Betsy Vasquez, MD, on Autonomy, Connectivity, and Detective Work

Our “Physician Voices” series empowers doctors to share their unique stories, expert perspectives, and helpful insights. In this Q&A, Dr. Vasquez explores autonomy’s role in patient-centered care, pros and cons of 24/7 access, investigating health issues like a detective, and more.

What do you love most about your work?

I’m grateful for the opportunity to get to know my patients — their medical conditions and concerns but also their lives and stories. It’s this relationship that truly allows me to assist them. Together, we find potential solutions that benefit their overall well-being, and I consider that a privilege.

Years ago, I was standing in the doctors’ lounge talking with a fellow physician. I said something along the lines of, “I’m a little overwhelmed. This is hard!” I distinctly remember him replying, “Yes, it is. But it’s also the only profession I know of where total strangers open up to you with their problems and trust you to help them. And that is just such an honor.”

Those words have stayed with me because they’re so true. Where else do people reveal their deepest, most vulnerable selves within five minutes of meeting you? I always try to keep that sentiment in mind.

Why did you choose to go into independent practice?

When I was starting out, I never imagined I’d go into private practice. At first, I worked in academia, then joined an HMO, which I credit for helping me develop my style of medicine. While working for the HMO, I realized just how important providing patient-centered care is to me. As an independent physician, I can decide how much time I spend with patients, how I address their particular problems, and how I connect with them, whether through in-person appointments or, nowadays, virtual visits.

Prior to opening my own practice, I was often frustrated because I felt my patients’ needs weren’t the primary focus. For example, in the HMO group, I was treating many cancer patients. These can be very difficult, emotional visits, and so I needed to reserve extra time to talk with them regarding their disease and to develop their treatment plans.

However, the HMO did not allow changes to the schedule. All visits were allotted the same amount of time. That didn’t give me the space to address all of the facets that go into caring for a newly diagnosed cancer patient. There was one day in particular when I had two back-to-back appointments where I had to tell patients they had cancer. I requested that the scheduling department try to spread these visits out or give me more time, but they did not comply. That specific event was very influential in my decision to go into private practice.

Now, as an independent doctor, I control my schedule. I can allot time for special cases. I can use different tools, special studies, and medications in unique ways.

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How do you nurture relationships with your patients?

One of the concepts I introduce to patients when we first meet is that of a partnership. I dedicate time to teaching them about their conditions and discussing the different treatments. I communicate options but ultimately let them choose their treatment path. My goal is to empower patients to take charge of their wellness.

Another framework I keep in mind is that of the doctor as a detective. I ask a lot of questions. I often inform patients that I approach the medical problem like an investigator. In order to make a diagnosis, I have to gather the facts and evidence.

What misconceptions does the industry have about physicians?

Very few decision-makers truly understand what happens in the exam room. They expect patient care to follow a perfectly streamlined algorithm: say hello, quickly find out what’s wrong, then provide X, Y, and Z treatments. Sure, you can maybe paint the overall texture of patient care that way, but viewing it like an equation overlooks the many nuances and details.

I need to counsel and help patients work through their fears and questions for even the most routine procedures. I need time to build trust and nurture the doctor-patient relationship. And I need autonomy to provide high-quality, individualized care. Yet the industry wants doctors and patients to behave 100% rationally and predictably.

What challenges does your specialty face?

There’s a misconception that otolaryngologists are purely surgeons. When physicians refer patients to us, they expect a surgical solution. But ENT is a very diverse specialty. The reality is that — while surgery certainly is a large part of my day-to-day practice — I’m heavily involved in medical management of ENT problems also. I often think of my specialty as a bridge between medical and surgical practice. The challenge is the same as I imagine it is for all physicians, that is, how to stay informed and updated in a profession that is constantly growing and changing.

What tools and support have helped improve your daily practice?

The electronic health record (EHR) is incredibly important. I’ll be the first to admit that I was not a fan when the technology was introduced; there was such a steep learning curve for those of us who started with paper charts. At first, EHRs were clunky and confusing, but they have improved significantly over the years and made my life much easier.

Learn how to supercharge your EHR workflows!

When patients are referred to me, as a surgical subspecialist, I need to see their full medical history, emergency room visits, urgent care appointments, X-rays, and medications. Being a part of Privia is great because I can easily and accurately see patients’ records when they are members of our network. The interoperability is amazing.

On the other hand, I think that when it comes to the Quadruple Aim and improving physician well-being there is still work to be done. EHRs offer 24/7 connectivity, which can lead to making physicians feel they need to attend to all medical reports and messages immediately. I believe this is one of the causes of physician burnout. The healthcare industry needs to continue to develop resources that prioritize physicians’ well-being.

Betsy Vasquez, MD, is an otolaryngologist with Loudoun ENT Specialists in Sterling, Virginia. In her practice, Dr. Vasquez focuses on creating a sensitive, safe environment for her patients and providing state-of-the-art care. Outside of medicine, Dr. Vasquez enjoys gardening, cooking, traveling, and spending time with her family.