous what we can do.

As doctors, we can help individuals, but in the advocacy world, we can help people on a large scale. And I think., Tallahassee and Washington, both lack an appropriate amount of active and engaged and involved physicians who can really help really help improve lives.

Dr. JB: And why do you think there’s not a lot of physicians engaged in advocacy work?

Dr. Nitesh Paryani: I think, again, it goes back to the education aspects. I don’t think we stress it very much in medical school. We don’t encourage it very much. I think it might be somewhat of a personality type, too. Those folks who tend to be more scientific, tend to be more, I think, have a distaste for politics and advocacy. And I can certainly understand that. I mean, when I started in the world of politics and that intern with the Senator back in 2005, it was a very different world than it was now, people actually work together on different sides of the political and people. There was a sense of decency into quorum, which I think we’ve lost unfortunately over the last decade or so.

So I think it is off-putting to a lot of people and I can certainly understand that. But at the end of the day, I think there’s an old adage in politics that holds true is you’re either at the table or you’re on the menu. And that’s, unfortunately, reality. If we don’t show up to advocate on behalf of our patients and on behalf of our profession, the lawmakers are still going to make laws that impact us.

Dr. JB: And we experience that every single day.

Dr. Nitesh Paryani: Unfortunately, unfortunately, we experienced the negative consequences of our overall lack of involvement. Yes. so that’s why I’ve always been a big advocate for physician involvement.

Dr. JB: Yes. So, if my listener wanted to get in touch with you, and find out more about what you’re doing and how you did it, is there a way that they can meet you?

Dr. Nitesh Paryani: Absolutely. So my practice website my practice is tamponcology and proton. So it’s Top, T-O- P… So my website is www.topdocsfl.com. There’s a Contact Us site or link there that they could use to get in touch with me. That actually comes directly to me, again, the benefit of being a small practice owner is you micromanage a lot. So that’s an easy way to get in touch with me, and then, our practice number’s on there, too.

Dr. JB: And in closing, do you have any pearls of wisdom you’d like to share with my listeners?

Dr. Nitesh Paryani: I think what I would say is, if you have a passion for medicine, don’t let some of the bureaucracy and some of the difficulties and challenges get in the way of that passion. Eventually, you’re going to get to the point—you say a lot of your readers are pre-med students—eventually, you’re going to get to the point, but you’re going to have control over your future and control over your profession. And you’re going to remember why you went into this. So just put your head down, push through the rough parts and you’ll get to the point where you expect to be.

Outro: Yeah. Who says a doc can’t rap, D–O–C–T–O-R-J–B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or pre-recorded. Come learn some. Each one, teach one. I’m done.