WEBVTT
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Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Let's dive in.
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Hey everyone, Matt Robinson with the Physician Association of California.
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Another episode of Pack and Forth, joined by my co-host, Alan Young.
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How are you doing?
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Great to see you, Matt.
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Doing well.
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Thank you.
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Well, I'm very uh excited about who we have on this next episode.
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Uh one of my cherished board members, uh Dr.
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Lanya Gabal, is joining us remotely from Orange County.
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Super excited to have her and uh very, very successful in what she does within her business.
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Uh she's an entrepreneur.
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Do you have any entrepreneurialism in your family?
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I am not an entrepreneur, but um my daughter did something pretty impressive last weekend.
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She uh she comes in and announces that she wants a puppy into our room.
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And uh and I said, There's no way you're getting a puppy, we just got you a fish.
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You learn how to take care of the fish, you know, maybe we'll talk.
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She says, What if I sell the fish?
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If I sell the fish and get some money, can I get the puppy?
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And I and I just black and I was like, Yeah, no, we're we're we're not selling your fish to anybody.
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Go ahead.
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Uh try.
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And she makes a sign that says free fish, and she draws a picture of the fish, and then she wants to set up a stand, like a lemonade stand, to sell the fish to bring it up to a bigger enterprise, which is the puppy.
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I love it.
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I love it.
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I need her to come over to my place, actually.
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I have so many animals I can't keep track.
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I mean, it's like a farm in my house.
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I got tortoises, I got six tortoises, actually, seven now, one just laid an egg.
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I got a dog, two cats.
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So if she can come over to my house, I'd be more than happy to have her over.
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How did you end up with this menagerie in your home?
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Like it goes on and on, but I know I wanna I want to get to Dr.
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Gabal, a very busy person.
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Dr.
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Lamia Gabal is a board-certified urologist and the founder of Prestige Medical Group, an independent practice in Southern California.
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She brings more than 20 years of clinical experience and leads a female forward team focused on compassionate and patient-centered care.
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Dr.
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Gabal is also a board member of PAC and a strong advocate for position-led and independent medicine.
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Dr.
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Gabal, welcome to PAC and Ford.
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Thank you both so much.
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I'm so happy to be here, and thanks for having me on.
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Well, let's talk about what has happened to you in your life.
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Uh starting with your background, I understand your family immigrated here from Egypt to San Francisco when you were just a baby.
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And I'm curious how those early experiences uh shaped you and ultimately shaped your your role as a physician.
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Yeah.
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So um, yeah, so we immigrated here.
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I was two years old, 1969.
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And um my it was me and my sister.
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My brother was born here in the U.S.
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afterwards, actually, after my mom was told she'd never have children because of a bad car accident that she got into uh when we were in San Francisco.
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And my dad, you know, both my parents had degrees in agricultural engineering from University of uh Cairo University in Egypt, and um but couldn't barely speak English, had two little babies.
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So my dad took a job as a dishwasher in a um in a hospital, actually, and ended up saving enough money to buy a little car that then broke down at the top of a hill.
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My mom was pushing um from the back.
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Like this is as they tell it, of course.
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I have no memory of it.
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My dad was kind of pushing from the front and steering.
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The car rolled back on my mom, crushed her pelvis, and um, she was like stuck between two cars, apparently.
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Um, so she was put in traction for six months.
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My sister and I were put in foster care for six months because my dad didn't know what to do with two small children.
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Um, but then he was able to, you know, after six months collect us all, we moved to Southern California.
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And I know I get my entrepreneurial sort of um bent from my father because um, like me, I don't think he liked working for anyone else.
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And so he um became an engineer.
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They uh they helped him to become an engineer, some people that were helping us with all of our medical stuff, um, but didn't want to work for anyone else.
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And then, like um most of us good Arabs, we uh he owned a couple of gas stations and then turned that into owning an auto parts store called King Tut Auto Parts because um I am Egyptian and we were in Anaheim, and that was we're literally, I think, the first Arabs in Anaheim.
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Now, if you want good Arabic food, go to Anaheim.
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It's amazing.
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It's like they actually just got the moniker, Little Arabia.
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But so um grew up mostly there in Anaheim, worked at the auto parts store.
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Um, and so I think that's where I also got some of my surgical bent.
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Um, I think parts is parts.
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And as I tell my male patients, I'm really just one of the guys.
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And so they don't have to get embarrassed, you know, to come see me.
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And I also have smaller fingers than the guys.
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So that's a good, you know, sales point when you're a urologist.
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And so um, so yeah, that's how I kind of I think my mom's experience and and some of the stuff she had to deal with after that, I think that really um, really uh influenced me to go into medicine, plus, you know, my parents constantly reminding us we came to this country for better opportunities, you know, for you, you know, for our children.
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And so, you know, there's immigrant pressure there as well.
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But I can't imagine myself doing anything else, to be honest.
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Well, thank you very much, Dr.
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Ball.
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So, I mean, obviously, as it's relative to PAC, right?
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I mean, we we advocate uh for private practice.
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So what is it that drew you into private practice versus you know, working within a larger system or within a larger group?
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Like, why did you want to go out on your own?
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Then also why did you become a urologist?
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So um, as my sister first initially thought when I chose urology, she thought it was to meet men.
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I'm like, no, not the reason, no.
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Um so you know, I it was given to me as a um third-year medical student.
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It was I wanted plastic surgery and I wanted um ENT, head and neck surgery.
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And during our third year rotations, I ended up getting plastic surgery and urology, and I thought, this is ridiculous.
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Who wants to be a urologist?
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It's stupid, I don't even know what they do.
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They just play with urine all day long.
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Like, who wants to do that?
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And so I tried to trade it, I tried to give it away, no one would take it.
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So finally, I'm like, fine, I'll just suck it up, I'll go ahead and go through the three-week, you know, clerkship, whatever.
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And I loved it.
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And I'm like, wow, I had no idea what urologists do.
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Most people think that urology is actually like a gynecologist for men, but that's not at all what a urologist does.
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And in fact, my sub-specialty is female public medicine and reconstructive surgery.
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So 70% of my practice is female.
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I end up doing a lot of prolapse surgeries, incontinence, but still do kidney stones, bladder cancer.
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Um, you know, there's things that happen in both men and women.
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So it's not just about um being a pecker checker, if I can say that.
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Um, it's also about treating men and women for these other things that happen.
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Yes, we deal with prostate cancer, only happens in men, um kidney cancer, both men and women.
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So there's a lot of things that do happen in both men and women.
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So then um, as I did the rotation, loved it and um and uh got accepted at UCSD, which I was very grateful for.
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It's very difficult, actually.
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It's a pretty um competitive residency to get.
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Um and so then I I didn't realize like there needed to be more women.
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Only 4% of board-certified urologists were female at the time that I finished in 2001.
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We're up to about 10% now, so we're getting there.
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But it's still a bit of a boys' club, probably mostly because it is a surgical specialty.
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Um, and a lot of women end up not wanting to go into surgical specialties just because of the lifestyle commitments.
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But um urology is a great, great specialty.
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And I thought that I wanted to be an employed physician, even back then.
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I finished residency in 2001.
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Um, and that was sort of the beginning of people going into being employed physicians.
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It's since snowballed, I think um private practice is the minority now.
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I know that it is, but um, so I want I thought I wanted to work for like a big group like Kaiser, that kind of a thing.
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But this opportunity came to me from a previous UCSD uh um residency graduate to go into private practice here in in Orange County where I grew up.
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And um I'm so glad that I took it.
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And part of my trepidation at the beginning was I, you know, I saw my parents owning their own business, businesses, and you know, struggling with keeping the lights on, paying their, you know, paying their employees, all these things.
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I thought I thought I don't want to do that.
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But um it turns out medicine's different than auto parts in that way.
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And luckily I don't have a problem, you know, doing those things.
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But there are a lot of other struggles in private practice.
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But it I for me, you know, in total, I feel like it's still worthwhile to have control over my life and control over what I can do for my patients, as opposed to someone telling me, you know, what I can and can't do.
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We we've talked about this.
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I mean, so much frustration though, with when you're practicing on what you want to be able to do, what you should be doing, uh, and also though your hands are tied, it's not from your employer.
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Um it's it it's it's it's from the payer.
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I mean, you want to walk through any of that here on like what kind of like what are your top two frustrations that's you know limiting access to care?
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Yeah, and so you know, insurance has definitely changed the game over the last 20 years.
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And in, you know, trying I I need to now hire more staff in order to get more prior authorizations.
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Um I even though we're getting prior authorizations, you know, the verbiage is this is not a guarantee for payment.
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And so now I have, you know, my billing company and their entire staff making sure I'm getting paid for the things that we're supposed to be getting paid for.
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Um the down coding issue has been a big one recently where some of the big payers have been found to be automatically down coding our office visits, where we are allowed to code a certain level if we can show the medical necessity, the complexity of the visit, the time spent with the patient.
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We are allowed to bill a certain level.
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We are allowed to get paid for our time and our work and our knowledge.
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Um, yet the insurance companies have taken it upon themselves to just automatically downcode some of these visits, and not all insurance companies, but some of the bigger ones have done that recently.
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Um, where they without any notice, without getting any medical records to make sure you're coding appropriately, without even giving you a reason on the EOB, on the um on the the payment explanation, the explanation of benefits.
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They don't even give you a code that you can search for that, yes, we've automatically downcoded you.
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So now, in order to figure this out, if we're getting automatically downcoded, I have to hire another team of people to look at my contracts, then look at some of the payments that we've gotten to make sure that they match.
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That's the only way.
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And and our electronic medical record doesn't do it automatically.
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It's just, it's it has become very onerous.
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And I I can imagine that's a big reason why a lot of um you know people coming out of residency don't want to go into private practice, but they still have their own issues with billing and coding and and um and RVU, you know, generation being employed physicians as well.
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Well, I mean that I mean that's just I mean absolutely just crazy and absurd because I mean, number one, you have to spend money uh and your time to get the money that you should be owed for the service you provided.
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I mean it's like going going to a nice steak restaurant, ordering a hundred dollar steak, eating the whole thing, and then when it's time to settle up, you decide to give the restaurant forty dollars.
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Exactly, because that's what I've decided.
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Thank you.
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Well, yeah.
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And by the way, when I started in practice in 2001, um I I got paid more for certain surgeries than I do today.
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Probably like like they've been some certain surgeries have been cut by more than half in 24 years.
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Um and you know, the ENM coding has become more onerous.
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Um, you know, Medicare has come down at least 20, 30 percent in the last 20 uh years or so.
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But guess what hasn't come down?
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You know, my my employees, um, you know, paying my employees, that's gone up.
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My rent has gone up, all of our expenses are going up, you know, the cost of living.
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And so that's been pretty frustrating.
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And why I've also tried to add this side of my practice.
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You guys were talking about being an entrepreneur, um, you know, trying to add that side of my practice, which is not insurance-based.
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Sure, sure.
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So me, um, I mean, you're you're you got a lot of things going on, busy with work, uh, you know, family person, daughters, uh a lot of things going on.
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So, I mean, one of the things I mean I was super appreciative of, right, was when you decided to dedicate some of your time uh to join, you know, our board at PAC.
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Like what why is it that you wanted to get involved um, you know, with our association, which again, we just hit two years, uh, our anniversary this last month, which we're super proud of.
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Yeah.
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Thank you.
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Um, but you know, what why did you why did you want to take on uh this leadership role uh with uh everything else going on?
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Well, I just love the mission that PAC uh came forward with.
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And I feel like some of the bigger societies don't have my best interest at heart.
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Um I think that some of these other medical societies are full of people who are in bigger medical groups that are employed physicians and have different um perspectives and probably different goals.
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And so no one had my back.
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And um, and so this was what I really liked about PAC.
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I feel like um you are looking at smaller practices, private practice, trying to focus on the struggles that we in particular have that might be different from these other bigger medical groups and helping us with those with those issues.
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And so that was why I felt it was really important, even though yes, everyone's busy, so crazy busy, but I felt like this was an important thing to really give my time to.
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And Dr.
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Gabal, where do you hope it goes from here?
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You're in leadership, Pact just is coming off a great win last year with AB 1041.
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Um from here, what is your hope for the organization?
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I would love to see us being able to have more of a voice with the insurers, um, you know, because that is part of our biggest struggle, I feel like, right now.
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I love that the very first bill that we introduced into legislation got passed and signed by the governor.
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That's just incredible for such a young group.
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Um, so now that we have some clout, you know, hoping that there is some strength in numbers, that us as, you know, me alone is not gonna cut it.
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Um, even me with my two other urologists and my three PAs, you know, in my practice, that's not gonna cut it either.
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But if a bunch of us, if you know, thousands of us private practice physicians came together as one voice, then maybe we would have some more leverage, some clout with the insurers.
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That's really what I'm hoping to see.
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I mean, one question we didn't ask, and I'm just curious, is you mentioned this boys' club that is that is your field.
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Um is that something would you like to expand on, you know, with with an eye toward women that are listening to this, just your experiences in a male-dominated field and and and not only as a urologist, but also as a business leader?
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I I feel like women should not make their choices based on you know what might happen in the future.
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There's an excellent book called Lean In that was written by Cheryl Sandberg, and she was uh I think CFO of Facebook.
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And I I love that book.
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And whenever I'm mentoring students, I I tend to do that in the office.
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I have high school students, college students, pre-meds that come and shadow me.
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Um they're usually female, and I love to recommend that book.
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It's a it's an amazing book, which really I think speaks to this.
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Like, like don't limit yourself because you think you might have kids later, because you think you might get married later, because you know, women tend to do that, or I might not get that job, so I'm not gonna go for it.
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I think um I've been accused of having bigger testicles than some men, and that I um probably think more like a dude than some, but I will go for it, you know, and then if I don't get it, then that's fine.
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And um, and so I think that is something that can be helpful for women is just not to be, you know, not to be sidelined and to just really try to go for whatever you think you you want to do and not and not limit yourself because of what might happen.
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And um, you know, whether male or female, just to to go out and try new things, I think is important.
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You've been obviously, you know, very generous over time.
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I know you've had a lot going on.
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I know you just got out of surgery, uh, which uh uh uh thank you so much for even squeezing in uh the time uh for this podcast.
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Thank you so much.
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Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Let's dive in.
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Hey everyone, Matt Robinson with the Physician Association of California.
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Another episode of Pack and Forth, joined by my co-host, Alan Young.
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How are you doing?
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Great to see you, Matt.
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Doing well.
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Thank you.
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Well, I'm very uh excited about who we have on this next episode.
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Uh one of my cherished board members, uh Dr.
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Lanya Gabal, is joining us remotely from Orange County.
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Super excited to have her and uh very, very successful in what she does within her business.
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Uh she's an entrepreneur.
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Do you have any entrepreneurialism in your family?
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I am not an entrepreneur, but um my daughter did something pretty impressive last weekend.
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She uh she comes in and announces that she wants a puppy into our room.
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And uh and I said, There's no way you're getting a puppy, we just got you a fish.
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You learn how to take care of the fish, you know, maybe we'll talk.
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She says, What if I sell the fish?
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If I sell the fish and get some money, can I get the puppy?
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And I and I just black and I was like, Yeah, no, we're we're we're not selling your fish to anybody.
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Go ahead.
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Uh try.
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And she makes a sign that says free fish, and she draws a picture of the fish, and then she wants to set up a stand, like a lemonade stand, to sell the fish to bring it up to a bigger enterprise, which is the puppy.
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I love it.
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I love it.
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I need her to come over to my place, actually.
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I have so many animals I can't keep track.
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I mean, it's like a farm in my house.
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I got tortoises, I got six tortoises, actually, seven now, one just laid an egg.
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I got a dog, two cats.
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So if she can come over to my house, I'd be more than happy to have her over.
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How did you end up with this menagerie in your home?
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Like it goes on and on, but I know I wanna I want to get to Dr.
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Gabal, a very busy person.
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Dr.
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Lamia Gabal is a board-certified urologist and the founder of Prestige Medical Group, an independent practice in Southern California.
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She brings more than 20 years of clinical experience and leads a female forward team focused on compassionate and patient-centered care.
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Dr.
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Gabal is also a board member of PAC and a strong advocate for position-led and independent medicine.
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Dr.
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Gabal, welcome to PAC and Ford.
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Thank you both so much.
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I'm so happy to be here, and thanks for having me on.
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Well, let's talk about what has happened to you in your life.
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Uh starting with your background, I understand your family immigrated here from Egypt to San Francisco when you were just a baby.
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And I'm curious how those early experiences uh shaped you and ultimately shaped your your role as a physician.
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Yeah.
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So um, yeah, so we immigrated here.
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I was two years old, 1969.
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And um my it was me and my sister.
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My brother was born here in the U.S.
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afterwards, actually, after my mom was told she'd never have children because of a bad car accident that she got into uh when we were in San Francisco.
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And my dad, you know, both my parents had degrees in agricultural engineering from University of uh Cairo University in Egypt, and um but couldn't barely speak English, had two little babies.
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So my dad took a job as a dishwasher in a um in a hospital, actually, and ended up saving enough money to buy a little car that then broke down at the top of a hill.
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My mom was pushing um from the back.
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Like this is as they tell it, of course.
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I have no memory of it.
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My dad was kind of pushing from the front and steering.
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The car rolled back on my mom, crushed her pelvis, and um, she was like stuck between two cars, apparently.
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Um, so she was put in traction for six months.
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My sister and I were put in foster care for six months because my dad didn't know what to do with two small children.
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Um, but then he was able to, you know, after six months collect us all, we moved to Southern California.
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And I know I get my entrepreneurial sort of um bent from my father because um, like me, I don't think he liked working for anyone else.
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And so he um became an engineer.
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They uh they helped him to become an engineer, some people that were helping us with all of our medical stuff, um, but didn't want to work for anyone else.
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And then, like um most of us good Arabs, we uh he owned a couple of gas stations and then turned that into owning an auto parts store called King Tut Auto Parts because um I am Egyptian and we were in Anaheim, and that was we're literally, I think, the first Arabs in Anaheim.
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Now, if you want good Arabic food, go to Anaheim.
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It's amazing.
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It's like they actually just got the moniker, Little Arabia.
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But so um grew up mostly there in Anaheim, worked at the auto parts store.
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Um, and so I think that's where I also got some of my surgical bent.
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Um, I think parts is parts.
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And as I tell my male patients, I'm really just one of the guys.
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And so they don't have to get embarrassed, you know, to come see me.
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And I also have smaller fingers than the guys.
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So that's a good, you know, sales point when you're a urologist.
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And so um, so yeah, that's how I kind of I think my mom's experience and and some of the stuff she had to deal with after that, I think that really um, really uh influenced me to go into medicine, plus, you know, my parents constantly reminding us we came to this country for better opportunities, you know, for you, you know, for our children.
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And so, you know, there's immigrant pressure there as well.
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But I can't imagine myself doing anything else, to be honest.
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Well, thank you very much, Dr.
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Ball.
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So, I mean, obviously, as it's relative to PAC, right?
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I mean, we we advocate uh for private practice.
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So what is it that drew you into private practice versus you know, working within a larger system or within a larger group?
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Like, why did you want to go out on your own?
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Then also why did you become a urologist?
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So um, as my sister first initially thought when I chose urology, she thought it was to meet men.
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I'm like, no, not the reason, no.
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Um so you know, I it was given to me as a um third-year medical student.
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It was I wanted plastic surgery and I wanted um ENT, head and neck surgery.
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And during our third year rotations, I ended up getting plastic surgery and urology, and I thought, this is ridiculous.
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Who wants to be a urologist?
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It's stupid, I don't even know what they do.
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They just play with urine all day long.
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Like, who wants to do that?
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And so I tried to trade it, I tried to give it away, no one would take it.
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So finally, I'm like, fine, I'll just suck it up, I'll go ahead and go through the three-week, you know, clerkship, whatever.
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And I loved it.
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And I'm like, wow, I had no idea what urologists do.
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Most people think that urology is actually like a gynecologist for men, but that's not at all what a urologist does.
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And in fact, my sub-specialty is female public medicine and reconstructive surgery.
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So 70% of my practice is female.
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I end up doing a lot of prolapse surgeries, incontinence, but still do kidney stones, bladder cancer.
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Um, you know, there's things that happen in both men and women.
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So it's not just about um being a pecker checker, if I can say that.
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Um, it's also about treating men and women for these other things that happen.
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Yes, we deal with prostate cancer, only happens in men, um kidney cancer, both men and women.
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So there's a lot of things that do happen in both men and women.
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So then um, as I did the rotation, loved it and um and uh got accepted at UCSD, which I was very grateful for.
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It's very difficult, actually.
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It's a pretty um competitive residency to get.
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Um and so then I I didn't realize like there needed to be more women.
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Only 4% of board-certified urologists were female at the time that I finished in 2001.
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We're up to about 10% now, so we're getting there.
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But it's still a bit of a boys' club, probably mostly because it is a surgical specialty.
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Um, and a lot of women end up not wanting to go into surgical specialties just because of the lifestyle commitments.
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But um urology is a great, great specialty.
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And I thought that I wanted to be an employed physician, even back then.
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I finished residency in 2001.
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Um, and that was sort of the beginning of people going into being employed physicians.
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It's since snowballed, I think um private practice is the minority now.
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I know that it is, but um, so I want I thought I wanted to work for like a big group like Kaiser, that kind of a thing.
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But this opportunity came to me from a previous UCSD uh um residency graduate to go into private practice here in in Orange County where I grew up.
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And um I'm so glad that I took it.
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And part of my trepidation at the beginning was I, you know, I saw my parents owning their own business, businesses, and you know, struggling with keeping the lights on, paying their, you know, paying their employees, all these things.
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I thought I thought I don't want to do that.
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But um it turns out medicine's different than auto parts in that way.
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And luckily I don't have a problem, you know, doing those things.
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But there are a lot of other struggles in private practice.
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But it I for me, you know, in total, I feel like it's still worthwhile to have control over my life and control over what I can do for my patients, as opposed to someone telling me, you know, what I can and can't do.
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We we've talked about this.
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I mean, so much frustration though, with when you're practicing on what you want to be able to do, what you should be doing, uh, and also though your hands are tied, it's not from your employer.
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Um it's it it's it's it's from the payer.
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I mean, you want to walk through any of that here on like what kind of like what are your top two frustrations that's you know limiting access to care?
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Yeah, and so you know, insurance has definitely changed the game over the last 20 years.
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And in, you know, trying I I need to now hire more staff in order to get more prior authorizations.
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Um I even though we're getting prior authorizations, you know, the verbiage is this is not a guarantee for payment.
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And so now I have, you know, my billing company and their entire staff making sure I'm getting paid for the things that we're supposed to be getting paid for.
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Um the down coding issue has been a big one recently where some of the big payers have been found to be automatically down coding our office visits, where we are allowed to code a certain level if we can show the medical necessity, the complexity of the visit, the time spent with the patient.
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We are allowed to bill a certain level.
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We are allowed to get paid for our time and our work and our knowledge.
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Um, yet the insurance companies have taken it upon themselves to just automatically downcode some of these visits, and not all insurance companies, but some of the bigger ones have done that recently.
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Um, where they without any notice, without getting any medical records to make sure you're coding appropriately, without even giving you a reason on the EOB, on the um on the the payment explanation, the explanation of benefits.
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They don't even give you a code that you can search for that, yes, we've automatically downcoded you.
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So now, in order to figure this out, if we're getting automatically downcoded, I have to hire another team of people to look at my contracts, then look at some of the payments that we've gotten to make sure that they match.
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That's the only way.
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And and our electronic medical record doesn't do it automatically.
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It's just, it's it has become very onerous.
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And I I can imagine that's a big reason why a lot of um you know people coming out of residency don't want to go into private practice, but they still have their own issues with billing and coding and and um and RVU, you know, generation being employed physicians as well.
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Well, I mean that I mean that's just I mean absolutely just crazy and absurd because I mean, number one, you have to spend money uh and your time to get the money that you should be owed for the service you provided.
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I mean it's like going going to a nice steak restaurant, ordering a hundred dollar steak, eating the whole thing, and then when it's time to settle up, you decide to give the restaurant forty dollars.
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Exactly, because that's what I've decided.
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Thank you.
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Well, yeah.
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And by the way, when I started in practice in 2001, um I I got paid more for certain surgeries than I do today.
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Probably like like they've been some certain surgeries have been cut by more than half in 24 years.
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Um and you know, the ENM coding has become more onerous.
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Um, you know, Medicare has come down at least 20, 30 percent in the last 20 uh years or so.
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But guess what hasn't come down?
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You know, my my employees, um, you know, paying my employees, that's gone up.
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My rent has gone up, all of our expenses are going up, you know, the cost of living.
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And so that's been pretty frustrating.
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And why I've also tried to add this side of my practice.
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You guys were talking about being an entrepreneur, um, you know, trying to add that side of my practice, which is not insurance-based.
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Sure, sure.
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So me, um, I mean, you're you're you got a lot of things going on, busy with work, uh, you know, family person, daughters, uh a lot of things going on.
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So, I mean, one of the things I mean I was super appreciative of, right, was when you decided to dedicate some of your time uh to join, you know, our board at PAC.
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Like what why is it that you wanted to get involved um, you know, with our association, which again, we just hit two years, uh, our anniversary this last month, which we're super proud of.
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Yeah.
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Thank you.
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Um, but you know, what why did you why did you want to take on uh this leadership role uh with uh everything else going on?
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Well, I just love the mission that PAC uh came forward with.
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And I feel like some of the bigger societies don't have my best interest at heart.
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Um I think that some of these other medical societies are full of people who are in bigger medical groups that are employed physicians and have different um perspectives and probably different goals.
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And so no one had my back.
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And um, and so this was what I really liked about PAC.
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I feel like um you are looking at smaller practices, private practice, trying to focus on the struggles that we in particular have that might be different from these other bigger medical groups and helping us with those with those issues.
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And so that was why I felt it was really important, even though yes, everyone's busy, so crazy busy, but I felt like this was an important thing to really give my time to.
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And Dr.
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Gabal, where do you hope it goes from here?
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You're in leadership, Pact just is coming off a great win last year with AB 1041.
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Um from here, what is your hope for the organization?
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I would love to see us being able to have more of a voice with the insurers, um, you know, because that is part of our biggest struggle, I feel like, right now.
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I love that the very first bill that we introduced into legislation got passed and signed by the governor.
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That's just incredible for such a young group.
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Um, so now that we have some clout, you know, hoping that there is some strength in numbers, that us as, you know, me alone is not gonna cut it.
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Um, even me with my two other urologists and my three PAs, you know, in my practice, that's not gonna cut it either.
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But if a bunch of us, if you know, thousands of us private practice physicians came together as one voice, then maybe we would have some more leverage, some clout with the insurers.
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That's really what I'm hoping to see.
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I mean, one question we didn't ask, and I'm just curious, is you mentioned this boys' club that is that is your field.
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Um is that something would you like to expand on, you know, with with an eye toward women that are listening to this, just your experiences in a male-dominated field and and and not only as a urologist, but also as a business leader?
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I I feel like women should not make their choices based on you know what might happen in the future.
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There's an excellent book called Lean In that was written by Cheryl Sandberg, and she was uh I think CFO of Facebook.
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And I I love that book.
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And whenever I'm mentoring students, I I tend to do that in the office.
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I have high school students, college students, pre-meds that come and shadow me.
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Um they're usually female, and I love to recommend that book.
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It's a it's an amazing book, which really I think speaks to this.
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Like, like don't limit yourself because you think you might have kids later, because you think you might get married later, because you know, women tend to do that, or I might not get that job, so I'm not gonna go for it.
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I think um I've been accused of having bigger testicles than some men, and that I um probably think more like a dude than some, but I will go for it, you know, and then if I don't get it, then that's fine.
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And um, and so I think that is something that can be helpful for women is just not to be, you know, not to be sidelined and to just really try to go for whatever you think you you want to do and not and not limit yourself because of what might happen.
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And um, you know, whether male or female, just to to go out and try new things, I think is important.
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You've been obviously, you know, very generous over time.
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I know you've had a lot going on.
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I know you just got out of surgery, uh, which uh uh uh thank you so much for even squeezing in uh the time uh for this podcast.
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Thank you so much.
