By Dr. Margaret Curtis, WCI Columnist
Many physicians want to augment or move away from their clinical careers, but not many can—and even fewer can do so in a way that marries their interests and the public good in the way Dr. Laura Blaisdell, MD MPH FAAP, has. I was so happy to get to interview Blaisdell, a friend and fellow pediatrician here in Maine who has parlayed her public health experience into a successful COVID consulting firm.
Blaisdell was raised and educated in Minnesota (Carleton College, University of Minnesota) and did her pediatrics residency at Maine Medical Center. She has a CV as long as your arm, full of public health and academic positions, publications, and accolades. She is married with two sons, and her husband runs a summer camp.
When I met Blaisdell, she was a general pediatrician and an investigator with the National Children’s Study. She later became active with the No On One referendum, which requires certain vaccinations for children in public schools in Maine. In the spring of 2020, she started advising camps on navigating the threat of COVID-19. In August 2020, when schools were scrambling to set up remote learning, she was the lead author of a paper in Morbidity and Mortality Weekly Report (MMWR) which described how her family’s camp, and three others, managed nearly normal operations despite the pandemic. Her consulting business took off, and she now has clients across the United States.
Unfortunately for all of us, it looks like Blaisdell will be busy with COVID-related work for the foreseeable future. But we are lucky to have her on our side.
You can learn more about her work at laurablaisdell.com. What follows is a transcript of my conversation with Blaisdell in September 2021, edited for clarity and length.
Q&A with Laura Blaisdell, Pediatrician and COVID Expert
Where were you between college and medical school?
Blaisdell: I was trying to decide if I wanted to get a Ph.D, an MPH, or an MD. So I did biochemistry and molecular biology research at the Mayo Clinic and decided that I didn't want a Ph.D. Then I went to D.C. and worked in public health for a year. That's where I met my husband and decided that I did want to get an MPH, but I also wanted an MD. That's how I ended up with the current letters after my name.
When I met you, you were working at a private practice and for the National Children's Study.
Blaisdell: [The National Children’s Study] ended up just being shuttered after 10 years and lots of money spent. It got too big with too many questions. So I was at [my previous practice], which I really liked as a physician-owned company. I was there for 12 years and did leadership roles there.
I realized that I was ready to move out of clinical medicine. My husband helped remind me that I never went into medical school thinking that I would always be a community doctor right until the end of my life. I had gotten to the point where, as you know, so much of practice can become quite algorithmic. You look at your schedule every day and you know what 90% is going to be without even seeing the patient, and you go through the motions. Sometimes people surprise you, and that's exciting. And you're like, “Wow, I didn't expect that diagnosis or that conversation.” I was really still enjoying being a pediatrician, but I saw the horizon where I might get a little bored or burnt out.
I found a life coach that specializes in women transitioning from different areas of their life. She calls it women in the middle, which is 50-year-olds, but she says that doctors transition earlier because we've worked about five times as much. So we are the equivalent of 50-year-olds at 40.
We are prematurely aged! And we are in the middle, with jobs and kids and parents.
Blaisdell: Yes. So I started working with her. The goal really was to figure out if I could like being a community pediatrician. That was the first step. And I decided that I could do that, but I would be more proud of myself and I would like what I was doing more if I left that. So, I did end up leaving. I don't think I knew exactly what I was doing at that point. I started an LLC just because I figured if I was going to give advice, I should at least get paid for it.
The No On One referendum just came into my lap, and I became really involved in that. That just went into effect on Sept. 2, 2021, after a year of labor. Literally, [the referendum campaign] ended March 3, 2020, and within two weeks, the pandemic was upon us. I spent a lot of time at that point feeling guilty about my colleagues who are on the front lines. I had this training in pediatrics and public health, and [I felt guilty that] I wasn't helping with the heavy lifting. I started just doing a lot of volunteer work in public health.
It became clear as the spring went on that summer camps might not open. I felt very strongly that camps could open after we learned the disease profile for kids. I was worried about the adults, but I had published a paper on opening camps in H1N1 with the state back in 2009. I started using that and talking to people about how camps can open. Pretty soon, I was thrust into these conversations with hundreds of camps. Then it became clear that there would be a business model behind that which would really align my passion for kids, my deep commitment to helping them during this time of the pandemic, to helping camps survive economically, and providing guidance to the national dialogue which at that point was: “Shutter everything. It's not safe. There's no way to open camps, there's no way to open schools, there's no way to go back to work.” I felt very strongly that was not true.
That's when I really started focusing on a business model. I was able to prove that we had a successful summer and then publish that in MMWR. That's when my business really took off. Any business has to have earned media or some sort of advertising. My advertising was through publishing this paper and then the ensuing media onslaught because it was really the first paper published about what could be done as opposed to just [reports about] massive outbreaks. I quickly decided that there was an opportunity to assist but also be successful in a business.
That article made national news. Between March 2020 and August 2020, were you getting paid for any of your work?
Blaisdell: I felt like I hadn't established myself in that space yet, which is a common feeling among women. I definitely had that imposter syndrome. Like, why am I here talking about this? And then I quickly realized that nobody knew what they were talking about with COVID. Everybody was just making it up. What needed to be done was to stop making it up and just make plans for the safest way to move forward, to give the science behind gathering safely as it came out. Now we're gonna use masks, because, apparently, they're effective. Now, kids do spread COVID, so let's be a little bit more careful about this. What people really needed was an answer for how to move forward, not that they couldn't.
Back to your question, I was billing for speaking. I started off volunteering a lot of my time to put myself in places where I felt that I would ultimately benefit. For instance, the American Camp Association hired environmental health and engineering experts to write a field guide for them and they asked me to be on the advisory committee for the field guide. I said, “Absolutely.” They said, “It's not a paying gig,” and I said that's fine. But it ended up putting me in front of thousands of people as I talked about these field guides. So, you develop that traction through volunteering. Very quickly, I was getting paid to do those lectures. Of course, people will let you volunteer as long as you want to. At some point, I had to say, my time is very limited and I'm going to have to ask for an honorarium or to be paid. My hourly started lower and then slowly crept up as I became more established.
My husband is really helpful in that regard. He always says, “You are the only person in this space so you can charge whatever you want.” I didn't want to be seen as a price-gouger, which is important for my value system. I got dressed down by one camp manager [who wanted to hire me] to do a two-hour lecture with a group of camps. He said, “What do you charge?” and I said $500 an hour. And he said, “OK, I'm going to stop you. You are totally undervaluing yourself. I have $3,500 to put to this project. That's what I've been given. And I would like to give that to you. But you need to revalue yourself and send me a contract that spends $3,500.”
It only happened twice [that someone didn’t want to pay my fees]. A couple of camps said, “Well, is there anybody else in this field?” I said, “No, actually not.” They said, “I think we'll just work with the doctor-parent who's willing to volunteer their time.” I said, “That's fine. They might not have the public health expertise that you're needing, but that’s OK.” And both those camps came back to me about two months later. They said, “So tell us again what exactly it is that you do?” So you have to just really calmly stick to [your fees], but in the long run, you're going to do much better.
What is your fee structure now?
Blaisdell: I have a couple of service lines. The Signature Consult is you're buying me and my time and a spot on my dance card. I’m on call 8 am-8 pm, you can call me anytime and I'll provide you with my blog updates. I only took 15 camps. Based on the size of the camp, they needed to pay upfront. It's not in a retainer where you pay the money upfront, and then you work against that. My retainer was a one-time fee based on the size of the camp. So for camps that were less than 200 campers, that retainer was $5,000. For 200-300, it was $8,000, and greater than 300, it was $12,000. My hourly now is $350. I give a discount for nonprofits. But at that point, I was charging camps $250 an hour for the work that we did together.
I ended up being full fairly quickly. I also did what I call the Custom Consult [which is] a one-time flat fee of $3,600. Camps could come to me for up to six hours of consulting…but they couldn’t call me whenever they wanted during the summer. They got access to my blog, and they got access to the tools that I had developed, such as a PPE calculator so that they could calculate how much PPE they needed. Then I also had many that were just either hourly or negotiated contracts that were one-offs.
Then, after camp, I started working with schools. I had a contact in L.A. who was a camp parent and the executive director of a charter school. He’d seen the communication that my husband and I did with the parents and felt like that would be really important for the teachers. Of course, L.A. didn't open until last spring. They were my only L.A. school, but my name in the L.A. area has spread. Now I have five different L.A. schools, and keeping up with California state law is a full-time job. I work with a couple of private schools here in Maine. I'm still contracting with [the American Camp Association] environmental health and engineering. They ended up hiring me as a contractor after volunteering.
Do you have any collaborators or subcontractors?
Blaisdell: I hired another MD-MPH. I have a billing person who does invoices for me. I'm starting to get to the point where I'm thinking about what an office manager could do for me, because it's getting to be a little overwhelming. My business plan was to do camps, and then I would be done because there would be a vaccine. That was my plan.
Do you carry liability insurance as part of your business?
Blaisdell: Yes, I carry public health consulting liability, which is why I'm very clear about the fact that I don't provide medical guidance. I don't provide medical advice or diagnostic interpretations, because I would need to have medical liability insurance for that. I'm very clear with that I can provide your public health consulting, but you're going to have to find somebody to tell you that you have to take that strep throat in to be seen.
And what is the liability for public health consulting? Is it lawsuits from outbreaks? Loss of business?
Blaisdell: Honestly, I think they were most concerned about me causing damage or becoming injured when I was on site. But when they found out that I wasn't on site, I guess they weren’t so worried. I worked with a lawyer. I had one lawyer who had just a very skimpy contract. And as we got into more and more camps that I didn't know the owners of as well, I felt like I needed a stronger contract. Now I have a very strong contract that specifically states that I don't provide medical or diagnostic interpretations and that I'm not promising a COVID-free environment.
Could you see yourself scaling this into an even bigger gig, or is that hard to imagine?
Blaisdell: I think that's the exact question I need to sit down and figure out. My husband keeps saying the money is in the scalability, and I think that's true. It's whether or not that's the size of the universe I want to go to or not. Then I get mad at myself about thinking small. “Are you holding yourself back? Because you think you're an imposter? Why is it that you don't want to scale?”
My philosophy is that bigger is not always better. My true value is in providing high-touch consulting, which I really enjoy. I enjoy being the person they call. I had a call last night at 10 pm from my school in L.A., and I like being that person. I think that's [part of] being a physician. We like being the person that they call.
We'll see. Many of us who live in Maine could be at Boston Children's, we could be at CHoP, we could be at Stanford, but we choose to live here for a reason. If I scale out, I will want to create an infrastructure. That means that I don't have to work more, just smarter.
What do you think? Do you have the skills or desire needed to find another path like Blaisdell? Would you want to leave clinical work for the unknown? Comment below!