Med Page 10 Question Interview

What's the biggest barrier to practicing medicine today? Loops of complexity between the provider and the patient that interfere with most medical encounters, Jodi Ritsch, MD, a family physician in Menomonie, Wis., said in response to one of 10 questions MedPage Today is asking thought leaders in medicine.

Ritsch earned her medical degree at the Medical College of Wisconsin in Milwaukee, and completed her residency training at the University of Wisconsin at Eau Claire family medicine program. She is board certified in family medicine and integrative holistic medicine.

She practiced family medicine for 15 years at Mayo Clinic Health System -- Eau Claire and started a private, direct-pay primary care practice, The Joyful Doc Clinic, in 2013.

In addition to her medical practice, Ritsch described herself as "a wife to a wonderful man and mother of four amazing teenagers." She also is a certified leader of Laughter Yoga, and a Guiding Mindful Change life coach.

1.What's the biggest barrier to practicing medicine today?

Loops of complexity between the provider and the patient that interfere with most medical encounters. Direct-pay clinics help to eliminate many of these frustrations by simplifying the experience.

2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.) and how did you respond?

In my previous big clinic job, I rarely knew the cost of tests until patients let me know. I had little control over what a person was charged and never knew for sure what they would be left with for a bill.

Now, in my small direct-pay clinic I can exchange visits for anything or nothing, which is freeing and terrifying at the same time because I want to be generous, but I also want to thrive in business. Right now, I donate 10% to charities in my local community as a part of advertising with a bigger purpose.

3. What do you most often wish you could say to patients, but don't?

Let go of all the fear of what could be wrong with your body and be grateful for all the things that are working well. Love yourself and your body.

4. If you could change or eliminate something about the healthcare system, what would it be?

Complexity! Patients and healthcare workers are totally overwhelmed by all the complexity and apathy is often the result. That doesn't serve anyone well.

5. What is the most important piece of advice for students or clinicians just starting out today?

Spend time with your friends and family whenever possible. Those connections will support you during the times of stress and times of celebration. Make time for fun! A full life makes you a better clinician and communicator.

6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?

If your soul calling is to heal, medicine opens many doors. People let you into their lives and are appreciative of your help. If you think medicine is a stable choice for a lucrative career, I am confident you can make more money with less frustration doing other work in the world.

7. What is the most rewarding aspect of being a clinician?

Times when you know you have made a difference in the life of another person.

8. What is the most memorable research published since you became a clinician and why?

David Rakel, MD, at University of Wisconsin [in Madison] published a study on the importance of relating to patients and not just staring at the computer during a visit.

Patients with cold symptoms were randomized between [standard care or an enhanced physician visit with the clinician expressing empathy]. You can guess which group felt better faster, but the fascinating thing is how the group that did not come to clinic was better faster than patients seen by the provider that only stared at the computer. Focusing on the relationship with the patient is an exciting frontier of medicine.

9. Do you have a favorite medical-themed book, movie or TV show?

"The Mindy Project" TV show: it's hilarious and nothing like my life.

10. What is your advice to other clinicians on how to avoid burnout?

Rekindle the passion you once had for healing. If you can find higher meaning and purpose in the calling of medicine, the daily annoyances are less of an issue. Spend time on healing yourself. Enjoy life and practice gratitude. The more joyful you are the better care you can offer others.



Jodi Ritsch

Jodi Ritsch M.D. created The Joyful Doc Clinic S.C. to offer primary care to your whole family based on relationship not red tape, with simple direct pay pricing and easy online scheduling.

Why Direct Pay?

I decided to leave my big clinic job so I could cut the layers of complexity out between me as a provider and my patients.  Having minimal staff at the clinic (no coders, billers, receptionist, etc) allows us to keep prices more reasonable which is especially great for people with high deductible insurance &/or healthcare savings accounts.

 I recently had a patient come in for an infection that had returned after similar symptoms 3 months earlier.  She has a high deductible insurance policy and wanted to find a more affordable clinic.  Her appointment with lab tests in December had come to almost $800.  I was able to see her and prescribe treatment for the $100 office visit.  She can submit her superbill receipt to her insurance to see if they will reimburse her.  This will depend on her individual policy.  She left the clinic very satisfied and said she was not worried about the cost because she knew upfront what it would be and that there will not be any surprise additional bills coming later.

Personally, the encounter for me highlights the bigger reason to be a direct pay clinic.  I was able to spend 45min listening to her history as well as current symptoms.  In my former traditional clinic job, this visit would have been scheduled for 15min but I would have had 5 or maybe (if we were lucky) 10min to actually spend with the patient after she checked in at the desk and went through a prolonged check in process with the nursing staff.  I would have saved my computer work for the end of the day and spent hours answering phone messages and emails that had gone through receptionists and triage nurses.

If this patient calls The Joyful Doc Clinic S.C. later this week, I will likely answer the phone or quickly call her back.  If she needs another follow up appointment, she will again see all of the options available for a visit on our online scheduling page by clicking the "schedule now" button.  She will then get a reminder email the day before the visit.  When she returns we will likely have tea and she will leave with a hug instead of a sanitized hand shake.  This is care based on love instead of fear.

Returning to a simplified clinic where treatment is an agreement between physician and patient, instead of what insurance allows or protocols dictate, makes me a Joyful Doc and the patients benefit from that joy everyday.  

I would love to read your comments below.  To meet me (Dr.Jodi Ritsch M.D.) and my wonderful assistants, join us any Tuesday or Thursday at 12:30 for a free 20min "Walk with the Doc." 

And of course we would love to have you schedule an appointment by clicking the "schedule now" button above.


Jodi Ritsch

Jodi Ritsch M.D. created The Joyful Doc Clinic S.C. to offer primary care to your whole family based on relationship not red tape, with simple direct pay pricing and easy online scheduling.

Birth of The Joyful Doc Clinic S.C.

Once upon a time, I, Jodi Ritsch M.D., was a busy wife and mother of four young children spending my nights awake at the hospital welcoming new babies as they arrived on the planet.  I attended 95% of my patient's births which left me very sleepy and eventually, after 11 years, very burned-out.  I reluctantly gave up the baby business part of my family medicine career and discovered how wonderful it is consistently sleeping through the night (who knew?).  

During my journey to better balance and whole living, I started to breathe deeply with meditation, stretch with yoga, feel energy with Reiki and laugh more with laughter yoga.  Always wanting to share the information I learned with others.  I started retreats for burned-out physicians, met wonderful new friends in holistic healing practices, trained as a Mindful Life Coach and a certified leader of Laughter Yoga.  

As my paradigm of healing expanded, it became more difficult to stuff myself into the small box of corporate medicine.  The connection with families I had time to develop over multiple pregnancy and well child visits was replaced with seeing patients for only minutes a time (or two) each year.  I longed to spend more time connecting with patients.  I felt like only a small part of me was able to show up for work and longed to work in a bigger way.  I started buying lottery tickets. 

Then the "aha" moment came when I realized that living as a woman at this time in history with a supportive family and wonderful friends...I already had won the great cosmic lottery!  It was time to get busy and bring more love and healing into the world.   

Just like during pregnancy, it is hard to think past the time that the baby is born.  A few days later, you are stunned and sleep deprived, marveling at this new person wondering what the next step is and how you are going to prevent screwing things up.  

Here we are at the birth of The Joyful Doc Clinic.  It's empowering, overwhelming, exciting, nerve racking and just plain fun.  I hope you will join me in the adventure!



Jodi Ritsch

Jodi Ritsch M.D. created The Joyful Doc Clinic S.C. to offer primary care to your whole family based on relationship not red tape, with simple direct pay pricing and easy online scheduling.