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The Pioneer: Diana Girnita MD, PhD

Updated: Feb 5

Diana M. Girnita, MD, PhD is the CEO& Founder of Rheumatologist OnCall , a telemedicine company that provides specialized services to patients in multiple US states. Rheumatologist OnCall broadens the access to a top expert rheumatologist for patients with autoimmune diseases and arthritis. Access to specialists is delayed in our days up to 6 months. Rheumatologist OnCall offers quick access to top expert specialist care at affordable and transparent pricing to patients in eight US states. The approach to patients is comprehensive and includes evidence-based medicine, but also provides nutrition, mindfulness and physical therapy services.

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Dr. Girnita is a strong advocate for digital health, and telemedicine. She is also a nationwide promoter of practicing direct care as a specialist, to reduce costs and promote price transparency in healthcare. She is the Co-Founder of Direct Specialty Care Alliance and co-leader of the Free Market Medical Association California Chapter.

Educational background: US board certified in rheumatology and internal medicine, licenced to practice in 10 US states. Dr Girnita completed a PhD in immunology, a postdoctoral fellowship at Harvard University, immunology fellowship at University of Pittsburgh and rheumatology fellowship at University of Cincinnati. Dr. Girnita graduated from the Nutrition Science course from Stanford University and a Mindfulness course from The University of Massachusetts. She was recognized with the “Top Doctor” award (2017-2020) and is frequently invited guest speaker of the National Arthritis Foundation and American Congress of Rheumatology.

DR. Girnita continues her academic appointment as volunteer assistant professor at University of Cincinnati Medical Center where she is involved in research and teaching services.

She is the founder of the Autoimmune and Arthritis Support group on Facebook that has more than 9000 members and growing.

Dr. Girnita’s Prescription for Success:

Number 1: Ask your self why do you want to go on this journey. Make sure the answer resonates with you.

Number 2: When you start your business, be open to learning new skills.

Number 3: Build up your brand early. Be respectful, and be respected by others.

Number 4: Hard work and perseverance is behind all successful companies.

Number 5: Keep a positive mindset.

Number 6: Connect with people outside of the medical field.

Number 7: Your success is measured in what you leave behind, and how people will remember you.

Connect with Dr. Girnita

Notable quotes from Dr. Girnita’s interview:

A Doctor can influence your whole life.
My parents are the foundation of what I am today.
I wanted think big, and If I wanted to make an impact, I wanted that impact to be significant.
Cardiology is part of Rheumatology. All of the autoimmune diseases will affect the heart.
Always offer exceptional care.

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Access the Show Transcript Here

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[0:46] The impact that they make and the rheumatologist can make in the life of a patient that comes in horrible pain many times crippled and in a couple of months you bring them back to life.

[0:58] Music.

[1:03] Paging dr. cook paging dr. cook dr. cook you’re wanted in the o.r. dr. Koh your.

[1:11] Music.

[1:34] Hello everyone and welcome to prescription for Success I’m dr. Randy cook your host for the podcast. Which is a production of MD coaches. Providing leadership and Executive coaching for Physicians by physicians to overcome burnout transition your career.

[1:53] Develop as a leader or whatever your goal might be. Visit MD coaches on the web at my MD because you’re not in this alone.

[2:04] And don’t forget CME credit is available when you listen with us just look for cmf I in the show notes to learn how.

[2:13] My guest today is a rheumatologist and also a Pioneer in the new medical practice model known as direct Specialty Care. She grew up in Eastern Europe and now makes her home in Sunnyvale California so let’s hear my conversation with dr. Diana girnita and I want to welcome my very special guest today dr. Dianna granita out in Sunnyvale California who’s going to be talking to us at Great length about direct Specialty Care particularly as it applies to.

[2:49] Rheumatology and Dianna I’m really looking forward to this although I’ve heard a good bit about direct Primary Care this is. This business of direct Specialty Care is sounding very exciting to me so I’m delighted to have you here and thank you so much for joining us.

[3:08] Dr. Cooks thank you very much for inviting me I feel honored to be part of this and I’m looking forward to share my journey and the mission that I assume in the last couple of years. Alrighty well that’s exactly what we’re going to do before we get into the. Details of what you’re doing right now I’m going to do what I really like to do a lot and that is find out about. The very beginnings of your background and I’m always particularly fascinated with people who. I didn’t start out in this country because they are such. Incredible examples of how a person when they put their mind to it can accomplish pretty much anything that they want to and that certainly applies to you.

[3:57] So tell us about your childhood you grew up in Romania what was that like what was your family life like. Definitely I was born in Romania in a small city called Craiova it’s in the South part of Romania and their I lived until I was 20 eight years old I have done all my school there including my medical school and I also started my residency at that point I started a residency in cardiology because that sounds very very exciting and I could save lives I have to tell you that none of my parents were Physicians nobody in my family was a physician and I was the first one in my family who went to graduate at University wow Jeremy many others followed but I remember going up the stairs when I started my medical school only at that point I realized how far I thought I yeah I got where do you think what do you think the inspiration came from you you are not really around any medical people in the family did were there visits to the doctor and where you’re around people in healthcare professions that gave you inspiration how did that.

[5:22] The inspiration came when I was about 12 years old I was admitted in the hospital was with a liver disease and it was a complicated situation and I spent about 12 days in the hospital and just seeing the dynamic in the hospital I thought that is fascinating to to come you know I look at the doctor who was coming to see me everyday followed by Young doctors and nurses and he was so respectful I’m in so respected by everyone and he really did.

[6:00] Help me he brought me to a normal life and it was an incredible physician and I will always be grateful to that moment that me what it means to be a patient. But also what it means to interact with your doctor and how much a doctor can influence your whole life and how did your family feel about that how did you come one day and say well I’m going to be a physician how did that work out my family was always very supportive my parents actually tried to warn me that they cannot help me with anything but. They did support me and. I was very fortunate I have to tell you that my parents were the foundation of what I am today. Well they did very well obviously and I’m going to ask you one other thing that’s way off.

[6:57] Typical subject but I’m very curious I know that. There was quite a bit of political unrest in Romania particularly in the late 1980s and I am curious I’ve no idea what your age is but were you aware of any of that turmoil and did it have any effect on your life at all.

[7:18] Yes it did so when I was born in 76 1976 and until I was 14 years old I lived in the Communist era and probably the worst of the you know the worst part of the Communist area that we we lived in Romania between 1980s and 1990s actually 1989 when the Revolution game and our dictators dictator I was actually killed I leave that area and I remember that we had almost nothing it was nothing in the stores nothing to buy no food you know everything was rationalized from oil the oil that you had to buy the vegetable oil to the sugar the bread we were only allowed to have two breads a day as a family of four we had to stay in line you know to get not a gal like half a gallon of milk and you know besides that my life was not very sad I would say we enjoyed being kids and our parents tried to protect us to eat right through. Help us dream big you know they all said you can do whatever you want and.

[8:46] We will be here to help you well good for them.

[8:49] But the revolution came and although I was 14 years old we had Big Dreams in a we had a dream that we are finally free to say everything that we want to do everything that we dream of because in the Communist area. Era in the Communist era you are not allowed to say whatever you want you’re not allowed to do whatever you you want to do because you will always have to be tied by the political views that you were supposed to have even as a child you know we were organized or we were asked to be in certain organization to be. In a way brainwash was the of course politics you know was the the views that we had to follow and that started at a very young age but when the revolution came we thought finally we are free to do everything that we want and it was a time that a very Tomatoes time when people did not know what to do with the freedom that they have and you know some of the communist ideas persisted for a long time and that was hard for my generation I bet it was and you were those of us in this country actually watched. The.

[10:13] The execution of the child catcher screws on television in 1989 and you would have been about what age at that point I was 14.

[10:23] Wow and yet in the midst of all that turmoil in the midst of an entire nation facing tremendous struggle you set your eyes on. Career in medicine and how did that actually.

[10:43] Unfold I will give you know we will most of the people that are listening to this podcast are not going to have any idea what it’s like to apply to medical school in Romania so can you just give us the quick version of the Hat.

[10:56] Yes so medical school in Romania last six years and you have to pass an exam. After you graduate high school you pass an exam and accordingly to that. Score that you get in that exam you can qualify on the number of available spots that on University can offer any room any at that point they were only six universities in the whole country and I was interested to stay close to my family and I remain in Craiova so I passed the exam I qualify and I entered to do medical school and for six years you are in the medical school and after you graduate again there is at this point a national exam and again you have to pass that exam to get a certain score the highest the score the higher the probability that you’re going to get what specialty you want because every specialty Has Annie limited number of spots so think about for for example Cardiology there are only 50 spots in the whole Romania so you have to have a high score to qualify for that specialty and depending on your interests as well you have to have a higher score to qualify for what you want and your pic was.

[12:21] Cardiology any idea of why why that stood out for you definitely when I was in in my internship here because you have a one year of internship between the time that you graduate and you start residency my father had a myocardial infarction and you know one of the physician that I respected very much he came in the middle of the night and he started tamales is for my father and he saved his life so again another big big impact yes another pivotal moment in my life that I thought that here is a specialty that really makes an impact and probably when you are young you think that only a few organs are important right the break their heart in the kidneys and then the rest can you know can function somehow you can fix the others but. You know I want you to think big and if I want to make an impact that impact I wanted to be significant.

[13:27] Hi I’m Rhonda Crow founder and CEO Forum D coaches here on our X for Success we interview a lot of great medical professionals on how they grew their careers how they overcame challenges. And how they handle day-to-day work I really hope you’re getting a lot of great information. But if you’re looking for an answer to a specific problem management or Administration challenge. Or if you’re feeling just a bit burnt out like maybe you chose the wrong career. Well then there’s a faster way to get the help you need now it’s not counseling it’s coaching. RX for success is produced by MD coaches a team of Physicians who have been where you are I know you’re used to going it alone but you don’t have to. Get the support you need today visit us at my MD to schedule your complimentary consultation. Again that’s my MD because you’re not in this alone.

[14:29] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook.

[14:36] If you haven’t discovered this remarkable magazine please do so very soon it was created by physicians for Physicians to showcase the intersection between clinical and non-clinical interests whether it’s writing. Painting cooking politics and dozens of other topics physician Outlook gives a physician perspective it’s available online and in print it’s really unique among physician lifestyle magazines and like the prescription for Success podcast physician Outlook amplifies the voice of any physician who has something to say it also engages patients who still believe in physician-led. Team-based care and prescription for Success listeners can get 3 months free when you enter our promo code. RX for success and select the monthly option at checkout that’s a really great deal on this stunning publication.

[15:32] And now let’s get back to today’s interview well I bet you were. A very good cardiologist but from looking at your CV it was it about that time that you decided to come to this country and I’m really interested to know how that came about. Definitely so when I was a cardiologist resident I started to be very interested in research and I apply for a Ph.D program and I started to you know study many things in cardiology of course but then I discovered the.

[16:12] Transplant immunology and I discovered that transplantation can make a huge difference to to the patients that had a big myocardial infarction or heart disease incompatible with life so I applied and I was surprised to receive an invitation for a postdoctoral fellowship at Harvard University and that was another moment in my life that I said okay I’m I’m going to go there I’m Gonna Learn publish do an impact and I’m going to come back to Romania so that moment of leaving Romania as a medical cardiologist and coming to the United States was was very important in my life and I love my family my friends I came to leave in a 300 square feet Loft. And then I had to start learning a new Society role that was brutal actually because it really yes because you don’t know anything you don’t know anything about you know banking Social Security it is very hard to navigate a new system without the knowledge of.

[17:30] That you actually take it for granted when you leave here and when I came here I was really excited I never thought about any of those small details are just like okay I’m going there but coming here you you have to learn those things and and I learned but still it wasn’t easy I have to say that I can’t imagine did you did you by any chance know anyone who. Was Romanian when you first arrived in Boston. You going to laugh about that but right before I came here I connected with someone from my City from my group of friends actually and after I came in the United States we stay in touch we became friends and today he is my husband and I have three kids that’s a pretty good connection yes we have three kids and enter dog so you not have navigated the the ways of the United States together and decided to make a lifetime of it that’s a great story. He was here already oh I shouldn’t and I was just asking questions about small things that I supposed to know you know like Visa issues and sure how to find a house I did not know about.

[18:54] The fact that when you were in something here you have to have a credit history or. Background check and all of those things were like why I’m a normal person I never did anything wrong or anyone why would they want to check me but those things I think you know. Took me time to understand and.

[19:14] It was in a way easier to navigate if you have someone to ask questions it’s so much easier to navigate but it was funny that you know we did not connected or Romania we had to cross an ocean to come here and connect those stories really fascinated me when I even think about being dropped down into another country where I don’t know the language I don’t know East from West I you know I don’t know anything and and not only did you survive but my goodness you have become at least a nationally and probably an internationally famous physician and if that’s not a prescription for success I don’t know where we’re going to find one but but let’s move you on the it some point there was a transition from Cardiology to rheumatology. And I’d like to know more about that so after I spent about four years and a half in research I did a lot of clinical research and you know I work I was fortunate again to working in a project of heart transplants and I work with centers that were probably the biggest in the world I enjoy that I enjoy presenting to.

[20:34] Congress is national International I enjoy writing and Publishing but at some point I wanted my interaction with the patients back and when I started to talk to people around me about what I need to do to be able to practice medicine in the in the initial phase it was scary. Because I already had one kid and the family to take care of and that seemed to be very very hard. To pass again all the steps and go into the into the residences here and eventually I decided that I will do that and in one year I pass all the USMLE steps I apply and I got an internal medicine and my thought at that point was that I will continue in my Cardiology interest and I’m going to work in transplant Immunology until one day when I was at a lecture and somebody you know that was later on one of my mentors he was presenting about rheumatoid arthritis and lupus Bulls and the connection with the immune system and remember I have a PhD in immunology and I was like what is he talking about you know because the all I knew about Rheumatology was.

[21:52] People you know it was not too much exposure that I had in Romania in Rheumatology and I thought I always had this. Misconception that Rheumatology is for those laid-back people and that will be just our try this and it’s nothing exciting about it and you know. He was talking about the advances in. The treatments and he was talking about things that I have a studied in transplantation and I was like wow this is a field that is blooming actually and there’s so much more to understand and so much more that we can apply to make a difference in the lives of our patients so I followed him and I asked him to have a rotation with him and what I was there I was like Blown Away by many things first. The impact that they make and the rheumatologist can make in the life of a patient that comes in horrible pain many times crippled and in a couple of months you bring them back to life and then the second thing that kind of.

[22:57] Shocked me is this. Profound relationship that a rheumatologist develops with the patient you know you take care of chronic conditions and the patient you have time as a patient too. To develop that kind of relationship and that seems to me are real based on what I was seeing that is happening in the traditional medical system when you go in quickly see the patient give up he’ll move on to the next one so that kind of relationship. Was very close to my mind and to my heart yet it appears to me that. The connection came from your familiarization with Immunology in the transplant world. Which actually translated fairly well into the way we look at rheumatologic disease nowadays am I close to correct.

[23:49] That’s very true the end of the question that I get asked all the time is like how did you transition from Cardiology to rheumatology but Cardiology is part of Rheumatology you know all of my diseases my autoimmune diseases will affect the heart and all these chronic inflammation that we talked about is actually the source of our chronic conditions including heart disease and people came ashore at the Rose chlorosis and all the other chronic condition that we talk today and even obesity is connected with inflammation so. It took me a long time to understand that immune system is not impacting only the you know the way that we respond to to a transplant or how we can defeat bacteria or viruses then you know in a couple of years I discovered that the impact of our immune system. Is so broad that it’s unbelievable how ignorant I was you know I’m going to talk about me and thinking that there’s just affecting one area I think that probably applies to all of us one of the things that I reflect upon frequently is that when I began my surgical training many many many years ago we thought peptic ulcer disease was a malfunction that.

[25:11] Caused the stomach to create too much acid and there were dozens of different kinds of operations that you could do to support fresh acid production and you know you could do they got amazing you could remove part of the stomach and you could reroute the stomach and all those kinds of things that we were doing back then and then one day we discovered that indeed it was an infectious disease. That’s very true it’s by and we’re learning yeah and and and what you’re getting at is that the inflammatory response the immune response is at the seat of so much of mammalian pathology. And and I can see how that would have significant interest for a person like you who had dealt with Cardiology that again we thought about it in an entirely different way thirty years ago and nowadays things have changed quite a bit so again getting the getting the story back to you.

[26:14] Obviously that was a good move for you you have found yourself to be very very comfortable and very fulfilled as a rheumatologist but apparently something else was missing and it had I think it might have had something to do with patient access so would you like to talk about that definitely so after I graduate in my fellowship you know in the initial phase I started and a private practice system and you. Don’t know the system or you don’t know how the system works being a fellow or a medical resident or even okay.

[26:53] And you just have to be on your own interact with the system as a physician to understand the system so I was going into this journey and I started to notice things that. We’re very hard for me to understand you know we live here in the United States where we have the most advanced Medical system in the world the most advanced. Technological system the books are written here many of the therapeutic options are invented here but then I was seeing patients suffering because they don’t have enough access you know they don’t have the access when they need it to a specialist like me I was seeing patients that. For a consultation they had to wait between four and six months I was seeing patients that were waiting too much in the waiting rooms the time that I was supposed to spend with the patient was short. And shorter and shorter and my schedule was flooded every way every day I was.

[28:00] Not able to give the care that I wanted to give to the patients and on top of that there were a couple of situations when I realize that without even knowing. Because you don’t know anything about the cost of the test or the cost of the consultation that you give I was actually hurting financially. My patience I had a few situations when the patients came to me with a huge bill and. I knew I was not responsible for those money or charging any of this money and when I try to help the patient there was no way to find out how much of test will cost or you know a medication will cost and I was asking even for an infusion that I was prescribing how much is that costing the vision because the patient is asking me we The Physician of the interface with the patients and the physician The Physician is responsible to answer the question to answer the questions of the patient and when the patient was asking me that.

[29:03] I had no idea about how much it’s going to cost my consultation my you know Labs that I wonder where my x-ray and those were my orders and I started to dig into this and I realized that there are ways to find out the prices but not in the traditional system. And the patient would have to be willing to pay cash and many times the cash prize was incredibly lower compared to the you know prices that I was able to see on those beams and I’m going to give you a straight example I was talking to a colleague of mine that went to direct Primary Care she was an internal medicine doctor and she told me that ICBC test in her practice is five dollars or six dollars you know and I was like Wow but the my practice is 70 or $80 when I was asking her how much is an a an A in your practice and she was telling me and Ina is about $20 and I was like Wow in my practice is $150 just a and a not the Venom of what the antibodies and then I started to ask about Imaging is it possible to find x-rays for cash prize or medication for class price not all medication can be. Found that for cash prizes but many can and you know at some point I was like.

[30:26] I was sad to see all these things happening and you know the time that was restricted with a patient the communication was fragmented you know between the patient’s there were six or seven other people’s that would interact with the patient before the patient sends a message to me and.

[30:45] I said to myself you know I think we have the tools in our days to do medicine otherwise and that was before the pandemic and you know I had these discussions even was my friends my doctors you know that my friends there were doctors and I was telling them about telemedicine you know I said to them why are we comfortable to do our banking our shopping our entertainment online and we cannot give a consultation or follow a patient online or you know doing telemedicine and I look to the to the roots of telemedicine and I figure out that telemedicine is practice for many years in this country and a form of or a type of telemedicine and Kai decided at some point to do my practice and to be able with my practice to break the norms you know from breaking geographical barriers to avoiding this delay in care and help the patient not only to get better but also help the patient be responsible and never burn financially the patients so that’s how I started my company which is called rheumatologist on call in. 2019.

[32:05] Before the pandemic was this Vision in my head to be able to change the way that Medical Care is delivered you know it’s the same medical care but. The way that we deliver it it’s a little bit different well I think a lot of people are familiar with direct Primary Care. Which has really blossomed tremendously and just in the last three to five years. In this country and. That one’s pretty easy to figure out patient pays a subscription fee and they can see the doctor.

[32:42] For whatever reason I it’s difficult for me to digest how that works and Specialty Care so can you Enlighten us a little bit on that how does the economics of that system work. When I started my journey as a specialist in Direct Care I had no idea that there is another specialist in the United States that are practiced that is practicing in this model and when I talk to other people every single one try to discourage me because the way that we receive our patients is through a referral system from primary care physicians so without the backup of a system to feed your patience as a specialist you think you might not survive but I was stubborn and I started to dig into the direct primary care and I said to myself you know there must be a way that we can provide. Excellent care to the say on the same principles you know be affordable and be transparent as well and for specialist it’s a little bit difficult because you have to figure out ways to put yourself out there for patients to find you because what I’ve learned is that you don’t need the system to back you up you don’t need a system to send your patients patients will find you.

[34:05] But for that you have to be there you have to be seen you have to be present and you have to connect with a lot of people and always offer exceptional care and I know many of us if not all of us we that’s that’s the way that we want to offer we want to offer exceptional care.

[34:26] But you asked me about the dynamic or but about economic engine. You can do it in two ways one is just to charge a fee for service which again is Affordable and transparent more you can have a hybrid model where you offer. The cash prize but you also take some insurances that you consider are worthwhile to take it and the other way is that for some people including myself patients that do need chronic care.

[35:00] They can pay a membership and they can have access every time when they need it it’s very similar to the direct primary care but in my specialty for example patients with lupus or rheumatoid arthritis. These are the patients the majority of patients that I have patients with inflammatory arthritis like rheumatoid arthritis psoriatic arthritis Ankylosing Spondylitis they do need frequent checkups of their medication and you know their labs they do need chronic monitoring for those patients you can offer them a membership model that makes a lot of sense. And I’m also wondering a little bit about how the patients find you I suspect that a great many patients. Who find themselves in need of a rheumatologist do so because they are seeing either a family practitioner or an internist who has come to the conclusion. This is a problem in need of a rheumatologist and they make a phone call to their favorite rheumatologist in their told well you’re next. They label appointment is five months from now and then we just. Wait do people actually do that still and accidentally find that.

[36:24] That they can actually find Dianna girnita in the Yellow Pages or how did the patient’s find their way to you. This is very true most patients they do realize that after a visit with their primary care physician they have to see a specialist for a rheumatologist and in United States there are about 6,000 rheumatologist in the whole United States and imagine there are.

[36:52] About 72 million people with a diagnosis of arthritis that we know today and this is on the rise. So those rheumatologist most of them are limited to see patients in one area.

[37:09] Right because when you graduate you go your past the board and then you stay in an area and you are limited to see patients where you are licensed so they’re not able to see a lot of patients and some rheumatologist they work part-time and the numbers of you know rheumatologist that come out every year is very limited and a lot of other rheumatologist will retire in the next 10 years so patients were trying to find a rheumatologist looking at their insurance website and you know they either take the recommendation from the primary care or they look on their insurance website and try to find someone that is in there. Network right our Network myths and they start making phone calls and they cannot find a rheumatologist to see them though the national average time for mythology is between four and six months and we are talking about those times if you are located in a metropolitan area. Or if you are located on the east or the West Coast. In the middle of America North North part of America or South part there are not many rheumatologists. And most of their mythology is there we’ll see patients in person.

[38:27] And that limits the access of patients so patients in our days they are very smart and they say Okay what is what are my options and they start looking online that’s how many of them will find my website and. 99% of them will read the reviews about me because you know when you do business online people think that it might be something fishy about it and I actually had you know someone I’ll tell you a story that that’s very very relevant for what’s going on in the online space today and then they start calling you and they make an appointment.

[39:08] But let me come back to that story so it was this gentleman which was a veteran a very young veteran he had an inflammatory arthritis that came out of the blue. And he tried through the VA system to find something through their you know connected. People that they need to find someone and he could not find anyone for three months he was in terrible pain and his wife. Started to look online for a rheumatologist and she found me she called my office. I pick up the phone that day and I talked to her and I said I’m the doctor and she said are you the doctor said yes I am and you know that never happened to her before exactly after a couple of other sentences. She stopped and she said are you sure you are the doctor and I said ma’am I Am the Doctor my name is doctor girnita and I’m here to find out how can I help you. And in the end of the conversation she said to me I have never spoke to a doctor on the phone.

[40:11] To answer B you know those phone 22 to schedule an appointment with me and then she said to me I’m going to talk to my husband and we’ll call you back. The next day the husband called.

[40:22] And you know my assistant answer and she said yes dr. girnita is the doctor you know it’s a legit doctor and he said to her but I would like to speak to her and to see if she’s really the one who talked to my wife and I pick up the phone and I talked to him and then he said to me you know. Last night I spend two hours to research everything about you and I know you are from Romania and I know you are you know doing this business and I read every single review you had 80 reviews do you know the others like I don’t know that. You know you are too good to be true that’s what he said to me well you know I can see that that that is.

[41:06] A problem yet to be solved but this whole area of direct primary care direct Specialty Care clearly. Has created a tremendous amount of interest and I should think it would only be a matter of time that those access problems began to find Solutions particularly the because there are people like you with the motivation to make those problems go away so that’s a really good sign for those of us in the US who have. Dealt with the system that is only grown worse over the years that I practiced medicine so I can’t tell you how it warms my heart to know that it really looks like things are going to get better and not only are you doing it right there in Sunnyvale California you’re actually in.

[41:59] Is it ten States now yes I am licensing 10 states how do you do that.

[42:06] Whisper Severus so when I started I started to get license in a few States and then when I started to see there is interest from other states I added those dates to my license but the hole process of getting license in in each state. Because you basically have to do it in each state still it’s very complicated and to be sincere with you this is not my the scope of my of this discussion or my role here but I think it’s very hard and is not going to serve the patients if we are so few specialists in all specialties. We should be able to practice in multiple states to be able to serve more patients otherwise limiting us to a certain area will not help the patients that are truly in need we all know that we have a very good medical training here in not in the United States and we passed the same type of boards. Um why are we not able to practice in all states and if you are in good faith I really don’t know what Dianna is clear from.

[43:25] Your record of success so far that you are very good at recognizing problems and you are very good at coming up with Solutions so I have no doubt that you are going to be a very big part of this solution and I’m excited to sit back and watch and see how it develops.

[43:47] I’ve really enjoyed this conversation today but at this point what I’m going to do is get out of your way and give you an opportunity to do what I think my audience came for that is here you talk about yourself so I’m going to close my Mike and dr. Deanna girnita will give us her personal prescriptions for success.

[44:07] Thank you so I want to tell you all about seven lessons that I learned being a woman entrepreneur I never dreamed to become an entrepreneur actually entrepreneurship found me and I’m going to start with the first lesson and this is called why I had to understand that when.

[44:31] You set up your goals for becoming successful in your career or your business you should always start by asking why why do I want to join or why do I want to go in this journey and make sure that reason resonates with you. Because somebody told me at some point is like having a personal mission is like designing the footprint for your dream house okay when I started my company rheumatologist on call I wanted to break the geographical barriers and use the technology that I have today to serve patients in time. To avoid the delay in care and the bottlenecks of the traditional system where you cannot see a specialist if you don’t have a referral from a primary care physician I wanted to cut the wasted time in Waiting rooms I wanted to offer my patients direct communication with me and make Health Care affordable and offer transparent pricing number two.

[45:41] When you start your business be open to learn new skills. Even things that you don’t like I never liked accounting or looking at finances I did not know anything about marketing or branding.

[45:59] But I had to learn and I think this is the best way to do things because you are the advocate for your business and you have to know what you have to ask the others to do for you.

[46:13] And one time I heard someone saying that you must learn things that you hate to achieve what you love. And that applies to me as well number three build up your brand early obviously be respectful and be respected by others.

[46:34] Inspiring them. Most of your patients are most of our patients Associates our face with the practice that we have and when you offer exceptional care.

[46:48] Patients will not forget. And you are there to build the brand of your practice doesn’t matter if you are an employee. Or an employer you are still the Builder of that brand. Number for hard work and perseverance are behind all successful companies.

[47:13] Being an entrepreneur is like running a marathon and not a Sprint. And be prepared to fail or pivot because this is part of the journey I had to do that myself number five.

[47:28] Keep a positive mindset. We all have good bad days and very few memorable days and the other day I was walking on the streets with my daughter and I saw a coat that I want to tell you about today. We cannot control the wind but we can adjust the sails. I think this is very important about how you look at things and how you address the roadblocks that you’re going to have.

[48:03] Number 6 and this is very important connect with people outside of the medical field. Being a physician most of my interactions were with people in the medical field.

[48:18] However being an entrepreneur I understood there are so many outside intelligent and bright people. Outside of my field. So start paying attention learn and connect with the people with all backgrounds because you will be amazed about their contribution to the world and number seven. Then this is the last your success is measured in what you leave behind.

[48:49] How people will remember you and your contribution to this world as Steve Jobs and.

[48:57] We are here to put a dent in the universe and people that will be crazy enough to think they can change the world. Are actually the ones that will do change the world. Those are my seven lessons that I had to learn and I’m very happy to share them with you thank you.

[49:18] Well dr. Deanna girnita you have clearly accumulated a tremendous amount of wisdom in your years and. I think the medical profession is very fortunate to have you. Among us and it has been a great pleasure for me to speak with you today I thank you for being here before we go I want to give you an opportunity to tell our audience where they can find you and more about you.

[49:47] Sure they can find me on my website it’s called the rheumatologist on I do have an Instagram account and a Facebook account and I also have a YouTube channel it’s also called rheumatologist on call or you can research my name Deanna girnita and you will find the channel the channel was created to educate patients. And offer them good quality education materials about autoimmune diseases and especially arthritis and if they are interested in other people are interested especially Physicians looking to change their way of practicing and being a specialist in direct care I have started the direct Specialty Care Alliance where we want to nurture and grow people and grow other physician in the field in the directs specialty care field and together with a few other very enthusiastic Physicians that I was able to find along my journey we build resources and we want to promote your practice and we want to create an organization that will be nurturing this community and we want to help each other. And our patients of course.

[51:13] Well dr. Deanna girnita thank you so much for being with us today it really has been a pleasure for me to have this conversation I thank you so much for your time and I wish you much success.

[51:26] Thank you thank you so much for joining us today please remember that when you review us and leave a 5-star rating. That helps give our podcast much more visibility and reach more listeners.

[51:42] Exclusive content is available on our patreon page including membership only material like personal rapid fire Q & A sessions with our guests. And to be sure you never miss an episode visit our website at RX 46s to subscribe.

[52:00] And while you’re there learn how to get CME credit from cmf I just by listening.

[52:06] Special thanks to Ryan Jones who created and performs our theme music and remember. Be sure to fill your prescription for success with my next episode.

[52:19] Music.

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