Provider Spotlight

We sat down with Dr. Julie Nissim, an internist in MSHP’s Clinically Integrated Network (CIN) with an unorthodox journey and a palpable passion for delivering quality care to her patients. After finding her professional calling where she least expected it and leaving academic practice to open a solo practice without a backup plan, a second income, or any idea of how to run a business, Dr. Nissim’s commitment to providing the best care to her patients and fearlessness in identifying diagnoses has made her practice thrive. She speaks to some of the challenges she faced along the way, her motivations, and her experience as a CIN member.

Was medicine always your life plan?

Not at all. In college, I studied French translation and English literature and wanted to work for the United Nations. My advisor told me about an internship at a local ER to promote smoking cessation, which I was not at all interested in, but I had to write a science paper in order to graduate.

I was blown away. The “local ER” that my advisor described was a level 2 trauma center at Morristown Memorial Hospital. I was like a kid in a candy store. There was one doctor I loved who, after the smoking cessation study concluded, told me I had to leave and that there was nothing there for me. But eventually he gave me a white coat and said “Four hours max. Every Friday, 7pm – 11pm.” I was in college and every Friday night that’s where I was. I started walking around pediatrics and the ICU and the coronary care unit and the cancer unit, just taking it all in, and I was completely enamored. I decided that year, my senior year, to change my major despite my advisor’s objections. I took all the courses I needed that year, over the summer, and in the intersessions to graduate as a biology major with a chemistry minor.

After teaching AP biology and chemistry at a local, elite private school, I decided to apply to medical school. My friends and family thought it was the biggest joke. They told me, “you can aim high and dream big but it will never happen.” I decided to apply anyway and see what happened. I ultimately decided to attend New York College of Osteopathic Medicine because I knew I wanted to be a DO and stay close to home.

Could you describe your switch from employed to voluntary practice?

The decision really came down to defining success. For me, it wasn’t financial but about freedom. I had to decide what I wanted to work for: money, people, patients, myself, the community? I really wanted to spend more time with patients. I’m constantly in love with primary care. I have no idea what’s behind the door every day and I love the mystery aspect, the problem solving, and hearing the details all in one visit. I met many of my patients in academic practice, but I got to know them as people in private practice. 

How did you manage all the details to get your practice up and running?

I had to take a loan. I was still paying off my medical school debt and had no equity, no practice, and no family money. I would go to tutorials at a small business association every Thursday until I found a loan officer willing to give me a very small loan with a ridiculous interest rate. I met a friend of a friend, Joe, who sells medical supplies. Joe came to my office and, using the flashlight on my cell phone because I didn’t yet have lights, told me he’d order everything I needed and gave the name of someone to set up a credit card terminal for patient copays. I had to have my office firewalled and hardwired. Joe the vendor, the Time Warner guy, and the credit card terminal guy all came on the same day and that’s how my practice got started.

In retrospect I don’t think I could have done it again. It takes 6 months to get paid when you change your address. The insurance companies told me to collect my copays in cash, which I did because I had no income, and I used that cash to buy groceries. I was afraid I wouldn’t be able to pay my staff. I didn’t have a backup. I had nothing left to sell when I finally got paid retroactively. These are the things you have to worry about in private practice.

Does being in the MSHP CIN help with the difficulties of private practice?

Primary care is grossly undervalued, even by our own colleagues, and that’s one of the things that makes the MSHP CIN so special to me. Being a solo doc is very isolating — you don’t have anyone to run things by in private practice. Attending MSHP events with all these other people with many of the same issues I face on a day-to-day basis makes me feel like a normal PCP.

Many providers say rates are their main reason for joining the MSHP CIN but it sounds like that wasn’t the case for you. Did you join looking for that kind of social connection?

The CIN was in its infancy when I first heard about it – someone came to my office with a binder and said Mount Sinai was trying to put together a network to get independent physicians better rates and that they already had Aetna on board. I thought it was just more paperwork. Within the next year more payers joined. I still felt like it was just attestations and checking boxes. Learning to do the quality reporting was a challenge.

But then it started to pick up more momentum. I’d attend meetings, mandatory or not. The pod meetings were a revelation. All these people showed up saying they didn’t know how to do this and asking for help with that. It was troubleshooting. Now I love the CIN. They send me a quality check after doing all this, care I’m providing anyway because I’m following the guidelines of my training. But now Medicare knows I’m doing what I’m supposed to and I know I’m doing what I’m supposed to. Until you take that moment to attest, you’re doing what your training tells you to but you don’t realize it’s really good quality. The checks started pouring in independent of me needing to do anything different and I know I’m doing good work.

What keeps you motivated?

There are a lot of people without access to care. When I’m fatigued doing this, I want to take a long sabbatical and deliver really good health care to underserved populations. Health literacy became the love of my life while I was doing my MPH, and I decided I would dedicate my life to teaching people how to be patients, and getting through to patients. It’s all about access and creating a venue and space for care.

Any words to live by?

The most important thing to know as a doctor is what you don’t know. Not knowing doesn’t make you a bad doctor—you just don’t have the diagnosis yet. I have no fear of not knowing, and that’s why I’ve been successful in private practice.

Learn more about Dr. Nissim’s journey and commitment to her patients in her podcast interview here. 

If you are interested in being featured in the MSHP Provider Spotlight Series, please contact Jade Bettine at jade.bettine@mountsinai.org.

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